{"id":23498,"date":"2024-01-23T02:21:18","date_gmt":"2024-01-22T17:51:18","guid":{"rendered":"https:\/\/sg.euyansangclinic.com\/?page_id=23498"},"modified":"2024-03-06T13:52:05","modified_gmt":"2024-03-06T05:22:05","slug":"delivery-request-form","status":"publish","type":"page","link":"http:\/\/13.229.232.152\/cn\/delivery-request-form\/","title":{"rendered":"\u836f\u7c89\u8fd0\u9001\u4e0a\u95e8\u670d\u52a1\u7533\u8bf7\u8868"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"23498\" class=\"elementor elementor-23498 elementor-23263\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-25ff128 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"25ff128\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\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-3e2a1a6\" data-id=\"3e2a1a6\" 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-e77b57f elementor-widget elementor-widget-template\" data-id=\"e77b57f\" data-element_type=\"widget\" data-widget_type=\"template.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-template\">\n\t\t\t\t\t<div data-elementor-type=\"section\" data-elementor-id=\"17138\" class=\"elementor elementor-17138 elementor-228\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2b2ae62 elementor-section-full_width elementor-section-height-full elementor-section-items-top elementor-hidden-mobile elementor-section-height-default elementor-invisible\" data-id=\"2b2ae62\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[],&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeIn&quot;}\">\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-4be60ae\" data-id=\"4be60ae\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\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-1635e8a elementor-section-full_width elementor-section-height-full elementor-section-items-top elementor-hidden-desktop elementor-hidden-tablet elementor-section-height-default elementor-invisible\" data-id=\"1635e8a\" data-element_type=\"section\" 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data-settings=\"{&quot;jet_parallax_layout_list&quot;:[],&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeIn&quot;}\">\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-1456dc0\" data-id=\"1456dc0\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\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-1f11dd3 elementor-section-full_width elementor-section-height-full elementor-section-height-default elementor-section-items-middle elementor-invisible\" data-id=\"1f11dd3\" data-element_type=\"section\" id=\"page-masthead\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[],&quot;animation&quot;:&quot;fadeIn&quot;}\">\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-03bedae\" data-id=\"03bedae\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-82343ab elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"82343ab\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\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-inner-column elementor-element elementor-element-7849c61\" data-id=\"7849c61\" 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-227f6cb elementor-hidden-desktop elementor-widget elementor-widget-spacer\" data-id=\"227f6cb\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 20-03-2024 *\/\n.elementor-column .elementor-spacer-inner{height:var(--spacer-size)}.e-con{--container-widget-width:100%}.e-con-inner>.elementor-widget-spacer,.e-con>.elementor-widget-spacer{width:var(--container-widget-width,var(--spacer-size));--align-self:var(--container-widget-align-self,initial);--flex-shrink:0}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container,.e-con>.elementor-widget-spacer>.elementor-widget-container{height:100%;width:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer{height:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner{height:var(--container-widget-height,var(--spacer-size))}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty,.e-con>.elementor-widget-spacer.elementor-widget-empty{position:relative;min-height:22px;min-width:22px}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon,.e-con>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon{position:absolute;top:0;bottom:0;left:0;right:0;margin:auto;padding:0;width:22px;height:22px}<\/style>\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<!