{"id":150,"date":"2013-01-20T15:52:37","date_gmt":"2013-01-20T20:52:37","guid":{"rendered":"http:\/\/www.rockandrollshrink.com\/?page_id=150"},"modified":"2013-01-20T15:57:43","modified_gmt":"2013-01-20T20:57:43","slug":"video-consult-1-hour","status":"publish","type":"page","link":"http:\/\/www.rockandrollshrink.com\/?page_id=150","title":{"rendered":"Video Consult &#8211; 1 Hour"},"content":{"rendered":"<p style=\"text-align: center;\"><strong>YOU WILL BE DIRECTED TO PAYPAL TO PROCESS PAYMENT FOR THE CONSULTATION IN ADVANCE AFTER SUBMITTING THIS FORM.<\/strong><\/p>\n<p style=\"text-align: center;\">In the event that Dr. Mathis is unable to accommodate your scheduling or consultation needs, your payment will be refunded.<\/p>\n<\/p><link href=\"http:\/\/www.rockandrollshrink.com\/wp-content\/plugins\/cp-contact-form-with-paypal\/css\/stylepublic.css\" type=\"text\/css\" rel=\"stylesheet\" \/><link href=\"http:\/\/www.rockandrollshrink.com\/wp-content\/plugins\/cp-contact-form-with-paypal\/css\/cupertino\/jquery-ui-1.8.20.custom.css\" type=\"text\/css\" rel=\"stylesheet\" \/>\r\n<script type=\"text\/javascript\">\r\n function cp_contactformpp_cerror(id){$dexQuery = jQuery.noConflict();$dexQuery(\"#hdcaptcha_error\"+id).css('top',$dexQuery(\"#hdcaptcha\"+id).outerHeight());$dexQuery(\"#hdcaptcha_error\"+id).css(\"display\",\"inline\");}\r\n function doValidate_1(form)\r\n {\r\n    $dexQuery = jQuery.noConflict();\r\n    document.cp_contactformpp_pform_1.cp_ref_page.value = document.location;\r\n     if ($dexQuery(\"#hdcaptcha_cp_contact_form_paypal_post_1\").val() == '')\r\n    {\r\n        \/\/alert('Please enter the captcha verification code.');\r\n        setTimeout( \"cp_contactformpp_cerror('_1')\", 100);\r\n        return false;\r\n    }\r\n    var result = $dexQuery.ajax({\r\n        type: \"GET\",\r\n        url: \"?ps=_1\"+String.fromCharCode(38)+\"inAdmin=1\"+String.fromCharCode(38)+\"cp_contactformpp_id=1\"+String.fromCharCode(38)+\"hdcaptcha_cp_contact_form_paypal_post=\"+$dexQuery(\"#hdcaptcha_cp_contact_form_paypal_post_1\").val(),\r\n        async: false\r\n    }).responseText;\r\n    if (result.indexOf(\"captchafailed\") != -1)\r\n    {        \r\n        $dexQuery(\"#captchaimg_1\").attr('src', $dexQuery(\"#captchaimg_1\").attr('src')+'&r='+Math.floor((Math.random() * 100) + 1));\r\n        \/\/alert('Incorrect captcha code. Please try again.');\r\n        setTimeout( \"cp_contactformpp_cerror('_1')\", 100);\r\n        return false;\r\n    }\r\n    else     {\r\n        var cpefb_error = 0;\r\n        $dexQuery(\"#cp_contactformpp_pform_1\").find(\".cpefb_error\").each(function(index){\r\n            if ($dexQuery(this).css(\"display\")!=\"none\")\r\n                cpefb_error++;    \r\n            });\r\n        if (cpefb_error==0)\r\n        {\r\n            $dexQuery(\"#cp_contactformpp_pform_1\").find(\"select\").children().each(function(){\r\n\t\t    \t    $dexQuery(this).val($dexQuery(this).attr(\"vt\"));\r\n\t        });\r\n\t        $dexQuery(\"#cp_contactformpp_pform_1\").find(\"input:checkbox,input:radio\").each(function(){\t            \r\n\t\t    \t    $dexQuery(this).val($dexQuery(this).attr(\"vt\"));\r\n\t        });\r\n\t\t\t$dexQuery(\"#cp_contactformpp_pform_1\").find( '.ignore' ).parents( '.fields' ).remove();\r\n\t\t}\r\n        return true;\r\n    }  \r\n }\r\n<\/script>\r\n<form