{"id":55,"date":"2022-03-08T09:49:24","date_gmt":"2022-03-08T08:49:24","guid":{"rendered":"https:\/\/cita.doctorsky.es\/?page_id=55"},"modified":"2024-05-10T18:11:12","modified_gmt":"2024-05-10T16:11:12","slug":"inicio","status":"publish","type":"page","link":"https:\/\/cita.doctorsky.es\/fr\/","title":{"rendered":"Prendre un rendez-vous m\u00e9dical"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"55\" class=\"elementor elementor-55\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e898665 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e898665\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-efff52e\" data-id=\"efff52e\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a4d0830 elementor-view-stacked elementor-shape-circle elementor-position-top elementor-mobile-position-top elementor-widget elementor-widget-icon-box\" data-id=\"a4d0830\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-user-md\"><\/i>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tPrenez rendez-vous\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tPrenez rendez-vous avec le m\u00e9decin de votre choix, au jour et \u00e0 l'heure de votre choix.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-d7ae3ae\" data-id=\"d7ae3ae\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-421b381 elementor-view-stacked elementor-shape-circle elementor-position-top elementor-mobile-position-top elementor-widget elementor-widget-icon-box\" data-id=\"421b381\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-user-plus\"><\/i>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tRegistre\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tInscrivez-vous sur notre plateforme pour continuer \u00e0 prendre votre rendez-vous.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-e827237\" data-id=\"e827237\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6ef90a8 elementor-view-stacked elementor-shape-circle elementor-position-top elementor-mobile-position-top elementor-widget elementor-widget-icon-box\" data-id=\"6ef90a8\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-shopping-cart\"><\/i>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tPaiement de la nomination\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tCompl\u00e9tez votre r\u00e9servation en effectuant un paiement imm\u00e9diat pour le rendez-vous. Vous recevrez toutes les informations par e-mail.\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7fef2ee elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7fef2ee\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c2c5542\" data-id=\"c2c5542\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9ee8550 elementor-widget elementor-widget-shortcode\" data-id=\"9ee8550\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><link rel='stylesheet' id='kc_book_appointment-css' href='https:\/\/cita.doctorsky.es\/wp-content\/plugins\/kivicare-clinic-management-system\/assets\/css\/book-appointment.css?ver=3.6.11' type='text\/css' media='' \/>\n<div class=\"kivi-widget\" id=\"kivi-appointment-widget-b1d0e25c-ab27-43fb-8fa8-a82ee4ddf603\">\n        \n    <div class=\"container-fluid d-none\" id=\"kivicare-widget-main-content\" dir=''>\n        <div class=\"widget-layout\" id=\"widgetOrders\">\n                        <div class=\"iq-card iq-card-lg iq-bg-primary widget-tabs\" style=\"overflow: hidden;\">\n                <ul class=\"tab-list mb-2\" id=\"kivicare-animate-ul\">\n                                            <li class=\"tab-item active\" data-check=\"false\">\n                            <a class=\"tab-link\" href=\"#doctor\" data-iq-toggle=\"tab\" data-iq-tab=\"prevent\" id=\"doctor-tab\">\n    <span class=\"sidebar-heading-text\">Choose Your Doctor<\/span>\n    <p> pick a specific Doctor to perform your service <\/p>\n<\/a>                        <\/li>\n                                                <li class=\"tab-item\" data-check=\"false\">\n                            <a class=\"tab-link\" href=\"#category\" data-iq-toggle=\"tab\" data-iq-tab=\"prevent\" id=\"category-tab\">\n    <span class=\"sidebar-heading-text\">Doctor Services<\/span>\n    <p> Please select a service from below options <\/p>\n<\/a>\n                        <\/li>\n                                                <li class=\"tab-item\" data-check=\"false\">\n                            <a class=\"tab-link\" href=\"#date-time\" data-iq-toggle=\"tab\" data-iq-tab=\"prevent\" id=\"date-time-tab\">\n    <span class=\"sidebar-heading-text\"> Select Date and Time <\/span>\n    <p> Select date to see a timeline of available slots <\/p>\n<\/a>                        <\/li>\n                                                <li class=\"tab-item\" data-check=\"false\">\n                            <a class=\"tab-link\" href=\"#file-uploads-custom\" data-iq-toggle=\"tab\" data-iq-tab=\"prevent\" id=\"file-uploads-custom-tab\">\n    <span class=\"sidebar-heading-text\"> Appointment Extra Data <\/span>\n    <p> Upload file and description about appointment <\/p>\n<\/a>                        <\/li>\n                                                <li class=\"tab-item\" data-check=\"false\">\n                            <a class=\"tab-link\" href=\"#detail-info\" data-iq-toggle=\"tab\" data-iq-tab=\"prevent\" id=\"detail-info-tab\">\n    <span class=\"sidebar-heading-text\"> User Detail Information <\/span>\n    <p>Please provide you contact details<\/p>\n<\/a>                        <\/li>\n                                                <li class=\"tab-item\" data-check=\"false\">\n                            <a class=\"tab-link confirm-page\" href=\"#confirm\" data-iq-toggle=\"tab\" data-iq-tab=\"prevent\" id=\"confirm-tab\">\n    <span class=\"sidebar-heading-text\"> Confirmation <\/span>\n    <p> Confirm your booking <\/p>\n<\/a>                        <\/li>\n                                        <\/ul>\n                <div class=\"\" style=\"margin-top: auto;\">\n                    <button id=\"kivicare_logout_btn\"\n                            class=\"iq-button iq-button-secondary w-100 mt-auto d-none\">\n                        Logout                    <\/button>\n                <\/div>\n            <\/div>\n            <div class=\"widget-pannel alert-relative\">\n                <span id=\"kivicare_server_error_msg\" class=\"alert alert-popup alert-danger alert-left error\" style=\"display:none\">&nbsp;<\/span>\n                <span id=\"kivicare_success_msg\" class=\"alert alert-popup alert-success alert-left\" style=\"display:none;\"><\/span>\n                <div class=\"iq-card iq-card-sm tab-content\" id=\"wizard-tab\">\n                                                <div id=\"doctor\"\n                                 class=\"iq-fade iq-tab-pannel active\">\n                                <form    id=\"\"\n                                                                            action=\"#category\"\n                                                                            data-prev=\"#\" data-trp-original-action=\"#category\">\n                                    <div class=\"d-flex justify-content-between align-items-center flex-wrap gap-1\">\n<div class=\"iq-kivi-tab-panel-title-animation\">    \n<h3 class=\"iq-kivi-tab-panel-title\">Select Doctor<\/h3>\n<\/div>\n    <div class=\"iq-kivi-search\">\n        <svg width=\"18\" height=\"18\" class=\"iq-kivi-icon\" viewbox=\"0 0 24 24\" fill=\"none\"\n             xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n            <circle cx=\"11.7669\" cy=\"11.7666\" r=\"8.98856\" stroke=\"#727d93\" fill=\"none\" stroke-width=\"1.5\"\n                    stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/circle>\n            <path d=\"M18.0186 18.4851L21.5426 22\" stroke=\"#727d93\" stroke-width=\"1.5\" stroke-linecap=\"round\"\n                  stroke-linejoin=\"round\"><\/path>\n        <\/svg>\n        <input type=\"text\" class=\"iq-kivicare-form-control iq-search-bg-color\"\n               placeholder=\"Search....