{"id":766,"date":"2022-05-24T19:21:11","date_gmt":"2022-05-24T19:21:11","guid":{"rendered":"https:\/\/killerwebs1.com\/churchmanrobertsdds\/?page_id=766"},"modified":"2024-01-08T15:56:17","modified_gmt":"2024-01-08T15:56:17","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/churchmanrobertsdds.com\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"766\" class=\"elementor elementor-766\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-17a747d9 elementor-section-content-bottom elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"17a747d9\" data-element_type=\"section\" data-settings=\"{&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<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5141257e\" data-id=\"5141257e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-699b7bb elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"699b7bb\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.18.0 - 20-12-2023 *\/\n.elementor-widget-divider{--divider-border-style:none;--divider-border-width:1px;--divider-color:#0c0d0e;--divider-icon-size:20px;--divider-element-spacing:10px;--divider-pattern-height:24px;--divider-pattern-size:20px;--divider-pattern-url:none;--divider-pattern-repeat:repeat-x}.elementor-widget-divider .elementor-divider{display:flex}.elementor-widget-divider .elementor-divider__text{font-size:15px;line-height:1;max-width:95%}.elementor-widget-divider .elementor-divider__element{margin:0 var(--divider-element-spacing);flex-shrink:0}.elementor-widget-divider .elementor-icon{font-size:var(--divider-icon-size)}.elementor-widget-divider .elementor-divider-separator{display:flex;margin:0;direction:ltr}.elementor-widget-divider--view-line_icon .elementor-divider-separator,.elementor-widget-divider--view-line_text .elementor-divider-separator{align-items:center}.elementor-widget-divider--view-line_icon .elementor-divider-separator:after,.elementor-widget-divider--view-line_icon .elementor-divider-separator:before,.elementor-widget-divider--view-line_text .elementor-divider-separator:after,.elementor-widget-divider--view-line_text .elementor-divider-separator:before{display:block;content:\"\";border-bottom:0;flex-grow:1;border-top:var(--divider-border-width) var(--divider-border-style) var(--divider-color)}.elementor-widget-divider--element-align-left .elementor-divider .elementor-divider-separator>.elementor-divider__svg:first-of-type{flex-grow:0;flex-shrink:100}.elementor-widget-divider--element-align-left .elementor-divider-separator:before{content:none}.elementor-widget-divider--element-align-left .elementor-divider__element{margin-left:0}.elementor-widget-divider--element-align-right .elementor-divider .elementor-divider-separator>.elementor-divider__svg:last-of-type{flex-grow:0;flex-shrink:100}.elementor-widget-divider--element-align-right .elementor-divider-separator:after{content:none}.elementor-widget-divider--element-align-right .elementor-divider__element{margin-right:0}.elementor-widget-divider:not(.elementor-widget-divider--view-line_text):not(.elementor-widget-divider--view-line_icon) .elementor-divider-separator{border-top:var(--divider-border-width) var(--divider-border-style) var(--divider-color)}.elementor-widget-divider--separator-type-pattern{--divider-border-style:none}.elementor-widget-divider--separator-type-pattern.elementor-widget-divider--view-line .elementor-divider-separator,.elementor-widget-divider--separator-type-pattern:not(.elementor-widget-divider--view-line) .elementor-divider-separator:after,.elementor-widget-divider--separator-type-pattern:not(.elementor-widget-divider--view-line) .elementor-divider-separator:before,.elementor-widget-divider--separator-type-pattern:not([class*=elementor-widget-divider--view]) .elementor-divider-separator{width:100%;min-height:var(--divider-pattern-height);-webkit-mask-size:var(--divider-pattern-size) 100%;mask-size:var(--divider-pattern-size) 100%;-webkit-mask-repeat:var(--divider-pattern-repeat);mask-repeat:var(--divider-pattern-repeat);background-color:var(--divider-color);-webkit-mask-image:var(--divider-pattern-url);mask-image:var(--divider-pattern-url)}.elementor-widget-divider--no-spacing{--divider-pattern-size:auto}.elementor-widget-divider--bg-round{--divider-pattern-repeat:round}.rtl .elementor-widget-divider .elementor-divider__text{direction:rtl}.e-con-inner>.elementor-widget-divider,.e-con>.elementor-widget-divider{width:var(--container-widget-width,100%);--flex-grow:var(--container-widget-flex-grow)}<\/style>\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-39b250c elementor-section-content-middle elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"39b250c\" data-element_type=\"section\" data-settings=\"{&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<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-993d9e1\" data-id=\"993d9e1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-faf4ec7 elementor-widget elementor-widget-text-editor\" data-id=\"faf4ec7\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.18.0 - 20-12-2023 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p style=\"text-align: center;\">Download the forms below and fill out before your first visit. All forms are in PDF format.