{"id":1964,"date":"2026-10-16T16:38:38","date_gmt":"2026-10-16T06:38:38","guid":{"rendered":"https:\/\/bnspainmobileclinic.com\/?page_id=1964"},"modified":"2026-10-16T16:39:29","modified_gmt":"2026-10-16T06:39:29","slug":"book-an-appointment","status":"publish","type":"page","link":"https:\/\/bnspainmobileclinic.com\/?page_id=1964","title":{"rendered":"Book an Appointment"},"content":{"rendered":"\t\t<form class=\"bns-bk\" id=\"bns-booking-form\" method=\"post\" novalidate>\r\n\t\t\t<input type=\"hidden\" name=\"action\" value=\"bns_booking_submit\">\r\n\t\t\t<input type=\"hidden\" name=\"bns_nonce\" value=\"\">\r\n\t\t\t<div class=\"bns-hp\" aria-hidden=\"true\"><label>Leave this field empty<input type=\"text\" name=\"website\" tabindex=\"-1\" autocomplete=\"off\"><\/label><\/div>\r\n\r\n\t\t\t<div class=\"bns-notice\">\r\n\t\t\t\t<p>If you have severe symptoms, such as pain after a fall or injury, numbness or weakness, loss of bladder or bowel control, or chest pain, please seek urgent medical care instead of waiting for a booking.<\/p>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"bns-card\">\r\n\t\t\t\t<h3 class=\"bns-card-title\"><span class=\"bns-step\">1<\/span>Personal Details<\/h3>\r\n\t\t\t<div class=\"bns-field\" data-field=\"full_name\"><label for=\"bns-full_name\">Full Name <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"bns-full_name\" name=\"full_name\" required maxlength=\"150\" autocomplete=\"name\" placeholder=\"Enter your full name\"><p class=\"bns-err\" data-error-for=\"full_name\" role=\"alert\"><\/p><\/div>\r\n\t\t\t<div class=\"bns-grid two\">\r\n\t\t\t\t<div class=\"bns-field\" data-field=\"dob\"><label for=\"bns-dob\">Date of Birth <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"date\" id=\"bns-dob\" name=\"dob\" required min=\"1900-01-01\" max=\"2026-10-19\" autocomplete=\"bday\"><p class=\"bns-err\" data-error-for=\"dob\" role=\"alert\"><\/p><\/div><div class=\"bns-field\" data-field=\"mobile\"><label for=\"bns-mobile\">Mobile Number <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"bns-mobile\" name=\"mobile\" required maxlength=\"20\" autocomplete=\"tel\" placeholder=\"+675 7000 0000\"><p class=\"bns-err\" data-error-for=\"mobile\" role=\"alert\"><\/p><\/div><fieldset class=\"bns-field bns-choices\" data-field=\"gender\"><legend>Gender <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options pills\"><label class=\"bns-opt\"><input type=\"radio\" name=\"gender\" value=\"Male\" required><span>Male<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"gender\" value=\"Female\" required><span>Female<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"gender\" value=\"Prefer not to say\" required><span>Prefer not to say<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"gender\" role=\"alert\"><\/p><\/fieldset><div class=\"bns-field\" data-field=\"email\"><label for=\"bns-email\">Email Address <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"bns-email\" name=\"email\" required maxlength=\"150\" autocomplete=\"email\" placeholder=\"yourname@example.com\"><p class=\"bns-err\" data-error-for=\"email\" role=\"alert\"><\/p><\/div><div class=\"bns-field\" data-field=\"occupation\"><label for=\"bns-occupation\">Occupation <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"bns-occupation\" name=\"occupation\" required maxlength=\"100\" placeholder=\"e.g., Office Administrator\"><p class=\"bns-err\" data-error-for=\"occupation\" role=\"alert\"><\/p><\/div><div class=\"bns-field\" data-field=\"town\"><label for=\"bns-town\">Town <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"bns-town\" name=\"town\" required maxlength=\"100\" placeholder=\"e.g., Port Moresby\"><p class=\"bns-err\" data-error-for=\"town\" role=\"alert\"><\/p><\/div><div class=\"bns-field\" data-field=\"province\"><label for=\"bns-province\">Province <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><select id=\"bns-province\" name=\"province\" required><option value=\"\">\u2013 Select Province \u2013<\/option><option value=\"Autonomous Region of Bougainville\">Autonomous Region of Bougainville<\/option><option value=\"Central\">Central<\/option><option