<form  class="jet-form layout-column submit-type-ajax" action="/services/%da%a9%d8%a7%d8%b1-%d8%af%d8%b1%d9%85%d8%a7%d9%86%db%8c-%d8%af%d8%b1-%d9%81%d9%84%d8%ac-%d9%85%d8%ba%d8%b2%db%8c/?jet_engine_action=book&#038;nocache=1770055344" method="POST" data-form-id="9001"><input class="jet-form__field hidden-field" type="hidden" name="_jet_engine_booking_service_id" value="9476" data-field-name="_jet_engine_booking_service_id"><input class="jet-form__field hidden-field" type="hidden" name="_jet_engine_booking_form_id" value="9001" data-field-name="_jet_engine_booking_form_id"><input class="jet-form__field hidden-field" type="hidden" name="_jet_engine_refer" value="https://abidarphysiotherapy.ir/services/%da%a9%d8%a7%d8%b1-%d8%af%d8%b1%d9%85%d8%a7%d9%86%db%8c-%d8%af%d8%b1-%d9%81%d9%84%d8%ac-%d9%85%d8%ba%d8%b2%db%8c" data-field-name="_jet_engine_refer"><div  class="jet-form-row jet-form-row--hidden"><div class="jet-form-col jet-form-col-12  field-type-hidden  jet-form-field-container" data-field="service_id" data-conditional="false"><input class="jet-form__field hidden-field" type="hidden" name="service_id" value="9476" data-field-name="service_id"></div></div><div  class="jet-form-row jet-form-row--first-visible"><div class="jet-form-col jet-form-col-3  field-type-text  jet-form-field-container" data-field="user_name" data-conditional="false"><input class="jet-form__field text-field " placeholder="نام و نام خانوادگی" value="" required="required" name="user_name" id="user_name" type="text" data-field-name="user_name"></div><div class="jet-form-col jet-form-col-3  field-type-text  jet-form-field-container" data-field="user-email" data-conditional="false"><input class="jet-form__field text-field " placeholder="ایمیل شما" value="" required="required" name="user-email" id="user-email" type="email" data-field-name="user-email"></div><div class="jet-form-col jet-form-col-2  field-type-text  jet-form-field-container" data-field="user_code" data-conditional="false"><input class="jet-form__field text-field " placeholder="کد ملی شما" value="" required="required" name="user_code" id="user_code" type="text" data-field-name="user_code"></div><div class="jet-form-col jet-form-col-2  field-type-text  jet-form-field-container" data-field="phone_number" data-conditional="false"><input class="jet-form__field text-field " placeholder="شماره تماس" value="" required="required" name="phone_number" id="phone_number" type="text" data-field-name="phone_number"></div><div class="jet-form-col jet-form-col-2  field-type-appointment_provider  jet-form-field-container" data-field="provider_id" data-conditional="false"><select class="appointment-provider jet-form__field select-field" name="provider_id" required data-args="{&quot;service&quot;:{&quot;id&quot;:9476},&quot;api&quot;:{&quot;date_slots&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/appointment-date-slots/&quot;,&quot;refresh_dates&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/appointment-refresh-date/&quot;,&quot;service_providers&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/appointment-service-providers/&quot;,&quot;provider_services&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/appointment-provider-services/&quot;,&quot;appointments_list&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/appointments-list/&quot;,&quot;delete_appointment&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/delete-appointment/&quot;,&quot;update_appointment&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/update-appointment/&quot;,&quot;add_appointment&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/appointment-add-appointment/&quot;,&quot;update_workflows&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/update-appointment-workflows/&quot;,&quot;appointment_meta&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/appointment-meta/&quot;,&quot;get_appointment&quot;:&quot;https://abidarphysiotherapy.ir/wp-json/jet-engine/v2/get-appointment/&quot;},&quot;placeholder&quot;:&quot;u0627u0646u062au062eu0627u0628 u067eu0632u0634u06a9&quot;}"><option value="">انتخاب پزشک</option><option value="8010">مهدی رسول زاده</option><option value="8017">مجید عظیمی</option><option value="8028">علی رجبی</option><option value="8418">ارسلان کیانی</option></select></div></div><div  class="jet-form-row"><div class="jet-form-col jet-form-col-12  field-type-textarea  jet-form-field-container" data-field="field_description" data-conditional="false"><textarea class="jet-form__field textarea-field" placeholder="شرح مشکل" name="field_description" data-field-name="field_description" id="field_description"></textarea></div></div><div  class="jet-form-row"><div class="jet-form-col jet-form-col-12  field-type-appointment_date  jet-form-field-container" data-field="appointment_date" data-conditional="false"><div class="jet-apb-calendar-wrapper">
	<div class="appointment-calendar jet-apb-calendar" data-args="{&quot;booking_type&quot;:&quot;slot&quot;,&quot;excludedDates&quot;:[],&quot;datesMode&quot;:&quot;override_full&quot;,&quot;worksDates&quot;:[],&quot;datesRange&quot;:{&quot;start&quot;:0,&quot;end&quot;:0},&quot;availableWeekDays&quot;:[&quot;monday&quot;,&quot;tuesday&quot;,&quot;wednesday&quot;,&quot;thursday&quot;,&quot;saturday&quot;,&quot;sunday&quot;],&quot;service&quot;:{&quot;id&quot;:9476},&quot;providerIsset&quot;:true,&quot;provider&quot;:{&quot;field&quot;:&quot;provider_id&quot;},&quot;inputName&quot;:&quot;appointment_date&quot;,&quot;isRequired&quot;:true,&quot;allowedServices&quot;:{&quot;field&quot;:&quot;provider_id&quot;}}"></div>

		<div class="jet-apb-calendar-appointments-list-wrapper" style="display: none">
		<div class="jet-form__heading">
			<span class="jet-form__label-text">جزئیات نوبت دهی:</span>
		</div>
		<div class="jet-apb-calendar-appointments-list"></div>
	</div>
	<div class="jet-apb-calendar-notification" style="display: none">
		<div class="jet-apb-calendar-notification-service">لطفاً ابتدا سرویس را انتخاب کنید.</div>
		<div class="jet-apb-calendar-notification-provider">لطفا ابتدا ارائه دهنده را انتخاب کنید.</div>
		<div class="jet-apb-calendar-notification-service-field">لطفاً فیلد خدمات را برای تقویم فعلی تنظیم کنید</div>
		<div class="jet-apb-calendar-notification-max-slots">متاسفیم. شما حداکثر تعداد نوبت‌دهی را دارید!</div>
	</div>
</div>
</div></div><div  class="jet-form-row"><div class="jet-form-col jet-form-col-12  field-type-calculated  jet-form-field-container" data-field="calc_field" data-conditional="false"><div class="jet-form__calculated-field" data-formula="%appointment_date%" data-name="calc_field" data-listen_to="[&quot;appointment_date&quot;]">
		<input type="hidden" name="calc_field" value="" class="jet-form__calculated-field-input jet-form__field" data-field-name="calc_field">
			<div class="jet-form__calculated-field-val"></div>
				<div class="jet-form__calculated-field-suffix">
			 تومان 		</div>
	</div></div></div><div  class="jet-form-row jet-form-row--submit"><div class="jet-form-col jet-form-col-12  field-type-submit  jet-form-field-container" data-field="Submit" data-conditional="false"><div class="jet-form__submit-wrap">
		<button class="jet-form__submit submit-type-ajax" type="button">ثبت نوبت</button>
</div></div></div></form>