{"id":8893,"date":"2025-06-18T08:37:23","date_gmt":"2025-06-18T00:37:23","guid":{"rendered":"https:\/\/allcancer.com\/%e7%b4%84%e6%9c%83\/"},"modified":"2025-07-07T13:22:37","modified_gmt":"2025-07-07T05:22:37","slug":"%e7%b4%84%e6%9c%83","status":"publish","type":"page","link":"https:\/\/allcancer.com\/hk\/%e7%b4%84%e6%9c%83\/","title":{"rendered":"\u7d04\u6703"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"8893\" class=\"elementor elementor-8893\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4a2f4e73 e-flex e-con-boxed e-con e-parent\" data-id=\"4a2f4e73\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a4305a2 elementor-widget elementor-widget-shortcode\" data-id=\"a4305a2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\r\n<div class=\"ugf-bg ufg-main-container\">\r\n    <div class=\"container\">\r\n        <div class=\"row\">\r\n            <div class=\"col-lg-12\">\r\n                <div class=\"ugf-form\">\r\n                    <form id=\"commentForm\" enctype=\"multipart\/form-data\">\r\n                        <div class=\"input-block\">\r\n                            <h4 style=\"margin-bottom: 50px\">Personal Information<\/h4>\r\n                            <div class=\"row\" style=\"margin-bottom: 50px;\">\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputFname\">First Name\r\n                                            <span style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <input type=\"text\" name=\"first_name\" class=\"form-control\" id=\"inputFname\"\r\n                                            placeholder=\"e.g. Robert\" data-must-fill=\"true\">\r\n                                        <span class=\"error\" style=\"color: red; display: none;\"><\/span>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputLname\">Last Name <span\r\n                                                style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <input type=\"text\" name=\"last_name\" class=\"form-control\" id=\"inputLname\"\r\n                                            placeholder=\"e.g. Smith\">\r\n                                        <span class=\"error\" style=\"color: red; display: none;\"><\/span>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputPreferredLname\">Preferred name<\/label>\r\n                                        <input type=\"text\" name=\"preferred_name\" class=\"form-control\"\r\n                                            id=\"inputPreferredLname\" placeholder=\"e.g. Robert\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">    \r\n                                        <label for=\"inputRelationship\">Relationship to the Patient <span\r\n                                                style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <div class=\"relationship\">\r\n                                            <select name=\"relationship\" class=\"form-control\" id=\"inputRelationship\">\r\n                                                <option value=\"\">Relationship<\/option>\r\n                                                <option value=\"Myself\">Myself<\/option>\r\n                                                <option value=\"Spouse\/Partner\">Spouse\/Partner<\/option>\r\n                                                <option value=\"Child\">Child<\/option>\r\n                                                <option value=\"Parent\">Parent<\/option>\r\n                                                <option value=\"Sibling\">Sibling<\/option>\r\n                                                <option value=\"Other Relative\">Other Relative<\/option>\r\n                                                <option value=\"Friend\">Friend<\/option>\r\n                                                <option value=\"Caregiver\">Caregiver<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputPnumber\">Phone Number <span\r\n                                                style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <input type=\"text\" name=\"phone_number\" class=\"form-control\" id=\"inputPnumber\"\r\n                                            placeholder=\"e.g. +85296009600\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputEmail\">Email <span style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <input type=\"email\" name=\"email\" class=\"form-control\" id=\"inputEmail\"\r\n                                            placeholder=\"e.g. allcancer@gmail.com\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputWeChat\">WeChat<\/label>\r\n                                        <input type=\"text\" name=\"wechat\" class=\"form-control\" id=\"inputWeChat\"\r\n                                            placeholder=\"e.g. +85296009600\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputWhatsapp\">WhatsApp<\/label>\r\n                                        <input type=\"text\" name=\"whatsapp\" class=\"form-control\" id=\"inputWhatsapp\"\r\n                                            placeholder=\"e.g. +85296009600\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputLine\">Line<\/label>\r\n                                        <input type=\"text\" name=\"line\" class=\"form-control\" id=\"inputLine\"\r\n                                            placeholder=\"e.g. robertlineid\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputOtherIM\">Other IM<\/label>\r\n                                        <input type=\"text\" name=\"other_im\" class=\"form-control\" id=\"inputOtherIM\"\r\n                                            placeholder=\"e.g. Skype ID\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"formcountry country-select\">\r\n                                        <label for=\"inputNationality\" style=\"    font-size: 16px !important;\r\n                                         align-items: baseline !important;\r\n                                                display: flex !important\r\n                                            ;\r\n                                                gap: 5px !important;\r\n                                                    font-weight: 700;\r\n                                                font-family: DM Sans !important;\r\n                                                margin-bottom: 10px;\r\n                                            \">Country of Nationality <span style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <div class=\"select-input choose-country\">\r\n                                            <select id=\"inputNationality\" name=\"nationality\" class=\"form-control\">\r\n                                                <option value=\"\">Country<\/option>\r\n                                                <option value=\"Hong Kong\">Hong Kong<\/option>\r\n                                                <option value=\"USA\">USA<\/option>\r\n                                                <option value=\"Russia\">Russia<\/option>\r\n                                                <option value=\"China\">China<\/option>\r\n                                                <option value=\"England\">England<\/option>\r\n                                                <option value=\"France\">France<\/option>\r\n                                                <option value=\"Germany\">Germany<\/option>\r\n                                                <option value=\"Spain\">Spain<\/option>\r\n                                                <option value=\"Netherland\">Netherland<\/option>\r\n                                                <option value=\"Singapore\">Singapore<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label>Date of Birth <span style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <div class=\"birth-date\">\r\n                                            <div