{"id":76,"date":"2021-11-18T13:12:04","date_gmt":"2021-11-18T13:12:04","guid":{"rendered":"https:\/\/veteransdrivedental.ca\/staging\/?page_id=76"},"modified":"2021-12-14T13:29:07","modified_gmt":"2021-12-14T13:29:07","slug":"patients","status":"publish","type":"page","link":"https:\/\/veteransdrivedental.ca\/staging\/patients\/","title":{"rendered":"Patients"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"76\" class=\"elementor elementor-76\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-85ce16b elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"85ce16b\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-565b848\" data-id=\"565b848\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-55496f0 elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"55496f0\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInRight&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Patient Forms<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-293e72f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"293e72f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-60302f4\" data-id=\"60302f4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5c042940 elementor-widget elementor-widget-heading\" data-id=\"5c042940\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Patient Forms<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1a54505 elementor-widget elementor-widget-text-editor\" data-id=\"1a54505\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>We&#8217;re excited to have you for your first visit at Brampton or Orangeville Office. For your first visit with us, we need some information about your medical and dental history. Download and print the form\/s below. Complete it and bring it to your first appointment. We value our patients&#8217; privacy and keep these forms confidential.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-516f131 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"516f131\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-3f3994b\" data-id=\"3f3994b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1e9c766 ekit-equal-height-enable elementor-widget elementor-widget-elementskit-icon-box\" data-id=\"1e9c766\" data-element_type=\"widget\" data-widget_type=\"elementskit-icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"ekit-wid-con\" >        <!-- link opening -->\n                <!-- end link opening -->\n\n        <div class=\"elementskit-infobox text-center text-center icon-top-align elementor-animation-   \">\n                            <div class=\"elementskit-box-header\">\n                <div class=\"elementskit-info-box-icon \">\n                    <img loading=\"lazy\" decoding=\"async\" width=\"501\" height=\"334\" src=\"https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/form1.jpg\" class=\"attachment- size-\" alt=\"\" srcset=\"https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/form1.jpg 501w, https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/form1-300x200.jpg 300w\" sizes=\"auto, (max-width: 501px) 100vw, 501px\" \/>                <\/div>\n          <\/div>\n                <div class=\"box-body\">\n                            <h3 class=\"elementskit-info-box-title\">\n                    Medical History                <\/h3>\n                                                    <div class=\"box-footer disable_hover_button\">\n                    <div class=\"btn-wraper\">\n                                                            <a href=\"https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/medical-history-form-dental-clinic.pdf\"  target=\"_blank\" rel=\"\" class=\"elementskit-btn whitespace--normal elementor-animation-\">\n                                        Download\n                                        <i aria-hidden=\"true\" class=\"fas fa-cloud-download-alt\"><\/i>\n                                    <\/a>\n                                                        <\/div>\n                <\/div>\n                    <\/div>\n        \n        \n                <\/div>\n        <\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-21f9a94\" data-id=\"21f9a94\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1c41353 ekit-equal-height-enable elementor-widget elementor-widget-elementskit-icon-box\" data-id=\"1c41353\" data-element_type=\"widget\" data-widget_type=\"elementskit-icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"ekit-wid-con\" >        <!-- link opening -->\n                <!