{"id":1352,"date":"2025-05-13T13:49:40","date_gmt":"2025-05-13T13:49:40","guid":{"rendered":"https:\/\/softwavetherapycanada.com\/arc\/?page_id=1352"},"modified":"2025-05-13T13:56:31","modified_gmt":"2025-05-13T13:56:31","slug":"patient-health-condition-form","status":"publish","type":"page","link":"https:\/\/softwavetherapycanada.com\/arc\/patient-health-condition-form\/","title":{"rendered":"Patient Health Condition Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1352\" class=\"elementor elementor-1352\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-216ba9c e-flex e-con-boxed e-con e-parent\" data-id=\"216ba9c\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-25a8cc4 elementor-widget elementor-widget-heading\" data-id=\"25a8cc4\" 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\">Patient Health Condition Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1087c0c e-flex e-con-boxed e-con e-parent\" data-id=\"1087c0c\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-aae8723 e-flex e-con-boxed e-con e-child\" data-id=\"aae8723\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-37beb41 elementor-widget elementor-widget-heading\" data-id=\"37beb41\" 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<h4 class=\"elementor-heading-title elementor-size-default\">Patient<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b612de3 elementor-widget elementor-widget-heading\" data-id=\"b612de3\" 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\">Health Condition Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b0aaf56 contact-form elementor-widget elementor-widget-shortcode\" data-id=\"b0aaf56\" 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-f1354-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1354\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/arc\/wp-json\/wp\/v2\/pages\/1352#wpcf7-f1354-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1354\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1354-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"row\">\n  <div class=\"form-group col-md-6 mb-3\">\n    <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 form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span>\n  <\/div>\n  <div class=\"form-group col-md-6 mb-3\">\n    <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 form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span>\n  <\/div>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"height\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Please enter your height (ft\/in, cm, etc.)\" value=\"\" type=\"text\" name=\"height\" \/><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"weight\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Please enter your weight (kg, lbs, etc.)\" value=\"\" type=\"text\" name=\"weight\" \/><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"symptom\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"What is your major complaint\/problem? (required)\" name=\"symptom\"><\/textarea><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"symptom-cause\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"When did your complaint begin?\" name=\"symptom-cause\"><\/textarea><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"symptom-how\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"How you think the problem started?\" name=\"symptom-how\"><\/textarea><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <strong>Is your condition getting progressively worse?<\/strong><br>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"progressively-worse\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"progressively-worse\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"progressively-worse\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"progressively-worse\" value=\"Same\" \/><span class=\"wpcf7-list-item-label\">Same<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <strong>Is this problem:<\/strong><br>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"problem-type\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"problem-type[]\" value=\"Constant\" \/><span class=\"wpcf7-list-item-label\">Constant<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"problem-type[]\" value=\"Comes and Goes\" \/><span class=\"wpcf7-list-item-label\">Comes and Goes<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <strong>Please select the boxes that best describe your sensation of pain:<\/strong><br>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"pain-type\"><select class=\"wpcf7-form-control wpcf7-select form-control\" aria-invalid=\"false\" name=\"pain-type\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Aching\">Aching<\/option><option value=\"Burning\">Burning<\/option><option value=\"Dull\">Dull<\/option><option value=\"Sharp\">Sharp<\/option><option value=\"Sore\">Sore<\/option><option value=\"Stiff\">Stiff<\/option><option value=\"Tingling\">Tingling<\/option><option value=\"Throbbing\">Throbbing<\/option><option value=\"Shooting\">Shooting<\/option><\/select><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"what-relieves\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"What makes your condition better?\" name=\"what-relieves\"><\/textarea><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"what-worsens\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"What makes your condition worse?