class=\"select-input birth-date-input\">\r\n                                                <select id=\"dob_date\" name=\"dob_date\" class=\"form-control\">\r\n                                                    <option value=\"\">Date<\/option>\r\n                                                                                                            <option value=\"01\">\r\n                                                            01                                                        <\/option>\r\n                                                                                                            <option value=\"02\">\r\n                                                            02                                                        <\/option>\r\n                                                                                                            <option value=\"03\">\r\n                                                            03                                                        <\/option>\r\n                                                                                                            <option value=\"04\">\r\n                                                            04                                                        <\/option>\r\n                                                                                                            <option value=\"05\">\r\n                                                            05                                                        <\/option>\r\n                                                                                                            <option value=\"06\">\r\n                                                            06                                                        <\/option>\r\n                                                                                                            <option value=\"07\">\r\n                                                            07                                                        <\/option>\r\n                                                                                                            <option value=\"08\">\r\n                                                            08                                                        <\/option>\r\n                                                                                                            <option value=\"09\">\r\n                                                            09                                                        <\/option>\r\n                                                                                                            <option value=\"10\">\r\n                                                            10                                                        <\/option>\r\n                                                                                                            <option value=\"11\">\r\n                                                            11                                                        <\/option>\r\n                                                                                                            <option value=\"12\">\r\n                                                            12                                                        <\/option>\r\n                                                                                                            <option value=\"13\">\r\n                                                            13                                                        <\/option>\r\n                                                                                                            <option value=\"14\">\r\n                                                            14                                                        <\/option>\r\n                                                                                                            <option value=\"15\">\r\n                                                            15                                                        <\/option>\r\n                                                                                                            <option value=\"16\">\r\n                                                            16                                                        <\/option>\r\n                                                                                                            <option value=\"17\">\r\n                                                            17                                                        <\/option>\r\n                                                                                                            <option value=\"18\">\r\n                                                            18                                                        <\/option>\r\n                                                                                                            <option value=\"19\">\r\n                                                            19                                                        <\/option>\r\n                                                                                                            <option value=\"20\">\r\n                                                            20                                                        <\/option>\r\n                                                                                                            <option value=\"21\">\r\n                                                            21                                                        <\/option>\r\n                                                                                                            <option value=\"22\">\r\n                                                            22                                                        <\/option>\r\n                                                                                                            <option value=\"23\">\r\n                                                            23                                                        <\/option>\r\n                                                                                                            <option value=\"24\">\r\n                                                            24                                                        <\/option>\r\n                                                                                                            <option value=\"25\">\r\n                                                            25                                                        <\/option>\r\n                                                                                                            <option value=\"26\">\r\n                                                            26                                                        <\/option>\r\n                                                                                                            <option value=\"27\">\r\n                                                            27                                                        <\/option>\r\n                                                                                                            <option value=\"28\">\r\n                                                            28                                                        <\/option>\r\n                                                                                                            <option value=\"29\">\r\n                                                            