{"id":73,"date":"2014-07-11T11:27:36","date_gmt":"2014-07-11T10:27:36","guid":{"rendered":"http:\/\/drbarnard.genpra.net\/?page_id=73"},"modified":"2019-07-27T14:29:01","modified_gmt":"2019-07-27T13:29:01","slug":"send-a-message","status":"publish","type":"page","link":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/about-us\/contact\/send-a-message\/","title":{"rendered":"Send a Message"},"content":{"rendered":"\n<p>Please<span style=\"font-weight: bold;\" class=\"tadv-format-panel\"> do not use <\/span>this facility if your message is of a medical nature. For reasons of patient confidentiality we do not correspond on clinical matters. In this instance, you are advised to contact the Practice directly.<\/p>\n\n\n<link rel='stylesheet' id='formidable-css' href='https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-content\/plugins\/formidable\/css\/formidableforms.css?ver=4271546' media='all' \/>\n<div class=\"frm_forms  with_frm_style frm_style_big_text\" id=\"frm_form_13_container\" data-token=\"28db8e035a81c2174f36bdf877d2abd9\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_hnlsj6\"  data-token=\"28db8e035a81c2174f36bdf877d2abd9\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Contact the Practice<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"13\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_13\" id=\"frm_hide_fields_13\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"hnlsj6\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_13\" name=\"frm_submit_entry_13\" value=\"e7e38161d2\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/73\" \/><div id=\"frm_field_266_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_xu1tj6\" class=\"frm_primary_label\">First Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xu1tj6\" name=\"item_meta[266]\" value=\"\"  data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_267_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_xt7az6\" class=\"frm_primary_label\">Last Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xt7az6\" name=\"item_meta[267]\" value=\"\"  data-reqmsg=\"Last Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_268_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_ppbxb6\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_ppbxb6\" name=\"item_meta[268]\" value=\"\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ppbxb6\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ppbxb6\">Enter Email<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_conf_268_container\" class=\"frm_form_field frm_none_container frm_conf_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_conf_ppbxb6\" class=\"frm_conf_label frm_primary_label\">Confirm Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_conf_ppbxb6\" name=\"item_meta[conf_268]\" value=\"\"  placeholder=\"Please confirm your email\" data-reqmsg=\"Confirm Email cannot be blank.\" aria-required=\"true\" data-confmsg=\"The entered values do not match\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_conf_ppbxb6\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_conf_ppbxb6\">Confirm Email<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_269_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_w1eya6\" class=\"frm_primary_label\">Date of birth\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_w1eya6\" name=\"item_meta[269]\" value=\"\"  data-frmmask=\"99\/99\/9999\" placeholder=\"DD\/MM\/YYYY\" data-reqmsg=\"Date of birth cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\" pattern=\"\\d\\d\\\/\\d\\d\\\/\\d\\d\\d\\d$\"   aria-describedby=\"frm_desc_field_w1eya6\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_w1eya6\">Please use format day\/month\/year e.g. 12\/05\/1979<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_270_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_spq8l4\" class=\"frm_primary_label\">Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_spq8l4\" name=\"item_meta[270]\" value=\"\"  data-reqmsg=\"Phone Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_271_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_d08kt\" class=\"frm_primary_label\">Your named GP\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_d08kt\" name=\"item_meta[271]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_272_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_djto1\" class=\"frm_primary_label\">Message\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[272]\" id=\"field_djto1\" rows=\"5\"  data-reqmsg=\"Message cannot be blank.\" aria-required=\"true\" data-invmsg=\"Message is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_273_container\" class=\"frm_form_field form-field  frm_required_field frm_inline_container vertical_radio\">\r\n    <label for=\"field_xzyfw\" class=\"frm_primary_label\"> \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_273-0\"><label for=\"field_xzyfw-0\"><input type=\"checkbox\" name=\"item_meta[273][]\" id=\"field_xzyfw-0\" value=\"I confirm that my enquiry is not urgent, and understand it may take up to 5 working days or more  before I receive a reply.\"  data-reqmsg=\"We need your confirmation to proceed. Please tick the box to confirm.\" data-invmsg=\"  is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> I confirm that my enquiry is not urgent, and understand it may take up to 5 working days or more  before I receive a reply.