{"id":244,"date":"2025-11-09T13:47:01","date_gmt":"2025-11-09T13:47:01","guid":{"rendered":"https:\/\/nichtrix.co.uk\/?page_id=244"},"modified":"2025-11-11T22:34:56","modified_gmt":"2025-11-11T22:34:56","slug":"book-your-appointment","status":"publish","type":"page","link":"https:\/\/nichtrix.co.uk\/?page_id=244","title":{"rendered":"Book Your Appointment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"244\" class=\"elementor elementor-244\" data-elementor-settings=\"{&quot;ha_cmc_init_switcher&quot;:&quot;no&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3ad964e e-flex e-con-boxed e-con e-parent\" data-id=\"3ad964e\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fa10287 elementor-widget elementor-widget-elementskit-heading\" data-id=\"fa10287\" data-element_type=\"widget\" data-widget_type=\"elementskit-heading.default\">\n\t\t\t\t\t<div class=\"ekit-wid-con\" ><div class=\"ekit-heading elementskit-section-title-wraper text_left   ekit_heading_tablet-   ekit_heading_mobile-\"><h2 class=\"ekit-heading--title elementskit-section-title \">Appointment Booking Form<\/h2><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-cd3ec81 e-flex e-con-boxed e-con e-parent\" data-id=\"cd3ec81\" data-element_type=\"container\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c014101 elementor-widget elementor-widget-text-editor\" data-id=\"c014101\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p data-start=\"218\" data-end=\"596\">At Nichtrix, we understand that every individual\u2019s ADHD journey is unique. Our compassionate team is here to provide expert assessments, guidance, and ongoing support to help you or your loved one thrive.\u00a0Please complete the form below to schedule your appointment. Once submitted, a member of our care team will reach out to confirm your booking and discuss the next steps.\u00a0<span style=\"font-size: 14px;\">We\u2019re committed to providing a calm, understanding, and confidential environment where you can get the help you need \u2014 at your own pace.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-5ae6b84 e-flex e-con-boxed e-con e-parent\" data-id=\"5ae6b84\" data-element_type=\"container\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e079a2b elementor-widget__width-initial elementor-widget elementor-widget-shortcode\" data-id=\"e079a2b\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-217 forminator-design--flat  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-217\" data-uid=\"69e4c8484e871\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-217\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-217 forminator-design--flat  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"217\"\n\t\t\t\t data-color-option=\"default\" data-design=\"flat\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69e4c8484e871\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div tabindex=\"-1\" role=\"tabpanel\" id=\"forminator-custom-form-217--page-0\" class=\"forminator-pagination forminator-pagination-start\" aria-labelledby=\"forminator-custom-form-217--page-0-label\" data-step=\"0\" data-label=\"Finish\" data-name=\"page-break-1\"><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_69e4c8484e871\" id=\"forminator-field-first-name-1_69e4c8484e871-label\" class=\"forminator-label\">First Name<\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"\" id=\"forminator-field-first-name-1_69e4c8484e871\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_69e4c8484e871\" id=\"forminator-field-last-name-1_69e4c8484e871-label\" class=\"forminator-label\">Last Name<\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"\" id=\"forminator-field-last-name-1_69e4c8484e871\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-4 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69e4c8484e871\" id=\"forminator-field-address-1-street_address_69e4c8484e871-label\" class=\"forminator-label\">Street Address<\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"\" id=\"forminator-field-address-1-street_address_69e4c8484e871\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><\/div><div id=\"address-2\" class=\"forminator-field-address forminator-col forminator-col-4 \"><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-2-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-city_69e4c8484e871\" id=\"forminator-field-address-2-city_69e4c8484e871-label\" class=\"forminator-label\">City<\/label><input type=\"text\" name=\"address-2-city\" placeholder=\"\" id=\"forminator-field-address-2-city_69e4c8484e871\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><\/div><div id=\"address-3\" class=\"forminator-field-address forminator-col forminator-col-4 \"><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-3-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-3-zip_69e4c8484e871\" id=\"forminator-field-address-3-zip_69e4c8484e871-label\" class=\"forminator-label\">ZIP \/ Postal Code<\/label><input type=\"text\" name=\"address-3-zip\" placeholder=\"\" id=\"forminator-field-address-3-zip_69e4c8484e871\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-4\" class=\"forminator-field-address forminator-col forminator-col-6 \"><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-4-country\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-217__field--address-4-country_69e4c8484e871\" id=\"forminator-field-217__field--address-4-country_69e4c8484e871-label\" class=\"forminator-label\">Country<\/label><select name=\"address-4-country\" id=\"forminator-field-217__field--address-4-country_69e4c8484e871\" class=\"forminator-select2\" data-search=\"true\" data-placeholder=\"Select country\" autocomplete=\"country-name country\" data-default-value=\"\"><option value=\"\" data-country-code=\"\" selected=\"selected\"><\/option><option value=\"Afghanistan\" data-country-code=\"AF\" >Afghanistan<\/option><option value=\"Albania\" data-country-code=\"AL\" >Albania<\/option><option value=\"Algeria\" data-country-code=\"DZ\" >Algeria<\/option><option value=\"American Samoa\" data-country-code=\"AS\" >American Samoa<\/option><option value=\"Andorra\" data-country-code=\"AD\" >Andorra<\/option><option value=\"Angola\" data-country-code=\"AO\" >Angola<\/option><option value=\"Anguilla\" data-country-code=\"AI\" >Anguilla<\/option><option value=\"Antarctica\" data-country-code=\"AQ\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" data-country-code=\"AG\" >Antigua and Barbuda<\/option><option value=\"Argentina\" data-country-code=\"AR\" >Argentina<\/option><option value=\"Armenia\" data-country-code=\"AM\" >Armenia<\/option><option value=\"Aruba\" data-country-code=\"AW\" >Aruba<\/option><option value=\"Australia\" data-country-code=\"AU\" >Australia<\/option><option value=\"Austria\" data-country-code=\"AT\" >Austria<\/option><option value=\"Azerbaijan\" data-country-code=\"AZ\" >Azerbaijan<\/option><option value=\"Bahamas\" data-country-code=\"BS\" >Bahamas<\/option><option value=\"Bahrain\" data-country-code=\"BH\" >Bahrain<\/option><option value=\"Bangladesh\" data-country-code=\"BD\" >Bangladesh<\/option><option value=\"Barbados\" data-country-code=\"BB\" >Barbados<\/option><option value=\"Belarus\" data-country-code=\"BY\" >Belarus<\/option><option value=\"Belgium\" data-country-code=\"BE\" >Belgium<\/option><option value=\"Belize\" data-country-code=\"BZ\" >Belize<\/option><option value=\"Benin\" data-country-code=\"BJ\" >Benin<\/option><option value=\"Bermuda\" data-country-code=\"BM\" >Bermuda<\/option><option value=\"Bhutan\" data-country-code=\"BT\" >Bhutan<\/option><option value=\"Bolivia\" data-country-code=\"BO\" >Bolivia<\/option><option value=\"Bosnia and Herzegovina\" data-country-code=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" data-country-code=\"BW\" >Botswana<\/option><option value=\"Bouvet Island\" data-country-code=\"BV\" >Bouvet Island<\/option><option value=\"Brazil\" data-country-code=\"BR\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" data-country-code=\"IO\" >British Indian Ocean Territory<\/option><option value=\"Brunei\" data-country-code=\"BN\" >Brunei<\/option><option value=\"Bulgaria\" data-country-code=\"BG\" >Bulgaria<\/option><option value=\"Burkina Faso\" data-country-code=\"BF\" >Burkina Faso<\/option><option value=\"Burundi\" data-country-code=\"BI\" >Burundi<\/option><option value=\"Cabo Verde\" data-country-code=\"CV\" >Cabo Verde<\/option><option value=\"Cambodia\" data-country-code=\"KH\" >Cambodia<\/option><option value=\"Cameroon\" data-country-code=\"CM\" >Cameroon<\/option><option value=\"Canada\" data-country-code=\"CA\" >Canada<\/option><option value=\"Cayman Islands\" data-country-code=\"KY\" >Cayman Islands<\/option><option value=\"Central African Republic\" data-country-code=\"CF\" >Central African Republic<\/option><option value=\"Chad\" data-country-code=\"TD\" >Chad<\/option><option value=\"Chile\" data-country-code=\"CL\" >Chile<\/option><option value=\"China, People's Republic of\" data-country-code=\"CN\" >China, People's Republic of<\/option><option value=\"Christmas Island\" data-country-code=\"CX\" >Christmas Island<\/option><option value=\"Cocos Islands\" data-country-code=\"CC\" >Cocos Islands<\/option><option value=\"Colombia\" data-country-code=\"CO\" >Colombia<\/option><option value=\"Comoros\" data-country-code=\"KM\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" data-country-code=\"CD\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" data-country-code=\"CG\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" data-country-code=\"CK\" >Cook Islands<\/option><option value=\"Costa Rica\" data-country-code=\"CR\" >Costa Rica<\/option><option value=\"Croatia\" data-country-code=\"HR\" >Croatia<\/option><option value=\"Cuba\" data-country-code=\"CU\" >Cuba<\/option><option value=\"Cura\u00e7ao\" data-country-code=\"CW\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" data-country-code=\"CY\" >Cyprus<\/option><option value=\"Czech Republic\" data-country-code=\"CZ\" >Czech Republic<\/option><option value=\"C\u00f4te d'Ivoire\" data-country-code=\"CI\" >C\u00f4te d'Ivoire<\/option><option value=\"Denmark\" data-country-code=\"DK\" >Denmark<\/option><option value=\"Djibouti\" data-country-code=\"DJ\" >Djibouti<\/option><option value=\"Dominica\" data-country-code=\"DM\" >Dominica<\/option><option value=\"Dominican Republic\" data-country-code=\"DO\" >Dominican Republic<\/option><option value=\"East