{"id":1357,"date":"2020-01-13T06:10:10","date_gmt":"2020-01-13T06:10:10","guid":{"rendered":"http:\/\/tms.topitdev.com\/?page_id=1357"},"modified":"2025-08-26T23:24:25","modified_gmt":"2025-08-26T23:24:25","slug":"appointment-request","status":"publish","type":"page","link":"https:\/\/tmscentercentennial.com\/staging\/2437\/appointment-request\/","title":{"rendered":"Appointment Request"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1357\" class=\"elementor elementor-1357\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6c6ec92 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6c6ec92\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-9e04fad\" data-id=\"9e04fad\" data-element_type=\"column\" data-e-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-bc79d4c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bc79d4c\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&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-50 elementor-top-column elementor-element elementor-element-d8fb7b5\" data-id=\"d8fb7b5\" data-element_type=\"column\" data-e-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-7b8ddb6 elementor-widget elementor-widget-text-editor\" data-id=\"7b8ddb6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"padding: 0px;\">A new <span style=\"font-size: 42px;\">hope<\/span> with amazing <span style=\"font-size: 42px;c;\">results<\/span><\/p>\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<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-ebf916f\" data-id=\"ebf916f\" data-element_type=\"column\" data-e-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-a8e780c elementor-mobile-align-center elementor-widget elementor-widget-button\" data-id=\"a8e780c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-md\" href=\"https:\/\/tmscentercentennial.com\/staging\/2437\/contact-us\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"icon icon-right-arrow\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Start Here<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\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-e1f021a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e1f021a\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&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-50 elementor-top-column elementor-element elementor-element-57d1f9b\" data-id=\"57d1f9b\" data-element_type=\"column\" data-e-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-74f60c5 elementor-widget elementor-widget-heading\" data-id=\"74f60c5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Appointment Request<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b5af915 elementor-widget elementor-widget-text-editor\" data-id=\"b5af915\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Please complete the form below to schedule an appointment.<\/p><p>I will try my best to accommodate your request and will be in touch ASAP.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b9f97ed elementor-widget-divider--separator-type-pattern elementor-widget-divider--no-spacing elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"b9f97ed\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\" style=\"--divider-pattern-url: url(&quot;data:image\/svg+xml,%3Csvg xmlns=&#039;http:\/\/www.w3.org\/2000\/svg&#039; preserveAspectRatio=&#039;xMidYMid meet&#039; overflow=&#039;visible&#039; height=&#039;100%&#039; viewBox=&#039;0 0 120 26&#039; fill=&#039;black&#039; stroke=&#039;none&#039;%3E%3Cpath d=&#039;M11.9,15.9L11.9,15.9L0,16c-0.2-3.7,1.5-5.7,4.9-6C10,9.6,12.4,14.2,11.9,15.9zM26.9,15.9L26.9,15.9L15,16c0.5-3.7,2.5-5.7,5.9-6C26,9.6,27.4,14.2,26.9,15.9z M37.1,10c3.4,0.3,5.1,2.3,4.9,6H30.1C29.5,14.4,31.9,9.6,37.1,10z M57,15.9L57,15.9L45,16c0-3.4,1.6-5.4,4.9-5.9C54.8,9.3,57.4,14.2,57,15.9z M71.9,15.9L71.9,15.9L60,16c-0.2-3.7,1.5-5.7,4.9-6C70,9.6,72.4,14.2,71.9,15.9z M82.2,10c3.4,0.3,5,2.3,4.8,6H75.3C74,13,77.1,9.6,82.2,10zM101.9,15.9L101.9,15.9L90,16c-0.2-3.7,1.5-5.7,4.9-6C100,9.6,102.4,14.2,101.9,15.9z M112.1,10.1c2.7,0.5,4.3,2.5,4.9,5.9h-11.9l0,0C104.5,14.4,108,9.3,112.1,10.1z&#039;\/%3E%3C\/svg%3E&quot;);\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-18b82f5 elementor-widget elementor-widget-heading\" data-id=\"18b82f5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">\"TMS treatment, the non-invasive alternative, to feel alive again!