class=\"cpp_form\" name=\"cp_contactformpp_pform_1\" id=\"cp_contactformpp_pform_1\" action=\"\" method=\"post\" enctype=\"multipart\/form-data\" onsubmit=\"return doValidate_1(this);\"><input type=\"hidden\" name=\"cp_pform_psequence\" value=\"_1\" \/><input type=\"hidden\" name=\"cp_contactformpp_pform_process\" value=\"1\" \/><input type=\"hidden\" name=\"cp_contactformpp_id\" value=\"1\" \/><input type=\"hidden\" name=\"cp_ref_page\" value=\"\" \/><input type=\"hidden\" name=\"form_structure_1\" id=\"form_structure_1\" size=\"180\" value=\"[[{&quot;name&quot;:&quot;fieldname5&quot;,&quot;index&quot;:0,&quot;title&quot;:&quot;Name&quot;,&quot;required&quot;:true,&quot;userhelp&quot;:&quot;Please enter your name.&quot;,&quot;ftype&quot;:&quot;ftext&quot;,&quot;csslayout&quot;:&quot;&quot;,&quot;predefined&quot;:&quot;&quot;,&quot;size&quot;:&quot;medium&quot;},{&quot;name&quot;:&quot;email&quot;,&quot;index&quot;:1,&quot;title&quot;:&quot;Email&quot;,&quot;ftype&quot;:&quot;femail&quot;,&quot;userhelp&quot;:&quot;Enter your email address. PLEASE VERIFY YOU HAVE ENTERED THIS CORRECTLY BEFORE SUBMITTING! If you enter your email incorrectly, your scheduling may be delayed.&quot;,&quot;csslayout&quot;:&quot;&quot;,&quot;required&quot;:true,&quot;predefined&quot;:&quot;&quot;,&quot;size&quot;:&quot;medium&quot;},{&quot;name&quot;:&quot;fieldname1&quot;,&quot;index&quot;:2,&quot;title&quot;:&quot;Phone Number&quot;,&quot;required&quot;:true,&quot;userhelp&quot;:&quot;Enter your primary phone number.&quot;,&quot;ftype&quot;:&quot;ftext&quot;,&quot;csslayout&quot;:&quot;&quot;,&quot;predefined&quot;:&quot;&quot;,&quot;size&quot;:&quot;medium&quot;},{&quot;name&quot;:&quot;fieldname2&quot;,&quot;index&quot;:3,&quot;title&quot;:&quot;Alternate Number&quot;,&quot;userhelp&quot;:&quot;If you wish, enter a second phone number where you can be reached.&quot;,&quot;ftype&quot;:&quot;ftext&quot;,&quot;csslayout&quot;:&quot;&quot;,&quot;required&quot;:false,&quot;predefined&quot;:&quot;&quot;,&quot;size&quot;:&quot;medium&quot;},{&quot;choices&quot;:[&quot;Email&quot;,&quot;Phone Number&quot;,&quot;Alternate Number&quot;],&quot;name&quot;:&quot;fieldname3&quot;,&quot;index&quot;:4,&quot;required&quot;:true,&quot;title&quot;:&quot;Preferred Contact Method&quot;,&quot;userhelp&quot;:&quot;Please select a preferred method for Dr. Mathis to reach you.&quot;,&quot;choiceSelected&quot;:&quot;Email&quot;,&quot;ftype&quot;:&quot;fdropdown&quot;,&quot;csslayout&quot;:&quot;&quot;,&quot;size&quot;:&quot;medium&quot;},{&quot;name&quot;:&quot;message&quot;,&quot;index&quot;:5,&quot;size&quot;:&quot;large&quot;,&quot;required&quot;:true,&quot;title&quot;:&quot;Regarding:&quot;,&quot;ftype&quot;:&quot;ftextarea&quot;,&quot;userhelp&quot;:&quot;Briefly describe what you would like to discuss during the consultation with Dr. Mathis.&quot;,&quot;csslayout&quot;:&quot;&quot;,&quot;predefined&quot;:&quot;&quot;},{&quot;name&quot;:&quot;fieldname4&quot;,&quot;index&quot;:6,&quot;size&quot;:&quot;large&quot;,&quot;required&quot;:true,&quot;title&quot;:&quot;Scheduling Notes:&quot;,&quot;userhelp&quot;:&quot;Please indicate any schedule preferences or restrictions that Dr. Mathis should be aware of when booking time.&quot;,&quot;ftype&quot;:&quot;ftextarea&quot;,&quot;csslayout&quot;:&quot;&quot;,&quot;predefined&quot;:&quot;&quot;},{&quot;choices&quot;:[&quot;Yes.&quot;],&quot;choiceSelected&quot;:[false],&quot;name&quot;:&quot;fieldname6&quot;,&quot;index&quot;:7,&quot;title&quot;:&quot;I have read and agree to the Confidentiality Disclaimer on the Consultation Overview Page.