{"id":209,"date":"2024-12-18T11:42:31","date_gmt":"2024-12-18T11:42:31","guid":{"rendered":"https:\/\/www.centralcmhospital.com\/?page_id=209"},"modified":"2025-03-21T09:16:08","modified_gmt":"2025-03-21T09:16:08","slug":"appointments-form","status":"publish","type":"page","link":"https:\/\/www.centralcmhospital.com\/th\/appointments-form\/","title":{"rendered":"\u0e01\u0e32\u0e23\u0e19\u0e31\u0e14\u0e2b\u0e21\u0e32\u0e22"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"209\" class=\"elementor elementor-209\" data-elementor-post-type=\"page\">\n\t\t\t\t<div data-dce-background-image-url=\"https:\/\/www.centralcmhospital.com\/wp-content\/uploads\/2025\/01\/Asset-1.png\" class=\"elementor-element elementor-element-3fcfa6 e-flex e-con-boxed e-con e-parent\" data-id=\"3fcfa6\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-792f1c86 e-con-full e-flex e-con e-child\" data-id=\"792f1c86\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-27ab85fa e-con-full e-flex e-con e-child\" data-id=\"27ab85fa\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3b92d01f elementor-widget elementor-widget-heading\" data-id=\"3b92d01f\" 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\">\u0e19\u0e31\u0e14\u0e2b\u0e21\u0e32\u0e22<\/br>\n<span style=\"color: #05B79F\">\u0e41\u0e1e\u0e17\u0e22\u0e4c<\/span><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c227a0b elementor-widget__width-initial elementor-widget elementor-widget-spacer\" data-id=\"c227a0b\" 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\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\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-133f21d elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"133f21d\" 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 Form\" action=\"\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"209\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"133f21d\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Central Memorial Hospital\" \/>\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-step elementor-field-group elementor-column elementor-field-group-field_56032ee elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Appointment Info\" data-previousbutton=\"\" data-nextbutton=\"\" data-iconurl=\"\" data-iconlibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\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-field_2e3fb64 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2e3fb64\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u0e40\u0e25\u0e37\u0e2d\u0e01\u0e04\u0e27\u0e32\u0e21\u0e0a\u0e33\u0e19\u0e32\u0e0d\u0e41\u0e1e\u0e17\u0e22\u0e4c :\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<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewbox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_2e3fb64]\" id=\"form-field-field_2e3fb64\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Central Chiangmai Aesthetics Center\">\u0e28\u0e39\u0e19\u0e22\u0e4c\u0e04\u0e27\u0e32\u0e21\u0e07\u0e32\u0e21\u0e40\u0e0b\u0e47\u0e19\u0e17\u0e23\u0e31\u0e25\u0e40\u0e0a\u0e35\u0e22\u0e07\u0e43\u0e2b\u0e21\u0e48<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Central Chiang Mai Memorial Hospital medical service\">\u0e28\u0e39\u0e19\u0e22\u0e4c\u0e01\u0e32\u0e23\u0e41\u0e1e\u0e17\u0e22\u0e4c\u0e42\u0e23\u0e07\u0e1e\u0e22\u0e32\u0e1a\u0e32\u0e25\u0e40\u0e0b\u0e47\u0e19\u0e17\u0e23\u0e31\u0e25\u0e40\u0e0a\u0e35\u0e22\u0e07\u0e43\u0e2b\u0e21\u0e48\u0e40\u0e21\u0e42\u0e21\u0e40\u0e23\u0e35\u0e22\u0e25<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Central Chiangmai Healthcare Vending Machine\">\u0e15\u0e39\u0e49\u0e08\u0e33\u0e2b\u0e19\u0e48\u0e32\u0e22\u0e22\u0e32\u0e2d\u0e31\u0e15\u0e42\u0e19\u0e21\u0e31\u0e15\u0e34\u0e40\u0e0b\u0e47\u0e19\u0e17\u0e23\u0e31\u0e25\u0e40\u0e0a\u0e35\u0e22\u0e07\u0e43\u0e2b\u0e21\u0e48<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"CCMH Speedy Care Service\">\u0e1a\u0e23\u0e34\u0e01\u0e32\u0e23\u0e14\u0e39\u0e41\u0e25\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e40\u0e0b\u0e47\u0e19\u0e17\u0e23\u0e31\u0e25\u0e40\u0e0a\u0e35\u0e22\u0e07\u0e43\u0e2b\u0e21\u0e48<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Central Care Clinic\">Central Care Clinic<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Universal Coverage Scheme\">\u0e2a\u0e34\u0e17\u0e18\u0e34\u0e2b\u0e25\u0e31\u0e01\u0e1b\u0e23\u0e30\u0e01\u0e31\u0e19\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e41\u0e2b\u0e48\u0e07\u0e0a\u0e32\u0e15\u0e34<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Central chiangmai medical cannabis wellness\">\u0e28\u0e39\u0e19\u0e22\u0e4c\u0e01\u0e31\u0e0d\u0e0a\u0e32\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e01\u0e32\u0e23\u0e41\u0e1e\u0e17\u0e22\u0e4c\u0e40\u0e0b\u0e47\u0e19\u0e17\u0e23\u0e31\u0e25\u0e40\u0e0a\u0e35\u0e22\u0e07\u0e43\u0e2b\u0e21\u0e48<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Central Chiangmai Wellness Center\">\u0e28\u0e39\u0e19\u0e22\u0e4c\u0e15\u0e23\u0e27\u0e08\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e40\u0e0b\u0e47\u0e19\u0e17\u0e23\u0e31\u0e25\u0e40\u0e0a\u0e35\u0e22\u0e07\u0e43\u0e2b\u0e21\u0e48<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Central Chiangmai Trauma &#038; Emergency Center\">\u0e28\u0e39\u0e19\u0e22\u0e4c\u0e2d\u0e38\u0e1a\u0e31\u0e15\u0e34\u0e40\u0e2b\u0e15\u0e38\u0e40\u0e0b\u0e47\u0e19\u0e17\u0e23\u0e31\u0e25\u0e40\u0e0a\u0e35\u0e22\u0e07\u0e43\u0e2b\u0e21\u0e48<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Central Chiangmai Medical 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elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3f428e3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u0e2d\u0e32\u0e01\u0e32\u0e23\u0e2b\u0e23\u0e37\u0e2d\u0e1b\u0e31\u0e0d\u0e0d\u0e2b\u0e32\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e02\u0e2d\u0e07\u0e04\u0e38\u0e13 :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_3f428e3]\" id=\"form-field-field_3f428e3\" rows=\"4\" required=\"required\"><\/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-field_f41ef2b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f41ef2b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u0e41\u0e19\u0e1a\u0e23\u0e39\u0e1b\u0e1b\u0e23\u0e30\u0e01\u0e2d\u0e1a\u0e2d\u0e32\u0e01\u0e32\u0e23 (\u0e44\u0e21\u0e48\u0e1a\u0e31\u0e07\u0e04\u0e31\u0e1a) 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512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\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-field_90f0676 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_90f0676\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u0e0a\u0e37\u0e48\u0e2d\u0e1c\u0e39\u0e49\u0e1b\u0e48\u0e27\u0e22 :\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_90f0676]\" id=\"form-field-field_90f0676\" class=\"elementor-field elementor-size-sm  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