{"id":334,"date":"2023-08-01T19:12:11","date_gmt":"2023-08-01T19:12:11","guid":{"rendered":"https:\/\/palmettochiropractic.com\/?page_id=334"},"modified":"2024-02-27T17:20:40","modified_gmt":"2024-02-27T17:20:40","slug":"contact-us","status":"publish","type":"page","link":"https:\/\/palmettochiropractic.com\/contact-us","title":{"rendered":"Contact Us"},"content":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_1_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_contact-form\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Contact Us<\/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=\"1\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_1\" id=\"frm_hide_fields_1\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"contact-form\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_1\" name=\"frm_submit_entry_1\" value=\"f37d5ef762\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/334\" \/><div id=\"frm_field_7_container\" class=\"frm_form_field frm_section_heading form-field  frm6 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Full Name<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container frm6 frm_first\">\r\n    <label for=\"field_qh4icy\" id=\"field_qh4icy_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh4icy\" name=\"item_meta[1]\" value=\"\"  data-sectionid=\"7\" placeholder=\"First Name\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_2_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container frm6\">\r\n    <label for=\"field_ocfup1\" id=\"field_ocfup1_label\" class=\"frm_primary_label\">Last\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ocfup1\" name=\"item_meta[2]\" value=\"\"  placeholder=\"Last Name\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_9_container\" class=\"frm_form_field frm_section_heading form-field  frm6\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Contact<\/h3>\r\n\r\n\r\n<div id=\"frm_field_3_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container frm6 frm_first\">\r\n    <label for=\"field_29yf4d\" id=\"field_29yf4d_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_29yf4d\" name=\"item_meta[3]\" value=\"\"  data-sectionid=\"9\" placeholder=\"Email\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please enter a valid email address\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11_container\" class=\"frm_form_field form-field  frm_none_container frm6\">\r\n    <label for=\"field_6hq5a\" id=\"field_6hq5a_label\" class=\"frm_primary_label\">Phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_6hq5a\" name=\"item_meta[11]\" value=\"\"  data-sectionid=\"9\" data-frmmask=\"(999) 999-9999\" placeholder=\"Phone\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"\\(\\d\\d\\d\\) \\d\\d\\d-\\d\\d\\d\\d$\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_12_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Address<\/h3>\r\n\r\n\r\n<div id=\"frm_field_14_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <div  id=\"field_f95wr_label\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_f95wr_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tAddress<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_14-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_f95wr_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_f95wr_line1\" value=\"\" name=\"item_meta[14][line1]\"  placeholder=\"Address Line 1\"  data-sectionid=\"12\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_14-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_f95wr_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_f95wr_line2\" value=\"\" name=\"item_meta[14][line2]\"  placeholder=\"Address Line 2\"  data-sectionid=\"12\" data-invmsg=\"Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_14-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_f95wr_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_f95wr_city\" value=\"\" name=\"item_meta[14][city]\"  placeholder=\"City\"  data-sectionid=\"12\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<\/div>\n<div id=\"frm_field_14-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_f95wr_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t\t<select name=\"item_meta[14][state]\" id=\"field_f95wr_state\"  placeholder=\"State\/Province\"  data-sectionid=\"12\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\">\n\t\t\t<option value=\"\">\n\t\t\t\tState\/Province\t\t\t<\/option>\n\t\t\t<option  value=\"Alabama\">Alabama<\/option><option  value=\"Alaska\">Alaska<\/option><option  value=\"Arkansas\">Arkansas<\/option><option  value=\"Arizona\">Arizona<\/option><option  value=\"California\">California<\/option><option  value=\"Colorado\">Colorado<\/option><option  value=\"Connecticut\">Connecticut<\/option><option  value=\"Delaware\">Delaware<\/option><option  value=\"District of Columbia\">District of Columbia<\/option><option  value=\"Florida\">Florida<\/option><option  value=\"Georgia\">Georgia<\/option><option  value=\"Hawaii\">Hawaii<\/option><option  value=\"Idaho\">Idaho<\/option><option  value=\"Illinois\">Illinois<\/option><option  value=\"Indiana\">Indiana<\/option><option  value=\"Iowa\">Iowa<\/option><option  value=\"Kansas\">Kansas<\/option><option  value=\"Kentucky\">Kentucky<\/option><option  