{"id":955,"date":"2025-09-30T16:37:58","date_gmt":"2025-09-30T16:37:58","guid":{"rendered":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/?page_id=955"},"modified":"2025-09-30T17:13:15","modified_gmt":"2025-09-30T17:13:15","slug":"general-intake","status":"publish","type":"page","link":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/general-intake\/","title":{"rendered":"General Intake"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"955\" class=\"elementor elementor-955\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-85146d9 e-flex e-con-boxed e-con e-parent\" data-id=\"85146d9\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-afaed4f e-con-full e-flex e-con e-child\" data-id=\"afaed4f\" data-element_type=\"container\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d21e15f e-con-full e-flex elementor-invisible e-con e-child\" data-id=\"d21e15f\" data-element_type=\"container\" data-settings=\"{&quot;animation&quot;:&quot;bounceInDown&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c213ef7 elementor-widget elementor-widget-heading\" data-id=\"c213ef7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">General Intake\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0909483 e-con-full e-flex e-con e-child\" data-id=\"0909483\" data-element_type=\"container\">\n\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-ef3ec91 e-flex e-con-boxed e-con e-parent\" data-id=\"ef3ec91\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-15fde32 elementor-widget elementor-widget-heading\" data-id=\"15fde32\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">All of this information is considered confidential.\n<\/h2>\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-681eb51 e-flex e-con-boxed e-con e-parent\" data-id=\"681eb51\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-b3ac199 e-con-full e-flex e-con e-child\" data-id=\"b3ac199\" data-element_type=\"container\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f569475 e-con-full e-flex e-con e-child\" data-id=\"f569475\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8abd582 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"8abd582\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\" aria-label=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"955\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"8abd582\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"General Intake\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"955\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFirst Name (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_72663a6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_72663a6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_72663a6]\" id=\"form-field-field_72663a6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Last Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tYour Email (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Your Email \" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_3b7b3af elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3b7b3af\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tYour Age (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_3b7b3af]\" id=\"form-field-field_3b7b3af\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Your Age \" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_3f41546 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3f41546\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBirthdate (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_3f41546]\" id=\"form-field-field_3f41546\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Birthdate \" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_73fc0c8 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_73fc0c8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStreet Address (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_73fc0c8]\" id=\"form-field-field_73fc0c8\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Street Address\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_962b6aa elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_962b6aa\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCity (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_962b6aa]\" id=\"form-field-field_962b6aa\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City \" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_1adb2bf elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1adb2bf\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tState\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_1adb2bf]\" id=\"form-field-field_1adb2bf\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"Alabama\">Alabama<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Alaska \">Alaska <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Arizona\">Arizona<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Arkansas\">Arkansas<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_f7b581d elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f7b581d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tZip Code (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_f7b581d]\" id=\"form-field-field_f7b581d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Zip Code \" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_0903063 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0903063\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHome Phone (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_0903063]\" id=\"form-field-field_0903063\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Home Phone \" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_c8675a6 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c8675a6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCell Phone (required)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_c8675a6]\" id=\"form-field-field_c8675a6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Cell Phone \" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_0efdf79 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0efdf79\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat services are you requesting?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Professional Consultation  \" id=\"form-field-field_0efdf79-0\" name=\"form_fields[field_0efdf79]\"> <label for=\"form-field-field_0efdf79-0\">Professional Consultation  <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_fc9bb80 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Face to Face Counseling at your office\" id=\"form-field-field_fc9bb80-0\" name=\"form_fields[field_fc9bb80]\"> <label for=\"form-field-field_fc9bb80-0\">Face to Face Counseling at your office<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_ca5620d elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Substance Use Evaluation\" id=\"form-field-field_ca5620d-0\" name=\"form_fields[field_ca5620d]\"> <label for=\"form-field-field_ca5620d-0\">Substance Use Evaluation<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_d87bdfd elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"e-Therapy or Online Counseling\" id=\"form-field-field_d87bdfd-0\" name=\"form_fields[field_d87bdfd]\"> <label for=\"form-field-field_d87bdfd-0\">e-Therapy or Online Counseling<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_74eb68c elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Integrated Yoga Therapy\" id=\"form-field-field_74eb68c-0\" name=\"form_fields[field_74eb68c]\"> <label for=\"form-field-field_74eb68c-0\">Integrated Yoga Therapy<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_6b979f8 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Recovery Maintenance Support\" id=\"form-field-field_6b979f8-0\" name=\"form_fields[field_6b979f8]\"> <label for=\"form-field-field_6b979f8-0\">Recovery Maintenance Support<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_627e12f elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Help with Chronic Pain Management\" id=\"form-field-field_627e12f-0\" name=\"form_fields[field_627e12f]\"> <label for=\"form-field-field_627e12f-0\">Help with Chronic Pain Management<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_8b30b90 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Telephone Counseling\" id=\"form-field-field_8b30b90-0\" name=\"form_fields[field_8b30b90]\"> <label for=\"form-field-field_8b30b90-0\">Telephone Counseling<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c6e5cc5 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other (please explain)\" id=\"form-field-field_c6e5cc5-0\" name=\"form_fields[field_c6e5cc5]\"> <label for=\"form-field-field_c6e5cc5-0\">Other (please explain)<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_00898d2 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_00898d2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescribe other:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_00898d2]\" id=\"form-field-field_00898d2\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_55bb33d elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_55bb33d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow did you hear about my services?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_55bb33d]\" id=\"form-field-field_55bb33d\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b2fee9c elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b2fee9c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBriefly describe what you want from or hope to accomplish with these services.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_b2fee9c]\" id=\"form-field-field_b2fee9c\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c5616e4 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c5616e4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have specific concerns you want to address?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_c5616e4]\" id=\"form-field-field_c5616e4\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_331ab68 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_331ab68\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow or what have you done to deal with these concerns or this situation? ...what has helped?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_331ab68]\" id=\"form-field-field_331ab68\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_7f38471 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7f38471\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat are your strengths?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_7f38471]\" id=\"form-field-field_7f38471\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_5bd9542 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5bd9542\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlease describe any previous counseling or therapy services; date & location\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_5bd9542]\" id=\"form-field-field_5bd9542\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_015d9a4 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_015d9a4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat was helpful & what was not so helpful?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_015d9a4]\" id=\"form-field-field_015d9a4\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_ed2f816 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ed2f816\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you taking any medications? If so, please list what they are & what you are taking them for & the name\/contact information of the prescribing medical provider.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_ed2f816]\" id=\"form-field-field_ed2f816\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_9298819 elementor-col-100\">\n\t\t\t\t\tMay I contact them?\n\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_ea70ca1 elementor-col-20\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"yes\" id=\"form-field-field_ea70ca1-0\" name=\"form_fields[field_ea70ca1]\"> <label for=\"form-field-field_ea70ca1-0\">yes<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_44395dd elementor-col-20\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_44395dd-0\" name=\"form_fields[field_44395dd]\"> <label for=\"form-field-field_44395dd-0\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_baa1442 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_baa1442\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhen was your last visit to the doctor and what was the purpose of the appointment?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_baa1442]\" id=\"form-field-field_baa1442\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_987fc4c elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_987fc4c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWho is your doctor?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_987fc4c]\" id=\"form-field-field_987fc4c\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_0f3eedc elementor-col-100\">\n\t\t\t\t\tMay I contact them?\n\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_f7d3594 elementor-col-20\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"yes\" id=\"form-field-field_f7d3594-0\" name=\"form_fields[field_f7d3594]\"> <label for=\"form-field-field_f7d3594-0\">yes<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_4b3d885 elementor-col-20\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-field_4b3d885-0\" name=\"form_fields[field_4b3d885]\"> <label for=\"form-field-field_4b3d885-0\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_ca776ee elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ca776ee\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDoctor Address & Phone:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_ca776ee]\" id=\"form-field-field_ca776ee\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_7e5601f elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7e5601f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs substance use (yours or someone else) a concern or causing problems for you? Please explain.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_7e5601f]\" id=\"form-field-field_7e5601f\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_8440f46 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8440f46\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf you consume alcohol or other drugs, please list them, how much you are currently using, any periods of controlled use or abstinence.