{"id":6,"date":"2024-02-04T12:42:46","date_gmt":"2024-02-04T12:42:46","guid":{"rendered":"http:\/\/upload.healwise.net\/?page_id=6"},"modified":"2025-01-18T13:38:23","modified_gmt":"2025-01-18T12:38:23","slug":"6-2","status":"publish","type":"page","link":"https:\/\/upload.healwise.net\/","title":{"rendered":"Healwise Upload"},"content":{"rendered":"\n\n\n<div class=\"wp-block-group alignfull has-background has-global-padding is-layout-constrained wp-container-core-group-is-layout-bc88805c wp-block-group-is-layout-constrained\" style=\"background-color:#3b9095;min-height:100vh;margin-top:0;margin-bottom:0;padding-top:var(--wp--preset--spacing--60);padding-right:var(--wp--preset--spacing--50);padding-bottom:var(--wp--preset--spacing--60);padding-left:var(--wp--preset--spacing--50)\">\n<div style=\"height:0px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div class=\"wpforms-container wpforms-container-full wpforms-form-abandonment wpforms-container-save-resume wpforms-block wpforms-block-3535adcf-4077-418c-ab36-bba2a050d39c\" id=\"wpforms-115\"><form id=\"wpforms-form-115\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"115\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F6&#038;wpforms_form_id=115\" data-token=\"d7b4afab2ef657243b111c6d47ebe9b2\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-115-field_21-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"21\"><h3 id=\"wpforms-115-field_21\" name=\"wpforms[fields][21]\">Personal Information<\/h3><\/div><div id=\"wpforms-115-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_1\">Full Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-115-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" required><\/div><div id=\"wpforms-115-field_2-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_2\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-115-field_2\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][2][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-115-field_4-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_4\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-115-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-115-field_35-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"35\"><h3 id=\"wpforms-115-field_35\" name=\"wpforms[fields][35]\">Medical Documentation<\/h3><\/div><div id=\"wpforms-115-field_8-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-115-field_8\">Please upload any relevant medical documents. <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"file\" id=\"wpforms-115-field_8\" class=\"wpforms-field-required\" data-rule-extension=\"png,gif,jpg,doc,xls,ppt,pdf,wav,mp3,mp4,mpg,mov,wmv,rar,zip,iso,dicom\" data-rule-maxsize=\"5242880000\" name=\"wpforms_115_8\" accept=\".png,.gif,.jpg,.doc,.xls,.ppt,.pdf,.wav,.mp3,.mp4,.mpg,.mov,.wmv,.rar,.zip,.iso,.dicom\" required><div class=\"wpforms-field-description\">E.g., medical reports, diagnostic test results, referral letters, etc.<\/div><\/div><div id=\"wpforms-115-field_10-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"10\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-115-field_10\">File Upload<\/label><input type=\"file\" id=\"wpforms-115-field_10\" data-rule-extension=\"png,gif,jpg,doc,xls,ppt,pdf,wav,mp3,mp4,mpg,mov,wmv,rar,zip,iso,dicom\" data-rule-maxsize=\"5242880000\" name=\"wpforms_115_10\" accept=\".png,.gif,.jpg,.doc,.xls,.ppt,.pdf,.wav,.mp3,.mp4,.mpg,.mov,.wmv,.rar,.zip,.iso,.dicom\" ><\/div><div id=\"wpforms-115-field_11-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"11\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-115-field_11\">File Upload<\/label><input type=\"file\" 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