{"id":449,"date":"2020-10-07T12:09:54","date_gmt":"2020-10-07T08:09:54","guid":{"rendered":"https:\/\/patientlearning.kanadhospital.org\/?page_id=449"},"modified":"2020-10-13T22:08:23","modified_gmt":"2020-10-13T18:08:23","slug":"sign-up","status":"publish","type":"page","link":"https:\/\/patientlearning.kanadhospital.org\/ar\/sign-up\/","title":{"rendered":"Sign up"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"449\" class=\"elementor elementor-449\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1881f6d elementor-section-height-full elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"1881f6d\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-50 elementor-top-column elementor-element elementor-element-665e853\" data-id=\"665e853\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-6f1f9ba\" data-id=\"6f1f9ba\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2e41f5c elementor-absolute elementor-widget elementor-widget-shortcode\" data-id=\"2e41f5c\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_position&quot;:&quot;absolute&quot;}\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"um um-register um-438\">\n\t<div class=\"um-form\" data-mode=\"register\">\n\t\t<form method=\"post\" action=\"\" data-trp-original-action=\"\">\n\t\t\t<div class=\"um-row _um_row_1  um-customized-row\" style=\"padding: 0px 0px 0px 0px;margin: 25px 0px 30px 0px;border-width: 0px 0px 0px 0px;border-style: solid;border-radius: 0px;color: #1e73be !important;\"><div class=\"um-col-121\"><div  id=\"um_field_438_first_name\" class=\"um-field um-field-text  um-field-first_name um-field-text um-field-type_text\" data-key=\"first_name\"><div class=\"um-field-label\"><label for=\"first_name-438\">\u0627\u0644\u0627\u0633\u0645 \u0627\u0644\u0623\u0648\u0644<\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid\" type=\"text\" name=\"first_name-438\" id=\"first_name-438\" value=\"\" placeholder=\"\" data-validate=\"\" data-key=\"first_name\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_438_last_name\" class=\"um-field um-field-text  um-field-last_name um-field-text um-field-type_text\" data-key=\"last_name\"><div class=\"um-field-label\"><label for=\"last_name-438\">\u0627\u0644\u0627\u0633\u0645 \u0627\u0644\u0623\u062e\u064a\u0631<\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid\" type=\"text\" name=\"last_name-438\" id=\"last_name-438\" value=\"\" placeholder=\"\" data-validate=\"\" data-key=\"last_name\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_438_mobile_number\" class=\"um-field um-field-tel  um-field-mobile_number um-field-tel um-field-type_tel\" data-key=\"mobile_number\"><div class=\"um-field-label\"><div class=\"um-field-label-icon\"><i class=\"um-faicon-mobile\" aria-label=\"Mobile Number\"><\/i><\/div><label for=\"mobile_number-438\">\u0631\u0642\u0645 \u0627\u0644\u062c\u0648\u0627\u0644<\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid\" type=\"tel\" name=\"mobile_number-438\" id=\"mobile_number-438\" value=\"\" placeholder=\"\" data-validate=\"phone_number\" data-key=\"mobile_number\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><\/div><div class=\"um-col-122\"><div  id=\"um_field_438_user_email\" class=\"um-field um-field-text  um-field-user_email um-field-text um-field-type_text\" data-key=\"user_email\"><div class=\"um-field-label\"><label for=\"user_email-438\">E-mail Address<\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input  autocomplete=\"off\" class=\"um-form-field valid\" type=\"text\" name=\"user_email-438\" id=\"user_email-438\" value=\"\" placeholder=\"\" data-validate=\"unique_email\" data-key=\"user_email\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_438_user_password\" class=\"um-field um-field-password  um-field-user_password um-field-password um-field-type_password\" data-key=\"user_password\"><div class=\"um-field-label\"><label for=\"user_password-438\">\u0643\u0644\u0645\u0629 \u0627\u0644\u0645\u0631\u0648\u0631<span class=\"um-req\" title=\"\u0645\u0637\u0644\u0648\u0628\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input class=\"um-form-field valid\" type=\"password\" name=\"user_password-438\" id=\"user_password-438\" value=\"\" placeholder=\"\" data-validate=\"\" data-key=\"user_password\"  aria-invalid=\"false\" \/>\n\n\t\t\t\t\t\t\t<\/div><\/div><div  