{"id":8913,"date":"2025-06-29T11:02:12","date_gmt":"2025-06-29T07:32:12","guid":{"rendered":"https:\/\/iranafra.com\/pharmacy-and-medical-center-registration-form\/"},"modified":"2025-12-27T16:43:13","modified_gmt":"2025-12-27T13:13:13","slug":"pharmacy-and-medical-center-registration-form","status":"publish","type":"page","link":"https:\/\/iranafra.com\/en\/pharmacy-and-medical-center-registration-form\/","title":{"rendered":"Pharmacy and Medical Center Registration Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"8913\" class=\"elementor elementor-8913 elementor-7586\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-43695c9 e-flex e-con-boxed e-con e-child\" data-id=\"43695c9\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-daa826e elementor-widget elementor-widget-heading\" data-id=\"daa826e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Pharmacies, laboratories, medical and cosmetic centers...<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-23dd717 elementor-button-align-end elementor-widget elementor-widget-form\" data-id=\"23dd717\" data-element_type=\"widget\" data-settings=\"{&quot;button_width&quot;:&quot;20&quot;,&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" id=\"physicianregistrationform\" name=\"Physician registration form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"8913\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"23dd717\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Center name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-phonenumber elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[phonenumber]\" id=\"form-field-phonenumber\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"phone number\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-family elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-family\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlease enter the required center:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[family]\" id=\"form-field-family\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"Pharmacy\">Pharmacy<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Medical Laboratory\">Medical Laboratory<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Medical Centers\">Medical Centers<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Beauty Centers\">Beauty Centers<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Radiology\">Radiology<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ultrasound\">Ultrasound<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Governorate\/city\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-nationalcode elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[nationalcode]\" id=\"form-field-nationalcode\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Full address of the center \" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-fathersname elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[fathersname]\" id=\"form-field-fathersname\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Website link or Instagram page \">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100\">\n\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"4\" placeholder=\"Additional comments or your message to us \"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-fileupload elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-fileupload\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlease upload your operating license:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[fileupload][]\" id=\"form-field-fileupload\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" multiple=\"multiple\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_2b5afe1 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2b5afe1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlease upload a picture of the manager:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_2b5afe1][]\" id=\"form-field-field_2b5afe1\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" multiple=\"multiple\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-20 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm elementor-animation-grow\" type=\"submit\" id=\"send\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">sends<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Pharmacies, laboratories, medical and cosmetic centers&#8230;<\/p>\n","protected":false},"author":15,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8913","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/iranafra.com\/en\/wp-json\/wp\/v2\/pages\/8913","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/iranafra.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/iranafra.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/iranafra.com\/en\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/iranafra.com\/en\/wp-json\/wp\/v2\/comments?post=8913"}],"version-history":[{"count":4,"href":"https:\/\/iranafra.com\/en\/wp-json\/wp\/v2\/pages\/8913\/revisions"}],"predecessor-version":[{"id":8932,"href":"https:\/\/iranafra.com\/en\/wp-json\/wp\/v2\/pages\/8913\/revisions\/8932"}],"wp:attachment":[{"href":"https:\/\/iranafra.com\/en\/wp-json\/wp\/v2\/media?parent=8913"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}