\"<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-404eb7e elementor-widget-divider--separator-type-pattern elementor-widget-divider--no-spacing elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"404eb7e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\" style=\"--divider-pattern-url: url(&quot;data:image\/svg+xml,%3Csvg xmlns=&#039;http:\/\/www.w3.org\/2000\/svg&#039; preserveAspectRatio=&#039;xMidYMid meet&#039; overflow=&#039;visible&#039; height=&#039;100%&#039; viewBox=&#039;0 0 120 26&#039; fill=&#039;black&#039; stroke=&#039;none&#039;%3E%3Cpath d=&#039;M11.9,15.9L11.9,15.9L0,16c-0.2-3.7,1.5-5.7,4.9-6C10,9.6,12.4,14.2,11.9,15.9zM26.9,15.9L26.9,15.9L15,16c0.5-3.7,2.5-5.7,5.9-6C26,9.6,27.4,14.2,26.9,15.9z M37.1,10c3.4,0.3,5.1,2.3,4.9,6H30.1C29.5,14.4,31.9,9.6,37.1,10z M57,15.9L57,15.9L45,16c0-3.4,1.6-5.4,4.9-5.9C54.8,9.3,57.4,14.2,57,15.9z M71.9,15.9L71.9,15.9L60,16c-0.2-3.7,1.5-5.7,4.9-6C70,9.6,72.4,14.2,71.9,15.9z M82.2,10c3.4,0.3,5,2.3,4.8,6H75.3C74,13,77.1,9.6,82.2,10zM101.9,15.9L101.9,15.9L90,16c-0.2-3.7,1.5-5.7,4.9-6C100,9.6,102.4,14.2,101.9,15.9z M112.1,10.1c2.7,0.5,4.3,2.5,4.9,5.9h-11.9l0,0C104.5,14.4,108,9.3,112.1,10.1z&#039;\/%3E%3C\/svg%3E&quot;);\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\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-50 elementor-top-column elementor-element elementor-element-fadadd0\" data-id=\"fadadd0\" data-element_type=\"column\" data-e-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-969a63d elementor-widget elementor-widget-image\" data-id=\"969a63d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" loading=\"lazy\" width=\"580\" height=\"491\" src=\"https:\/\/tmscentercentennial.com\/staging\/2437\/wp-content\/uploads\/2020\/01\/Appointment-Request.jpg\" class=\"attachment-large size-large wp-image-2003\" alt=\"Appointment\" srcset=\"https:\/\/tmscentercentennial.com\/staging\/2437\/wp-content\/uploads\/2020\/01\/Appointment-Request.jpg 656w, https:\/\/tmscentercentennial.com\/staging\/2437\/wp-content\/uploads\/2020\/01\/Appointment-Request-300x254.jpg 300w\" sizes=\"auto, (max-width: 580px) 100vw, 580px\" \/>\t\t\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-c6ffa8d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c6ffa8d\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&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-17936a5\" data-id=\"17936a5\" data-element_type=\"column\" data-e-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-ae1dddb elementor-widget elementor-widget-shortcode\" data-id=\"ae1dddb\" data-element_type=\"widget\" data-e-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\"><div class=\"everest-forms\"><div class=\"evf-container default\" id=\"evf-1985\"><form id=\"evf-form-1985\" class=\"everest-form\" data-formid=\"1985\" data-ajax_submission=\"0\" data-keyboard_friendly_form=\"0\" data-form_state_type=\"\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/staging\/2437\/wp-json\/wp\/v2\/pages\/1357\"><div class=\"evf-field-container\"><input type=\"hidden\" id=\"_wpnonce1985\" name=\"_wpnonce1985\" value=\"77526a3128\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/staging\/2437\/wp-json\/wp\/v2\/pages\/1357\" \/><div class=\"evf-frontend-row\" data-row=\"row_1\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1985-field_xda7FSjFWd-1-container\" class=\"evf-field evf-field-first-name form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"xda7FSjFWd-1\"><label class=\"evf-field-label\" for=\"evf-1985-field_xda7FSjFWd-1\"><span class=\"evf-label\">Name<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-1985-field_xda7FSjFWd-1\" class=\"input-text\" name=\"everest_forms[form_fields][xda7FSjFWd-1]\" required><\/div><div id=\"evf-1985-field_FhdPG81Jp8-2-container\" class=\"evf-field evf-field-email form-row validate-required validate-email\" data-required-field-message=\"Please enter a valid email address.