{"id":30917,"date":"2025-04-03T10:51:26","date_gmt":"2025-04-03T08:51:26","guid":{"rendered":"https:\/\/app.cmwum.pl\/?page_id=30917"},"modified":"2025-04-04T11:29:05","modified_gmt":"2025-04-04T09:29:05","slug":"e-rejestracja-zapis","status":"publish","type":"page","link":"https:\/\/app.cmwum.pl\/index.php\/e-rejestracja-zapis\/","title":{"rendered":"e-rejestracja-zapis"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Header Section&#8221; _builder_version=&#8221;4.18.0&#8243; background_color=&#8221;#252e5e&#8221; background_image=&#8221;https:\/\/app.cmwum.pl\/wp-content\/uploads\/2022\/10\/tech-08.png&#8221; custom_padding=&#8221;0px||0px|||&#8221; da_disable_devices=&#8221;off|off|off&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; 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header_2_text_shadow_color__hover_enabled=&#8221;rgba(0,0,0,0.4)&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h2>e-rejestracja<\/h2>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;2_5&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;20px|||&#8221; custom_padding_tablet=&#8221;0px||&#8221; custom_padding_phone=&#8221;&#8221; custom_padding_last_edited=&#8221;on|tablet&#8221; global_colors_info=&#8221;{}&#8221; padding_tablet=&#8221;0px||&#8221; padding_last_edited=&#8221;on|tablet&#8221; custom_padding__hover=&#8221;|||&#8221; padding_phone=&#8221;0px||&#8221;][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_5,1_5,1_5,1_5,1_5&#8243; use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; _builder_version=&#8221;4.16&#8243; max_width=&#8221;1280px&#8221; custom_padding=&#8221;27px|0px|0px|0px|false|false&#8221; use_custom_width=&#8221;on&#8221; custom_width_px=&#8221;1280px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column 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link_option_url=&#8221;\/index.php\/e-rejestracja-stm&#8221; hover_enabled=&#8221;0&#8243; border_radii=&#8221;on|5px|5px|5px|5px&#8221; icon_font_size=&#8221;32px&#8221; global_colors_info=&#8221;{}&#8221; icon_color__hover_enabled=&#8221;on&#8221; icon_color__hover=&#8221;#ffffff&#8221; header_text_color__hover=&#8221;#ffffff&#8221; background_color__hover=&#8221;#30bce6&#8243; background__hover_enabled=&#8221;on|hover&#8221; background_enable_color__hover=&#8221;on&#8221; sticky_enabled=&#8221;0&#8243;][\/et_pb_blurb][\/et_pb_column][et_pb_column type=&#8221;1_5&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][\/et_pb_column][et_pb_column type=&#8221;1_5&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][\/et_pb_column][et_pb_column type=&#8221;1_5&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][\/et_pb_column][et_pb_column type=&#8221;1_5&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; da_disable_devices=&#8221;off|off|off&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][et_pb_row _builder_version=&#8221;4.17.6&#8243; _module_preset=&#8221;default&#8221; width=&#8221;95%&#8221; max_width=&#8221;1920px&#8221; module_alignment=&#8221;center&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_code _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_208_container\" data-token=\"cf7140f17acbd27afb9553beb5e5358a\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_e-rejestracja\" data-token=\"cf7140f17acbd27afb9553beb5e5358a\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">e-rejestracja<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"208\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_208\" id=\"frm_hide_fields_208\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"e-rejestracja\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_208\" name=\"frm_submit_entry_208\" value=\"13e573fdf4\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/30917\" \/><div id=\"frm_field_1988_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Wybrana poradnia<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_1987_container\" class=\"frm_form_field form-field  form-group frm_top_container\">\r\n\t<label for=\"field_joadm\" id=\"field_joadm_label\" class=\"frm_primary_label col-form-label form-label\">Poradnia\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\t\t<input name=\"item_meta[1987]\" type=\"hidden\" value=\"\"  data-invmsg=\"Poradnia is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\n\t\t\t\t<select  disabled=\"disabled\" name=\"item_meta[1987]\" id=\"field_joadm\"  data-invmsg=\"Poradnia is invalid\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t\t\t\t\t\t<option  value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\t\t \t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Chirurgii Stomatologicznej\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Chirurgii Stomatologicznej\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Ortodoncji\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Ortodoncji\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Protetyki\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Protetyki\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Stomatologiczna\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Stomatologiczna\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Stomatologii Dzieci\u0119cej\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Stomatologii Dzieci\u0119cej\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Chirurgii