{"id":3986,"date":"2021-06-21T15:25:02","date_gmt":"2021-06-21T15:25:02","guid":{"rendered":"http:\/\/localhost\/victor\/wordpress\/?page_id=3986"},"modified":"2024-03-29T02:12:23","modified_gmt":"2024-03-29T02:12:23","slug":"formulario-de-nuevo-cliente","status":"publish","type":"page","link":"https:\/\/laveterinarycenter.com\/jeffersonpark\/formulario-de-nuevo-cliente\/","title":{"rendered":"Formulario de Nuevo Cliente"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3986\" class=\"elementor elementor-3986\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2c6851b elementor-section-height-min-height elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"2c6851b\" 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\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-5622099b\" data-id=\"5622099b\" 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-0d93595 elementor-widget elementor-widget-heading\" data-id=\"0d93595\" 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\">Formulario de Nuevo Cliente<\/h2>\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-563445bf elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"563445bf\" 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-5d61e7d3\" data-id=\"5d61e7d3\" 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-2c66a47b elementor-widget elementor-widget-spacer\" data-id=\"2c66a47b\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\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-723bfffd elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"723bfffd\" 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-29b174bb\" data-id=\"29b174bb\" 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-ea6ecad elementor-widget elementor-widget-shortcode\" data-id=\"ea6ecad\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4290-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"4290\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/jeffersonpark\/wp-json\/wp\/v2\/pages\/3986#wpcf7-f4290-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=\"4290\" \/>\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-f4290-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 id=\"responsive-form\" class=\"clearfix\">\n\t<div class=\"form-row\">\n\t\t<p>Due\u00f1o principal *\n\t\t<\/p>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Primer Nombre* <span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Apellido* <span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>Fecha de nacimiento <span class=\"wpcf7-form-control-wrap\" data-name=\"datep-545\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"datep-545\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<hr style=\"     margin-bottom: 30px;height:2px;border-width:0;color:gray;background-color:gray\" \/>\n\t<div class=\"form-row\">\n\t\t<p>Due\u00f1o secundario\n\t\t<\/p>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Primer nombre <span class=\"wpcf7-form-control-wrap\" data-name=\"sfirst-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"sfirst-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Apellido <span class=\"wpcf7-form-control-wrap\" data-name=\"slast-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"slast-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>Fecha de nacimiento<span class=\"wpcf7-form-control-wrap\" data-name=\"sdatep-545\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"sdatep-545\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<hr style=\"     margin-bottom: 30px;height:2px;border-width:0;color:gray;background-color:gray\" \/>\n\t<div class=\"form-row\">\n\t\t<p> Direcci\u00f3n\n\t\t<\/p>\n\t\t<div class=\"column-full\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Ingrese su direccion\" value=\"\" type=\"text\" name=\"address\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Ciudad<span class=\"wpcf7-form-control-wrap\" data-name=\"your-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-city\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Estado <span class=\"wpcf7-form-control-wrap\" data-name=\"States\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"States\"><option value=\"Alabama\">Alabama<\/option><option value=\"Alaska\">Alaska<\/option><option value=\"Arizona\">Arizona<\/option><option value=\"Arkansas\">Arkansas<\/option><option value=\"California\">California<\/option><option value=\"Colorado\">Colorado<\/option><option value=\"Connecticut\">Connecticut<\/option><option value=\"Delaware\">Delaware<\/option><option value=\"Florida\">Florida<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Hawaii\">Hawaii<\/option><option value=\"Idaho\">Idaho<\/option><option value=\"Illinois\">Illinois<\/option><option value=\"Indiana\">Indiana<\/option><option value=\"Iowa\">Iowa<\/option><option value=\"Kansas\">Kansas<\/option><option value=\"Kentucky\">Kentucky<\/option><option value=\"Louisiana\">Louisiana<\/option><option value=\"Maine\">Maine<\/option><option value=\"Maryland\">Maryland<\/option><option value=\"Massachusetts\">Massachusetts<\/option><option value=\"Michigan\">Michigan<\/option><option