Timor\" data-country-code=\"TL\" >East Timor<\/option><option value=\"Ecuador\" data-country-code=\"EC\" >Ecuador<\/option><option value=\"Egypt\" data-country-code=\"EG\" >Egypt<\/option><option value=\"El Salvador\" data-country-code=\"SV\" >El Salvador<\/option><option value=\"Equatorial Guinea\" data-country-code=\"GQ\" >Equatorial Guinea<\/option><option value=\"Eritrea\" data-country-code=\"ER\" >Eritrea<\/option><option value=\"Estonia\" data-country-code=\"EE\" >Estonia<\/option><option value=\"Ethiopia\" data-country-code=\"ET\" >Ethiopia<\/option><option value=\"Falkland Islands\" data-country-code=\"FK\" >Falkland Islands<\/option><option value=\"Faroe Islands\" data-country-code=\"FO\" >Faroe Islands<\/option><option value=\"Fiji\" data-country-code=\"FJ\" >Fiji<\/option><option value=\"Finland\" data-country-code=\"FI\" >Finland<\/option><option value=\"France\" data-country-code=\"FR\" >France<\/option><option value=\"France, Metropolitan\" data-country-code=\"FX\" >France, Metropolitan<\/option><option value=\"French Guiana\" data-country-code=\"GF\" >French Guiana<\/option><option value=\"French Polynesia\" data-country-code=\"PF\" >French Polynesia<\/option><option value=\"French South Territories\" data-country-code=\"TF\" >French South Territories<\/option><option value=\"Gabon\" data-country-code=\"GA\" >Gabon<\/option><option value=\"Gambia\" data-country-code=\"GM\" >Gambia<\/option><option value=\"Georgia\" data-country-code=\"GE\" >Georgia<\/option><option value=\"Germany\" data-country-code=\"DE\" >Germany<\/option><option value=\"Ghana\" data-country-code=\"GH\" >Ghana<\/option><option value=\"Gibraltar\" data-country-code=\"GI\" >Gibraltar<\/option><option value=\"Greece\" data-country-code=\"GR\" >Greece<\/option><option value=\"Greenland\" data-country-code=\"GL\" >Greenland<\/option><option value=\"Grenada\" data-country-code=\"GD\" >Grenada<\/option><option value=\"Guadeloupe\" data-country-code=\"GP\" >Guadeloupe<\/option><option value=\"Guam\" data-country-code=\"GU\" >Guam<\/option><option value=\"Guatemala\" data-country-code=\"GT\" >Guatemala<\/option><option value=\"Guernsey\" data-country-code=\"GG\" >Guernsey<\/option><option value=\"Guinea\" data-country-code=\"GN\" >Guinea<\/option><option value=\"Guinea-Bissau\" data-country-code=\"GW\" >Guinea-Bissau<\/option><option value=\"Guyana\" data-country-code=\"GY\" >Guyana<\/option><option value=\"Haiti\" data-country-code=\"HT\" >Haiti<\/option><option value=\"Heard Island And Mcdonald Island\" data-country-code=\"HM\" >Heard Island And Mcdonald Island<\/option><option value=\"Honduras\" data-country-code=\"HN\" >Honduras<\/option><option value=\"Hong Kong\" data-country-code=\"HK\" >Hong Kong<\/option><option value=\"Hungary\" data-country-code=\"HU\" >Hungary<\/option><option value=\"Iceland\" data-country-code=\"IS\" >Iceland<\/option><option value=\"India\" data-country-code=\"IN\" >India<\/option><option value=\"Indonesia\" data-country-code=\"ID\" >Indonesia<\/option><option value=\"Iran\" data-country-code=\"IR\" >Iran<\/option><option value=\"Iraq\" data-country-code=\"IQ\" >Iraq<\/option><option value=\"Ireland\" data-country-code=\"IE\" >Ireland<\/option><option value=\"Israel\" data-country-code=\"IL\" >Israel<\/option><option value=\"Italy\" data-country-code=\"IT\" >Italy<\/option><option value=\"Jamaica\" data-country-code=\"JM\" >Jamaica<\/option><option value=\"Japan\" data-country-code=\"JP\" >Japan<\/option><option value=\"Jersey\" data-country-code=\"JE\" >Jersey<\/option><option value=\"Johnston Island\" data-country-code=\"JT\" >Johnston Island<\/option><option value=\"Jordan\" data-country-code=\"JO\" >Jordan<\/option><option value=\"Kazakhstan\" data-country-code=\"KZ\" >Kazakhstan<\/option><option value=\"Kenya\" data-country-code=\"KE\" >Kenya<\/option><option value=\"Kiribati\" data-country-code=\"KI\" >Kiribati<\/option><option value=\"Korea, Democratic People's Republic of\" data-country-code=\"KP\" >Korea, Democratic People's Republic of<\/option><option value=\"Korea, Republic of\" data-country-code=\"KR\" >Korea, Republic of<\/option><option value=\"Kosovo\" data-country-code=\"XK\" >Kosovo<\/option><option value=\"Kuwait\" data-country-code=\"KW\" >Kuwait<\/option><option value=\"Kyrgyzstan\" data-country-code=\"KG\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" data-country-code=\"LA\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" data-country-code=\"LV\" >Latvia<\/option><option value=\"Lebanon\" data-country-code=\"LB\" >Lebanon<\/option><option value=\"Lesotho\" data-country-code=\"LS\" >Lesotho<\/option><option value=\"Liberia\" data-country-code=\"LR\" >Liberia<\/option><option value=\"Libya\" data-country-code=\"LY\" >Libya<\/option><option value=\"Liechtenstein\" data-country-code=\"LI\" >Liechtenstein<\/option><option value=\"Lithuania\" data-country-code=\"LT\" >Lithuania<\/option><option value=\"Luxembourg\" data-country-code=\"LU\" >Luxembourg<\/option><option value=\"Macau\" data-country-code=\"MO\" >Macau<\/option><option value=\"Madagascar\" data-country-code=\"MG\" >Madagascar<\/option><option value=\"Malawi\" data-country-code=\"MW\" >Malawi<\/option><option