{"id":478,"date":"2025-09-15T09:40:51","date_gmt":"2025-09-15T09:40:51","guid":{"rendered":"https:\/\/caribbeanmedicalsolution.com\/?page_id=478"},"modified":"2025-09-16T14:30:32","modified_gmt":"2025-09-16T14:30:32","slug":"form","status":"publish","type":"page","link":"https:\/\/caribbeanmedicalsolution.com\/es\/form\/","title":{"rendered":"Form"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_code _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<style id=\"wpforms-css-vars-469\">\n\t\t\t\t#wpforms-469 {\n\t\t\t\t--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-469\"><form id=\"wpforms-form-469\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"469\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/478\" data-token=\"f9dc39066da41f425ecfbf6cdf73abb8\" data-token-time=\"1776716012\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-469-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Full name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-469-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-469-field_0-error\" required><label for=\"wpforms-469-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-469-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-469-field_0-last-error\" required><label for=\"wpforms-469-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-469-field_8-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_8\">Country of residence <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-469-field_8\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-469-field_8-error\" aria-describedby=\"wpforms-469-field_8-description\" required><div id=\"wpforms-469-field_8-description\" class=\"wpforms-field-description\">USA, Dominican Republic, etc.<\/div><\/div>\t\t<div id=\"wpforms-469-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-469-field_3\" >for time Requested<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-469-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-469-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-469-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-469-field_1-error\" aria-describedby=\"wpforms-469-field_1-description\" required><div id=\"wpforms-469-field_1-description\" class=\"wpforms-field-description\">your@email.com<\/div><\/div><div id=\"wpforms-469-field_10-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_10\">Phone (WhatsApp) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-469-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" step=\"any\" aria-errormessage=\"wpforms-469-field_10-error\" aria-describedby=\"wpforms-469-field_10-description\" required><div id=\"wpforms-469-field_10-description\" class=\"wpforms-field-description\">+1809000000<\/div><\/div><div id=\"wpforms-469-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Type of Service Required <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-469-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Dentistry (implants, veneers, orthodontics)\" aria-errormessage=\"wpforms-469-field_20_1-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_1\">Dentistry (implants, veneers, orthodontics)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_2\" name=\"wpforms[fields][20][]\" value=\"Ophthalmology (cataracts, LASIK, diagnostics)\" aria-errormessage=\"wpforms-469-field_20_2-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_2\">Ophthalmology (cataracts, LASIK, diagnostics)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_3\" name=\"wpforms[fields][20][]\" value=\"Oncology (chemotherapy, radiotherapy, diagnostics)\" aria-errormessage=\"wpforms-469-field_20_3-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_3\">Oncology (chemotherapy, radiotherapy, diagnostics)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_4\" name=\"wpforms[fields][20][]\" value=\"Orthopedics (hip, knee, spine)\" aria-errormessage=\"wpforms-469-field_20_4-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_4\">Orthopedics (hip, knee, spine)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_5\" name=\"wpforms[fields][20][]\" value=\"Bariatric surgery\" aria-errormessage=\"wpforms-469-field_20_5-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_5\">Bariatric surgery<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_6\" name=\"wpforms[fields][20][]\" value=\"Fertility\" aria-errormessage=\"wpforms-469-field_20_6-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_6\">Fertility<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_7\" name=\"wpforms[fields][20][]\" value=\"Executive \/ Preventive check-up (e.g., full-body MRI)\" aria-errormessage=\"wpforms-469-field_20_7-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_7\">Executive \/ Preventive check-up (e.g., full-body MRI)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_8\" name=\"wpforms[fields][20][]\" value=\"Wellness and recovery (spa, physiotherapy)\" aria-errormessage=\"wpforms-469-field_20_8-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_8\">Wellness and recovery (spa, physiotherapy)<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_9\" name=\"wpforms[fields][20][]\" value=\"Other (please specify)\" aria-errormessage=\"wpforms-469-field_20_9-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_9\">Other (please specify)<\/label><\/li><\/ul><div id=\"wpforms-469-field_20-description\" class=\"wpforms-field-description\">You can select one or more.