value=\"Minnesota\">Minnesota<\/option><option value=\"Mississippi\">Mississippi<\/option><option value=\"Missouri\">Missouri<\/option><option value=\"Montana\">Montana<\/option><option value=\"Nebraska\">Nebraska<\/option><option value=\"Nevada\">Nevada<\/option><option value=\"New Hampshire\">New Hampshire<\/option><option value=\"New Jersey\">New Jersey<\/option><option value=\"New Mexico\">New Mexico<\/option><option value=\"New York\">New York<\/option><option value=\"North Carolina\">North Carolina<\/option><option value=\"North Dakota\">North Dakota<\/option><option value=\"Ohio\">Ohio<\/option><option value=\"Oklahoma\">Oklahoma<\/option><option value=\"Oregon\">Oregon<\/option><option value=\"Pennsylvania\">Pennsylvania<\/option><option value=\"Rhode Island\">Rhode Island<\/option><option value=\"South Carolina\">South Carolina<\/option><option value=\"South Dakota\">South Dakota<\/option><option value=\"Tennessee\">Tennessee<\/option><option value=\"Texas\">Texas<\/option><option value=\"Utah\">Utah<\/option><option value=\"Vermont\">Vermont<\/option><option value=\"Virginia\">Virginia<\/option><option value=\"Washington\">Washington<\/option><option value=\"West Virginia\">West Virginia<\/option><option value=\"Wisconsin\">Wisconsin<\/option><option value=\"Wyoming\">Wyoming<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>C\u00f3digo postal<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-zip\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-zip\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<hr style=\"     margin-bottom: 30px;height:2px;border-width:0;color:gray;background-color:gray\" \/>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p>Tel\u00e9fono de contacto preferido #* <span class=\"wpcf7-form-control-wrap\" data-name=\"p-phone\"><input size=\"40\" maxlength=\"400\" 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=\"p-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>Tipo de telefono <span class=\"wpcf7-form-control-wrap\" data-name=\"ptype\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"ptype\" value=\"Casa\" \/><span class=\"wpcf7-list-item-label\">Casa<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"ptype\" value=\"Trabajo\" \/><span class=\"wpcf7-list-item-label\">Trabajo<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"ptype\" value=\"Celular\" \/><span class=\"wpcf7-list-item-label\">Celular<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p>Tel\u00e9fono de contacto alternativo # <span class=\"wpcf7-form-control-wrap\" data-name=\"c-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"c-phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>Tipo de telefono <span class=\"wpcf7-form-control-wrap\" data-name=\"ctype\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"ctype\" value=\"Casa\" \/><span class=\"wpcf7-list-item-label\">Casa<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"ctype\" value=\"Trabajo\" \/><span class=\"wpcf7-list-item-label\">Trabajo<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"ctype\" value=\"Celular\" \/><span class=\"wpcf7-list-item-label\">Celular<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p>Email <span class=\"wpcf7-form-control-wrap\" data-name=\"email-780\"><input size=\"40\" maxlength=\"400\" 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=\"email-780\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>\u00bfPodemos enviarle notificaciones por mensaje de texto?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"notify-txt\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"notify-txt\" value=\"Si\" \/><span class=\"wpcf7-list-item-label\">Si<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"notify-txt\" value=\"nN\" \/><span class=\"wpcf7-list-item-label\">nN<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>M\u00e9todo de comunicaci\u00f3n preferido<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"com-method\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"com-method\" value=\"Llamada\" \/><span class=\"wpcf7-list-item-label\">Llamada<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"com-method\" value=\"Texto\" \/><span class=\"wpcf7-list-item-label\">Texto<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"com-method\" value=\"Email\" \/><span class=\"wpcf7-list-item-label\">Email<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"com-method\" value=\"El correo\" \/><span class=\"wpcf7-list-item-label\">El correo<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p>C\u00f3mo se enter\u00f3 de nosotros ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"reference\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"reference\" value=\"Caminar \/ conducir por\" \/><span class=\"wpcf7-list-item-label\">Caminar \/ conducir por<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"reference\" value=\"Aqu\u00ed anteriormente\" \/><span class=\"wpcf7-list-item-label\">Aqu\u00ed anteriormente<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"reference\" value=\"Internet\" \/><span class=\"wpcf7-list-item-label\">Internet<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"reference\" value=\"Yelp\" \/><span