{"id":9830,"date":"2019-11-11T21:02:47","date_gmt":"2019-11-11T21:02:47","guid":{"rendered":"https:\/\/www.advanceddoctorsaco.org\/?page_id=9830"},"modified":"2023-10-04T17:43:22","modified_gmt":"2023-10-04T17:43:22","slug":"physician-enrollment-form","status":"publish","type":"page","link":"https:\/\/nhealthnetworkpartners.com\/?page_id=9830","title":{"rendered":"Physician Enrollment Form"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\"  style='background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;'><div class=\"fusion-builder-row fusion-row \"><div  class=\"fusion-layout-column fusion_builder_column fusion_builder_column_1_1 fusion-builder-column-1 fusion-one-full fusion-column-first fusion-column-last 1_1\"  style='margin-top:0px;margin-bottom:20px;'>\n\t\t\t\t\t<div class=\"fusion-column-wrapper\" style=\"padding: 0px 0px 0px 0px;background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;\"   data-bg-url=\"\">\n\t\t\t\t\t\t\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f10619-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F9830#wpcf7-f10619-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"10619\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f10619-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><label>Name: (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fullname\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please enter your name\" value=\"\" type=\"text\" name=\"fullname\" \/><\/span><\/label>\n<\/p>\n<p><label>Address:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address1\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address1\" \/><\/span><\/label>\n<\/p>\n<p><label>Address 2:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"address2\" 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wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email-247\" \/><\/span><\/label>\n<\/p>\n<p><label>Questions or Comments?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-259\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-259\"><\/textarea><\/span><\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Enroll\" \/>\n<\/p><div class=\"fusion-alert alert custom alert-custom fusion-alert-center wpcf7-response-output fusion-alert-capitalize alert-dismissable\" style=\"border-width:1px;\"><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-hidden=\"true\">&times;<\/button><div class=\"fusion-alert-content-wrapper\"><span class=\"fusion-alert-content\"><\/span><\/div><\/div>\n<\/form>\n<\/div>\n<div 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