Formulario citas - Copia-Daeh

[et_pb_section fb_built=»1″ theme_builder_area=»post_content» _builder_version=»4.24.3″ _module_preset=»default»][et_pb_row _builder_version=»4.24.3″ _module_preset=»default» theme_builder_area=»post_content» column_structure=»1_3,1_3,1_3″ background_color=»rgba(0,0,0,0.41)» title_text=»ambulancia-daeh-02″ background_image=»https://daeh.gob.do/copia/wp-content/uploads/sites/6/2023/05/ambulancia-daeh-02.jpg» parallax=»on» use_background_color_gradient=»on» background_color_gradient_overlays_image=»on» background_blend=»darken» hover_enabled=»0″ sticky_enabled=»0″ background_color_gradient_stops=»rgba(0,9,12,0.42) 0%|rgba(0,12,10,0.54) 100%»][et_pb_column _builder_version=»4.24.3″ _module_preset=»default» type=»1_3″ theme_builder_area=»post_content»][et_pb_image src=»https://daeh.gob.do/copia/wp-content/uploads/sites/6/2023/04/logo-daeh.png» _builder_version=»4.24.3″ _module_preset=»default» theme_builder_area=»post_content» alt=»DAEH» title_text=»logo-daeh» hover_enabled=»0″ sticky_enabled=»0″][/et_pb_image][/et_pb_column][et_pb_column _builder_version=»4.24.3″ _module_preset=»default» type=»1_3″ theme_builder_area=»post_content»][et_pb_text _builder_version=»4.24.3″ _module_preset=»default» theme_builder_area=»post_content» hover_enabled=»0″ sticky_enabled=»0″ custom_padding=»42px|||||»]