value=\"Chimbu\">Chimbu<\/option><option value=\"East New Britain\">East New Britain<\/option><option value=\"East Sepik\">East Sepik<\/option><option value=\"Eastern Highlands\">Eastern Highlands<\/option><option value=\"Enga\">Enga<\/option><option value=\"Gulf\">Gulf<\/option><option value=\"Hela\">Hela<\/option><option value=\"Jiwaka\">Jiwaka<\/option><option value=\"Madang\">Madang<\/option><option value=\"Manus\">Manus<\/option><option value=\"Milne Bay\">Milne Bay<\/option><option value=\"Morobe\">Morobe<\/option><option value=\"National Capital District\">National Capital District<\/option><option value=\"New Ireland\">New Ireland<\/option><option value=\"Oro\">Oro<\/option><option value=\"Southern Highlands\">Southern Highlands<\/option><option value=\"West New Britain\">West New Britain<\/option><option value=\"West Sepik\">West Sepik<\/option><option value=\"Western\">Western<\/option><option value=\"Western Highlands\">Western Highlands<\/option><\/select><p class=\"bns-err\" data-error-for=\"province\" role=\"alert\"><\/p><\/div>\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"bns-field\" data-field=\"address\"><label for=\"bns-address\">Residential Address <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"bns-address\" name=\"address\" rows=\"4\" placeholder=\"Enter your full residential address\" required><\/textarea><p class=\"bns-err\" data-error-for=\"address\" role=\"alert\"><\/p><\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"bns-card\">\r\n\t\t\t\t<h3 class=\"bns-card-title\"><span class=\"bns-step\">2<\/span>Emergency Contact<\/h3>\r\n\t\t\t<div class=\"bns-grid two\">\r\n\t\t\t\t<div class=\"bns-field\" data-field=\"emergency_name\"><label for=\"bns-emergency_name\">Emergency Contact Name <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"bns-emergency_name\" name=\"emergency_name\" required maxlength=\"150\" placeholder=\"Emergency Contact Name\"><p class=\"bns-err\" data-error-for=\"emergency_name\" role=\"alert\"><\/p><\/div><div class=\"bns-field\" data-field=\"emergency_phone\"><label for=\"bns-emergency_phone\">Emergency Contact Number <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"bns-emergency_phone\" name=\"emergency_phone\" required maxlength=\"20\" placeholder=\"+675 7000 0000\"><p class=\"bns-err\" data-error-for=\"emergency_phone\" role=\"alert\"><\/p><\/div>\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"bns-field\" data-field=\"heard_from\"><label for=\"bns-heard_from\">How Did You Hear About Us?<\/label><select id=\"bns-heard_from\" name=\"heard_from\"><option value=\"\">\u2013 Select Option \u2013<\/option><option value=\"Facebook\">Facebook<\/option><option value=\"WhatsApp\">WhatsApp<\/option><option value=\"Friend or family\">Friend or family<\/option><option value=\"Doctor or clinic referral\">Doctor or clinic referral<\/option><option value=\"Workplace\">Workplace<\/option><option value=\"Other\">Other<\/option><\/select><p class=\"bns-err\" data-error-for=\"heard_from\" role=\"alert\"><\/p><\/div>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"bns-card\">\r\n\t\t\t\t<h3 class=\"bns-card-title\"><span class=\"bns-step\">3<\/span>Appointment Details<\/h3>\r\n\t\t\t<div class=\"bns-grid\">\r\n\t\t\t\t<div class=\"bns-field\" data-field=\"preferred_date\"><label for=\"bns-preferred_date\">Preferred Appointment Date <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"date\" id=\"bns-preferred_date\" name=\"preferred_date\" required min=\"2026-10-19\"><p class=\"bns-err\" data-error-for=\"preferred_date\" role=\"alert\"><\/p><\/div><fieldset class=\"bns-field bns-choices\" data-field=\"preferred_time\"><legend>Preferred Time <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options\"><label class=\"bns-opt\"><input type=\"radio\" name=\"preferred_time\" value=\"Morning (8:00 AM \u2013 12:00 PM)\" required><span>Morning (8:00 AM \u2013 12:00 PM)<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"preferred_time\" value=\"Afternoon (12:00 PM \u2013 10:00 PM)\" required><span>Afternoon (12:00 PM \u2013 10:00 