{"id":305,"date":"2021-04-06T18:57:51","date_gmt":"2021-04-06T18:57:51","guid":{"rendered":"http:\/\/fieldschiropractic.splashclients.com\/?page_id=305"},"modified":"2021-05-26T18:15:48","modified_gmt":"2021-05-26T18:15:48","slug":"schedule-appointment","status":"publish","type":"page","link":"https:\/\/www.fieldschiro.com\/schedule-appointment","title":{"rendered":"Request Appointment"},"content":{"rendered":"\n<p>Improve your joint mobility and alleviate inflammation, schedule your chiropractic consultation today!<\/p>\n\n\n<div class=\"frm_forms \" id=\"frm_form_7_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_pro_form \" id=\"form_scheduleappointment\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"7\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_7\" id=\"frm_hide_fields_7\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"scheduleappointment\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_7\" name=\"frm_submit_entry_7\" value=\"44885fcf9c\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/305\" \/><div class=\"row\">\r\n<div id=\"frm_field_40_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_lnds9\">First Name*<\/label>\r\n    <input type=\"text\" id=\"field_lnds9\" name=\"item_meta[40]\" value=\"\"  data-reqmsg=\"First Name* cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n    \r\n<\/div>\n<div id=\"frm_field_58_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_e6d4b\" id=\"field_e6d4b_label\" class=\"frm_primary_label\">Middle Initial\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e6d4b\" name=\"item_meta[58]\" value=\"\"  data-reqmsg=\"Middle Initial 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_41_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_azozy\">Last Name*<\/label>\r\n    <input type=\"text\" id=\"field_azozy\" name=\"item_meta[41]\" value=\"\"  data-reqmsg=\"Last Name* cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n    \r\n<\/div>\n<div id=\"frm_field_59_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_9pw9d\" id=\"field_9pw9d_label\" class=\"frm_primary_label\">DOB (MM\/DD\/YYYY)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9pw9d\" name=\"item_meta[59]\" value=\"\"  data-reqmsg=\"DOB (MM\/DD\/YYYY) cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_42_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_m693e\">Email Address*<\/label>\r\n    <input type=\"email\" id=\"field_m693e\" name=\"item_meta[42]\" value=\"\"  data-reqmsg=\"Email Address* cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n    \r\n<\/div>\n<div id=\"frm_field_43_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_b31a0\">Phone Number*<\/label>\r\n    <input type=\"text\" id=\"field_b31a0\" name=\"item_meta[43]\" value=\"\"  data-frmmask=\"(999) 999-9999\" data-reqmsg=\"Phone Number* cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"form-control\" aria-invalid=\"false\" pattern=\"\\(\\d\\d\\d\\) \\d\\d\\d-\\d\\d\\d\\d$\"  \/>\r\n    \r\n<\/div>\n<div id=\"frm_field_44_container\" class=\"col-sm-6 col-lg-3 input-box calendar-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_pb92x\">Preferred Date 1*<\/label>\r\n    <input type=\"text\" id=\"field_pb92x\" name=\"item_meta[44]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"Preferred Date 1* cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"form-control frm_date\" aria-invalid=\"false\"  \/><img decoding=\"async\" src=\"\/wp-content\/themes\/splashomnimediatheme\/images\/img-calendar.png\" alt=\"calendar\">\r\n    \r\n<\/div>\n<div id=\"frm_field_53_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_vt98v\">Preferred Time of Day 1*<\/label>\r\n    <div class=\"selectbox\">\r\n    \t\t<select name=\"item_meta[53]\" id=\"field_vt98v\"  data-placeholder=\"-Please Select-\"  placeholder=\"-Please Select-\" data-reqmsg=\"Preferred Time of Day 1* cannot be blank.