{"id":1007,"date":"2024-11-11T11:26:28","date_gmt":"2024-11-11T11:26:28","guid":{"rendered":"https:\/\/nypeye.com\/?page_id=1007"},"modified":"2026-03-02T20:47:41","modified_gmt":"2026-03-02T20:47:41","slug":"appointment-request","status":"publish","type":"page","link":"https:\/\/nypeye.com\/es\/appointment-request\/","title":{"rendered":"Solicitud de cita"},"content":{"rendered":"<style>.elementor-1007 .elementor-element.elementor-element-1820a242 > .elementor-background-overlay{background-color:var( --e-global-color-primary );opacity:0.9;}.elementor-1007 .elementor-element.elementor-element-1820a242 > .elementor-container{max-width:1170px;}.elementor-1007 .elementor-element.elementor-element-1820a242{padding:100px 0px 100px 0px;z-index:0;}.elementor-1007 .elementor-element.elementor-element-692b9fff{text-align:center;}.elementor-1007 .elementor-element.elementor-element-692b9fff .elementor-heading-title{font-family:var( --e-global-typography-secondary-font-family ), 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.elementor-element.elementor-element-1820a242{margin-top:0px;margin-bottom:0px;padding:152px 10px 80px 10px;}.elementor-1007 .elementor-element.elementor-element-692b9fff .elementor-heading-title{font-size:var( --e-global-typography-secondary-font-size );line-height:var( --e-global-typography-secondary-line-height );}}<\/style>\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1007\" class=\"elementor elementor-1007\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1820a242 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1820a242\" data-element_type=\"section\">\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-21af49b1\" data-id=\"21af49b1\" 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-692b9fff elementor-widget elementor-widget-heading\" data-id=\"692b9fff\" 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\">Solicitud de cita\n\n<\/h2>\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-3337ff98 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3337ff98\" 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-2c8f6f8a\" data-id=\"2c8f6f8a\" 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-13c077c4 elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"13c077c4\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&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\" name=\"Appointment Request\" action=\"\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1007\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"13c077c4\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Appointment Request - NY Partners Ophthalmology\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1007\"\/>\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-radio elementor-field-group elementor-column elementor-field-group-field_33e46b2 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_33e46b2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you a new or returning patient?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"New\" id=\"form-field-field_33e46b2-0\" name=\"form_fields[field_33e46b2]\" required=\"required\"> <label for=\"form-field-field_33e46b2-0\">New<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Returning \" id=\"form-field-field_33e46b2-1\" name=\"form_fields[field_33e46b2]\" required=\"required\"> <label for=\"form-field-field_33e46b2-1\">Returning <\/label><\/span><\/div>\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-name elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNombre de pila\t\t\t\t\t\t\t<\/label>\n\t\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-md  elementor-field-textual\" placeholder=\"Nombre de pila\" 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-field_d22811e elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d22811e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tApellido\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d22811e]\" id=\"form-field-field_d22811e\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Apellido\" 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-email 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<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCorreo electr\u00f3nico\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Correo electr\u00f3nico\" 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-tel elementor-field-group elementor-column elementor-field-group-field_58ca5cb elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_58ca5cb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tN\u00famero de tel\u00e9fono\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_58ca5cb]\" id=\"form-field-field_58ca5cb\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"N\u00famero de tel\u00e9fono\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_ccbdbef elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ccbdbef\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of Birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_ccbdbef]\" id=\"form-field-field_ccbdbef\" class=\"elementor-field elementor-size-md  elementor-field-textual elementor-date-field elementor-use-native\" placeholder=\"Date of Birth\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_5b387a7 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5b387a7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSex\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Male\" id=\"form-field-field_5b387a7-0\" name=\"form_fields[field_5b387a7]\" required=\"required\"> <label for=\"form-field-field_5b387a7-0\">Male<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Female\" id=\"form-field-field_5b387a7-1\" name=\"form_fields[field_5b387a7]\" required=\"required\"> <label for=\"form-field-field_5b387a7-1\">Female<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Other\" id=\"form-field-field_5b387a7-2\" name=\"form_fields[field_5b387a7]\" required=\"required\"> <label for=\"form-field-field_5b387a7-2\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_26bb138 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_26bb138\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhich Office\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Brooklyn\" id=\"form-field-field_26bb138-0\" name=\"form_fields[field_26bb138]\"> <label for=\"form-field-field_26bb138-0\">Brooklyn<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Flushing, Queens\" id=\"form-field-field_26bb138-1\" name=\"form_fields[field_26bb138]\"> <label for=\"form-field-field_26bb138-1\">Flushing, Queens<\/label><\/span><\/div>\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-message elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReason for Visit (optional)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[message]\" id=\"form-field-message\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Reason for Visit\">\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-acceptance elementor-field-group elementor-column elementor-field-group-field_e4d4872 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_e4d4872]\" id=\"form-field-field_e4d4872\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\" checked=\"checked\">\n\t\t\t\t<label for=\"form-field-field_e4d4872\">I have read and agreed to the <a href=\"https:\/\/nypeye.com\/es\/privacy-policy\/\">Privacy Policy<\/a> and <a href=\"https:\/\/nypeye.com\/es\/terms-conditions\/\"> Terms of Use<\/a> and I am at least 13 and have the authority to make this appointment.\n<\/label>\t\t\t<\/span>\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-acceptance elementor-field-group elementor-column elementor-field-group-field_d0b67d3 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_d0b67d3]\" id=\"form-field-field_d0b67d3\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\">\n\t\t\t\t<label for=\"form-field-field_d0b67d3\">I agree to receive text messages from this practice and understand that message frequency and data rates may apply.<\/label>\t\t\t<\/span>\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-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\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\">Enviar<\/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<input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/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<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t\n    <div class=\"xs_social_share_widget xs_share_url after_content \t\tmain_content  wslu-style-1 wslu-share-box-shaped wslu-fill-colored wslu-none wslu-share-horizontal wslu-theme-font-no wslu-main_content\">\n\n\t\t\n        <ul>\n\t\t\t        <\/ul>\n    <\/div>","protected":false},"excerpt":{"rendered":"<p>Solicitud de 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