{"id":157,"date":"2017-03-27T20:47:38","date_gmt":"2017-03-27T20:47:38","guid":{"rendered":"http:\/\/adamsdentist.com\/?page_id=157"},"modified":"2018-03-12T08:48:14","modified_gmt":"2018-03-12T14:48:14","slug":"patient-info","status":"publish","type":"page","link":"http:\/\/adamsdentist.com\/index.php\/patient-info\/","title":{"rendered":"Patient Info"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row bg_type=&#8221;bg_color&#8221; bg_color_value=&#8221;#ffffff&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text css=&#8221;.vc_custom_1499733972926{margin-right: 20px !important;}&#8221;]<strong>\u00a0A pdf reader like <a href=\"https:\/\/get.adobe.com\/reader\/\">Adobe<\/a> will be needed to view the forms. Send us any questions in the contact form below, or call us at <a href=\"tel:(251)343-3214\">(251) 343-3214<\/a>. We will be happy to answer any questions and arrange an appointment that fits your busy schedule.<\/strong>[\/vc_column_text]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f6-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"6\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/157#wpcf7-f6-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=\"6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f6-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> Your Name (required)<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\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Your Email (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Subject<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-subject\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-subject\" \/><\/span> <\/label>\n<\/p>\n<p><label> Your Message<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][vc_column width=&#8221;1\/4&#8243;]<div class=\" ubtn-ctn-center \"><a class=\"ubtn-link ult-adjust-bottom-margin ubtn-center ubtn-custom \" href = \"http:\/\/adamsdentist.com\/wp-content\/uploads\/2018\/03\/Patient_Registration_Form-Eaglesoft.pdf\" target='_blank' ><button type=\"button\" id=\"ubtn-7541\" class=\"ubtn ult-adjust-bottom-margin ult-responsive ubtn-custom ubtn-no-hover-bg  none  ubtn-sep-icon ubtn-sep-icon-top-push  ubtn-center   tooltip-69d182f462d22\"  data-hover=\"#eeee22\" data-border-color=\"#1e73be\" data-bg=\"#81d742\" data-hover-bg=\"#1e73be\" data-border-hover=\"\" data-shadow-hover=\"\" data-shadow-click=\"none\" data-shadow=\"\" data-shd-shadow=\"\"  data-ultimate-target='#ubtn-7541'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:normal;width:200px;min-height:60px;padding:px px;border-radius:3px;border-width:1px;border-color:#1e73be;border-style:solid;background: #81d742;color: #eeee22;\"><span class=\"ubtn-data ubtn-icon\"><i class=\"Defaults-file-pdf-o\" style=\"font-size:32px;color:#ffffff;\"><\/i><\/span><span class=\"ubtn-hover\" style=\"background-color:#1e73be\"><\/span><span class=\"ubtn-data ubtn-text \" >Patient Registration <\/span><\/button><\/a><\/div><div class=\" ubtn-ctn-center \"><a class=\"ubtn-link ult-adjust-bottom-margin ubtn-center ubtn-custom \" href = \"http:\/\/adamsdentist.com\/wp-content\/uploads\/2017\/05\/Medical_History_Form.pdf\" target='_blank' ><button type=\"button\" id=\"ubtn-4852\" class=\"ubtn ult-adjust-bottom-margin ult-responsive ubtn-custom ubtn-no-hover-bg  none  ubtn-sep-icon ubtn-sep-icon-top-push  ubtn-center   tooltip-69d182f462e6b\"  data-hover=\"\" data-border-color=\"#1e73be\" data-bg=\"#dd3333\" data-hover-bg=\"\" data-border-hover=\"\" data-shadow-hover=\"\" data-shadow-click=\"none\" data-shadow=\"\" data-shd-shadow=\"\"  data-ultimate-target='#ubtn-4852'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:normal;width:200px;min-height:60px;padding:px px;border-radius:3px;border-width:1px;border-color:#1e73be;border-style:solid;background: #dd3333;color: #ffffff;\"><span class=\"ubtn-data ubtn-icon\"><i class=\"Defaults-file-pdf-o\" style=\"font-size:32px;color:#ffffff;\"><\/i><\/span><span class=\"ubtn-hover\" style=\"background-color:\"><\/span><span class=\"ubtn-data ubtn-text \" >Medical History<\/span><\/button><\/a><\/div><div class=\" ubtn-ctn-center \"><a class=\"ubtn-link ult-adjust-bottom-margin ubtn-center ubtn-custom \" href = \"http:\/\/adamsdentist.com\/wp-content\/uploads\/2017\/05\/Internet-Consent.pdf\" target='_blank' ><button type=\"button\" id=\"ubtn-7409\" class=\"ubtn ult-adjust-bottom-margin ult-responsive ubtn-custom ubtn-no-hover-bg  none  ubtn-sep-icon ubtn-sep-icon-top-push  ubtn-center   tooltip-69d182f462efd\"  data-hover=\"\" data-border-color=\"#1e73be\" data-bg=\"#dd3333\" data-hover-bg=\"\" data-border-hover=\"\" data-shadow-hover=\"\" data-shadow-click=\"none\" data-shadow=\"\" data-shd-shadow=\"\"  data-ultimate-target='#ubtn-7409'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:normal;width:200px;min-height:60px;padding:px px;border-radius:3px;border-width:1px;border-color:#1e73be;border-style:solid;background: #dd3333;color: #ffffff;\"><span class=\"ubtn-data ubtn-icon\"><i