{"id":155,"date":"2021-05-25T15:12:43","date_gmt":"2021-05-25T19:12:43","guid":{"rendered":"https:\/\/myskincareclub.com\/forms\/?page_id=155"},"modified":"2021-05-26T09:59:44","modified_gmt":"2021-05-26T13:59:44","slug":"covid-vaccination","status":"publish","type":"page","link":"https:\/\/myskincareclub.com\/forms\/covid-vaccination\/","title":{"rendered":"COVID VACCINATION"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"155\" class=\"elementor elementor-155\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9cefc36 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9cefc36\" data-element_type=\"section\" data-e-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-top-column elementor-element elementor-element-1d0ba06\" data-id=\"1d0ba06\" data-element_type=\"column\" data-e-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-42f5749 elementor-widget elementor-widget-heading\" data-id=\"42f5749\" data-element_type=\"widget\" data-e-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\">COVID VACCINATION FORM<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c6b21aa elementor-widget elementor-widget-wp-widget-frm_show_form\" data-id=\"c6b21aa\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wp-widget-frm_show_form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"frm_form_widget\"><div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_11_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_covidvacc\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">CovidVacc<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"11\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_11\" id=\"frm_hide_fields_11\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"covidvacc\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_11\" name=\"frm_submit_entry_11\" value=\"7304d70deb\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/forms\/wp-json\/wp\/v2\/pages\/155\" \/><div id=\"frm_field_166_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half frm_first\">\r\n    <label for=\"field_6qxm6\" id=\"field_6qxm6_label\" class=\"frm_primary_label\">FirstName\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6qxm6\" name=\"item_meta[166]\" value=\"\"  data-reqmsg=\"FirstName cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_167_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half frm_alignright\">\r\n    <label for=\"field_p18n7\" id=\"field_p18n7_label\" class=\"frm_primary_label\">LastName\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_p18n7\" name=\"item_meta[167]\" value=\"\"  data-reqmsg=\"LastName cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_157_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_1esi2_label\" class=\"frm_primary_label\">Did you receive the COVID vaccine?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_1esi2_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_157-0\">\t\t\t<label  for=\"field_1esi2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[157]\" id=\"field_1esi2-0\" value=\"Yes\"\n\t\t data-invmsg=\"Did you receive the COVID vaccine? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_157-1\">\t\t\t<label  for=\"field_1esi2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[157]\" id=\"field_1esi2-1\" value=\"No\"\n\t\t data-invmsg=\"Did you receive the COVID vaccine? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_158_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2gj1b\" id=\"field_2gj1b_label\" class=\"frm_primary_label\">When did you receive the first vaccination?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2gj1b\" name=\"item_meta[158]\" value=\"\"  maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_159_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_v0xcw\" id=\"field_v0xcw_label\" class=\"frm_primary_label\">When did you receive the second vaccination?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_v0xcw\" name=\"item_meta[159]\" value=\"\"  maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_160_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_lit0x_label\" class=\"frm_primary_label\">Which vaccine did you receive (Pfizer or Moderna)?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_lit0x_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_160-0\">\t\t\t<label  for=\"field_lit0x-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[160]\" id=\"field_lit0x-0\" value=\"Pfizer\"\n\t\t data-invmsg=\"Which vaccine did you receive (Pfizer or Moderna)? is invalid\"   \/> Pfizer<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_160-1\">\t\t\t<label  for=\"field_lit0x-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[160]\" id=\"field_lit0x-1\" value=\"Moderna\"\n\t\t data-invmsg=\"Which vaccine did you receive (Pfizer or Moderna)? is invalid\"   \/> Moderna<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_165_container\" class=\"frm_form_field  frm_html_container form-field\">I acknowledge herby that I can earliest receive Botox\/Dysport injections two (2) weeks AFTER the first COVID vaccination and NOT less than two (2)<br \/>\nweeks BEFORE second vaccination.Dermal Filler injections can be received earliest two (2) weeks AFTER the first COVID vaccination and<br \/>\nNOT less than two (2) weeks BEFORE second vaccination. Therefore, I am responsible to postpone my appointment for such treatment accordingly.<\/div>\n<div id=\"frm_field_161_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_krd82\" id=\"field_krd82_label\" class=\"frm_primary_label\">Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id='sigPad161' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#BFC3C8;--bg-color:#ffffff;--active:#579AF6;--inactive:#eaeaea;--active-text:#ffffff;--inactive-text:#3f4b5b;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 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data-fieldname=\"item_meta[161]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[161][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_162_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_tp5in\" id=\"field_tp5in_label\" class=\"frm_primary_label\">Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_tp5in\" name=\"item_meta[162]\" value=\"04\/14\/2026\"  readonly=\"readonly\"  maxlength=\"10\" data-frmval=\"04\/14\/2026\" data-reqmsg=\"Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_236_container\">\n\t\t\t<label for=\"field_3bwfv\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_3bwfv\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[236]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"xgbTmpRrvI+5BluaOEpLIrmP2q3GG2NAsldbgtVnnuUjS3KpEZyml5XwyM3Uji75\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n<\/div>\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>\n\t\t","protected":false},"excerpt":{"rendered":"<p>COVID VACCINATION FORM<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-155","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/myskincareclub.com\/forms\/wp-json\/wp\/v2\/pages\/155","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myskincareclub.com\/forms\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/myskincareclub.com\/forms\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/myskincareclub.com\/forms\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myskincareclub.com\/forms\/wp-json\/wp\/v2\/comments?post=155"}],"version-history":[{"count":8,"href":"https:\/\/myskincareclub.com\/forms\/wp-json\/wp\/v2\/pages\/155\/revisions"}],"predecessor-version":[{"id":227,"href":"https:\/\/myskincareclub.com\/forms\/wp-json\/wp\/v2\/pages\/155\/revisions\/227"}],"wp:attachment":[{"href":"https:\/\/myskincareclub.com\/forms\/wp-json\/wp\/v2\/media?parent=155"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}