class=\"wpcf7-list-item-label\">Yelp<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"reference\" value=\"Google\" \/><span class=\"wpcf7-list-item-label\">Google<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"reference\" value=\"Amigo pariente\" \/><span class=\"wpcf7-list-item-label\">Amigo pariente<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>Si es amigo \/ familiar: \u00bfA qui\u00e9n podemos agradecer? <span class=\"wpcf7-form-control-wrap\" data-name=\"refer-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"refer-name\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p>Fecha y hora preferida para su cita (si no tiene una cita, ll\u00e1menos al 323-685-7131 para programarla hoy)\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Fecha <span class=\"wpcf7-form-control-wrap\" data-name=\"app-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Appointment Date\" value=\"\" type=\"date\" name=\"app-date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Tiempo <span class=\"wpcf7-form-control-wrap\" data-name=\"app-time\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Appointment Time\" value=\"\" type=\"text\" name=\"app-time\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>&nbsp;\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p> Nombre de su mascota* <span class=\"wpcf7-form-control-wrap\" data-name=\"petname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"petname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Perro o gato<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dorg\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"dorg\" value=\"Perro\" \/><span class=\"wpcf7-list-item-label\">Perro<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"dorg\" value=\"Gato\" \/><span class=\"wpcf7-list-item-label\">Gato<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Raza* <span class=\"wpcf7-form-control-wrap\" data-name=\"breed\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"breed\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Edad \/ Fecha de nacimiento * <span class=\"wpcf7-form-control-wrap\" data-name=\"age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"age\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Color* <span class=\"wpcf7-form-control-wrap\" data-name=\"color\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"color\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Sexo <span class=\"wpcf7-form-control-wrap\" data-name=\"sex\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"sex\" value=\"Macho\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Macho<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"sex\" value=\"Hembra\" \/><span class=\"wpcf7-list-item-label\">Hembra<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Esterilizado \/ castrado <span class=\"wpcf7-form-control-wrap\" data-name=\"spayed\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"spayed\" value=\"Si\" \/><span class=\"wpcf7-list-item-label\">Si<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"spayed\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Microchip # <span class=\"wpcf7-form-control-wrap\" data-name=\"mchip\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"mchip\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Nombre del m\u00e9dico \/ cl\u00ednica anterior <span class=\"wpcf7-form-control-wrap\" data-name=\"pdocter\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pdocter\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>\u00bfPodemos solicitar registros?\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"records\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"records\" value=\"Si\" \/><span class=\"wpcf7-list-item-label\">Si<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"records\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Historia de vacunaci\u00f3n<span class=\"wpcf7-form-control-wrap\" data-name=\"vhistory\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"vhistory\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Cargar archivos adjuntos (p. Ej., Im\u00e1genes de rayos X de informes de pruebas anteriores)\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"upload-file-854\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-drag-n-drop-file d-none\" aria-invalid=\"false\" type=\"file\" multiple=\"multiple\" data-name=\"upload-file-854\" data-type=\"jpeg|png|jpg|pdf|\" data-limit=\"3000000\" data-min=\"1\" data-max=\"5\" data-id=\"4290\" data-version=\"free version 1.3.8.9\" accept=\".jpeg, .png, .jpg, .pdf, .\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Adjuntos adicionales\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"upload-file-a\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-drag-n-drop-file d-none\" aria-invalid=\"false\" type=\"file\" multiple=\"multiple\" data-name=\"upload-file-a\" data-type=\"jpeg|png|jpg|pdf|\" data-limit=\"3000000\" data-min=\"1\" data-max=\"5\" data-id=\"4290\" data-version=\"free version 1.3.8.9\" accept=\".jpeg, .png, .jpg, .pdf, .