-- hidden widget -->\t\t<div class=\"elementor-element elementor-element-707f76f elementor-widget elementor-widget-shortcode\" data-id=\"707f76f\" 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<div class=\"elementor-shortcode\"><nav aria-label=\"breadcrumbs\" class=\"rank-math-breadcrumb\"><p><span class=\"last\">\u9996\u9875<\/span><\/p><\/nav><\/div>\n\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\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\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\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-ae80475 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ae80475\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\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-3b3880d\" data-id=\"3b3880d\" 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-9fe1da1 elementor-widget elementor-widget-spacer\" data-id=\"9fe1da1\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0b2e415 elementor-widget elementor-widget-image\" data-id=\"0b2e415\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 20-03-2024 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"2320\" height=\"320\" src=\"http:\/\/13.229.232.152\/wp-content\/uploads\/2024\/02\/EYS-Home-D-page-cn.jpg\" class=\"attachment-full size-full wp-image-23920\" alt=\"Herbal Medication Home Delivery CN\" srcset=\"http:\/\/13.229.232.152\/wp-content\/uploads\/2024\/02\/EYS-Home-D-page-cn.jpg 2320w, http:\/\/13.229.232.152\/wp-content\/uploads\/2024\/02\/EYS-Home-D-page-cn-300x41.jpg 300w, http:\/\/13.229.232.152\/wp-content\/uploads\/2024\/02\/EYS-Home-D-page-cn-1024x141.jpg 1024w, http:\/\/13.229.232.152\/wp-content\/uploads\/2024\/02\/EYS-Home-D-page-cn-768x106.jpg 768w, http:\/\/13.229.232.152\/wp-content\/uploads\/2024\/02\/EYS-Home-D-page-cn-1536x212.jpg 1536w, http:\/\/13.229.232.152\/wp-content\/uploads\/2024\/02\/EYS-Home-D-page-cn-2048x282.jpg 2048w\" sizes=\"(max-width: 2320px) 100vw, 2320px\" \/>\t\t\t\t\t\t\t\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-17bac43 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"17bac43\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\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-910b623\" data-id=\"910b623\" 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-7a00aff elementor-widget elementor-widget-heading\" data-id=\"7a00aff\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 20-03-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h4 class=\"elementor-heading-title elementor-size-default\">\u4eab\u53d7\u836f\u7c89\u8fd0\u9001\u670d\u52a1\u3002<\/h4>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bce200a elementor-widget elementor-widget-text-editor\" data-id=\"bce200a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 20-03-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p><span style=\"color: var( --e-global-color-text ); font-family: var( --e-global-typography-text-font-family ), Sans-serif;\"><b>4\u4e2a\u7b80\u5355\u6b65\u9aa4\uff1a<\/b><\/span><\/p><ol><li>\u2060\u586b\u5199\u4ee5\u4e0b\u8868\u683c<\/li><li>\u6211\u4eec\u7684\u56e2\u961f\u9700\u89813\u4e2a\u5de5\u4f5c\u65e5\u6765\u786e\u8ba4\u60a8\u7684\u8ba2\u5355<\/li><li>\u6211\u4eec\u7684\u56e2\u961f\u5c06\u4e0e\u60a8\u8054\u7cfb\u5e76\u63d0\u4f9b\u652f\u4ed8\u8be6\u60c5<\/li><li>\u2060\u6536\u5230\u4ed8\u6b3e\u540e\uff0c\u60a8\u7684\u5904\u65b9\u5c06\u57283\u4e2a\u5de5\u4f5c\u65e5\u5185\u9001\u8fbe<\/li><\/ol><p>\u60a8\u4e5f\u53ef\u4ee5\u62e8\u6253\u6211\u4eec\u7684\u514d\u8d39\u70ed\u7ebf <a href=\"tel:800 225 1887\">1800 225 1887<\/a>\uff0c\u4ee5\u83b7\u5f97\u5373\u65f6\u5e2e\u52a9\u3002<\/p>\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-f984d66 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f984d66\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\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-16 elementor-top-column elementor-element elementor-element-0267f2a\" data-id=\"0267f2a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-9e86646\" data-id=\"9e86646\" 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-175a26c elementor-widget