{"id":2063,"date":"2023-10-31T11:43:28","date_gmt":"2023-10-31T11:43:28","guid":{"rendered":"https:\/\/puzzlerbox.com\/levelup\/?page_id=2063"},"modified":"2023-10-31T15:43:41","modified_gmt":"2023-10-31T15:43:41","slug":"appointment","status":"publish","type":"page","link":"https:\/\/newimagewellness.net\/newsite\/appointment\/","title":{"rendered":"Book an Appointment"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row custom_padding=&#8221;true&#8221; custom_padding_t=&#8221;60&#8243; text_align=&#8221;center&#8221; css=&#8221;.vc_custom_1698348705525{padding-top: 5% !important;}&#8221;][vc_column][vc_column_text max_width=&#8221;600&#8243;]Lorem ipsum dolor sit amet, consectetur adipiscing elit. Curabitur malesuada bibendum ante vel convallis. Integer pellentesque nibh metus, et iaculis turpis porttitor ut. Cras consequat tortor tortor, sed semper turpis semper ac. Suspendisse vel massa egestas, egestas metus ut, suscipit leo.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column width=&#8221;1\/3&#8243; css=&#8221;.vc_custom_1698348527504{border-right-width: 1px !important;border-right-color: #dddddd !important;border-right-style: solid !important;}&#8221;][vc_column_text]<\/p>\n<h2 style=\"text-align: left;\"><strong>Established Patients<\/strong><\/h2>\n<p style=\"text-align: left;\"><strong>To schedule an appointment, please use one of the following options:<\/strong><\/p>\n<div class=\"O0\" style=\"text-align: left;\">\n<p>1.Log in to your <u><a href=\"https:\/\/phr.charmtracker.com\/login.sas\">P<\/a><\/u><u><a href=\"https:\/\/phr.charmtracker.com\/login.sas\">atient <\/a><\/u><u><a href=\"https:\/\/phr.charmtracker.com\/login.sas\">P<\/a><\/u><u><a href=\"https:\/\/phr.charmtracker.com\/login.sas\">ortal<\/a><\/u> to request an appointment<\/p>\n<\/div>\n<div class=\"O0\" style=\"text-align: left;\">2.Contact the office today.<\/div>\n<p>[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/3&#8243; css=&#8221;.vc_custom_1698348533571{border-right-width: 1px !important;border-right-color: #dddddd !important;border-right-style: solid !important;}&#8221;][vc_column_text]<\/p>\n<h2 style=\"text-align: left;\"><strong>New Patients<\/strong><\/h2>\n<p><strong>We are not accepting new patients at this time.<\/strong><\/p>\n<p>If you would like to be added to our wait list, please complete the below form.[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/3&#8243; css=&#8221;.vc_custom_1698348432960{border-right-width: 1px !important;}&#8221;][vc_column_text]<\/p>\n<h2 style=\"text-align: left;\"><strong>Forensic Evaluation<\/strong><\/h2>\n<p style=\"text-align: left;\"><strong>Any attorney requesting an evaluation or testimony for a client.<\/strong><\/p>\n<p style=\"text-align: left;\">Get started below<\/p>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row custom_padding=&#8221;true&#8221; custom_padding_t=&#8221;0&#8243; custom_padding_b=&#8221;60&#8243;][vc_column][vc_separator color=&#8221;#cccccc&#8221; width_in_percentages=&#8221;yes&#8221;][\/vc_column][\/vc_row][vc_row][vc_column vertical_spacing=&#8221;15&#8243; width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1698350154548{border-right-width: 1px !important;border-right-color: #dddddd !important;border-right-style: solid !important;}&#8221;][vc_custom_heading text=&#8221;New Patients&#8221; use_theme_fonts=&#8221;yes&#8221; font_container=&#8221;tag:h2|font_size:25|text_align:left|color:%23000000&#8243;][vc_column_text]<div id=\"quform-601ee0\" class=\"quform quform-1 quform-support-page-caching\"><form id=\"quform-form-601ee0\" class=\"quform-form quform-form-1\" action=\"\/newsite\/wp-json\/wp\/v2\/pages\/2063#quform-601ee0\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:1,&quot;uniqueId&quot;:&quot;601ee0&quot;,&quot;theme&quot;:&quot;&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:[],&quot;dependents&quot;:[],&quot;elementIds&quot;:[],&quot;dependentElementIds&quot;:[],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\" tabindex=\"-1\"><\/button><div class=\"quform-form-inner quform-form-inner-1\"><input type=\"hidden\" name=\"quform_form_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"601ee0\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/newimagewellness.net\/newsite\/wp-json\/wp\/v2\/pages\/2063\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"ZvcmkwHkkKVGgxaismpbSEfQI38LkVl9fx4yH1Ec\" \/><div