{"id":1083,"date":"2025-03-28T15:52:06","date_gmt":"2025-03-28T07:52:06","guid":{"rendered":"https:\/\/healingthee.com\/?page_id=1083"},"modified":"2025-03-28T15:52:40","modified_gmt":"2025-03-28T07:52:40","slug":"service-provider-after-service-form","status":"publish","type":"page","link":"https:\/\/healingthee.com\/en\/service-provider-after-service-form\/","title":{"rendered":"Service Provider After Service Form"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-d923db6d-208c-4db6-918f-e376952265fd wpforms-render-modern\" id=\"wpforms-1071\"><form id=\"wpforms-form-1071\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1071\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/1083\" data-token=\"d8b34e5cabad2a12538fa68dc66cab27\" data-token-time=\"1780099546\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1071-field_18-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"18\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1071-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_1\">Provider Name : <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1071-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-1071-field_1-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1071-field_19-container\" class=\"wpforms-field wpforms-field-email mainContent display none opacity visibility hidden\" data-field-type=\"email\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_19\">Provider Email :<\/label><input type=\"email\" id=\"wpforms-1071-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1071-field_19-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1071-field_2-container\" class=\"wpforms-field wpforms-field-text wpf-disable-field\" data-field-type=\"text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_2\">Client Name :<\/label><input type=\"text\" id=\"wpforms-1071-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-1071-field_2-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1071-field_20-container\" class=\"wpforms-field wpforms-field-email mainContent display none opacity visibility hidden\" data-field-type=\"email\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_20\">Client Email :<\/label><input type=\"email\" id=\"wpforms-1071-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1071-field_20-error\" ><\/div><\/div><\/div><\/div><\/div>\t\t<div id=\"wpforms-1071-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1071-field_3\" >: Session Name<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1071-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1071-field_16-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"16\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1071-field_5-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">Service Datetime\uff1a<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1071-field_5\" class=\"wpforms-field-date-time-date wpforms-datepicker\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][5][date]\" aria-errormessage=\"wpforms-1071-field_5-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-1071-field_5\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-1071-field_5-time\" class=\"wpforms-field-date-time-time wpforms-timepicker\" data-time-format=\"H:i\" data-step=\"30\" data-rule-time24h=\"true\" name=\"wpforms[fields][5][time]\" aria-errormessage=\"wpforms-1071-field_5-time-error\" ><label for=\"wpforms-1071-field_5-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1071-field_6-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_6\">Service Mode :<\/label><select id=\"wpforms-1071-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\"><option value=\"Face to Face\"  class=\"choice-1 depth-1\"  >Face to Face<\/option><option value=\"Online Meeting\"  class=\"choice-2 depth-1\"  >Online Meeting<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1071-field_17-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_17\">Session Attend :<\/label><input type=\"number\" id=\"wpforms-1071-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" step=\"any\" aria-errormessage=\"wpforms-1071-field_17-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1071-field_11-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_11\">Evaluation Report\/Service Progress Description : <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1071-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-1071-field_11-error\" aria-describedby=\"wpforms-1071-field_11-description\" required><\/textarea><div id=\"wpforms-1071-field_11-description\" class=\"wpforms-field-description\">Your professional strategy, therapeutic goal, or method.<\/div><\/div><div id=\"wpforms-1071-field_33-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_33\">Message to Client\/Parent (may disclose to client\/parent) : <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1071-field_33\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][33]\" aria-errormessage=\"wpforms-1071-field_33-error\" aria-describedby=\"wpforms-1071-field_33-description\" required><\/textarea><div id=\"wpforms-1071-field_33-description\" class=\"wpforms-field-description\">Update or remind about client progress, assignments, and relevant information.\n<br \/>\nRespect client privacy when informing parents. \n<br \/>\nPrivacy alert: \n<br \/>\nuse general terms (e.g., \u201cmother,\u201d \u201cchild,\u201d \u201ccaregiver\u201d) instead of names or nicknames.<\/div><\/div><div id=\"wpforms-1071-field_34-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_34\">Message to Healing Thee :<\/label><textarea id=\"wpforms-1071-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-1071-field_34-error\" ><\/textarea><\/div><div id=\"wpforms-1071-field_27-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"27\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1071-field_25-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_25\">Need follow up session : <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1071-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" required=\"required\"><option value=\"Yes\"  class=\"choice-1 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-2 depth-1\"  >No<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1071-field_28-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"28\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_28\">Reason :<\/label><select id=\"wpforms-1071-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\"><option value=\"One-off service\"  class=\"choice-1 depth-1\"  >One-off service<\/option><option value=\"File closed\"  class=\"choice-2 depth-1\"  >File closed<\/option><option value=\"Referral out\"  class=\"choice-3 depth-1\"  >Referral out<\/option><option value=\"Others\"  class=\"choice-4 depth-1\"  >Others<\/option><\/select><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1071-field_36-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"36\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Next session datetime\uff1a<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1071-field_36\" class=\"wpforms-field-date-time-date wpforms-datepicker\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][36][date]\" aria-errormessage=\"wpforms-1071-field_36-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-1071-field_36\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-1071-field_36-time\" class=\"wpforms-field-date-time-time wpforms-timepicker\" data-time-format=\"H:i\" data-step=\"30\" data-rule-time24h=\"true\" name=\"wpforms[fields][36][time]\" aria-errormessage=\"wpforms-1071-field_36-time-error\" ><label for=\"wpforms-1071-field_36-time\" class=\"wpforms-field-sublabel after\">Time<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><div id=\"wpforms-1071-field_12-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1071-field_12\">Remarks\/Comment :<\/label><textarea id=\"wpforms-1071-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-1071-field_12-error\" ><\/textarea><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1071-field_3-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-1071-field_3-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-1071-field_3-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1071\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/healingthee.com\/en\/wp-json\/wp\/v2\/pages\/1083\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1071\" class=\"wpforms-submit\" data-alt-text=\"Submitting ...\" data-submit-text=\"Confirm\" aria-live=\"assertive\" value=\"wpforms-submit\">Confirm<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/healingthee.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"nf_dc_page":"","_view_id":"","footnotes":""},"class_list":["post-1083","page","type-page","status-publish","hentry"],"featured_image_src":null,"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/healingthee.com\/en\/wp-json\/wp\/v2\/pages\/1083","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healingthee.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/healingthee.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/healingthee.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healingthee.com\/en\/wp-json\/wp\/v2\/comments?post=1083"}],"version-history":[{"count":3,"href":"https:\/\/healingthee.com\/en\/wp-json\/wp\/v2\/pages\/1083\/revisions"}],"predecessor-version":[{"id":2292,"href":"https:\/\/healingthee.com\/en\/wp-json\/wp\/v2\/pages\/1083\/revisions\/2292"}],"wp:attachment":[{"href":"https:\/\/healingthee.com\/en\/wp-json\/wp\/v2\/media?parent=1083"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}