29                                                        <\/option>\r\n                                                                                                            <option value=\"30\">\r\n                                                            30                                                        <\/option>\r\n                                                                                                            <option value=\"31\">\r\n                                                            31                                                        <\/option>\r\n                                                                                                    <\/select>\r\n                                            <\/div>\r\n                                            <div class=\"select-input birth-date-input\">\r\n                                                <select id=\"dob_month\" name=\"dob_month\" class=\"form-control\">\r\n                                                    <option value=\"\">Month<\/option>\r\n                                                                                                            <option value=\"01\">\r\n                                                            01                                                        <\/option>\r\n                                                                                                            <option value=\"02\">\r\n                                                            02                                                        <\/option>\r\n                                                                                                            <option value=\"03\">\r\n                                                            03                                                        <\/option>\r\n                                                                                                            <option value=\"04\">\r\n                                                            04                                                        <\/option>\r\n                                                                                                            <option value=\"05\">\r\n                                                            05                                                        <\/option>\r\n                                                                                                            <option value=\"06\">\r\n                                                            06                                                        <\/option>\r\n                                                                                                            <option value=\"07\">\r\n                                                            07                                                        <\/option>\r\n                                                                                                            <option value=\"08\">\r\n                                                            08                                                        <\/option>\r\n                                                                                                            <option value=\"09\">\r\n                                                            09                                                        <\/option>\r\n                                                                                                            <option value=\"10\">\r\n                                                            10                                                        <\/option>\r\n                                                                                                            <option value=\"11\">\r\n                                                            11                                                        <\/option>\r\n                                                                                                            <option value=\"12\">\r\n                                                            12                                                        <\/option>\r\n                                                                                                    <\/select>\r\n                                            <\/div>\r\n                                            <div class=\"select-input birth-date-input\">\r\n                                                <select id=\"dob_year\" name=\"dob_year\" class=\"form-control\">\r\n                                                    <option value=\"\">Year<\/option>\r\n                                                                                                            <option value=\"2035\">2035<\/option>\r\n                                                                                                            <option value=\"2034\">2034<\/option>\r\n                                                                                                            <option value=\"2033\">2033<\/option>\r\n                                                                                                            <option value=\"2032\">2032<\/option>\r\n                                                                                                            <option value=\"2031\">2031<\/option>\r\n                                                                                                            <option value=\"2030\">2030<\/option>\r\n                                                                                                            <option value=\"2029\">2029<\/option>\r\n                                                                                                            <option value=\"2028\">2028<\/option>\r\n                                                                                                            <option value=\"2027\">2027<\/option>\r\n                                                                                                            <option value=\"2026\">2026<\/option>\r\n                                                                                                            <option value=\"2025\">2025<\/option>\r\n                                                                                                            <option value=\"2024\">2024<\/option>\r\n                                                                                                            <option value=\"2023\">2023<\/option>\r\n                                                                                                            <option value=\"2022\">2022<\/option>\r\n                                                                                                            <option value=\"2021\">2021<\/option>\r\n                                                                                                            <option value=\"2020\">2020<\/option>\r\n                                                                                                            <option value=\"2019\">2019<\/option>\r\n                                                                                                            <option value=\"2018\">2018<\/option>\r\n                                                                                                            <option value=\"2017\">2017<\/option>\r\n                                                                                                            <option value=\"2016\">2016<\/option>\r\n                                                                                                            <option