{"id":5488,"date":"2019-12-04T12:39:29","date_gmt":"2019-12-04T11:39:29","guid":{"rendered":"https:\/\/www.beautyinprague.com\/lens-replacement-questionnaire\/"},"modified":"2019-12-04T12:39:29","modified_gmt":"2019-12-04T11:39:29","slug":"lens-replacement-questionnaire","status":"publish","type":"page","link":"https:\/\/www.beautyinprague.com\/de\/lens-replacement-questionnaire\/","title":{"rendered":"Lens Replacement"},"content":{"rendered":"\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2913-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"2913\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"> <ul><\/ul><\/div>\n<form action=\"\/de\/wp-json\/wp\/v2\/pages\/5488#wpcf7-f2913-o1\" method=\"post\" class=\"wpcf7-form init wpcf7-acceptance-as-validation\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2913\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2913-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"upload_dir\" value=\"0496368510\" \/><input type=\"hidden\" name=\"generate_name\" value=\"04-30-26-69f3b4e2df263\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"special-form special-form--lens\">\n    <div class=\"row\">\n        <span class=\"show-me note\">PLEASE NOTE: It is necessary to provide us with all medication you use for all health problems in order to correctly indicate you to a surgery. In case if false, not complete information or concealed medical history is provided your treatment might be cancelled with no financial refund.<\/span>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"input-wrapper input-50\">\n            <label for=\"full-name\">Name and Surname: <span class=\"red\">*<\/span><\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"full-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"full-name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"John Doe\" value=\"\" type=\"text\" name=\"full-name\" \/><\/span>\n        <\/div>\n        <div class=\"input-wrapper select-wrapper input-50\">\n            <label for=\"country\">Country:<\/label>\n            <div class=\"select-wrap\">\n                <span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><select class=\"wpcf7-form-control wpcf7-select\" id=\"country\" aria-invalid=\"false\" name=\"country\"><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Aruba\">Aruba<\/option><option value=\"Afghanistan\">Afghanistan<\/option><option value=\"Angola\">Angola<\/option><option value=\"Albania\">Albania<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"United Arab Emirates\">United Arab Emirates<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"American Samoa\">American Samoa<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Benin\">Benin<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Bahamas\">Bahamas<\/option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belize\">Belize<\/option><option value=\"Bermuda\">Bermuda<\/option><option value=\"Bolivia, Plurinational State of\">Bolivia, Plurinational State of<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Brunei Darussalam\">Brunei Darussalam<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Central African Republic\">Central African Republic<\/option><option value=\"Canada\">Canada<\/option><option value=\"Switzerland\">Switzerland<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"C\u00f4te d\u2019Ivoire\">C\u00f4te d\u2019Ivoire<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Congo, the Democratic Republic of the\">Congo, the Democratic Republic of the<\/option><option value=\"Congo\">Congo<\/option><option value=\"Cook Islands\">Cook Islands<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Comoros\">Comoros<\/option><option value=\"Cape Verde\">Cape Verde<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cayman Islands\">Cayman Islands<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic\">Czech Republic<\/option><option value=\"Germany\">Germany<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Dominican Republic\">Dominican Republic<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Spain\">Spain<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Finland\">Finland<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"France\">France<\/option><option value=\"Micronesia, Federated States of\">Micronesia, Federated States of<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Gambia\">Gambia<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Greece\">Greece<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guam\">Guam<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Hong Kong\">Hong Kong<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Croatia\">Croatia<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"India\">India<\/option><option value=\"Iran, Islamic Republic of\">Iran, Islamic Republic of<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Japan\">Japan<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option value=\"Korea, Republic of\">Korea, Republic of<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Lao People\u2019s Democratic Republic\">Lao People\u2019s Democratic Republic<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libya\">Libya<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Sri Lanka\">Sri Lanka<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Moldova, Republic of\">Moldova, Republic of<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Marshall Islands\">Marshall Islands<\/option><option value=\"Macedonia, the former Yugoslav Republic of\">Macedonia, the former Yugoslav Republic of<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Montenegro\">Montenegro<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Niger\">Niger<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Netherlands\">Netherlands<\/option><option value=\"Norway\">Norway<\/option><option value=\"Nepal\">Nepal<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Panama\">Panama<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines\">Philippines<\/option><option value=\"Palau\">Palau<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Poland\">Poland<\/option><option value=\"Puerto Rico\">Puerto Rico<\/option><option value=\"Korea, Democratic People\u2019s Republil Salvador\">Korea, Democratic People\u2019s Republil Salvador<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Somalia\">Somalia<\/option><option value=\"Serbia\">Serbia<\/option><option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Slovakia\">Slovakia<\/option><option value=\"Slovenia\">Slovenia<\/option><option value=\"Sweden\">Sweden<\/option><option value=\"Swaziland\">Swaziland<\/option><option value=\"Seychelles\">Seychelles<\/option><option value=\"Syrian Arab Republic\">Syrian Arab Republic<\/option><option value=\"Chad\">Chad<\/option><option value=\"Togo\">Togo<\/option><option value=\"Thailand\">Thailand<\/option><option value=\"Tajikistan\">Tajikistan<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Timor-Leste\">Timor-Leste<\/option><option value=\"Tonga\">Tonga<\/option><option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Taiwan, Province of China\">Taiwan, Province of China<\/option><option value=\"Tanzania, United Republic of\">Tanzania, United Republic of<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"United States\">United States<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines<\/option><option value=\"Venezuela, Bolivarian Republic of\">Venezuela, Bolivarian Republic of<\/option><option value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.