Stomatologicznej\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Chirurgii Stomatologicznej\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Chor\u00f3b B\u0142ony \u015aluzowej i Przyz\u0119bia\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Chor\u00f3b B\u0142ony \u015aluzowej i Przyz\u0119bia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Ortodoncji\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Ortodoncji\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Ortodoncji - PROGRAM ORTODONTYCZNEJ OPIEKI NAD DZIE\u0106MI Z WRODZONYMI WADAMI CZ\u0118\u015aCI TWARZOWEJ CZASZKI\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Ortodoncji - PROGRAM ORTODONTYCZNEJ OPIEKI NAD DZIE\u0106MI Z WRODZONYMI WADAMI CZ\u0118\u015aCI TWARZOWEJ CZASZKI\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Protetyki\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Protetyki\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Protetyki - DLA \u015aWIADCZENIOBIORC\u00d3W PO CHIRURGICZNYM LECZENIU NOWOTWOR\u00d3W W OBR\u0118BIE TWARZOCZASZKI\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Protetyki - DLA \u015aWIADCZENIOBIORC\u00d3W PO CHIRURGICZNYM LECZENIU NOWOTWOR\u00d3W W OBR\u0118BIE TWARZOCZASZKI\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1990_container\" class=\"frm_form_field form-field  form-group frm_top_container\">\r\n\t<label for=\"field_6f0ih\" id=\"field_6f0ih_label\" class=\"frm_primary_label col-form-label form-label\">Adres poradni\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_6f0ih\" name=\"item_meta[1990]\" value=\"\"  readonly=\"readonly\"  data-invmsg=\"Adres poradni is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1991_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Pacjent<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1978_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n\t<div  id=\"field_u0xmb_label\" class=\"frm_primary_label col-form-label form-label\">Dane pacjenta\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_u0xmb_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tDane pacjenta\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_1978\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_1978-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_u0xmb_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tImi\u0119\t\t\t\t<\/label>\n\n\t\t\t\t\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\t\t\t\tid=\"field_u0xmb_first\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[1978][first]\"  data-sectionid=\"1991\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Dane pacjenta is invalid\" class=\"form-control\" aria-invalid=\"false\"  \t\t\t\t\t\t\/>\n\t\t\t\t\t\t<div class=\"frm_description\" id=\"frm_field_1978_first_desc\">Imi\u0119<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_1978-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_u0xmb_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tNazwisko\t\t\t\t<\/label>\n\n\t\t\t\t\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\t\t\t\tid=\"field_u0xmb_last\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[1978][last]\"  data-sectionid=\"1991\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Dane pacjenta is invalid\" class=\"form-control\" aria-invalid=\"false\"  \t\t\t\t\t\t\/>\n\t\t\t\t\t\t<div class=\"frm_description\" id=\"frm_field_1978_last_desc\">Nazwisko<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1979_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_g4yhm\" id=\"field_g4yhm_label\" class=\"frm_primary_label col-form-label form-label\">Email\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_g4yhm\" name=\"item_meta[1979]\" value=\"\"  data-sectionid=\"1991\"  autocomplete=\"email\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Email jest nieprawid\u0142owy\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1980_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n\t<label for=\"field_vlene\" id=\"field_vlene_label\" class=\"frm_primary_label col-form-label form-label\">Telefon\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_vlene\" name=\"item_meta[1980]\" value=\"\"  data-sectionid=\"1991\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Telefon jest nieprawid\u0142owy\" class=\"form-control\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_1993_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Termin wizyty<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1995_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_3f5zz\" id=\"field_3f5zz_label\" class=\"frm_primary_label col-form-label form-label\">Data wizyty\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_3f5zz\" name=\"item_meta[1995]\" value=\"\"  data-sectionid=\"1993\"  maxlength=\"10\" data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Data wizyty jest nieprawid\u0142owa\" class=\"frm_date form-control\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1996_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n\t<div  id=\"field_6resh_label\" class=\"frm_primary_label col-form-label form-label\">Godzina\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<select aria-labelledby=\"field_6resh_label\" name=\"item_meta[1996]\" id=\"field_6resh\"  data-sectionid=\"1993\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Godzina jest