value=\"2015\">2015<\/option>\r\n                                                                                                            <option value=\"2014\">2014<\/option>\r\n                                                                                                            <option value=\"2013\">2013<\/option>\r\n                                                                                                            <option value=\"2012\">2012<\/option>\r\n                                                                                                            <option value=\"2011\">2011<\/option>\r\n                                                                                                            <option value=\"2010\">2010<\/option>\r\n                                                                                                            <option value=\"2009\">2009<\/option>\r\n                                                                                                            <option value=\"2008\">2008<\/option>\r\n                                                                                                            <option value=\"2007\">2007<\/option>\r\n                                                                                                            <option value=\"2006\">2006<\/option>\r\n                                                                                                            <option value=\"2005\">2005<\/option>\r\n                                                                                                            <option value=\"2004\">2004<\/option>\r\n                                                                                                            <option value=\"2003\">2003<\/option>\r\n                                                                                                            <option value=\"2002\">2002<\/option>\r\n                                                                                                            <option value=\"2001\">2001<\/option>\r\n                                                                                                            <option value=\"2000\">2000<\/option>\r\n                                                                                                            <option value=\"1999\">1999<\/option>\r\n                                                                                                            <option value=\"1998\">1998<\/option>\r\n                                                                                                            <option value=\"1997\">1997<\/option>\r\n                                                                                                            <option value=\"1996\">1996<\/option>\r\n                                                                                                            <option value=\"1995\">1995<\/option>\r\n                                                                                                            <option value=\"1994\">1994<\/option>\r\n                                                                                                            <option value=\"1993\">1993<\/option>\r\n                                                                                                            <option value=\"1992\">1992<\/option>\r\n                                                                                                            <option value=\"1991\">1991<\/option>\r\n                                                                                                            <option value=\"1990\">1990<\/option>\r\n                                                                                                            <option value=\"1989\">1989<\/option>\r\n                                                                                                            <option value=\"1988\">1988<\/option>\r\n                                                                                                            <option value=\"1987\">1987<\/option>\r\n                                                                                                            <option value=\"1986\">1986<\/option>\r\n                                                                                                            <option value=\"1985\">1985<\/option>\r\n                                                                                                            <option value=\"1984\">1984<\/option>\r\n                                                                                                            <option value=\"1983\">1983<\/option>\r\n                                                                                                            <option value=\"1982\">1982<\/option>\r\n                                                                                                            <option value=\"1981\">1981<\/option>\r\n                                                                                                            <option value=\"1980\">1980<\/option>\r\n                                                                                                            <option value=\"1979\">1979<\/option>\r\n                                                                                                            <option value=\"1978\">1978<\/option>\r\n                                                                                                            <option value=\"1977\">1977<\/option>\r\n                                                                                                            <option value=\"1976\">1976<\/option>\r\n                                                                                                            <option value=\"1975\">1975<\/option>\r\n                                                                                                            <option value=\"1974\">1974<\/option>\r\n                                                                                                            <option value=\"1973\">1973<\/option>\r\n                                                                                                            <option value=\"1972\">1972<\/option>\r\n                                                                                                            <option value=\"1971\">1971<\/option>\r\n                                                                                                            <option value=\"1970\">1970<\/option>\r\n                                                                                                            <option value=\"1969\">1969<\/option>\r\n                                                                                                            <option value=\"1968\">1968<\/option>\r\n                                                                                                            <option value=\"1967\">1967<\/option>\r\n                                                                                                            <option value=\"1966\">1966<\/option>\r\n                                                                                                            <option value=\"1965\">1965<\/option>\r\n                                                                                                            <option value=\"1964\">1964<\/option>\r\n                                                                                                            <option value=\"1963\">1963<\/option>\r\n                                                                                                            <option value=\"1962\">1962<\/option>\r\n                                                                                                            <option value=\"1961\">1961<\/option>\r\n                                                                                                            <option value=\"1960\">1960<\/option>\r\n                                                                                                            <option value=\"1959\">1959<\/option>\r\n                                                                                                            <option value=\"1958\">1958<\/option>\r\n                                                                                                            <option value=\"1957\">1957<\/option>\r\n                                                                                                            <option value=\"1956\">1956<\/option>\r\n                                                                                                            <option value=\"1955\">1955<\/option>\r\n                                                                                                            <option value=\"1954\">1954<\/option>\r\n                                                                                                            <option value=\"1953\">1953<\/option>\r\n                                                                                                            <option value=\"1952\">1952<\/option>\r\n                                                                                                            <option value=\"1951\">1951<\/option>\r\n                                                                                                            <option value=\"1950\">1950<\/option>\r\n                                                                                                            <option value=\"1949\">1949<\/option>\r\n                                                                                                            <option value=\"1948\">1948<\/option>\r\n                                                                                                            <option value=\"1947\">1947<\/option>\r\n                                                                                                            <option value=\"1946\">1946<\/option>\r\n                                                                                                            <option value=\"1945\">1945<\/option>\r\n                                                                                                            <option value=\"1944\">1944<\/option>\r\n                                                                                                            <option value=\"1943\">1943<\/option>\r\n                                                                                                            <option value=\"1942\">1942<\/option>\r\n                                                                                                            <option value=\"1941\">1941<\/option>\r\n                                                                                                            <option value=\"1940\">1940<\/option>\r\n                                                                                                            <option value=\"1939\">1939<\/option>\r\n                                                                                                            <option value=\"1938\">1938<\/option>\r\n                                                                                                            <option value=\"1937\">1937<\/option>\r\n                                                                                                            <option value=\"1936\">1936<\/option>\r\n                                                                                                            <option value=\"1935\">1935<\/option>\r\n                                                                                                            <option value=\"1934\">1934<\/option>\r\n                                                                                                            <option value=\"1933\">1933<\/option>\r\n                                                                                                            <option value=\"1932\">1932<\/option>\r\n                                                                                                            <option value=\"1931\">1931<\/option>\r\n                                                                                                            <option value=\"1930\">1930<\/option>\r\n                                                                                                            <option value=\"1929\">1929<\/option>\r\n                                                                                                            <option value=\"1928\">1928<\/option>\r\n                                                                                                            <option value=\"1927\">1927<\/option>\r\n                                                                                                            <option value=\"1926\">1926<\/option>\r\n                                                                                                            <option value=\"1925\">1925<\/option>\r\n                                                                                                            <option value=\"1924\">1924<\/option>\r\n                                                                                                            <option value=\"1923\">1923<\/option>\r\n                                                                                                            <option value=\"1922\">1922<\/option>\r\n                                                                                                            <option value=\"1921\">1921<\/option>\r\n                                                                                                            <option value=\"1920\">1920<\/option>\r\n                                                                                                    <\/select>\r\n                                            <\/div>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group country-select\">\r\n                                        <label for=\"inputCountryResidence\">Country of Residence <span\r\n                                                style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <div class=\"select-input choose-country\">\r\n                                            <select id=\"inputCountryResidence\" name=\"country_residence\"\r\n                                                class=\"form-control\">\r\n                                                <option selected value=\"\">Country<\/option>\r\n                                                <option value=\"USA\">USA<\/option>\r\n                                                <option value=\"Russia\">Russia<\/option>\r\n                                                <option value=\"China\">China<\/option>\r\n                                                <option value=\"England\">England<\/option>\r\n                                                <option value=\"France\">France<\/option>\r\n                                                <option value=\"Germany\">Germany<\/option>\r\n                                                <option value=\"Spain\">Spain<\/option>\r\n                                                <option