{"id":1438,"date":"2025-05-14T07:42:46","date_gmt":"2025-05-14T07:42:46","guid":{"rendered":"https:\/\/softwavetherapycanada.com\/arc\/?page_id=1438"},"modified":"2025-05-14T09:25:42","modified_gmt":"2025-05-14T09:25:42","slug":"health-history-form","status":"publish","type":"page","link":"https:\/\/softwavetherapycanada.com\/arc\/health-history-form\/","title":{"rendered":"Health History Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1438\" class=\"elementor elementor-1438\" 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\">Health History Form\n<\/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\">Health<\/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\">History Form\n<\/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-f1450-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1450\">\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\/1438#wpcf7-f1450-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=\"1450\" \/><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-f1450-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"container\">\n  <!-- Patient Information -->\n  <div class=\"row mb-3\">\n    <div class=\"col-md-6\">\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\" id=\"first-name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span>\n    <\/div>\n    <div class=\"col-md-6\">\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\" id=\"last-name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"occupation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" id=\"occupation\" aria-invalid=\"false\" placeholder=\"Your Occupation\" value=\"\" type=\"text\" name=\"occupation\" \/><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"reason\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" id=\"reason\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Reason for seeking massage therapy\" name=\"reason\"><\/textarea><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"massage-before\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"massage-before\" value=\"Have you received massage therapy before?\" \/><span class=\"wpcf7-list-item-label\">Have you received massage therapy before?<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"massage-before\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"referred\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"referred\" value=\"Did a health care practitioner refer you?\" \/><span class=\"wpcf7-list-item-label\">Did a health care practitioner refer you?<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"referred\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"referral-details\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"If yes, provide their name &amp; info\" value=\"\" type=\"text\" name=\"referral-details\" \/><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"primary-physician\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Primary Care Physician (Phone number, Address)\" value=\"\" type=\"text\" name=\"primary-physician\" \/><\/span>\n  <\/div>\n\n  <!-- Medical History & Info -->\n  <h3 class=\"margintop-do\">Medical History & Information<\/h3>\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"general-health\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Overall, how is your general health?\" value=\"\" type=\"text\" name=\"general-health\" \/><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"treatment-details\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Receiving treatment from another professional?\" value=\"\" type=\"text\" name=\"treatment-details\" \/><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"medications\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Medications (If yes, what &amp; why)\" value=\"\" type=\"text\" name=\"medications\" \/><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"accidents\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"accidents[]\" value=\"Automobile accidents\" \/><span class=\"wpcf7-list-item-label\">Automobile accidents<\/span><\/label><\/span><\/span><\/span>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"accidents-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"Details\" name=\"accidents-details\"><\/textarea><\/span>\n\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"surgeries\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"surgeries[]\" value=\"Surgeries\" \/><span class=\"wpcf7-list-item-label\">Surgeries<\/span><\/label><\/span><\/span><\/span>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"surgeries-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"Details\" name=\"surgeries-details\"><\/textarea><\/span>\n\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"broken-bones\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"broken-bones[]\" value=\"Broken Bones\" \/><span class=\"wpcf7-list-item-label\">Broken Bones<\/span><\/label><\/span><\/span><\/span>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"bones-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"Details\" name=\"bones-details\"><\/textarea><\/span>\n\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"major-injuries\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"major-injuries[]\" value=\"Falls\/Major Injuries\" \/><span class=\"wpcf7-list-item-label\">Falls\/Major Injuries<\/span><\/label><\/span><\/span><\/span>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"injuries-details\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"Details\" name=\"injuries-details\"><\/textarea><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"implants\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Pins, wires, joints or equipment in body? If yes, what &amp; where\" value=\"\" type=\"text\" name=\"implants\" \/><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\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=\"ADD\/ADHD\" \/><span class=\"wpcf7-list-item-label\">ADD\/ADHD<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Allergies\" \/><span class=\"wpcf7-list-item-label\">Allergies<\/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=\"Asthma\" \/><span class=\"wpcf7-list-item-label\">Asthma<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Bronchitis\" \/><span class=\"wpcf7-list-item-label\">Bronchitis<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Chronic Cough\" \/><span class=\"wpcf7-list-item-label\">Chronic Cough<\/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=\"Chronic Fatigue\" \/><span class=\"wpcf7-list-item-label\">Chronic Fatigue<\/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=\"Digestive Problems\" \/><span class=\"wpcf7-list-item-label\">Digestive Problems<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Ear Problems\" \/><span class=\"wpcf7-list-item-label\">Ear Problems<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Emphysema\" \/><span class=\"wpcf7-list-item-label\">Emphysema<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Epilepsy\" \/><span class=\"wpcf7-list-item-label\">Epilepsy<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Hemophilia\" \/><span class=\"wpcf7-list-item-label\">Hemophilia<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Hepatitis\" \/><span class=\"wpcf7-list-item-label\">Hepatitis<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Herpes\" \/><span class=\"wpcf7-list-item-label\">Herpes<\/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=\"Loss Of Sensation\" \/><span class=\"wpcf7-list-item-label\">Loss Of Sensation<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Mental Illness\" \/><span class=\"wpcf7-list-item-label\">Mental Illness<\/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=\"Pacemaker\" \/><span class=\"wpcf7-list-item-label\">Pacemaker<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Poor Circulation\" \/><span class=\"wpcf7-list-item-label\">Poor Circulation<\/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=\"Shingles\" \/><span class=\"wpcf7-list-item-label\">Shingles<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Shortness Of Breath\" \/><span class=\"wpcf7-list-item-label\">Shortness Of Breath<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Skin Conditions\" \/><span class=\"wpcf7-list-item-label\">Skin Conditions<\/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 Problems\" \/><span class=\"wpcf7-list-item-label\">Thyroid Problems<\/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\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Varicose Veins\" \/><span class=\"wpcf7-list-item-label\">Varicose Veins<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Vertigo\/Dizziness\" \/><span class=\"wpcf7-list-item-label\">Vertigo\/Dizziness<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"conditions[]\" value=\"Vision Problems\" \/><span class=\"wpcf7-list-item-label\">Vision Problems<\/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=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"family-history\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Arthritis\" \/><span class=\"wpcf7-list-item-label\">Arthritis<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Cancer\" \/><span class=\"wpcf7-list-item-label\">Cancer<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Diabetes\" \/><span class=\"wpcf7-list-item-label\">Diabetes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Heart Problems\" \/><span class=\"wpcf7-list-item-label\">Heart Problems<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"High\/Low Blood Pressure\" \/><span class=\"wpcf7-list-item-label\">High\/Low Blood Pressure<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Respiratory Conditions\" \/><span class=\"wpcf7-list-item-label\">Respiratory Conditions<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <h3 class=\"margintop-do\">Females<\/h3>\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"pregnant\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Are you pregnant? If yes, when are you due?\" value=\"\" type=\"text\" name=\"pregnant\" \/><\/span>\n  <\/div>\n\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"gyn-conditions\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Any gynaecological conditions? If yes, what?\" value=\"\" type=\"text\" name=\"gyn-conditions\" \/><\/span>\n  <\/div>\n\n  <h3 class=\"margintop-do\">Agreement<\/h3>\n  <div class=\"mb-3\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"agreement\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"agreement\" value=\"Agree\" \/><span class=\"wpcf7-list-item-label\">Agree<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"agreement\" value=\"Disagree\" \/><span class=\"wpcf7-list-item-label\">Disagree<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n\n  <div class=\"btn-fomr mb-3\">\n    <input class=\"wpcf7-form-control wpcf7-submit has-spinner btn btn-default\" type=\"submit\" value=\"Submit\" \/>\n  <\/div>\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>Health History Form Health History 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-1438","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/pages\/1438","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=1438"}],"version-history":[{"count":0,"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/pages\/1438\/revisions"}],"wp:attachment":[{"href":"https:\/\/softwavetherapycanada.com\/arc\/wp-json\/wp\/v2\/media?parent=1438"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}