id=\"um_field_438_confirm_user_password\" class=\"um-field um-field-password  um-field-user_password um-field-password um-field-type_password\" data-key=\"confirm_user_password\"><div class=\"um-field-label\"><label for=\"confirm_user_password-438\">\u062a\u0623\u0643\u064a\u062f \u0643\u0644\u0645\u0629 \u0627\u0644\u0645\u0631\u0648\u0631<span class=\"um-req\" title=\"\u0645\u0637\u0644\u0648\u0628\">*<\/span><\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><input class=\"um-form-field valid\" type=\"password\" name=\"confirm_user_password-438\" id=\"confirm_user_password-438\" value=\"\" placeholder=\"\u062a\u0623\u0643\u064a\u062f \u0643\u0644\u0645\u0629 \u0627\u0644\u0645\u0631\u0648\u0631\" data-validate=\"\" data-key=\"confirm_user_password\"  aria-invalid=\"false\" \/><\/div><\/div><\/div><div class=\"um-clear\"><\/div><\/div><div class=\"um-row _um_row_2\" style=\"margin: 0 0 30px 0;\"><div class=\"um-col-1\"><div  id=\"um_field_438_Chocie_1\" class=\"um-field um-field-checkbox  um-is-conditional um-field-Chocie_1 um-field-checkbox um-field-type_checkbox\" data-key=\"Chocie_1\" data-cond-0-action=\"show\" data-cond-0-field=\"first_name\" data-cond-0-operator=\"empty\" data-cond-0-value=\"\"  aria-invalid=\"false\" ><div class=\"um-field-label\"><label for=\"Chocie_1-438\">Please &quot;Tick&quot; if you are an existing patient<\/label><div class=\"um-clear\"><\/div><\/div><div class=\"um-field-area\"><label class=\"um-field-checkbox  um-field-half\"><input   type=\"checkbox\" name=\"Chocie_1[]\" value=\"I am a Kanad Hospital Patient\"  \/><span class=\"um-field-checkbox-state\"><i class=\"um-icon-android-checkbox-outline-blank\"><\/i><\/span><span class=\"um-field-checkbox-option\">I am a Kanad Hospital Patient<\/span><\/label><div class=\"um-clear\"><\/div><\/div><\/div><div  id=\"um_field_438_Dr_Name\" class=\"um-field um-field-text  um-is-conditional um-field-Dr_Name um-field-text um-field-type_text\" data-key=\"Dr_Name\" data-cond-0-action=\"show\" data-cond-0-field=\"Chocie_1\" data-cond-0-operator=\"not empty\" data-cond-0-value=\"\"><div class=\"um-field-label\"><label for=\"Dr_Name-438\">Doctor&#039;s Name<\/label><span class=\"um-tip um-tip-e\" title=\"Please enter your consulting doctor name\"><i class=\"um-icon-help-circled\"><\/i><\/span><div class=\"um-clear\"><\/div><\/div><div 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class=\"um-button\" id=\"um-submit-btn\" \/>\n\t\t\t<\/div>\n\t\t\t<div class=\"um-right um-half\">\n\t\t\t\t<a href=\"https:\/\/patientlearning.kanadhospital.org\/ar\/sign-in\/\" class=\"um-button um-alt\">\n\t\t\t\t\t\u062a\u0633\u062c\u064a\u0644 \u0627\u0644\u062f\u062e\u0648\u0644\t\t\t\t<\/a>\n\t\t\t<\/div>\n\n\t\t\n\t\t<div class=\"um-clear\"><\/div>\n\n\t<\/div>\n\n\t\t\t<input type=\"hidden\" name=\"trp-form-language\" value=\"ar\"\/><\/form>\n\t<\/div>\n<\/div>\n<style>\n\t\t\t.um-438.um {\n\t\t\tmax-width: 600px;\n\t\t}\n\t\t<\/style>\n<\/div>\n\t\t\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<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":977,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/template_page-builder.php","meta":{"_acf_changed":false,"nf_dc_page":"","pagelayer_contact_templates":[],"_pagelayer_content":"","footnotes":""},"class_list":["post-449","page","type-page","status-publish","hentry"],"acf":[],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/patientlearning.kanadhospital.org\/ar\/wp-json\/wp\/v2\/pages\/449","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/patientlearning.kanadhospital.org\/ar\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/patientlearning.kanadhospital.org\/ar\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/patientlearning.kanadhospital.org\/ar\/wp-json\/wp\/v2\/users\/977"}],"replies":[{"embeddable":true,"href":"https:\/\/patientlearning.kanadhospital.org\/ar\/wp-json\/wp\/v2\/comments?post=449"}],"version-history":[{"count":45,"href":"https:\/\/patientlearning.kanadhospital.org\/ar\/wp-json\/wp\/v2\/pages\/449\/revisions"}],"predecessor-version":[{"id":594,"href":"https:\/\/patientlearning.kanadhospital.org\/ar\/wp-json\/wp\/v2\/pages\/449\/revisions\/594"}],"wp:attachment":[{"href":"https:\/\/patientlearning.kanadhospital.org\/ar\/wp-json\/wp\/v2\/media?parent=449"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}