{"id":942,"date":"2021-07-17T06:10:07","date_gmt":"2021-07-17T06:10:07","guid":{"rendered":"https:\/\/experiordiagnostics.com\/home\/?page_id=942"},"modified":"2021-08-13T13:06:17","modified_gmt":"2021-08-13T13:06:17","slug":"back-to-school-checks-booking-appointment","status":"publish","type":"page","link":"https:\/\/experiordiagnostics.com\/home\/back-to-school-checks-booking-appointment\/","title":{"rendered":"Back to school checks Booking &#038; Appointment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"942\" class=\"elementor elementor-942\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e0bb328 elementor-section-height-min-height elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"e0bb328\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-932d2c9\" data-id=\"932d2c9\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ebf2c5b elementor-widget elementor-widget-heading\" data-id=\"ebf2c5b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">To book a sample collection <br>back to school medical checks appointment,<br>Fill the form below.<br><\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-907b48d elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default elementor-invisible\" data-id=\"907b48d\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;bounceIn&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-82e2a24\" data-id=\"82e2a24\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-85bea77 elementor-widget elementor-widget-spacer\" data-id=\"85bea77\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-43a0b08 elementor-section-stretched animated-slow elementor-section-boxed elementor-section-height-default elementor-section-height-default elementor-invisible\" data-id=\"43a0b08\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation_mobile&quot;:&quot;bounceIn&quot;,&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;animation_delay&quot;:200,&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-900316c animated-slow elementor-invisible\" data-id=\"900316c\" data-element_type=\"column\" data-settings=\"{&quot;animation&quot;:&quot;fadeIn&quot;,&quot;animation_delay&quot;:100}\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9ca4d72 elementor-widget elementor-widget-spacer\" data-id=\"9ca4d72\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-02e88bf animated-slow elementor-invisible elementor-widget elementor-widget-shortcode\" data-id=\"02e88bf\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeIn&quot;,&quot;_animation_delay&quot;:200}\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><h2>Back to School Medical Checks Registration Form<\/h2>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_11_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form \" id=\"form_back_school_form\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_hidden\">Back to school medical checks Appointment Booking<\/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=\"11\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_11\" id=\"frm_hide_fields_11\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"back_school_form\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_11\" name=\"frm_submit_entry_11\" value=\"8d35f4659b\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/home\/wp-json\/wp\/v2\/pages\/942\" \/><div id=\"frm_field_260_container\" class=\"frm_form_field frm_section_heading form-field frm_top_container\">\r\n<h3 class=\"frm_pos_ frm_primary_label[collapse_class]\">Profile of Parent\/Guardian<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_307_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_iysuv\" id=\"field_iysuv_label\" class=\"frm_primary_label\">School Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_iysuv\" name=\"item_meta[307]\" value=\"Destiny Christian Academy\"  data-frmval=\"Destiny Christian Academy\" data-reqmsg=\"School 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_262_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_hybpeedb7da8041\" id=\"field_hybpeedb7da8041_label\" class=\"frm_primary_label\">Student Reference Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hybpeedb7da8041\" name=\"item_meta[262]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"Student Reference 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_308_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_two_col\">\r\n    <div  id=\"field_w4o02_label\" class=\"frm_primary_label\">Approved Tests\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_w4o02_label\" role=\"group\"><input type=\"hidden\" value=\"Hepatitis B\" name=\"item_meta[308][]\"  \/><input type=\"hidden\" value=\"Hepatitis C\" name=\"item_meta[308][]\"  \/><input type=\"hidden\" value=\"HIV 1&amp;2\" name=\"item_meta[308][]\"  \/><input type=\"hidden\" value=\"Blood group\" name=\"item_meta[308][]\"  \/><input type=\"hidden\" value=\"Genotype\" name=\"item_meta[308][]\"  \/><input type=\"hidden\" value=\"Urinalysis\" name=\"item_meta[308][]\"  \/>\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_308-260-0\">\t\t\t<label  for=\"field_w4o02-0\" class=\"frm-label-disabled\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[308][]\" id=\"field_w4o02-0\" value=\"Hepatitis B\" checked=\"checked\"  data-frmval=\"[&quot;Hepatitis B&quot;,&quot;Hepatitis C&quot;,&quot;HIV 1&amp;2&quot;,&quot;Blood group&quot;,&quot;Genotype&quot;,&quot;Urinalysis&quot;]\" data-invmsg=\"Approved Tests is invalid\" aria-invalid=\"false\"   \/> Hepatitis B<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_308-260-1\">\t\t\t<label  for=\"field_w4o02-1\" class=\"frm-label-disabled\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[308][]\" id=\"field_w4o02-1\" value=\"Hepatitis C\" checked=\"checked\"  data-frmval=\"[&quot;Hepatitis B&quot;,&quot;Hepatitis C&quot;,&quot;HIV 1&amp;2&quot;,&quot;Blood group&quot;,&quot;Genotype&quot;,&quot;Urinalysis&quot;]\" data-invmsg=\"Approved Tests is invalid\" aria-invalid=\"false\"   \/> Hepatitis C<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_308-260-2\">\t\t\t<label  for=\"field_w4o02-2\" class=\"frm-label-disabled\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[308][]\" id=\"field_w4o02-2\" value=\"HIV 1&amp;2\" checked=\"checked\"  data-frmval=\"[&quot;Hepatitis B&quot;,&quot;Hepatitis C&quot;,&quot;HIV 1&amp;2&quot;,&quot;Blood group&quot;,&quot;Genotype&quot;,&quot;Urinalysis&quot;]\" data-invmsg=\"Approved Tests is invalid\" aria-invalid=\"false\"   \/> HIV 1&amp;2<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_308-260-3\">\t\t\t<label  for=\"field_w4o02-3\" class=\"frm-label-disabled\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[308][]\" id=\"field_w4o02-3\" value=\"Blood group\" checked=\"checked\"  data-frmval=\"[&quot;Hepatitis B&quot;,&quot;Hepatitis C&quot;,&quot;HIV 1&amp;2&quot;,&quot;Blood group&quot;,&quot;Genotype&quot;,&quot;Urinalysis&quot;]\" data-invmsg=\"Approved Tests is invalid\" aria-invalid=\"false\"   \/> Blood group<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_308-260-4\">\t\t\t<label  for=\"field_w4o02-4\" class=\"frm-label-disabled\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[308][]\" id=\"field_w4o02-4\" value=\"Genotype\" checked=\"checked\"  data-frmval=\"[&quot;Hepatitis B&quot;,&quot;Hepatitis C&quot;,&quot;HIV 1&amp;2&quot;,&quot;Blood group&quot;,&quot;Genotype&quot;,&quot;Urinalysis&quot;]\" data-invmsg=\"Approved Tests is invalid\" aria-invalid=\"false\"   \/> Genotype<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_308-260-5\">\t\t\t<label  for=\"field_w4o02-5\" class=\"frm-label-disabled\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[308][]\" id=\"field_w4o02-5\" value=\"Urinalysis\" checked=\"checked\"  data-frmval=\"[&quot;Hepatitis B&quot;,&quot;Hepatitis C&quot;,&quot;HIV 1&amp;2&quot;,&quot;Blood group&quot;,&quot;Genotype&quot;,&quot;Urinalysis&quot;]\" data-invmsg=\"Approved Tests is invalid\" aria-invalid=\"false\"   \/> Urinalysis<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_263_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_qsrt5496692bd28\" class=\"frm_primary_label\">Title\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[263]\" id=\"field_qsrt5496692bd28\"  data-reqmsg=\"Title cannot be blank.\" aria-required=\"true\" data-invmsg=\"Title is invalid\" class=\"auto_width\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Choose Title\">Choose Title<\/option><option  value=\"Sir\">Sir<\/option><option  value=\"Mr.\">Mr.<\/option><option  value=\"Mrs.\">Mrs.<\/option><option  value=\"Miss.\">Miss.<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_264_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n    <label for=\"field_ocfup13d4af8fd6a50c8c5b80ddbf1a2d21cc\" class=\"frm_primary_label\">Surname\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ocfup13d4af8fd6a50c8c5b80ddbf1a2d21cc\" name=\"item_meta[264]\" value=\"\"  data-reqmsg=\"Surname cannot be blank.