&quot;,&quot;required&quot;:true,&quot;ftype&quot;:&quot;fcheck&quot;,&quot;userhelp&quot;:&quot;&quot;,&quot;csslayout&quot;:&quot;&quot;,&quot;layout&quot;:&quot;one_column&quot;},{&quot;name&quot;:&quot;fieldname7&quot;,&quot;index&quot;:8,&quot;title&quot;:&quot;Please type your name here, as a \\&quot;digital signature\\&quot; to the above disclaimer.&quot;,&quot;required&quot;:true,&quot;size&quot;:&quot;large&quot;,&quot;ftype&quot;:&quot;ftext&quot;,&quot;userhelp&quot;:&quot;&quot;,&quot;csslayout&quot;:&quot;&quot;,&quot;predefined&quot;:&quot;&quot;}],[{&quot;title&quot;:&quot;1 Hour Video Consultation&quot;,&quot;description&quot;:&quot;&quot;,&quot;formlayout&quot;:&quot;top_aligned&quot;}]]\" \/>\r\n<div id=\"fbuilder\">\r\n  <div id=\"fbuilder_1\">\r\n      <div id=\"formheader_1\"><\/div>\r\n      <div id=\"fieldlist_1\"><\/div>\r\n  <\/div>\r\n<\/div>    \r\n<div id=\"cpcaptchalayer_1\">\r\n     Coupon code (optional):<br \/>\r\n     <input type=\"text\" name=\"couponcode\" value=\"\"><br \/>\r\n  \r\n  <br \/>Please enter the security code:<br \/>\r\n  <img decoding=\"async\" src=\"\/?cp_contactformpp=captcha&ps=_1&inAdmin=1&width=180&height=60&letter_count=5&min_size=25&max_size=35&noise=200&noiselength=4&bcolor=ffffff&border=000000&font=font-1.ttf\"  id=\"captchaimg_1\" alt=\"security code\" border=\"0\"  \/>\r\n  <br \/>\r\n  Security Code (lowercase letters):<br \/>\r\n  <div class=\"dfield\">\r\n  <input type=\"text\" size=\"20\" name=\"hdcaptcha_cp_contact_form_paypal_post\" id=\"hdcaptcha_cp_contact_form_paypal_post_1\" value=\"\" \/>\r\n  <div class=\"error cpefb_error message\" id=\"hdcaptcha_error_1\" generated=\"true\" style=\"display:none;position: absolute; left: 0px; top: 25px;\">Please enter the captcha verification code.<\/div>\r\n  <\/div>\r\n  <br \/>\r\n<\/div>\r\n<div id=\"cp_subbtn_1\" class=\"cp_subbtn\">Submit<\/div>\r\n<\/form>\n","protected":false},"excerpt":{"rendered":"<p>YOU WILL BE DIRECTED TO PAYPAL TO PROCESS PAYMENT FOR THE CONSULTATION IN ADVANCE AFTER SUBMITTING THIS FORM. In the event that Dr. Mathis is unable to accommodate your scheduling or consultation needs, your payment will be refunded.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":147,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-150","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"http:\/\/www.rockandrollshrink.com\/index.php?rest_route=\/wp\/v2\/pages\/150","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.rockandrollshrink.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/www.rockandrollshrink.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/www.rockandrollshrink.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.rockandrollshrink.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=150"}],"version-history":[{"count":4,"href":"http:\/\/www.rockandrollshrink.com\/index.php?rest_route=\/wp\/v2\/pages\/150\/revisions"}],"predecessor-version":[{"id":157,"href":"http:\/\/www.rockandrollshrink.com\/index.php?rest_route=\/wp\/v2\/pages\/150\/revisions\/157"}],"up":[{"embeddable":true,"href":"http:\/\/www.rockandrollshrink.com\/index.php?rest_route=\/wp\/v2\/pages\/147"}],"wp:attachment":[{"href":"http:\/\/www.rockandrollshrink.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=150"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}