value=\"Malaysia\" data-country-code=\"MY\" >Malaysia<\/option><option value=\"Maldives\" data-country-code=\"MV\" >Maldives<\/option><option value=\"Mali\" data-country-code=\"ML\" >Mali<\/option><option value=\"Malta\" data-country-code=\"MT\" >Malta<\/option><option value=\"Marshall Islands\" data-country-code=\"MH\" >Marshall Islands<\/option><option value=\"Martinique\" data-country-code=\"MQ\" >Martinique<\/option><option value=\"Mauritania\" data-country-code=\"MR\" >Mauritania<\/option><option value=\"Mauritius\" data-country-code=\"MU\" >Mauritius<\/option><option value=\"Mayotte\" data-country-code=\"YT\" >Mayotte<\/option><option value=\"Mexico\" data-country-code=\"MX\" >Mexico<\/option><option value=\"Micronesia\" data-country-code=\"FM\" >Micronesia<\/option><option value=\"Moldova\" data-country-code=\"MD\" >Moldova<\/option><option value=\"Monaco\" data-country-code=\"MC\" >Monaco<\/option><option value=\"Mongolia\" data-country-code=\"MN\" >Mongolia<\/option><option value=\"Montenegro\" data-country-code=\"ME\" >Montenegro<\/option><option value=\"Montserrat\" data-country-code=\"MS\" >Montserrat<\/option><option value=\"Morocco\" data-country-code=\"MA\" >Morocco<\/option><option value=\"Mozambique\" data-country-code=\"MZ\" >Mozambique<\/option><option value=\"Myanmar\" data-country-code=\"MM\" >Myanmar<\/option><option value=\"Namibia\" data-country-code=\"NA\" >Namibia<\/option><option value=\"Nauru\" data-country-code=\"NR\" >Nauru<\/option><option value=\"Nepal\" data-country-code=\"NP\" >Nepal<\/option><option value=\"Netherlands\" data-country-code=\"NL\" >Netherlands<\/option><option value=\"Netherlands Antilles\" data-country-code=\"AN\" >Netherlands Antilles<\/option><option value=\"New Caledonia\" data-country-code=\"NC\" >New Caledonia<\/option><option value=\"New Zealand\" data-country-code=\"NZ\" >New Zealand<\/option><option value=\"Nicaragua\" data-country-code=\"NI\" >Nicaragua<\/option><option value=\"Niger\" data-country-code=\"NE\" >Niger<\/option><option value=\"Nigeria\" data-country-code=\"NG\" >Nigeria<\/option><option value=\"Niue\" data-country-code=\"NU\" >Niue<\/option><option value=\"Norfolk Island\" data-country-code=\"NF\" >Norfolk Island<\/option><option value=\"North Macedonia\" data-country-code=\"MK\" >North Macedonia<\/option><option value=\"Northern Mariana Islands\" data-country-code=\"MP\" >Northern Mariana Islands<\/option><option value=\"Norway\" data-country-code=\"NO\" >Norway<\/option><option value=\"Oman\" data-country-code=\"OM\" >Oman<\/option><option value=\"Pakistan\" data-country-code=\"PK\" >Pakistan<\/option><option value=\"Palau\" data-country-code=\"PW\" >Palau<\/option><option value=\"Palestine, State of\" data-country-code=\"PS\" >Palestine, State of<\/option><option value=\"Panama\" data-country-code=\"PA\" >Panama<\/option><option value=\"Papua New Guinea\" data-country-code=\"PG\" >Papua New Guinea<\/option><option value=\"Paraguay\" data-country-code=\"PY\" >Paraguay<\/option><option value=\"Peru\" data-country-code=\"PE\" >Peru<\/option><option value=\"Philippines\" data-country-code=\"PH\" >Philippines<\/option><option value=\"Pitcairn Islands\" data-country-code=\"PN\" >Pitcairn Islands<\/option><option value=\"Poland\" data-country-code=\"PL\" >Poland<\/option><option value=\"Portugal\" data-country-code=\"PT\" >Portugal<\/option><option value=\"Puerto Rico\" data-country-code=\"PR\" >Puerto Rico<\/option><option value=\"Qatar\" data-country-code=\"QA\" >Qatar<\/option><option value=\"Reunion Island\" data-country-code=\"RE\" >Reunion Island<\/option><option value=\"Romania\" data-country-code=\"RO\" >Romania<\/option><option value=\"Russia\" data-country-code=\"RU\" >Russia<\/option><option value=\"Rwanda\" data-country-code=\"RW\" >Rwanda<\/option><option value=\"Saint Helena\" data-country-code=\"SH\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" data-country-code=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" data-country-code=\"LC\" >Saint Lucia<\/option><option value=\"Saint Pierre & Miquelon\" data-country-code=\"PM\" >Saint Pierre & Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" data-country-code=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" data-country-code=\"WS\" >Samoa<\/option><option value=\"San Marino\" data-country-code=\"SM\" >San Marino<\/option><option value=\"Sao Tome and Principe\" data-country-code=\"ST\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" data-country-code=\"SA\" >Saudi Arabia<\/option><option value=\"Senegal\" data-country-code=\"SN\" >Senegal<\/option><option value=\"Serbia\" data-country-code=\"RS\" >Serbia<\/option><option value=\"Seychelles\" data-country-code=\"SC\" >Seychelles<\/option><option value=\"Sierra Leone\" data-country-code=\"SL\" >Sierra Leone<\/option><option value=\"Singapore\" data-country-code=\"SG\" >Singapore<\/option><option value=\"Sint Maarten\" data-country-code=\"MF\" >Sint Maarten<\/option><option value=\"Slovakia\" data-country-code=\"SK\" >Slovakia<\/option><option value=\"Slovenia\" data-country-code=\"SI\" >Slovenia<\/option><option value=\"Solomon Islands\" data-country-code=\"SB\" >Solomon Islands<\/option><option