\" aria-required=\"true\" data-invmsg=\"Surname is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ocfup13d4af8fd6a50c8c5b80ddbf1a2d21cc\"\/>\r\n    <div id=\"frm_desc_field_ocfup13d4af8fd6a50c8c5b80ddbf1a2d21cc\" class=\"frm_description\">Last<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_265_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_qh4icy33d063913b0f6f13480e713533da59d\" class=\"frm_primary_label\">First Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh4icy33d063913b0f6f13480e713533da59d\" name=\"item_meta[265]\" value=\"\"  data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"First Name is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_qh4icy33d063913b0f6f13480e713533da59d\"\/>\r\n    <div id=\"frm_desc_field_qh4icy33d063913b0f6f13480e713533da59d\" class=\"frm_description\">First<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_266_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_qimmqaad000118c7d47b6a5451e2006eb58\" class=\"frm_primary_label\">Other Names\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qimmqaad000118c7d47b6a5451e2006eb58\" name=\"item_meta[266]\" value=\"\"  data-invmsg=\"Other Names 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_first frm_half\">\r\n    <label for=\"field_vywq85c011ae7e72f0c4ec4d47a191c2a6d\" class=\"frm_primary_label\">Date of Birth\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_vywq85c011ae7e72f0c4ec4d47a191c2a6d\" name=\"item_meta[267]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"Date of Birth cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date of Birth 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 frm_half\">\r\n    <label for=\"field_b8k0wa33dce5e9b6babda935928393a7575\" class=\"frm_primary_label\">Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_b8k0wa33dce5e9b6babda935928393a7575\" name=\"item_meta[268]\" value=\"\"  maxlength=\"11\" data-reqmsg=\"Phone Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone Number is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \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_29yf4d36bfa17ab53b819c339ff05e646706d\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_29yf4d36bfa17ab53b819c339ff05e646706d\" name=\"item_meta[269]\" value=\"\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please enter a valid email address\" aria-invalid=\"false\"  \/>\r\n    \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_kml4q2db4a3f48b94de2018e118fc8b5bdb\" class=\"frm_primary_label\">Gender\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[270]\" id=\"field_kml4q2db4a3f48b94de2018e118fc8b5bdb\"  data-reqmsg=\"Gender cannot be blank.\" aria-required=\"true\" data-invmsg=\"Gender is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Select Gender\">Select Gender<\/option><option  value=\"Male\">Male<\/option><option  value=\"Female\">Female<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_271_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_half\">\r\n    <label for=\"field_bgox98570397037f50006c7a14a5eee1439\" class=\"frm_primary_label\">Street Address\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_bgox98570397037f50006c7a14a5eee1439\" name=\"item_meta[271]\" value=\"\"  data-invmsg=\"Street Address is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_309_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_p0f0v\" id=\"field_p0f0v_label\" class=\"frm_primary_label\">Occupation\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[309]\" id=\"field_p0f0v\"  data-reqmsg=\"Occupation cannot be blank.\" aria-required=\"true\" data-invmsg=\"Occupation is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Select as appropriate\">Select as appropriate<\/option><option  value=\"Civil Servant\">Civil Servant<\/option><option  value=\"Businessman\/Woman\">Businessman\/Woman<\/option><option  value=\"Healthcare Practitioners and Technical Occupations\">Healthcare Practitioners and Technical Occupations<\/option><option  value=\"Nursing, Psychiatric, or Home Health Aide\">Nursing, Psychiatric, or Home Health Aide<\/option><option  value=\"Architect, Surveyor, or Cartographer\">Architect, Surveyor, or Cartographer<\/option><option  value=\"Primary, Secondary, or Special Education School Teacher\">Primary, Secondary, or Special Education School Teacher<\/option><option  value=\"Arts, Design, Entertainment, Sports, and Media Occupations\">Arts, Design, Entertainment, Sports, and Media Occupations<\/option><option  value=\"Construction and Extraction\">Construction and Extraction<\/option><option  value=\"Aircraft Pilot or Flight Engineer\">Aircraft Pilot or Flight Engineer<\/option><option  value=\"Other Occupations\" class=\"frm_other_trigger\">Other Occupations<\/option>\t<\/select>\n\t<label for=\"field_p0f0v-otext\" class=\"frm_screen_reader frm_hidden\">Occupation<\/label><input type=\"text\" id=\"field_p0f0v-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][309]\" value=\"\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_273_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_9sjnk073c4fb81e1d8e4ca8f399058e7e25\" class=\"frm_primary_label\">Town\/City\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9sjnk073c4fb81e1d8e4ca8f399058e7e25\" name=\"item_meta[273]\" value=\"\"  data-reqmsg=\"Town\/City cannot be blank.