elementor-widget-wpforms\" data-id=\"175a26c\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-page-break-color: #066aab;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><style id=\"wpforms-css-vars-elementor-widget-175a26c\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-175a26c {\n\t\t\t\t\t--wpforms-field-background-color: #FFFFFF;\n--wpforms-button-background-color: #9A0537;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full home-delivery-form wpforms-render-modern\" id=\"wpforms-23190\"><form id=\"wpforms-form-23190\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"23190\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/cn\/wp-json\/wp\/v2\/pages\/23498\" data-token=\"cd8a486434501488754058e656f33f2b\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-23190-field_7-container\" class=\"wpforms-field wpforms-field-divider section-title\" data-field-id=\"7\"><h3 id=\"wpforms-23190-field_7\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-23190-field_7-error\" aria-describedby=\"wpforms-23190-field_7-description\">\u4e2a\u4eba\u8d44\u6599<\/h3><div id=\"wpforms-23190-field_7-description\" class=\"wpforms-field-description\">We use this information to verify your identity, kindly enter the information registered with our clinics.<\/div><\/div><div id=\"wpforms-23190-field_1-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_1\">\u79f0\u547c <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-23190-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>\u8bf7\u9009\u62e9<\/option><option value=\"\u5148\u751f\" >\u5148\u751f<\/option><option value=\"\u592a\u592a\" >\u592a\u592a<\/option><option value=\"\u5973\u58eb\" >\u5973\u58eb<\/option><\/select><\/div><div id=\"wpforms-23190-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_2\">\u59d3\u540d\uff08\u5982\u8eab\u4efd\u8bc1\uff09 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-23190-field_2\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-23190-field_2-error\" required><\/div><div id=\"wpforms-23190-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_3\">Full NRIC \/ Passport No. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-23190-field_3\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-23190-field_3-error\" required><\/div><div id=\"wpforms-23190-field_4-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_4\">\u51fa\u751f\u65e5\u671f <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-23190-field_4\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][4][date]\" aria-errormessage=\"wpforms-23190-field_4-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-23190-field_5-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_5\">\u8054\u7edc\u7535\u8bdd <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-23190-field_5\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-23190-field_5-error\" required><\/div><div id=\"wpforms-23190-field_6-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_6\">\u7535\u90ae\u5730\u5740 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-23190-field_6\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][6]\" spellcheck=\"false\" aria-errormessage=\"wpforms-23190-field_6-error\" required><\/div><div id=\"wpforms-23190-field_8-container\" class=\"wpforms-field wpforms-field-divider section-title\" data-field-id=\"8\"><h3 id=\"wpforms-23190-field_8\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-23190-field_8-error\">\u8fd0\u9001\u7ec6\u8282<\/h3><\/div><div id=\"wpforms-23190-field_16-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_16\">\u8fd0\u9001\u5730\u5740 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-23190-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-23190-field_16-error\" required><\/textarea><\/div><div id=\"wpforms-23190-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_17\">\u90ae\u653f\u7f16\u7801 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-23190-field_17\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-23190-field_17-error\" required><\/div><div id=\"wpforms-23190-field_10-container\" class=\"wpforms-field wpforms-field-divider section-title\" data-field-id=\"10\"><h3 id=\"wpforms-23190-field_10\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-23190-field_10-error\">\u7eed\u836f\u9012\u9001\u7ec6\u8282<\/h3><\/div><div