{"id":36,"date":"2020-08-06T12:58:00","date_gmt":"2020-08-06T12:58:00","guid":{"rendered":"http:\/\/fieldschiropractic.splashclients.com\/?page_id=36"},"modified":"2021-05-26T18:17:43","modified_gmt":"2021-05-26T18:17:43","slug":"physician-referrals","status":"publish","type":"page","link":"https:\/\/www.fieldschiro.com\/physician-referrals","title":{"rendered":"Physician Referrals"},"content":{"rendered":"\n<p>Our team is here to offer your patients the highest quality chiropractic care! With same day appointments, top of the line equipment and knowledgable doctors you can feel confident referring your patients. We have two convenient locations, one in Downtown Columbia and one Northeast Columbia SC.<\/p>\n\n\n\n<p>For more information about how we can help your patients find relief, contact the team at Fields Chiropractic.&nbsp;<\/p>\n\n\n<div class=\"frm_forms \" id=\"frm_form_6_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_pro_form \" id=\"form_physicianreferrals\"  >\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=\"6\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_6\" id=\"frm_hide_fields_6\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"physicianreferrals\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_6\" name=\"frm_submit_entry_6\" value=\"ca0ff1a2ad\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/36\" \/><div class=\"row\">\r\n<div id=\"frm_field_32_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_v8ol8\" id=\"field_v8ol8_label\">Patient's First Name*<\/label>\r\n    <input type=\"text\" id=\"field_v8ol8\" name=\"item_meta[32]\" value=\"\"  data-reqmsg=\"Patient&#039;s 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_33_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_plktm\" id=\"field_plktm_label\">Patient's Last Name*<\/label>\r\n    <input type=\"text\" id=\"field_plktm\" name=\"item_meta[33]\" value=\"\"  data-reqmsg=\"Patient&#039;s 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_37_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n     <label for=\"field_bcr8j\" id=\"field_bcr8j_label\">Patient's Email Address*<\/label>\r\n    <input type=\"email\" id=\"field_bcr8j\" name=\"item_meta[37]\" value=\"\"  data-reqmsg=\"Patient&#039;s 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_36_container\" class=\"col-sm-6 col-lg-3 input-box  frm_required_field frm_top_container\">\r\n     <label for=\"field_sul21\" id=\"field_sul21_label\">Patient's Phone Number*<\/label>\r\n    <input type=\"text\" id=\"field_sul21\" name=\"item_meta[36]\" value=\"\"  data-frmmask=\"(999) 999-9999\" data-reqmsg=\"Patient&#039;s 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_34_container\" class=\"col-sm-6 col-lg-6 input-box  frm_required_field frm_top_container\">\r\n    <label for=\"field_d0qpe\" id=\"field_d0qpe_label\">Physician's First Name*<\/label>\r\n    <input type=\"text\" id=\"field_d0qpe\" name=\"item_meta[34]\" value=\"\"  data-reqmsg=\"Physician&#039;s 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_35_container\" class=\"col-sm-6 col-lg-6 input-box  frm_required_field frm_top_container\">\r\n     <label for=\"field_g12et\" id=\"field_g12et_label\">Physician's Last Name*<\/label>\r\n    <input type=\"text\" id=\"field_g12et\" name=\"item_meta[35]\" value=\"\"  data-reqmsg=\"Physician&#039;s 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_38_container\" class=\"col-12 input-box  frm_top_container\">\r\n     <label for=\"field_41869a\" id=\"field_41869a_label\">Physician Referral Slip<\/label>\r\n    <input type=\"hidden\" name=\"item_meta[38]\"  value=\"\" data-frmfile=\"38\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file38_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file38\" id=\"field_41869a\"\n\t\t\t data-invmsg=\"File Upload is invalid\" class=\"form-control\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 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Drop a file here or click to upload. Maximum file size: 104.86MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Physician Referral Slip. Choose File. Maximum file size: 104.86MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 104.86MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\r\n    \r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"col-12 input-box  frm_top_container\">\r\n     <label for=\"field_vq16c\" id=\"field_vq16c_label\">Comments<\/label>\r\n    <textarea name=\"item_meta[39]\" id=\"field_vq16c\" rows=\"5\"  data-invmsg=\"Comments is invalid\" class=\"form-control\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n<\/div>\n<div id=\"frm_field_62_container\" class=\"frm_form_field form-field  frm_none_container\">\n    <label for=\"g-recaptcha-response\" id=\"field_eyg6q_label\" class=\"frm_primary_label\">Captcha\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n    <\/label>\n    <div  id=\"field_eyg6q\" 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_6\" >\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_6\" 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=\"vTqjkAtvH2R08edLhz7lTQEnBdF4\/wEyv6UjSjeKSTY=\" \/><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', '667867770');\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_physicianreferrals') != -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=\"222\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Our team is here to offer your patients the highest quality chiropractic care! With same day appointments, top of the line equipment and knowledgable doctors you can feel confident referring your patients. We have two convenient locations, one in Downtown Columbia and one Northeast Columbia SC. For more information about how we can help your [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-inner-page.php","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>Physician Referrals - Fields Chiropractic | Columbia, SC<\/title>\n<meta name=\"description\" content=\"You can rely on Fields Chiropractic in Columbia, SC to provide you with immediate chiropractic or medical care if you have suffered a personal injury.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.fieldschiro.com\/physician-referrals\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Physician Referrals - 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