\" aria-required=\"true\" data-invmsg=\"Town\/City is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_274_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_wp8434df55f80cd0bf0ed321e0536364955\" class=\"frm_primary_label\">State\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[274]\" id=\"field_wp8434df55f80cd0bf0ed321e0536364955\"  data-invmsg=\"State is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Select a State\">Select a State<\/option><option  value=\"Abia\">Abia<\/option><option  value=\"Adamawa\">Adamawa<\/option><option  value=\"Akwa Ibom\">Akwa Ibom<\/option><option  value=\"Anambra\">Anambra<\/option><option  value=\"Bauchi\">Bauchi<\/option><option  value=\"Bayelsa\">Bayelsa<\/option><option  value=\"Benue\">Benue<\/option><option  value=\"Borno\">Borno<\/option><option  value=\"Cross River\">Cross River<\/option><option  value=\"Delta\">Delta<\/option><option  value=\"Ebonyi\">Ebonyi<\/option><option  value=\"Edo\">Edo<\/option><option  value=\"Ekiti\">Ekiti<\/option><option  value=\"Enugu\">Enugu<\/option><option  value=\"Gombe\">Gombe<\/option><option  value=\"Imo\">Imo<\/option><option  value=\"Jigawa\">Jigawa<\/option><option  value=\"Kaduna\">Kaduna<\/option><option  value=\"Kano\">Kano<\/option><option  value=\"Katsina\">Katsina<\/option><option  value=\"Kebbi\">Kebbi<\/option><option  value=\"Kogi\">Kogi<\/option><option  value=\"Kwara\">Kwara<\/option><option  value=\"Lagos\">Lagos<\/option><option  value=\"Niger\">Niger<\/option><option  value=\"Ondo\">Ondo<\/option><option  value=\"Osun\">Osun<\/option><option  value=\"Oyo\">Oyo<\/option><option  value=\"Plateau\">Plateau<\/option><option  value=\"Rivers\">Rivers<\/option><option  value=\"Sokoto\">Sokoto<\/option><option  value=\"Taraba\">Taraba<\/option><option  value=\"Yobe\">Yobe<\/option><option  value=\"FCT\">FCT<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_275_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_hbjfjb83f7c0300\" id=\"field_hbjfjb83f7c0300_label\" class=\"frm_primary_label\">Section Buttons\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"text\" id=\"field_hbjfjb83f7c0300\" name=\"item_meta[275]\" value=\"\"  data-invmsg=\"Section Buttons is invalid\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_276_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_frojz6b47778a21\" id=\"field_frojz6b47778a21_label\" class=\"frm_primary_label\">Next\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"text\" id=\"field_frojz6b47778a21\" name=\"item_meta[276]\" value=\"\"  data-invmsg=\"Next is invalid\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_277_container\" class=\"frm_form_field frm_section_heading form-field frm_top_container\">\r\n<h3 class=\"frm_pos_ frm_primary_label[collapse_class]\">Details of Child\/ Ward<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_278_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n    <label for=\"field_10vnyf5d0d2ccd8a3f1cc386e7a744ed347\" class=\"frm_primary_label\">Surname\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_10vnyf5d0d2ccd8a3f1cc386e7a744ed347\" name=\"item_meta[278]\" value=\"\"  data-reqmsg=\"Surname cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name of Child is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_279_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_pvl28b16ccaa680\" id=\"field_pvl28b16ccaa680_label\" class=\"frm_primary_label\">Firstname\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_pvl28b16ccaa680\" name=\"item_meta[279]\" value=\"\"  data-reqmsg=\"Firstname 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_280_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_half\">\r\n    <label for=\"field_fjyxfc11e753fcf\" id=\"field_fjyxfc11e753fcf_label\" class=\"frm_primary_label\">Othername\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_fjyxfc11e753fcf\" name=\"item_meta[280]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_310_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_nb6hf\" id=\"field_nb6hf_label\" class=\"frm_primary_label\">Age\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nb6hf\" name=\"item_meta[310]\" value=\"\"  maxlength=\"2\" data-reqmsg=\"Age cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\" pattern=\"\\d\\d$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_283_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_2w2pk245860d054fa4eea1be97e7d0df77f\" class=\"frm_primary_label\">Select Child's Gender?