value=\"Somalia\" data-country-code=\"SO\" >Somalia<\/option><option value=\"South Africa\" data-country-code=\"ZA\" >South Africa<\/option><option value=\"South Georgia and South Sandwich\" data-country-code=\"GS\" >South Georgia and South Sandwich<\/option><option value=\"Spain\" data-country-code=\"ES\" >Spain<\/option><option value=\"Sri Lanka\" data-country-code=\"LK\" >Sri Lanka<\/option><option value=\"Stateless Persons\" data-country-code=\"XX\" >Stateless Persons<\/option><option value=\"Sudan\" data-country-code=\"SD\" >Sudan<\/option><option value=\"Sudan, South\" data-country-code=\"SS\" >Sudan, South<\/option><option value=\"Suriname\" data-country-code=\"SR\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen\" data-country-code=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"Swaziland\" data-country-code=\"SZ\" >Swaziland<\/option><option value=\"Sweden\" data-country-code=\"SE\" >Sweden<\/option><option value=\"Switzerland\" data-country-code=\"CH\" >Switzerland<\/option><option value=\"Syria\" data-country-code=\"SY\" >Syria<\/option><option value=\"Taiwan, Republic of China\" data-country-code=\"TW\" >Taiwan, Republic of China<\/option><option value=\"Tajikistan\" data-country-code=\"TJ\" >Tajikistan<\/option><option value=\"Tanzania\" data-country-code=\"TZ\" >Tanzania<\/option><option value=\"Thailand\" data-country-code=\"TH\" >Thailand<\/option><option value=\"Togo\" data-country-code=\"TG\" >Togo<\/option><option value=\"Tokelau\" data-country-code=\"TK\" >Tokelau<\/option><option value=\"Tonga\" data-country-code=\"TO\" >Tonga<\/option><option value=\"Trinidad and Tobago\" data-country-code=\"TT\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" data-country-code=\"TN\" >Tunisia<\/option><option value=\"Turkey\" data-country-code=\"TR\" >Turkey<\/option><option value=\"Turkmenistan\" data-country-code=\"TM\" >Turkmenistan<\/option><option value=\"Turks And Caicos Islands\" data-country-code=\"TC\" >Turks And Caicos Islands<\/option><option value=\"Tuvalu\" data-country-code=\"TV\" >Tuvalu<\/option><option value=\"US Minor Outlying Islands\" data-country-code=\"UM\" >US Minor Outlying Islands<\/option><option value=\"Uganda\" data-country-code=\"UG\" >Uganda<\/option><option value=\"Ukraine\" data-country-code=\"UA\" >Ukraine<\/option><option value=\"United Arab Emirates\" data-country-code=\"AE\" >United Arab Emirates<\/option><option value=\"United Kingdom\" data-country-code=\"GB\" >United Kingdom<\/option><option value=\"United States of America (USA)\" data-country-code=\"US\" >United States of America (USA)<\/option><option value=\"Uruguay\" data-country-code=\"UY\" >Uruguay<\/option><option value=\"Uzbekistan\" data-country-code=\"UZ\" >Uzbekistan<\/option><option value=\"Vanuatu\" data-country-code=\"VU\" >Vanuatu<\/option><option value=\"Vatican City\" data-country-code=\"VA\" >Vatican City<\/option><option value=\"Venezuela\" data-country-code=\"VE\" >Venezuela<\/option><option value=\"Vietnam\" data-country-code=\"VN\" >Vietnam<\/option><option value=\"Virgin Islands, British\" data-country-code=\"VG\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" data-country-code=\"VI\" >Virgin Islands, U.S.<\/option><option value=\"Wallis And Futuna Islands\" data-country-code=\"WF\" >Wallis And Futuna Islands<\/option><option value=\"Western Sahara\" data-country-code=\"EH\" >Western Sahara<\/option><option value=\"Yemen\" data-country-code=\"YE\" >Yemen<\/option><option value=\"Zambia\" data-country-code=\"ZM\" >Zambia<\/option><option value=\"Zimbabwe\" data-country-code=\"ZW\" >Zimbabwe<\/option><\/select><\/div><\/div><\/div><\/div><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-69e4c8484e871-label\"><span id=\"forminator-radiogroup-radio-3-69e4c8484e871-label\" class=\"forminator-label\">Gender<\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-69e4c8484e871\" class=\"forminator-radio forminator-radio-inline\" title=\"Female\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-69e4c8484e871\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Female<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-69e4c8484e871\" class=\"forminator-radio forminator-radio-inline\" title=\"Male\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-69e4c8484e871\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Male<\/span><\/label><label id=\"forminator-field-radio-3-label-3\" for=\"forminator-field-radio-3-3-69e4c8484e871\" class=\"forminator-radio forminator-radio-inline\" title=\"Prefer not to say\"><input type=\"radio\" name=\"radio-3\" value=\"Prefer-not-to-say\" id=\"forminator-field-radio-3-3-69e4c8484e871\" aria-labelledby=\"forminator-field-radio-3-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Prefer not to say<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69e4c8484e871\" id=\"forminator-field-email-1_69e4c8484e871-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_69e4c8484e871\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" autocomplete=\"email\" \/><\/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_69e4c8484e871\" id=\"forminator-field-phone-1_69e4c8484e871-label\" class=\"forminator-label\">Phone Number<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_69e4c8484e871\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><div tabindex=\"-1\" role=\"tabpanel\" id=\"forminator-custom-form-217--page-1\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-217--page-1-label\" aria-hidden=\"true\" data-step=\"1\" data-label=\"Personal Information\" data-name=\"page-break-2\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-69e4c8484e871-label\"><span id=\"forminator-radiogroup-radio-1-69e4c8484e871-label\" class=\"forminator-label\">How can we assist you?