-- end link opening -->\n\n        <div class=\"elementskit-infobox text-center text-center icon-top-align elementor-animation-   \">\n                            <div class=\"elementskit-box-header\">\n                <div class=\"elementskit-info-box-icon \">\n                    <img loading=\"lazy\" decoding=\"async\" width=\"501\" height=\"334\" src=\"https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/form2.jpg\" class=\"attachment- size-\" alt=\"\" srcset=\"https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/form2.jpg 501w, https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/form2-300x200.jpg 300w\" sizes=\"auto, (max-width: 501px) 100vw, 501px\" \/>                <\/div>\n          <\/div>\n                <div class=\"box-body\">\n                            <h3 class=\"elementskit-info-box-title\">\n                    Patient Consent                <\/h3>\n                                                    <div class=\"box-footer disable_hover_button\">\n                    <div class=\"btn-wraper\">\n                                                            <a href=\"https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/patient_consent_form.pdf\"  target=\"_blank\" rel=\"\" class=\"elementskit-btn whitespace--normal elementor-animation-\">\n                                        Download\n                                        <i aria-hidden=\"true\" class=\"fas fa-cloud-download-alt\"><\/i>\n                                    <\/a>\n                                                        <\/div>\n                <\/div>\n                    <\/div>\n        \n        \n                <\/div>\n        <\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-23dc4db\" data-id=\"23dc4db\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-afe5dac ekit-equal-height-enable elementor-widget elementor-widget-elementskit-icon-box\" data-id=\"afe5dac\" data-element_type=\"widget\" data-widget_type=\"elementskit-icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"ekit-wid-con\" >        <!-- link opening -->\n                <!-- end link opening -->\n\n        <div class=\"elementskit-infobox text-center text-center icon-top-align elementor-animation-   \">\n                            <div class=\"elementskit-box-header\">\n                <div class=\"elementskit-info-box-icon \">\n                    <img loading=\"lazy\" decoding=\"async\" width=\"501\" height=\"334\" src=\"https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/form3.jpg\" class=\"attachment- size-\" alt=\"\" srcset=\"https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/form3.jpg 501w, https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/form3-300x200.jpg 300w\" sizes=\"auto, (max-width: 501px) 100vw, 501px\" \/>                <\/div>\n          <\/div>\n                <div class=\"box-body\">\n                            <h3 class=\"elementskit-info-box-title\">\n                    Release of Records                <\/h3>\n                                                    <div class=\"box-footer disable_hover_button\">\n                    <div class=\"btn-wraper\">\n                                                            <a href=\"https:\/\/veteransdrivedental.ca\/staging\/wp-content\/uploads\/2021\/11\/personal_information.pdf\"  target=\"_blank\" rel=\"\" class=\"elementskit-btn whitespace--normal elementor-animation-\">\n                                        Download\n                                        <i aria-hidden=\"true\" class=\"fas fa-cloud-download-alt\"><\/i>\n                                    <\/a>\n                                                        <\/div>\n                <\/div>\n                    <\/div>\n        \n        \n                <\/div>\n        <\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2215d906 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2215d906\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-3fb39323 elementor-invisible\" data-id=\"3fb39323\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;zoomInUp&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-153c7b86 elementor-widget elementor-widget-heading\" data-id=\"153c7b86\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Emergency?<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-66edf37e elementor-widget elementor-widget-heading\" data-id=\"66edf37e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Get Help Now by Calling Our Emergency Service<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-41fd9ed0 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"41fd9ed0\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-709fe003 elementor-widget elementor-widget-button\" data-id=\"709fe003\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a href=\"#\" class=\"elementor-button-link elementor-button elementor-size-md\" role=\"button\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-text\">Call Emergency Service<\/span>\n\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-35f0a3fc\" data-id=\"35f0a3fc\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-37b42a6 elementor-widget elementor-widget-text-editor\" data-id=\"37b42a6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div data-uniq='69decdb64a5ac' class='uniq-69decdb64a5ac formcraft-css form-live align-left'><style type='text\/css' scoped='scoped'>input{\n    border-radius: 20px  !important;\n}\ntextarea{\n    border-radius: 20px  !important;\n}\nspan.main-label {\n    color: #3a4b6c;\n    font-size: 16px;\n}\nhtml .formcraft-css .fc-form .form-element .checkbox-cover>div {\n    color: #3a4b6c;\n}\nbutton.button.submit-button {width:30% !important;border-radius: 20px !important;}<\/style><script> window.formcraftLogic = window.formcraftLogic || {}; window.formcraftLogic[2] = []; <\/script><div class=\"fc-pagination-cover fc-pagination-1\">\n\t\t\t\t<div class=\"fc-pagination width-100\">\n\t\t\t\t\t<!