\" data-field-id=\"FhdPG81Jp8-2\"><label class=\"evf-field-label\" for=\"evf-1985-field_FhdPG81Jp8-2\"><span class=\"evf-label\">Email<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"email\" id=\"evf-1985-field_FhdPG81Jp8-2\" class=\"input-text\" name=\"everest_forms[form_fields][FhdPG81Jp8-2]\" required ><\/div><div id=\"evf-1985-field_eUMpTT6oKp-7-container\" class=\"evf-field evf-field-last-name form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"eUMpTT6oKp-7\"><label class=\"evf-field-label\" for=\"evf-1985-field_eUMpTT6oKp-7\"><span class=\"evf-label\">Phone<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-1985-field_eUMpTT6oKp-7\" class=\"input-text\" name=\"everest_forms[form_fields][eUMpTT6oKp-7]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_2\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-1985-field_UnRiAa1VSR-4-container\" class=\"evf-field evf-field-date-time form-row\" data-field-id=\"UnRiAa1VSR-4\"><label class=\"evf-field-label\" for=\"evf-1985-field_UnRiAa1VSR-4\"><span class=\"evf-label\">Preferred Date<\/span> <\/label><input type=\"text\" id=\"evf-1985-field_UnRiAa1VSR-4\" class=\"flatpickr-field input-text\" name=\"everest_forms[form_fields][UnRiAa1VSR-4]\" data-time-interval=\"15\" data-date-time=\"date\" data-mode=\"single\" data-locale=\"en\" data-date-format=\"Y-m-d\"  ><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-1985-field_xaoapCblpD-5-container\" class=\"evf-field evf-field-date-time form-row\" data-field-id=\"xaoapCblpD-5\"><label class=\"evf-field-label\" for=\"evf-1985-field_xaoapCblpD-5\"><span class=\"evf-label\">Time<\/span> <\/label><input type=\"text\" id=\"evf-1985-field_xaoapCblpD-5\" class=\"flatpickr-field input-text\" name=\"everest_forms[form_fields][xaoapCblpD-5]\" data-time-interval=\"15\" data-date-time=\"date\" data-mode=\"single\" data-locale=\"en\" data-date-format=\"Y-m-d\"  ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_3\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-1985-field_0Qjo9qu1Do-6-container\" class=\"evf-field evf-field-textarea form-row\" data-field-id=\"0Qjo9qu1Do-6\"><label class=\"evf-field-label\" for=\"evf-1985-field_0Qjo9qu1Do-6\"><span class=\"evf-label\">Your Message<\/span> <\/label><textarea id=\"evf-1985-field_0Qjo9qu1Do-6\" class=\"input-text\" name=\"everest_forms[form_fields][0Qjo9qu1Do-6]\"  ><\/textarea><\/div><\/div><\/div><\/div><div class=\"evf-honeypot-container evf-field-hp\"><label for=\"evf-1985-field-hp\" class=\"evf-field-label\">Message<\/label><input type=\"text\" name=\"everest_forms[hp]\" id=\"evf-1985-field-hp\" class=\"input-text\"><\/div><div class=\"evf-recaptcha-container \" style=\"display:block\"><div class=\"g-recaptcha\" data-sitekey=\"6LdSEe0UAAAAAM9oi87YvvN_F6IMSLPB3hhGlfy6\"><\/div><\/div><div class=\"evf-submit-container \" ><input type=\"hidden\" name=\"everest_forms[id]\" value=\"1985\"><input type=\"hidden\" name=\"everest_forms[author]\" value=\"1\"><button type='submit' name='everest_forms[submit]' class='everest-forms-submit-button button evf-submit ' id='evf-submit-1985' value='evf-submit' data-process-text=\"Processing\u2026\" conditional_rules='&quot;&quot;' conditional_id='evf-submit-1985'  id=\"evf-submit-1985\" aria-live=\"assertive\">Submit<\/button><\/div><\/form><\/div><!-- .evf-container --><\/div><\/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-a5dc46a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a5dc46a\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&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-1a34edb\" data-id=\"1a34edb\" data-element_type=\"column\" data-e-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-dff5589 elementor-widget elementor-widget-elementskit-client-logo\" data-id=\"dff5589\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"elementskit-client-logo.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"ekit-wid-con\" >\t\t<div class=\"elementskit-clients-slider  simple_logo_image\" data-config=\"{&quot;rtl&quot;:false,&quot;arrows&quot;:false,&quot;dots&quot;:false,&quot;autoplay&quot;:true,&quot;speed&quot;:1000,&quot;slidesPerView&quot;:5,&quot;slidesPerGroup&quot;:1,&quot;pauseOnHover&quot;:true,&quot;loop&quot;:false,&quot;breakpoints&quot;:{&quot;320&quot;:{&quot;slidesPerView&quot;:1,&quot;slidesPerGroup&quot;:1,&quot;spaceBetween&quot;:10},&quot;768&quot;:{&quot;slidesPerView&quot;:2,&quot;slidesPerGroup&quot;:1,&quot;spaceBetween&quot;:10},&quot;1024&quot;:{&quot;slidesPerView&quot;:5,&quot;slidesPerGroup&quot;:1,&quot;spaceBetween&quot;:5}}}\" data-direction=\"\">\n\t\t\t<div class=\"ekit-main-swiper swiper\">\n\t\t\t\t<div class=\"swiper-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementskit-client-slider-item swiper-slide \">\n\t\t\t\t\t\t\t<div class=\"swiper-slide-inner\">\n\t\t\t\t\t\t\t\t<div class=\"single-client image-switcher\" title=\"Title #3\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div 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