{"id":4913,"date":"2025-08-20T11:21:02","date_gmt":"2025-08-20T11:21:02","guid":{"rendered":"https:\/\/enfieldroyalclinic.com\/texas\/?page_id=4913"},"modified":"2025-08-20T11:27:52","modified_gmt":"2025-08-20T11:27:52","slug":"patient-record-request-form","status":"publish","type":"page","link":"https:\/\/enfieldroyalclinic.com\/texas\/patient-record-request-form\/","title":{"rendered":"Patient Record Request Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4913\" class=\"elementor elementor-4913\" data-elementor-post-type=\"page\">\n\t\t\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-6f5d88e e-flex e-con-boxed e-con e-parent\" data-id=\"6f5d88e\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f2ef9d5 elementor-widget elementor-widget-shortcode\" data-id=\"f2ef9d5\" data-element_type=\"widget\" data-e-type=\"widget\" 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\"><div id=\"crumbs\"><a href=\"https:\/\/enfieldroyalclinic.com\/texas\">Home<\/a> <i class=\"fa-solid fa-chevron-right\"><\/i> <span class=\"current\">Page<\/span><\/div><\/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\t\t<\/div>\n\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-eeece68 e-flex e-con-boxed e-con e-parent\" data-id=\"eeece68\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ad9344c elementor-widget elementor-widget-heading\" data-id=\"ad9344c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Patient Record Request Form\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-572a8ef elementor-widget elementor-widget-shortcode\" data-id=\"572a8ef\" data-element_type=\"widget\" data-e-type=\"widget\" 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-f4931-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"4931\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/texas\/wp-json\/wp\/v2\/pages\/4913#wpcf7-f4931-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=\"4931\" \/><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-f4931-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"custom-cf7-form\">\n\t<div class=\"form-row two-cols\">\n\t\t<div class=\"form-col\">\n\t\t\t<p><label>First name <span class=\"required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First name\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-col\">\n\t\t\t<p><label>Email <span class=\"required\">*<\/span><\/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\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row two-cols\">\n\t\t<div class=\"form-col\">\n\t\t\t<p><label>Phone No <span class=\"required\">*<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone No\" value=\"\" type=\"tel\" name=\"phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"form-col \">\n\t\t\t<p><label>Message<\/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\" aria-invalid=\"false\" placeholder=\"Message\" name=\"message\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-submit\">\n\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"SEND\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\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\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Patient Record Request Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4913","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/enfieldroyalclinic.com\/texas\/wp-json\/wp\/v2\/pages\/4913","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/enfieldroyalclinic.com\/texas\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/enfieldroyalclinic.com\/texas\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/enfieldroyalclinic.com\/texas\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/enfieldroyalclinic.com\/texas\/wp-json\/wp\/v2\/comments?post=4913"}],"version-history":[{"count":0,"href":"https:\/\/enfieldroyalclinic.com\/texas\/wp-json\/wp\/v2\/pages\/4913\/revisions"}],"wp:attachment":[{"href":"https:\/\/enfieldroyalclinic.com\/texas\/wp-json\/wp\/v2\/media?parent=4913"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}