{"id":673,"date":"2017-11-28T05:35:11","date_gmt":"2017-11-28T05:35:11","guid":{"rendered":"https:\/\/victorthemes.com\/?page_id=673"},"modified":"2021-01-06T12:24:30","modified_gmt":"2021-01-06T12:24:30","slug":"appointment-form","status":"publish","type":"page","link":"https:\/\/victorthemes.com\/themes\/cosgrove\/appointment-form\/","title":{"rendered":"Appointment Form"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row full_width=&#8221;stretch_row&#8221; parallax=&#8221;content-moving&#8221; overlay_dotted=&#8221;&#8221; overlay_color=&#8221;rgba(52,132,219,0.2)&#8221; css=&#8221;.vc_custom_1522908386650{padding-top: 10% !important;padding-bottom: 10% !important;background-image: url(https:\/\/victorthemes.com\/wp-content\/uploads\/2017\/11\/background6.png?id=674) !important;}&#8221;][vc_column text_alignment=&#8221;text-center&#8221; css=&#8221;.vc_custom_1522908037894{padding-top: 100px !important;padding-bottom: 100px !important;}&#8221;][vc_custom_heading text=&#8221;Wide network of healthcare<br \/>\nsolutions&#8221; font_container=&#8221;tag:h2|font_size:50px|text_align:center|color:%23ffffff|line_height:58px&#8221; google_fonts=&#8221;font_family:Asap%3Aregular%2Citalic%2C700%2C700italic|font_style:700%20bold%20regular%3A700%3Anormal&#8221; css=&#8221;.vc_custom_1522908315401{padding-bottom: 30px !important;}&#8221;]<a href=\"#0\" class=\"csgve-btn text-center csgve-btn-69e9ce71af88c\">Make An Appointment<\/a>[\/vc_column][\/vc_row][vc_row][vc_column]<div class=\"csgve-emergency  csgve-valuable-status-69e9ce71af8a0-book-an-appointment \"><div class=\"our-valuable-status\"><div class=\"csgve-item valuable-status-item\"><div class=\"value-stat-content\"> <h3 class=\"status-title\">Book An Appointment<\/h3><div class=\"appointment-form valuable-form\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f404-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/themes\/cosgrove\/wp-json\/wp\/v2\/pages\/673#wpcf7-f404-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"404\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f404-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f4-p8-o1\" dir=\"ltr\" lang=\"en-US\">\n\t<div class=\"screen-reader-response\">\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-4\">\n\t\t\t<p><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-943\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-943\"><option value=\"Department\">Department<\/option><option value=\"Neurology\">Neurology<\/option><option value=\"Cardiology\">Cardiology<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-4\">\n\t\t\t<p><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-doctor\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-doctor\"><option value=\"Doctor\">Doctor<\/option><option value=\"Helen Wilmore\">Helen Wilmore<\/option><option value=\"Kristina Castle\">Kristina Castle<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-4\">\n\t\t\t<p><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-671\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Full Name\" value=\"\" type=\"text\" name=\"text-671\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-4\">\n\t\t\t<p><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-237\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Phone Number\" value=\"\" type=\"text\" name=\"text-237\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-2\">\n\t\t\t<p><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-558\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required csgve-datepicker\" aria-required=\"true\" aria-invalid=\"false\" value=\"2018-04-01\" type=\"text\" name=\"text-558\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-2\">\n\t\t\t<p><br \/>\n<input class=\"clockpicker\" data-provide=\"clockpicker\" data-autoclose=\"true\" value=\"\" id=\"clock-in\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" type=\"text\" placeholder=\"Time\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-4\">\n\t\t\t<p><br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Make An Appointment\" \/>\n\t\t\t<\/p>\n\t\t<input class=\"wpcf7-form-control wpcf7-hidden\" id=\"time-pick\" value=\"\" type=\"hidden\" name=\"text-408\" \/>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row&#8221; overlay_dotted=&#8221;&#8221; css=&#8221;.vc_custom_1511851344339{padding-top: 42px !important;padding-bottom: 25px !important;background-color: #fcfcfc !important;}&#8221;][vc_column width=&#8221;1\/4&#8243;]<div class=\"csgve-facilities csgve-facilities-69e9ce71afdb5 \">\r\n                <div class=\"csgve-item facilities-item\">\r\n                  <div class=\"csgve-icon\"><img decoding=\"async\" src=\"https:\/\/victorthemes.com\/themes\/cosgrove\/wp-content\/uploads\/2017\/11\/icon5@1x.png\" alt=\"\"><\/div>\r\n                  <div class=\"facilities-info\"><h4 class=\"facilities-title\"><a href=\"https:\/\/victorthemes.com\/about-us\/\" >Health Essentials<\/a><\/h4><p>Startup burn rate business plan beta handshake network effects stealth freemium proof.