{"id":6380,"date":"2018-12-24T13:42:18","date_gmt":"2018-12-24T13:42:18","guid":{"rendered":"https:\/\/www.swissmicrodentistry.com\/?page_id=6380"},"modified":"2019-01-30T10:34:34","modified_gmt":"2019-01-30T10:34:34","slug":"referral","status":"publish","type":"page","link":"https:\/\/www.swissmicrodentistry.com\/en\/referral\/","title":{"rendered":"Referral"},"content":{"rendered":"[vc_row type=”full_width_background” full_screen_row_position=”middle” bg_image=”5897″ bg_position=”center top” bg_repeat=”no-repeat” scene_position=”center” text_color=”light” text_align=”left” top_padding=”11%” bottom_padding=”11%” color_overlay=”rgba(10,10,10,0.13)” overlay_strength=”0.8″ shape_divider_position=”bottom” bg_image_animation=”zoom-out-slow” parallax_bg=”true” parallax_bg_speed=”fixed” shape_type=””][vc_column centered_text=”true” column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ column_link_target=”_self” column_shadow=”none” column_border_radius=”none” width=”1\/1″ tablet_width_inherit=”default” tablet_text_alignment=”default” phone_text_alignment=”default” column_border_width=”none” column_border_style=”solid” bg_image_animation=”none”][divider line_type=”No Line” custom_height=”120″][\/vc_column][\/vc_row][vc_row type=”full_width_background” full_screen_row_position=”middle” bg_color=”#ffffff” scene_position=”center” text_color=”dark” text_align=”left” top_padding=”8%” bottom_padding=”7%” id=”about-text” overlay_strength=”1″ shape_divider_position=”bottom” bg_image_animation=”none” shape_type=””][vc_column column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ column_link_target=”_self” column_shadow=”none” column_border_radius=”none” width=”1\/1″ tablet_width_inherit=”default” tablet_text_alignment=”default” phone_text_alignment=”default” column_border_width=”none” column_border_style=”solid” bg_image_animation=”none” enable_animation=”true” animation=”fade-in-from-bottom”][vc_column_text css_animation=”fadeInUp” css=”.vc_custom_1545658928922{padding-bottom: 1.5% !important;}”]\n

Referral<\/h1>\n[\/vc_column_text][vc_row_inner column_margin=”default” text_align=”left”][vc_column_inner column_padding=”padding-3-percent” column_padding_position=”top-bottom” background_color_opacity=”1″ background_hover_color_opacity=”1″ column_shadow=”none” column_border_radius=”none” column_link_target=”_self” width=”1\/1″ tablet_width_inherit=”default” column_border_width=”none” column_border_style=”solid” bg_image_animation=”none” enable_animation=”true” animation=”fade-in-from-bottom”][vc_column_text css=”.vc_custom_1545658888988{padding-right: 10% !important;}”]Fields with * are mandatory.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner column_margin=”default” text_align=”left”][vc_column_inner column_padding=”padding-3-percent” column_padding_position=”top-bottom” background_color_opacity=”1″ background_hover_color_opacity=”1″ column_shadow=”none” column_border_radius=”none” column_link_target=”_self” width=”1\/1″ tablet_width_inherit=”default” column_border_width=”none” column_border_style=”solid” bg_image_animation=”none” enable_animation=”true” animation=”fade-in-from-bottom”]\n
\n

<\/p>

    <\/ul><\/div>\n
    \n
    \n<\/fieldset>\n
    \n\t

    Referral dental office\n\t<\/h3>\n\t

     \n\t<\/p>\n\t

    Referring dental practice*
    \n<\/span>\n\t<\/p>\n\t

    Referring dentist*
    \n<\/span>\n\t<\/p>\n\t

    Street\/No*
    \n<\/span>\n\t<\/p>\n\t

    Postcode\/City*
    \n<\/span>\n\t<\/p>\n\t

    Phone number*
    \n<\/span>\n\t<\/p>\n\t

    E-Mail-Address*
    \n<\/span>\n\t<\/p>\n\t

     \n\t<\/p>\n<\/div>\n

    \n\t

    Patient information\n\t<\/h3>\n\t

     \n\t<\/p>\n\t

    First name (Patient)*
    \n<\/span>\n\t<\/p>\n\t

    Last name (Patient)*
    \n<\/span>\n\t<\/p>\n\t

    Street\/No (Patient)*
    \n<\/span>\n\t<\/p>\n\t

    Postcode\/City (Patient)*
    \n<\/span>\n\t<\/p>\n\t

    Phone (Patient)*
    \n<\/span>\n\t<\/p>\n\t

    E-Mail-Address (Patient)
    \n<\/span>\n\t<\/p>\n\t

     \n\t<\/p>\n<\/div>\n

    \n\t

    Desired treatment\n\t<\/h3>\n\t

     \n\t<\/p>\n\t

    Tooth\/s No.*
    \n<\/span>\n\t<\/p>\n\t

    Root canal treatment<\/span><\/span>Root canal re-treatment<\/span><\/span>Apical microsurgery<\/span><\/span><\/span><\/span>\n\t<\/p>\n\t

    Therapy urgency*
    \nurgent<\/span><\/span>not urgent<\/span><\/span><\/span><\/span>\n\t<\/p>\n\t

    Attachment 1 (X-ray photograph etc.)
    \n<\/span>\n\t<\/p>\n\t

    Attachment 2 (X-ray photograph etc.)
    \n<\/span>\n\t<\/p>\n\t

    Other comments
    \n