class=\"Defaults-file-pdf-o\" style=\"font-size:32px;color:#ffffff;\"><\/i><\/span><span class=\"ubtn-hover\" style=\"background-color:\"><\/span><span class=\"ubtn-data ubtn-text \" >Internet Consent <\/span><\/button><\/a><\/div>[\/vc_column][vc_column width=&#8221;1\/4&#8243;]<div class=\" ubtn-ctn-center \"><a class=\"ubtn-link ult-adjust-bottom-margin ubtn-center ubtn-custom \" href = \"http:\/\/adamsdentist.com\/wp-content\/uploads\/2017\/05\/HIPPA-pt-acknowledgement.pdf\" target='_blank' ><button type=\"button\" id=\"ubtn-8651\" class=\"ubtn ult-adjust-bottom-margin ult-responsive ubtn-custom ubtn-no-hover-bg  none  ubtn-sep-icon ubtn-sep-icon-top-push  ubtn-center   tooltip-69d182f462f84\"  data-hover=\"\" data-border-color=\"#1e73be\" data-bg=\"#dd3333\" data-hover-bg=\"\" data-border-hover=\"\" data-shadow-hover=\"\" data-shadow-click=\"none\" data-shadow=\"\" data-shd-shadow=\"\"  data-ultimate-target='#ubtn-8651'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:normal;width:200px;min-height:60px;padding:px px;border-radius:3px;border-width:1px;border-color:#1e73be;border-style:solid;background: #dd3333;color: #ffffff;\"><span class=\"ubtn-data ubtn-icon\"><i class=\"Defaults-file-pdf-o\" style=\"font-size:32px;color:#ffffff;\"><\/i><\/span><span class=\"ubtn-hover\" style=\"background-color:\"><\/span><span class=\"ubtn-data ubtn-text \" >HIPPA Acknowledgement<\/span><\/button><\/a><\/div><div class=\" ubtn-ctn-center \"><a class=\"ubtn-link ult-adjust-bottom-margin ubtn-center ubtn-custom \" href = \"http:\/\/adamsdentist.com\/wp-content\/uploads\/2017\/05\/General-Consent-for-Tx.pdf\" target='_blank' ><button type=\"button\" id=\"ubtn-1264\" class=\"ubtn ult-adjust-bottom-margin ult-responsive ubtn-custom ubtn-no-hover-bg  none  ubtn-sep-icon ubtn-sep-icon-top-push  ubtn-center   tooltip-69d182f462ffe\"  data-hover=\"\" data-border-color=\"#1e73be\" data-bg=\"#dd3333\" data-hover-bg=\"\" data-border-hover=\"\" data-shadow-hover=\"\" data-shadow-click=\"none\" data-shadow=\"\" data-shd-shadow=\"\"  data-ultimate-target='#ubtn-1264'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:normal;width:200px;min-height:60px;padding:px px;border-radius:3px;border-width:1px;border-color:#1e73be;border-style:solid;background: #dd3333;color: #ffffff;\"><span class=\"ubtn-data ubtn-icon\"><i class=\"Defaults-file-pdf-o\" style=\"font-size:32px;color:#ffffff;\"><\/i><\/span><span class=\"ubtn-hover\" style=\"background-color:\"><\/span><span class=\"ubtn-data ubtn-text \" >General Consent<\/span><\/button><\/a><\/div><div class=\" ubtn-ctn-center \"><a class=\"ubtn-link ult-adjust-bottom-margin ubtn-center ubtn-custom \" href = \"http:\/\/adamsdentist.com\/wp-content\/uploads\/2017\/05\/Financial-Policy.pdf\" target='_blank' ><button type=\"button\" id=\"ubtn-7114\" class=\"ubtn ult-adjust-bottom-margin ult-responsive ubtn-custom ubtn-no-hover-bg  none  ubtn-sep-icon ubtn-sep-icon-top-push  ubtn-center   tooltip-69d182f463073\"  data-hover=\"\" data-border-color=\"#1e73be\" data-bg=\"#dd3333\" data-hover-bg=\"\" data-border-hover=\"\" data-shadow-hover=\"\" data-shadow-click=\"none\" data-shadow=\"\" data-shd-shadow=\"\"  data-ultimate-target='#ubtn-7114'  data-responsive-json-new='{\"font-size\":\"\",\"line-height\":\"\"}'  style=\"font-weight:normal;width:200px;min-height:60px;padding:px px;border-radius:3px;border-width:1px;border-color:#1e73be;border-style:solid;background: #dd3333;color: #ffffff;\"><span class=\"ubtn-data ubtn-icon\"><i class=\"Defaults-file-pdf-o\" style=\"font-size:32px;color:#ffffff;\"><\/i><\/span><span class=\"ubtn-hover\" style=\"background-color:\"><\/span><span class=\"ubtn-data ubtn-text \" >Financial Policy<\/span><\/button><\/a><\/div>[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row bg_type=&#8221;bg_color&#8221; bg_color_value=&#8221;#ffffff&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text css=&#8221;.vc_custom_1499733972926{margin-right: 20px !important;}&#8221;]\u00a0A pdf reader like Adobe will be needed to view the forms. Send us any questions in the contact form<span class=\"excerpt-hellip\"> [\u2026]<\/span><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-157","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"http:\/\/adamsdentist.com\/index.php\/wp-json\/wp\/v2\/pages\/157"}],"collection":[{"href":"http:\/\/adamsdentist.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/adamsdentist.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/adamsdentist.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/adamsdentist.com\/index.php\/wp-json\/wp\/v2\/comments?post=157"}],"version-history":[{"count":80,"href":"http:\/\/adamsdentist.com\/index.php\/wp-json\/wp\/v2\/pages\/157\/revisions"}],"predecessor-version":[{"id":297,"href":"http:\/\/adamsdentist.com\/index.php\/wp-json\/wp\/v2\/pages\/157\/revisions\/297"}],"wp:attachment":[{"href":"http:\/\/adamsdentist.com\/index.php\/wp-json\/wp\/v2\/media?parent=157"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}