{"id":211,"date":"2016-04-14T05:22:51","date_gmt":"2016-04-14T05:22:51","guid":{"rendered":"http:\/\/chris.businessbox.com.au\/?page_id=211"},"modified":"2021-07-01T04:09:18","modified_gmt":"2021-07-01T04:09:18","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/www.s3c.com.au\/patient-forms\/","title":{"rendered":"Pre-consult"},"content":{"rendered":"<h1 class=\"sample-title\">Pre-consult<\/h1>\n<div style=\"padding: 0px 10px;\">\n\t<div id=\"ninja_forms_form_5_cont\" class=\"ninja-forms-cont\">\n\t\t<div id=\"ninja_forms_form_5_wrap\" class=\"ninja-forms-form-wrap\">\n\t<div id=\"ninja_forms_form_5_response_msg\" style=\"\" class=\"ninja-forms-response-msg \"><\/div>\t<form id=\"ninja_forms_form_5\" enctype=\"multipart\/form-data\" method=\"post\" name=\"\" action=\"\" class=\"ninja-forms-form\">\n\n\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"9c0c4d1092\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/211\" \/>\t<input type=\"hidden\" name=\"_ninja_forms_display_submit\" value=\"1\">\n\t<input type=\"hidden\" name=\"_form_id\"  id=\"_form_id\" value=\"5\">\n\t\t<div class=\"hp-wrap\">\n\t\t<label>If you are a human and are seeing this field, please leave it blank.\t\t\t<input type=\"text\" value=\"\" name=\"_oNe9s\">\n\t\t\t<input type=\"hidden\" value=\"_oNe9s\" name=\"_hp_name\">\n\t\t<\/label>\n\t<\/div>\n\t\t<div id=\"ninja_forms_form_5_all_fields_wrap\" class=\"ninja-forms-all-fields-wrap\">\n\t\t\t<div class=\"ninja-forms-required-items\">Fields marked with an <span class=\"ninja-forms-req-symbol\">*<\/span> are required<\/div>\n\t\t\t<div class=\"ninja-forms-field  nf-desc\" id=\"ninja_forms_field_44_div_wrap\" style=\"\" rel=\"44\"><\/div>\n\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_9_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_9_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_9\" id=\"ninja_forms_field_9_label\" class=\"\">Patient name \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_9\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"\" name=\"ninja_forms_field_9\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"9\"   \/>\n\t\t<div id=\"ninja_forms_field_9_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_10_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_10_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_10\" id=\"ninja_forms_field_10_label\" class=\"\">Parents (if child) \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_10\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_10\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"10\"   \/>\n\t\t<div id=\"ninja_forms_field_10_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_11_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_11_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_11\" id=\"ninja_forms_field_11_label\" class=\"\">Date of birth \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_11\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_11\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"11\"   \/>\n\t\t<div id=\"ninja_forms_field_11_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_12_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_12_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_12\" id=\"ninja_forms_field_12_label\" class=\"\">Age \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_12\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_12\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"12\"   \/>\n\t\t<div id=\"ninja_forms_field_12_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap list-radio-wrap label-left\"  id=\"ninja_forms_field_49_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_49_type\" value=\"list\">\n\t\t<input type=\"hidden\" id=\"ninja_forms_field_49_list_type\" value=\"radio\">\n\t\t\t\t<label for=\"ninja_forms_field_49\" id=\"ninja_forms_field_49_label\" class=\"\">Gender \t\t\t\t<\/label>\n\t\t<input type=\"hidden\" name=\"ninja_forms_field_49\" value=\"\"><span id=\"ninja_forms_field_49_options_span\" class=\"\" rel=\"49\"><ul><li><label id=\"ninja_forms_field_49_0_label\" class=\"ninja-forms-field-49-options\" style=\"\" for=\"ninja_forms_field_49_0\"><input id=\"ninja_forms_field_49_0\" name=\"ninja_forms_field_49\" type=\"radio\" class=\"ninja-forms-field \" value=\"Male\"  rel=\"49\" \/>Male<\/label><\/li><li><label id=\"ninja_forms_field_49_1_label\" class=\"ninja-forms-field-49-options\" style=\"\" for=\"ninja_forms_field_49_1\"><input id=\"ninja_forms_field_49_1\" name=\"ninja_forms_field_49\" type=\"radio\" class=\"ninja-forms-field \" value=\"Female\"  rel=\"49\" \/>Female<\/label><\/li><\/ul><\/span><li style=\"display:none;\" id=\"ninja_forms_field_49_template\"><label><input id=\"ninja_forms_field_49_\" name=\"\" type=\"radio\" class=\"ninja-forms-field \" value=\"\" rel=\"49\" \/><\/label><\/li>\n\t\t\t\t<div id=\"ninja_forms_field_49_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_14_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_14_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_14\" id=\"ninja_forms_field_14_label\" class=\"\">Address \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_14\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"\" name=\"ninja_forms_field_14\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  address address1 \" value=\"\" rel=\"14\"   \/>\n\t\t<div id=\"ninja_forms_field_14_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_15_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_15_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_15\" id=\"ninja_forms_field_15_label\" class=\"\">Suburb \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_15\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_15\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"15\"   \/>\n\t\t<div id=\"ninja_forms_field_15_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_16_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_16_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_16\" id=\"ninja_forms_field_16_label\" class=\"\">Zip \/ Postcode \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_16\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"\" name=\"ninja_forms_field_16\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  address zip \" value=\"\" rel=\"16\"   \/>\n\t\t<div id=\"ninja_forms_field_16_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_17_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_17_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_17\" id=\"ninja_forms_field_17_label\" class=\"\">Home telephone \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_17\" data-mask=\"9999999999\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"\" name=\"ninja_forms_field_17\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  ninja-forms-mask\" value=\"\" rel=\"17\"   \/>\n\t\t<div