\" aria-required=\"true\" data-invmsg=\"Preferred Time of Day 1* is invalid\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">-Please Select-<\/option><option  value=\"07:30 am\">07:30 am<\/option><option  value=\"08:00 am\">08:00 am<\/option><option  value=\"08:30 am\">08:30 am<\/option><option  value=\"09:00 am\">09:00 am<\/option><option  value=\"09:30 am\">09:30 am<\/option><option  value=\"10:00 am\">10:00 am<\/option><option  value=\"10:30 am\">10:30 am<\/option><option  value=\"11:00 am\">11:00 am<\/option><option  value=\"11:30 am\">11:30 am<\/option><option  value=\"12:00 pm\">12:00 pm<\/option><option  value=\"12:30 pm\">12:30 pm<\/option><option  value=\"01:00 pm\">01:00 pm<\/option><option  value=\"01:30 pm\">01:30 pm<\/option><option  value=\"02:00 pm\">02:00 pm<\/option><option  value=\"02:30 pm\">02:30 pm<\/option><option  value=\"03:00 pm\">03:00 pm<\/option><option  value=\"03:30 pm\">03:30 pm<\/option><option  value=\"04:00 pm\">04:00 pm<\/option><option  value=\"04:30 pm\">04:30 pm<\/option><option  value=\"05:00 pm\">05:00 pm<\/option><option  value=\"05:30 pm\">05:30 pm<\/option><option  value=\"06:00 pm\">06:00 pm<\/option>\t<\/select>\n\t\r\n    <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_46_container\" class=\"col-sm-6 col-lg-3 input-box calendar-box  frm_top_container\">\r\n    <label for=\"field_np3qe\">Preferred Date 2<\/label>\r\n    <input type=\"text\" id=\"field_np3qe\" name=\"item_meta[46]\" value=\"\"  maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"form-control frm_date\" aria-invalid=\"false\"  \/><img decoding=\"async\" src=\"\/wp-content\/themes\/splashomnimediatheme\/images\/img-calendar.png\" alt=\"calendar\">\r\n    \r\n<\/div>\n<div id=\"frm_field_54_container\" class=\"col-sm-6 col-lg-3 input-box  frm_top_container\">\r\n    <label for=\"field_w2dwa\">Preferred Time of Day 2<\/label>\r\n     <div class=\"selectbox\">\r\n    \t\t<select name=\"item_meta[54]\" id=\"field_w2dwa\"  data-placeholder=\"-Please Select-\"  placeholder=\"-Please Select-\" data-invmsg=\"Preferred Time of Day 2 is invalid\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">-Please Select-<\/option><option  value=\"07:30 am\">07:30 am<\/option><option  value=\"08:00 am\">08:00 am<\/option><option  value=\"08:30 am\">08:30 am<\/option><option  value=\"09:00 am\">09:00 am<\/option><option  value=\"09:30 am\">09:30 am<\/option><option  value=\"10:00 am\">10:00 am<\/option><option  value=\"10:30 am\">10:30 am<\/option><option  value=\"11:00 am\">11:00 am<\/option><option  value=\"11:30 am\">11:30 am<\/option><option  value=\"12:00 pm\">12:00 pm<\/option><option  value=\"12:30 pm\">12:30 pm<\/option><option  value=\"01:00 pm\">01:00 pm<\/option><option  value=\"01:30 pm\">01:30 pm<\/option><option  value=\"02:00 pm\">02:00 pm<\/option><option  value=\"02:30 pm\">02:30 pm<\/option><option  value=\"03:00 pm\">03:00 pm<\/option><option  value=\"03:30 pm\">03:30 pm<\/option><option  value=\"04:00 pm\">04:00 pm<\/option><option  value=\"04:30 pm\">04:30 pm<\/option><option  value=\"05:00 pm\">05:00 pm<\/option><option  value=\"05:30 pm\">05:30 pm<\/option><option  value=\"06:00 pm\">06:00 pm<\/option>\t<\/select>\n\t\r\n    <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_48_container\" class=\"col-sm-6 col-lg-3 input-box  frm_top_container\">\r\n    <label for=\"field_gtlkw\">Location<\/label>\r\n    <div class=\"selectbox\">\r\n    \t\t<select name=\"item_meta[48]\" id=\"field_gtlkw\"  data-placeholder=\"-Please Select-\"  placeholder=\"-Please Select-\" data-invmsg=\"Location is invalid\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">-Please Select-<\/option><option  value=\"Downtown Columbia\">Downtown Columbia<\/option>\t<\/select>\n\t\r\n    <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_55_container\" class=\"col-sm-6 col-lg-3 input-box  frm_top_container\">\r\n    <label for=\"field_qn4vx\">Preferred Provider<\/label>\r\n    <div class=\"selectbox\">\r\n    \t\t<select name=\"item_meta[55]\" id=\"field_qn4vx\"  data-placeholder=\"-Please Select-\"  placeholder=\"-Please Select-\" data-invmsg=\"Preferred Provider is invalid\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">-Please Select-<\/option><option  value=\"Dr. Chapin Jennings, DC\">Dr. Chapin Jennings, DC<\/option><option  value=\"Dr. Morgan Pough, DC\">Dr. Morgan Pough, DC<\/option><option  value=\"Dr. Clifford Morrow, DC\">Dr. Clifford Morrow, DC<\/option>\t<\/select>\n\t\r\n    <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_56_container\" class=\"col-sm-6 col-lg-3 input-box  frm_top_container\">\r\n    <label for=\"field_c1wup\">Payment Type<\/label>\r\n    <div class=\"selectbox\">\r\n    \t\t<select name=\"item_meta[56]\" id=\"field_c1wup\"  data-placeholder=\"-Please Select-\"  placeholder=\"-Please Select-\" data-invmsg=\"Payment Type is invalid\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">-Please Select-<\/option><option  value=\"Insurance\">Insurance<\/option><option  value=\"Self-Pay\">Self-Pay<\/option>\t<\/select>\n\t\r\n    <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_49_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_3t46x\">How Did You Hear About Us?