\" id=\"doctorSearch\">\n    <\/div>\n<\/div>\n<hr>\n<div class=\"widget-content\">\n    <div class=\"card-list-data text-center pt-2 pe-2\" name=\"doctorLists\" id=\"doctorLists\">\n        <span class=\"loader-class\" id=\"doctor_loader\">\n                            <div class=\"double-lines-spinner\"><\/div>\n                    <\/span>\n    <\/div>\n<\/div>\n    <div class=\"card-widget-footer\">\n        <span id=\"kivicare_error_msg_doctor\" class=\"alert alert-popup alert-danger alert-left error\"\n            style=\"display:none\">&nbsp;<\/span>\n        <div class=\"d-flex justify-content-end gap-1-5\" style=\"margin-left: auto;\">\n                                        <button type=\"submit\" name=\"submit\" value=\"submit\" data-step=\"next\"\n                    class=\"iq-button iq-button-primary\">Next<\/button>\n                    <\/div>\n    <\/div>\n                                    <input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form>\n                            <\/div>\n                                                        <div id=\"category\"\n                                 class=\"iq-fade iq-tab-pannel\">\n                                <form    id=\"\"\n                                                                            action=\"#date-time\"\n                                                                            data-prev=\"#doctor\" data-trp-original-action=\"#date-time\">\n                                    <div class=\"d-flex justify-content-between align-items-center flex-wrap gap-1\">\n    <div class=\"iq-kivi-tab-panel-title-animation\">\n        <h3 class=\"iq-kivi-tab-panel-title\">Select Service<\/h3>\n    <\/div>\n    <div class=\"iq-kivi-search\">\n        <svg width=\"18\" height=\"18\" class=\"iq-kivi-icon\" viewbox=\"0 0 24 24\" fill=\"none\"\n             xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n            <circle cx=\"11.7669\" cy=\"11.7666\" r=\"8.98856\" stroke=\"#727d93\" fill=\"none\" stroke-width=\"1.5\"\n                    stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/circle>\n            <path d=\"M18.0186 18.4851L21.5426 22\" stroke=\"#727d93\" stroke-width=\"1.5\" stroke-linecap=\"round\"\n                  stroke-linejoin=\"round\"><\/path>\n        <\/svg>\n        <input type=\"text\" class=\"iq-kivicare-form-control iq-search-bg-color\"\n               placeholder=\"Search....\" id=\"serviceSearch\">\n    <\/div>\n<\/div>\n<hr>\n<div class=\"widget-content\">\n    <div class=\"card-list-data flex-column gap-2 pe-2\" id=\"serviceLists\" name=\"serviceLists\">\n        <span class=\"loader-class\">\n                            <div class=\"double-lines-spinner\"><\/div>\n                    <\/span>\n    <\/div>\n<\/div>    <div class=\"card-widget-footer\">\n        <span id=\"kivicare_error_msg_category\" class=\"alert alert-popup alert-danger alert-left error\"\n            style=\"display:none\">&nbsp;<\/span>\n        <div class=\"d-flex justify-content-end gap-1-5\" style=\"margin-left: auto;\">\n                            <button type=\"button\" class=\"iq-button iq-button-secondary\" id=\"iq-widget-back-button\"\n                    data-step=\"prev\">Back<\/button>\n                                        <button type=\"submit\" name=\"submit\" value=\"submit\" data-step=\"next\"\n                    class=\"iq-button iq-button-primary\">Next<\/button>\n                    <\/div>\n    <\/div>\n                                    <input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form>\n                            <\/div>\n                                                        <div id=\"date-time\"\n                                 class=\"iq-fade iq-tab-pannel\">\n                                <form    id=\"\"\n                                                                            action=\"#file-uploads-custom\"\n                                                                            data-prev=\"#category\" data-trp-original-action=\"#file-uploads-custom\">\n                                    <div class=\"d-flex justify-content-between align-items-center flex-wrap gap-1\">\n    <div class=\"iq-kivi-tab-panel-title-animation\">\n        <h3 class=\"iq-kivi-tab-panel-title\"> Select Date and Time <\/h3>\n    <\/div>\n        <div id=\"iq_kivi_timezone\">\n        <span style=\"font-weight: bold; font-size: 0.9rem;\">Time Zone: <\/span>Europe\/Madrid    <\/div>\n    <hr>\n<\/div>\n<div class=\"widget-content\">    \n    <div class=\"d-grid grid-template-2 card-list-data iq-kivi-calendar-slot\" id=\"datepicker-grid\">\n        <input type=\"hidden\" class=\"inline-flatpicker iq-inline-datepicker d-none\" style=\"display:none\">\n        <div class=\"time-slots\" id=\"time-slot\">\n            <div class=\"iq-card iq-bg-primary-light text-center\" style=\"min-height: 100%; height:400px\">\n                <h5 id=\"selectedDate\" name=\"selectedDate\">\n                    Available time slots                <\/h5>\n                <div class=\"grid-template-3 iq-calendar-card\" id=\"timeSlotLists\" name=\"timeSlotLists\" style=\"height:100%\">\n\n                    <p class=\"loader-class\">Please Select Date<\/p>\n                <\/div>\n            <\/div>\n        <\/div>\n        <span class=\"d-none\" id=\"selectedAppointmentDate\">\n        <\/span>\n    <\/div>\n    <div class=\"doctor-session-error loader-class\">\n        <p class=\"\">\n            Select doctor session is not available with selected clinic, please select other doctor or other clinic        <\/p>\n    <\/div>\n    <span class=\"loader-class doctor-session-loader\" id=\"doctor_loader\">\n           \n            <div class=\"double-lines-spinner\"><\/div>\n            <\/span>\n<\/div>\n    <div class=\"card-widget-footer\">\n        <span id=\"kivicare_error_msg_date_time\" class=\"alert alert-popup alert-danger alert-left error\"\n            style=\"display:none\">&nbsp;<\/span>\n        <div class=\"d-flex justify-content-end gap-1-5\" style=\"margin-left: auto;\">\n                            <button type=\"button\" class=\"iq-button iq-button-secondary\" id=\"iq-widget-back-button\"\n                    data-step=\"prev\">Back<\/button>\n                                        <button type=\"submit\" name=\"submit\" value=\"submit\" data-step=\"next\"\n                    class=\"iq-button iq-button-primary\">Next<\/button>\n                    <\/div>\n    <\/div>\n                                    <input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form>\n                            <\/div>\n                                                        <div id=\"file-uploads-custom\"\n                                 class=\"iq-fade iq-tab-pannel\">\n                                <form  enctype=\"&quot;multipart\/form-data&quot;\"  id=\"kivicare-file-upload-form\"\n                                                                            action=\"#detail-info\"\n                                                                            data-prev=\"#date-time\" data-trp-original-action=\"#detail-info\">\n                                    <div class=\"d-flex justify-content-between align-items-center flex-wrap gap-1\">\n<div class=\"iq-kivi-tab-panel-title-animation\">\n    <h3 class=\"iq-kivi-tab-panel-title\">More About Appointment<\/h3>\n    <\/div>\n<\/div>\n<hr>\n<div class=\"widget-content\">\n    \n    <div class=\"card-list-data pt-2 