{"id":10840,"date":"2025-09-03T08:24:11","date_gmt":"2025-09-03T08:24:11","guid":{"rendered":"https:\/\/sanjivaneehealthcare.in\/?page_id=10840"},"modified":"2025-09-03T08:25:53","modified_gmt":"2025-09-03T08:25:53","slug":"patient-register","status":"publish","type":"page","link":"https:\/\/sanjivaneehealthcare.in\/index.php\/patient-register\/","title":{"rendered":"Patient Register"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"10840\" class=\"elementor elementor-10840\">\n\t\t\t\t<div class=\"wd-negative-gap elementor-element elementor-element-05fd8e4 e-flex e-con-boxed e-con e-parent\" data-id=\"05fd8e4\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-da14dee e-con-full e-flex e-con e-child\" data-id=\"da14dee\" data-element_type=\"container\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-265c2ff e-con-full e-flex e-con e-child\" data-id=\"265c2ff\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-05a5a64 elementor-widget elementor-widget-shortcode\" data-id=\"05a5a64\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-10839 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-10839\" data-uid=\"6a6a212190ac0\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-10839\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-10839 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"10839\"\n\t\t\t\t\n\t\t\t\tdata-design=\"default\"\n\t\t\t\tdata-color-option=\"theme\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"6a6a212190ac0\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a6a212190ac0\" id=\"forminator-field-name-1_6a6a212190ac0-label\" class=\"forminator-label\">Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a6a212190ac0\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a6a212190ac0\" id=\"forminator-field-email-1_6a6a212190ac0-label\" class=\"forminator-label\">Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6a6a212190ac0\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a6a212190ac0\" id=\"forminator-field-phone-1_6a6a212190ac0-label\" class=\"forminator-label\">Mobile Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6a6a212190ac0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a6a212190ac0\" id=\"forminator-field-address-1-street_address_6a6a212190ac0-label\" class=\"forminator-label\">Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"\" id=\"forminator-field-address-1-street_address_6a6a212190ac0\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a6a212190ac0\" id=\"forminator-field-date-1-picker_6a6a212190ac0-label\" class=\"forminator-label\">Date of Birth<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-1-picker_6a6a212190ac0\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Register<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"13bffefbdc\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/10840\" \/><input type=\"hidden\" name=\"form_id\" value=\"10839\"><input type=\"hidden\" name=\"page_id\" value=\"10840\"><input type=\"hidden\" name=\"form_type\" value=\"registration\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/sanjivaneehealthcare.in\/index.php\/patient-register\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d224ac5 e-con-full e-flex e-con e-child\" data-id=\"d224ac5\" data-element_type=\"container\">\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-10840","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sanjivaneehealthcare.in\/index.php\/wp-json\/wp\/v2\/pages\/10840","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sanjivaneehealthcare.in\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sanjivaneehealthcare.in\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sanjivaneehealthcare.in\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sanjivaneehealthcare.in\/index.php\/wp-json\/wp\/v2\/comments?post=10840"}],"version-history":[{"count":4,"href":"https:\/\/sanjivaneehealthcare.in\/index.php\/wp-json\/wp\/v2\/pages\/10840\/revisions"}],"predecessor-version":[{"id":10844,"href":"https:\/\/sanjivaneehealthcare.in\/index.php\/wp-json\/wp\/v2\/pages\/10840\/revisions\/10844"}],"wp:attachment":[{"href":"https:\/\/sanjivaneehealthcare.in\/index.php\/wp-json\/wp\/v2\/media?parent=10840"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}