<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_274_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Privacy Policy<\/h3>\r\n\r\n\r\n<div id=\"frm_field_275_container\" class=\"frm_form_field  frm_html_container form-field\">This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our <a href=\"https:\/\/www.thevicaragelanesurgery.nhs.uk\/about-us\/practice-policies\/patient-record\/how-we-use-your-data\/privacy-policy\/\" target=\"_blank\">Privacy Policy<\/a> to discover how we protect and manage your submitted data.<\/div>\n<div id=\"frm_field_276_container\" class=\"frm_form_field form-field  frm_required_field frm_inline_container vertical_radio\">\r\n    <label for=\"field_9ho4b\" class=\"frm_primary_label\"> \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_276-274-0\"><label for=\"field_9ho4b-0\"><input type=\"checkbox\" name=\"item_meta[276][]\" id=\"field_9ho4b-0\" value=\"I consent to the Practice collecting and storing my data from this form.\"  data-sectionid=\"274\" data-reqmsg=\"We need your consent to proceed. Please tick the box to consent.\" data-invmsg=\"  is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> I consent to the Practice collecting and storing my data from this form.<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1047_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"g-recaptcha-response\" id=\"field_43wwj_label\" class=\"frm_primary_label\">reCAPTCHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div  id=\"field_43wwj\" class=\"g-recaptcha\" data-sitekey=\"6LcMjOgcAAAAAAGXSVgbKK2mwbkSyqZnj_FWUTY-\" data-size=\"normal\" data-theme=\"light\"><\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__654269977078e\">\n\t\t\t\t<label for=\"frm_email_13\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_13\" type=\"text\" class=\"frm_verify\" name=\"frm__654269977078e\" value=\"\" autocomplete=\"false\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"81TV1LM0CHK8U8W597zOAgnSJV3YMFAqprTRuMrGCyw=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Send<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Please do not use this facility if your message is of a medical nature. For reasons of patient confidentiality we do not correspond on clinical matters. In this instance, you are advised to contact the Practice directly.<\/p>\n","protected":false},"author":6577921,"featured_media":2536,"parent":1270,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","_uag_custom_page_level_css":"","footnotes":"","_links_to":"","_links_to_target":""},"acf":[],"uagb_featured_image_src":{"full":["https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-content\/uploads\/2019\/02\/casual-cellphone-contemporary-1471752.jpg",2048,1366,false],"thumbnail":["https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-content\/uploads\/2019\/02\/casual-cellphone-contemporary-1471752-150x150.jpg",150,150,true],"medium":["https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-content\/uploads\/2019\/02\/casual-cellphone-contemporary-1471752-300x200.jpg",300,200,true],"medium_large":["https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-content\/uploads\/2019\/02\/casual-cellphone-contemporary-1471752-768x512.jpg",768,512,true],"large":["https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-content\/uploads\/2019\/02\/casual-cellphone-contemporary-1471752-1024x683.jpg",1024,683,true],"1536x1536":["https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-content\/uploads\/2019\/02\/casual-cellphone-contemporary-1471752.jpg",1536,1025,false],"2048x2048":["https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-content\/uploads\/2019\/02\/casual-cellphone-contemporary-1471752.jpg",2048,1366,false],"mailpoet_newsletter_max":["https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-content\/uploads\/2019\/02\/casual-cellphone-contemporary-1471752.jpg",1320,880,false]},"uagb_author_info":{"display_name":"Editor","author_link":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/author\/gary-genpra\/"},"uagb_comment_info":0,"uagb_excerpt":"Please do not use this facility if your message is of a medical nature. For reasons of patient confidentiality we do not correspond on clinical matters. In this instance, you are advised to contact the Practice directly.","publishpress_future_action":{"enabled":false,"date":"2024-05-05 09:14:01","action":"change-status","newStatus":"draft","terms":[],"taxonomy":""},"_links":{"self":[{"href":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-json\/wp\/v2\/pages\/73"}],"collection":[{"href":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-json\/wp\/v2\/users\/6577921"}],"replies":[{"embeddable":true,"href":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-json\/wp\/v2\/comments?post=73"}],"version-history":[{"count":0,"href":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-json\/wp\/v2\/pages\/73\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-json\/wp\/v2\/pages\/1270"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-json\/wp\/v2\/media\/2536"}],"wp:attachment":[{"href":"https:\/\/www.thevicaragelanesurgery.nhs.uk\/wp-json\/wp\/v2\/media?parent=73"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}