<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69e4c8484e871\" class=\"forminator-radio forminator-radio-inline\" title=\"ADHD Initial Assessment\"><input type=\"radio\" name=\"radio-1\" value=\"ADHD Initial Assessment\" id=\"forminator-field-radio-1-1-69e4c8484e871\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">ADHD Initial Assessment<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69e4c8484e871\" class=\"forminator-radio forminator-radio-inline\" title=\"ADHD Follow-up Consultation\"><input type=\"radio\" name=\"radio-1\" value=\"ADHD Follow-up Consultation\" id=\"forminator-field-radio-1-2-69e4c8484e871\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">ADHD Follow-up Consultation<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-69e4c8484e871\" class=\"forminator-radio forminator-radio-inline\" title=\"Medication Review\"><input type=\"radio\" name=\"radio-1\" value=\"Medication Review\" id=\"forminator-field-radio-1-3-69e4c8484e871\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Medication Review<\/span><\/label><label id=\"forminator-field-radio-1-label-4\" for=\"forminator-field-radio-1-4-69e4c8484e871\" class=\"forminator-radio forminator-radio-inline\" title=\"Counselling \/ Therapy Session\"><input type=\"radio\" name=\"radio-1\" value=\"Counselling \/ Therapy Session\" id=\"forminator-field-radio-1-4-69e4c8484e871\" aria-labelledby=\"forminator-field-radio-1-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Counselling \/ Therapy Session<\/span><\/label><label id=\"forminator-field-radio-1-label-5\" for=\"forminator-field-radio-1-5-69e4c8484e871\" class=\"forminator-radio forminator-radio-inline\" title=\"Parental Consultation\"><input type=\"radio\" name=\"radio-1\" value=\"Parental Consultation\" id=\"forminator-field-radio-1-5-69e4c8484e871\" aria-labelledby=\"forminator-field-radio-1-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Parental Consultation<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_69e4c8484e871\" id=\"forminator-field-date-1-picker_69e4c8484e871-label\" class=\"forminator-label\">Preferred Date<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"\" id=\"forminator-field-date-1-picker_69e4c8484e871\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"time-1\" class=\"forminator-field-time forminator-col forminator-col-4 \"><label for=\"forminator-field-time-1\" id=\"forminator-field-time-1-label\" class=\"forminator-label\">Prefered Time<\/label><div class=\"forminator-timepicker\" ><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"time-1-hours\" class=\"forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-217__field--time-1-hours_69e4c8484e871\" id=\"forminator-field-217__field--time-1-hours_69e4c8484e871-label\" class=\"forminator-label\">Hours<\/label><select name=\"time-1-hours\" id=\"forminator-field-217__field--time-1-hours_69e4c8484e871\" class=\"forminator-select2 time-hours \" data-field=\"hours\" data-placeholder=\"Select\" aria-labelledby=\"forminator-field-217__field--time-1-hours_69e4c8484e871-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">-<\/option><option value=\"12\" >12<\/option><option value=\"1\" >01<\/option><option value=\"2\" >02<\/option><option value=\"3\" >03<\/option><option value=\"4\" >04<\/option><option value=\"5\" >05<\/option><option value=\"6\" >06<\/option><option value=\"7\" >07<\/option><option value=\"8\" >08<\/option><option value=\"9\" >09<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><\/select><\/div><\/div><div id=\"time-1-minutes\" class=\"forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-217__field--time-1-minutes_69e4c8484e871\" id=\"forminator-field-217__field--time-1-minutes_69e4c8484e871-label\" class=\"forminator-label\">Minutes<\/label><select name=\"time-1-minutes\" id=\"forminator-field-217__field--time-1-minutes_69e4c8484e871\" class=\"forminator-select2 time-minutes \" data-field=\"minutes\" data-placeholder=\"Select\" aria-labelledby=\"forminator-field-217__field--time-1-minutes_69e4c8484e871-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">-<\/option><option value=\"0\" >00<\/option><option value=\"1\" >01<\/option><option value=\"2\" >02<\/option><option value=\"3\" >03<\/option><option value=\"4\" >04<\/option><option value=\"5\" >05<\/option><option value=\"6\" >06<\/option><option value=\"7\" >07<\/option><option value=\"8\" >08<\/option><option value=\"9\" >09<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><option value=\"32\" >32<\/option><option value=\"33\" >33<\/option><option value=\"34\" >34<\/option><option value=\"35\" >35<\/option><option value=\"36\" >36<\/option><option value=\"37\" >37<\/option><option value=\"38\" >38<\/option><option