\" name=\"what-worsens\"><\/textarea><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <strong>Does it interfere with your:<\/strong><br>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"interferes-with\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"interferes-with[]\" value=\"Work\" \/><span class=\"wpcf7-list-item-label\">Work<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"interferes-with[]\" value=\"Sleep\" \/><span class=\"wpcf7-list-item-label\">Sleep<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"interferes-with[]\" value=\"Daily Routine\" \/><span class=\"wpcf7-list-item-label\">Daily Routine<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"interferes-with[]\" value=\"Recreation\" \/><span class=\"wpcf7-list-item-label\">Recreation<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n\n<hr>\n<h3 class=\"margintop-do\">Past Injuries<\/h3>\n\n<div class=\"form-group mb-3\">\n  <strong>Have you ever had:<\/strong><br>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"past-injuries\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"past-injuries[]\" value=\"Auto Accidents\" \/><span class=\"wpcf7-list-item-label\">Auto Accidents<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"past-injuries[]\" value=\"Surgeries\" \/><span class=\"wpcf7-list-item-label\">Surgeries<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"past-injuries[]\" value=\"Broken Bones\" \/><span class=\"wpcf7-list-item-label\">Broken Bones<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"past-injuries[]\" value=\"Falls\/Other Injuries\" \/><span class=\"wpcf7-list-item-label\">Falls\/Other Injuries<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"past-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"Please describe the accident or injury in relevant details\" name=\"past-details\"><\/textarea><\/span>\n<\/div>\n\n<hr>\n<h3 class=\"margintop-do\" >Stressors<\/h3>\n\n<div class=\"form-group mb-3\">\n  <strong>Are any of the following a source of stress in your life?<\/strong><br>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"stressors\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"stressors[]\" value=\"Finances\" \/><span class=\"wpcf7-list-item-label\">Finances<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"stressors[]\" value=\"Work\" \/><span class=\"wpcf7-list-item-label\">Work<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"stressors[]\" value=\"Unfulfilled Career Goals\" \/><span class=\"wpcf7-list-item-label\">Unfulfilled Career Goals<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"stressors[]\" value=\"Health\" \/><span class=\"wpcf7-list-item-label\">Health<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"stressors[]\" value=\"Major Health Issues in Family\" \/><span class=\"wpcf7-list-item-label\">Major Health Issues in Family<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"stressors[]\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"stress-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"Please describe if any of the selected stressors apply\" name=\"stress-details\"><\/textarea><\/span>\n<\/div>\n\n<hr>\n<h3 class=\"margintop-do\">Females<\/h3>\n\n<div class=\"form-group mb-3\">\n  <strong>Are you pregnant?<\/strong><br>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"pregnant\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"pregnant\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"pregnant\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"pregnancy-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"Please list any medications you are taking\" name=\"pregnancy-details\"><\/textarea><\/span>\n<\/div>\n\n<hr>\n<h3 class=\"margintop-do\">Conditions<\/h3>\n\n<div class=\"form-group mb-3\">\n  <strong>Check any of the following conditions you have had:<\/strong><br>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"conditions\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Anxiety\" \/><span class=\"wpcf7-list-item-label\">Anxiety<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Back Pain\" \/><span class=\"wpcf7-list-item-label\">Back Pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Neck Pain\" \/><span class=\"wpcf7-list-item-label\">Neck Pain<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Arthritis\" \/><span class=\"wpcf7-list-item-label\">Arthritis<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Cancer\" \/><span class=\"wpcf7-list-item-label\">Cancer<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Diabetes\" \/><span class=\"wpcf7-list-item-label\">Diabetes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Frequent Headaches\" \/><span class=\"wpcf7-list-item-label\">Frequent Headaches<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"High Blood Pressure\" \/><span class=\"wpcf7-list-item-label\">High Blood Pressure<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Low Blood Pressure\" \/><span class=\"wpcf7-list-item-label\">Low Blood Pressure<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Heart Problems\" \/><span class=\"wpcf7-list-item-label\">Heart Problems<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Neuropathy\" \/><span class=\"wpcf7-list-item-label\">Neuropathy<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Herniated Disk\" \/><span class=\"wpcf7-list-item-label\">Herniated Disk<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Sleep Issues\" \/><span class=\"wpcf7-list-item-label\">Sleep Issues<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Depression\" \/><span