pe-2 mb-3\">\n            <div id=\"appointment-descriptions\" >\n            <div class=\"form-group mb-2\">\n                <label class=\"form-label\"\n                       for=\"appointment-descriptions-field\"> Appointment Descriptions                <\/label>\n                <textarea class=\"iq-kivicare-form-control\"\n                          id=\"appointment-descriptions-field\"\n                          placeholder=\"Enter Appointment Descriptions\"><\/textarea>\n            <\/div>\n        <\/div>\n            <div>\n        <div id=\"file-upload\" >\n                            <div class=\"form-group mb-2\">\n                    <label class=\"form-label\" for=\"addMedicalReport\"> Add Medical Report                    <\/label>\n                    <input type=\"file\" name=\"file_multi[]\" class=\"iq-kivicare-form-control\" id=\"kivicareaddMedicalReport\"\n                        placeholder=\"Add Your Medical Report\"  multiple>\n                <\/div>\n                <div id=\"kivicare_file_upload_review\">\n                <\/div>\n                        <\/div>\n        <div  id=\"customFieldsListAppointment\">\n\n        <\/div>\n    <\/div>\n    <\/div>\n<\/div>    <div class=\"card-widget-footer\">\n        <span id=\"kivicare_error_msg\" class=\"alert alert-popup alert-danger alert-left error\"\n            style=\"display:none\">&nbsp;<\/span>\n        <div class=\"d-flex justify-content-end gap-1-5\" style=\"margin-left: auto;\">\n                            <button type=\"button\" class=\"iq-button iq-button-secondary\" id=\"iq-widget-back-button\"\n                    data-step=\"prev\">Back<\/button>\n                                        <button type=\"submit\" name=\"submit\" value=\"submit\" data-step=\"next\"\n                    class=\"iq-button iq-button-primary\">Next<\/button>\n                    <\/div>\n    <\/div>\n                                    <input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form>\n                            <\/div>\n                                                        <div id=\"detail-info\"\n                                 class=\"iq-fade iq-tab-pannel\">\n                                <form  enctype=\"&quot;multipart\/form-data&quot;\"  id=\"kiviLoginRegister\"\n                                                                            action=\"#confirm\"\n                                                                            data-prev=\"#file-uploads-custom\" data-trp-original-action=\"#confirm\">\n                                    <style>\n.custom-control.custom-radio.custom-control-inline {\n    margin-right: 12px;\n}\n<\/style>\n<div class=\"d-flex align-items-center justify-content-between\">\n    <div class=\"iq-kivi-tab-panel-title-animation\">\n       <h3 class=\"iq-kivi-tab-panel-title\"> Enter Details <\/h3>\n    <\/div>\n<\/div>\n<hr>\n<ul class=\"nav-tabs\">\n    <li class=\"tab-item active\">\n        <a href=\"#kc_register\" class=\"tab-link\" id=\"register-tab\"\n           data-iq-toggle=\"tab\"> Register <\/a>\n    <\/li>\n    <li class=\"tab-item\">\n        <a href=\"#kc_login\" class=\"tab-link\" id=\"login-tab\"\n           data-iq-toggle=\"tab\"> Login <\/a>\n    <\/li>\n<\/ul>\n<div class=\"widget-content\">\n    <div id=\"login-register-panel\" class=\"card-list-data\">\n        <div id=\"kc_register\" class=\"iq-tab-pannel kivicare-register-form-data iq-fade active authActive card-list\" >\n            <div id=\"kivicare-register-form\">\n                <div class=\"d-grid grid-template-2\"  id=\"kivicare-register\">\n                                        <input type=\"hidden\" name=\"widgettype\" value=\"new_appointment_widget\" id=\"widgettype\">\n                    <div class=\"form-group\">\n                        <input type=\"hidden\" id=\"registerClinicId\">\n                        <label class=\"form-label\" for=\"firstName\">First Name                            <span>*<\/span><\/label>\n                        <input type=\"text\" name=\"first_name\" class=\"iq-kivicare-form-control\" id=\"firstName\"\n                            placeholder=\"Enter your first name\" required>\n                    <\/div>\n                    <div class=\"form-group\">\n                        <label class=\"form-label\" for=\"lastName\"> Last Name                            <span>*<\/span><\/label>\n                        <input type=\"text\" name=\"last_name\" class=\"iq-kivicare-form-control\" id=\"lastName\"\n                            placeholder=\"Enter your last name\" required>\n                    <\/div>\n                    <div class=\"form-group\">\n                        <label class=\"form-label\" for=\"userEmail\">Email                            <span>*<\/span><\/label>\n                        <input type=\"email\" name=\"user_email\" class=\"iq-kivicare-form-control\" id=\"userEmail\"\n                            placeholder=\"Enter your email\" required>\n                    <\/div>\n                    <div class=\"form-group\">\n                        <label class=\"form-label\" for=\"userContact\"> Contact                            <span>*<\/span><\/label>\n                            <div class=\"contact-box-inline\">\n                            \n                                <select name=\"country_code\" class=\"iq-kivicare-form-control\" id=\"CountryCode\">\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+93&quot;,&quot;countryCode&quot;:&quot;AF&quot;}\" >+93 - Afghanistan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+358&quot;,&quot;countryCode&quot;:&quot;AX&quot;}\" >+358 - Aland Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+355&quot;,&quot;countryCode&quot;:&quot;AL&quot;}\" >+355 - Albania<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+213&quot;,&quot;countryCode&quot;:&quot;DZ&quot;}\" >+213 - Algeria<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1684&quot;,&quot;countryCode&quot;:&quot;AS&quot;}\" >+1684 - AmericanSamoa<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+376&quot;,&quot;countryCode&quot;:&quot;AD&quot;}\" >+376 - Andorra<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+244&quot;,&quot;countryCode&quot;:&quot;AO&quot;}\" >+244 - Angola<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1264&quot;,&quot;countryCode&quot;:&quot;AI&quot;}\" >+1264 - Anguilla<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+672&quot;,&quot;countryCode&quot;:&quot;AQ&quot;}\" >+672 - Antarctica<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1268&quot;,&quot;countryCode&quot;:&quot;AG&quot;}\" >+1268 - Antigua and Barbuda<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+54&quot;,&quot;countryCode&quot;:&quot;AR&quot;}\" >+54 - Argentina<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+374&quot;,&quot;countryCode&quot;:&quot;AM&quot;}\" >+374 - Armenia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+297&quot;,&quot;countryCode&quot;:&quot;AW&quot;}\" >+297 - Aruba<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+61&quot;,&quot;countryCode&quot;:&quot;AU&quot;}\" >+61 - Australia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+43&quot;,&quot;countryCode&quot;:&quot;AT&quot;}\" >+43 - Austria<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+994&quot;,&quot;countryCode&quot;:&quot;AZ&quot;}\" >+994 - Azerbaijan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1242&quot;,&quot;countryCode&quot;:&quot;BS&quot;}\" >+1242 - Bahamas<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+973&quot;,&quot;countryCode&quot;:&quot;BH&quot;}\" >+973 - Bahrain<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+880&quot;,&quot;countryCode&quot;:&quot;BD&quot;}\" >+880 - Bangladesh<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1246&quot;,&quot;countryCode&quot;:&quot;BB&quot;}\" >+1246 - Barbados<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+375&quot;,&quot;countryCode&quot;:&quot;BY&quot;}\" >+375 - Belarus<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+32&quot;,&quot;countryCode&quot;:&quot;BE&quot;}\" >+32 - Belgium<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+501&quot;,&quot;countryCode&quot;:&quot;BZ&quot;}\" >+501 - Belize<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+229&quot;,&quot;countryCode&quot;:&quot;BJ&quot;}\" >+229 - Benin<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1441&quot;,&quot;countryCode&quot;:&quot;BM&quot;}\" >+1441 - Bermuda<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+975&quot;,&quot;countryCode&quot;:&quot;BT&quot;}\" >+975 - Bhutan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+591&quot;,&quot;countryCode&quot;:&quot;BO&quot;}\" >+591 - Bolivia, Plurinational State of<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+387&quot;,&quot;countryCode&quot;:&quot;BA&quot;}\" >+387 - Bosnia and Herzegovina<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+267&quot;,&quot;countryCode&quot;:&quot;BW&quot;}\" >+267 - Botswana<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+55&quot;,&quot;countryCode&quot;:&quot;BR&quot;}\" >+55 - Brazil<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+246&quot;,&quot;countryCode&quot;:&quot;IO&quot;}\" >+246 - British Indian Ocean Territory<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+673&quot;,&quot;countryCode&quot;:&quot;BN&quot;}\" >+673 - Brunei Darussalam<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+359&quot;,&quot;countryCode&quot;:&quot;BG&quot;}\" >+359 - Bulgaria<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+226&quot;,&quot;countryCode&quot;:&quot;BF&quot;}\" >+226 - Burkina Faso<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+257&quot;,&quot;countryCode&quot;:&quot;BI&quot;}\" >+257 - Burundi<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+855&quot;,&quot;countryCode&quot;:&quot;KH&quot;}\" >+855 - Cambodia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+237&quot;,&quot;countryCode&quot;:&quot;CM&quot;}\" >+237 - Cameroon<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1&quot;,&quot;countryCode&quot;:&quot;CA&quot;}\" >+1 - Canada<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+238&quot;,&quot;countryCode&quot;:&quot;CV&quot;}\" >+238 - Cape Verde<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+ 345&quot;,&quot;countryCode&quot;:&quot;KY&quot;}\" >+ 345 - Cayman Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+236&quot;,&quot;countryCode&quot;:&quot;CF&quot;}\" >+236 - Central African Republic<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+235&quot;,&quot;countryCode&quot;:&quot;TD&quot;}\" >+235 - Chad<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+56&quot;,&quot;countryCode&quot;:&quot;CL&quot;}\" >+56 - Chile<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+86&quot;,&quot;countryCode&quot;:&quot;CN&quot;}\" >+86 - China<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+61&quot;,&quot;countryCode&quot;:&quot;CX&quot;}\" >+61 - Christmas Island<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+61&quot;,&quot;countryCode&quot;:&quot;CC&quot;}\" >+61 - Cocos (Keeling) Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+57&quot;,&quot;countryCode&quot;:&quot;CO&quot;}\" >+57 - Colombia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+269&quot;,&quot;countryCode&quot;:&quot;KM&quot;}\" >+269 - Comoros<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+242&quot;,&quot;countryCode&quot;:&quot;CG&quot;}\" >+242 - Congo<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+243&quot;,&quot;countryCode&quot;:&quot;CD&quot;}\" >+243 - Congo, The Democratic Republic of the Congo<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+682&quot;,&quot;countryCode&quot;:&quot;CK&quot;}\" >+682 - Cook Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+506&quot;,&quot;countryCode&quot;:&quot;CR&quot;}\" >+506 - Costa Rica<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+225&quot;,&quot;countryCode&quot;:&quot;CI&quot;}\" >+225 - Cote d&#039;Ivoire<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+385&quot;,&quot;countryCode&quot;:&quot;HR&quot;}\" >+385 - Croatia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+53&quot;,&quot;countryCode&quot;:&quot;CU&quot;}\" >+53 - Cuba<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+357&quot;,&quot;countryCode&quot;:&quot;CY&quot;}\" >+357 - Cyprus<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+420&quot;,&quot;countryCode&quot;:&quot;CZ&quot;}\" >+420 - Czech Republic<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+45&quot;,&quot;countryCode&quot;:&quot;DK&quot;}\" >+45 - Denmark<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+253&quot;,&quot;countryCode&quot;:&quot;DJ&quot;}\" >+253 - Djibouti<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1767&quot;,&quot;countryCode&quot;:&quot;DM&quot;}\" >+1767 - Dominica<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1809&quot;,&quot;countryCode&quot;:&quot;DO&quot;}\" >+1809 - Dominican Republic<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1829&quot;,&quot;countryCode&quot;:&quot;DO&quot;}\" >+1829 - Dominican Republic<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1849&quot;,&quot;countryCode&quot;:&quot;DO&quot;}\" >+1849 - Dominican Republic<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+593&quot;,&quot;countryCode&quot;:&quot;EC&quot;}\" >+593 - Ecuador<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+20&quot;,&quot;countryCode&quot;:&quot;EG&quot;}\" >+20 - Egypt<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+503&quot;,&quot;countryCode&quot;:&quot;SV&quot;}\" >+503 - El Salvador<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+240&quot;,&quot;countryCode&quot;:&quot;GQ&quot;}\" >+240 - Equatorial Guinea<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+291&quot;,&quot;countryCode&quot;:&quot;ER&quot;}\" >+291 - Eritrea<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+372&quot;,&quot;countryCode&quot;:&quot;EE&quot;}\" >+372 - Estonia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+251&quot;,&quot;countryCode&quot;:&quot;ET&quot;}\" >+251 - Ethiopia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+500&quot;,&quot;countryCode&quot;:&quot;FK&quot;}\" >+500 - Falkland Islands (Malvinas)<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+298&quot;,&quot;countryCode&quot;:&quot;FO&quot;}\" >+298 - Faroe Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+679&quot;,&quot;countryCode&quot;:&quot;FJ&quot;}\" >+679 - Fiji<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+358&quot;,&quot;countryCode&quot;:&quot;FI&quot;}\" >+358 - Finland<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+33&quot;,&quot;countryCode&quot;:&quot;FR&quot;}\" >+33 - France<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+594&quot;,&quot;countryCode&quot;:&quot;GF&quot;}\" >+594 - French Guiana<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+689&quot;,&quot;countryCode&quot;:&quot;PF&quot;}\" >+689 - French Polynesia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+241&quot;,&quot;countryCode&quot;:&quot;GA&quot;}\" >+241 - Gabon<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+220&quot;,&quot;countryCode&quot;:&quot;GM&quot;}\" >+220 - Gambia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+995&quot;,&quot;countryCode&quot;:&quot;GE&quot;}\" >+995 - Georgia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+49&quot;,&quot;countryCode&quot;:&quot;DE&quot;}\" >+49 - Germany<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+233&quot;,&quot;countryCode&quot;:&quot;GH&quot;}\" >+233 - Ghana<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+350&quot;,&quot;countryCode&quot;:&quot;GI&quot;}\" >+350 - Gibraltar<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+30&quot;,&quot;countryCode&quot;:&quot;GR&quot;}\" >+30 - Greece<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+299&quot;,&quot;countryCode&quot;:&quot;GL&quot;}\" >+299 - Greenland<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1473&quot;,&quot;countryCode&quot;:&quot;GD&quot;}\" >+1473 - Grenada<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+590&quot;,&quot;countryCode&quot;:&quot;GP&quot;}\" >+590 - Guadeloupe<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1671&quot;,&quot;countryCode&quot;:&quot;GU&quot;}\" >+1671 - Guam<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+502&quot;,&quot;countryCode&quot;:&quot;GT&quot;}\" >+502 - Guatemala<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+44&quot;,&quot;countryCode&quot;:&quot;GG&quot;}\" >+44 - Guernsey<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+224&quot;,&quot;countryCode&quot;:&quot;GN&quot;}\" >+224 - Guinea<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+245&quot;,&quot;countryCode&quot;:&quot;GW&quot;}\" >+245 - Guinea-Bissau<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+592&quot;,&quot;countryCode&quot;:&quot;GY&quot;}\" >+592 - Guyana<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+509&quot;,&quot;countryCode&quot;:&quot;HT&quot;}\" >+509 - Haiti<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+379&quot;,&quot;countryCode&quot;:&quot;VA&quot;}\" >+379 - Holy See (Vatican City State)<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+504&quot;,&quot;countryCode&quot;:&quot;HN&quot;}\" >+504 - Honduras<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+852&quot;,&quot;countryCode&quot;:&quot;HK&quot;}\" >+852 - Hong Kong<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+36&quot;,&quot;countryCode&quot;:&quot;HU&quot;}\" >+36 - Hungary<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+354&quot;,&quot;countryCode&quot;:&quot;IS&quot;}\" >+354 - Iceland<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+91&quot;,&quot;countryCode&quot;:&quot;IN&quot;}\" >+91 - India<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+62&quot;,&quot;countryCode&quot;:&quot;ID&quot;}\" >+62 - Indonesia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+98&quot;,&quot;countryCode&quot;:&quot;IR&quot;}\" >+98 - Iran, Islamic Republic of Persian Gulf<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+964&quot;,&quot;countryCode&quot;:&quot;IQ&quot;}\" >+964 - Iraq<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+353&quot;,&quot;countryCode&quot;:&quot;IE&quot;}\" >+353 - Ireland<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+44&quot;,&quot;countryCode&quot;:&quot;IM&quot;}\" >+44 - Isle of Man<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+972&quot;,&quot;countryCode&quot;:&quot;IL&quot;}\" >+972 - Israel<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+39&quot;,&quot;countryCode&quot;:&quot;IT&quot;}\" >+39 - Italy<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1876&quot;,&quot;countryCode&quot;:&quot;JM&quot;}\" >+1876 - Jamaica<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+81&quot;,&quot;countryCode&quot;:&quot;JP&quot;}\" >+81 - Japan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+44&quot;,&quot;countryCode&quot;:&quot;JE&quot;}\" >+44 - Jersey<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+962&quot;,&quot;countryCode&quot;:&quot;JO&quot;}\" >+962 - Jordan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+77&quot;,&quot;countryCode&quot;:&quot;KZ&quot;}\" >+77 - Kazakhstan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+254&quot;,&quot;countryCode&quot;:&quot;KE&quot;}\" >+254 - Kenya<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+686&quot;,&quot;countryCode&quot;:&quot;KI&quot;}\" >+686 - Kiribati<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+850&quot;,&quot;countryCode&quot;:&quot;KP&quot;}\" >+850 - Korea, Democratic People&#039;s Republic of Korea<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+82&quot;,&quot;countryCode&quot;:&quot;KR&quot;}\" >+82 - Korea, Republic of South Korea<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+383&quot;,&quot;countryCode&quot;:&quot;XK&quot;}\" >+383 - Kosovo<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+965&quot;,&quot;countryCode&quot;:&quot;KW&quot;}\" >+965 - Kuwait<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+996&quot;,&quot;countryCode&quot;:&quot;KG&quot;}\" >+996 - Kyrgyzstan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+856&quot;,&quot;countryCode&quot;:&quot;LA&quot;}\" >+856 - Laos<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+371&quot;,&quot;countryCode&quot;:&quot;LV&quot;}\" >+371 - Latvia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+961&quot;,&quot;countryCode&quot;:&quot;LB&quot;}\" >+961 - Lebanon<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+266&quot;,&quot;countryCode&quot;:&quot;LS&quot;}\" >+266 - Lesotho<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+231&quot;,&quot;countryCode&quot;:&quot;LR&quot;}\" >+231 - Liberia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+218&quot;,&quot;countryCode&quot;:&quot;LY&quot;}\" >+218 - Libyan Arab Jamahiriya<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+423&quot;,&quot;countryCode&quot;:&quot;LI&quot;}\" >+423 - Liechtenstein<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+370&quot;,&quot;countryCode&quot;:&quot;LT&quot;}\" >+370 - Lithuania<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+352&quot;,&quot;countryCode&quot;:&quot;LU&quot;}\" >+352 - Luxembourg<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+853&quot;,&quot;countryCode&quot;:&quot;MO&quot;}\" >+853 - Macao<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+389&quot;,&quot;countryCode&quot;:&quot;MK&quot;}\" >+389 - Macedonia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+261&quot;,&quot;countryCode&quot;:&quot;MG&quot;}\" >+261 - Madagascar<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+265&quot;,&quot;countryCode&quot;:&quot;MW&quot;}\" >+265 - Malawi<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+60&quot;,&quot;countryCode&quot;:&quot;MY&quot;}\" >+60 - Malaysia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+960&quot;,&quot;countryCode&quot;:&quot;MV&quot;}\" >+960 - Maldives<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+223&quot;,&quot;countryCode&quot;:&quot;ML&quot;}\" >+223 - Mali<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+356&quot;,&quot;countryCode&quot;:&quot;MT&quot;}\" >+356 - Malta<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+692&quot;,&quot;countryCode&quot;:&quot;MH&quot;}\" >+692 - Marshall Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+596&quot;,&quot;countryCode&quot;:&quot;MQ&quot;}\" >+596 - Martinique<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+222&quot;,&quot;countryCode&quot;:&quot;MR&quot;}\" >+222 - Mauritania<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+230&quot;,&quot;countryCode&quot;:&quot;MU&quot;}\" >+230 - Mauritius<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+262&quot;,&quot;countryCode&quot;:&quot;YT&quot;}\" >+262 - Mayotte<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+52&quot;,&quot;countryCode&quot;:&quot;MX&quot;}\" >+52 - Mexico<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+691&quot;,&quot;countryCode&quot;:&quot;FM&quot;}\" >+691 - Micronesia, Federated States of Micronesia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+373&quot;,&quot;countryCode&quot;:&quot;MD&quot;}\" >+373 - Moldova<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+377&quot;,&quot;countryCode&quot;:&quot;MC&quot;}\" >+377 - Monaco<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+976&quot;,&quot;countryCode&quot;:&quot;MN&quot;}\" >+976 - Mongolia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+382&quot;,&quot;countryCode&quot;:&quot;ME&quot;}\" >+382 - Montenegro<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1664&quot;,&quot;countryCode&quot;:&quot;MS&quot;}\" >+1664 - Montserrat<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+212&quot;,&quot;countryCode&quot;:&quot;MA&quot;}\" >+212 - Morocco<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+258&quot;,&quot;countryCode&quot;:&quot;MZ&quot;}\" >+258 - Mozambique<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+95&quot;,&quot;countryCode&quot;:&quot;MM&quot;}\" >+95 - Myanmar<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+264&quot;,&quot;countryCode&quot;:&quot;NA&quot;}\" >+264 - Namibia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+674&quot;,&quot;countryCode&quot;:&quot;NR&quot;}\" >+674 - Nauru<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+977&quot;,&quot;countryCode&quot;:&quot;NP&quot;}\" >+977 - Nepal<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+31&quot;,&quot;countryCode&quot;:&quot;NL&quot;}\" >+31 - Netherlands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+599&quot;,&quot;countryCode&quot;:&quot;AN&quot;}\" >+599 - Netherlands Antilles<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+687&quot;,&quot;countryCode&quot;:&quot;NC&quot;}\" >+687 - New Caledonia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+64&quot;,&quot;countryCode&quot;:&quot;NZ&quot;}\" >+64 - New Zealand<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+505&quot;,&quot;countryCode&quot;:&quot;NI&quot;}\" >+505 - Nicaragua<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+227&quot;,&quot;countryCode&quot;:&quot;NE&quot;}\" >+227 - Niger<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+234&quot;,&quot;countryCode&quot;:&quot;NG&quot;}\" >+234 - Nigeria<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+683&quot;,&quot;countryCode&quot;:&quot;NU&quot;}\" >+683 - Niue<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+672&quot;,&quot;countryCode&quot;:&quot;NF&quot;}\" >+672 - Norfolk Island<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1670&quot;,&quot;countryCode&quot;:&quot;MP&quot;}\" >+1670 - Northern Mariana Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+47&quot;,&quot;countryCode&quot;:&quot;NO&quot;}\" >+47 - Norway<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+968&quot;,&quot;countryCode&quot;:&quot;OM&quot;}\" >+968 - Oman<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+92&quot;,&quot;countryCode&quot;:&quot;PK&quot;}\" >+92 - Pakistan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+680&quot;,&quot;countryCode&quot;:&quot;PW&quot;}\" >+680 - Palau<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+970&quot;,&quot;countryCode&quot;:&quot;PS&quot;}\" >+970 - Palestinian Territory, Occupied<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+507&quot;,&quot;countryCode&quot;:&quot;PA&quot;}\" >+507 - Panama<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+675&quot;,&quot;countryCode&quot;:&quot;PG&quot;}\" >+675 - Papua New Guinea<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+595&quot;,&quot;countryCode&quot;:&quot;PY&quot;}\" >+595 - Paraguay<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+51&quot;,&quot;countryCode&quot;:&quot;PE&quot;}\" >+51 - Peru<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+63&quot;,&quot;countryCode&quot;:&quot;PH&quot;}\" >+63 - Philippines<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+872&quot;,&quot;countryCode&quot;:&quot;PN&quot;}\" >+872 - Pitcairn<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+48&quot;,&quot;countryCode&quot;:&quot;PL&quot;}\" >+48 - Poland<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+351&quot;,&quot;countryCode&quot;:&quot;PT&quot;}\" >+351 - Portugal<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1939&quot;,&quot;countryCode&quot;:&quot;PR&quot;}\" >+1939 - Puerto Rico<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+974&quot;,&quot;countryCode&quot;:&quot;QA&quot;}\" >+974 - Qatar<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+40&quot;,&quot;countryCode&quot;:&quot;RO&quot;}\" >+40 - Romania<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+7&quot;,&quot;countryCode&quot;:&quot;RU&quot;}\" >+7 - Russia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+250&quot;,&quot;countryCode&quot;:&quot;RW&quot;}\" >+250 - Rwanda<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+262&quot;,&quot;countryCode&quot;:&quot;RE&quot;}\" >+262 - Reunion<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+590&quot;,&quot;countryCode&quot;:&quot;BL&quot;}\" >+590 - Saint Barthelemy<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+290&quot;,&quot;countryCode&quot;:&quot;SH&quot;}\" >+290 - Saint Helena, Ascension and Tristan Da Cunha<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1869&quot;,&quot;countryCode&quot;:&quot;KN&quot;}\" >+1869 - Saint Kitts and Nevis<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1758&quot;,&quot;countryCode&quot;:&quot;LC&quot;}\" >+1758 - Saint Lucia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+590&quot;,&quot;countryCode&quot;:&quot;MF&quot;}\" >+590 - Saint Martin<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+508&quot;,&quot;countryCode&quot;:&quot;PM&quot;}\" >+508 - Saint Pierre and Miquelon<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1784&quot;,&quot;countryCode&quot;:&quot;VC&quot;}\" >+1784 - Saint Vincent and the Grenadines<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+685&quot;,&quot;countryCode&quot;:&quot;WS&quot;}\" >+685 - Samoa<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+378&quot;,&quot;countryCode&quot;:&quot;SM&quot;}\" >+378 - San Marino<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+239&quot;,&quot;countryCode&quot;:&quot;ST&quot;}\" >+239 - Sao Tome and Principe<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+966&quot;,&quot;countryCode&quot;:&quot;SA&quot;}\" >+966 - Saudi Arabia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+221&quot;,&quot;countryCode&quot;:&quot;SN&quot;}\" >+221 - Senegal<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+381&quot;,&quot;countryCode&quot;:&quot;RS&quot;}\" >+381 - Serbia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+248&quot;,&quot;countryCode&quot;:&quot;SC&quot;}\" >+248 - Seychelles<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+232&quot;,&quot;countryCode&quot;:&quot;SL&quot;}\" >+232 - Sierra Leone<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+65&quot;,&quot;countryCode&quot;:&quot;SG&quot;}\" >+65 - Singapore<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+421&quot;,&quot;countryCode&quot;:&quot;SK&quot;}\" >+421 - Slovakia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+386&quot;,&quot;countryCode&quot;:&quot;SI&quot;}\" >+386 - Slovenia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+677&quot;,&quot;countryCode&quot;:&quot;SB&quot;}\" >+677 - Solomon Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+252&quot;,&quot;countryCode&quot;:&quot;SO&quot;}\" >+252 - Somalia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+27&quot;,&quot;countryCode&quot;:&quot;ZA&quot;}\" >+27 - South Africa<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+211&quot;,&quot;countryCode&quot;:&quot;SS&quot;}\" >+211 - South Sudan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+500&quot;,&quot;countryCode&quot;:&quot;GS&quot;}\" >+500 - South Georgia and the South Sandwich Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+34&quot;,&quot;countryCode&quot;:&quot;ES&quot;}\" >+34 - Spain<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+94&quot;,&quot;countryCode&quot;:&quot;LK&quot;}\" >+94 - Sri Lanka<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+249&quot;,&quot;countryCode&quot;:&quot;SD&quot;}\" >+249 - Sudan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+597&quot;,&quot;countryCode&quot;:&quot;SR&quot;}\" >+597 - Suriname<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+47&quot;,&quot;countryCode&quot;:&quot;SJ&quot;}\" >+47 - Svalbard and Jan Mayen<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+268&quot;,&quot;countryCode&quot;:&quot;SZ&quot;}\" >+268 - Swaziland<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+46&quot;,&quot;countryCode&quot;:&quot;SE&quot;}\" >+46 - Sweden<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+41&quot;,&quot;countryCode&quot;:&quot;CH&quot;}\" >+41 - Switzerland<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+963&quot;,&quot;countryCode&quot;:&quot;SY&quot;}\" >+963 - Syrian Arab Republic<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+886&quot;,&quot;countryCode&quot;:&quot;TW&quot;}\" >+886 - Taiwan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+992&quot;,&quot;countryCode&quot;:&quot;TJ&quot;}\" >+992 - Tajikistan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+255&quot;,&quot;countryCode&quot;:&quot;TZ&quot;}\" >+255 - Tanzania, United Republic of Tanzania<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+66&quot;,&quot;countryCode&quot;:&quot;TH&quot;}\" >+66 - Thailand<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+670&quot;,&quot;countryCode&quot;:&quot;TL&quot;}\" >+670 - Timor-Leste<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+228&quot;,&quot;countryCode&quot;:&quot;TG&quot;}\" >+228 - Togo<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+690&quot;,&quot;countryCode&quot;:&quot;TK&quot;}\" >+690 - Tokelau<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+676&quot;,&quot;countryCode&quot;:&quot;TO&quot;}\" >+676 - Tonga<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1868&quot;,&quot;countryCode&quot;:&quot;TT&quot;}\" >+1868 - Trinidad and Tobago<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+216&quot;,&quot;countryCode&quot;:&quot;TN&quot;}\" >+216 - Tunisia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+90&quot;,&quot;countryCode&quot;:&quot;TR&quot;}\" >+90 - Turkey<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+993&quot;,&quot;countryCode&quot;:&quot;TM&quot;}\" >+993 - Turkmenistan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1649&quot;,&quot;countryCode&quot;:&quot;TC&quot;}\" >+1649 - Turks and Caicos Islands<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+688&quot;,&quot;countryCode&quot;:&quot;TV&quot;}\" >+688 - Tuvalu<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+256&quot;,&quot;countryCode&quot;:&quot;UG&quot;}\" >+256 - Uganda<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+380&quot;,&quot;countryCode&quot;:&quot;UA&quot;}\" >+380 - Ukraine<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+971&quot;,&quot;countryCode&quot;:&quot;AE&quot;}\" >+971 - United Arab Emirates<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+44&quot;,&quot;countryCode&quot;:&quot;GB&quot;}\" >+44 - United Kingdom<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1&quot;,&quot;countryCode&quot;:&quot;US&quot;}\" selected>+1 - United States<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+598&quot;,&quot;countryCode&quot;:&quot;UY&quot;}\" >+598 - Uruguay<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+998&quot;,&quot;countryCode&quot;:&quot;UZ&quot;}\" >+998 - Uzbekistan<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+678&quot;,&quot;countryCode&quot;:&quot;VU&quot;}\" >+678 - Vanuatu<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+58&quot;,&quot;countryCode&quot;:&quot;VE&quot;}\" >+58 - Venezuela, Bolivarian Republic of Venezuela<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+84&quot;,&quot;countryCode&quot;:&quot;VN&quot;}\" >+84 - Vietnam<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1284&quot;,&quot;countryCode&quot;:&quot;VG&quot;}\" >+1284 - Virgin Islands, British<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+1340&quot;,&quot;countryCode&quot;:&quot;VI&quot;}\" >+1340 - Virgin Islands, U.S.<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+681&quot;,&quot;countryCode&quot;:&quot;WF&quot;}\" >+681 - Wallis and Futuna<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+967&quot;,&quot;countryCode&quot;:&quot;YE&quot;}\" >+967 - Yemen<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+260&quot;,&quot;countryCode&quot;:&quot;ZM&quot;}\" >+260 - Zambia<\/option>\n                                                                            <option value=\"{&quot;countryCallingCode&quot;:&quot;+263&quot;,&quot;countryCode&quot;:&quot;ZW&quot;}\" >+263 - Zimbabwe<\/option>\n                                                                    <\/select>\n                            \n\n                            <input type=\"tel\" name=\"mobile_number\" class=\"iq-kivicare-form-control\" id=\"userContact\" placeholder=\"Enter your contact number\" required>\n                        <\/div>\n\n                    <\/div>\n\n                    <div class=\"form-group\">\n                        <label class=\"form-label\" for=\"gender\">Gender                            <span>*<\/span><\/label>\n                        <div class=\"d-flex flex-wrap\">\n                            <div class=\"custom-control custom-radio custom-control-inline\">\n                                <input type=\"radio\" id=\"male\" name=\"gender\" value=\"male\" class=\"custom-control-input\" required>\n                                <label class=\"custom-control-label\" for=\"male\">Male<\/label>\n                            <\/div>\n                            <div class=\"custom-control custom-radio custom-control-inline\">\n                                <input type=\"radio\" id=\"female\" name=\"gender\" value=\"female\" class=\"custom-control-input\">\n                                <label class=\"custom-control-label\" for=\"female\">Female<\/label>\n                            <\/div>\n                            <div class=\"custom-control custom-radio custom-control-inline\" id=\"otherGenderOption\">\n                                <input type=\"radio\" id=\"other\" name=\"gender\" value=\"other\" class=\"custom-control-input\">\n                                <label class=\"custom-control-label\" for=\"other\">Other<\/label>\n                            <\/div>\n                        <\/div>\n                    <\/div>\n\n                                    <\/div>\n                <div  id=\"customFieldsList\">\n\n                                                <div class=\"kivi-row\">\n                                    <div class=\"form-group kivi-col-6 mt-2 text\">\n                    <label class=\"form-label\" for=\"Pasaporte o DNI_1\">\n\n                        Passeport ou carte d'identit\u00e9\n                                            <\/label>\n                                            <input id=\"Pasaporte o DNI_1\"\n                            placeholder=\"\"\n                            name=\"custom_field_1\"\n                            type=\"text\"\n                            class=\"iq-kivicare-form-control\" \/>\n                                        <\/div>\n                                            <div class=\"form-group kivi-col-6 mt-2 text\">\n                    <label class=\"form-label\" for=\"Antecedentes