<\/div><\/fieldset><\/div><div id=\"wpforms-469-field_18-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">Reason for Consultation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-469-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_18_1\" name=\"wpforms[fields][18][]\" value=\"First time (exploring options)\" aria-errormessage=\"wpforms-469-field_18_1-error\" aria-describedby=\"wpforms-469-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_18_1\">First time (exploring options)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_18_2\" name=\"wpforms[fields][18][]\" value=\"Second medical opinion\" aria-errormessage=\"wpforms-469-field_18_2-error\" aria-describedby=\"wpforms-469-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_18_2\">Second medical opinion<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_18_3\" name=\"wpforms[fields][18][]\" value=\"Procedure already indicated by physician\" aria-errormessage=\"wpforms-469-field_18_3-error\" aria-describedby=\"wpforms-469-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_18_3\">Procedure already indicated by physician<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_18_4\" name=\"wpforms[fields][18][]\" value=\"Preventive consultation\" aria-errormessage=\"wpforms-469-field_18_4-error\" aria-describedby=\"wpforms-469-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_18_4\">Preventive consultation<\/label><\/li><\/ul><div id=\"wpforms-469-field_18-description\" class=\"wpforms-field-description\">You can select one or more.<\/div><\/fieldset><\/div><div id=\"wpforms-469-field_12-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Insurance Coverage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-469-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-469-field_12_1\" name=\"wpforms[fields][12]\" value=\"Yes, I have international insurance\" aria-errormessage=\"wpforms-469-field_12_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_12_1\">Yes, I have international insurance<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-469-field_12_2\" name=\"wpforms[fields][12]\" value=\"No, I will pay privately\" aria-errormessage=\"wpforms-469-field_12_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_12_2\">No, I will pay privately<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-469-field_22-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Additional Services Requested<\/legend><ul id=\"wpforms-469-field_22\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_22_1\" name=\"wpforms[fields][22][]\" value=\"Local transfers and logistics\" aria-errormessage=\"wpforms-469-field_22_1-error\" aria-describedby=\"wpforms-469-field_22-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_22_1\">Local transfers and logistics<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_22_2\" name=\"wpforms[fields][22][]\" value=\"Hotel \/ recovery accommodation\" aria-errormessage=\"wpforms-469-field_22_2-error\" aria-describedby=\"wpforms-469-field_22-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_22_2\">Hotel \/ recovery accommodation<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_22_3\" name=\"wpforms[fields][22][]\" value=\"Personalized support (concierge)\" aria-errormessage=\"wpforms-469-field_22_3-error\" aria-describedby=\"wpforms-469-field_22-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_22_3\">Personalized support (concierge)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_22_4\" name=\"wpforms[fields][22][]\" value=\"Tourist and wellness experiences\" aria-errormessage=\"wpforms-469-field_22_4-error\" aria-describedby=\"wpforms-469-field_22-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_22_4\">Tourist and wellness experiences<\/label><\/li><\/ul><div id=\"wpforms-469-field_22-description\" class=\"wpforms-field-description\">(Concierge support is always included in your package.)<\/div><\/fieldset><\/div><div id=\"wpforms-469-field_15-container\" class=\"wpforms-field wpforms-field-payment-select wpforms-field-select-style-classic\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_15\">Preferred Contact Method<\/label><select id=\"wpforms-469-field_15\" class=\"wpforms-payment-price wpforms-field-medium\" name=\"wpforms[fields][15]\"><option value=\"1\" data-amount=\"0.00\" >Email<\/option><option value=\"2\" data-amount=\"0.00\" >Whatsapp<\/option><option value=\"3\" data-amount=\"0.00\" >Phone Call<\/option><\/select><\/div><div id=\"wpforms-469-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_16\">Preferred date (optional)<\/label><input type=\"text\" id=\"wpforms-469-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-469-field_16-error\" aria-describedby=\"wpforms-469-field_16-description\" ><div id=\"wpforms-469-field_16-description\" class=\"wpforms-field-description\">dd-mm-yy<\/div><\/div><div id=\"wpforms-469-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_17\">Preferred time (optional)<\/label><input type=\"text\" id=\"wpforms-469-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-469-field_17-error\" aria-describedby=\"wpforms-469-field_17-description\" ><div id=\"wpforms-469-field_17-description\" class=\"wpforms-field-description\">00:00<\/div><\/div><div id=\"wpforms-469-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_2\">Relevant Medical Information<\/label><textarea id=\"wpforms-469-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-469-field_2-error\" aria-describedby=\"wpforms-469-field_2-description\" ><\/textarea><div id=\"wpforms-469-field_2-description\" class=\"wpforms-field-description\">Tell us briefly about your case, previous diagnoses, allergies, current medications or medical instructions : (Do not share highly sensitive information at this stage)]<\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-469-field_3-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-469-field_3-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-469-field_3-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"469\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/pages\/478\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-469\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Request my personalized quote\" aria-live=\"assertive\" value=\"wpforms-submit\">Request my personalized quote<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/caribbeanmedicalsolution.