{"id":6226,"date":"2025-12-31T10:29:58","date_gmt":"2025-12-31T06:59:58","guid":{"rendered":"https:\/\/namvarhealth.com\/order-registration-form\/"},"modified":"2026-01-12T22:52:06","modified_gmt":"2026-01-12T19:22:06","slug":"order-registration-form","status":"publish","type":"page","link":"https:\/\/namvarhealth.com\/en\/order-registration-form\/","title":{"rendered":"Order Registration Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6226\" class=\"elementor elementor-6226 elementor-4956\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d233116 e-con-full e-flex e-con e-parent\" data-id=\"d233116\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-37e3419 e-flex e-con-boxed e-con e-parent\" data-id=\"37e3419\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-50b1674 e-con-full e-flex e-con e-child\" data-id=\"50b1674\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-99c4030 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"99c4030\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Place Order\" aria-label=\"Place Order\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"6226\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"99c4030\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Order Registration Form\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"6226\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b272107 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b272107\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b272107]\" id=\"form-field-field_b272107\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Last Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-message elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tContact number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[message]\" id=\"form-field-message\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Contact number\" min=\"\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_a37aec6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a37aec6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tProducts\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"5cc Luer Lock Syringe\" id=\"form-field-field_a37aec6-0\" name=\"form_fields[field_a37aec6][]\"> <label for=\"form-field-field_a37aec6-0\">5cc Luer Lock Syringe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"5cc Luer Slip Syringe\" id=\"form-field-field_a37aec6-1\" name=\"form_fields[field_a37aec6][]\"> <label for=\"form-field-field_a37aec6-1\">5cc Luer Slip Syringe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"3cc Luer Slip Syringe\" id=\"form-field-field_a37aec6-2\" name=\"form_fields[field_a37aec6][]\"> <label for=\"form-field-field_a37aec6-2\">3cc Luer Slip Syringe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"3cc Luer Lock Syringe\" id=\"form-field-field_a37aec6-3\" name=\"form_fields[field_a37aec6][]\"> <label for=\"form-field-field_a37aec6-3\">3cc Luer Lock Syringe<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_4d91293 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4d91293\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescription\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_4d91293]\" id=\"form-field-field_4d91293\" rows=\"4\" placeholder=\"Description\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Register<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-59ce85f e-flex e-con-boxed e-con e-parent\" data-id=\"59ce85f\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-71587f4 e-con-full e-flex e-con e-child\" data-id=\"71587f4\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-d134625 e-con-full e-flex e-con e-child\" data-id=\"d134625\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-92a4b66 elementor-widget elementor-widget-heading\" data-id=\"92a4b66\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Place order<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-18d4bcb elementor-widget elementor-widget-text-editor\" data-id=\"18d4bcb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Contact us or send an email to receive a free consultation<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1955512 e-con-full e-flex e-con e-child\" data-id=\"1955512\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5e7054 elementor-widget__width-initial elementor-widget-tablet__width-initial elementor-mobile-align-center elementor-widget-mobile__width-initial elementor-widget elementor-widget-button\" data-id=\"a5e7054\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm elementor-animation-pop\" href=\"https:\/\/namvarhealth.com\/en\/contact-us-2\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Place order<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-52d19bd e-con-full e-flex e-con e-child\" data-id=\"52d19bd\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-50d7e94 elementor-widget__width-initial elementor-button-align-start elementor-widget-tablet__width-initial elementor-widget elementor-widget-form\" data-id=\"50d7e94\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;none&quot;,&quot;step_icon_shape&quot;:&quot;none&quot;,&quot;button_width&quot;:&quot;100&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\" aria-label=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"6226\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"50d7e94\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Order Registration Form\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"6226\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-80 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Enter your email\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-xs elementor-animation-wobble-skew\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Membership<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1ec7b23 e-con-full e-flex e-con e-child\" data-id=\"1ec7b23\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9c6459a elementor-widget elementor-widget-image\" data-id=\"9c6459a\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"250\" height=\"250\" src=\"data:image\/svg+xml,%3Csvg%20xmlns%3D&#39;http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg&#39;%20width=&#39;250&#39;%20height=&#39;250&#39;%20viewBox%3D&#39;0%200%20250%20250&#39;%2F%3E\" data-czlz data-src=\"https:\/\/namvarhealth.com\/wp-content\/uploads\/2025\/12\/\u0628\u0627-\u0645\u0627-\u0627\u067e\u0645\u0648\u0646-rddve3d6ou4wbg939zdkxzqxidg208sw1uyw1ld6pw.webp\" class=\"attachment-large size-large wp-image-2478\" alt=\"\" data-srcset=\"https:\/\/namvarhealth.com\/wp-content\/uploads\/2025\/12\/\u0628\u0627-\u0645\u0627-\u0627\u067e\u0645\u0648\u0646-rddve3d6ou4wbg939zdkxzqxidg208sw1uyw1ld6pw.webp 250w, https:\/\/namvarhealth.com\/wp-content\/uploads\/2025\/12\/\u0628\u0627-\u0645\u0627-\u0627\u067e\u0645\u0648\u0646-rddve3d6ou4wbg939zdkxzqxidg208sw1uyw1ld6pw-150x150.webp 150w, 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<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-6226","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/namvarhealth.com\/en\/wp-json\/wp\/v2\/pages\/6226","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/namvarhealth.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/namvarhealth.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/namvarhealth.com\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/namvarhealth.com\/en\/wp-json\/wp\/v2\/comments?post=6226"}],"version-history":[{"count":11,"href":"https:\/\/namvarhealth.com\/en\/wp-json\/wp\/v2\/pages\/6226\/revisions"}],"predecessor-version":[{"id":6578,"href":"https:\/\/namvarhealth.com\/en\/wp-json\/wp\/v2\/pages\/6226\/revisions\/6578"}],"wp:attachment":[{"href":"https:\/\/namvarhealth.com\/en\/wp-json\/wp\/v2\/media?parent=6226"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}