value=\"39\" >39<\/option><option value=\"40\" >40<\/option><option value=\"41\" >41<\/option><option value=\"42\" >42<\/option><option value=\"43\" >43<\/option><option value=\"44\" >44<\/option><option value=\"45\" >45<\/option><option value=\"46\" >46<\/option><option value=\"47\" >47<\/option><option value=\"48\" >48<\/option><option value=\"49\" >49<\/option><option value=\"50\" >50<\/option><option value=\"51\" >51<\/option><option value=\"52\" >52<\/option><option value=\"53\" >53<\/option><option value=\"54\" >54<\/option><option value=\"55\" >55<\/option><option value=\"56\" >56<\/option><option value=\"57\" >57<\/option><option value=\"58\" >58<\/option><option value=\"59\" >59<\/option><\/select><\/div><\/div><div id=\"time-1-ampm\" class=\"forminator-col forminator-col-4\"><div class=\"forminator-field\"><label for=\"forminator-field-217__field--time-1-ampm_69e4c8484e871\" id=\"forminator-field-217__field--time-1-ampm_69e4c8484e871-label\" class=\"forminator-label\">AM\/PM<\/label><select name=\"time-1-ampm\" id=\"forminator-field-217__field--time-1-ampm_69e4c8484e871\" class=\"forminator-select2 time-ampm \" data-field=\"ampm\" aria-labelledby=\"forminator-field-217__field--time-1-ampm_69e4c8484e871-label\" data-default-value=\"\"><option value=\"am\" >AM<\/option><option value=\"pm\" >PM<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-217__field--select-1_69e4c8484e871\" id=\"forminator-form-217__field--select-1_69e4c8484e871-label\" class=\"forminator-label\">Preferred Consultation Mode<\/label><select  id=\"forminator-form-217__field--select-1_69e4c8484e871\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-217__field--select-1_69e4c8484e871-label\"><option value=\"In-person\"  data-calculation=\"0\">In-person<\/option><option value=\"Online (Video Call)\"  data-calculation=\"0\">Online (Video Call)<\/option><option value=\"Telephone\"  data-calculation=\"0\">Telephone<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div tabindex=\"-1\" role=\"tabpanel\" id=\"forminator-custom-form-217--page-2\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-217--page-2-label\" aria-hidden=\"true\" data-step=\"2\" data-label=\"Appointment Details\" data-name=\"page-break-3\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-217__field--select-2_69e4c8484e871\" id=\"forminator-form-217__field--select-2_69e4c8484e871-label\" class=\"forminator-label\">Have you been previously diagnosed with ADHD?<\/label><select  id=\"forminator-form-217__field--select-2_69e4c8484e871\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-217__field--select-2_69e4c8484e871-label\"><option value=\"one\"  data-calculation=\"0\">Yes<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69e4c8484e871\" id=\"forminator-field-textarea-1_69e4c8484e871-label\" class=\"forminator-label\">If yes, please provide details<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_69e4c8484e871\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-217__field--select-3_69e4c8484e871\" id=\"forminator-form-217__field--select-3_69e4c8484e871-label\" class=\"forminator-label\">Do you currently take any medication?<\/label><select  id=\"forminator-form-217__field--select-3_69e4c8484e871\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-217__field--select-3_69e4c8484e871-label\"><option value=\"one\"  data-calculation=\"0\">Yes<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69e4c8484e871\" id=\"forminator-field-textarea-2_69e4c8484e871-label\" class=\"forminator-label\">If yes, list medication names and dosages<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_69e4c8484e871\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_69e4c8484e871\" id=\"forminator-field-textarea-3_69e4c8484e871-label\" class=\"forminator-label\">Briefly describe your current symptoms or concerns<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_69e4c8484e871\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_69e4c8484e871\" id=\"forminator-field-textarea-4_69e4c8484e871-label\" class=\"forminator-label\">Do you have any other medical conditions we should know about?<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_69e4c8484e871\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div tabindex=\"-1\" role=\"tabpanel\" id=\"forminator-custom-form-217--page-3\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-217--page-3-label\" aria-hidden=\"true\" data-step=\"3\" data-label=\"Medical Information\" data-name=\"page-break-4\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-217__field--select-4_69e4c8484e871\" id=\"forminator-form-217__field--select-4_69e4c8484e871-label\" class=\"forminator-label\">Were you referred by someone?