{"id":947,"date":"2020-09-12T03:45:01","date_gmt":"2020-09-12T03:45:01","guid":{"rendered":"https:\/\/www.associatedderm.net\/?page_id=947"},"modified":"2023-07-14T06:06:02","modified_gmt":"2023-07-14T06:06:02","slug":"request-telehealth-appointment","status":"publish","type":"page","link":"https:\/\/www.associatedderm.net\/request-telehealth-appointment\/","title":{"rendered":"Request Telehealth Appointment"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;RGBA(0,0,0,0)&#8221; background_image=&#8221;https:\/\/www.associatedderm.net\/wp-content\/uploads\/2021\/11\/Image-from-iOS-12-scaled.jpg&#8221; background_blend=&#8221;overlay&#8221; height=&#8221;70vh&#8221; height_tablet=&#8221;&#8221; height_phone=&#8221;&#8221; height_last_edited=&#8221;on|tablet&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;6.6%||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; text_font_size=&#8221;8px&#8221; header_font=&#8221;Montserrat|700|||||||&#8221; header_text_align=&#8221;center&#8221; header_text_color=&#8221;#ffffff&#8221; header_font_size=&#8221;43px&#8221; header_line_height=&#8221;1.2em&#8221; header_2_text_color=&#8221;#ffffff&#8221; header_6_font=&#8221;Montserrat|600|||||||&#8221; header_6_text_align=&#8221;center&#8221; header_6_text_color=&#8221;#ffffff&#8221; max_width=&#8221;69%&#8221; module_alignment=&#8221;center&#8221; custom_margin=&#8221;||9px||false|false&#8221; header_font_size_tablet=&#8221;&#8221; header_font_size_phone=&#8221;26px&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h6>Associated Dermatologists<\/h6>\n<h1>Request Telehealth Appointment<\/h1>\n<p>[\/et_pb_text][et_pb_blurb url=&#8221;#about&#8221; use_icon=&#8221;on&#8221; font_icon=&#8221;&#x3b;||divi||400&#8243; icon_color=&#8221;#ffffff&#8221; image_icon_width=&#8221;55px&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; icon_font_size=&#8221;55px&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_blurb][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; module_id=&#8221;about&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row make_equal=&#8221;on&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_code _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f955-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/wp-json\/wp\/v2\/pages\/947#wpcf7-f955-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=\"955\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.7.7\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f955-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><span class=\"wpcf7-form-control-wrap\" data-name=\"PatientName\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient Name\" value=\"\" type=\"text\" name=\"PatientName\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"DOB\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"2020-09-12\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"DOB\" value=\"\" type=\"date\" name=\"DOB\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"PatientEmail\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient Email\" value=\"\" type=\"email\" name=\"PatientEmail\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"PatientPhoneNumber\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient Phone Number\" value=\"\" type=\"tel\" name=\"PatientPhoneNumber\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"RequestedAppointmentDate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"2020-09-12\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Requested Appointment Date\" value=\"\" type=\"date\" name=\"RequestedAppointmentDate\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"ReasonForAppointment\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Reason For Appointment\" value=\"\" type=\"text\" name=\"ReasonForAppointment\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"AMPMDesired\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"AMPMDesired\"><option value=\"AM\">AM<\/option><option value=\"PM\">PM<\/option><\/select><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"AreYouAnExistingPatient\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"AreYouAnExistingPatient\"><option value=\"YES\">YES<\/option><option value=\"No\">No<\/option><\/select><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"InsuranceProvider\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please list your insurance provider\" value=\"\" type=\"text\" name=\"InsuranceProvider\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"InsuranceProvider\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"InsuranceProvider\" value=\"\" type=\"text\" name=\"InsuranceProvider\" \/><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control has-spinner wpcf7-submit\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; prev_background_color=&#8221;#ffffff&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#419dec&#8221; top_divider_style=&#8221;wave2&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;97px|||||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; header_2_font=&#8221;Montserrat|700|||||||&#8221; header_2_text_color=&#8221;#ffffff&#8221; header_2_font_size=&#8221;32px&#8221; text_orientation=&#8221;center&#8221; custom_margin=&#8221;||2%||false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>About Associated Dermatologists<\/h2>\n<p>[\/et_pb_text][et_pb_divider color=&#8221;#ffffff&#8221; divider_weight=&#8221;2px&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; max_width=&#8221;7%&#8221; module_alignment=&#8221;center&#8221; custom_margin=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_divider][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;|700|||||||&#8221; text_text_color=&#8221;#ffffff&#8221; text_font_size=&#8221;27px&#8221; text_line_height=&#8221;40px&#8221; link_text_color=&#8221;#ffffff&#8221; text_orientation=&#8221;center&#8221; max_width=&#8221;75%&#8221; module_alignment=&#8221;center&#8221; custom_padding=&#8221;0px|||||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Submit your request for a Telehealth appointment here, and we\u2019ll reach back out as soon as possible. If you have a question regarding an existing appointment, please call us at:<a href=\"tel:(205) 853-3960\"> (205) 853-3960<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Associated Dermatologists Request Telehealth Appointment\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f955-o2\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/wp-json\/wp\/v2\/pages\/947#wpcf7-f955-o2\" 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=\"955\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.7.7\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f955-o2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"PatientName\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient Name\" value=\"\" type=\"text\" name=\"PatientName\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"DOB\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"2020-09-12\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"DOB\" value=\"\" type=\"date\" name=\"DOB\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"PatientEmail\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient Email\" value=\"\" type=\"email\" name=\"PatientEmail\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"PatientPhoneNumber\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient Phone Number\" value=\"\" type=\"tel\" name=\"PatientPhoneNumber\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"RequestedAppointmentDate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"2020-09-12\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Requested Appointment Date\" value=\"\" type=\"date\" name=\"RequestedAppointmentDate\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"ReasonForAppointment\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Reason For Appointment\" value=\"\" type=\"text\" name=\"ReasonForAppointment\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"AMPMDesired\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"AMPMDesired\"><option value=\"AM\">AM<\/option><option value=\"PM\">PM<\/option><\/select><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"AreYouAnExistingPatient\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"AreYouAnExistingPatient\"><option value=\"YES\">YES<\/option><option value=\"No\">No<\/option><\/select><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"InsuranceProvider\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please list your insurance provider\" value=\"\" type=\"text\" name=\"InsuranceProvider\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"InsuranceProvider\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"InsuranceProvider\" value=\"\" type=\"text\" name=\"InsuranceProvider\" \/><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control has-spinner wpcf7-submit\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\nAbout Associated DermatologistsSubmit your request for a Telehealth appointment here, and we\u2019ll reach back out as soon as possible. If you have a question regarding an existing appointment, please call us at: (205) 853-3960<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":""},"_links":{"self":[{"href":"https:\/\/www.associatedderm.net\/wp-json\/wp\/v2\/pages\/947"}],"collection":[{"href":"https:\/\/www.associatedderm.net\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.associatedderm.net\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.associatedderm.net\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.associatedderm.net\/wp-json\/wp\/v2\/comments?post=947"}],"version-history":[{"count":13,"href":"https:\/\/www.associatedderm.net\/wp-json\/wp\/v2\/pages\/947\/revisions"}],"predecessor-version":[{"id":2976,"href":"https:\/\/www.associatedderm.net\/wp-json\/wp\/v2\/pages\/947\/revisions\/2976"}],"wp:attachment":[{"href":"https:\/\/www.associatedderm.net\/wp-json\/wp\/v2\/media?parent=947"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}