value=\"Netherland\">Netherland<\/option>\r\n                                                <option value=\"Singapur\">Singapur<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"state\">State\/Province<\/label>\r\n                                        <input type=\"text\" class=\"form-control\" name=\"state_province\" id=\"state\"\r\n                                            placeholder=\"e.g. State\/Province\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"address1\">Address Line 1<span\r\n                                                style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <input type=\"text\" class=\"form-control\" name=\"address_line_1\" id=\"address1\"\r\n                                            placeholder=\"e.g. Room 802, Marina Tower\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"address2\">Address Line 2<\/label>\r\n                                        <input type=\"text\" class=\"form-control\" name=\"address_line_2\" id=\"address2\"\r\n                                            placeholder=\"e.g. Los Beach Garden, CA 90013\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"city\">City <span style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <input type=\"text\" class=\"form-control\" name=\"city\" id=\"city\"\r\n                                            placeholder=\"e.g. City\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"zip\">Post Code<\/label>\r\n                                        <input type=\"number\" class=\"form-control\" name=\"post_code\" id=\"zip\"\r\n                                            placeholder=\"e.g. 0000\">\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-12 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label>Gender<span style=\"color: red;\"><b><\/b><\/span><\/label>\r\n                                        <div class=\"check-gender\">\r\n                                            <div class=\"custom-radio\">\r\n                                                <input type=\"radio\" name=\"gender\" class=\"custom-control-input\"\r\n                                                    id=\"Gmale\" value=\"Male\">\r\n                                                <label class=\"custom-control-label\" for=\"Gmale\">Male<\/label>\r\n                                            <\/div>\r\n                                            <div class=\"custom-radio\">\r\n                                                <input type=\"radio\" name=\"gender\" class=\"custom-control-input\"\r\n                                                    id=\"Gfemale\" value=\"Female\">\r\n                                                <label class=\"custom-control-label\" for=\"Gfemale\">Female<\/label>\r\n                                            <\/div>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                        <div class=\"input-block\">\r\n                            <h4 style=\"margin-bottom: 50px\">Medical Information<\/h4>\r\n                            <div class=\"row\" style=\"margin-bottom: 50px !important\">\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputCancerType\">Cancer Type <span\r\n                                                style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <div class=\"select-input\">\r\n                                            <select id=\"inputCancerType\" name=\"cancer_type\" class=\"form-control\">\r\n                                                <option value=\"\">-- Select Cancer Type --<\/option>\r\n                                                <option value=\"I am not sure\">I am not sure<\/option>\r\n                                                <option value=\"Breast Cancer\">Breast Cancer<\/option>\r\n                                                <option value=\"Lung Cancer\">Lung Cancer<\/option>\r\n                                                <option value=\"Colorectal Cancer\">Colorectal Cancer<\/option>\r\n                                                <option value=\"Prostate Cancer\">Prostate Cancer<\/option>\r\n                                                <option value=\"Pancreatic Cancer\">Pancreatic Cancer<\/option>\r\n                                                <option value=\"Liver Cancer\">Liver Cancer<\/option>\r\n                                                <option value=\"Ovarian Cancer\">Ovarian Cancer<\/option>\r\n                                                <option value=\"Leukemia\">Leukemia<\/option>\r\n                                                <option value=\"Lymphoma\">Lymphoma<\/option>\r\n                                                <option value=\"Melanoma\">Melanoma<\/option>\r\n                                                <option value=\"Bladder Cancer\">Bladder Cancer<\/option>\r\n                                                <option value=\"Kidney Cancer\">Kidney Cancer<\/option>\r\n                                                <option value=\"Thyroid Cancer\">Thyroid Cancer<\/option>\r\n                                                <option value=\"Endometrial Cancer\">Endometrial Cancer<\/option>\r\n                                                <option value=\"Cervical Cancer\">Cervical Cancer<\/option>\r\n                                                <option value=\"Gastric Cancer\">Gastric Cancer<\/option>\r\n                                                <option value=\"Esophageal Cancer\">Esophageal Cancer<\/option>\r\n                                                <option value=\"Brain Cancer\">Brain Cancer<\/option>\r\n                                                <option value=\"Bone Cancer\">Bone Cancer<\/option>\r\n                                                <option value=\"Skin Cancer (Non-Melanoma)\">Skin Cancer (Non-Melanoma)\r\n                                                <\/option>\r\n                                                <option value=\"Head and Neck Cancer\">Head and Neck Cancer<\/option>\r\n                                                <option value=\"Multiple Myeloma\">Multiple Myeloma<\/option>\r\n                                                <option value=\"Sarcoma\">Sarcoma<\/option>\r\n                                                <option value=\"Testicular Cancer\">Testicular Cancer<\/option>\r\n                                                <option value=\"Other\">Other<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputDiagnosisStatus\">Diagnosis Status <span\r\n                                                style=\"color: red;\"><b>*<\/b><\/span> <\/label>\r\n                                        <div class=\"select-input\">\r\n                                            <select id=\"inputDiagnosisStatus\" name=\"diagnosis_status\"\r\n                                                class=\"form-control\">\r\n                                                <option value=\"\">-- Select Diagnosis Status --<\/option>\r\n                                                <option value=\"Not yet diagnosed \/ Uncertain\">Not yet diagnosed \/\r\n                                                    Uncertain<\/option>\r\n                                                <option value=\"Stage 0 (In situ)\">Stage 0 (In situ)<\/option>\r\n                                                <option value=\"Stage I\">Stage I<\/option>\r\n                                                <option value=\"Stage II\">Stage II<\/option>\r\n                                                <option value=\"Stage III\">Stage III<\/option>\r\n                                                <option value=\"Stage IV\">Stage IV<\/option>\r\n                                                <option value=\"Recurrent\">Recurrent<\/option>\r\n                                                <option value=\"In Remission\">In