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_8440f46]\" id=\"form-field-field_8440f46\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_21efddb elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_21efddb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCurrent and most recent 3 years employment history\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_21efddb]\" id=\"form-field-field_21efddb\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_db8d96f elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_db8d96f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMilitary experience? What & when\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_db8d96f]\" id=\"form-field-field_db8d96f\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_4190ef7 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4190ef7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlease describe your current living arrangements; single, married, divorced, living with family or partner, homeless, etc.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_4190ef7]\" id=\"form-field-field_4190ef7\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_eb8378e elementor-col-100\">\n\t\t\t\t\tPlease describe any physical symptoms you are having (or in past 12 months):\n\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_2a3c910 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Quality of sleep &amp; # of hours of sleep\" id=\"form-field-field_2a3c910-0\" name=\"form_fields[field_2a3c910]\"> <label for=\"form-field-field_2a3c910-0\">Quality of sleep & # of hours of sleep<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_676cc94 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Appetite\/weight gain or loss\" id=\"form-field-field_676cc94-0\" name=\"form_fields[field_676cc94]\"> <label for=\"form-field-field_676cc94-0\">Appetite\/weight gain or loss<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c9b6962 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Headaches\" id=\"form-field-field_c9b6962-0\" name=\"form_fields[field_c9b6962]\"> <label for=\"form-field-field_c9b6962-0\">Headaches<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_41b2cb8 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Fatigue\" id=\"form-field-field_41b2cb8-0\" name=\"form_fields[field_41b2cb8]\"> <label for=\"form-field-field_41b2cb8-0\">Fatigue<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_22eabf5 elementor-col-33\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Trauma History\" id=\"form-field-field_22eabf5-0\" name=\"form_fields[field_22eabf5]\"> <label for=\"form-field-field_22eabf5-0\">Trauma History<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c0ed074 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c0ed074\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tExplain Other:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_c0ed074]\" id=\"form-field-field_c0ed074\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_46d3454 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_46d3454\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAny Family medical history you think is important to share?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_46d3454]\" id=\"form-field-field_46d3454\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_76d267e elementor-col-100\">\n\t\t\t\t\tIf you have health insurance and plan to use it to pay for services, please provide the following\n\n\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_fb05719 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fb05719\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName of Insurance Company\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_fb05719]\" id=\"form-field-field_fb05719\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_73be7bf elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_73be7bf\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tID#\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_73be7bf]\" id=\"form-field-field_73be7bf\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_6e6bebc elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6e6bebc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName of your coverage plan\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_6e6bebc]\" id=\"form-field-field_6e6bebc\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_99e01d0 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_99e01d0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGroup #\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_99e01d0]\" id=\"form-field-field_99e01d0\" rows=\"6\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_6d93213 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6d93213\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tProvider Relations Phone #\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_6d93213]\" id=\"form-field-field_6d93213\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_d6c98a4 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d6c98a4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName of Member\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_d6c98a4]\" id=\"form-field-field_d6c98a4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_7ea75d8 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7ea75d8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of Birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_7ea75d8]\" id=\"form-field-field_7ea75d8\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_d3f076f elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d3f076f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmployer\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_d3f076f]\" id=\"form-field-field_d3f076f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_7afa55a elementor-col-100\">\n\t\t\t\t\tPlease contact your Insurance representative to confirm they have me listed as an in-network provider, your coverage for these services, your co-pay amount, and deductible.\n\n\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c095d0d elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c095d0d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have any questions?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_c095d0d]\" id=\"form-field-field_c095d0d\" rows=\"8\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-9e5c38e e-con-full e-flex e-con e-child\" data-id=\"9e5c38e\" data-element_type=\"container\">\n\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>General Intake All of this information is considered confidential.<\/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":{"footnotes":""},"class_list":["post-955","page","type-page","status-publish","hentry","entry","owp-thumbs-layout-horizontal","owp-btn-normal","owp-tabs-layout-horizontal","has-no-thumbnails","has-product-nav"],"_links":{"self":[{"href":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/wp-json\/wp\/v2\/pages\/955","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/wp-json\/wp\/v2\/comments?post=955"}],"version-history":[{"count":16,"href":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/wp-json\/wp\/v2\/pages\/955\/revisions"}],"predecessor-version":[{"id":973,"href":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/wp-json\/wp\/v2\/pages\/955\/revisions\/973"}],"wp:attachment":[{"href":"https:\/\/projectdemo.pro\/Angela-thomas-Jones\/wp-json\/wp\/v2\/media?parent=955"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}