class=\"quform-elements quform-elements-1 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-1_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-name quform-element-1_4 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_4\"><label class=\"quform-label-text\" id=\"quform_1_4_601ee0_label\">Name<\/label><\/div><div class=\"quform-inner quform-inner-name quform-inner-1_4\"><div class=\"quform-input quform-input-name quform-input-1_4 quform-cf\"><div class=\"quform-element-row quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element-column\"><div class=\"quform-element quform-element-text quform-element-1_4_2 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-1_4_2\"><div class=\"quform-input quform-input-text quform-input-1_4_2 quform-cf\"><input type=\"text\" id=\"quform_1_4_2_601ee0\" name=\"quform_1_4[2]\" class=\"quform-field quform-field-text quform-field-1_4_2\" aria-labelledby=\"quform_1_4_601ee0_label quform_1_4_2_601ee0_sub_label_below\" \/><\/div><label id=\"quform_1_4_2_601ee0_sub_label_below\" class=\"quform-sub-label quform-sub-label-below\">First<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element-column\"><div class=\"quform-element quform-element-text quform-element-1_4_4 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-1_4_4\"><div class=\"quform-input quform-input-text quform-input-1_4_4 quform-cf\"><input type=\"text\" id=\"quform_1_4_4_601ee0\" name=\"quform_1_4[4]\" class=\"quform-field quform-field-text quform-field-1_4_4\" aria-labelledby=\"quform_1_4_601ee0_label quform_1_4_4_601ee0_sub_label_below\" \/><\/div><label id=\"quform_1_4_4_601ee0_sub_label_below\" class=\"quform-sub-label quform-sub-label-below\">Last<\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-email quform-element-1_5 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_5\"><label class=\"quform-label-text\" for=\"quform_1_5_601ee0\">Email address<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-email quform-inner-1_5\"><div class=\"quform-input quform-input-email quform-input-1_5 quform-cf\"><input type=\"email\" id=\"quform_1_5_601ee0\" name=\"quform_1_5\" class=\"quform-field quform-field-email quform-field-1_5\" \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-textarea quform-element-1_7 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-1_7\"><label class=\"quform-label-text\" for=\"quform_1_7_601ee0\">Message<\/label><\/div><div class=\"quform-inner quform-inner-textarea quform-inner-1_7\"><div class=\"quform-input quform-input-textarea quform-input-1_7 quform-cf\"><textarea id=\"quform_1_7_601ee0\" name=\"quform_1_7\" class=\"quform-field quform-field-textarea quform-field-1_7\"><\/textarea><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-1_2 quform-cf quform-button-style-theme\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-1_2\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-text quform-button-submit-text\">Send<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element-tree\"><label for=\"quform_1_0_601ee0\">This field should be left blank<\/label><input type=\"text\" id=\"quform_1_0_601ee0\" name=\"quform_1_0\" class=\"quform-field quform-field-tree quform-field-1_0\" tabindex=\"-1\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><\/form><\/div>[\/vc_column_text][\/vc_column][vc_column vertical_spacing=&#8221;15&#8243; width=&#8221;1\/2&#8243;][vc_custom_heading text=&#8221;Forensic Evaluations&#8221; use_theme_fonts=&#8221;yes&#8221; font_container=&#8221;tag:h2|font_size:25|text_align:left|color:%23000000&#8243;][vc_column_text]<div id=\"quform-a6d75d\" class=\"quform quform-2 quform-support-page-caching quform-is-first-page\"><form id=\"quform-form-a6d75d\" class=\"quform-form quform-form-2\" action=\"\/newsite\/wp-json\/wp\/v2\/pages\/2063#quform-a6d75d\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:2,&quot;uniqueId&quot;:&quot;a6d75d&quot;,&quot;theme&quot;:&quot;&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:[],&quot;dependents&quot;:[],&quot;elementIds&quot;:[],&quot;dependentElementIds&quot;:[],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:true,&quot;pages&quot;:[1,17],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\" tabindex=\"-1\"><\/button><div