Remission<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputTreatmentStatus\">Treatment Status<\/label>\r\n                                        <div class=\"select-input\">\r\n                                            <select id=\"inputTreatmentStatus\" name=\"treatment_status\"\r\n                                                class=\"form-control\">\r\n                                                <option value=\"\">-- Select Treatment Status --<\/option>\r\n                                                <option value=\"Immunotherapy\">Immunotherapy<\/option>\r\n                                                <option value=\"Chemotherapy\">Chemotherapy<\/option>\r\n                                                <option value=\"Radiotherapy\">Radiotherapy<\/option>\r\n                                                <option value=\"Multidisciplinary surgical treatment\">Multidisciplinary\r\n                                                    surgical treatment<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputMedicalStatus\">Medical Status<span\r\n                                                style=\"color: red;\"><b>*<\/b><\/span> <\/label>\r\n                                        <div class=\"select-input\">\r\n                                            <select id=\"inputMedicalStatus\" name=\"medical_status\" class=\"form-control\">\r\n                                                <option value=\"\">-- Select Medical Status --<\/option>\r\n                                                <option value=\"Under examination\">Under examination<\/option>\r\n                                                <option value=\"Under inpatient treatment\">Under inpatient treatment\r\n                                                <\/option>\r\n                                                <option value=\"Recovering at home\">Recovering at home<\/option>\r\n                                                <option value=\"Other status\">Other status<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputDiagnosisDate\">Diagnosis Date<span\r\n                                                style=\"color: red;\"><b>*<\/b><\/span><\/label>\r\n                                        <div class=\"select-input\">\r\n                                            <select id=\"inputDiagnosisDate\" name=\"diagnosis_date\" class=\"form-control\">\r\n                                                <option value=\"\">-- Select Diagnosis Date --<\/option>\r\n                                                <option value=\"Within the past 3 months\">Within the past 3 months\r\n                                                <\/option>\r\n                                                <option value=\"3\u20136 months ago\">3\u20136 months ago<\/option>\r\n                                                <option value=\"6\u201312 months ago\">6\u201312 months ago<\/option>\r\n                                                <option value=\"1\u20132 years ago\">1\u20132 years ago<\/option>\r\n                                                <option value=\"Over 2 years ago\">Over 2 years ago<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"col-md-6 p-sm-0\">\r\n                                    <div class=\"form-group\">\r\n                                        <label for=\"inputInsurance\">Health Insurance<\/label>\r\n                                        <div class=\"select-input\">\r\n                                            <select id=\"inputInsurance\" name=\"health_insurance\" class=\"form-control\">\r\n                                                <option value=\"\">-- Select Insurance Option --<\/option>\r\n                                                <option value=\"Yes, local (Hong Kong-based)\">Yes, local (Hong\r\n                                                    Kong-based)<\/option>\r\n                                                <option value=\"Yes, international\">Yes, international<\/option>\r\n                                                <option value=\"No\">No<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>  \r\n                                                        \r\n                        <div class=\"input-block\" style=\"margin-bottom: 50px;\">\r\n                            <h4>Medical Records Upload<\/h4>\r\n                            <p>Purpose: Collect detailed clinical data for accurate diagnosis and treatment planning.\r\n                            <\/p>\r\n                            <div class=\"documents-upload-wrap\">\r\n                                <div class=\"tab-content\" id=\"pills-tabContent\">\r\n                                    <div class=\"tab-pane fade show active\" id=\"passport\" role=\"tabpanel\"\r\n                                        aria-labelledby=\"home-tab\">\r\n                                        <div class=\"documents-upload\">\r\n                                            <div class=\"upload-item\">\r\n                                                <input type=\"file\" id=\"input1\" name=\"input1\" class=\"input-file\"\r\n                                                    accept=\"image\/jpeg,image\/jpg,image\/png,.pdf,.doc,.docx\" hidden \/>\r\n                                                <label class=\"btn-upload\" for=\"input1\" role=\"button\">\r\n                                                    <img decoding=\"async\"\r\n                                                        src=\"https:\/\/allcancer.com\/wp-content\/plugins\/allcancer_form_plugin\/forms\/form_one\/assets\/images\/cloud.png\">\r\n                                                    <div id=\"p-input1\" class=\"preview-box\"><\/div>\r\n                                                <\/label>\r\n                                                <div class=\"upload-direction\"><span class=\"text\">Diagnosis\r\n                                                        Records<\/span><a href=\"#\"><img decoding=\"async\"\r\n                                                            src=\"https:\/\/allcancer.com\/wp-content\/plugins\/allcancer_form_plugin\/forms\/form_one\/assets\/images\/download.png\"><\/a>\r\n                                                <\/div>\r\n                                            <\/div>\r\n                                            <div class=\"upload-item\">\r\n                                                <input type=\"file\" id=\"input2\" name=\"input2\" class=\"input-file\"\r\n                                                    accept=\"image\/jpeg,image\/jpg,image\/png,.pdf,.doc,.docx\" hidden \/>\r\n                                                <label class=\"btn-upload\" for=\"input2\" role=\"button\">\r\n                                                    <img decoding=\"async\"\r\n                                                        src=\"https:\/\/allcancer.com\/wp-content\/plugins\/allcancer_form_plugin\/forms\/form_one\/assets\/images\/cloud.png\">\r\n                                                    <div id=\"p-input2\" class=\"preview-box\"><\/div>\r\n                                                <\/label>\r\n                                                <div class=\"upload-direction\"><span class=\"text\">Pathology\r\n                                                        Report<\/span><a href=\"#\"><img decoding=\"async\"\r\n                                                            src=\"https:\/\/allcancer.com\/wp-content\/plugins\/allcancer_form_plugin\/forms\/form_one\/assets\/images\/download.png\"><\/a>\r\n                                                <\/div>\r\n                                            <\/div>\r\n                                            <div class=\"upload-item\">\r\n                                                <input