nieprawid\u0142owa\" class=\"form-control\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"08:00\" >08:00<\/option><option value=\"08:30\" >08:30<\/option><option value=\"09:00\" >09:00<\/option><\/select>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_1977_container\" class=\"frm_form_field form-field  form-group\">\r\n\t<div class=\"form-group frm_submit frm_flex\">\r\n<button class=\"frm_button_submit btn btn-secondary frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Potwierdzam rezerwacj\u0119 wybranego terminu<\/button>\r\n\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__65cbbeb47783c\">\n\t\t\t\t<label for=\"frm_email_208\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_208\" type=\"text\" class=\"frm_verify\" name=\"frm__65cbbeb47783c\" value=\"\" autocomplete=\"off\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"8N1Zko1iIsmsfPCwXOuQMIm6l0MbDlU+EqBgK6V+PFRHvolffh9x+8zlMtKHGZ\/C\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>e-rejestracja<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_208_container\" data-token=\"cf7140f17acbd27afb9553beb5e5358a\" data-token=\"cf7140f17acbd27afb9553beb5e5358a\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_e-rejestracja\" data-token=\"cf7140f17acbd27afb9553beb5e5358a\" data-token=\"cf7140f17acbd27afb9553beb5e5358a\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">e-rejestracja<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"208\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_208\" id=\"frm_hide_fields_208\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"e-rejestracja\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_208\" name=\"frm_submit_entry_208\" value=\"13e573fdf4\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/30917\" \/><div id=\"frm_field_1988_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Wybrana poradnia<\/h3>\r\n\r\n\r\n<\/div>\n<div id=\"frm_field_1987_container\" class=\"frm_form_field form-field  form-group frm_top_container\">\r\n\t<label for=\"field_joadm\" id=\"field_joadm_label\" class=\"frm_primary_label col-form-label form-label\">Poradnia\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\t\t<input name=\"item_meta[1987]\" type=\"hidden\" value=\"\"  data-invmsg=\"Poradnia is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\n\t\t\t\t<select  disabled=\"disabled\" name=\"item_meta[1987]\" id=\"field_joadm\"  data-invmsg=\"Poradnia is invalid\" class=\"form-control\" aria-invalid=\"false\"  >\n\t\t\t\t\t\t\t<option  value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\t\t \t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Chirurgii Stomatologicznej\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Chirurgii Stomatologicznej\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Ortodoncji\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Ortodoncji\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Protetyki\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Protetyki\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Stomatologiczna\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Stomatologiczna\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oddzia\u0142 Stomatologii - Poradnia Stomatologii Dzieci\u0119cej\">\n\t\t\t\t\tOddzia\u0142 Stomatologii - Poradnia Stomatologii Dzieci\u0119cej\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Chirurgii Stomatologicznej\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Chirurgii Stomatologicznej\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Chor\u00f3b B\u0142ony \u015aluzowej i Przyz\u0119bia\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Chor\u00f3b B\u0142ony \u015aluzowej i Przyz\u0119bia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Ortodoncji\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Ortodoncji\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Ortodoncji - PROGRAM ORTODONTYCZNEJ OPIEKI NAD DZIE\u0106MI Z WRODZONYMI WADAMI CZ\u0118\u015aCI TWARZOWEJ CZASZKI\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Ortodoncji - PROGRAM ORTODONTYCZNEJ OPIEKI NAD DZIE\u0106MI Z WRODZONYMI WADAMI CZ\u0118\u015aCI TWARZOWEJ CZASZKI\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Protetyki\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Protetyki\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uniwersyteckie Centrum Stomatologii - Zak\u0142ad Protetyki - DLA \u015aWIADCZENIOBIORC\u00d3W PO CHIRURGICZNYM LECZENIU NOWOTWOR\u00d3W W OBR\u0118BIE TWARZOCZASZKI\">\n\t\t\t\t\tUniwersyteckie Centrum Stomatologii - Zak\u0142ad Protetyki - DLA \u015aWIADCZENIOBIORC\u00d3W PO CHIRURGICZNYM LECZENIU NOWOTWOR\u00d3W W OBR\u0118BIE TWARZOCZASZKI\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1990_container\" class=\"frm_form_field form-field  form-group frm_top_container\">\r\n\t<label for=\"field_6f0ih\" id=\"field_6f0ih_label\" class=\"frm_primary_label col-form-label form-label\">Adres poradni\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_6f0ih\" name=\"item_meta[1990]\" value=\"\"  readonly=\"readonly\"  data-invmsg=\"Adres poradni is invalid\" class=\"form-control\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1991_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Pacjent<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1978_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container\">\r\n\t<div  id=\"field_u0xmb_label\" class=\"frm_primary_label