{"id":7,"date":"2014-04-28T11:15:08","date_gmt":"2014-04-28T11:15:08","guid":{"rendered":"https:\/\/palfamilydentistry.com\/?page_id=7"},"modified":"2019-11-16T15:01:32","modified_gmt":"2019-11-16T15:01:32","slug":"book-an-appointment","status":"publish","type":"page","link":"https:\/\/www.palfamilydentistry.com\/staging\/book-an-appointment\/","title":{"rendered":"Book An Appointment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"7\" class=\"elementor elementor-7\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-588bbbf elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"588bbbf\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-844eecc\" data-id=\"844eecc\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-662ca03 elementor-widget elementor-widget-heading\" data-id=\"662ca03\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Request an appointment<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-23cebbf elementor-widget elementor-widget-text-editor\" data-id=\"23cebbf\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f82-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"82\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/staging\/wp-json\/wp\/v2\/pages\/7#wpcf7-f82-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=\"82\" \/>\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-f82-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"cs-row clearfix\">\n\t<div class=\"col col-4\">\n\t\t<p><span class=\"label\">PATIENT\u2019S FULL NAME (REQUIRED)<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"pfname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"John Doe\" value=\"\" type=\"text\" name=\"pfname\" \/><\/span>\n\t\t<\/p>\n\t\t<p><span class=\"label\">PATIENT\u2019S BIRTHDATE, FOR POSITIVE IDENTIFICATION (REQUIRED)<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"bdate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"mm\/dd\/yyyy\" type=\"date\" name=\"bdate\" \/><\/span>\n\t\t<\/p>\n\t\t<p><span class=\"label\">EMAIL (REQUIRED)<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"pemail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" placeholder=\"john.d@email.com\" value=\"\" type=\"email\" name=\"pemail\" \/><\/span>\n\t\t<\/p>\n\t\t<p><span class=\"label\">DAYTIME PHONE NUMBER (REQUIRED)<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"dphone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"+1998765432\" value=\"\" type=\"text\" name=\"dphone\" \/><\/span>\n\t\t<\/p>\n\t\t<p><span class=\"label\">WHAT IS THE PURPOSE OF THIS APPOINTMENT?<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"apurpose\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"apurpose\"><option value=\"Cleaning and examination\">Cleaning and examination<\/option><option value=\"Emergency (tooth ache)\">Emergency (tooth ache)<\/option><option value=\"Cosmetic procedure\">Cosmetic procedure<\/option><option value=\"Second opinion\">Second opinion<\/option><option value=\"Other - explain below\">Other &#8211; explain below<\/option><\/select><\/span>\n\t\t<\/p>\n\t\t<p><span class=\"label\">HOW SOON WOULD YOU LIKE TO COME IN?<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"scheddate\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"scheddate\"><option value=\"Whenever you have time available\">Whenever you have time available<\/option><option value=\"As soon as possible\">As soon as possible<\/option><option value=\"Next week\">Next week<\/option><option value=\"In two weeks\">In two weeks<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col col-6\">\n\t\t<div class=\"cs-row clearfix\">\n\t\t\t<div class=\"col col-2\">\n\t\t\t\t<p><span class=\"label\">DO YOU PREFER A PARTICULAR DAY?<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"aday-1\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"aday-1\"><option value=\"Any day\">Any day<\/option><option value=\"Monday\">Monday<\/option><option value=\"Tuesday\">Tuesday<\/option><option value=\"Wednesday\">Wednesday<\/option><option value=\"Thursday\">Thursday<\/option><option value=\"Friday\">Friday<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col col-2\">\n\t\t\t\t<p><span class=\"label\">SECOND CHOICE OF DAYS?<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"aday-2\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"aday-2\"><option value=\"Any day\">Any day<\/option><option value=\"Monday\">Monday<\/option><option value=\"Tuesday\">Tuesday<\/option><option value=\"Wednesday\">Wednesday<\/option><option value=\"Thursday\">Thursday<\/option><option value=\"Friday\">Friday<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"cs-row clearfix\">\n\t\t\t<div class=\"col col-2\">\n\t\t\t\t<p><span class=\"label\">DO YOU PREFER A PARTICULAR TIME?<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"atime-1\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"atime-1\"><option value=\"Any time\">Any time<\/option><option value=\"Early morning\">Early morning<\/option><option value=\"Late morning\">Late morning<\/option><option value=\"Mid-day\">Mid-day<\/option><option value=\"Early Afternoon\">Early Afternoon<\/option><option value=\"Late Afternoon\">Late Afternoon<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col col-2\">\n\t\t\t\t<p><span class=\"label\">SECOND CHOICE OF TIME?