type=\"file\" id=\"input3\" name=\"input3\" class=\"input-file\"\r\n                                                    accept=\"image\/jpeg,image\/jpg,image\/png,.pdf,.doc,.docx\" hidden \/>\r\n                                                <label class=\"btn-upload\" for=\"input3\" role=\"button\">\r\n                                                    <img decoding=\"async\"\r\n                                                        src=\"https:\/\/allcancer.com\/wp-content\/plugins\/allcancer_form_plugin\/forms\/form_one\/assets\/images\/cloud.png\">\r\n                                                    <div id=\"p-input3\" class=\"preview-box\"><\/div>\r\n                                                <\/label>\r\n                                                <div class=\"upload-direction\"><span class=\"text\">MRI & PET-CT<\/span><a\r\n                                                        href=\"#\"><img decoding=\"async\"\r\n                                                            src=\"https:\/\/allcancer.com\/wp-content\/plugins\/allcancer_form_plugin\/forms\/form_one\/assets\/images\/download.png\"><\/a>\r\n                                                <\/div>\r\n                                            <\/div>\r\n                                        <\/div>\r\n                                        <div class=\"conditions form-group\">\r\n                                            <div class=\"upload-resume-container\">\r\n                                                <label> <strong>Upload Other Reports <\/strong> <\/label>\r\n                                                <p>\r\n                                                    (Such as Laboratory Results; Treatment Records; Genetic Testing\r\n                                                    Results; Hospital Discharge Summaries; Other Relevant Documents)<\/p>\r\n                                                <div\r\n                                                    style=\"border: 1px dashed #ccc; padding: 10px; margin-top: 5px; display: flex; align-items: center; \">\r\n                                                    <input type=\"file\" accept=\"image\/jpeg,image\/jpg,image\/png,.pdf,.doc,.docx\" style=\"display: none;\"\r\n                                                        id=\"resume-upload\" name=\"resume-upload\">\r\n                                                    <div style=\"background: #e0e0e0; border: none; padding: 5px 10px; cursor: pointer;\"\r\n                                                        onclick=\"document.getElementById('resume-upload').click();\">+\r\n                                                        CHOOSE FILE<\/div>           \r\n                                                    <span style=\"margin-left: 10px; color: #666;\"\r\n                                                        id=\"resume-filename\">No file chosen<\/span>\r\n                                                <\/div>\r\n                                            <\/div>\r\n                                        <\/div>\r\n                                        <div class=\"conditions\">\r\n                                            <ul\r\n                                                style=\"list-style: none; padding-left: 10px; margin-top: 5px;flex-direction: column;\">\r\n                                                <li style=\"margin-left: -23px;\" class=\"instructiontittle\"><strong>\r\n                                                        Instructions for Patients:<\/strong> <\/li>\r\n                                                <li class=\"complete\"> Upload clear, legible files in PDF, JPEG, PNG, or\r\n                                                    DOC formats.<\/li>\r\n                                                <li class=\"complete\"> Ensure documents include your name and date for\r\n                                                    verification.<\/li>\r\n                                                <li class=\"complete\"> If possible, provide records from the past 12\r\n                                                    months for most relevance.<\/li>\r\n                                            <\/ul>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"form-group\">\r\n                                <div class=\"custom-checkbox\">\r\n                                    <input type=\"checkbox\" name=\"terms_accepted\" class=\"custom-control-input\"\r\n                                        id=\"customControlValidation1\" value=\"1\" required>\r\n                                    <label class=\"custom-control-label\" for=\"customControlValidation1\">I accept the <a\r\n                                            href=\"#\">Terms & Conditions<\/a> and <a href=\"#\">Privacy policy<\/a><\/label>\r\n                                <\/div>\r\n\r\n                            <\/div>\r\n                        <\/div>\r\n                        <button type=\"submit\" class=\"btn btn-primary\" id=\"submitBtn\">Submit Documents<\/button>\r\n\r\n                    <\/form>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n<\/div>\r\n\r\n\r\n<!----------------------------------------------\r\n * Toast Wrapper\r\n ----------------------------------------------->\r\n\r\n<div id=\"toast-wrapper\" class=\"position-fixed bottom-0 end-0 p-3\" style=\"z-index: 9999;\">\r\n\r\n    <!-- Success Toast -->\r\n    <div id=\"successToast\" class=\"toast bg-success text-white\" role=\"alert\" aria-live=\"assertive\" aria-atomic=\"true\"\r\n        style=\"min-width: 400px; font-size: 1.5rem; padding: 1rem 1.5rem;\">\r\n        <div class=\"d-flex\">\r\n            <div class=\"toast-body\">\r\n                Form submitted successfully!\r\n            <\/div>\r\n            <button type=\"button\" class=\"btn-close btn-close-white me-2 m-auto\" data-bs-dismiss=\"toast\"><\/button>\r\n        <\/div>\r\n    <\/div>\r\n\r\n    <!-- Error Toast -->\r\n    <div id=\"errorToast\" class=\"toast bg-danger text-white\" role=\"alert\" aria-live=\"assertive\" aria-atomic=\"true\"\r\n        style=\"min-width: 400px; font-size: 1.3rem; padding: 1rem 1.5rem;\">\r\n        <div class=\"d-flex\">\r\n            <div class=\"toast-body\">\r\n                An error occurred. Please try again.\r\n            <\/div>\r\n            <button type=\"button\" class=\"btn-close btn-close-white me-2 m-auto\" data-bs-dismiss=\"toast\"><\/button>\r\n        <\/div>\r\n    <\/div>\r\n<\/div>\r\n\r\n\r\n<script>\r\n    jQuery(document).ready(function () {\r\n        jQuery('#inputNationality').selectize({\r\n            sortField: false,\r\n            placeholder: '',\r\n            openOnFocus: true\r\n        });\r\n        var selectizeControl = jQuery('#inputNationality')[0].selectize;\r\n        selectizeControl.setValue('Hong Kong');\r\n    });\r\n<\/script><\/div>\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":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-8893","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/allcancer.com\/hk\/wp-json\/wp\/v2\/pages\/8893","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/allcancer.com\/hk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/allcancer.com\/hk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/allcancer.com\/hk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/allcancer.com\/hk\/wp-json\/wp\/v2\/comments?post=8893"}],"version-history":[{"count":1,"href":"https:\/\/allcancer.com\/hk\/wp-json\/wp\/v2\/pages\/8893\/revisions"}],"predecessor-version":[{"id":8896,"href":"https:\/\/allcancer.com\/hk\/wp-json\/wp\/v2\/pages\/8893\/revisions\/8896"}],"wp:attachment":[{"href":"https:\/\/allcancer.com\/hk\/wp-json\/wp\/v2\/media?parent=8893"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}