{"id":8281,"date":"2018-08-10T05:37:02","date_gmt":"2018-08-10T05:37:02","guid":{"rendered":"https:\/\/publicancy.com\/ybp\/?page_id=8281"},"modified":"2026-04-02T01:57:11","modified_gmt":"2026-04-02T05:57:11","slug":"book-an-appointment","status":"publish","type":"page","link":"https:\/\/publicancy.com\/ybp\/book-an-appointment\/","title":{"rendered":"Request Appointment"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row css=&#8221;.vc_custom_1774816749621{margin-top: 0px !important;margin-bottom: 0px !important;padding-top: 70px !important;padding-bottom: 50px !important;}&#8221;][vc_column css=&#8221;.vc_custom_1533879065137{margin-top: 0px !important;margin-bottom: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;}&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<p style=\"text-align: center;\">Need an urgent appointment? Call us now at <a href=\"tel:+17705850190\">(770) 585-0190<\/a> for immediate assistance.<\/p>\n<p>[\/vc_column_text][vc_custom_heading text=&#8221;Request Appointment&#8221; font_container=&#8221;tag:h3|font_size:36px|text_align:center|color:%232d2d2d|line_height:50px&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1561625686197{margin-top: 0px !important;margin-bottom: 0px !important;padding-top: 0px !important;padding-bottom: 40px !important;}&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<p style=\"text-align: center;\">Please fill this form &amp; we will call you<\/p>\n<p>[\/vc_column_text][vc_column_text css=&#8221;&#8221;]<div class=\"forminator-ui forminator-custom-form forminator-custom-form-9236 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-9236\" data-uid=\"69d30639c7892\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-9236\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-9236 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"9236\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69d30639c7892\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69d30639c7892\" id=\"forminator-field-name-1_69d30639c7892-label\" class=\"forminator-label\">First Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_69d30639c7892\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69d30639c7892\" id=\"forminator-field-email-1_69d30639c7892-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_69d30639c7892\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69d30639c7892\" id=\"forminator-field-address-1-city_69d30639c7892-label\" class=\"forminator-label\">City<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"\" id=\"forminator-field-address-1-city_69d30639c7892\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69d30639c7892\" id=\"forminator-field-phone-1_69d30639c7892-label\" class=\"forminator-label\">Phone Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_69d30639c7892\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-9236__field--select-1_69d30639c7892\" id=\"forminator-form-9236__field--select-1_69d30639c7892-label\" class=\"forminator-label\">Your Child&#039;s Concern?<\/label><select multiple id=\"forminator-form-9236__field--select-1_69d30639c7892\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1[]\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Well Visits\" data-search=\"false\" data-search-placeholder=\"Search\" data-checkbox=\"false\" data-allow-clear=\"true\" aria-labelledby=\"forminator-form-9236__field--select-1_69d30639c7892-label\"><option value=\"one\"  data-calculation=\"0\">Well Visits<\/option><option value=\"two\"  data-calculation=\"0\">Same Day Sick Visits<\/option><option value=\"Premature-Infants\"  data-calculation=\"0\">Premature Infants<\/option><option value=\"Asthma---Breathing-Problems\"  data-calculation=\"0\">Asthma \/ Breathing Problems<\/option><option value=\"ADHD\"  data-calculation=\"0\">ADHD<\/option><option value=\"Allergy\"  data-calculation=\"0\">Allergy<\/option><option value=\"Behavioral-Problems\"  data-calculation=\"0\">Behavioral Problems<\/option><option value=\"Obesity\"  data-calculation=\"0\">Obesity<\/option><option value=\"Skin-Conditions\"  data-calculation=\"0\">Skin Conditions<\/option><option value=\"Teen-Mental-Health\"  data-calculation=\"0\">Teen Mental Health<\/option><option value=\"Sports-School-Physicals\"  data-calculation=\"0\">Sports\/School Physicals<\/option><option value=\"Wart-Molluscum-Treatment\"  data-calculation=\"0\">Wart\/Molluscum Treatment<\/option><option value=\"Ear-Piercings\"  data-calculation=\"0\">Ear Piercings<\/option><\/select><\/div><\/div><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-6 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69d30639c7892\" id=\"forminator-field-textarea-1_69d30639c7892-label\" class=\"forminator-label\">Message <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-textarea-1_69d30639c7892-description\" class=\"forminator-description\"><span data-limit=\"180\" data-type=\"characters\" data-editor=\"\">0 \/ 180<\/span><\/span><textarea name=\"textarea-1\" placeholder=\"Do NOT provide any medical information\" id=\"forminator-field-textarea-1_69d30639c7892\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" maxlength=\"180\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"3917712934\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/ybp\/wp-json\/wp\/v2\/pages\/8281\" \/><input type=\"hidden\" name=\"form_id\" value=\"9236\"><input type=\"hidden\" name=\"page_id\" value=\"8281\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/publicancy.com\/ybp\/book-an-appointment\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><label for=\"input_7\" class=\"forminator-hidden\" aria-hidden=\"true\">Please do not fill in this field. <input id=\"input_7\" type=\"text\" name=\"input_7\" value=\"\" autocomplete=\"off\"><\/label><\/form>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row css=&#8221;.vc_custom_1774816749621{margin-top: 0px !important;margin-bottom: 0px !important;padding-top: 70px !important;padding-bottom: 50px !important;}&#8221;][vc_column css=&#8221;.vc_custom_1533879065137{margin-top: 0px !important;margin-bottom: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;}&#8221;][vc_column_text css=&#8221;&#8221;] Need an urgent appointment? Call us now at (770) 585-0190 for immediate assistance. [\/vc_column_text][vc_custom_heading text=&#8221;Request Appointment&#8221; font_container=&#8221;tag:h3|font_size:36px|text_align:center|color:%232d2d2d|line_height:50px&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1561625686197{margin-top: 0px !important;margin-bottom: 0px !important;padding-top: 0px !important;padding-bottom: 40px !important;}&#8221;][vc_column_text css=&#8221;&#8221;] Please fill this form &amp; we will [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8281","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/publicancy.com\/ybp\/wp-json\/wp\/v2\/pages\/8281","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/publicancy.com\/ybp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/publicancy.com\/ybp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/publicancy.com\/ybp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/publicancy.com\/ybp\/wp-json\/wp\/v2\/comments?post=8281"}],"version-history":[{"count":11,"href":"https:\/\/publicancy.com\/ybp\/wp-json\/wp\/v2\/pages\/8281\/revisions"}],"predecessor-version":[{"id":8852,"href":"https:\/\/publicancy.com\/ybp\/wp-json\/wp\/v2\/pages\/8281\/revisions\/8852"}],"wp:attachment":[{"href":"https:\/\/publicancy.com\/ybp\/wp-json\/wp\/v2\/media?parent=8281"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}