{"id":4193,"date":"2021-07-31T07:34:06","date_gmt":"2021-07-31T07:34:06","guid":{"rendered":"http:\/\/meditourturkei.com\/?page_id=4193"},"modified":"2021-07-31T07:34:06","modified_gmt":"2021-07-31T07:34:06","slug":"patients-registration-form","status":"publish","type":"page","link":"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/","title":{"rendered":"PATIENTS REGISTRATION FORM"},"content":{"rendered":"<div id='av_section_1'  class='avia-section main_color avia-section-default avia-no-border-styling  avia-full-stretch av-parallax-section av-section-color-overlay-active avia-bg-style-parallax  avia-builder-el-0  el_before_av_layout_row  avia-builder-el-first   container_wrap sidebar_right' style=' '  data-section-bg-repeat='stretch'><div class='av-parallax' data-avia-parallax-ratio='0.3' ><div class='av-parallax-inner main_color  avia-full-stretch' style = 'background-repeat: no-repeat; background-image: url(https:\/\/www.meditourturkei.com\/en\/wp-content\/uploads\/2021\/07\/o2.jpg);background-attachment: scroll; background-position: center center; ' ><\/div><\/div><div class='av-section-color-overlay-wrap'><div class='av-section-color-overlay' style='opacity: 0.5; background-color: #417591; background-image: url(https:\/\/www.meditourturkei.com\/en\/wp-content\/themes\/enfold\/enfold\/images\/background-images\/dots-mini-light.png); background-repeat: repeat;'><\/div><a href='#next-section' title='' class='scroll-down-link  av-custom-scroll-down-color' style='color: #ffffff;' aria-hidden='true' data-av_icon='\ue877' data-av_iconfont='entypo-fontello'><\/a><div class='container' ><main  role=\"main\" itemprop=\"mainContentOfPage\"  class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-4193'><div class='entry-content-wrapper clearfix'>\n<div  style='padding-bottom:10px; color:#ffffff;' class='av-special-heading av-special-heading-h3 custom-color-heading blockquote modern-quote modern-centered  avia-builder-el-1  avia-builder-el-no-sibling  '><h3 class='av-special-heading-tag '  itemprop=\"headline\"  >PATIENTS REGISTRATION FORM<\/h3><div class ='av-subheading av-subheading_below av_custom_color ' style='font-size:15px;'><p>Meditour Turkei<\/p>\n<\/div><div class='special-heading-border'><div class='special-heading-inner-border' style='border-color:#ffffff'><\/div><\/div><\/div>\n<\/div><\/div><\/main><!-- close content main element --><\/div><\/div><\/div><div id='av-layout-grid-1'  class='av-layout-grid-container entry-content-wrapper main_color av-flex-cells     avia-builder-el-2  el_after_av_section  avia-builder-el-last  submenu-not-first container_wrap sidebar_right' style=' '  >\n<div class=\"flex_cell no_margin av_three_fourth  avia-builder-el-3  el_before_av_cell_one_fourth  avia-builder-el-first   \" ><div class='flex_cell_inner' ><div class=\"flex_column av_one_full  flex_column_div av-zero-column-padding first  avia-builder-el-4  avia-builder-el-no-sibling  \" style='border-radius:0px; '><form action=\"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/\" method=\"post\"  class=\"avia_ajax_form av-form-labels-visible   avia-builder-el-5  avia-builder-el-no-sibling   \" data-avia-form-id=\"1\" data-avia-redirect='' ><fieldset><p class='  first_form  form_element form_element_half' id='element_avia_1_1'><label for=\"avia_1_1\">Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_1_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_1_1\" value=\"\" \/><\/p><p class='  form_element form_element_half' id='element_avia_2_1'><label for=\"avia_2_1\">E-Mail <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_2_1\" class=\"text_input is_email\" type=\"text\" id=\"avia_2_1\" value=\"\" \/><\/p><p class='  first_form  form_element form_element_third' id='element_avia_3_1'><label for=\"avia_3_1\">Weight <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_3_1\" class=\"text_input is_number\" type=\"text\" id=\"avia_3_1\" value=\"\" \/><\/p><p class='  form_element form_element_third' id='element_avia_4_1'><label for=\"avia_4_1\">Size (cm) <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_4_1\" class=\"text_input