{"id":1520,"date":"2018-10-12T12:27:03","date_gmt":"2018-10-12T12:27:03","guid":{"rendered":"https:\/\/www.noblecosmeticsurgery.com\/?page_id=1520"},"modified":"2024-01-12T13:08:51","modified_gmt":"2024-01-12T13:08:51","slug":"request-an-appointment","status":"publish","type":"page","link":"https:\/\/www.noblecosmeticsurgery.com\/request-an-appointment\/","title":{"rendered":"Request for an Appointment"},"content":{"rendered":"<div class=\"patient-links\"><\/div>\n    \n\t    <form class=\"form-horizontal\" id=\"form1739\" name=\"form1739\" onsubmit=\"return AppointmentFormValidate(this);\"   method=\"post\" action=\"https:\/\/www.ekwa.com\/ekwa-wufoo-handler\/\">\n\n                \n               <div class=\"form-group\">\n                 <i class=\"fa fa-history\"><\/i>\n                    <label for=\"Field116\">Appointment type *<\/label>\n                    <select id=\"Field116\" name=\"Field116\" class=\"field select medium form-control\" tabindex=\"1\">\n                        <option value=\"\" selected=\"selected\" disabled>Appointment Type *<\/option>\n                        <option value=\"In Office Visit\">In Office Visit<\/option>\n                        <option value=\"Virtual Consultation\" >Virtual Consultation<\/option>\n                    <\/select>\n                <\/div>\n\n\t\t    <div class=\"form-group\">\n                        <label for=\"Field1\">Appointment Date *<\/label>\n                        <i class=\"fa fa-calendar-o\" aria-hidden=\"true\"><\/i>\n                        <input placeholder=\"Appointment Date *\" name=\"Field1\"  type=\"text\" class=\"form-control\" id=\"Field1\">\n                    <\/div>\n\t\t    <!--<div class=\"form-group\">\n                        <label for=\"\">Time * <\/label>\n                        <i class=\"fa fa-clock-o\" aria-hidden=\"true\"><\/i>\n                        <input  name=\"\" type=\"text\" class=\"form-control timepicker\" id=\"\" placeholder=\"Time*\">\n                    <\/div>-->\n\t\t    <div class=\"form-group\">\n\t\t\t<label for=\"Field2\">Time * <\/label>\n                        <i class=\"fa fa-clock-o\" aria-hidden=\"true\"><\/i>\n\t\t            <select  class=\"form-control\" id=\"Field2\" name=\"Field2\">\n                        <option value=\"Time\" selected=\"selected\">Time<\/option>\n                        <option value=\"Morning\" >Morning<\/option>\n                        <option value=\"Lunch\" >Lunch<\/option>\n                        <option value=\"Evening\" >Evening<\/option>\n                    <\/select>\n\t\t    <\/div>\n\t\t   <div class=\"form-group\">\n\t\t\t <i class=\"fa fa-map-marker\"><\/i>\n\t\t\t\t<label for=\"Field4\">Location<\/label>\n\t\t\t\t<select id=\"Field4\" name=\"Field4\" class=\"field select medium form-control\" tabindex=\"2\">\n\t\t\t\t\t<option value=\"Location\" selected=\"selected\">Location<\/option>\n\t\t\t\t\t<option value=\"6201 K Ave, Suite 100, Plano, TX 75074\">6201 K Ave, Suite 100, Plano, TX 75074<\/option>\n\t\t\t\t\t<option value=\"2727 Bolton Boone Drive, Suite 101, Desoto, TX 75115\" >2727 Bolton Boone Drive, Suite 101, Desoto, TX 75115<\/option>\n\t\t\t\t<\/select>\n\t\t\t<\/div>\n\t\t    <div class=\"form-group\">\n                        <label for=\"Field5\">Your Name * <\/label>\n                        <i class=\"fa fa-user\" aria-hidden=\"true\"><\/i>\n                        <input  name=\"Field5\" type=\"text\" class=\"form-control\" id=\"Field5\" placeholder=\"Your Name * \">\n                    <\/div>\n                    <div class=\"form-group\">\n                        <label for=\"Field7\">Email Address * <\/label>\n                        <i class=\"fa fa-envelope-o\"><\/i>\n                        <input  name=\"Field7\" type=\"text\" class=\"form-control\" id=\"Field7\" placeholder=\"Email