value=\"Louisiana\">Louisiana<\/option><option  value=\"Maine\">Maine<\/option><option  value=\"Maryland\">Maryland<\/option><option  value=\"Massachusetts\">Massachusetts<\/option><option  value=\"Michigan\">Michigan<\/option><option  value=\"Minnesota\">Minnesota<\/option><option  value=\"Mississippi\">Mississippi<\/option><option  value=\"Missouri\">Missouri<\/option><option  value=\"Montana\">Montana<\/option><option  value=\"Nebraska\">Nebraska<\/option><option  value=\"Nevada\">Nevada<\/option><option  value=\"New Hampshire\">New Hampshire<\/option><option  value=\"New Jersey\">New Jersey<\/option><option  value=\"New Mexico\">New Mexico<\/option><option  value=\"New York\">New York<\/option><option  value=\"North Carolina\">North Carolina<\/option><option  value=\"North Dakota\">North Dakota<\/option><option  value=\"Ohio\">Ohio<\/option><option  value=\"Oklahoma\">Oklahoma<\/option><option  value=\"Oregon\">Oregon<\/option><option  value=\"Pennsylvania\">Pennsylvania<\/option><option  value=\"Rhode Island\">Rhode Island<\/option><option  value=\"South Carolina\">South Carolina<\/option><option  value=\"South Dakota\">South Dakota<\/option><option  value=\"Tennessee\">Tennessee<\/option><option  value=\"Texas\">Texas<\/option><option  value=\"Utah\">Utah<\/option><option  value=\"Vermont\">Vermont<\/option><option  value=\"Virginia\">Virginia<\/option><option  value=\"Washington\">Washington<\/option><option  value=\"West Virginia\">West Virginia<\/option><option  value=\"Wisconsin\">Wisconsin<\/option><option  value=\"Wyoming\">Wyoming<\/option>\t\t<\/select>\n\t<\/div>\n<div id=\"frm_field_14-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_f95wr_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_f95wr_zip\" value=\"\" name=\"item_meta[14][zip]\"  placeholder=\"Zip\/Postal\"  data-sectionid=\"12\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_238_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Are you looking to schedule an appointment?<\/h3>\r\n\r\n\r\n<div id=\"frm_field_242_container\" class=\"frm_form_field form-field  frm_none_container horizontal_radio\">\r\n    <div  id=\"field_l2sif_label\" class=\"frm_primary_label\">Are you looking to schedule an appointment?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_l2sif_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_242-238-0\"><label for=\"field_l2sif-0\">\t\t<input type=\"radio\" name=\"item_meta[242]\" id=\"field_l2sif-0\" value=\"Yes\"\n\t\t   data-sectionid=\"238\" data-invmsg=\"Are you looking to schedule an appointment? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_242-238-1\"><label for=\"field_l2sif-1\">\t\t<input type=\"radio\" name=\"item_meta[242]\" id=\"field_l2sif-1\" value=\"No\"\n\t\t   data-sectionid=\"238\" data-invmsg=\"Are you looking to schedule an appointment? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_241_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p style=\"text-align: left;\"><a href=\"https:\/\/palmettochiropractic.com\/schedule-an-appointment\">please click this link and fill out our schedule an appointment form<\/a><\/p>\n<\/div>\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Are you new patient?<\/h3>\r\n\r\n\r\n<div id=\"frm_field_23_container\" class=\"frm_form_field form-field  frm_none_container horizontal_radio\">\r\n    <div  id=\"field_otnwz_label\" class=\"frm_primary_label\">New Patient\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_otnwz_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_23-21-0\"><label for=\"field_otnwz-0\">\t\t<input type=\"radio\" name=\"item_meta[23]\" id=\"field_otnwz-0\" value=\"Yes\"\n\t\t   data-sectionid=\"21\" data-invmsg=\"New Patient is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_23-21-1\"><label for=\"field_otnwz-1\">\t\t<input type=\"radio\" name=\"item_meta[23]\" id=\"field_otnwz-1\" value=\"No\"\n\t\t   data-sectionid=\"21\" data-invmsg=\"New Patient is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_24_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p>Note: This is an appointment request form and not a guaranteed appointment. Upon receipt, you will be contacted to schedule and confirm your actual appointment.<\/p>\n<\/div>\n<div id=\"frm_field_5_container\" class=\"frm_form_field form-field  frm_none_container frm_full\">\r\n    <label for=\"field_9jv0r1\" id=\"field_9jv0r1_label\" class=\"frm_primary_label\">What can we help you with?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[5]\" id=\"field_9jv0r1\" rows=\"5\"  placeholder=\"Comments\" data-invmsg=\"Message is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__653faba951d2e\">\n\t\t\t\t<label for=\"frm_email_1\" >\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_1\" type=\"email\" class=\"frm_verify\" name=\"frm__653faba951d2e\" value=\"\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"ULbxc7xX\/PnFM\/tpY+5vCxpNT2+\/aIy2UzCjlkXkYxU=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"235\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n<\/div>\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":{"_acf_changed":false,"ep_exclude_from_search":false,"footnotes":""},"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.1 - 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