is_number\" type=\"text\" id=\"avia_4_1\" value=\"\" \/><\/p><p class='  form_element form_element_third' id='element_avia_5_1'><label for=\"avia_5_1\">Age <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_5_1\" class=\"text_input is_number\" type=\"text\" id=\"avia_5_1\" value=\"\" \/><\/p><p class=' first_form  form_element form_fullwidth' id='element_avia_6_1'><label for=\"avia_6_1\">Highlight the diseases you have. <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <select multiple name=\"avia_6_1\" class=\"select is_empty av-multi-select\" id=\"avia_6_1\"><option  value ='Diabetes'>Diabetes<\/option><option  value ='Hypertension'>Hypertension<\/option><option  value ='Heart Disease'>Heart Disease<\/option><option  value ='Insulin Resistance'>Insulin Resistance<\/option><option  value ='Asthma'>Asthma<\/option><option  value ='Snoring'>Snoring<\/option><option  value ='Sexual problems'>Sexual problems<\/option><option  value ='Gastritis'>Gastritis<\/option><\/select><\/p><p class=' first_form  form_element form_fullwidth' id='element_avia_7_1'><label for=\"avia_7_1\">Has a psychiatric diagnosis been made for drug or alcohol addiction? <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <select  name=\"avia_7_1\" class=\"select is_empty\" id=\"avia_7_1\"><option  value ='Yes'>Yes<\/option><option  value ='No'>No<\/option><\/select><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_8_1'><label for=\"avia_8_1\">Please write down your chronic illnesses or other illnesses. <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_8_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_8_1\" value=\"\" \/><\/p><p class=' first_form  form_element form_fullwidth' id='element_avia_9_1'><label for=\"avia_9_1\">Do you smoke? (Answer after the last 3 months.) <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <select  name=\"avia_9_1\" class=\"select is_empty\" id=\"avia_9_1\"><option  value ='Yes half a pack a day'>Yes half a pack a day<\/option><option  value ='Yes one pack a day'>Yes one pack a day<\/option><option  value ='Yes more than one pack a day'>Yes more than one pack a day<\/option><option  value ='No I don\u2019t use'>No I don\u2019t use<\/option><\/select><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_10_1'><label for=\"avia_10_1\">Please indicate the medications you take regularly. <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_10_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_10_1\" value=\"\" \/><\/p><p class=' first_form  form_element form_fullwidth av-last-visible-form-element' id='element_avia_11_1'><label for=\"avia_11_1\">Have you been trying to lose weight for a long time? <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <select  name=\"avia_11_1\" class=\"select is_empty\" id=\"avia_11_1\"><option  value ='Yes'>Yes<\/option><option  value ='No'>No<\/option><\/select><\/p><p class=\"hidden\"><input type=\"text\" name=\"avia_12_1\" class=\"hidden \" id=\"avia_12_1\" value=\"\" \/><\/p><p class=\"form_element \"><input type=\"hidden\" value=\"1\" name=\"avia_generated_form1\" \/><input type=\"submit\" value=\"Submit\" class=\"button\"  data-sending-label=\"Sending\"\/><\/p><\/fieldset><\/form><div id=\"ajaxresponse_1\" class=\"ajaxresponse ajaxresponse_1 hidden\"><\/div><\/div>\n<\/div><\/div><div class=\"flex_cell no_margin av_one_fourth  avia-builder-el-6  el_after_av_cell_three_fourth  avia-builder-el-last   \"  style='background: #efefef; vertical-align:top; padding:30px; background-color:#efefef; ' ><div class='flex_cell_inner' ><div  class='avia-builder-widget-area clearfix  avia-builder-el-7  avia-builder-el-no-sibling '><section id=\"avia_fb_likebox-4\" class=\"widget clearfix avia_fb_likebox\"><h3 class=\"widgettitle\">Facebook<\/h3><div class='av_facebook_widget_wrap ' ><div class=\"fb-page\" data-width=\"500\" data-href=\"https:\/\/www.facebook.com\/MeditourTurkei-101428558897548\" data-small-header=\"false\" data-adapt-container-width=\"true\" data-hide-cover=\"false\" data-show-facepile=\"true\" data-show-posts=\"false\"><div class=\"fb-xfbml-parse-ignore\"><\/div><\/div><\/div><span class=\"seperator