Address *\">\n                    <\/div>\n\t\t    <div class=\"form-group\">\n                        <label for=\"Field9\">Contact Number * <\/label>\n                        <i class=\"fa fa-phone\" aria-hidden=\"true\"><\/i>\n                        <input  name=\"Field9\" type=\"text\" class=\"form-control\" id=\"Field9\" placeholder=\"Contact Number *\">\n                    <\/div>\n\t\t    <div class=\"form-group\">\n                        <label for=\"Field11\">Comments * <\/label>\n                        <i class=\"fa fa-comments-o\" aria-hidden=\"true\"><\/i>\n\t\t\t    <textarea class=\"form-control\"  name=\"Field11\" id=\"Field11\" placeholder=\"Comments *\"><\/textarea>\n                    <\/div>\n\t\t    <div class=\"form-group\">\n                        <label class=\"hide\" for=\"Field13\">Privacy Policy<\/label>\n\t\t\t\t\t<input id=\"Field13\" name=\"Field13\" type=\"checkbox\"  value=\"I Agree\" \/>\n\t\t\t\t\t<label for=\"Field13\" style=\"display: inline;\">By submitting the above form you agree and accept our <a href=\"https:\/\/www.noblecosmeticsurgery.com\/privacy-policy\/\">Privacy Policy<\/a>*.<\/label>\n                    <\/div>\n\t\t    \n\t\t    <div id=\"contact-form-captcha\"><\/div>\n\t\t    \n                    <div class=\"form-group\">\n                        <button type=\"submit\" class=\"btn btn-default\">Submit<\/button>\n\t\t\t<input type=\"hidden\" name=\"url\" value=\"https:\/\/salesmanager.wufoo.com\/forms\/z17eqkc712wmh62\/#public\">\n\t\t\t<input type=\"hidden\" id=\"idstamp\" name=\"idstamp\" value=\"WB9btUCi1GfsHKo\/wXkQ4ZMPXBUiNRguRhC7xT7Lt+U=\" \/>\n                    <\/div>\n                <\/form>\n<link rel=\"stylesheet\" href=\"https:\/\/www.noblecosmeticsurgery.com\/wp-content\/themes\/ekwa\/plugins\/flatpickr\/flatpickr.min.css\">\n<style>\n #Field13 {\n    transform: scale(2);\n    margin: auto 10px;\n }\n #form1739 ::placeholder { \/* Chrome, Firefox, Opera, Safari 10.1+ *\/\n   color: #888;\n   opacity: 1; \/* Firefox *\/\n }\n\n #form1739 :-ms-input-placeholder { \/* Internet Explorer 10-11 *\/\n   color: #888;\n }\n\n #form1739  ::-ms-input-placeholder { \/* Microsoft Edge *\/\n   color: #888;\n }\n\n #form1739  select {\n   color: #888;\n }\n.form-horizontal .form-group i {\n    color: #888;\n}\n.form-bg{ background: #ddd; }\n.form-horizontal{\n    background: none;\n    padding: 0px 50px;\n}\n.form-horizontal .form-group{\n    margin: 0 0 30px 0;\n    position: relative;\n}\n.form-horizontal .form-group:last-child{ margin: 40px 0 0 0; }\n.form-horizontal .form-group i{\n    width: 50px;\n    height: 50px;\n    line-height: 50px;\n    font-size: 18px;\n    color: #c4c4c4;\n    text-align: center;\n    position: absolute;\n    top: 0;\n    left: 0;\n    z-index: 1;\n}\n.form-horizontal .form-control{\n    height: 50px;\n    background: #fff;\n    border: 2px solid #d9d9d9;\n    box-shadow: none;\n    padding: 0 20px 0 50px;\n    font-size: 16px;\n    color: #7f8291;\n    position: relative;\n    transition: all 0.3s ease 0s;\n    width: 100%;\n}\n.form-horizontal textarea.form-control{\n    padding-top: 10px;\n    height: 80px;\n}\n.form-horizontal select.form-control{\n    padding-left: 50px;\n    -webkit-appearance: none;\n    -moz-appearance: none;\n    appearance: none;\n}\n.form-horizontal .form-control[type=password]{ padding: 0 105px 0 50px; }\n.form-horizontal .form-control:focus{\n    box-shadow: none;\n    outline: 0 none;\n    border-color: #870292;\n}\n.form-horizontal .form-control::-webkit-input-placeholder,\n.form-horizontal .form-control::-moz-placeholder,\n.form-horizontal .form-control::placeholder{\n    color: #c4c4c4;\n    }\n.form-horizontal .form-group label{\n    display: none;\n}\n\n.form-horizontal .signup{\n    display: inline-block;\n    font-size: 16px;\n    color: #8f8f8f;\n    text-transform: capitalize;\n    margin-top: 8px;\n}\n.form-horizontal .signup a{ color: #870292; }\n.form-horizontal .btn{\n    font-size: 16px;\n    height: 40px;\n\twidth: 100%;\n\ttext-align: center;\n\tline-height: 28px;\n\tfont-weight: bold;\n\t-webkit-border-radius: 15px;\n\t-moz-border-radius: 15px;\n\tborder-radius: 15px;\n\tborder: 1px solid #870292;\n\tdisplay: inline-block;\n\ttext-transform: uppercase;\n\tcolor: #fff;\n\tbackground: #870292;\n\t-webkit-transition: all 300ms;\n\t-moz-transition: all 300ms;\n\t-ms-transition: all 300ms;\n\t-o-transition: all 300ms;\n\ttransition: all 300ms;\n        &:hover{\n\t\tbackground: #fff;\n\t\tcolor: #ce70f3;\n\t\ttext-decoration: none;\n        }\n}\n.form-horizontal .btn:focus{\n    background: #870292;\n    color: #fff;\n}\n@media only screen and (max-width: 479px){\n    .form-horizontal{ padding: 40px 20px; }\n    .form-horizontal .form-group:last-child{\n        text-align: center;\n        margin-top: 0;\n    }\n    .form-horizontal .signup{\n        display: block;\n        margin-bottom: 10px;\n    }\n    .form-horizontal .btn{ float: none; }\n}\n.firefox .form-horizontal select {\n\tcolor: #b6b6b6;\n}\n<\/style>\n\n<script src=\"https:\/\/www.noblecosmeticsurgery.com\/wp-content\/themes\/ekwa\/plugins\/flatpickr\/flatpickr.js\"><\/script>\n<script>\n    flatpickr(\"#Field1\", {\n\tdisableMobile: true,\n\tminDate: \"today\"\n\t\n\t});\n<\/script>\n  \n<script>\n    function AppointmentFormValidate(theForm) {\n    var reason = \"\";\n    reason += validateType(theForm.Field116);\n    reason += validateDate(theForm.Field1);\n    reason += validateName(theForm.Field5);\n    reason += validateEmail(theForm.Field7);\n    reason += validateTel(theForm.Field9);\n    reason += validateMessage(theForm.Field11);\n    reason += validateConfirm(theForm.Field13);\n\treason += validateCaptcha(contactFormCaptcha);\n  \/\/  reason += validateQuestion(theForm.question);\n\n    if (reason != \"\") {\n        alert(reason);\n        return false;\n    }\n    if(checkValue(theForm)) {\n        insitePost(theForm);\n    }\n    setTimeout(function(){theForm.submit();},500); \/\/ increase this value if it's not tracking properly\n    return true;\n}\n\n\n\nfunction validateConfirm(fld) {\n                  var error = \"\";\n                  if (fld.checked == \"\") {\n                    fld.style.background = \"\";\n                    error = \"- Please accept our privacy policy\\n\"\n                  }\n                  return error;\n                } \n\nfunction validateDate(fld) {\n    var error = \"\";\n\n    if (fld.value == \"\") {\n        fld.style.background = \"\";\n        error = \"- Please select an appointment date\\n\"\n    } else if (fld.value == \"Appointment Date *\") {\n        fld.style.background = \"\";\n        error = \"- Please select an appointment date\\n\"\n    } else {\n        fld.style.background = \"\";\n    }\n    return error;\n}\n\nfunction validateTime(fld) {\n    var error = \"\";\n\n    if (fld.value == \"\") {\n        fld.style.background = \"\";\n        error = \"- Please select required time\\n\"\n    } else if (fld.value == \"Time\") {\n        fld.style.background = \"\";\n        error = \"- Please select required time\\n\"\n    } else {\n        fld.style.background = \"\";\n    }\n    return error;\n}\n\nfunction validateType(fld) {\n    var error = \"\";\n\n    if (fld.value == \"\") {\n        fld.style.background = \"\";\n        error = \"- Please select an appointment type\\n\"\n    } else if (fld.value == \"Appointment Type *\") {\n        fld.style.background = \"\";\n        error = \"- Please select an appointment type\\n\"\n    } else {\n        fld.style.background = \"\";\n    }\n    