id=\"wpforms-23190-field_11-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_11\">\u6700\u8fd1\u5c31\u8bca\u8bca\u6240 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-23190-field_11\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"1\" name=\"wpforms[fields][11]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>\u8bf7\u9009\u62e9<\/option><option value=\"19072\" >\u4ec1\u6c47\u4e2d\u897f\u4f1a\u8bca\u4e2d\u5fc3 @ &lt;br&gt;i12 \u52a0\u4e1c\u8d2d\u7269\u4e2d\u5fc3<\/option><option value=\"19109\" >\u4ec1\u6c47\u4e2d\u897f\u4f1a\u8bca\u4e2d\u5fc3 @ &lt;br&gt;\u76db\u6e2f\u6c47\u8d2d\u7269\u4e2d\u5fc3<\/option><option value=\"18641\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u4e2d\u5fc3 @ &lt;br&gt;\u4f0a\u4e3d\u838e\u767d\u8bfa\u7ef4\u5a1c\u533b\u9662<\/option><option value=\"18897\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u4e09\u5df4\u65fa<\/option><option value=\"19018\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u4e2d\u5cc7\u9c81\u5e7f\u573a<\/option><option value=\"19052\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u5140\u5170\u4e2d\u5fc3<\/option><option value=\"18662\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u52ff\u6d1b\u9547\u4e2d\u5fc3<\/option><option value=\"18973\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u56db\u7f8e\u4e1c\u798f\u574a<\/option><option value=\"18946\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u5b9e\u9f99\u5c97NEX<\/option><option value=\"18882\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u699c\u9e45\u6c34\u6ee8\u574a<\/option><option value=\"18740\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u6b66\u5409\u73ed\u8ba9\u5927\u53a6<\/option><option value=\"18999\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u6de1\u6ee8\u5c3c\u4e16\u7eaa\u5e7f\u573a<\/option><option value=\"18758\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u725b\u8f66\u6c34\u5510\u57ce\u574a<\/option><option value=\"17700\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u72ee\u57ce\u5927\u53a6<\/option><option value=\"18907\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u76db\u6e2f\u52d8\u5b9d\u574a<\/option><option value=\"18673\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u78a7\u5c71\u7b2c\u516b\u7ad9\u8d2d\u7269\u4e2d\u5fc3<\/option><option value=\"18856\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u88d5\u5eca JEM \u8d2d\u7269\u4e2d\u5fc3<\/option><option value=\"18793\" >\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240 @ &lt;br&gt;\u91d1\u6587\u6cf0\u5e7f\u573a<\/option><option value=\"18637\" >\u4f59\u4ec1\u751f\u4f18\u9009\u4e2d\u533b\u4e2d\u5fc3 @ &lt;br&gt;\u6866\u4e3d\u5546\u57ce<\/option><option value=\"18626\" >\u4f59\u4ec1\u751f\u4f18\u9009\u4e2d\u533b\u4e2d\u5fc3 @ &lt;br&gt;\u767e\u5229\u5bab\u533b\u836f\u5927\u53a6<\/option><\/select><\/div><div id=\"wpforms-23190-field_12-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_12\">\u6700\u8fd1\u5c31\u8bca\u65e5\u671f <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-23190-field_12\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][12][date]\" placeholder=\"Please select date of last visit\" aria-errormessage=\"wpforms-23190-field_12-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-23190-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-23190-field_13\">\u7eed\u836f\u5929\u6570 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-23190-field_13\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-23190-field_13-error\" required><\/div><div id=\"wpforms-23190-field_15-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"15\"><div id=\"wpforms-23190-field_15\" aria-errormessage=\"wpforms-23190-field_15-error\"><div id=\"tnc\">\n<h4 style=\"margin-top:1rem; margin-bottom:1rem;\">\u6761\u6b3e\u4e0e\u6761\u89c4<\/h4>\n\n<ul class=\"margin-left:1rem !important;\">\n<li>\u9002\u7528\u4e8e\u73b0\u6709\u7684\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u5ba2\u6237\u3002<\/li>\n<li>\u9002\u7528\u4e8e\u4ece\u770b\u8bca\u65e5\u8d77\u8fc7\u53bb\u4e09\u4e2a\u6708\u5185\u7684\u6162\u6027\u75c5\u3002 \u9664\u975e\u7ecf\u8fc7\u4e3b\u6cbb\u533b\u5e08\u7684\u6279\u51c6\uff0c\u5426\u5219\u9700\u8981\u5bf9\u60a3 \u8005\u8fdb\u884c\u68c0\u67e5\u3002 <\/li>\n<li>\u4ed8\u6b3e\u4ec5\u9650\u4e8e\u4fe1\u7528\u5361, PayPal \u6216PayNow\u3002 <\/li>\n<li>\u8ba2\u5355\u901a\u8fc7\u786e\u8ba4\u4e0e\u4ed8\u6b3e\u540e\u5c06\u9012\u9001\u5230\u6307\u5b9a\u7684\u65b0\u52a0\u5761\u5730\u5740\u3002\u8fd9\u5c06\u9700\u65f6\u7ea63\u4e2a\u5de5\u4f5c\u65e5\u3002 <\/li>\n<li>\u7eed\u836f\u9012\u9001\u670d\u52a1\u6536\u8d39\uff08\u5305\u62ec\u836f\u8d39\u4e0e\u914d\u836f\u8d39\uff09\u4e0e\u8bca\u6240\u6536\u8d39\u4e00\u81f4\u3002 <\/li>\n<li>\u6bcf\u5b97\u8ba2\u5355\u9700\u652f\u4ed8$8\u8fd0\u8f93\u8d39\u3002 <\/li>\n<li>\u6536\u8d39\u987b\u9644\u52a0\u6d88\u8d39\u7a0e\u3002 <\/li>\n<li>\u5df2\u8ba2\u8d2d\u836f\u7269\u6055\u4e0d\u9000\u8fd8\uff0c\u4e5f\u4e0d\u53ef\u5151\u6362\u3002<\/li> \n<li>\u9644\u5e26\u653f\u7b56\u3002 For more details, please refer to our <a target=\"_blank\" href=\"https:\/\/sg.euyansangclinic.com\/homedelivery-service-policy\/\" rel=\"noopener\">Home Delivery Service Policy<\/a>.<\/li>\n<\/ul>\n\n<p>\u901a\u8fc7\u586b\u5199\u5e76\u63d0\u4ea4\u6b64\u8868\u683c\uff0c\u672c\u4eba\u7279\u6b64\u58f0\u660e\u548c\u4fdd\u8bc1\uff0c\u5728\u8868\u683c\u63d0\u4f9b\u7684\u6240\u6709\u4fe1\u606f\u5b8c\u6574\u3001\u771f\u5b9e\u4e14\u51c6\u786e\uff0c \u63d0\u4f9b\u4e2a\u4eba\u4fe1\u606f\u4e88\u4f59\u4ec1\u751f\u533b\u7597\u7efc\u5408\u6709\u9650\u516c\u53f8\uff08\u65e0\u8bba\u662f\u76f4\u63a5\u8fd8\u662f\u901a\u8fc7\u7b2c\u4e09\u65b9\u670d\u52a1\u63d0\u4f9b\u5546\uff09\u6536\u96c6\u3001 \u4f7f\u7528\u3001\u62ab\u9732\u6216\u5904\u7406\uff0c\u7528\u4e8e\u5904\u7406\u7eed\u836f\u9012\u9001\u670d\u52a1\u76ee\u7684\u3002<\/p>\n\n<p>\u6211\u540c\u610f\u4f59\u4ec1\u751f\u533b\u7597\u7efc\u5408\u6709\u9650\u516c\u53f8\u5728\u5904\u7406\u7eed\u836f\u9012\u9001\u670d\u52a1\u7684\u8fc7\u7a0b\u4e2d\u4e0e\u6211\u8054\u7cfb\u3002<\/p>\n\n<p>\u6709\u5173\u4e8e\u6570\u636e\u9690\u79c1\uff0c\u8bf7\u53c2 <a target=\"_blank\" href=\"https:\/\/sg.euyansangclinic.com\/privacy-policy\/\" rel=\"noopener\">\u9605\u9690\u79c1\u653f\u7b56\u3002<\/a><\/p>\n\n<p>\u4f59\u4ec1\u751f\u8bca\u6240\u7ba1\u7406\u5c42\u6709\u6743\u968f\u65f6\u5728\u4e0d\u53e6\u884c\u901a\u77e5\u4e0b\u4fee\u6539\u8fd9\u4e9b\u6761\u6b3e\u548c\u6761\u4ef6\u3002 \u4efb\u4f55\u6b64\u7c7b\u7ecf\u4fee\u8ba2\u7684\u6761\u6b3e\u548c \u6761\u4ef6\u5e94\u7acb\u5373\u751f\u6548\uff0c\u5e76\u53ef\u5728\u4f59\u4ec1\u751f\u4e2d\u533b\u8bca\u6240\u7f51\u7ad9\u4e0a\u627e\u5230\u3002 \u8fd9\u4e9b\u6761\u6b3e\u548c\u6761\u4ef6\u662f\u6700\u7ec8\u7684\u8d2d\u4e70\u6761\u4ef6\u3002<\/p>\n\n<p>\u82e5\u6709\u4efb\u4f55\u4e89\u8bae\uff0c\u4f59\u4ec1\u751f\u8bca\u6240\u7ba1\u7406\u5c42\u4fdd\u7559\u6700\u7ec8\u51b3\u5b9a\u6743\u3002<\/p><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v3\" ><input type=\"hidden\" name=\"wpforms[recaptcha]\" value=\"\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"23190\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-23190\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"\u63d0\u4ea4\" aria-live=\"assertive\" value=\"wpforms-submit\">\u63d0\u4ea4<\/button><img decoding=\"async\" src=\"http:\/\/13.229.232.152\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\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-16 elementor-top-column elementor-element elementor-element-c660f1b\" data-id=\"c660f1b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\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<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u4eab\u53d7\u836f\u7c89\u8fd0\u9001\u670d\u52a1\u3002 4\u4e2a\u7b80\u5355\u6b65\u9aa4\uff1a \u2060\u586b\u5199\u4ee5\u4e0b\u8868\u683c \u6211\u4eec\u7684\u56e2\u961f\u9700\u89813\u4e2a\u5de5\u4f5c\u65e5\u6765\u786e\u8ba4\u60a8\u7684\u8ba2\u5355 \u6211\u4eec\u7684\u56e2\u961f\u5c06\u4e0e\u60a8\u8054\u7cfb\u5e76\u63d0\u4f9b\u652f\u4ed8\u8be6\u60c5 \u2060\u6536\u5230\u4ed8\u6b3e\u540e\uff0c\u60a8\u7684\u5904\u65b9\u5c06\u57283\u4e2a\u5de5\u4f5c\u65e5\u5185\u9001\u8fbe \u60a8\u4e5f\u53ef\u4ee5\u62e8\u6253\u6211\u4eec\u7684\u514d\u8d39\u70ed\u7ebf 1800 225 1887\uff0c\u4ee5\u83b7\u5f97\u5373\u65f6\u5e2e\u52a9\u3002 Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. \u4e2a\u4eba\u8d44\u6599 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