PM)<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"preferred_time\" value=\"Flexible\" required><span>Flexible<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"preferred_time\" role=\"alert\"><\/p><\/fieldset>\t\t\t<\/div>\r\n\r\n\t\t\t<fieldset class=\"bns-field bns-choices\" data-field=\"services\" data-need=\"any\"><legend>Service Required (Select all that apply) <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options cols\"><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"General Pain Management &amp; Treatment\"><span>General Pain Management &amp; Treatment<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Back Pain Management &amp; Treatment\"><span>Back Pain Management &amp; Treatment<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Neck Pain Management &amp; Treatment\"><span>Neck Pain Management &amp; Treatment<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Shoulder Pain Management &amp; Treatment\"><span>Shoulder Pain Management &amp; Treatment<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Knee &amp; Ankle Pain Management &amp; Treatment\"><span>Knee &amp; Ankle Pain Management &amp; Treatment<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Advanced Sciatica Pain Management &amp; Treatment\"><span>Advanced Sciatica Pain Management &amp; Treatment<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Chiropractic (Bone Cracking &amp; Alignment)\"><span>Chiropractic (Bone Cracking &amp; Alignment)<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Sports Related Injuries\"><span>Sports Related Injuries<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Musculoskeletal Pain Management &amp; Treatment\"><span>Musculoskeletal Pain Management &amp; Treatment<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Advanced Stroke Rehabilitation\"><span>Advanced Stroke Rehabilitation<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Work Related Pain Management On-site\"><span>Work Related Pain Management On-site<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Advanced Stroke Muscle Stimulation\"><span>Advanced Stroke Muscle Stimulation<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Advanced Weak Muscle Stimulation\"><span>Advanced Weak Muscle Stimulation<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Electric &amp; Manual Acupuncture for Upper &amp; Lower Limbs\"><span>Electric &amp; Manual Acupuncture for Upper &amp; Lower Limbs<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"services[]\" value=\"Other (Please Specify)\"><span>Other (Please Specify)<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"services\" role=\"alert\"><\/p><\/fieldset>\t\t\t<div class=\"bns-group\" id=\"bns-grp-service-other\" hidden>\r\n\t\t\t\t<div class=\"bns-field\" data-field=\"service_other\"><label for=\"bns-service_other\">Other service (please specify) <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"bns-service_other\" name=\"service_other\" required maxlength=\"150\"><p class=\"bns-err\" data-error-for=\"service_other\" role=\"alert\"><\/p><\/div>\t\t\t<\/div>\r\n\r\n\t\t\t<fieldset class=\"bns-field bns-choices\" data-field=\"branch\"><legend>Visit Location <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options\"><label class=\"bns-opt\"><input type=\"radio\" name=\"branch\" value=\"Waigani Islander Branch\" required><span>Waigani Islander Branch<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"branch\" value=\"Gerehu (POMCARE Clinic) Branch\" required><span>Gerehu (POMCARE Clinic) Branch<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"branch\" value=\"Other Location\" required><span>Other Location<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"branch\" role=\"alert\"><\/p><\/fieldset>\t\t\t<div class=\"bns-group\" id=\"bns-grp-branch-other\" hidden>\r\n\t\t\t\t<div class=\"bns-field\" data-field=\"branch_other\"><label for=\"bns-branch_other\">Select Location <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><select id=\"bns-branch_other\" name=\"branch_other\" required><option value=\"\">\u2013 Select Location \u2013<\/option><option value=\"Goroka\">Goroka<\/option><option value=\"Lae\">Lae<\/option><option value=\"Madang\">Madang<\/option><option value=\"Mendi\">Mendi<\/option><option value=\"Mount Hagen\">Mount