{"id":76,"date":"2026-09-27T09:12:11","date_gmt":"2026-09-27T09:12:11","guid":{"rendered":"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/?page_id=76"},"modified":"2026-09-27T09:12:11","modified_gmt":"2026-09-27T09:12:11","slug":"appointment-request","status":"publish","type":"page","link":"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/?page_id=76","title":{"rendered":"Appointment Request"},"content":{"rendered":"        <section class=\"ncfmc-public-form\" aria-labelledby=\"ncfmc-request-title\">\n                    <span class=\"ncfmc-public-form__eyebrow\">Secure administrative request<\/span>\n          <h2 id=\"ncfmc-request-title\">Request an appointment<\/h2>\n          <p id=\"ncfmc-request-guidance\">This private demonstration records synthetic information only. Do not enter an emergency, diagnosis, medication list or detailed medical history. Staff must review the request before any appointment is confirmed.<\/p>\n          <aside class=\"ncfmc-public-form__safety\" aria-label=\"Emergency and direct contact guidance\"><strong>Emergency or urgent medical problem?<\/strong> Do not use this form. Contact emergency services or an appropriate emergency unit. For ordinary appointment administration, phone <a href=\"tel:+27325331535\">032 533 1535<\/a>.<\/aside>\n          <form method=\"post\" action=\"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/wp-admin\/admin-post.php\" data-ncfmc-public-request>\n            <input type=\"hidden\" name=\"action\" value=\"ncfmc_public_request\">\n            <input type=\"hidden\" name=\"ncfmc_started\" value=\"1794204027\">\n            <input type=\"hidden\" name=\"ncfmc_signature\" value=\"46e5a3ed094c3e2547b4e5a8faa196335e38e5680217c1ca4caa68267f7b2f7d\">\n            <input type=\"hidden\" name=\"ncfmc_public_nonce\" value=\"fc994ef8a2\">\n            <label class=\"ncfmc-hp\" aria-hidden=\"true\" inert>Website <input name=\"website\" tabindex=\"-1\" autocomplete=\"off\"><\/label>\n            <label>Name <span class=\"screen-reader-text\">required<\/span><input required name=\"name\" minlength=\"2\" maxlength=\"120\" autocomplete=\"name\" aria-describedby=\"ncfmc-request-guidance\"><\/label>\n            <label>Safe contact number <span class=\"screen-reader-text\">required<\/span><input required name=\"phone\" type=\"tel\" minlength=\"9\" maxlength=\"40\" inputmode=\"tel\" autocomplete=\"tel\"><\/label>\n            <label>Email, if supplied <input type=\"email\" name=\"email\" maxlength=\"191\" autocomplete=\"email\"><\/label>\n            <label>Preferred date and time <input type=\"datetime-local\" name=\"preferred_at\"><\/label>\n            <label>Broad service category <select name=\"service\"><option value=\"general_appointment\">General appointment<\/option><option value=\"chronic_care\">Chronic care<\/option><option value=\"procedure_enquiry\">Procedure enquiry<\/option><option value=\"womens_health\">Women\u2019s health<\/option><option value=\"mens_health\">Men\u2019s health<\/option><option value=\"child_family_health\">Child and family health<\/option><option value=\"audiology\">Audiology<\/option><option value=\"other_admin\">Other administrative enquiry<\/option><\/select><\/label>\n            <label>Funding <select name=\"funding\"><option value=\"not_stated\">Prefer not to state<\/option><option value=\"medical_aid\">Medical aid<\/option><option value=\"private\">Private<\/option><\/select><\/label>\n            <label>Callback preference <select name=\"callback_preference\"><option value=\"phone\">Phone<\/option><option value=\"email\">Email<\/option><\/select><\/label>\n            <label class=\"ncfmc-field--wide\">Short non-clinical note <textarea name=\"note\" maxlength=\"500\" aria-describedby=\"ncfmc-note-help\"><\/textarea><small id=\"ncfmc-note-help\">Administrative details only; never include symptoms, diagnoses, medication or medical history here.<\/small><\/label>\n            <label class=\"ncfmc-check ncfmc-field--wide\"><input required type=\"checkbox\" name=\"consent_contact\" value=\"1\"> <span>I consent to the practice contacting me about this request.<\/span><\/label>\n            <button type=\"submit\">Send request for review<\/button>\n            <p class=\"ncfmc-public-form__privacy\">Submitting saves a private synthetic request in Care Command for staff review. It does not send an email, confirm a booking, provide medical advice or guarantee a response time.<\/p>\n          <\/form>\n        <\/section>\n        \n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-76","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/index.php?rest_route=\/wp\/v2\/pages\/76","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=76"}],"version-history":[{"count":0,"href":"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/index.php?rest_route=\/wp\/v2\/pages\/76\/revisions"}],"wp:attachment":[{"href":"https:\/\/enthusiastic-maroon-chicken.culltron.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=76"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}