personales\/enfermedades_6\">\n\n                        Ant\u00e9c\u00e9dents personnels\/maladies\n                                                    <span>*<\/span>\n                                                <\/label>\n                                            <input id=\"Antecedentes personales\/enfermedades_6\"\n                            placeholder=\"\"\n                            name=\"custom_field_6\"\n                            type=\"text\"\n                            class=\"iq-kivicare-form-control kivicare-required\" \/>\n                                        <\/div>\n                                <\/div>\n                                            <div class=\"kivi-row\">\n                                    <div class=\"form-group kivi-col-6 mt-2 text\">\n                    <label class=\"form-label\" for=\"Cirug\u00edas_7\">\n\n                        Chirurgies\n                                                    <span>*<\/span>\n                                                <\/label>\n                                            <input id=\"Cirug\u00edas_7\"\n                            placeholder=\"\"\n                            name=\"custom_field_7\"\n                            type=\"text\"\n                            class=\"iq-kivicare-form-control kivicare-required\" \/>\n                                        <\/div>\n                                            <div class=\"form-group kivi-col-6 mt-2 text\">\n                    <label class=\"form-label\" for=\"Medicaci\u00f3n actual_8\">\n\n                        M\u00e9dicaments actuels\n                                                    <span>*<\/span>\n                                                <\/label>\n                                            <input id=\"Medicaci\u00f3n actual_8\"\n                            placeholder=\"\"\n                            name=\"custom_field_8\"\n                            type=\"text\"\n                            class=\"iq-kivicare-form-control kivicare-required\" \/>\n                                        <\/div>\n                                <\/div>\n                                            <div class=\"kivi-row\">\n                                    <div class=\"form-group kivi-col-6 mt-2 select\">\n                    <label class=\"form-label\" for=\"\u00bfEs fumador? \u00bfCu\u00e1nto fuma?_9\">\n\n                        \u00cates-vous fumeur et combien fumez-vous ?\n                                                    <span>*<\/span>\n                                                <\/label>\n                                            <select id=\"\u00bfEs fumador? \u00bfCu\u00e1nto fuma?_9\"\n                            class=\"iq-kivicare-form-control text-capitalize kivicare-required\"\n                            name=\"custom_field_9\">\n                            <option value=\"\"> Select Option <\/option>\n                                                            <option value=\"No fumo\" key=\"0\">\n                                    Je ne fume pas                                <\/option>\n                                                                <option value=\"Menos de 10 cigarrillos al d\u00eda\" key=\"1\">\n                                    Moins de 10 cigarettes par jour                                <\/option>\n                                                                <option value=\"De 10 a 20 cigarrillos al d\u00eda\" key=\"2\">\n                                    10 \u00e0 20 cigarettes par jour                                <\/option>\n                                                                <option value=\"M\u00e1s de 20 cigarrillos al d\u00eda\" key=\"3\">\n                                    Plus de 20 cigarettes par jour                                <\/option>\n                                                        <\/select>\n                                        <\/div>\n                                            <div class=\"form-group kivi-col-6 mt-2 text\">\n                    <label class=\"form-label\" for=\"Alergias a Medicamentos y alimentarias_11\">\n\n                        Allergies m\u00e9dicamenteuses et alimentaires\n                                                    <span>*<\/span>\n                                                <\/label>\n                                            <input id=\"Alergias a Medicamentos y alimentarias_11\"\n                            placeholder=\"\"\n                            name=\"custom_field_11\"\n                            type=\"text\"\n                            class=\"iq-kivicare-form-control kivicare-required\" \/>\n                                        <\/div>\n                                <\/div>\n                                  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action=\"#payment_mode\"\n                                      data-prev=\"#clinic\" data-trp-original-action=\"#payment_mode\">\n                                    <div class=\"iq-kivi-tab-panel-title-animation\">\n<h3 class=\"iq-kivi-tab-panel-title\"> Confirmation Detail <\/h3>\n<\/div>\n<hr>\n<div class=\"widget-content\" style=\"position: relative\">\n    <div class=\"kivi-row card-list-data d-none\" id=\"kivi_confirm_page\" style=\"height: 470px; position:absolute;\">\n        \n    <\/div>\n    \n    <span id=\"confirm_loader\" class=\"kivi-overlay-spinner\" style=\"position:absolute;top:40%;left:40%\">\n                    <div class=\"double-lines-spinner\"><\/div>\n            <\/span>\n<\/div>    <div class=\"card-widget-footer\">\n        <span id=\"kivicare_error_msg_confirm\" class=\"alert alert-popup alert-danger alert-left error\"\n            style=\"display:none\">&nbsp;<\/span>\n        <div class=\"d-flex justify-content-end gap-1-5\" style=\"margin-left: auto;\">\n                            <button type=\"button\" class=\"iq-button iq-button-secondary\" id=\"iq-widget-back-button\"\n                    data-step=\"prev\">Back<\/button>\n                                        <button type=\"submit\" name=\"submit\" value=\"submit\" data-step=\"next\"\n                    class=\"iq-button iq-button-primary\">Next<\/button>\n                    <\/div>\n    <\/div>\n                                    <input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form>\n                            <\/div>\n                                                            <div id=\"payment_mode\" class=\"iq-fade iq-tab-pannel\">\n                                    <form id=\"payment_mode_form\" action=\"#confirmed\"\n                                          data-prev=\"#confirm\" data-trp-original-action=\"#confirmed\">\n                                        <div class=\"iq-kivi-tab-panel-title-animation\">\n    <h3 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de tu elecci\u00f3n, d\u00eda y hora de tu preferencia. Reg\u00edstrate Reg\u00edstrate en nuestra plataforma para continuar con la reserva de tu cita. Pago de la cita Completa tu reserva realizando el pago instant\u00e1neo de la cita. Recibir\u00e1s toda la informaci\u00f3n por correo electr\u00f3nico.<\/p>","protected":false},"author":1,"featured_media":64,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"pmpro_default_level":"","footnotes":""},"class_list":["post-55","page","type-page","status-publish","has-post-thumbnail","hentry","pmpro-has-access"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.7 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>DoctorSky - Gesti&oacute;n de Citas<\/title>\n<meta name=\"description\" content=\"Portal de Gesti\u00f3n y reserva de Citas DoctorSky. 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