{"id":686,"date":"2018-11-15T10:04:55","date_gmt":"2018-11-15T10:04:55","guid":{"rendered":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/?page_id=686"},"modified":"2025-06-15T06:38:59","modified_gmt":"2025-06-15T06:38:59","slug":"appointment-form","status":"publish","type":"page","link":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/appointment-form\/","title":{"rendered":"Appointment Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"686\" class=\"elementor elementor-686\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a9ecbdd elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a9ecbdd\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-db5e03d make-an-appointment\" data-id=\"db5e03d\" data-element_type=\"column\" data-e-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\t<div class=\"elementor-element elementor-element-83e542d elementor-widget elementor-widget-rt-title\" data-id=\"83e542d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rt-title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n<div class=\"rt-el-title section-heading heading-dark heading-layout5 style3\">\r\n\t<h2 class=\"rtin-title\">Make an Appointment<\/h2>\r\n<\/div>\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dffb470 elementor-widget elementor-widget-text-editor\" data-id=\"dffb470\" data-element_type=\"widget\" data-e-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\t\t<p>Fill the information below to book an appointment..<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-be62598 elementor-widget elementor-widget-shortcode\" data-id=\"be62598\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"appointment_form\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f711-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"711\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/dr-nk-singla\/wp-json\/wp\/v2\/pages\/686#wpcf7-f711-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"711\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f711-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"appointment-box-layout1\">\n\t<div class=\"row gutters-15\">\n\t\t<div class=\"col-12 form-group\">\n\t\t\t<p><label for=\"department\">Department:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"department\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required select2\" id=\"department\" aria-required=\"true\" aria-invalid=\"false\" name=\"department\"><option value=\"Select Department\">Select Department<\/option><option value=\"Plastic Surgery\">Plastic Surgery<\/option><option value=\"Advance Laparoscopic Gastrosurgery\">Advance Laparoscopic Gastrosurgery<\/option><option value=\"Orthopaedics\">Orthopaedics<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-12 form-group\">\n\t\t\t<p><label for=\"doctor\">Doctor:<\/label><br \/>\n<select id=\"doctor\" name=\"doctor\" class=\"select2\">\n <option value=\"\">Please choose a department first<\/option>\n <\/select>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-12 form-group\">\n\t\t\t<p><label for=\"form-name\">Patient Name:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"form-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"form-name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient Name *\" value=\"\" type=\"text\" name=\"form-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 form-group\">\n\t\t\t<p><label for=\"phone\">Phone:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"phone\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone *\" value=\"\" type=\"text\" name=\"phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 form-group\">\n\t\t\t<p><label for=\"email\">E-mail:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" id=\"email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"E-mail*\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-sm-6 form-group\">\n\t\t\t<p><label for=\"date\">Date:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date form-control rt-date\" id=\"date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-sm-6 form-group\">\n\t\t\t<p><label for=\"time\">Time:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"time\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"time\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Time*\" value=\"\" type=\"text\" name=\"time\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-12 form-group\">\n\t\t\t<p><label for=\"message\">Appointment Note:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea textarea form-control\" id=\"message\" aria-invalid=\"false\" placeholder=\"Type Appointment Note\" name=\"message\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-12 form-group\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner item-btn\" type=\"submit\" value=\"Make an Appointment\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<p id=\"department-message\" style=\"display: none; color: red;\">Please choose a department first.