<\/p><div class=\"view-details\"><a href=\"https:\/\/victorthemes.com\/about-us\/\" > View Details<\/a><\/div>\r\n                  <\/div>\r\n\r\n                <\/div>\r\n\r\n              <\/div>[\/vc_column][vc_column width=&#8221;1\/4&#8243;]<div class=\"csgve-facilities csgve-facilities-69e9ce71afed4 \">\r\n                <div class=\"csgve-item facilities-item\">\r\n                  <div class=\"csgve-icon\"><img decoding=\"async\" src=\"https:\/\/victorthemes.com\/themes\/cosgrove\/wp-content\/uploads\/2017\/11\/icon6@1x.png\" alt=\"\"><\/div>\r\n                  <div class=\"facilities-info\"><h4 class=\"facilities-title\"><a href=\"https:\/\/victorthemes.com\/appointment-form\/\" >Health Foundation<\/a><\/h4><p>Startup burn rate business plan beta handshake network effects stealth freemium proof.<\/p><div class=\"view-details\"><a href=\"https:\/\/victorthemes.com\/appointment-form\/\" > View Details<\/a><\/div>\r\n                  <\/div>\r\n\r\n                <\/div>\r\n\r\n              <\/div>[\/vc_column][vc_column width=&#8221;1\/4&#8243;]<div class=\"csgve-facilities csgve-facilities-69e9ce71affde \">\r\n                <div class=\"csgve-item facilities-item\">\r\n                  <div class=\"csgve-icon\"><img decoding=\"async\" src=\"https:\/\/victorthemes.com\/themes\/cosgrove\/wp-content\/uploads\/2017\/11\/icon7@1x.png\" alt=\"\"><\/div>\r\n                  <div class=\"facilities-info\"><h4 class=\"facilities-title\"><a href=\"https:\/\/victorthemes.com\/medical-services\/\" >Quality &amp; Patient Safety<\/a><\/h4><p>Startup burn rate business plan beta handshake network effects stealth freemium proof.<\/p><div class=\"view-details\"><a href=\"https:\/\/victorthemes.com\/medical-services\/\" > View Details<\/a><\/div>\r\n                  <\/div>\r\n\r\n                <\/div>\r\n\r\n              <\/div>[\/vc_column][vc_column width=&#8221;1\/4&#8243;]<div class=\"csgve-facilities csgve-facilities-69e9ce71b00ea \">\r\n                <div class=\"csgve-item facilities-item\">\r\n                  <div class=\"csgve-icon\"><img decoding=\"async\" src=\"https:\/\/victorthemes.com\/themes\/cosgrove\/wp-content\/uploads\/2017\/11\/icon8@1x.png\" alt=\"\"><\/div>\r\n                  <div class=\"facilities-info\"><h4 class=\"facilities-title\"><a href=\"https:\/\/victorthemes.com\/our-doctors\/\" >Medical Records<\/a><\/h4><p>Startup burn rate business plan beta handshake network effects stealth freemium proof.<\/p><div class=\"view-details\"><a href=\"https:\/\/victorthemes.com\/our-doctors\/\" > View Details<\/a><\/div>\r\n                  <\/div>\r\n\r\n                <\/div>\r\n\r\n              <\/div>[\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; overlay_dotted=&#8221;&#8221;][vc_column css=&#8221;.vc_custom_1511848896427{padding-top: 0px !important;}&#8221;][vc_separator color=&#8221;custom&#8221; accent_color=&#8221;#ececec&#8221; css=&#8221;.vc_custom_1511852162250{margin-bottom: 1px !important;}&#8221;][\/vc_column][\/vc_row][vc_row overlay_dotted=&#8221;&#8221; css=&#8221;.vc_custom_1511852172486{padding-top: 75px !important;}&#8221;][vc_column css=&#8221;.vc_custom_1512125844797{padding-left: 20px !important;}&#8221;][vc_custom_heading text=&#8221;Frequently Asked Questions&#8221; font_container=&#8221;tag:h2|font_size:32|text_align:left|color:%23111111|line_height:30px&#8221; google_fonts=&#8221;font_family:Asap%3Aregular%2Citalic%2C700%2C700italic|font_style:700%20bold%20regular%3A700%3Anormal&#8221; css=&#8221;.vc_custom_1522306043091{padding-bottom: 14px !important;}&#8221;]<div id=\"accordion\" class=\"accordion \" role=\"tablist\" aria-multiselectable=\"true\"><div class=\"card\">\r\n                      <div class=\"card-header\" id=\"headingOne069e9ce71b0237\">\r\n                        <h4 class=\"accordion-title\">\r\n                          <a class=\"btn btn-link collapsed\" data-toggle=\"collapse\" data-target=\"#csgveAcc-069e9ce71b0237\" aria-expanded=\"true\" aria-controls=\"csgveAcc-069e9ce71b0237\">Can I request a copy of my MRI online?