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[283]\" id=\"field_2w2pk245860d054fa4eea1be97e7d0df77f\"  data-reqmsg=\"Select Child&#039;s Gender? cannot be blank.\" aria-required=\"true\" data-invmsg=\"Select Child&#039;s Gender? is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Select Gender\">Select Gender<\/option><option  value=\"Male\">Male<\/option><option  value=\"Female\">Female<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_284_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_9rahl18282798cc\" id=\"field_9rahl18282798cc_label\" class=\"frm_primary_label\">Year of Class\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9rahl18282798cc\" name=\"item_meta[284]\" value=\"\"  data-reqmsg=\"Year of Class 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_285_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_qcwmce04b9e32547f50d2883463efdd8814\" id=\"field_qcwmce04b9e32547f50d2883463efdd8814_label\" class=\"frm_primary_label\">End Section\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"text\" id=\"field_qcwmce04b9e32547f50d2883463efdd8814\" name=\"item_meta[285]\" value=\"\"  data-invmsg=\"End Section is invalid\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_286_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_io5nu7a49cd4265b43aa9a58e6c117bc5e7\" id=\"field_io5nu7a49cd4265b43aa9a58e6c117bc5e7_label\" class=\"frm_primary_label\">Next\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"text\" id=\"field_io5nu7a49cd4265b43aa9a58e6c117bc5e7\" name=\"item_meta[286]\" value=\"\"  data-invmsg=\"Next is invalid\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_287_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_zg6txa4be451f97bd7894310609238d4c06_label\" class=\"frm_primary_label\">Select your preferred mode of sample collection\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_zg6txa4be451f97bd7894310609238d4c06_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_287-0\">\t\t\t<label  for=\"field_zg6txa4be451f97bd7894310609238d4c06-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[287]\" id=\"field_zg6txa4be451f97bd7894310609238d4c06-0\" value=\"Walk-in\"\n\t\t   data-reqmsg=\"Select your preferred mode of sample collection cannot be blank.\" data-invmsg=\"Select your preferred mode of sample collection is invalid\" aria-invalid=\"false\"  \/> Walk-in<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_287-1\">\t\t\t<label  for=\"field_zg6txa4be451f97bd7894310609238d4c06-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[287]\" id=\"field_zg6txa4be451f97bd7894310609238d4c06-1\" value=\"VIP\"\n\t\t   data-reqmsg=\"Select your preferred mode of sample collection cannot be blank.\" data-invmsg=\"Select your preferred mode of sample collection is invalid\" aria-invalid=\"false\"  \/> VIP<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_287-2\">\t\t\t<label  for=\"field_zg6txa4be451f97bd7894310609238d4c06-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[287]\" id=\"field_zg6txa4be451f97bd7894310609238d4c06-2\" value=\"Mobile Phlebotomy\"\n\t\t   data-reqmsg=\"Select your preferred mode of sample collection cannot be blank.\" data-invmsg=\"Select your preferred mode of sample collection is invalid\" aria-invalid=\"false\"  \/> Mobile Phlebotomy<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_288_container\" class=\"frm_form_field frm_section_heading form-field frm_top_container\">\r\n<h3 class=\"frm_pos_ frm_primary_label[collapse_class]\">Walk-in<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_289_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_p015mc3cfdb93d099e96061f598d5c6ed1c\" class=\"frm_primary_label\">Select Appointment Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_p015mc3cfdb93d099e96061f598d5c6ed1c\" name=\"item_meta[289]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"Select Appointment Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Select Date is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_290_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half frm_two_col\">\r\n    <label  class=\"frm_primary_label\">Available time slot for Walk-in\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_290-288-0\">\t\t\t<label  for=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[290][]\" id=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-0\" value=\"10am\"  data-reqmsg=\"Available time slot for Walk-in cannot be blank.\" data-invmsg=\"Available time slot for Walk-in is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> 10am<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_290-288-1\">\t\t\t<label  for=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[290][]\" id=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-1\" value=\"11am\"  data-reqmsg=\"Available time slot for Walk-in cannot be blank.