Hagen<\/option><option value=\"Wabag\">Wabag<\/option><\/select><p class=\"bns-err\" data-error-for=\"branch_other\" role=\"alert\"><\/p><\/div>\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"bns-card\">\r\n\t\t\t\t<h3 class=\"bns-card-title\"><span class=\"bns-step\">4<\/span>Medical Information<\/h3>\r\n\t\t\t<fieldset class=\"bns-field bns-choices\" data-field=\"conditions\" data-need=\"any\"><legend>Do You Currently Have Any of the Following? <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options cols\"><label class=\"bns-opt\"><input type=\"checkbox\" name=\"conditions[]\" value=\"High Blood Pressure\"><span>High Blood Pressure<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"conditions[]\" value=\"Diabetes\"><span>Diabetes<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"conditions[]\" value=\"Heart Condition\"><span>Heart Condition<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"conditions[]\" value=\"Recent Surgery\"><span>Recent Surgery<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"conditions[]\" value=\"Stroke History\"><span>Stroke History<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"conditions[]\" value=\"Pregnancy\"><span>Pregnancy<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"conditions[]\" value=\"None\"><span>None<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"conditions[]\" value=\"Other (Please Specify)\"><span>Other (Please Specify)<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"conditions\" role=\"alert\"><\/p><\/fieldset>\t\t\t<div class=\"bns-group\" id=\"bns-grp-conditions-other\" hidden>\r\n\t\t\t\t<div class=\"bns-field\" data-field=\"conditions_other\"><label for=\"bns-conditions_other\">Other condition (please specify) <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"bns-conditions_other\" name=\"conditions_other\" required maxlength=\"200\"><p class=\"bns-err\" data-error-for=\"conditions_other\" role=\"alert\"><\/p><\/div>\t\t\t<\/div>\r\n\r\n\t\t\t<fieldset class=\"bns-field bns-choices\" data-field=\"medication\"><legend>Are You Currently Taking Any Medication? <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options pills\"><label class=\"bns-opt\"><input type=\"radio\" name=\"medication\" value=\"Yes\" required><span>Yes<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"medication\" value=\"No\" required><span>No<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"medication\" role=\"alert\"><\/p><\/fieldset><fieldset class=\"bns-field bns-choices\" data-field=\"pain_areas\" data-need=\"any\"><legend>What Area Is Causing Pain? <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options cols\"><label class=\"bns-opt\"><input type=\"checkbox\" name=\"pain_areas[]\" value=\"Neck\"><span>Neck<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"pain_areas[]\" value=\"Shoulder\"><span>Shoulder<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"pain_areas[]\" value=\"Upper Back\"><span>Upper Back<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"pain_areas[]\" value=\"Lower Back\"><span>Lower Back<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"pain_areas[]\" value=\"Knee\"><span>Knee<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"pain_areas[]\" value=\"Ankle\"><span>Ankle<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"pain_areas[]\" value=\"Arm\"><span>Arm<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"pain_areas[]\" value=\"Hip\"><span>Hip<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"pain_areas[]\" value=\"Multiple Areas\"><span>Multiple Areas<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"pain_areas\" role=\"alert\"><\/p><\/fieldset><fieldset class=\"bns-field bns-choices\" data-field=\"pain_duration\"><legend>How Long Have You Had This Pain? <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options pills\"><label class=\"bns-opt\"><input type=\"radio\" name=\"pain_duration\" value=\"Less than 1 Week\" required><span>Less than 1 Week<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"pain_duration\" value=\"1\u20134 Weeks\" required><span>1\u20134 Weeks<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"pain_duration\" value=\"1\u20136 