-- ngRepeat: page in Builder.FormElements track by $index --><div class=\"pagination-trigger \" data-index=\"0\">\n\t\t\t\t\t\t<span class=\"page-number\"><span >1<\/span><\/span>\n\t\t\t\t\t\t<span class=\"page-name \">Step 1<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div><!-- end ngRepeat: page in Builder.FormElements track by $index -->\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t<style scoped=\"scoped\" >\n\t\t\t@media (max-width : 480px) {\n\t\t\t\t.fc_modal-dialog-2 .fc-pagination-cover .fc-pagination\n\t\t\t\t{\n\t\t\t\t\tbackground-color: none !important;\n\t\t\t\t}\n\t\t\t}\n\t\t\t\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .submit-cover .submit-button,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .fileupload-cover .button-file,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover .button,\n\t\t\t.formcraft-datepicker .ui-datepicker-header,\n\t\t\t.formcraft-datepicker .ui-datepicker-title\n\t\t\t{\n\t\t\t\tbackground: #4488ee;\n\t\t\t\tcolor: #fff;\n\t\t\t}\n\t\t\t.formcraft-datepicker td .ui-state-active,\n\t\t\t.formcraft-datepicker td .ui-state-hover,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .slider-cover .ui-slider-range\n\t\t\t{\n\t\t\t\tbackground: #4488ee;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-header,\n\t\t\t.formcraft-css .fc-form .field-cover>div.full hr\n\t\t\t{\n\t\t\t\tborder-color: #3b77d1;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-prev:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-next:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker select.ui-datepicker-month:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker select.ui-datepicker-year:hover\n\t\t\t{\n\t\t\t\tbackground-color: #3b77d1;\n\t\t\t}\n\t\t\t.formcraft-css .fc-pagination>div.active .page-number,\n\t\t\t.formcraft-css .form-cover-builder .fc-pagination>div:first-child .page-number\n\t\t\t{\n\t\t\t\tbackground-color: #4488ee;\n\t\t\t\tcolor: #fff;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker table.ui-datepicker-calendar th,\n\t\t\t#ui-datepicker-div.formcraft-datepicker table.ui-datepicker-calendar td.ui-datepicker-today a,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .star-cover label,\n\t\t\thtml .formcraft-css .fc-form.label-floating .form-element .field-cover.has-focus>span,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .customText-cover a,\n\t\t\t.formcraft-css .prev-next>div span:hover\n\t\t\t{\n\t\t\t\tcolor: #4488ee;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .customText-cover a:hover\n\t\t\t{\n\t\t\t\tcolor: #3b77d1;\n\t\t\t}\n\t\t\thtml .formcraft-css .fc-form.fc-form-2.label-floating .form-element .field-cover > span\n\t\t\t{\n\t\t\t\tcolor: #666666;\n\t\t\t}\n\t\t\thtml .formcraft-css .fc-form .final-success .final-success-check {\n\t\t\t\tborder: 2px solid #666666;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"text\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"email\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"password\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"tel\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover textarea,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover select,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover .time-fields-cover,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover .awesomplete ul\n\t\t\t{\n\t\t\t\tcolor: #777;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"text\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"password\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"email\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"radio\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"checkbox\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"tel\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover select,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover textarea\n\t\t\t{\n\t\t\t\tbackground-color: #fafafa;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"radio\"]:checked,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"checkbox\"]:checked {\n\t\t\t\tborder-color: #3b77d1;\n\t\t\t\tbackground: #4488ee;\t\t\t\t\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .star-cover label .star\n\t\t\t{\n\t\t\t\ttext-shadow: 0px 1px 0px #3b77d1;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .slider-cover .ui-slider-range\n\t\t\t{\n\t\t\t\tbox-shadow: 0px 1px 1px #3b77d1 inset;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .fileupload-cover .button-file\n\t\t\t{\n\t\t\t\tborder-color: #3b77d1;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"password\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"email\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"tel\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"text\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html textarea:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html select:focus\n\t\t\t{\n\t\t\t\tborder-color: #4488ee;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html .field-cover .is-read-only:focus {\n\t\t\t\tborder-color: #ccc;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2\t\t\t{\n\t\t\t\tfont-family: Roboto;\n\t\t\t}\n\t\t\t@media (max-width : 480px) {\n\t\t\t\thtml .dedicated-page,\n\t\t\t\thtml .dedicated-page .formcraft-css .fc-pagination > div.active\n\t\t\t\t{\n\t\t\t\t\tbackground: none;\n\t\t\t\t}\n\t\t\t}\n\t\t<\/style>\n\t\t<div class=\"form-cover\">\n\t\t\t<form data-auto-scroll=\"\" data-no-message-redirect=\"\" data-thousand=\"\" data-decimal=\".