\" data-invmsg=\"Available time slot for Walk-in is invalid\" aria-invalid=\"false\"   \/> 11am<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_290-288-2\">\t\t\t<label  for=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[290][]\" id=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-2\" value=\"12pm\"  data-reqmsg=\"Available time slot for Walk-in cannot be blank.\" data-invmsg=\"Available time slot for Walk-in is invalid\" aria-invalid=\"false\"   \/> 12pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_290-288-3\">\t\t\t<label  for=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[290][]\" id=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-3\" value=\"1pm\"  data-reqmsg=\"Available time slot for Walk-in cannot be blank.\" data-invmsg=\"Available time slot for Walk-in is invalid\" aria-invalid=\"false\"   \/> 1pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_290-288-4\">\t\t\t<label  for=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[290][]\" id=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-4\" value=\"2pm\"  data-reqmsg=\"Available time slot for Walk-in cannot be blank.\" data-invmsg=\"Available time slot for Walk-in is invalid\" aria-invalid=\"false\"   \/> 2pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_290-288-5\">\t\t\t<label  for=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[290][]\" id=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-5\" value=\"3pm\"  data-reqmsg=\"Available time slot for Walk-in cannot be blank.\" data-invmsg=\"Available time slot for Walk-in is invalid\" aria-invalid=\"false\"   \/> 3pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_290-288-6\">\t\t\t<label  for=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[290][]\" id=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-6\" value=\"4pm\"  data-reqmsg=\"Available time slot for Walk-in cannot be blank.\" data-invmsg=\"Available time slot for Walk-in is invalid\" aria-invalid=\"false\"   \/> 4pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_290-288-7\">\t\t\t<label  for=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[290][]\" id=\"field_tdn7fc4e5a592c829e4b41c005512bdd89f-7\" value=\"5pm\"  data-reqmsg=\"Available time slot for Walk-in cannot be blank.\" data-invmsg=\"Available time slot for Walk-in is invalid\" aria-invalid=\"false\"   \/> 5pm<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_291_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_25716a7239a4ea43d1f00686608e10c8e936\" id=\"field_25716a7239a4ea43d1f00686608e10c8e936_label\" class=\"frm_primary_label\">Section Buttons\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"text\" id=\"field_25716a7239a4ea43d1f00686608e10c8e936\" name=\"item_meta[291]\" value=\"\"  data-invmsg=\"Section Buttons is invalid\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_292_container\" class=\"frm_form_field frm_section_heading form-field frm_top_container\">\r\n<h3 class=\"frm_pos_ frm_primary_label[collapse_class]\">Mobile Phlebotomy<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_293_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_md13f8cad9030fda56ea83e1\" class=\"frm_primary_label\">Select Appointment Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_md13f8cad9030fda56ea83e1\" name=\"item_meta[293]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"Select Appointment Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Select Date is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_294_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half frm_two_col\">\r\n    <label  class=\"frm_primary_label\">Available time slot for Mobile Phlebotomi\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_294-292-0\">\t\t\t<label  for=\"field_yfr7adb80b81faac72702255e0614317b1e-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[294][]\" id=\"field_yfr7adb80b81faac72702255e0614317b1e-0\" value=\"10am\"  data-reqmsg=\"Available time slot for Mobile Phlebotomi cannot be blank.\" data-invmsg=\"Available time slot for Mobile Phlebotomi is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> 10am<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_294-292-1\">\t\t\t<label  for=\"field_yfr7adb80b81faac72702255e0614317b1e-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[294][]\" id=\"field_yfr7adb80b81faac72702255e0614317b1e-1\" value=\"12pm\"  data-reqmsg=\"Available time slot for Mobile Phlebotomi cannot be blank.