<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"atime-2\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"atime-2\"><option value=\"Any time\">Any time<\/option><option value=\"Early morning\">Early morning<\/option><option value=\"Late morning\">Late morning<\/option><option value=\"Mid-day\">Mid-day<\/option><option value=\"Early Afternoon\">Early Afternoon<\/option><option value=\"Late Afternoon\">Late Afternoon<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<p><span class=\"desc\">Please tell us any additional special date \/ time requirements. If you would like us to make an appointment for other family members, please list the names here.<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"inquiry\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Please enter your inquiry here\" name=\"inquiry\"><\/textarea><\/span>\n\t\t<\/p>\n\t\t<p><span class=\"label\">TYPE IN THE CHARACTERS THAT APPEAR IN THE IMAGE ON THE LEFT OF THE BOX BELOW<\/span>\n\t\t<\/p>\n\t\t<p class=\"cptc\"><span class=\"cimage\"><br \/>\n<\/span>\n\t\t<\/p>\n\t\t<div class=\"cs-submit-btn\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner btn ba-btn\" type=\"submit\" value=\"Send appointment request\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\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-2798 elementor-section-stretched cs-header elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2798\" 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<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4d7b\" data-id=\"4d7b\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6cac elementor-widget elementor-widget-heading\" data-id=\"6cac\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Downloadable Forms<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5d75 dform-txt elementor-widget elementor-widget-text-editor\" data-id=\"5d75\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>We\u2019re so excited to have you as our patient! One of the best ways to help expedite your visit to our office is by filling out your medical and dental history forms before you arrive. Please download, print and complete each of the following forms.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-308064c download-section elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"308064c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-b99a239 col-left\" data-id=\"b99a239\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4e9297c elementor-widget elementor-widget-text-editor\" data-id=\"4e9297c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><a class=\"dl\" title=\"\" href=\"https:\/\/www.palfamilydentistry.com\/wp-content\/uploads\/2019\/11\/written-financial.docx\">Written Financial Policy Form<\/a><\/p><p><a class=\"dl\" title=\"\" href=\"https:\/\/www.palfamilydentistry.com\/wp-content\/uploads\/2019\/11\/insurance-note.docx\">A Note About Insurance Form<\/a><\/p><p><a class=\"dl\" title=\"\" href=\"https:\/\/www.palfamilydentistry.com\/wp-content\/uploads\/2019\/11\/informed-consent.docx\">Informed Consent<\/a><\/p><p><a class=\"dl\" title=\"\" href=\"https:\/\/www.palfamilydentistry.com\/wp-content\/uploads\/2019\/11\/Acknowledgement-of-Receipt-of-privacy.docx\">Privacy Acknowledgment<\/a><\/p><p><a class=\"dl\" title=\"\" href=\"https:\/\/www.palfamilydentistry.com\/wp-content\/uploads\/2019\/11\/patient-info.docx\">Patient Information<\/a><\/p><p>\u00a0<\/p><p>\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\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-inner-column elementor-element elementor-element-2a74d34 col-right\" data-id=\"2a74d34\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f0a36cd elementor-widget elementor-widget-text-editor\" data-id=\"f0a36cd\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Send these forms by:<\/strong><\/p><ol><li>Fax: 703.437.8339<\/li><li>Mail them to us before your appointment: 11711 Bowman Green Drive, Reston, Virginia 20190<\/li><li>Bring them with you to your appointment.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Request an appointment Downloadable Forms We\u2019re so excited to have you as our patient! One of the best ways to help expedite your visit to our office is by filling out your medical and dental history forms before you arrive. Please download, print and complete each of the following forms. Written Financial Policy Form A &#8230; <a title=\"Book An Appointment\" class=\"read-more\" href=\"https:\/\/www.palfamilydentistry.com\/staging\/book-an-appointment\/\">Read more<span class=\"screen-reader-text\">Book An Appointment<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-7","page","type-page","status-publish"],"_links":{"self":[{"href":"https:\/\/www.palfamilydentistry.com\/staging\/wp-json\/wp\/v2\/pages\/7","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.palfamilydentistry.com\/staging\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.palfamilydentistry.com\/staging\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.palfamilydentistry.com\/staging\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.palfamilydentistry.com\/staging\/wp-json\/wp\/v2\/comments?post=7"}],"version-history":[{"count":40,"href":"https:\/\/www.palfamilydentistry.com\/staging\/wp-json\/wp\/v2\/pages\/7\/revisions"}],"predecessor-version":[{"id":944,"href":"https:\/\/www.palfamilydentistry.com\/staging\/wp-json\/wp\/v2\/pages\/7\/revisions\/944"}],"wp:attachment":[{"href":"https:\/\/www.palfamilydentistry.com\/staging\/wp-json\/wp\/v2\/media?parent=7"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}