\u00a0<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-inner-section elementor-element elementor-element-adbfc01 elementor-section-content-top elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"adbfc01\" 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-inner-column elementor-element elementor-element-e14808a\" data-id=\"e14808a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4e60552 elementor-widget__width-initial elementor-widget elementor-widget-eael-feature-list\" data-id=\"4e60552\" data-element_type=\"widget\" data-widget_type=\"eael-feature-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"-icon-position-left -tablet-icon-position-left -mobile-icon-position-left\">\n\t\t\t<ul id=\"eael-feature-list-4e60552\" class=\"eael-feature-list-items circle stacked \">\n\t\t\t                <li class=\"eael-feature-list-item elementor-repeater-item-f79cc5a\">\n                    \n\t\t\t\t\t\t<div class=\"eael-feature-list-icon-box\">\n\t\t\t\t\t\t\t<div class=\"eael-feature-list-icon-inner\">\n\n\t\t\t\t\t\t\t\t<a class=\"eael-feature-list-icon fl-icon-0\"href=\"https:\/\/churchmanrobertsdds.com\/wp-content\/uploads\/2023\/11\/consent-2023.pdf\">\n\n\t\t<i aria-hidden=\"true\" class=\"far fa-file-pdf\"><\/i>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"eael-feature-list-content-box\">\n\t\t\t\t\t\t\t<h3 class=\"eael-feature-list-title\"\t\t\t\t\t\t\t><a href=\"https:\/\/churchmanrobertsdds.com\/wp-content\/uploads\/2023\/11\/consent-2023.pdf\">Consent Form (PDF)<\/a><\/h3\t\t\t\t\t\t>\n\t\t\t\t\t\t<p class=\"eael-feature-list-content\">Download &amp; Print<\/p>\n\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<\/li>\n\t\t\t\t                <li class=\"eael-feature-list-item elementor-repeater-item-d190cda\">\n                    \n\t\t\t\t\t\t<div class=\"eael-feature-list-icon-box\">\n\t\t\t\t\t\t\t<div class=\"eael-feature-list-icon-inner\">\n\n\t\t\t\t\t\t\t\t<a class=\"eael-feature-list-icon fl-icon-1\"href=\"https:\/\/churchmanrobertsdds.com\/wp-content\/uploads\/2023\/06\/Updated-Med-hx-form.pdf\">\n\n\t\t<i aria-hidden=\"true\" class=\"far fa-file-pdf\"><\/i>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"eael-feature-list-content-box\">\n\t\t\t\t\t\t\t<h3 class=\"eael-feature-list-title\"\t\t\t\t\t\t\t><a href=\"https:\/\/churchmanrobertsdds.com\/wp-content\/uploads\/2023\/06\/Updated-Med-hx-form.pdf\">New Patient Welcome (PDF)<\/a><\/h3\t\t\t\t\t\t>\n\t\t\t\t\t\t<p class=\"eael-feature-list-content\">Download &amp; Print<\/p>\n\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<\/li>\n\t\t\t\t                <li class=\"eael-feature-list-item elementor-repeater-item-0d97eb7\">\n                    \n\t\t\t\t\t\t<div class=\"eael-feature-list-icon-box\">\n\t\t\t\t\t\t\t<div class=\"eael-feature-list-icon-inner\">\n\n\t\t\t\t\t\t\t\t<a class=\"eael-feature-list-icon fl-icon-2\"href=\"https:\/\/churchmanrobertsdds.com\/wp-content\/uploads\/2022\/05\/noticeofprivacy.pdf\">\n\n\t\t<i aria-hidden=\"true\" class=\"far fa-file-pdf\"><\/i>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"eael-feature-list-content-box\">\n\t\t\t\t\t\t\t<h3 class=\"eael-feature-list-title\"\t\t\t\t\t\t\t><a href=\"https:\/\/churchmanrobertsdds.com\/wp-content\/uploads\/2022\/05\/noticeofprivacy.pdf\">Notice of Privacy Practices (PDF)<\/a><\/h3\t\t\t\t\t\t>\n\t\t\t\t\t\t<p class=\"eael-feature-list-content\">Download &amp; Print<\/p>\n\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<\/li>\n\t\t\t\t                <li class=\"eael-feature-list-item elementor-repeater-item-e080ba1\">\n                    \n\t\t\t\t\t\t<div class=\"eael-feature-list-icon-box\">\n\t\t\t\t\t\t\t<div class=\"eael-feature-list-icon-inner\">\n\n\t\t\t\t\t\t\t\t<a class=\"eael-feature-list-icon fl-icon-3\"href=\"https:\/\/churchmanrobertsdds.com\/wp-content\/uploads\/2022\/05\/receiptofnotice.pdf\">\n\n\t\t<i aria-hidden=\"true\" class=\"far fa-file-pdf\"><\/i>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"eael-feature-list-content-box\">\n\t\t\t\t\t\t\t<h3 class=\"eael-feature-list-title\"\t\t\t\t\t\t\t><a href=\"https:\/\/churchmanrobertsdds.com\/wp-content\/uploads\/2022\/05\/receiptofnotice.pdf\">Acknowledgement of Receipt of Notice of Privacy Practices (PDF)<\/a><\/h3\t\t\t\t\t\t>\n\t\t\t\t\t\t<p class=\"eael-feature-list-content\">Download &amp; Print<\/p>\n\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t<\/ul>\n\t\t<\/div>\n\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Download the forms below and fill out before your first visit. All forms are in PDF format.\u00a0 Consent Form (PDF) Download &amp; Print New Patient Welcome (PDF) Download &amp; Print Notice of Privacy Practices (PDF) Download &amp; Print Acknowledgement of Receipt of Notice of Privacy Practices (PDF) Download &amp; Print<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"enabled","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"_links":{"self":[{"href":"https:\/\/churchmanrobertsdds.com\/wp-json\/wp\/v2\/pages\/766"}],"collection":[{"href":"https:\/\/churchmanrobertsdds.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/churchmanrobertsdds.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/churchmanrobertsdds.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/churchmanrobertsdds.com\/wp-json\/wp\/v2\/comments?post=766"}],"version-history":[{"count":46,"href":"https:\/\/churchmanrobertsdds.com\/wp-json\/wp\/v2\/pages\/766\/revisions"}],"predecessor-version":[{"id":988,"href":"https:\/\/churchmanrobertsdds.com\/wp-json\/wp\/v2\/pages\/766\/revisions\/988"}],"wp:attachment":[{"href":"https:\/\/churchmanrobertsdds.com\/wp-json\/wp\/v2\/media?parent=766"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}