\r\n                          <\/a>\r\n                        <\/h4>\r\n                      <\/div>\r\n                      <div id=\"csgveAcc-069e9ce71b0237\" class=\"collapse \" data-parent=\"#accordion\">\r\n                        <div class=\"card-body\">\r\n                          [vc_column_text]Incubator launch party handshake bandwidth seed round. Business for model canvas product management android ramen. Business to business MVP network effects vesting period scrum project research &amp; development monetization early adopters.[\/vc_column_text]\r\n                        <\/div>\r\n                      <\/div>\r\n                    <\/div><div class=\"card\">\r\n                      <div class=\"card-header\" id=\"headingOne169e9ce71b0245\">\r\n                        <h4 class=\"accordion-title\">\r\n                          <a class=\"btn btn-link collapsed\" data-toggle=\"collapse\" data-target=\"#csgveAcc-169e9ce71b0245\" aria-expanded=\"true\" aria-controls=\"csgveAcc-169e9ce71b0245\">What if I do not have insurance?\r\n                          <\/a>\r\n                        <\/h4>\r\n                      <\/div>\r\n                      <div id=\"csgveAcc-169e9ce71b0245\" class=\"collapse \" data-parent=\"#accordion\">\r\n                        <div class=\"card-body\">\r\n                          [vc_column_text]Incubator launch party handshake bandwidth seed round. Business for model canvas product management android ramen. Business to business MVP network effects vesting period scrum project research &amp; development monetization early adopters.[\/vc_column_text]\r\n                        <\/div>\r\n                      <\/div>\r\n                    <\/div><div class=\"card show\">\r\n                      <div class=\"card-header\" id=\"headingOne269e9ce71b024e\">\r\n                        <h4 class=\"accordion-title\">\r\n                          <a class=\"btn btn-link \" data-toggle=\"collapse\" data-target=\"#csgveAcc-269e9ce71b024e\" aria-expanded=\"true\" aria-controls=\"csgveAcc-269e9ce71b024e\">How do I get a copy of my medical records?\r\n                          <\/a>\r\n                        <\/h4>\r\n                      <\/div>\r\n                      <div id=\"csgveAcc-269e9ce71b024e\" class=\"collapse  show\" data-parent=\"#accordion\">\r\n                        <div class=\"card-body\">\r\n                          [vc_column_text]Incubator launch party handshake bandwidth seed round. Business for model canvas product management android ramen. Business to business MVP network effects vesting period scrum project research &amp; development monetization early adopters.[\/vc_column_text]\r\n                        <\/div>\r\n                      <\/div>\r\n                    <\/div><div class=\"card\">\r\n                      <div class=\"card-header\" id=\"headingOne369e9ce71b0256\">\r\n                        <h4 class=\"accordion-title\">\r\n                          <a class=\"btn btn-link collapsed\" data-toggle=\"collapse\" data-target=\"#csgveAcc-369e9ce71b0256\" aria-expanded=\"true\" aria-controls=\"csgveAcc-369e9ce71b0256\">Does Cosgrove Clinic accept Dentalcare?\r\n                          <\/a>\r\n                        <\/h4>\r\n                      <\/div>\r\n                      <div id=\"csgveAcc-369e9ce71b0256\" class=\"collapse \" data-parent=\"#accordion\">\r\n                        <div class=\"card-body\">\r\n                          [vc_column_text]Incubator launch party handshake bandwidth seed round. Business for model canvas product management android ramen. 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css=&#8221;.vc_custom_1511851344339{padding-top: 42px !important;padding-bottom: 25px !important;background-color: #fcfcfc !important;}&#8221;][vc_column width=&#8221;1\/4&#8243;][\/vc_column][vc_column width=&#8221;1\/4&#8243;][\/vc_column][vc_column width=&#8221;1\/4&#8243;][\/vc_column][vc_column width=&#8221;1\/4&#8243;][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; overlay_dotted=&#8221;&#8221;][vc_column css=&#8221;.vc_custom_1511848896427{padding-top: 0px !important;}&#8221;][vc_separator color=&#8221;custom&#8221; accent_color=&#8221;#ececec&#8221; css=&#8221;.vc_custom_1511852162250{margin-bottom: 1px !important;}&#8221;][\/vc_column][\/vc_row][vc_row overlay_dotted=&#8221;&#8221; css=&#8221;.vc_custom_1511852172486{padding-top: 75px !important;}&#8221;][vc_column&#8230;","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Appointment Form - Cosgrove<\/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:\/\/victorthemes.com\/themes\/cosgrove\/appointment-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Appointment Form - Cosgrove\" \/>\n<meta property=\"og:description\" content=\"[vc_row full_width=&#8221;stretch_row&#8221; 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