*<\/label>\r\n    <div class=\"selectbox\">\r\n    \t\t<select name=\"item_meta[49]\" id=\"field_3t46x\"  data-placeholder=\"-Please Select-\"  placeholder=\"-Please Select-\" data-reqmsg=\"How Did You Hear About Us?* cannot be blank.\" aria-required=\"true\" data-invmsg=\"How Did You Hear About Us?* is invalid\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">-Please Select-<\/option><option  value=\"Online Search\">Online Search<\/option><option  value=\"Online Ad\">Online Ad<\/option><option  value=\"TV Commercial\">TV Commercial<\/option><option  value=\"Radio Commercial\">Radio Commercial<\/option><option  value=\"Mail Piece\">Mail Piece<\/option><option  value=\"Print Ad\">Print Ad<\/option><option  value=\"Social Media\">Social Media<\/option><option  value=\"Word of Mouth\">Word of Mouth<\/option><option  value=\"Other\">Other<\/option>\t<\/select>\n\t\r\n    <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_57_container\" class=\"col-sm-6 col-lg-6 input-box  frm_top_container\">\r\n    <label for=\"field_8dbbm\">Have you ever been seen by Fields Chiropractic?<\/label>\r\n    <div class=\"selectbox\">\r\n    \t\t<select name=\"item_meta[57]\" id=\"field_8dbbm\"  data-placeholder=\"-Please Select-\"  data-frmval=\"YES\" data-frmplaceholder=\"-Please Select-\" placeholder=\"-Please Select-\" data-invmsg=\"Have you ever been seen by Fields Chiropractic? is invalid\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t<option  class=\"frm-select-placeholder\" value=\"\" data-placeholder=\"true\">-Please Select-<\/option><option  value=\"YES\" selected='selected'>YES<\/option><option  value=\"NO\">NO<\/option>\t<\/select>\n\t\r\n    <\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_50_container\" class=\"col-12 input-box  frm_top_container\">\r\n   <label for=\"field_rt1ja\">Comments<\/label>\r\n    <textarea name=\"item_meta[50]\" id=\"field_rt1ja\" rows=\"5\"  data-invmsg=\"Comments is invalid\" class=\"form-control\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n<\/div>\r\n\n<div id=\"frm_field_52_container\" class=\"col-12 form-box\">\n<p>This is a request form and not a guarantee of appointment. We will contact you to confirm your actual appointment. <\/p>\n<\/div>\n<div id=\"frm_field_61_container\" class=\"frm_form_field form-field  frm_none_container\">\n    <label for=\"g-recaptcha-response\" id=\"field_qv6wh_label\" class=\"frm_primary_label\">Captcha\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n    <\/label>\n    <div  id=\"field_qv6wh\" class=\"frm-g-recaptcha\" data-sitekey=\"6LeU6_8nAAAAADONa-JvbxQZw7HdxKxalSFVPskq\" data-size=\"invisible\" data-theme=\"light\"><\/div>\n    \n    \n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__661eae238c870\">\n\t\t\t\t<label for=\"frm_email_7\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_7\" type=\"text\" class=\"frm_verify\" name=\"frm__661eae238c870\" value=\"\" autocomplete=\"false\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"vTqjkAtvH2R08edLhz7lTcT6FXfh5K49tR6IB9MZRkI=\" \/><div class=\"col clearfix box-btm\">\r\n\t<div class=\"captcha-img\">\r\n\t<\/div>\r\n\t<button class=\"btn btn-blue hvr-sweep-to-bottom\" type=\"submit\">Submit<\/button>\r\n<\/div>\r\n<\/div><!--row--><\/div>\n<\/fieldset>\n<\/div>\n<script type=\"text\/javascript\">var input = document.createElement('input');\n    input.setAttribute('type', 'hidden');\n    input.setAttribute('name', 'ct_checkjs_frm');\n    input.setAttribute('value', '1962557637');\n    for (i = 0; i < document.forms.length; i++) {\n        if (typeof document.forms[i].id == 'string'){\n\t\t\tif(document.forms[i].id.search('form_scheduleappointment') != -1) {\n            document.forms[i].appendChild(input);\n\t\t\t}\n        }\n    }<\/script>\n<p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"134\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Improve your joint mobility and alleviate inflammation, schedule your chiropractic consultation today!<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"ep_exclude_from_search":false,"footnotes":""},"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Request Appointment - Fields Chiropractic | Columbia, SC<\/title>\n<meta name=\"description\" content=\"Schedule a chiropractic appointment with Fields Chiropractic today to improve joint mobility and alleviate inflammation. 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