\" data-delay=\"\" data-id=\"2\" class=\"fc-form fc-form-2 align- fc-temp-class dont-submit-hidden- disable-enter- label-placeholder field-border-hidden frame-hidden save-form-false remove-asterisk-true icons-hide-true field-alignment-left options-fade  \" style=\"width: 100%; color: #666666; font-size: 100%; background: none\">\n\t\t\t\t<!-- ngRepeat: page in Builder.FormElements track by $index --><div class=\"form-page form-page-0\" data-index=\"0\">\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"form-page-content      ng-not-empty\">\n\t\t\t\t\t\t<div data-identifier=\"field11\" data-index=\"0\" style=\"width: 100%\" class=\" form-element form-element-field11 form-element-0 default-false form-element-type-heading is-required-false odd -handle options-true\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: center; font-size: 2.3000000000000007em; padding-top: 15px; padding-bottom: ; color: #3a4b6c\" class=\"bold-true\"><span >Book An Appointment<\/span><\/div><input type=\"hidden\" data-field-id=\"field11\" name=\"field11[]\" value=\"Book An Appointment\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field24\" data-index=\"1\" style=\"width: 100%; position: relative; z-index: 999; left: 0px; top: 0px\" class=\" even form-element form-element-field24 form-element-1 default-false form-element-type-checkbox is-required-true -handle options-true\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Choose Location:<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field24\" type=\"radio\" data-is-required=\"true\" name=\"field24[]\" value=\"Brampton\" class=\"validation-lenient\"><span><span >Brampton<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field24\" type=\"radio\" data-is-required=\"true\" name=\"field24[]\" value=\"Orangeville\" class=\"validation-lenient\"><span><span >Orangeville<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field24\" type=\"radio\" data-is-required=\"true\" name=\"field24[]\" value=\"North Brampton\" class=\"validation-lenient\"><span><span >North Brampton<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field13\" data-index=\"2\" style=\"width: 50%\" class=\" form-element form-element-field13 options-false form-element-2 default-false form-element-type-oneLineText is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >First Name<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"First Name\" make-read-only=\"false\" data-field-id=\"field13\" name=\"field13[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field19\" data-index=\"3\" style=\"width: 50%\" class=\" even form-element form-element-field19 options-false form-element-3 default-false form-element-type-oneLineText is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Last Name<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Last Name\" make-read-only=\"false\" data-field-id=\"field19\" name=\"field19[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field20\" data-index=\"4\" style=\"width: 50%\" class=\" form-element form-element-field20 options-false form-element-4 default-false form-element-type-email is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"email-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Email<\/span><\/span><span class=\"sub-label\"><span >a valid email<\/span><\/span><\/span><div><span class=\"error\"><\/span><input placeholder=\"Email\" data-field-id=\"field20\" type=\"text\" data-val-type=\"email\" make-read-only=\"\" data-is-required=\"true\" name=\"field20\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\"><i class=\"formcraft-icon\">email<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field21\" data-index=\"5\" style=\"width: 50%\" class=\" even form-element form-element-field21 options-false form-element-5 default-false form-element-type-oneLineText is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Phone<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Phone\" make-read-only=\"false\" data-field-id=\"field21\" name=\"field21[]\" data-min-char=\"10\" data-max-char=\"12\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field22\" data-index=\"6\" style=\"width: 100%\" class=\" form-element form-element-field22 options-false form-element-6 default-false form-element-type-textarea is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"textarea-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Comments<\/span><\/span><span class=\"sub-label\"><span >more