\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><strong>\u00bfPodemos usar fotos de sus mascotas en las redes sociales?<br \/>\n<\/strong><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"photos\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"photos\" value=\"Si\" \/><span class=\"wpcf7-list-item-label\">Si<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"photos\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span><br \/>\n&nbsp;\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p style=\"font-size: 14px; font-style: oblique;font-weight: 600; background-color: #f8f8f8; padding: 10px;\">Yo, el abajo firmante, propietario o agente autorizado del paciente anterior autorizo \u200b\u200bpor la presente a la admisi\u00f3n (y sus asociados \/ asistentes designados) a administrar dicho tratamiento seg\u00fan sea necesario para el beneficio de este paciente. Tambi\u00e9n doy mi consentimiento para la administraci\u00f3n de los anest\u00e9sicos necesarios. Adem\u00e1s, entiendo que no se ofrece ninguna garant\u00eda de \u00e9xito en el tratamiento. Tambi\u00e9n asumo la responsabilidad financiera por todos los cargos incurridos por este paciente y acepto pagar todos esos cargos en el momento en que el paciente sea dado de alta. EL PAGO SE DEBE EN EL MOMENTO DEL SERVICIO.\n\t\t\t<\/p>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"agree-499\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"agree-499[]\" value=\"He le\u00eddo y entiendo\" \/><span class=\"wpcf7-list-item-label\">He le\u00eddo y entiendo<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p><strong>Firma del propietario preferido *<\/strong><div class=\"wpcf7-form-control-signature-global-wrap wpcf7-form-control-wrap\" data-field-id=\"signature-p\">\n\t\t\t\t<div class=\"wpcf7-form-control-signature-wrap\" style=\"width:300px;height:200px;\">\n\t\t\t\t\t<div class=\"wpcf7-form-control-signature-body\">\n\t\t\t\t\t\t<canvas id=\"wpcf7_signature-p_signature\" class=\"signature-p\"><\/canvas>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpcf7-form-control-clear-wrap\">\n\t\t\t\t\t<input id=\"wpcf7_signature-p_clear\" type=\"button\" value=\"Clear\"\/>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<span class=\"wpcf7-form-control-wrap wpcf7-form-control-signature-input-wrap signature-p\">\n\t\t\t\t  <input aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"hidden\" name=\"signature-p\" id=\"wpcf7_input_signature-p\" class=\"wpcf7-form-control wpcf7-signature\" \/><input type=\"hidden\" name=\"signature-p-attachment\" id=\"wpcf7_input_signature-p_attachment\" class=\"wpcf7-form-control wpcf7-signature\" \/><input type=\"hidden\" name=\"signature-p-inline\" id=\"wpcf7_input_signature-p_inline\" class=\"wpcf7-form-control wpcf7-signature\" \/>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t\t\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Fecha de hoy* <span class=\"wpcf7-form-control-wrap\" data-name=\"date-psignature\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-psignature\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p><strong>Firma del propietario secundario*<br \/>\n<\/strong><div class=\"wpcf7-form-control-signature-global-wrap wpcf7-form-control-wrap\" data-field-id=\"signature-s\">\n\t\t\t\t<div class=\"wpcf7-form-control-signature-wrap\" style=\"width:300px;height:200px;\">\n\t\t\t\t\t<div class=\"wpcf7-form-control-signature-body\">\n\t\t\t\t\t\t<canvas id=\"wpcf7_signature-s_signature\" class=\"signature-s\"><\/canvas>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpcf7-form-control-clear-wrap\">\n\t\t\t\t\t<input id=\"wpcf7_signature-s_clear\" type=\"button\" value=\"Clear\"\/>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<span class=\"wpcf7-form-control-wrap wpcf7-form-control-signature-input-wrap signature-s\">\n\t\t\t\t  <input aria-invalid=\"false\" value=\"\" type=\"hidden\" name=\"signature-s\" id=\"wpcf7_input_signature-s\" class=\"wpcf7-form-control wpcf7-signature\" \/><input type=\"hidden\" name=\"signature-s-attachment\" id=\"wpcf7_input_signature-s_attachment\" class=\"wpcf7-form-control wpcf7-signature\" \/><input type=\"hidden\" name=\"signature-s-inline\" id=\"wpcf7_input_signature-s_inline\" class=\"wpcf7-form-control wpcf7-signature\" \/>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t\t\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Fecha de hoy* <span class=\"wpcf7-form-control-wrap\" data-name=\"date-ssignature\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-ssignature\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>&nbsp;\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"claro\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\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<div class=\"elementor-element elementor-element-7ed071cf elementor-widget elementor-widget-spacer\" data-id=\"7ed071cf\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-32e4a25b elementor-widget elementor-widget-spacer\" data-id=\"32e4a25b\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div 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