\n\t<\/p>\n<\/div>\n<p><script>\n document.addEventListener('DOMContentLoaded', function () {\n var departmentSelect = document.getElementById('department');\n var doctorSelect = document.getElementById('doctor');\n var departmentMessage = document.getElementById('department-message');\n\n var doctorOptions = {\n \"Plastic Surgery\": [\"Dr. Renu Verma Singla\"],\n \"Advance Laparoscopic Gastrosurgery\": [\"Dr. Navdeep Singla\"],\n \"Orthopaedics\": [\"Dr. N.K. Singla\"]\n };\n\n function populateDoctorOptions(selectedDepartment) {\n doctorSelect.innerHTML = ''; \/\/ Reset doctor options\n\n if (selectedDepartment && doctorOptions[selectedDepartment]) {\n doctorOptions[selectedDepartment].forEach(function (doctor) {\n var option = document.createElement('option');\n option.value = doctor;\n option.textContent = doctor;\n doctorSelect.appendChild(option);\n });\n } else {\n doctorSelect.innerHTML = '<option value=\"\">Please choose a department first<\/option>';\n }\n }\n\n departmentSelect.addEventListener('change', function () {\n var selectedDepartment = departmentSelect.value;\n populateDoctorOptions(selectedDepartment);\n\n if (selectedDepartment) {\n departmentMessage.style.display = 'none';\n } else {\n departmentMessage.style.display = 'block';\n }\n });\n\n \/\/ Initialize doctor options on page load\n populateDoctorOptions(departmentSelect.value);\n });\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\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<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7969598\" data-id=\"7969598\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0a22211 elementor-widget elementor-widget-image\" data-id=\"0a22211\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1333\" height=\"1690\" src=\"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-content\/uploads\/2024\/04\/nurse-e1712837708451.png\" class=\"attachment-full size-full wp-image-6437\" alt=\"\" srcset=\"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-content\/uploads\/2024\/04\/nurse-e1712837708451.png 1333w, https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-content\/uploads\/2024\/04\/nurse-e1712837708451-237x300.png 237w, https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-content\/uploads\/2024\/04\/nurse-e1712837708451-808x1024.png 808w, https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-content\/uploads\/2024\/04\/nurse-e1712837708451-1212x1536.png 1212w, https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-content\/uploads\/2024\/04\/nurse-e1712837708451-600x761.png 600w, https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-content\/uploads\/2024\/04\/nurse-e1712837708451-768x974.png 768w\" sizes=\"(max-width: 1333px) 100vw, 1333px\" \/>\t\t\t\t\t\t\t\t\t\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<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5c231c67 elementor-section-stretched elementor-section-full_width elementor-section-content-middle elementor-section-height-default elementor-section-height-default\" data-id=\"5c231c67\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&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-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-538ad58d\" data-id=\"538ad58d\" data-element_type=\"column\" data-e-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\t<div class=\"elementor-element elementor-element-7ceaf2dd elementor-widget elementor-widget-rt-cta\" data-id=\"7ceaf2dd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rt-cta.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n<div class=\"call-to-action-wrap-layout4\">\r\n    <div class=\"item-img\">\r\n           <\/div>\r\n    <div class=\"container\">\r\n        <div class=\"row\">\r\n            <div class=\"col-xl-12 col-lg-8 col-md-12 col-12\">\r\n                <div class=\"call-to-action-box-layout4\">\r\n                    <h2 class=\"item-title\">We Provide the highest level of satisfaction care &amp; services to our patients.<\/h2>\r\n                    <div class=\"call-to-action-phone\">\r\n                                                    <a href=\"tel:+91 98781 23121\"><i class=\"fas fa-phone\"><\/i>+91 98781 23121<\/a>\r\n                                            <\/div>\r\n\t\t\t\t\t\t                 \r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n<\/div>\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<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Make an Appointment Fill the information below to book an appointment.. We Provide the highest level of satisfaction care &amp; services to our patients. +91 98781 23121<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-686","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-json\/wp\/v2\/pages\/686","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-json\/wp\/v2\/comments?post=686"}],"version-history":[{"count":39,"href":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-json\/wp\/v2\/pages\/686\/revisions"}],"predecessor-version":[{"id":6978,"href":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-json\/wp\/v2\/pages\/686\/revisions\/6978"}],"wp:attachment":[{"href":"https:\/\/tattvhealthcare.com\/dr-nk-singla\/wp-json\/wp\/v2\/media?parent=686"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}