class=\"quform-form-inner quform-form-inner-2\"><input type=\"hidden\" name=\"quform_form_id\" value=\"2\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"a6d75d\" \/><input type=\"hidden\" name=\"quform_count\" value=\"2\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/newimagewellness.net\/newsite\/wp-json\/wp\/v2\/pages\/2063\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"ZvcmkwHkkKVGgxaismpbSEfQI38LkVl9fx4yH1Ec\" \/><div class=\"quform-elements quform-elements-2 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-page-progress quform-page-progress-type-numbers\"><div class=\"quform-page-progress-bar\" style=\"width: 50%;\"><span class=\"quform-page-progress-text\">Page <span class=\"quform-page-progress-number\">1<\/span> of 2<\/span><\/div><\/div><div class=\"quform-element quform-element-page quform-page-1 quform-page-2_1 quform-cf quform-group-style-plain quform-first-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-select quform-element-2_3 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_3\"><label class=\"quform-label-text\" for=\"quform_2_3_a6d75d\">Type of Evaluation<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-2_3\"><div class=\"quform-input quform-input-select quform-input-2_3 quform-cf\"><select id=\"quform_2_3_a6d75d\" name=\"quform_2_3\" class=\"quform-field quform-field-select quform-field-2_3\"><option value=\"\" selected=\"selected\">Please select<\/option><option value=\"Worker\u2019s Compensation\">Worker\u2019s Compensation<\/option><option value=\"Disability\">Disability<\/option><option value=\"Independent Medical Evaluation \">Independent Medical Evaluation <\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_5 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_6\"><div class=\"quform-element quform-element-name quform-element-2_4 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_4\"><label class=\"quform-label-text\" id=\"quform_2_4_a6d75d_label\">Name<\/label><\/div><div class=\"quform-inner quform-inner-name quform-inner-2_4\"><div class=\"quform-input quform-input-name quform-input-2_4 quform-cf\"><div class=\"quform-element-row quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element-column\"><div class=\"quform-element quform-element-text quform-element-2_4_2 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-2_4_2\"><div class=\"quform-input quform-input-text quform-input-2_4_2 quform-cf\"><input type=\"text\" id=\"quform_2_4_2_a6d75d\" name=\"quform_2_4[2]\" class=\"quform-field quform-field-text quform-field-2_4_2\" aria-labelledby=\"quform_2_4_a6d75d_label quform_2_4_2_a6d75d_sub_label_below\" \/><\/div><label id=\"quform_2_4_2_a6d75d_sub_label_below\" class=\"quform-sub-label quform-sub-label-below\">First<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element-column\"><div class=\"quform-element quform-element-text quform-element-2_4_4 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-2_4_4\"><div class=\"quform-input quform-input-text quform-input-2_4_4 quform-cf\"><input type=\"text\" id=\"quform_2_4_4_a6d75d\" name=\"quform_2_4[4]\" class=\"quform-field quform-field-text quform-field-2_4_4\" aria-labelledby=\"quform_2_4_a6d75d_label quform_2_4_4_a6d75d_sub_label_below\" \/><\/div><label id=\"quform_2_4_4_a6d75d_sub_label_below\" class=\"quform-sub-label quform-sub-label-below\">Last<\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_7\"><div class=\"quform-element quform-element-text quform-element-2_8 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_8\"><label class=\"quform-label-text\" for=\"quform_2_8_a6d75d\">DOB<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_8\"><div class=\"quform-input quform-input-text quform-input-2_8 quform-cf\"><input type=\"text\" id=\"quform_2_8_a6d75d\" name=\"quform_2_8\" class=\"quform-field quform-field-text quform-field-2_8\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_14 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_15\"><div class=\"quform-element quform-element-text quform-element-2_9 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_9\"><label