id=\"ninja_forms_field_17_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_18_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_18_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_18\" id=\"ninja_forms_field_18_label\" class=\"\">Work telephone \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_18\" data-mask=\"9999999999\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"\" name=\"ninja_forms_field_18\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  ninja-forms-mask\" value=\"\" rel=\"18\"   \/>\n\t\t<div id=\"ninja_forms_field_18_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_19_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_19_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_19\" id=\"ninja_forms_field_19_label\" class=\"\">Mobile telephone <span class='ninja-forms-req-symbol'><strong>*<\/strong><\/span>\t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_19\" data-mask=\"9999999999\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"\" name=\"ninja_forms_field_19\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  ninja-forms-req ninja-forms-mask\" value=\"\" rel=\"19\"   \/>\n\t\t<div id=\"ninja_forms_field_19_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_20_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_20_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_20\" id=\"ninja_forms_field_20_label\" class=\"\">Occupation (what takes up most of your time) \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_20\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_20\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"20\"   \/>\n\t\t<div id=\"ninja_forms_field_20_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_21_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_21_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_21\" id=\"ninja_forms_field_21_label\" class=\"\">Email \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_21\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"\" name=\"ninja_forms_field_21\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  email \" value=\"\" rel=\"21\"   \/>\n\t\t<div id=\"ninja_forms_field_21_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_22_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_22_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_22\" id=\"ninja_forms_field_22_label\" class=\"\">How did you find out about us?  \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_22\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_22\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"22\"   \/>\n\t\t<div id=\"ninja_forms_field_22_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_23_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_23_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_23\" id=\"ninja_forms_field_23_label\" class=\"\">Who referred you? \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_23\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_23\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"23\"   \/>\n\t\t<div id=\"ninja_forms_field_23_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<hr class=\"ninja-forms-field \" style=\"\" id=\"ninja_forms_field_46_div_wrap\" rel=\"46\" \/>\n\t\t<div class=\"ninja-forms-field  nf-desc\" id=\"ninja_forms_field_24_div_wrap\" style=\"\" rel=\"24\"><\/div>\n\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_25_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_25_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_25\" id=\"ninja_forms_field_25_label\" class=\"\">Please list all your current medications \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_25\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_25\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"25\"   \/>\n\t\t<div id=\"ninja_forms_field_25_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_26_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_26_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_26\" id=\"ninja_forms_field_26_label\" class=\"\">Please list all your previous surgeries or hospitalisations \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_26\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_26\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"26\"   \/>\n\t\t<div id=\"ninja_forms_field_26_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_27_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_27_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_27\" id=\"ninja_forms_field_27_label\" class=\"\">Please list any condition or illness you have previously been diagnosed with \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_27\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_27\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"27\"   \/>\n\t\t<div id=\"ninja_forms_field_27_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_28_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_28_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_28\" id=\"ninja_forms_field_28_label\" class=\"\">Please tell us the name of your GP and their address \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_28\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_28\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"28\"   \/>\n\t\t<div id=\"ninja_forms_field_28_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_29_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_29_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_29\" id=\"ninja_forms_field_29_label\" class=\"\">Please tell us about your family medical history, do you know of any conditions they have? \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_29\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_29\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"29\"   \/>\n\t\t<div id=\"ninja_forms_field_29_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<hr class=\"ninja-forms-field \" style=\"\" id=\"ninja_forms_field_45_div_wrap\" rel=\"45\" \/>\n\t\t<div class=\"ninja-forms-field  nf-desc\" id=\"ninja_forms_field_31_div_wrap\" style=\"\" rel=\"31\"><\/div>\n\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_32_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_32_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_32\" id=\"ninja_forms_field_32_label\" class=\"\">What is the main reason for your visit today? \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_32\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_32\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"32\"   \/>\n\t\t<div id=\"ninja_forms_field_32_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_33_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_33_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_33\" id=\"ninja_forms_field_33_label\" class=\"\">When did this start? (how long have you had it) \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_33\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_33\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"33\"   \/>\n\t\t<div