\" data-invmsg=\"Available time slot for Mobile Phlebotomi is invalid\" aria-invalid=\"false\"   \/> 12pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_294-292-2\">\t\t\t<label  for=\"field_yfr7adb80b81faac72702255e0614317b1e-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[294][]\" id=\"field_yfr7adb80b81faac72702255e0614317b1e-2\" value=\"2pm\"  data-reqmsg=\"Available time slot for Mobile Phlebotomi cannot be blank.\" data-invmsg=\"Available time slot for Mobile Phlebotomi is invalid\" aria-invalid=\"false\"   \/> 2pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_294-292-3\">\t\t\t<label  for=\"field_yfr7adb80b81faac72702255e0614317b1e-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[294][]\" id=\"field_yfr7adb80b81faac72702255e0614317b1e-3\" value=\"4pm\"  data-reqmsg=\"Available time slot for Mobile Phlebotomi cannot be blank.\" data-invmsg=\"Available time slot for Mobile Phlebotomi is invalid\" aria-invalid=\"false\"   \/> 4pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_294-292-4\">\t\t\t<label  for=\"field_yfr7adb80b81faac72702255e0614317b1e-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[294][]\" id=\"field_yfr7adb80b81faac72702255e0614317b1e-4\" value=\"6pm\"  data-reqmsg=\"Available time slot for Mobile Phlebotomi cannot be blank.\" data-invmsg=\"Available time slot for Mobile Phlebotomi is invalid\" aria-invalid=\"false\"   \/> 6pm<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_295_container\" class=\"frm_form_field  frm_html_container form-field\"><strong>Charges will apply at time of service delivery<\/strong><\/div>\n<div id=\"frm_field_296_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_qypd05d1b903cc01857ab54766dc3041572\" id=\"field_qypd05d1b903cc01857ab54766dc3041572_label\" class=\"frm_primary_label\">Section Buttons\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"text\" id=\"field_qypd05d1b903cc01857ab54766dc3041572\" name=\"item_meta[296]\" value=\"\"  data-invmsg=\"Section Buttons is invalid\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_297_container\" class=\"frm_form_field frm_section_heading form-field frm_top_container\">\r\n<h3 class=\"frm_pos_ frm_primary_label[collapse_class]\">VIP<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_298_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_xpj1n89d958aeb9e49d98d67080c0ac39dc\" class=\"frm_primary_label\">Select Appointment Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_xpj1n89d958aeb9e49d98d67080c0ac39dc\" name=\"item_meta[298]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"Select Appointment Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Select Date is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_299_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half frm_two_col\">\r\n    <label  class=\"frm_primary_label\">Available time slot for VIP\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_299-297-0\">\t\t\t<label  for=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[299][]\" id=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-0\" value=\"10am\"  data-reqmsg=\"Available time slot for VIP cannot be blank.\" data-invmsg=\"Available time slot for VIP is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> 10am<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_299-297-1\">\t\t\t<label  for=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[299][]\" id=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-1\" value=\"12pm\"  data-reqmsg=\"Available time slot for VIP cannot be blank.\" data-invmsg=\"Available time slot for VIP is invalid\" aria-invalid=\"false\"   \/> 12pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_299-297-2\">\t\t\t<label  for=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[299][]\" id=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-2\" value=\"2pm\"  data-reqmsg=\"Available time slot for VIP cannot be blank.\" data-invmsg=\"Available time slot for VIP is invalid\" aria-invalid=\"false\"   \/> 2pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_299-297-3\">\t\t\t<label  for=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[299][]\" id=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-3\" value=\"4pm\"  data-reqmsg=\"Available time slot for VIP cannot be blank.\" data-invmsg=\"Available time slot for VIP is invalid\" aria-invalid=\"false\"   \/> 4pm<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_299-297-4\">\t\t\t<label  for=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[299][]\" id=\"field_hdt8g8ddac21229288ad5e9a9c6a88b58b2-4\" value=\"6pm\"  data-reqmsg=\"Available time slot for VIP cannot be blank.