{"id":367,"date":"2016-11-16T16:08:12","date_gmt":"2016-11-16T16:08:12","guid":{"rendered":"http:\/\/dentistrybydesignks.com\/?page_id=367"},"modified":"2017-05-30T17:19:13","modified_gmt":"2017-05-30T17:19:13","slug":"request-an-appointment","status":"publish","type":"page","link":"https:\/\/dentistrybydesignks.com\/contact-us\/request-an-appointment\/","title":{"rendered":"Request an Appointment"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]<div class=\"ult-spacer spacer-65d26206d7969\" data-id=\"65d26206d7969\" data-height=\"20\" data-height-mobile=\"20\" data-height-tab=\"20\" data-height-tab-portrait=\"\" data-height-mobile-landscape=\"\" style=\"clear:both;display:block;\"><\/div>[\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]<\/p>\n<h1>Request an Appointment<\/h1>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column]<div class=\"ult-spacer spacer-65d26206d7986\" data-id=\"65d26206d7986\" data-height=\"20\" data-height-mobile=\"20\" data-height-tab=\"20\" data-height-tab-portrait=\"\" data-height-mobile-landscape=\"\" style=\"clear:both;display:block;\"><\/div>[\/vc_column][\/vc_row][vc_row][vc_column][vc_single_image image=&#8221;1001&#8243; img_size=&#8221;full&#8221;][\/vc_column][\/vc_row][vc_row][vc_column]<div class=\"ult-spacer spacer-65d26206d7993\" data-id=\"65d26206d7993\" data-height=\"20\" data-height-mobile=\"20\" data-height-tab=\"20\" data-height-tab-portrait=\"\" data-height-mobile-landscape=\"\" style=\"clear:both;display:block;\"><\/div>[\/vc_column][\/vc_row][vc_row][vc_column]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f395-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\/367#wpcf7-f395-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=\"395\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.8.7\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f395-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<p>Patient's First & Last Name:*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n<\/p>\n<p>Patient's Birthdate (Required for positive identification. *If using Firefox browser, please enter as yyyy-mm-dd):\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"date-your-birthdate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" id=\"bd\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-your-birthdate\" \/><\/span>\n<\/p>\n<p>Email Address*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" 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>\n<\/p>\n<p>Phone Number*\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span>\n<\/p>\n<p>Are you a new or current patient?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-iam\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"iam\" aria-invalid=\"false\" name=\"menu-iam\"><option value=\"New Patient\">New Patient<\/option><option value=\"Current Patient\">Current Patient<\/option><\/select><\/span>\n<\/p>\n<p>How did you hear about us?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text-Howheardaboutus\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"hearabout\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-Howheardaboutus\" \/><\/span>\n<\/p>\n<p>What is the purpose of this appointment?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-purpose\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"purpose\" aria-invalid=\"false\" name=\"menu-purpose\"><option value=\"Cleaning &amp; Exam\">Cleaning &amp; Exam<\/option><option value=\"Child&#039;s Visit\">Child&#039;s Visit<\/option><option value=\"Orthodontic Treatment\">Orthodontic Treatment<\/option><option value=\"Wisdom Teeth\">Wisdom Teeth<\/option><option value=\"Dentures or Implants\">Dentures or Implants<\/option><option value=\"Restorative (Filling, Crown, etc)\">Restorative (Filling, Crown, etc)<\/option><option value=\"Cosmetic (Whitening, etc)\">Cosmetic (Whitening, etc)<\/option><option value=\"Emergency (Toothache)\">Emergency (Toothache)<\/option><option value=\"Other\">Other<\/option><\/select><\/span>\n<\/p>\n<p>How soon would you like to come in?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-soon\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"soon\" aria-invalid=\"false\" name=\"menu-soon\"><option value=\"As soon as possible\">As soon as possible<\/option><option value=\"Whenever you have time available\">Whenever you have time available<\/option><option value=\"Next week\">Next week<\/option><option value=\"In two weeks\">In two weeks<\/option><\/select><\/span>\n<\/p>\n<p>Do you prefer a particular day?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-day\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"day\" aria-invalid=\"false\" name=\"menu-day\"><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><option value=\"Any day\">Any day<\/option><\/select><\/span>\n<\/p>\n<p>Do you prefer a particular time of day?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-appointmentTime\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"appointmentTime\" aria-invalid=\"false\" name=\"menu-appointmentTime\"><option value=\"Morning\">Morning<\/option><option value=\"Afternoon\">Afternoon<\/option><option value=\"Evening\">Evening<\/option><option value=\"Any time\">Any time<\/option><\/select><\/span>\n<\/p>\n<p><label> Your Message<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" 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_row][vc_row][vc_column]<div class=\"ult-spacer spacer-65d26206d887c\" data-id=\"65d26206d887c\" data-height=\"32\" data-height-mobile=\"32\" data-height-tab=\"32\" data-height-tab-portrait=\"\" data-height-mobile-landscape=\"\" style=\"clear:both;display:block;\"><\/div>[\/vc_column][\/vc_row]<\/p>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text] Request an Appointment [\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][vc_single_image image=&#8221;1001&#8243; img_size=&#8221;full&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":27,"menu_order":10,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Request an Appointment - Dentistry by Design | Manhattan, KS<\/title>\n<meta name=\"description\" content=\"Request and appointment at Dentistry by Design in Manhattan, KS with our online form. 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