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<style id=\"wpforms-css-vars-469\">\n\t\t\t\t#wpforms-469 {\n\t\t\t\t--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-469\"><form id=\"wpforms-form-469\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"469\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/478\" data-token=\"f9dc39066da41f425ecfbf6cdf73abb8\" data-token-time=\"1776716012\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-469-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Full name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-469-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-469-field_0-error\" required><label for=\"wpforms-469-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-469-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-469-field_0-last-error\" required><label for=\"wpforms-469-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-469-field_8-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_8\">Country of residence <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-469-field_8\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-469-field_8-error\" aria-describedby=\"wpforms-469-field_8-description\" required><div id=\"wpforms-469-field_8-description\" class=\"wpforms-field-description\">USA, Dominican Republic, etc.<\/div><\/div><div id=\"wpforms-469-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-469-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-469-field_1-error\" aria-describedby=\"wpforms-469-field_1-description\" required><div id=\"wpforms-469-field_1-description\" class=\"wpforms-field-description\">your@email.com<\/div><\/div><div id=\"wpforms-469-field_10-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_10\">Phone (WhatsApp) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-469-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" step=\"any\" aria-errormessage=\"wpforms-469-field_10-error\" aria-describedby=\"wpforms-469-field_10-description\" required><div id=\"wpforms-469-field_10-description\" class=\"wpforms-field-description\">+1809000000<\/div><\/div><div id=\"wpforms-469-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Type of Service Required <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-469-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Dentistry (implants, veneers, orthodontics)\" aria-errormessage=\"wpforms-469-field_20_1-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_1\">Dentistry (implants, veneers, orthodontics)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_2\" name=\"wpforms[fields][20][]\" value=\"Ophthalmology (cataracts, LASIK, diagnostics)\" aria-errormessage=\"wpforms-469-field_20_2-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_2\">Ophthalmology (cataracts, LASIK, diagnostics)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_3\" name=\"wpforms[fields][20][]\" value=\"Oncology (chemotherapy, radiotherapy, diagnostics)\" aria-errormessage=\"wpforms-469-field_20_3-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_3\">Oncology (chemotherapy, radiotherapy, diagnostics)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_4\" name=\"wpforms[fields][20][]\" value=\"Orthopedics (hip, knee, spine)\" aria-errormessage=\"wpforms-469-field_20_4-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_4\">Orthopedics (hip, knee, spine)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_5\" name=\"wpforms[fields][20][]\" value=\"Bariatric surgery\" aria-errormessage=\"wpforms-469-field_20_5-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_5\">Bariatric surgery<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_6\" name=\"wpforms[fields][20][]\" value=\"Fertility\" aria-errormessage=\"wpforms-469-field_20_6-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_6\">Fertility<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_7\" name=\"wpforms[fields][20][]\" value=\"Executive \/ Preventive check-up (e.g., full-body MRI)\" aria-errormessage=\"wpforms-469-field_20_7-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_7\">Executive \/ Preventive check-up (e.g., full-body MRI)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_8\" name=\"wpforms[fields][20][]\" value=\"Wellness and recovery (spa, physiotherapy)\" aria-errormessage=\"wpforms-469-field_20_8-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_8\">Wellness and recovery (spa, physiotherapy)<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_20_9\" name=\"wpforms[fields][20][]\" value=\"Other (please specify)\" aria-errormessage=\"wpforms-469-field_20_9-error\" aria-describedby=\"wpforms-469-field_20-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_20_9\">Other (please specify)<\/label><\/li><\/ul><div id=\"wpforms-469-field_20-description\" class=\"wpforms-field-description\">You can select one or more.<\/div><\/fieldset><\/div><div id=\"wpforms-469-field_18-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">Reason for Consultation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-469-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_18_1\" name=\"wpforms[fields][18][]\" value=\"First time (exploring options)\" aria-errormessage=\"wpforms-469-field_18_1-error\" aria-describedby=\"wpforms-469-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_18_1\">First time (exploring options)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_18_2\" name=\"wpforms[fields][18][]\" value=\"Second medical opinion\" aria-errormessage=\"wpforms-469-field_18_2-error\" aria-describedby=\"wpforms-469-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_18_2\">Second medical opinion<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_18_3\" name=\"wpforms[fields][18][]\" value=\"Procedure already indicated by physician\" aria-errormessage=\"wpforms-469-field_18_3-error\" aria-describedby=\"wpforms-469-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_18_3\">Procedure already indicated by physician<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_18_4\" name=\"wpforms[fields][18][]\" value=\"Preventive consultation\" aria-errormessage=\"wpforms-469-field_18_4-error\" aria-describedby=\"wpforms-469-field_18-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_18_4\">Preventive consultation<\/label><\/li><\/ul><div id=\"wpforms-469-field_18-description\" class=\"wpforms-field-description\">You can select one or more.