\" data-invmsg=\"Available time slot for VIP is invalid\" aria-invalid=\"false\"   \/> 6pm<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_300_container\" class=\"frm_form_field  frm_html_container form-field\"><strong>Charges will apply at time of service delivery<\/strong><\/div>\n<div id=\"frm_field_301_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_4lkqv652542cfade79c3708dbe75f49384e\" id=\"field_4lkqv652542cfade79c3708dbe75f49384e_label\" class=\"frm_primary_label\">Section Buttons\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"text\" id=\"field_4lkqv652542cfade79c3708dbe75f49384e\" name=\"item_meta[301]\" value=\"\"  data-invmsg=\"Section Buttons is invalid\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_304_container\" class=\"frm_form_field form-field\"> \r\n \t<h3 class=\"frm_pos_ frm_primary_label\">SUMMARY PAGE<\/h3>\r\n      <h4 class=\"frm_pos_ frm_primary_label\"><span><i>Confirmation Code: B2S-<\/span><\/i>rcyn15a5d705832<\/h4>\r\n\t\r\n    <input type=\"text\" id=\"field_rcyn15a5d705832\" name=\"item_meta[304]\" value=\"\"  data-invmsg=\"SUMMARY PAGE is invalid\" aria-invalid=\"false\"  \/>\r\n<\/div>\n<div id=\"frm_field_485_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"g-recaptcha-response\" id=\"field_vfn53_label\" class=\"frm_primary_label\">reCAPTCHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div  id=\"field_vfn53\" class=\"frm-g-recaptcha\" data-sitekey=\"6LdwoPMbAAAAAGpDU47TYrR7LQmspQUO7gQ1Tutd\" data-size=\"normal\" data-theme=\"light\"><\/div>\r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__679e09c76d1d2\">\n\t\t\t\t<label for=\"frm_email_11\" >\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_11\" type=\"text\" class=\"frm_verify\" name=\"frm__679e09c76d1d2\" value=\"\" autocomplete=\"off\"  \/>\n\t\t\t<\/div>\n\t\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Pay Now!<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-8fc27f6 elementor-invisible\" data-id=\"8fc27f6\" data-element_type=\"column\" data-settings=\"{&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c26e817 elementor-widget elementor-widget-spacer\" data-id=\"c26e817\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dabbe1a elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"dabbe1a\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;bounceIn&quot;,&quot;_animation_delay&quot;:100}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\"><b>Other<\/b> Services <\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7aeaf84 elementor-invisible elementor-widget elementor-widget-wp-widget-ocean_custom_links\" data-id=\"7aeaf84\" data-element_type=\"widget\" data-settings=\"{&quot;sticky&quot;:&quot;top&quot;,&quot;sticky_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;],&quot;_animation&quot;:&quot;bounceIn&quot;,&quot;_animation_delay&quot;:200,&quot;sticky_offset&quot;:0,&quot;sticky_effects_offset&quot;:0}\" data-widget_type=\"wp-widget-ocean_custom_links.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<ul class=\"oceanwp-custom-links\"><li><a href=\"#\" target=\"_self\" >Blood Bank<\/a><\/li><li><a href=\"https:\/\/experiordiagnostics.com\/home\/test-details\/#individual\" target=\"_self\" >Individual Medical Packages<\/a><\/li><li><a href=\"https:\/\/experiordiagnostics.com\/home\/test-details\/#cop\" target=\"_self\" >Corporate Medical Packages<\/a><\/li><li><a href=\"https:\/\/experiordiagnostics.com\/home\/routine-laboratory-test-services\/\" target=\"_self\" >Research Collaborations<\/a><\/li><li><a href=\"#\" target=\"_self\" >Routine Lab Test<\/a><\/li><\/ul>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>To book a sample collection back to school medical checks appointment,Fill the form below. Back to School Medical Checks Registration Form Other Services<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_vp_format_video_url":"","_vp_image_focal_point":[],"footnotes":""},"class_list":["post-942","page","type-page","status-publish","hentry","entry"],"_links":{"self":[{"href":"https:\/\/experiordiagnostics.com\/home\/wp-json\/wp\/v2\/pages\/942","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/experiordiagnostics.com\/home\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/experiordiagnostics.com\/home\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/experiordiagnostics.com\/home\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/experiordiagnostics.com\/home\/wp-json\/wp\/v2\/comments?post=942"}],"version-history":[{"count":22,"href":"https:\/\/experiordiagnostics.com\/home\/wp-json\/wp\/v2\/pages\/942\/revisions"}],"predecessor-version":[{"id":1114,"href":"https:\/\/experiordiagnostics.com\/home\/wp-json\/wp\/v2\/pages\/942\/revisions\/1114"}],"wp:attachment":[{"href":"https:\/\/experiordiagnostics.com\/home\/wp-json\/wp\/v2\/media?parent=942"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}