{"id":80,"date":"2021-07-04T08:22:29","date_gmt":"2021-07-04T08:22:29","guid":{"rendered":"https:\/\/martamagicmind.space\/?page_id=80"},"modified":"2021-07-04T17:59:57","modified_gmt":"2021-07-04T17:59:57","slug":"covid-forms","status":"publish","type":"page","link":"https:\/\/martamagicmind.space\/index.php\/covid-forms\/","title":{"rendered":"Covid Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"80\" class=\"elementor elementor-80\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-90c4eae elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"90c4eae\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-57d1dbe\" data-id=\"57d1dbe\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d1713bc elementor-widget elementor-widget-image\" data-id=\"d1713bc\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"180\" height=\"180\" src=\"https:\/\/martamagicmind.space\/wp-content\/uploads\/2021\/06\/138252567_107450621315608_2793615621034874228_n-removebg-preview.png\" class=\"attachment-large size-large wp-image-70\" alt=\"\" srcset=\"https:\/\/martamagicmind.space\/wp-content\/uploads\/2021\/06\/138252567_107450621315608_2793615621034874228_n-removebg-preview.png 180w, https:\/\/martamagicmind.space\/wp-content\/uploads\/2021\/06\/138252567_107450621315608_2793615621034874228_n-removebg-preview-150x150.png 150w, https:\/\/martamagicmind.space\/wp-content\/uploads\/2021\/06\/138252567_107450621315608_2793615621034874228_n-removebg-preview-146x146.png 146w, https:\/\/martamagicmind.space\/wp-content\/uploads\/2021\/06\/138252567_107450621315608_2793615621034874228_n-removebg-preview-50x50.png 50w, https:\/\/martamagicmind.space\/wp-content\/uploads\/2021\/06\/138252567_107450621315608_2793615621034874228_n-removebg-preview-75x75.png 75w, https:\/\/martamagicmind.space\/wp-content\/uploads\/2021\/06\/138252567_107450621315608_2793615621034874228_n-removebg-preview-85x85.png 85w, https:\/\/martamagicmind.space\/wp-content\/uploads\/2021\/06\/138252567_107450621315608_2793615621034874228_n-removebg-preview-80x80.png 80w\" sizes=\"auto, (max-width: 180px) 100vw, 180px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e4bd1a0 elementor-widget elementor-widget-heading\" data-id=\"e4bd1a0\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Covid-19 Form<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4413163 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"4413163\" 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<div class=\"elementor-widget-container\">\n\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Covid\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"80\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"4413163\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\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 elementor-field-required\">\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\tName\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=\"Name\" required=\"required\" aria-required=\"true\">\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-textarea 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\tAddress\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[email]\" id=\"form-field-email\" rows=\"3\" placeholder=\"Your full address\" required=\"required\" aria-required=\"true\"><\/textarea>\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-message elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t1. Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, flu like symptoms or loss or change to your sense of smell or taste now or in the past 14 days?\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<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[message]\" id=\"form-field-message\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t<option value=\" \"> <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/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-select elementor-field-group elementor-column elementor-field-group-field_661e8e2 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_661e8e2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t2. Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? \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<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_661e8e2]\" id=\"form-field-field_661e8e2\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t<option value=\" \"> <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/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-select elementor-field-group elementor-column elementor-field-group-field_8179097 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8179097\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t3. Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days ?\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<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_8179097]\" id=\"form-field-field_8179097\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t<option value=\" \"> <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/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-select elementor-field-group elementor-column elementor-field-group-field_1052d91 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1052d91\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t4. Have you been advised by a doctor to self-isolate at this time?\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<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_1052d91]\" id=\"form-field-field_1052d91\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t<option value=\" \"> <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Yes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">No<\/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-acceptance elementor-field-group elementor-column elementor-field-group-field_d1c38fc elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d1c38fc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tI certify that the above facts are true to the best of my knowledge.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_d1c38fc]\" id=\"form-field-field_d1c38fc\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t<\/span>\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-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-sm\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\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<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Covid-19 Form<\/p>\n","protected":false},"author":1,"featured_media":54,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-80","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/martamagicmind.space\/index.php\/wp-json\/wp\/v2\/pages\/80","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/martamagicmind.space\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/martamagicmind.space\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/martamagicmind.space\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/martamagicmind.space\/index.php\/wp-json\/wp\/v2\/comments?post=80"}],"version-history":[{"count":23,"href":"https:\/\/martamagicmind.space\/index.php\/wp-json\/wp\/v2\/pages\/80\/revisions"}],"predecessor-version":[{"id":110,"href":"https:\/\/martamagicmind.space\/index.php\/wp-json\/wp\/v2\/pages\/80\/revisions\/110"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/martamagicmind.space\/index.php\/wp-json\/wp\/v2\/media\/54"}],"wp:attachment":[{"href":"https:\/\/martamagicmind.space\/index.php\/wp-json\/wp\/v2\/media?parent=80"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}