FORMULARIO

SOLICITUD DE CITAS

[/et_pb_text][/et_pb_column][et_pb_column _builder_version=»4.24.3″ _module_preset=»default» type=»1_3″ theme_builder_area=»post_content»][et_pb_contact_form _builder_version=»4.24.3″ _module_preset=»default» _unique_id=»ed539a03-a24b-4224-b27c-011bf68f9eb3″ theme_builder_area=»post_content» hover_enabled=»0″ sticky_enabled=»0″ captcha=»off» submit_button_text=»@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoiY3VycmVudF9kYXRlIiwic2V0dGluZ3MiOnsiYmVmb3JlIjoiIiwiYWZ0ZXIiOiIiLCJkYXRlX2Zvcm1hdCI6ImRlZmF1bHQiLCJjdXN0b21fZGF0ZV9mb3JtYXQiOiIifX0=@» _dynamic_attributes=»submit_button_text» width=»100%» custom_button=»on» button_bg_enable_color=»off» button_text_size=»21px» button_border_width=»2px» button_border_radius=»0px» button_letter_spacing=»4px» button_font=»|||on|||||» button_icon=»||fa||900″ button_custom_padding=»0px|59px|5px|48px|false|false» box_shadow_style_button=»preset6″][et_pb_contact_field field_id=»Name» field_title=»Código:» _builder_version=»4.24.3″ hover_enabled=»0″ global_colors_info=»{}» button_text_size__hover_enabled=»off» button_one_text_size__hover_enabled=»off» button_two_text_size__hover_enabled=»off» button_text_color__hover_enabled=»off» button_one_text_color__hover_enabled=»off» button_two_text_color__hover_enabled=»off» button_border_width__hover_enabled=»off» button_one_border_width__hover_enabled=»off» button_two_border_width__hover_enabled=»off» button_border_color__hover_enabled=»off» button_one_border_color__hover_enabled=»off» button_two_border_color__hover_enabled=»off» button_border_radius__hover_enabled=»off» button_one_border_radius__hover_enabled=»off» button_two_border_radius__hover_enabled=»off» button_letter_spacing__hover_enabled=»off» button_one_letter_spacing__hover_enabled=»off» button_two_letter_spacing__hover_enabled=»off» button_bg_color__hover_enabled=»off» button_one_bg_color__hover_enabled=»off» button_two_bg_color__hover_enabled=»off» theme_builder_area=»post_content» sticky_enabled=»0″ fullwidth_field=»on»][/et_pb_contact_field][/et_pb_contact_form][/et_pb_column][/et_pb_row][et_pb_row _builder_version=»4.24.3″ _module_preset=»default» theme_builder_area=»post_content»][et_pb_column _builder_version=»4.24.3″ _module_preset=»default» type=»4_4″ theme_builder_area=»post_content»][et_pb_contact_form _builder_version=»4.24.3″ _module_preset=»default» _unique_id=»de3b723d-9d7b-4090-a282-7936e79a6f57″ theme_builder_area=»post_content» hover_enabled=»0″ sticky_enabled=»0″ captcha=»off»][et_pb_contact_field field_id=»Name» field_title=»NOMBRE:» _builder_version=»4.24.3″ global_colors_info=»{}» button_text_size__hover_enabled=»off» button_one_text_size__hover_enabled=»off» button_two_text_size__hover_enabled=»off» button_text_color__hover_enabled=»off» button_one_text_color__hover_enabled=»off» button_two_text_color__hover_enabled=»off» button_border_width__hover_enabled=»off» button_one_border_width__hover_enabled=»off» button_two_border_width__hover_enabled=»off» button_border_color__hover_enabled=»off» button_one_border_color__hover_enabled=»off» button_two_border_color__hover_enabled=»off» button_border_radius__hover_enabled=»off» button_one_border_radius__hover_enabled=»off» button_two_border_radius__hover_enabled=»off» button_letter_spacing__hover_enabled=»off» button_one_letter_spacing__hover_enabled=»off» button_two_letter_spacing__hover_enabled=»off» button_bg_color__hover_enabled=»off» button_one_bg_color__hover_enabled=»off» button_two_bg_color__hover_enabled=»off» theme_builder_area=»post_content»][/et_pb_contact_field][et_pb_contact_field _builder_version=»4.24.3″ _module_preset=»default» theme_builder_area=»post_content» allowed_symbols=»numbers» field_title=»NUMERO DE CÉDULA:» hover_enabled=»0″ sticky_enabled=»0″ field_id=»cedula»][/et_pb_contact_field][et_pb_contact_field field_id=»Email» field_title=»DIRECCIÓN DE CORREO ELECTRÓNICO:» field_type=»email» _builder_version=»4.24.3″ hover_enabled=»0″ global_colors_info=»{}» button_text_size__hover_enabled=»off» button_one_text_size__hover_enabled=»off» button_two_text_size__hover_enabled=»off» button_text_color__hover_enabled=»off» button_one_text_color__hover_enabled=»off» button_two_text_color__hover_enabled=»off» button_border_width__hover_enabled=»off» button_one_border_width__hover_enabled=»off» button_two_border_width__hover_enabled=»off» button_border_color__hover_enabled=»off» button_one_border_color__hover_enabled=»off» button_two_border_color__hover_enabled=»off» button_border_radius__hover_enabled=»off» button_one_border_radius__hover_enabled=»off» button_two_border_radius__hover_enabled=»off» button_letter_spacing__hover_enabled=»off» button_one_letter_spacing__hover_enabled=»off» button_two_letter_spacing__hover_enabled=»off» button_bg_color__hover_enabled=»off» button_one_bg_color__hover_enabled=»off» button_two_bg_color__hover_enabled=»off» theme_builder_area=»post_content» sticky_enabled=»0″][/et_pb_contact_field][et_pb_contact_field _builder_version=»4.24.3″ _module_preset=»default» theme_builder_area=»post_content» field_title=»NÚMERO DE CONTACTO» hover_enabled=»0″ sticky_enabled=»0″ field_id=»Contacto»][/et_pb_contact_field][et_pb_contact_field field_id=»Message» field_title=»TEMA A TRATAR / MOTIVO DE LA SOLICITUD DE CITA:» field_type=»text» fullwidth_field=»on» _builder_version=»4.24.3″ hover_enabled=»0″ global_colors_info=»{}» button_text_size__hover_enabled=»off» button_one_text_size__hover_enabled=»off» button_two_text_size__hover_enabled=»off» button_text_color__hover_enabled=»off» button_one_text_color__hover_enabled=»off» button_two_text_color__hover_enabled=»off» button_border_width__hover_enabled=»off» button_one_border_width__hover_enabled=»off» button_two_border_width__hover_enabled=»off» button_border_color__hover_enabled=»off» button_one_border_color__hover_enabled=»off» button_two_border_color__hover_enabled=»off» button_border_radius__hover_enabled=»off» button_one_border_radius__hover_enabled=»off» button_two_border_radius__hover_enabled=»off» button_letter_spacing__hover_enabled=»off» button_one_letter_spacing__hover_enabled=»off» button_two_letter_spacing__hover_enabled=»off» button_bg_color__hover_enabled=»off» button_one_bg_color__hover_enabled=»off» button_two_bg_color__hover_enabled=»off» theme_builder_area=»post_content» sticky_enabled=»0″][/et_pb_contact_field][/et_pb_contact_form][/et_pb_column][/et_pb_row][et_pb_row _builder_version=»4.24.3″ _module_preset=»default» theme_builder_area=»post_content»][et_pb_column _builder_version=»4.24.3″ _module_preset=»default» type=»4_4″ theme_builder_area=»post_content»][et_pb_text _builder_version=»4.24.3″ _module_preset=»default» theme_builder_area=»post_content» hover_enabled=»0″ sticky_enabled=»0″]

NOTA:

El presenta formulario es para uso exclusivo del control interno, ….

[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]