class=\"quform-label-text\" for=\"quform_2_9_a6d75d\">Address<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_9\"><div class=\"quform-input quform-input-text quform-input-2_9 quform-cf\"><input type=\"text\" id=\"quform_2_9_a6d75d\" name=\"quform_2_9\" class=\"quform-field quform-field-text quform-field-2_9\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_16\"><div class=\"quform-element quform-element-text quform-element-2_13 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_13\"><label class=\"quform-label-text\" for=\"quform_2_13_a6d75d\">Phone #<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_13\"><div class=\"quform-input quform-input-text quform-input-2_13 quform-cf\"><input type=\"text\" id=\"quform_2_13_a6d75d\" name=\"quform_2_13\" class=\"quform-field quform-field-text quform-field-2_13\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_10 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_11\"><\/div><div class=\"quform-element quform-element-column quform-element-2_12\"><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_2 quform-cf quform-button-style-theme\"><div class=\"quform-button-next quform-button-next-default quform-button-next-2_2\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">Next<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-17 quform-page-2_17 quform-cf quform-group-style-plain quform-last-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-name quform-element-2_19 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_19\"><label class=\"quform-label-text\" id=\"quform_2_19_a6d75d_label\">Person of Contact<\/label><\/div><div class=\"quform-inner quform-inner-name quform-inner-2_19\"><div class=\"quform-input quform-input-name quform-input-2_19 quform-cf\"><div class=\"quform-element-row quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element-column\"><div class=\"quform-element quform-element-text quform-element-2_19_2 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-2_19_2\"><div class=\"quform-input quform-input-text quform-input-2_19_2 quform-cf\"><input type=\"text\" id=\"quform_2_19_2_a6d75d\" name=\"quform_2_19[2]\" class=\"quform-field quform-field-text quform-field-2_19_2\" aria-labelledby=\"quform_2_19_a6d75d_label quform_2_19_2_a6d75d_sub_label_below\" \/><\/div><label id=\"quform_2_19_2_a6d75d_sub_label_below\" class=\"quform-sub-label quform-sub-label-below\">First<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element-column\"><div class=\"quform-element quform-element-text quform-element-2_19_4 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-2_19_4\"><div class=\"quform-input quform-input-text quform-input-2_19_4 quform-cf\"><input type=\"text\" id=\"quform_2_19_4_a6d75d\" name=\"quform_2_19[4]\" class=\"quform-field quform-field-text quform-field-2_19_4\" aria-labelledby=\"quform_2_19_a6d75d_label quform_2_19_4_a6d75d_sub_label_below\" \/><\/div><label id=\"quform_2_19_4_a6d75d_sub_label_below\" class=\"quform-sub-label quform-sub-label-below\">Last<\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-name quform-element-2_20 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_20\"><label class=\"quform-label-text\" id=\"quform_2_20_a6d75d_label\">Person For Invoicing<\/label><\/div><div class=\"quform-inner quform-inner-name quform-inner-2_20\"><div class=\"quform-input quform-input-name quform-input-2_20 quform-cf\"><div class=\"quform-element-row quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element-column\"><div class=\"quform-element quform-element-text quform-element-2_20_2 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-2_20_2\"><div class=\"quform-input quform-input-text quform-input-2_20_2 quform-cf\"><input type=\"text\" id=\"quform_2_20_2_a6d75d\" name=\"quform_2_20[2]\" class=\"quform-field quform-field-text quform-field-2_20_2\" aria-labelledby=\"quform_2_20_a6d75d_label quform_2_20_2_a6d75d_sub_label_below\" \/><\/div><label id=\"quform_2_20_2_a6d75d_sub_label_below\" class=\"quform-sub-label quform-sub-label-below\">First<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element-column\"><div class=\"quform-element quform-element-text quform-element-2_20_4 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-inner quform-inner-text quform-inner-2_20_4\"><div class=\"quform-input