col-form-label form-label\">Dane pacjenta\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_u0xmb_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tDane pacjenta\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_1978\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_1978-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_u0xmb_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tImi\u0119\t\t\t\t<\/label>\n\n\t\t\t\t\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\t\t\t\tid=\"field_u0xmb_first\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[1978][first]\"  data-sectionid=\"1991\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Dane pacjenta is invalid\" class=\"form-control\" aria-invalid=\"false\"  \t\t\t\t\t\t\/>\n\t\t\t\t\t\t<div class=\"frm_description\" id=\"frm_field_1978_first_desc\">Imi\u0119<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_1978-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_u0xmb_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tNazwisko\t\t\t\t<\/label>\n\n\t\t\t\t\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\t\t\t\tid=\"field_u0xmb_last\"\n\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t\t\tname=\"item_meta[1978][last]\"  data-sectionid=\"1991\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Dane pacjenta is invalid\" class=\"form-control\" aria-invalid=\"false\"  \t\t\t\t\t\t\/>\n\t\t\t\t\t\t<div class=\"frm_description\" id=\"frm_field_1978_last_desc\">Nazwisko<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1979_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_g4yhm\" id=\"field_g4yhm_label\" class=\"frm_primary_label col-form-label form-label\">Email\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_g4yhm\" name=\"item_meta[1979]\" value=\"\"  data-sectionid=\"1991\"  autocomplete=\"email\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Email jest nieprawid\u0142owy\" class=\"form-control\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1980_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n\t<label for=\"field_vlene\" id=\"field_vlene_label\" class=\"frm_primary_label col-form-label form-label\">Telefon\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_vlene\" name=\"item_meta[1980]\" value=\"\"  data-sectionid=\"1991\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Telefon jest nieprawid\u0142owy\" class=\"form-control\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_1993_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Termin wizyty<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1995_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_3f5zz\" id=\"field_3f5zz_label\" class=\"frm_primary_label col-form-label form-label\">Data wizyty\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_3f5zz\" name=\"item_meta[1995]\" value=\"\"  data-sectionid=\"1993\"  maxlength=\"10\" data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Data wizyty jest nieprawid\u0142owa\" class=\"frm_date form-control\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_1996_container\" class=\"frm_form_field form-field  frm_required_field form-group frm_top_container frm6\">\r\n\t<div  id=\"field_6resh_label\" class=\"frm_primary_label col-form-label form-label\">Godzina\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<select aria-labelledby=\"field_6resh_label\" name=\"item_meta[1996]\" id=\"field_6resh\"  data-sectionid=\"1993\"  data-reqmsg=\"To pole nie mo\u017ce pozosta\u0107 puste\" aria-required=\"true\" data-invmsg=\"Godzina jest nieprawid\u0142owa\" class=\"form-control\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"08:00\" >08:00<\/option><option value=\"08:30\" >08:30<\/option><option value=\"09:00\" >09:00<\/option><\/select>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_1977_container\" class=\"frm_form_field form-field  form-group\">\r\n\t<div class=\"form-group frm_submit frm_flex\">\r\n<button class=\"frm_button_submit btn btn-secondary frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Potwierdzam rezerwacj\u0119 wybranego terminu<\/button>\r\n\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__65cbbeb47783c\">\n\t\t\t\t<label for=\"frm_email_208\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_208\" type=\"text\" class=\"frm_verify\" name=\"frm__65cbbeb47783c\" value=\"\" autocomplete=\"off\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"8N1Zko1iIsmsfPCwXOuQMIm6l0MbDlU+EqBgK6V+PFRHvolffh9x+8zlMtKHGZ\/C\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-30917","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/app.cmwum.pl\/index.php\/wp-json\/wp\/v2\/pages\/30917","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/app.cmwum.pl\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/app.cmwum.pl\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/app.cmwum.pl\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/app.cmwum.pl\/index.php\/wp-json\/wp\/v2\/comments?post=30917"}],"version-history":[{"count":6,"href":"https:\/\/app.cmwum.pl\/index.php\/wp-json\/wp\/v2\/pages\/30917\/revisions"}],"predecessor-version":[{"id":31039,"href":"https:\/\/app.cmwum.pl\/index.php\/wp-json\/wp\/v2\/pages\/30917\/revisions\/31039"}],"wp:attachment":[{"href":"https:\/\/app.cmwum.pl\/index.php\/wp-json\/wp\/v2\/media?parent=30917"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}