<\/label><select  id=\"forminator-form-217__field--select-4_69e4c8484e871\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-217__field--select-4_69e4c8484e871-label\"><option value=\"one\"  data-calculation=\"0\">Yes<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69e4c8484e871\" id=\"forminator-field-text-1_69e4c8484e871-label\" class=\"forminator-label\">If yes, please provide the name of the referring doctor or organization<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69e4c8484e871\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><div tabindex=\"-1\" role=\"tabpanel\" id=\"forminator-custom-form-217--page-4\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-217--page-4-label\" aria-hidden=\"true\" data-step=\"4\" data-label=\"Referral Information (Optional)\" data-name=\"page-break-5\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-2_69e4c8484e871\" id=\"forminator-field-first-name-2_69e4c8484e871-label\" class=\"forminator-label\">First Name<\/label><input type=\"text\" name=\"name-2-first-name\" placeholder=\"\" id=\"forminator-field-first-name-2_69e4c8484e871\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-2_69e4c8484e871\" id=\"forminator-field-last-name-2_69e4c8484e871-label\" class=\"forminator-label\">Last Name<\/label><input type=\"text\" name=\"name-2-last-name\" placeholder=\"\" id=\"forminator-field-last-name-2_69e4c8484e871\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69e4c8484e871\" id=\"forminator-field-text-2_69e4c8484e871-label\" class=\"forminator-label\">Relationship<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_69e4c8484e871\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69e4c8484e871\" id=\"forminator-field-phone-2_69e4c8484e871-label\" class=\"forminator-label\">Phone Number<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_69e4c8484e871\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">Consent &amp; Acknowledgment<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_69e4c8484e871\" id=\"forminator-field-consent-1_69e4c8484e871-label\" class=\"forminator-label\">Consent <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_69e4c8484e871__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-1_69e4c8484e871-label\" aria-hidden=\"true\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_69e4c8484e871\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_69e4c8484e871-label\" aria-describedby=\"forminator-field-consent-1_69e4c8484e871__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_69e4c8484e871__description\" class=\"forminator-checkbox__label forminator-consent__label\"><ul data-end=\"1966\" data-start=\"1730\">\n<li data-end=\"1837\" data-start=\"1730\">\n<p data-end=\"1837\" data-start=\"1732\">I consent to Nichrix processing my personal and medical information for assessment and care purposes.<\/p>\n<\/li>\n<li data-end=\"1919\" data-start=\"1838\">\n<p data-end=\"1919\" data-start=\"1840\">I understand that this booking is subject to confirmation and availability.<\/p>\n<\/li>\n<li data-end=\"1966\" data-start=\"1920\">\n<p data-end=\"1966\" data-start=\"1922\">I agree to the terms and privacy policy.<\/p>\n<\/li>\n<\/ul><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div tabindex=\"-1\" role=\"tabpanel\" id=\"forminator-custom-form-217--page-5\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-217--page-5-label\" aria-hidden=\"true\" data-step=\"5\" data-label=\"Emergency Contact\" data-name=\"\" hidden><div class=\"forminator-pagination--content\"><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Submit<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"e8276b2499\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F244\" \/><input type=\"hidden\" name=\"form_id\" value=\"217\"><input type=\"hidden\" name=\"page_id\" value=\"244\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/nichtrix.co.uk\/?page_id=244\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Appointment Booking Form At Nichtrix, we understand that every individual\u2019s ADHD journey is unique. Our compassionate team is here to provide expert assessments, guidance, and ongoing support to help you or your loved one thrive.\u00a0Please complete the form below to schedule your appointment. Once submitted, a member of our care team will reach out to [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"ocean_post_layout":"","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"","ocean_second_sidebar":"","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"","ocean_custom_header_template":"","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"","ocean_menu_typo_font_family":"","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"default","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"","footnotes":""},"class_list":["post-244","page","type-page","status-publish","hentry","entry"],"_links":{"self":[{"href":"https:\/\/nichtrix.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/244","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nichtrix.co.uk\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/nichtrix.co.uk\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/nichtrix.co.uk\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/nichtrix.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=244"}],"version-history":[{"count":16,"href":"https:\/\/nichtrix.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/244\/revisions"}],"predecessor-version":[{"id":275,"href":"https:\/\/nichtrix.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/244\/revisions\/275"}],"wp:attachment":[{"href":"https:\/\/nichtrix.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=244"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}