{"id":664,"date":"2023-07-12T05:00:42","date_gmt":"2023-07-12T05:00:42","guid":{"rendered":"https:\/\/tapscard.in\/Profile\/?page_id=664"},"modified":"2023-07-26T12:20:21","modified_gmt":"2023-07-26T12:20:21","slug":"zero-gravity-appointment-form","status":"publish","type":"page","link":"https:\/\/tapscard.in\/Profile\/zero-gravity-appointment-form\/","title":{"rendered":"Zero Gravity Appointment Form"},"content":{"rendered":"<p>[vc_row css=&#8221;.vc_custom_1690201742385{margin-top: 40px !important;margin-bottom: 20px !important;}&#8221;][vc_column][vc_single_image image=&#8221;787&#8243; img_size=&#8221;medium&#8221; alignment=&#8221;center&#8221;][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1690202323526{margin-right: 20px !important;margin-bottom: 20px !important;margin-left: 20px !important;background-color: #111111 !important;border-radius: 15px !important;}&#8221;][vc_column]<style>.ld_fancy_heading_6aa3ecf0b4e20 h3 {font-size:18px; } .ld_fancy_heading_6aa3ecf0b4e20 h3 {padding-top:20px !important;  } .ld_fancy_heading_6aa3ecf0b4e20 .lqd-highlight-inner{height:0.275em!important;bottom:0px!important;}.ld_fancy_heading_6aa3ecf0b4e20 h3 {font-size:18px; } .ld_fancy_heading_6aa3ecf0b4e20 h3 {padding-top:20px !important;  } <\/style><div class=\"ld-fancy-heading text-center ld_fancy_heading_6aa3ecf0b4e20\">\n\t<h3 class=\"ld-fh-element lqd-highlight-underline lqd-highlight-grow-left text-decoration-default\"   >  BOOK ZERO GRAVITY PHYSIO SERVICES<\/h3><\/div><style>.ld_fancy_heading_6aa3ecf0b525c p{color:rgba(255, 255, 255, 0.37);}.ld_fancy_heading_6aa3ecf0b525c p {padding-bottom:20px !important;  } .ld_fancy_heading_6aa3ecf0b525c p {margin-bottom:0em !important;  } .ld_fancy_heading_6aa3ecf0b525c .lqd-highlight-inner{height:0.275em!important;bottom:0px!important;}.ld_fancy_heading_6aa3ecf0b525c p {padding-bottom:20px !important;  } .ld_fancy_heading_6aa3ecf0b525c p {margin-bottom:0em !important;  } <\/style><div class=\"ld-fancy-heading text-center ld_fancy_heading_6aa3ecf0b525c\">\n\t<p class=\"ld-fh-element lqd-highlight-underline lqd-highlight-grow-left text-decoration-default\"   >  Please enter your details and we will reach out to you as soon as we can.<\/p><\/div>[\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1690288556173{margin-top: 40px !important;margin-right: 20px !important;margin-left: 20px !important;}&#8221;][vc_column]<style>.ld_cf7_6aa3ecf0b5464 input,.ld_cf7_6aa3ecf0b5464 textarea,.ld_cf7_6aa3ecf0b5464 .ui-button.ui-selectmenu-button{font-size:16px;}.ld_cf7_6aa3ecf0b5464 input[type=\"submit\"]{background:rgb(29, 29, 29);border-color:rgb(29, 29, 29);}.ld_cf7_6aa3ecf0b5464 input, .ld_cf7_6aa3ecf0b5464 select, .ld_cf7_6aa3ecf0b5464 textarea, .ld_cf7_6aa3ecf0b5464 .ui-button.ui-selectmenu-button{background:rgba(255, 255, 255, 0.07);}.ld_cf7_6aa3ecf0b5464 input, .ld_cf7_6aa3ecf0b5464 select, .ld_cf7_6aa3ecf0b5464 textarea, .ld_cf7_6aa3ecf0b5464 .ui-button.ui-selectmenu-button, .ld_cf7_6aa3ecf0b5464 .wpcf7-form-control-wrap > i, .ld_cf7_6aa3ecf0b5464 .wpcf7-radio{color:rgb(184, 184, 184);}.ld_cf7_6aa3ecf0b5464 input:focus, .ld_cf7_6aa3ecf0b5464 select:focus, .ld_cf7_6aa3ecf0b5464 textarea:focus, .ld_cf7_6aa3ecf0b5464 .ui-button.ui-selectmenu-button:hover, .wpcf7-acceptance .wpcf7-list-item-label:after{color:rgb(255, 255, 255);}.ld_cf7_6aa3ecf0b5464 input, .ld_cf7_6aa3ecf0b5464 select, .ld_cf7_6aa3ecf0b5464 textarea, .ld_cf7_6aa3ecf0b5464 .ui-button.ui-selectmenu-button, .ld_cf7_6aa3ecf0b5464 .wpcf7-acceptance .wpcf7-list-item-label:before{border-color:rgba(255, 255, 255, 0.32);}.ld_cf7_6aa3ecf0b5464 input[type=\"submit\"]:focus,.ld_cf7_6aa3ecf0b5464 input[type=\"submit\"]:hover{background:rgb(46, 46, 46);}.ld_cf7_6aa3ecf0b5464 input[type=\"submit\"]:hover{border-color:rgb(46, 46, 46);}<\/style><div id=\"ld_cf7_6aa3ecf0b5464\" class=\"lqd-contact-form lqd-contact-form-inputs-md lqd-contact-form-inputs-filled lqd-contact-form-inputs-circle lqd-contact-form-button-block lqd-contact-form-button-circle ld_cf7_6aa3ecf0b5464\">\n\t\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f654-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=\"\/Profile\/wp-json\/wp\/v2\/pages\/664#wpcf7-f654-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=\"654\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.7\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f654-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><label> Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Mobile No.