extralight-border\"><\/span><\/section><section id=\"avia-instagram-feed-smash-2\" class=\"widget clearfix avia-instagram-smash-ballon\"><div class=\"avia-widget avia-instagram-feed-smash-widget noLightbox\"><div class=\"avia-widget-title avia-instagram-feed-smash-widget-title\"><h3 class=\"widgettitle\">Instagram<\/h3><\/div>\r\n<div id=\"sb_instagram\"  class=\"sbi sbi_mob_col_1 sbi_tab_col_2 sbi_col_2 sbi_width_resp sbi_disable_mobile\" style=\"padding-bottom: 10px;width: 100%;\" data-feedid=\"sbi_17841448822309037#8\"  data-res=\"auto\" data-cols=\"2\" data-colsmobile=\"1\" data-colstablet=\"2\" data-num=\"8\" data-nummobile=\"\" data-shortcode-atts=\"{&quot;num&quot;:&quot;8&quot;,&quot;cols&quot;:&quot;2&quot;,&quot;imageres&quot;:&quot;auto&quot;,&quot;disablemobile&quot;:&quot;true&quot;,&quot;showheader&quot;:&quot;true&quot;,&quot;showbio&quot;:&quot;false&quot;,&quot;headersize&quot;:&quot;small&quot;,&quot;buttontext&quot;:&quot;Load More Photos&quot;,&quot;followtext&quot;:&quot;Follow Me&quot;}\"  data-postid=\"4193\" data-locatornonce=\"eaa7db7fdd\" data-sbi-flags=\"favorLocal\">\r\n\t\r\n    <div id=\"sbi_images\"  style=\"padding: 5px;\">\r\n\t\t    <\/div>\r\n\r\n\t<div id=\"sbi_load\" >\r\n\r\n\t\r\n\t\t\t<span class=\"sbi_follow_btn\">\r\n        <a href=\"https:\/\/www.instagram.com\/17841448822309037\/\" target=\"_blank\" rel=\"nofollow noopener\">\r\n            <svg class=\"svg-inline--fa fa-instagram fa-w-14\" aria-hidden=\"true\" data-fa-processed=\"\" aria-label=\"Instagram\" data-prefix=\"fab\" data-icon=\"instagram\" role=\"img\" viewBox=\"0 0 448 512\">\n\t                <path fill=\"currentColor\" d=\"M224.1 141c-63.6 0-114.9 51.3-114.9 114.9s51.3 114.9 114.9 114.9S339 319.5 339 255.9 287.7 141 224.1 141zm0 189.6c-41.1 0-74.7-33.5-74.7-74.7s33.5-74.7 74.7-74.7 74.7 33.5 74.7 74.7-33.6 74.7-74.7 74.7zm146.4-194.3c0 14.9-12 26.8-26.8 26.8-14.9 0-26.8-12-26.8-26.8s12-26.8 26.8-26.8 26.8 12 26.8 26.8zm76.1 27.2c-1.7-35.9-9.9-67.7-36.2-93.9-26.2-26.2-58-34.4-93.9-36.2-37-2.1-147.9-2.1-184.9 0-35.8 1.7-67.6 9.9-93.9 36.1s-34.4 58-36.2 93.9c-2.1 37-2.1 147.9 0 184.9 1.7 35.9 9.9 67.7 36.2 93.9s58 34.4 93.9 36.2c37 2.1 147.9 2.1 184.9 0 35.9-1.7 67.7-9.9 93.9-36.2 26.2-26.2 34.4-58 36.2-93.9 2.1-37 2.1-147.8 0-184.8zM398.8 388c-7.8 19.6-22.9 34.7-42.6 42.6-29.5 11.7-99.5 9-132.1 9s-102.7 2.6-132.1-9c-19.6-7.8-34.7-22.9-42.6-42.6-11.7-29.5-9-99.5-9-132.1s-2.6-102.7 9-132.1c7.8-19.6 22.9-34.7 42.6-42.6 29.5-11.7 99.5-9 132.1-9s102.7-2.6 132.1 9c19.6 7.8 34.7 22.9 42.6 42.6 11.7 29.5 9 99.5 9 132.1s2.7 102.7-9 132.1z\"><\/path>\n\t            <\/svg>            <span>Follow Me<\/span>\r\n        <\/a>\r\n    <\/span>\r\n\t\r\n<\/div>\r\n\r\n\t    <span class=\"sbi_resized_image_data\" data-feed-id=\"sbi_17841448822309037#8\" data-resized=\"[]\">\n\t<\/span>\n\t<\/div>\r\n\r\n<\/div><span class=\"seperator extralight-border\"><\/span><\/section><\/div>\n<\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_joinchat":[]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>PATIENTS REGISTRATION FORM - Medi Tour Turkei<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"PATIENTS REGISTRATION FORM - Medi Tour Turkei\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/\" \/>\n<meta property=\"og:site_name\" content=\"Medi Tour Turkei\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/meditourturkei\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/\",\"url\":\"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/\",\"name\":\"PATIENTS REGISTRATION FORM - Medi Tour Turkei\",\"isPartOf\":{\"@id\":\"https:\/\/www.meditourturkei.com\/en\/#website\"},\"datePublished\":\"2021-07-31T07:34:06+00:00\",\"dateModified\":\"2021-07-31T07:34:06+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.meditourturkei.com\/en\/homepage\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"PATIENTS REGISTRATION FORM\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.meditourturkei.com\/en\/#website\",\"url\":\"https:\/\/www.meditourturkei.com\/en\/\",\"name\":\"Medi Tour Turkei\",\"description\":\"Gastric Sleeve Surgery, Obesity, Gastric