<\/option><option value=\"Viet Nam\">Viet Nam<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"Yemen\">Yemen<\/option><option value=\"South Africa\">South Africa<\/option><option value=\"Zambia\">Zambia<\/option><option value=\"Zimbabwe\">Zimbabwe<\/option><\/select><\/span>\n            <\/div>\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"input-wrapper input-50\">\n            <label for=\"phone\">Phone:<\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" id=\"phone\" aria-invalid=\"false\" placeholder=\"+420 111 222 333\" value=\"\" type=\"tel\" name=\"phone\" \/><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-50\">\n            <label for=\"email\">E-mail:  <span class=\"red\">*<\/span><\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" id=\"email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"john@doe.com\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"input-wrapper input-50\">\n            <label for=\"treatment-date\">Considered date for the treatment: <span class=\"red\">*<\/span><\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"treatment-date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"treatment-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"treatment-date\" \/><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-50\">\n            <label for=\"date-of-birth\">Date of Birth: <span class=\"red\">*<\/span><\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required js-datepicker\" id=\"date-of-birth\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"date-of-birth\" \/><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"input-wrapper input-50\">\n            <label for=\"weight\">Weight: <span class=\"red\">*<\/span><\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"weight\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"weight\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"64 kg\" value=\"\" type=\"text\" name=\"weight\" \/><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-50\">\n            <label for=\"height\">Height: <span class=\"red\">*<\/span><\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"height\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"height\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"168 cm\" value=\"\" type=\"text\" name=\"height\" \/><\/span>\n        <\/div>\n    <\/div>\n    <hr>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"glasses-for-distance-details\">Do you wear glasses for distance?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"glasses-for-distance\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"glasses-for-distance\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"glasses-for-distance\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"glasses-for-distance\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"glasses-for-reading-details\">Do you wear glasses for near vision\/ reading glasses?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"glasses-for-reading\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"glasses-for-reading\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"glasses-for-reading\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"glasses-for-reading\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"input-wrapper input-100\">\n            <label for=\"prescription\">Do you know your prescription - for both long and short distance?<\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"prescription\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"prescription\" aria-invalid=\"false\" placeholder=\"If yes, please specify:\" name=\"prescription\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <hr>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"fit-and-well-details\">1. Are you fit and well?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"fit-and-well\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"fit-and-well\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"fit-and-well\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"fit-and-well\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"eye-oparations-in-past-details\">2. Have you had any eye operations in the past?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"eye-oparations-in-past\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"eye-oparations-in-past\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"eye-oparations-in-past\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"eye-oparations-in-past\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"eye-oparations-in-past-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"eye-oparations-in-past-details\" aria-invalid=\"false\" placeholder=\"Which operation and when?\" name=\"eye-oparations-in-past-details\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"eye-drops-details\">3. Do you use any eye drops?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"eye-drops\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"eye-drops\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"eye-drops\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"eye-drops\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"eye-drops-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"eye-drops-details\" aria-invalid=\"false\" name=\"eye-drops-details\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"attend-hospital-fof-eyes-details\">4. Do you regularly attend hospital for your eyes?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"attend-hospital-fof-eyes\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"attend-hospital-fof-eyes\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"attend-hospital-fof-eyes\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"attend-hospital-fof-eyes\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"attend-hospital-fof-eyes-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"attend-hospital-fof-eyes-details\" aria-invalid=\"false\" placeholder=\"State circumstances\" name=\"attend-hospital-fof-eyes-details\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"auto-immune-disease-details\">5. Do you suffer from any auto immune disease?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"auto-immune-disease\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"auto-immune-disease\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"auto-immune-disease\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"auto-immune-disease\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"auto-immune-disease-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"auto-immune-disease-details\" aria-invalid=\"false\" placeholder=\"State what\" name=\"auto-immune-disease-details\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"operation-in-past-details\">6. Have you had any operation in the past? (heart, kidney etc.)