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Contact\"><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\" value=\"\" type=\"tel\" name=\"Contact\" \/><\/span> <\/label>\n<\/p>\n<p><label> Select Services<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Services\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" autocomplete=\"Services\" aria-required=\"true\" aria-invalid=\"false\" name=\"Services\"><option value=\"Physiotherapy\">Physiotherapy<\/option><option value=\"Osteopathy\">Osteopathy<\/option><option value=\"Chiropractor\">Chiropractor<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Select Localities<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Localities\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Localities\"><option value=\"Dahisar West\">Dahisar West<\/option><option value=\"Dahisar East\">Dahisar East<\/option><option value=\"Borivali West\">Borivali West<\/option><option value=\"Borivali East\">Borivali East<\/option><option value=\"Kandivali West\">Kandivali West<\/option><option value=\"Kandivali East\">Kandivali East<\/option><option value=\"Malad West\">Malad West<\/option><option value=\"Malad East\">Malad East<\/option><option value=\"Goregaon West\">Goregaon West<\/option><option value=\"Goregaon East\">Goregaon East<\/option><option value=\"Jogeshwari West\">Jogeshwari West<\/option><option value=\"Jogeshwari East\">Jogeshwari East<\/option><option value=\"Andheri West\">Andheri West<\/option><option value=\"Andheri East\">Andheri East<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Select Date<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"dd\/mm\/yy\" value=\"\" type=\"date\" name=\"Date\" \/><\/span> <\/label>\n<\/p>\n<p><label> Select Time Slot<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Time\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Time\"><option value=\"8am - 10am\">8am - 10am<\/option><option value=\"10am - 12pm\">10am - 12pm<\/option><option value=\"4pm - 6pm\">4pm - 6pm<\/option><option value=\"6pm - 8pm\">6pm - 8pm<\/option><option value=\"8pm - 10pm\">8pm - 10pm<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Since when are you experiencing the pain?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pain\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"pain\"><option value=\"1 Day\">1 Day<\/option><option value=\"1 Week\">1 Week<\/option><option value=\"1 Month\">1 Month<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> When did you meet the doctor last<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Meet\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Meet\"><option value=\"1 day back\">1 day back<\/option><option value=\"1 week back\">1 week back<\/option><option value=\"1 month back\">1 month back<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Has a doctor recommended you to see a physiotherapist?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Recommended\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"Recommended\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"Recommended\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span> <\/label>\n<\/p>\n<p><label> Are you flexible with your time preference?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"flexibletime\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"flexibletime\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"flexibletime\" value=\"No\" \/><span 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