<\/div><\/fieldset><\/div>\t\t<div id=\"wpforms-469-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-469-field_3\" >Type Coverage Country<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-469-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-469-field_12-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Insurance Coverage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-469-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-469-field_12_1\" name=\"wpforms[fields][12]\" value=\"Yes, I have international insurance\" aria-errormessage=\"wpforms-469-field_12_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_12_1\">Yes, I have international insurance<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-469-field_12_2\" name=\"wpforms[fields][12]\" value=\"No, I will pay privately\" aria-errormessage=\"wpforms-469-field_12_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_12_2\">No, I will pay privately<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-469-field_22-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Additional Services Requested<\/legend><ul id=\"wpforms-469-field_22\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_22_1\" name=\"wpforms[fields][22][]\" value=\"Local transfers and logistics\" aria-errormessage=\"wpforms-469-field_22_1-error\" aria-describedby=\"wpforms-469-field_22-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_22_1\">Local transfers and logistics<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_22_2\" name=\"wpforms[fields][22][]\" value=\"Hotel \/ recovery accommodation\" aria-errormessage=\"wpforms-469-field_22_2-error\" aria-describedby=\"wpforms-469-field_22-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_22_2\">Hotel \/ recovery accommodation<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_22_3\" name=\"wpforms[fields][22][]\" value=\"Personalized support (concierge)\" aria-errormessage=\"wpforms-469-field_22_3-error\" aria-describedby=\"wpforms-469-field_22-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_22_3\">Personalized support (concierge)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-469-field_22_4\" name=\"wpforms[fields][22][]\" value=\"Tourist and wellness experiences\" aria-errormessage=\"wpforms-469-field_22_4-error\" aria-describedby=\"wpforms-469-field_22-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-469-field_22_4\">Tourist and wellness experiences<\/label><\/li><\/ul><div id=\"wpforms-469-field_22-description\" class=\"wpforms-field-description\">(Concierge support is always included in your package.)<\/div><\/fieldset><\/div><div id=\"wpforms-469-field_15-container\" class=\"wpforms-field wpforms-field-payment-select wpforms-field-select-style-classic\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_15\">Preferred Contact Method<\/label><select id=\"wpforms-469-field_15\" class=\"wpforms-payment-price wpforms-field-medium\" name=\"wpforms[fields][15]\"><option value=\"1\" data-amount=\"0.00\" >Email<\/option><option value=\"2\" data-amount=\"0.00\" >Whatsapp<\/option><option value=\"3\" data-amount=\"0.00\" >Phone Call<\/option><\/select><\/div><div id=\"wpforms-469-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_16\">Preferred date (optional)<\/label><input type=\"text\" id=\"wpforms-469-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-469-field_16-error\" aria-describedby=\"wpforms-469-field_16-description\" ><div id=\"wpforms-469-field_16-description\" class=\"wpforms-field-description\">dd-mm-yy<\/div><\/div><div id=\"wpforms-469-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_17\">Preferred time (optional)<\/label><input type=\"text\" id=\"wpforms-469-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-469-field_17-error\" aria-describedby=\"wpforms-469-field_17-description\" ><div id=\"wpforms-469-field_17-description\" class=\"wpforms-field-description\">00:00<\/div><\/div><div id=\"wpforms-469-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-469-field_2\">Relevant Medical Information<\/label><textarea id=\"wpforms-469-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-469-field_2-error\" aria-describedby=\"wpforms-469-field_2-description\" ><\/textarea><div id=\"wpforms-469-field_2-description\" class=\"wpforms-field-description\">Tell us briefly about your case, previous diagnoses, allergies, current medications or medical instructions : (Do not share highly sensitive information at this stage)]<\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-469-field_3-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-469-field_3-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-469-field_3-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"469\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/pages\/478\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-469\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Request my personalized quote\" aria-live=\"assertive\" value=\"wpforms-submit\">Request my personalized quote<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/caribbeanmedicalsolution.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"difl_page_category":[],"class_list":["post-478","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/pages\/478","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/comments?post=478"}],"version-history":[{"count":5,"href":"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/pages\/478\/revisions"}],"predecessor-version":[{"id":501,"href":"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/pages\/478\/revisions\/501"}],"wp:attachment":[{"href":"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/media?parent=478"}],"wp:term":[{"taxonomy":"difl_page_category","embeddable":true,"href":"https:\/\/caribbeanmedicalsolution.com\/es\/wp-json\/wp\/v2\/difl_page_category?post=478"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}