<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"operation-in-past\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"operation-in-past\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"operation-in-past\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"operation-in-past\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"operation-in-past-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"operation-in-past-details\" aria-invalid=\"false\" placeholder=\"State what and when\" name=\"operation-in-past-details\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"operation-in-past-details\">7. Do you suffer from a lazy eye (amblyopia)?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"amblyopia\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"amblyopia\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"amblyopia\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"amblyopia\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"amblyopia-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"amblyopia-details\" aria-invalid=\"false\" placeholder=\"State what and when\" name=\"amblyopia-details\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"eye-injury-details\">8. Have you ever had any eye injury?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"eye-injury\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"eye-injury\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"eye-injury\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"eye-injury\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"eye-injury-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"eye-injury-details\" aria-invalid=\"false\" placeholder=\"State what and when\" name=\"eye-injury-details\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"hearth-problems-details\">9. Do you suffer from heart disease, or have you ever had problems with your heart? <\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"hearth-problems\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"hearth-problems\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"hearth-problems\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"hearth-problems\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"hearth-problems-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"hearth-problems-details\" aria-invalid=\"false\" placeholder=\"State what\" name=\"hearth-problems-details\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"high-blood-pressure-details\">10. Are you being treated for high blood pressure?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"high-blood-pressure\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"high-blood-pressure\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"high-blood-pressure\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"high-blood-pressure\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n\t\t<div class=\"input-wrapper input-75\">\n\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"high-blood-pressure-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"high-blood-pressure-details\" aria-invalid=\"false\" placeholder=\"\" name=\"high-blood-pressure-details\"><\/textarea><\/span>\n\t\t<\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"glaucoma-details\">11. Is anyone of your relatives being treated for glaucoma?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"glaucoma\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"glaucoma\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"glaucoma\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"glaucoma\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n\t\t<div class=\"input-wrapper input-75\">\n\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"glaucoma-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"glaucoma-details\" aria-invalid=\"false\" placeholder=\"\" name=\"glaucoma-details\"><\/textarea><\/span>\n\t\t<\/div>\t\t\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"respiratory-disorder-details\">12. Do you suffer from any respiratory disorder?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"respiratory-disorder\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"respiratory-disorder\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"respiratory-disorder\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"respiratory-disorder\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n\t\t<div class=\"input-wrapper input-75\">\n\t\t\t<span class=\"wpcf7-form-control-wrap\" data-name=\"respiratory-disorder-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"respiratory-disorder-details\" aria-invalid=\"false\" placeholder=\"\" name=\"respiratory-disorder-details\"><\/textarea><\/span>\n\t\t<\/div>\t\t\t\t\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"diabetes-details\">13. Do you receive treatment for diabetes? <\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"diabetes\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"diabetes\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"diabetes\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"diabetes\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"diabetes-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"diabetes-details\" aria-invalid=\"false\" placeholder=\"If yes, how long? Tablets or insulin?\" name=\"diabetes-details\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"nervous-disease-details\">14. Are you being treated for a nervous disease?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"nervous-disease\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"nervous-disease\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"nervous-disease\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"nervous-disease\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n\t\t<div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"nervous-disease-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"nervous-disease-details\" aria-invalid=\"false\" placeholder=\"\" name=\"nervous-disease-details\"><\/textarea><\/span>\n        <\/div>\t\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"cold-or-influenza-details\">15. Are you at present suffering from a cold or influenza?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"cold-or-influenza\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"cold-or-influenza\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"cold-or-influenza\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"cold-or-influenza\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n\t\t<div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"cold-or-influenza-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"cold-or-influenza-details\" aria-invalid=\"false\" placeholder=\"\" name=\"cold-or-influenza-details\"><\/textarea><\/span>\n        <\/div>\t\t\t\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <label class=\"label-with-padding\" for=\"mental-illness-details\">16. Have you ever been admitted to hospital or been treated \/ taken medication for a mental illness?