quform-input-text quform-input-2_20_4 quform-cf\"><input type=\"text\" id=\"quform_2_20_4_a6d75d\" name=\"quform_2_20[4]\" class=\"quform-field quform-field-text quform-field-2_20_4\" aria-labelledby=\"quform_2_20_a6d75d_label quform_2_20_4_a6d75d_sub_label_below\" \/><\/div><label id=\"quform_2_20_4_a6d75d_sub_label_below\" class=\"quform-sub-label quform-sub-label-below\">Last<\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-2_21 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-2_22\"><div class=\"quform-element quform-element-email quform-element-2_24 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_24\"><label class=\"quform-label-text\" for=\"quform_2_24_a6d75d\">Email address<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-email quform-inner-2_24\"><div class=\"quform-input quform-input-email quform-input-2_24 quform-cf\"><input type=\"email\" id=\"quform_2_24_a6d75d\" name=\"quform_2_24\" class=\"quform-field quform-field-email quform-field-2_24\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-2_23\"><div class=\"quform-element quform-element-text quform-element-2_25 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_25\"><label class=\"quform-label-text\" for=\"quform_2_25_a6d75d\">Phone #<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-2_25\"><div class=\"quform-input quform-input-text quform-input-2_25 quform-cf\"><input type=\"text\" id=\"quform_2_25_a6d75d\" name=\"quform_2_25\" class=\"quform-field quform-field-text quform-field-2_25\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-file quform-element-2_28 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-2_28\"><label class=\"quform-label-text\" for=\"quform_2_28_a6d75d\">Upload Supporting Documents Here:<\/label><\/div><div class=\"quform-inner quform-inner-file quform-inner-2_28\"><div class=\"quform-input quform-input-file quform-input-2_28 quform-cf quform-button-style-theme\"><input type=\"file\" id=\"quform_2_28_a6d75d\" name=\"quform_2_28[]\" class=\"quform-field quform-field-file quform-field-2_28 quform-field-file-enhanced\" data-config=\"{&quot;id&quot;:28,&quot;identifier&quot;:&quot;2_28&quot;,&quot;name&quot;:&quot;quform_2_28&quot;,&quot;max&quot;:1,&quot;size&quot;:10485760,&quot;allowedExtensions&quot;:[&quot;jpg&quot;,&quot;jpeg&quot;,&quot;png&quot;,&quot;gif&quot;],&quot;notAllowedTypeWithFilename&quot;:&quot;File type of &#039;%filename%&#039; is not allowed&quot;,&quot;tooBigWithFilename&quot;:&quot;File &#039;%filename%&#039; exceeds the maximum allowed file size&quot;,&quot;tooMany&quot;:&quot;You cannot upload more than %max% file(s)&quot;,&quot;buttonType&quot;:&quot;button&quot;,&quot;buttonText&quot;:&quot;Browse...&quot;,&quot;buttonIcon&quot;:&quot;qicon-file_upload&quot;,&quot;buttonIconPosition&quot;:&quot;right&quot;}\" \/><\/div><p class=\"quform-description quform-description-below\">*If your file is too large to upload here, please send as an attachment to our thirdparty email, share a link from adobe or dropbox or mail a flash drive to our office*\n\n*Upon Your Appointment Request please allow time to gather medical records and supporting documents prior to the appointment* \n\n\n<\/p><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-2_18 quform-cf quform-button-style-theme\"><div class=\"quform-button-back quform-button-back-default quform-button-back-2_18\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-text 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[&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"nf_dc_page":"","footnotes":""},"class_list":["post-2063","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Book an Appointment - New Image Wellness<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/newimagewellness.net\/newsite\/appointment\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Book an Appointment - New Image Wellness\" \/>\n<meta property=\"og:description\" content=\"[vc_row custom_padding=&#8221;true&#8221; custom_padding_t=&#8221;60&#8243; text_align=&#8221;center&#8221; css=&#8221;.vc_custom_1698348705525{padding-top: 5% !important;}&#8221;][vc_column][vc_column_text max_width=&#8221;600&#8243;]Lorem ipsum dolor sit amet, consectetur adipiscing elit. 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