Months\" required><span>1\u20136 Months<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"pain_duration\" value=\"More than 6 Months\" required><span>More than 6 Months<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"pain_duration\" role=\"alert\"><\/p><\/fieldset><div class=\"bns-field\" data-field=\"symptoms\"><label for=\"bns-symptoms\">Please Describe Your Symptoms <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"bns-symptoms\" name=\"symptoms\" rows=\"4\" placeholder=\"Examples: Lower Back Pain, Neck Stiffness, Headaches, Tingling Sensation, Numbness, Muscle Weakness, Difficulty Walking, Sports Injury\" required><\/textarea><p class=\"bns-err\" data-error-for=\"symptoms\" role=\"alert\"><\/p><\/div><fieldset class=\"bns-field bns-choices\" data-field=\"previous_treatment\"><legend>Have You Received Treatment for This Condition Before? <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options pills\"><label class=\"bns-opt\"><input type=\"radio\" name=\"previous_treatment\" value=\"Yes\" required><span>Yes<\/span><\/label><label class=\"bns-opt\"><input type=\"radio\" name=\"previous_treatment\" value=\"No\" required><span>No<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"previous_treatment\" role=\"alert\"><\/p><\/fieldset>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"bns-card\">\r\n\t\t\t\t<h3 class=\"bns-card-title\"><span class=\"bns-step\">5<\/span>Payment &amp; Consent<\/h3>\r\n\t\t\t<div class=\"bns-info\">\r\n\t\t\t\t<p><strong>Payment Options:<\/strong> You can pay your consultation fee in advance to secure your appointment, or pay upon arrival at the clinic after your consultation with the doctor.<\/p>\r\n\t\t\t\t<p><strong>Bank Account Details:<\/strong> Please email us on sales@bnspainmobileclinic.com or WhatsApp +675 7857 9744 for current bank account details.<\/p>\r\n\t\t\t<\/div>\r\n\r\n\t\t\t<div class=\"bns-field\" data-field=\"special\"><label for=\"bns-special\">Special Instructions or Requests<\/label><textarea id=\"bns-special\" name=\"special\" rows=\"4\" placeholder=\"Any special instructions or requests...\" ><\/textarea><p class=\"bns-err\" data-error-for=\"special\" role=\"alert\"><\/p><\/div>\r\n\t\t\t<h4 class=\"bns-subheading\">Privacy &amp; Consent<\/h4>\r\n\t\t\t<p class=\"bns-info-text\">Privacy Notice: All personal, medical and payment information collected through this form will be treated as strictly confidential and used solely for appointment booking, treatment, billing and healthcare communication purposes.<\/p>\r\n\t\t\t<fieldset class=\"bns-field bns-choices\" data-field=\"confirm\" data-need=\"all\"><legend>Please Confirm <span class=\"bns-req\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"bns-options\"><label class=\"bns-opt\"><input type=\"checkbox\" name=\"confirm[]\" value=\"I consent to BNS Mobile Clinic collecting and securely storing my personal and medical information.\"><span>I consent to BNS Mobile Clinic collecting and securely storing my personal and medical information.<\/span><\/label><label class=\"bns-opt\"><input type=\"checkbox\" name=\"confirm[]\" value=\"I understand that I can pay in advance to secure my appointment, or pay upon arrival after my consultation.\"><span>I understand that I can pay in advance to secure my appointment, or pay upon arrival after my consultation.<\/span><\/label><\/div><p class=\"bns-err\" data-error-for=\"confirm\" role=\"alert\"><\/p><\/fieldset>\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<div class=\"bns-field bns-recaptcha\" data-field=\"recaptcha\"><div id=\"bns-recaptcha\"><\/div><p class=\"bns-err\" data-error-for=\"recaptcha\" role=\"alert\"><\/p><\/div>\r\n\t\t\t\r\n\t\t\t<p class=\"bns-form-msg\" role=\"alert\"><\/p>\r\n\t\t\t<button type=\"submit\" class=\"bns-submit\">Send booking request<\/button>\r\n\t\t<\/form>\r\n\t\t\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":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_joinchat":[],"footnotes":""},"class_list":["post-1964","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 5.0.3 - aioseo.com -->\n\t<meta name=\"robots\" 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