<\/label>\n        <div class=\"input-wrapper input-25\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"mental-illness\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"mental-illness\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"mental-illness\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"mental-illness\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n\t\t<div class=\"input-wrapper input-75\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"mental-illness-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"mental-illness-details\" aria-invalid=\"false\" placeholder=\"\" name=\"mental-illness-details\"><\/textarea><\/span>\n        <\/div>\t\t\t\t\n    <\/div>\n    <hr>\n    <div class=\"row\">\n        <div class=\"input-wrapper input-100\">\n            <label for=\"allergies\"><strong>Drug Reactions\/Allergies:<\/strong> Please list below any known drug allergies or reactions, or sensitivities.<\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"allergies\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"allergies\" aria-invalid=\"false\" placeholder=\"Medication Name - Type of Drug Reaction \/ Allergy\" name=\"allergies\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"input-wrapper input-100\">\n            <label for=\"prescription-medications\"><strong>Prescription Medications:<\/strong> Please list all prescription medications you currently take:<\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"prescription-medications\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"prescription-medications\" aria-invalid=\"false\" placeholder=\"Medication Name\" name=\"prescription-medications\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row\">\n        <div class=\"input-wrapper input-100\">\n            <label for=\"non-prescription-medications\"><strong>Non-Prescription Medications \/ Dietary Supplements \/ Vitamins \/ Herbs \/ Minerals:<\/strong> If you currently take items in this category, please list below.<\/label>\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"non-prescription-medications\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"non-prescription-medications\" aria-invalid=\"false\" placeholder=\"Medication Name\" name=\"non-prescription-medications\"><\/textarea><\/span>\n        <\/div>\n    <\/div>\n    <div class=\"row row-checkbox\">\n        <span class=\"show-me note\" style=\"text-align:left;\"><strong>Smoking, Second-Hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal Spray)<\/strong><br>Please indicate your current status regarding these items below:<\/span>\n        <label class=\"label-with-padding\" for=\"smoking-details\">Do you SMOKE or use TOBACCO\/NICOTINE PRODUCTS?<\/label>\n        <div class=\"input-wrapper input-25 input-25--smoke\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"smoking\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"smoking\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"smoking\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"smoking\" value=\"I am a NON SMOKER and do not use nicotine products.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I am a NON SMOKER and do not use nicotine products.<\/span><\/label><\/span><\/span><\/span>\n        <\/div>\n        <div class=\"input-wrapper input-75 input-75--smoke\">\n            <span class=\"wpcf7-form-control-wrap\" data-name=\"smoking-details\"><textarea cols=\"40\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"smoking-details\" aria-invalid=\"false\" placeholder=\"How many cigarettes do you smoke a day?\" name=\"smoking-details\"><\/textarea><\/span>\n        <\/div>\n<div class=\"row\">\n  <div class=\"input-wrapper input-100\">\n    <span class=\"label\">Upload your glasses prescription \/ eye report (optional):<\/span>\n    <span class=\"wpcf7-form-control-wrap codedropz-theme-light\" data-name=\"eye-report\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-drag-n-drop-file d-none\" aria-invalid=\"false\" type=\"file\" multiple=\"multiple\" data-name=\"eye-report\" data-max=\"5\" data-id=\"2913\" \/><\/span>\n  <\/div>\n<\/div>\n    <\/div>\n    <hr>\n    <div class=\"row row-acceptance\" style=\"padding-bottom: 0;\">\n          <span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-188\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-188\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I agree with <a href=\"https:\/\/www.beautyinprague.com\/terms-conditions\/#medical-qa\" target=\"_blank\">processing<\/a> of my sensitive data <span class=\"red\">*<\/span><\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n    <div class=\"row row-acceptance\" style=\"padding-bottom: 0;\">\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance\" value=\"1\" id=\"acceptance\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I agree to the <a href=\"https:\/\/www.beautyinprague.com\/terms-conditions\/\" target=\"_blank\">Terms and Conditions<\/a> <span class=\"red\">*<\/span><\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n    <div class=\"row row-acceptance\">\n          <span class=\"wpcf7-form-control-wrap\" data-name=\"mailchimp\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"mailchimp\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I would like receive special offers and news via email (You can unsubscribe at any time). Information about <a href=\"https:\/\/www.beautyinprague.com\/terms-conditions\/#medical-qa\" target=\"_blank\">processing<\/a> my data.<\/span><\/label><\/span><\/span><\/span>\n    <\/div>\n    <span id=\"wpcf7-69f3b4e2e0772-wrapper\" class=\"wpcf7-form-control-wrap age-wrap\" ><label for=\"age\" class=\"hp-message\">Please leave this field empty.<\/label><input id=\"age\"  class=\"wpcf7-form-control wpcf7-text\" type=\"text\" name=\"age\" value=\"\" size=\"40\" tabindex=\"-1\" autocomplete=\"new-password\" \/><\/span>\n<div class=\"row\">\n    <div class=\"input-wrapper input-100\">\n        <label for=\"file-upload\">Upload your eye prescription \/ medical report (optional):<\/label>\n        <span class=\"wpcf7-form-control-wrap\" data-name=\"eye-file\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" id=\"file-upload\" accept=\".jpg,.jpeg,.png,.pdf\" aria-invalid=\"false\" type=\"file\" name=\"eye-file\" \/><\/span>\n    <\/div>\n<\/div>\n    <div class=\"submit-wrapper\">\n        <input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/><input class=\"wpcf7-form-control wpcf7-hidden\" value=\"Lens Replacement\" type=\"hidden\" name=\"treatment\" \/><input class=\"wpcf7-form-control wpcf7-hidden\" value=\"1\" type=\"hidden\" name=\"lens-replacement\" \/>\n    <\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":17,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-5488","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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