class=\"wpcf7-list-item-label\">Depression<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Seizures\" \/><span class=\"wpcf7-list-item-label\">Seizures<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Sciatica\" \/><span class=\"wpcf7-list-item-label\">Sciatica<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Stroke\" \/><span class=\"wpcf7-list-item-label\">Stroke<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Thyroid Issues\" \/><span class=\"wpcf7-list-item-label\">Thyroid Issues<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Osteoporosis\" \/><span class=\"wpcf7-list-item-label\">Osteoporosis<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Asthma\" \/><span class=\"wpcf7-list-item-label\">Asthma<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Scoliosis\" \/><span class=\"wpcf7-list-item-label\">Scoliosis<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Hearing Loss\" \/><span class=\"wpcf7-list-item-label\">Hearing Loss<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Rheumatoid Arthritis\" \/><span class=\"wpcf7-list-item-label\">Rheumatoid Arthritis<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"TMJ\" \/><span class=\"wpcf7-list-item-label\">TMJ<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n\n<div class=\"form-group mb-3\">\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"other-conditions\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"If selected &#039;Other&#039;, please list here.\" name=\"other-conditions\"><\/textarea><\/span>\n<\/div>\n\n<hr>\n<h3 class=\"margintop-do\">Agreement<\/h3>\n\n<div class=\"form-group mb-3\">\n  <p>By agreeing, you confirm that the above information is true to the best of your knowledge. You authorize your insurance benefits to be paid directly to Active Rehab Centre and understand that you are financially responsible for any balances. You authorize ARC or insurance companies to release any information required to process your claims. You also authorize ARC to release information regarding your condition to your family physician.<\/p>\n  <span class=\"wpcf7-form-control-wrap\" data-name=\"agreement-confirm\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"agreement-confirm\" value=\"Agree\" \/><span class=\"wpcf7-list-item-label\">Agree<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"agreement-confirm\" value=\"Disagree\" \/><span class=\"wpcf7-list-item-label\">Disagree<\/span><\/label><\/span><\/span><\/span>\n<\/div>\n\n<div class=\"text-center mt-4 btn-fomr\">\n  <input class=\"wpcf7-form-control wpcf7-submit has-spinner btn btn-default px-5 py-2 fw-bold\" type=\"submit\" value=\"SUBMIT\" \/>\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\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a490b6d e-con-full e-flex e-con e-parent\" data-id=\"a490b6d\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0eb2cfc elementor-widget elementor-widget-html\" data-id=\"0eb2cfc\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<iframe src=\"https:\/\/www.google.com\/maps\/embed?pb=!1m18!1m12!1m3!1d2528.2634840022547!2d-79.27715062381674!3d43.77555807109661!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x89d4d19bebda1ddd%3A0xc1c4cca0249bf38e!2s2240%20Midland%20Ave%2C%20Scarborough%2C%20ON%20M1P%204R9%2C%20Canada!5e1!3m2!1sen!2s!4v1747122853705!5m2!1sen!2s\" width=\"600\" height=\"450\" style=\"border:0;\" allowfullscreen=\"\" loading=\"lazy\" referrerpolicy=\"no-referrer-when-downgrade\"><\/iframe>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-51cb397 e-flex e-con-boxed e-con e-parent\" data-id=\"51cb397\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-9afec90 e-con-full e-flex e-con e-child\" data-id=\"9afec90\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b5dc4a3 elementor-widget elementor-widget-heading\" data-id=\"b5dc4a3\" 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\">Didn\u2019t find the answers you were looking for?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9698f7b elementor-widget elementor-widget-heading\" data-id=\"9698f7b\" 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<p class=\"elementor-heading-title elementor-size-default\">Just get in touch with us with your preferred method! We will try our best to help you with any and all questions.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1ada86d e-con-full e-flex e-con e-child\" data-id=\"1ada86d\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3edc205 elementor-align-center btn-default wow fadeInUp elementor-widget elementor-widget-button\" data-id=\"3edc205\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"#\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Contact Us<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Patient Health Condition Form Patient Health Condition Form Didn\u2019t find the answers you were looking for? Just get in touch with us with your preferred method! We will try our best to help you with any and all questions. Contact Us<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1352","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/pages\/1352","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/comments?post=1352"}],"version-history":[{"count":0,"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/pages\/1352\/revisions"}],"wp:attachment":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/media?parent=1352"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}