details<\/span><\/span><\/span><div><span class=\"error\"><\/span><textarea data-field-id=\"field22\" placeholder=\"Comments\" class=\"validation-lenient\" name=\"field22\" value=\"\" rows=\"3\" data-min-char=\"\" data-max-char=\"\" data-is-required=\"true\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\" style=\"min-height: 74.3594px\"><\/textarea><div class=\"count-\"><span class=\"current-count\">0<\/span> \/ <span class=\"max-count \"><\/span><\/div><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field23\" data-index=\"7\" style=\"width: 100%\" class=\" even form-element form-element-field23 options-false form-element-7 default-false form-element-type-submit is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"align-center wide-true submit-cover field-cover\"><button type=\"submit\" class=\"button submit-button\"><span class=\"text \">Submit<\/span><span class=\"spin-cover\"><i style=\"color:\" class=\"loading-icon icon-cog animate-spin\"><\/i><\/span><\/button><\/div><div class=\"submit-response \"><\/div><label ><input type=\"text\" class=\"required_field\" name=\"website\" autocomplete=\"maple-syrup-pot\"><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div><!-- end ngRepeat: page in Builder.FormElements track by $index -->\n\t\t\t<\/form>\n\t\t\t<div class=\"prev-next prev-next-1\" style=\"width: 100%; color: #666666; font-size: 100%; background: none\">\n\t\t\t\t<div>\n\t\t\t\t\t\n\t\t\t\t\t<span class=\"inactive page-prev \"><i class=\"formcraft-icon\">keyboard_arrow_left<\/i>Previous<\/span><\/div>\n\t\t\t\t<div>\n\t\t\t\t\t\n\t\t\t\t\t<span class=\"page-next \">Next<i class=\"formcraft-icon\">keyboard_arrow_right<\/i><\/span><\/div>\n\t\t\t<\/div>\n\t\t<\/div><a class=\"powered-by\" target=\"_blank\" href=\"http:\/\/formcraft-wp.com?source=pb\"\/>FormCraft &#8211; WordPress form builder<\/a><\/div>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-364b8cf2 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile eael-contact-form-7-button-align-left eael-contact-form-7-button-custom elementor-widget elementor-widget-eael-contact-form-7\" data-id=\"364b8cf2\" data-element_type=\"widget\" data-widget_type=\"eael-contact-form-7.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"eael-contact-form-7-wrapper\">\n                <div class=\"eael-contact-form eael-contact-form-7 eael-contact-form-364b8cf2 placeholder-show eael-contact-form-align-center\"><div class=\"eael-contact-form-7-heading\"><h3 class=\"eael-contact-form-title eael-contact-form-7-title\">\n                                    Contact Us\n                                <\/h3><\/div><div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f536-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/staging\/wp-json\/wp\/v2\/pages\/76#wpcf7-f536-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"536\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.5.2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f536-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><label> Your name<br \/>\n    <span class=\"wpcf7-form-control-wrap your-name\"><input type=\"text\" name=\"your-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Your email<br \/>\n    <span class=\"wpcf7-form-control-wrap your-email\"><input type=\"email\" name=\"your-email\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Your message (optional)<br \/>\n    <span class=\"wpcf7-form-control-wrap your-message\"><textarea name=\"your-message\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\"><\/textarea><\/span> <\/label><\/p>\n<p><input type=\"submit\" value=\"Submit\" class=\"wpcf7-form-control has-spinner wpcf7-submit\" \/><\/p>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div><\/div>\n            <\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Patient Forms Patient Forms We&#8217;re excited to have you for your first visit at Brampton or Orangeville Office. For your first visit with us, we need some information about your medical and dental history. Download and print the form\/s below. Complete it and bring it to your first appointment. We value our patients&#8217; privacy and [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-76","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/veteransdrivedental.ca\/staging\/wp-json\/wp\/v2\/pages\/76","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/veteransdrivedental.ca\/staging\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/veteransdrivedental.ca\/staging\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/veteransdrivedental.ca\/staging\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/veteransdrivedental.ca\/staging\/wp-json\/wp\/v2\/comments?post=76"}],"version-history":[{"count":22,"href":"https:\/\/veteransdrivedental.ca\/staging\/wp-json\/wp\/v2\/pages\/76\/revisions"}],"predecessor-version":[{"id":3651,"href":"https:\/\/veteransdrivedental.ca\/staging\/wp-json\/wp\/v2\/pages\/76\/revisions\/3651"}],"wp:attachment":[{"href":"https:\/\/veteransdrivedental.ca\/staging\/wp-json\/wp\/v2\/media?parent=76"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}