Bypass, Hair Transplant. Dental Treatments, Plastic Surgery. Body and Breast Aesthetics and other Medical Services in Turkey\",\"publisher\":{\"@id\":\"https:\/\/www.meditourturkei.com\/en\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.meditourturkei.com\/en\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.meditourturkei.com\/en\/#organization\",\"name\":\"MediTour Turkei\",\"url\":\"https:\/\/www.meditourturkei.com\/en\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.meditourturkei.com\/en\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.meditourturkei.com\/en\/wp-content\/uploads\/2021\/07\/meditour-01.png\",\"contentUrl\":\"https:\/\/www.meditourturkei.com\/en\/wp-content\/uploads\/2021\/07\/meditour-01.png\",\"width\":1041,\"height\":264,\"caption\":\"MediTour Turkei\"},\"image\":{\"@id\":\"https:\/\/www.meditourturkei.com\/en\/#\/schema\/logo\/image\/\"},\"sameAs\":[\"https:\/\/www.facebook.com\/meditourturkei\",\"https:\/\/www.instagram.com\/meditourturkei\/\",\"https:\/\/www.youtube.com\/channel\/UCSDoAEVuxpwKf9v-AaLQ8gg\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"PATIENTS REGISTRATION FORM - Medi Tour Turkei","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/","og_locale":"en_US","og_type":"article","og_title":"PATIENTS REGISTRATION FORM - Medi Tour Turkei","og_url":"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/","og_site_name":"Medi Tour Turkei","article_publisher":"https:\/\/www.facebook.com\/meditourturkei","twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/","url":"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/","name":"PATIENTS REGISTRATION FORM - Medi Tour Turkei","isPartOf":{"@id":"https:\/\/www.meditourturkei.com\/en\/#website"},"datePublished":"2021-07-31T07:34:06+00:00","dateModified":"2021-07-31T07:34:06+00:00","breadcrumb":{"@id":"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.meditourturkei.com\/en\/patients-registration-form\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.meditourturkei.com\/en\/homepage\/"},{"@type":"ListItem","position":2,"name":"PATIENTS REGISTRATION FORM"}]},{"@type":"WebSite","@id":"https:\/\/www.meditourturkei.com\/en\/#website","url":"https:\/\/www.meditourturkei.com\/en\/","name":"Medi Tour Turkei","description":"Gastric Sleeve Surgery, Obesity, Gastric Bypass, Hair Transplant. Dental Treatments, Plastic Surgery. Body and Breast Aesthetics and other Medical Services in Turkey","publisher":{"@id":"https:\/\/www.meditourturkei.com\/en\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.meditourturkei.com\/en\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.meditourturkei.com\/en\/#organization","name":"MediTour Turkei","url":"https:\/\/www.meditourturkei.com\/en\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.meditourturkei.com\/en\/#\/schema\/logo\/image\/","url":"https:\/\/www.meditourturkei.com\/en\/wp-content\/uploads\/2021\/07\/meditour-01.png","contentUrl":"https:\/\/www.meditourturkei.com\/en\/wp-content\/uploads\/2021\/07\/meditour-01.png","width":1041,"height":264,"caption":"MediTour Turkei"},"image":{"@id":"https:\/\/www.meditourturkei.com\/en\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/meditourturkei","https:\/\/www.instagram.com\/meditourturkei\/","https:\/\/www.youtube.com\/channel\/UCSDoAEVuxpwKf9v-AaLQ8gg"]}]}},"_links":{"self":[{"href":"https:\/\/www.meditourturkei.com\/en\/wp-json\/wp\/v2\/pages\/4193"}],"collection":[{"href":"https:\/\/www.meditourturkei.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.meditourturkei.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.meditourturkei.com\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.meditourturkei.com\/en\/wp-json\/wp\/v2\/comments?post=4193"}],"version-history":[{"count":2,"href":"https:\/\/www.meditourturkei.com\/en\/wp-json\/wp\/v2\/pages\/4193\/revisions"}],"predecessor-version":[{"id":4195,"href":"https:\/\/www.meditourturkei.com\/en\/wp-json\/wp\/v2\/pages\/4193\/revisions\/4195"}],"wp:attachment":[{"href":"https:\/\/www.meditourturkei.com\/en\/wp-json\/wp\/v2\/media?parent=4193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}