id=\"ninja_forms_field_33_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_34_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_34_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_34\" id=\"ninja_forms_field_34_label\" class=\"\">Please tell us where your pain \/ problem is located \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_34\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_34\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"34\"   \/>\n\t\t<div id=\"ninja_forms_field_34_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_35_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_35_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_35\" id=\"ninja_forms_field_35_label\" class=\"\">If you have pain, does your pain travel or refer to another area? Or does it stay in the one spot? \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_35\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_35\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"35\"   \/>\n\t\t<div id=\"ninja_forms_field_35_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_36_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_36_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_36\" id=\"ninja_forms_field_36_label\" class=\"\">If it does travel, where does it go? (eg down the arm to the middle finger) \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_36\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_36\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"36\"   \/>\n\t\t<div id=\"ninja_forms_field_36_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_37_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_37_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_37\" id=\"ninja_forms_field_37_label\" class=\"\">Have you had this pain or similar pain before? When? \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_37\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_37\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"37\"   \/>\n\t\t<div id=\"ninja_forms_field_37_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_38_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_38_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_38\" id=\"ninja_forms_field_38_label\" class=\"\">What makes this pain worse? Please list \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_38\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_38\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"38\"   \/>\n\t\t<div id=\"ninja_forms_field_38_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_39_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_39_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_39\" id=\"ninja_forms_field_39_label\" class=\"\">What makes this pain better? Please list \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_39\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_39\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"39\"   \/>\n\t\t<div id=\"ninja_forms_field_39_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_40_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_40_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_40\" id=\"ninja_forms_field_40_label\" class=\"\">Are you taking medications for it? And have these worked? \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_40\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_40\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"40\"   \/>\n\t\t<div id=\"ninja_forms_field_40_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_41_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_41_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_41\" id=\"ninja_forms_field_41_label\" class=\"\">Is your pain getting worse? \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_41\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_41\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"41\"   \/>\n\t\t<div id=\"ninja_forms_field_41_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_42_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_42_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_42\" id=\"ninja_forms_field_42_label\" class=\"\">Has it stopped you from doing anything? (eg sitting or running) \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_42\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_42\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"42\"   \/>\n\t\t<div id=\"ninja_forms_field_42_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap text-wrap label-above\"  id=\"ninja_forms_field_43_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_43_type\" value=\"text\">\n\t\t<label for=\"ninja_forms_field_43\" id=\"ninja_forms_field_43_label\" class=\"\">Have you seen anyone else (other treatment) for this condition? \t\t\t\t<\/label>\n\t\t\t<input id=\"ninja_forms_field_43\" data-mask=\"\" data-input-limit=\"\" data-input-limit-type=\"char\" data-input-limit-msg=\"character(s) left\" name=\"ninja_forms_field_43\" type=\"text\" placeholder=\"\" class=\"ninja-forms-field  \" value=\"\" rel=\"43\"   \/>\n\t\t<div id=\"ninja_forms_field_43_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field-wrap submit-wrap label-above\"  id=\"ninja_forms_field_48_div_wrap\" data-visible=\"1\">\n\t\t\t\t\t\t\t<input type=\"hidden\" id=\"ninja_forms_field_48_type\" value=\"submit\">\n\t<div id=\"nf_submit_5\">\n\t\t<input type=\"submit\" name=\"_ninja_forms_field_48\" class=\"ninja-forms-field \" id=\"ninja_forms_field_48\" value=\"Send\" rel=\"48\" >\n\t<\/div>\n\t<div id=\"nf_processing_5\" style=\"display:none;\">\n\t\t<input type=\"submit\" name=\"_ninja_forms_field_48\" class=\"ninja-forms-field \" id=\"ninja_forms_field_48\" value=\"Processing\" rel=\"48\" disabled>\n\t<\/div>\n\t\t<div id=\"ninja_forms_field_48_error\" style=\"display:none;\" class=\"ninja-forms-field-error\">\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/form>\n\t\t<\/div>\n\t\t<\/div>\n\t\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Pre-consult<\/p>\n","protected":false},"author":7,"featured_media":1965,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"footnotes":""},"_links":{"self":[{"href":"https:\/\/www.s3c.com.au\/wp-json\/wp\/v2\/pages\/211"}],"collection":[{"href":"https:\/\/www.s3c.com.au\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.s3c.com.au\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.s3c.com.au\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.s3c.com.au\/wp-json\/wp\/v2\/comments?post=211"}],"version-history":[{"count":2,"href":"https:\/\/www.s3c.com.au\/wp-json\/wp\/v2\/pages\/211\/revisions"}],"predecessor-version":[{"id":7232,"href":"https:\/\/www.s3c.com.au\/wp-json\/wp\/v2\/pages\/211\/revisions\/7232"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.s3c.com.au\/wp-json\/wp\/v2\/media\/1965"}],"wp:attachment":[{"href":"https:\/\/www.s3c.com.au\/wp-json\/wp\/v2\/media?parent=211"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}