{"id":1778,"date":"2025-12-15T13:34:51","date_gmt":"2025-12-15T08:04:51","guid":{"rendered":"https:\/\/ayurhealthveda.com\/?page_id=1778"},"modified":"2025-12-15T13:36:59","modified_gmt":"2025-12-15T08:06:59","slug":"book-an-appointment","status":"publish","type":"page","link":"https:\/\/ayurhealthveda.com\/index.php\/book-an-appointment\/","title":{"rendered":"Book An Appointment"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:var(--awb-color7);border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-justify-content-space-evenly\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><a class=\"fusion-modal-text-link\" href=\"#\"><div class='fluentform ff-default fluentform_wrapper_4 ffs_default_wrap'><form data-form_id=\"4\" id=\"fluentform_4\" class=\"frm-fluent-form fluent_form_4 ff-el-form-top ff_form_instance_4_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_4_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Treatment Booking Form<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='1778' \/><input type=\"hidden\" id=\"_fluentform_4_fluentformnonce\" name=\"_fluentform_4_fluentformnonce\" value=\"014023dc57\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1778\" \/><div data-type=\"name-element\" data-name=\"patient_name\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_patient_name_first_name_' id='label_ff_4_patient_name_first_name_' >First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"patient_name[first_name]\" id=\"ff_4_patient_name_first_name_\" class=\"ff-el-form-control\" placeholder=\"First Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_patient_name_last_name_' id='label_ff_4_patient_name_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"patient_name[last_name]\" id=\"ff_4_patient_name_last_name_\" class=\"ff-el-form-control\" placeholder=\"Last Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_age' id='label_ff_4_age' aria-label=\"Age\">Age<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"age\" id=\"ff_4_age\" class=\"ff-el-form-control\" placeholder=\"Age\" data-name=\"age\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Gender\">Gender<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='gender_7a1e1e3739f09e92abd248fe60417b7d'><input  type=\"radio\" name=\"gender\" data-name=\"gender\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"male\"  id='gender_7a1e1e3739f09e92abd248fe60417b7d' aria-label='Male' aria-invalid='false' aria-required=true> <span>Male<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='gender_63f6671b7335529f6196dbc1075d6fcb'><input  type=\"radio\" name=\"gender\" data-name=\"gender\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"female\"  id='gender_63f6671b7335529f6196dbc1075d6fcb' aria-label='Female' aria-invalid='false' aria-required=true> <span>Female<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='gender_68166caa9221908de6c07de2178c3fe1'><input  type=\"radio\" name=\"gender\" data-name=\"gender\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"other\"  id='gender_68166caa9221908de6c07de2178c3fe1' aria-label='Other' aria-invalid='false' aria-required=true> <span>Other<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_phone_number' id='label_ff_4_phone_number' aria-label=\"Phone Number\">Phone Number<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"phone_number\" data-mask=\"(000) 000-0000\" class=\"ff-el-form-control\" placeholder=\"(XXX) XXX-XXXX\" data-name=\"phone_number\" id=\"ff_4_phone_number\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_booking_date' id='label_ff_4_booking_date' aria-label=\"Booking Date\">Booking Date<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Booking Date Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='Y-m-d' type=\"text\" name=\"booking_date\" id=\"ff_4_booking_date\" class=\"ff-el-form-control ff-el-datepicker\" placeholder=\"Select Date\" data-name=\"booking_date\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_treatment_package' id='label_ff_4_treatment_package' aria-label=\"Select Treatment \/ Therapy\">Select Treatment \/ Therapy<\/label><\/div><div class='ff-el-input--content'><select name=\"treatment_package\" id=\"ff_4_treatment_package\" class=\"ff-el-form-control\" placeholder=\"Select Treatment \/ Therapy\" data-name=\"treatment_package\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_4_treatment_package\"><option value=\"\">Select Treatment \/ Package<\/option><option value=\"PRP Therapy\"  >PRP Therapy<\/option><option value=\"PLASMA PEN- Moles, Warts, Stretch marks and Tags removal\"  >PLASMA PEN- Moles, Warts, Stretch marks and Tags removal<\/option><option value=\"Collagen Induction Therapy\/ Microneedling\/ PRP\"  >Collagen Induction Therapy\/ Microneedling\/ PRP<\/option><option value=\"Cupping therapy\"  >Cupping therapy<\/option><option value=\"Udwarthanam treatment\"  >Udwarthanam treatment<\/option><option value=\"Nasyam treatment\"  >Nasyam treatment<\/option><option value=\"Snehpanam Ayurvedic Treatment\"  >Snehpanam Ayurvedic Treatment<\/option><option value=\"Pinda Sweda\/ Kizhi Massage\"  >Pinda Sweda\/ Kizhi Massage<\/option><option value=\"Dhanyamla Dhara Treatment\"  >Dhanyamla Dhara Treatment<\/option><option value=\"Thalam treatment\"  >Thalam treatment<\/option><option value=\"Thalapothichil Treatment\"  >Thalapothichil Treatment<\/option><option value=\"Yoni Prakshalanam Treatment\"  >Yoni Prakshalanam Treatment<\/option><option value=\"Ksheer dhoomam treatment\"  >Ksheer dhoomam treatment<\/option><option value=\"Lepanam treatment\"  >Lepanam treatment<\/option><option value=\"Mukh Lepam\/ Herbal Face Pack\"  >Mukh Lepam\/ Herbal Face Pack<\/option><option value=\"Marma Therapy\"  >Marma Therapy<\/option><option value=\"Netra Tharpanam\"  >Netra Tharpanam<\/option><option value=\"Shirovasti treatment\"  >Shirovasti treatment<\/option><option value=\"Basti Treatment\"  >Basti Treatment<\/option><option value=\"Shirodhara Treatment\"  >Shirodhara Treatment<\/option><option value=\"Shashtishaali Pind swed\/Njavarakizhi\"  >Shashtishaali Pind swed\/Njavarakizhi<\/option><option value=\"Abhyang \/ Pizhichil- Treatment\"  >Abhyang \/ Pizhichil- Treatment<\/option><option value=\"Leech Therapy\"  >Leech Therapy<\/option><option value=\"Rakt Mokshana\/ Bloodletting\"  >Rakt Mokshana\/ Bloodletting<\/option><option value=\"Aches and Pains\"  >Aches and Pains<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required 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