return error;\n}\n\nfunction validateName(fld) {\n    var error = \"\";\n\n    if (fld.value == \"\") {\n        fld.style.background = \"\";\n        error = \"- Please enter your name\\n\"\n    } else if (fld.value == \"Your Name *\") {\n        fld.style.background = \"\";\n        error = \"- Please enter your name\\n\"\n    } else {\n        fld.style.background = \"\";\n    }\n    return error;\n}\n\nfunction trim(s)\n{\n    return s.replace(\/^\\s+|\\s+$\/, '');\n}\n\nfunction validateEmail(fld) {\n    var error=\"\";\n    var tfld = trim(fld.value);                        \/\/ value of field with whitespace trimmed off\n    var emailFilter = \/^[^@]+@[^@.]+\\.[^@]*\\w\\w$\/ ;\n\n    if (fld.value == \"\") {\n        fld.style.background = \"\";\n        error = \"- Please enter your email address\\n\";\n    } else if (!emailFilter.test(tfld)) {              \/\/test email address for illegal characters\n        fld.style.background = \"\";\n        error = \"- Please enter a valid email address\\n\";\n    } else if (fld.value == \"Email Address *\") {              \/\/test email address for illegal characters\n        fld.style.background = \"\";\n        error = \"- Please enter a valid email address\\n\";\n    } else {\n        fld.style.background = \"\";\n    }\n    return error;\n}\n\nfunction isNumeric(v) {\n    return v.length > 0 && !isNaN(v) && v.search(\/[A-Z]|[#]\/ig) == -1;\n};\n\nfunction validateTel(fld) {\n    var error = \"\";\n    var stripped = fld.value.replace(\/[\\(\\)\\.\\-\\ ]\/g, '');\n\t\n    if (fld.value == \"\") {\n        error = \"- Please enter your contact number \\n\";\n        fld.style.color =\"\";\n    }\n    else if(stripped.length != 10){\n\t\terror = \"- Please enter valid contact number in correct format \\n Example: (xxx) xxx-xxxx | xxx-xxx-xxxx | xxxxxxxxxx \\n \\n\";\n    }\n    else if(fld.value == \"Your Contact Number *\"){\n\t\terror = \"- Please enter valid contact number in correct format \\n Example: (xxx) xxx-xxxx | xxx-xxx-xxxx | xxxxxxxxxx \\n \\n\";\n    }\n    else {\n        if (isNumeric(stripped) == false) {\n            error = \"- Enter only numeric values for your telephone number \\n\";\n        }\n        else{\n            fld.style.color =\"\";\n        }\n    }\n    return error;\n}\n\nfunction validateMessage(fld) {\n    var error = \"\";\n\n    if (fld.value == \"\") {\n        fld.style.background = \"\";\n        error = \"- Please enter your comments\\n\"\n    } else if (fld.value == \"Comments *\"){\n        fld.style.background = \"\";\n        error = \"- Please enter your comments\\n\"\n    } else {\n        fld.style.background = \"\";\n    }\n    return error;\n}\n\nfunction validateQuestion(fld){\n    var error = \"\";\n\n    if (fld.value == \"\") {\n        fld.style.background = \"\";\n        error = \"- Answer the simple question\\n\";\n    } else {\n        fld.style.background = \"\";\n    }\n    return error;\n}\n\n\n \nfunction validateCaptcha(fld) {\n    var error = \"\";\n    if (grecaptcha.getResponse(fld) == \"\") {\n        error = \"- Please confirm you are not a robot\\n\"\n    }\n    return error;\n}\nshowBackEndSuccess('rel');\n\nfunction showBackEndSuccess(uriSer) {\n    if (getUrlParameter(uriSer) && \/thank-you\/.test(getUrlParameter(uriSer))) {\n        setTimeout(function () {\n            alert(\n                'Successfully submitted. We ensure that we will get back to you as soon as possible during working hours.');\n        }, 2000);\n    }\n}\nshowBackEndError('form-error', 'error-elm');\n\nfunction showBackEndError(uriSer, uriElm) {\n    if (getUrlParameter(uriSer)) {\n        var elemStr = getUrlParameter(uriElm);\n        var tempElem = null;\n        if (elemStr != \"\") {\n            tempElem = document.querySelector('#' + getUrlParameter(uriElm));\n        }\n        if (tempElem) {\n            tempElem.style.borderColor = 'red';\n            tempElem.style.borderWidth = '1px';\n            tempElem.style.borderStyle = 'solid';\n            tempElem.focus();\n        }\n        setTimeout(function () {\n            alert(getUrlParameter(uriSer));\n        }, 2000);\n        if (getUrlParameter('form-data')) {\n            var formDataObj = JSON.parse(atob(getUrlParameter('form-data')))\n            var formDataKeyArr = Object.keys(formDataObj);\n            for (var i = 0; i < formDataKeyArr.length; i++) {\n                if (document.getElementById(formDataKeyArr[i])) {\n                    document.getElementById(formDataKeyArr[i]).value = formDataObj[formDataKeyArr[i]];\n                }\n\n            }\n        }\n    }\n}\n\nfunction getUrlParameter(name) {\n    name = name.replace(\/[\\[]\/, '\\\\[').replace(\/[\\]]\/, '\\\\]');\n    var regex = new RegExp('[\\\\?&]' + name + '=([^&#]*)');\n    var results = regex.exec(location.search);\n    return results === null ? '' : decodeURIComponent(results[1].replace(\/\\+\/g, ' '));\n};\n\nvar gCapLink = document.createElement('script');\ngCapLink.async = false;\ngCapLink.src = 'https:\/\/www.google.com\/recaptcha\/api.js?onload=renderRecaptcha&render=explicit';\ndocument.getElementsByTagName('body')[0].insertAdjacentElement('beforeend', gCapLink);\n\nvar contactFormCaptcha;\nvar aptFormCaptcha;\nvar renderRecaptcha = function () {\n    if (document.getElementById('contact-form-captcha')) {\n        contactFormCaptcha = grecaptcha.render('contact-form-captcha', {\n            \"sitekey\": \"6Ldtp2sUAAAAABiPf3Vz-mNr5C_WPuRGh4l4wak_\",\n            \"theme\": \"light\"\n        });\n    }\n    if (document.getElementById('apt-form-captcha')) {\n        aptFormCaptcha = grecaptcha.render('apt-form-captcha', {\n            \"sitekey\": \"6Ldtp2sUAAAAABiPf3Vz-mNr5C_WPuRGh4l4wak_\",\n            \"theme\": \"light\"\n        });\n    }\n};\n\n\n\n    \/*  var input = document.getElementById(\"Field1\");\n      var today = new Date();\n      var day = today.getDate();\n      \/\/ Set month to string to add leading 0\n      var mon = new String(today.getMonth()+1); \/\/January is 0!\n      var yr = today.getFullYear();\n      \n        if(mon.length < 2) { mon = \"0\" + mon; }\n      \n        var date = new String( yr + '-' + mon + '-' + day );\n      \n      input.disabled = false; \n      input.setAttribute('min', date); *\/\n    \n\n<\/script>\n\n\n\n\n\n\n\n\n\n    \n    \n","protected":false},"excerpt":{"rendered":"<p>Appointment type * Appointment Type *In Office VisitVirtual Consultation Appointment Date * Time * TimeMorningLunchEvening Location Location6201 K Ave, Suite 100, Plano, TX 750742727 Bolton Boone Drive, Suite 101, Desoto, TX 75115 Your Name * Email Address * Contact Number * Comments * Privacy Policy By submitting the above form you agree and accept our Privacy Policy*. Submit<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/www.noblecosmeticsurgery.com\/wp-json\/wp\/v2\/pages\/1520"}],"collection":[{"href":"https:\/\/www.noblecosmeticsurgery.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.noblecosmeticsurgery.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.noblecosmeticsurgery.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.noblecosmeticsurgery.com\/wp-json\/wp\/v2\/comments?post=1520"}],"version-history":[{"count":8,"href":"https:\/\/www.noblecosmeticsurgery.com\/wp-json\/wp\/v2\/pages\/1520\/revisions"}],"predecessor-version":[{"id":6281,"href":"https:\/\/www.noblecosmeticsurgery.com\/wp-json\/wp\/v2\/pages\/1520\/revisions\/6281"}],"wp:attachment":[{"href":"https:\/\/www.noblecosmeticsurgery.com\/wp-json\/wp\/v2\/media?parent=1520"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}