{"id":131,"date":"2024-06-29T08:22:22","date_gmt":"2024-06-29T07:22:22","guid":{"rendered":"https:\/\/berkhia.org\/?page_id=131"},"modified":"2024-06-29T09:57:04","modified_gmt":"2024-06-29T08:57:04","slug":"patient-history-form","status":"publish","type":"page","link":"https:\/\/berkhia.org\/index.php\/patient-history-form\/","title":{"rendered":"Patient Information Form"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f136-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"136\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/131#wpcf7-f136-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"136\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f136-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label> First - Middle - Last Name \u0645\u06a9\u0645\u0644 \u0646\u0627\u0645 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-full-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter your name!\" value=\"\" type=\"text\" name=\"your-full-name\" \/><\/span>\n<\/p>\n<p><label> Date Of Birth \u062a\u0627\u0631\u06cc\u062e \u067e\u06cc\u062f\u0627\u0626\u0634 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-of-birth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Date\" value=\"\" type=\"date\" name=\"date-of-birth\" \/><\/span>\n<\/p>\n<p><label>Gender \u0635\u0646\u0641 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"gender\" value=\"Male\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"gender\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Height \u0642\u062f <\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"height-in-ft\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" min=\"1\" max=\"8\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Feet\" value=\"\" type=\"number\" name=\"height-in-ft\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"height-in-inches\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" min=\"1\" max=\"12\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Inch\" value=\"\" type=\"number\" name=\"height-in-inches\" \/><\/span>\n<\/p>\n<p><label> Weight \u0648\u0632\u0646 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"weight-in-kg\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your weight in kg\" value=\"\" type=\"text\" name=\"weight-in-kg\" \/><\/span>\n<\/p>\n<p><label> Marital Status \u0627\u0632\u062f\u0648\u0627\u062c\u06cc \u062d\u06cc\u062b\u06cc\u062a <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"marital-status\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"marital-status\" value=\"Single\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Single<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"marital-status\" value=\"Married\" \/><span class=\"wpcf7-list-item-label\">Married<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"marital-status\" value=\"Widowed\" \/><span class=\"wpcf7-list-item-label\">Widowed<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"marital-status\" value=\"Divorced\" \/><span class=\"wpcf7-list-item-label\">Divorced<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Occupation \u067e\u06cc\u0634\u06c1 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"occupation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"occupation\" \/><\/span>\n<\/p>\n<p><label> Contact Number \u0631\u0627\u0628\u0637\u06c1 \u0646\u0645\u0628\u0631 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact-number\" \/><\/span>\n<\/p>\n<p><label> WhatsApp Number \u0648\u0627\u0679\u0633 \u0627\u06cc\u067e \u0646\u0645\u0628\u0631 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"whatsapp-number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"whatsapp-number\" \/><\/span>\n<\/p>\n<p><label> Email \u0627\u06cc \u0645\u06cc\u0644 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n<\/p>\n<p><label> Blood Group \u062e\u0648\u0646 \u06a9\u0627 \u06af\u0631\u0648\u067e <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"blood-group\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"blood-group\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"A+\">A+<\/option><option value=\"A-\">A-<\/option><option value=\"B+\">B+<\/option><option value=\"B-\">B-<\/option><option value=\"AB+\">AB+<\/option><option value=\"AB-\">AB-<\/option><option value=\"O+\">O+<\/option><option value=\"O-\">O-<\/option><\/select><\/span>\n<\/p>\n<p><label> Body Frame Type \u062c\u0633\u0645\u0627\u0646\u06cc \u0633\u0627\u062e\u062a <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"body-frame-type\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"body-frame-type\" value=\"Large frame, more muscles\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Large frame, more muscles<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"body-frame-type\" value=\"Large frame, more fats\" \/><span class=\"wpcf7-list-item-label\">Large frame, more fats<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"body-frame-type\" value=\"Medium frame, lean\" \/><span class=\"wpcf7-list-item-label\">Medium frame, lean<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"body-frame-type\" value=\"Thin\/bony frame (Short\/tall)\" \/><span class=\"wpcf7-list-item-label\">Thin\/bony frame (Short\/tall)<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Skin Touch & Texture \u062c\u0644\u062f \u06a9\u0627 \u0644\u0645\u0633 \u0627\u0648\u0631 \u062d\u0627\u0644\u062a <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"skin-touch-and-texture\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"skin-touch-and-texture\" value=\"Moderate in Softness and dryness. Warm to the touch\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Moderate in Softness and dryness. Warm to the touch<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"skin-touch-and-texture\" value=\"Soft, Moist and Cold\" \/><span class=\"wpcf7-list-item-label\">Soft, Moist and Cold<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"skin-touch-and-texture\" value=\"Dry and Warm\" \/><span class=\"wpcf7-list-item-label\">Dry and Warm<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"skin-touch-and-texture\" value=\"Dry, rough and Cold\" \/><span class=\"wpcf7-list-item-label\">Dry, rough and Cold<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Skin Complexion \u062c\u0644\u062f \u06a9\u06cc \u0631\u0646\u06af\u062a <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"skin-complexion\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"skin-complexion\" value=\"Reddish, glowing\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Reddish, glowing<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"skin-complexion\" value=\"Pale\/White\" \/><span class=\"wpcf7-list-item-label\">Pale\/White<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"skin-complexion\" value=\"Yellowish\" \/><span class=\"wpcf7-list-item-label\">Yellowish<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"skin-complexion\" value=\"Grayish\" \/><span class=\"wpcf7-list-item-label\">Grayish<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Hair \u0628\u0627\u0644 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"hair\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"hair\" value=\"Thick, Oily, Wavy\/Straight\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Thick, Oily, Wavy\/Straight<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"hair\" value=\"Thin, Oil, Straight\" \/><span class=\"wpcf7-list-item-label\">Thin, Oil, Straight<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"hair\" value=\"Moderate in thickness and softness, straight, Long\" \/><span class=\"wpcf7-list-item-label\">Moderate in thickness and softness, straight, Long<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"hair\" value=\"Dry, tends to curl\" \/><span class=\"wpcf7-list-item-label\">Dry, tends to curl<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Physical Activity \u062c\u0633\u0645\u0627\u0646\u06cc \u062d\u0631\u06a9\u0627\u062a <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"physical-activity\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"physical-activity\" value=\"Moderate to active, Good stamina and physical endurance\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Moderate to active, Good stamina and physical endurance<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"physical-activity\" value=\"Lethargic, slow and poor stamina\" \/><span class=\"wpcf7-list-item-label\">Lethargic, slow and poor stamina<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"physical-activity\" value=\"Very active, enthusiastic, precise and orderly\" \/><span class=\"wpcf7-list-item-label\">Very active, enthusiastic, precise and orderly<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"physical-activity\" value=\"Active, disorganized and erratic\" \/><span class=\"wpcf7-list-item-label\">Active, disorganized and erratic<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Diet \u063a\u0630\u0627 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diet\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"diet\" value=\"Cold and Dry\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Cold and Dry<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"diet\" value=\"Hot and Dry\" \/><span class=\"wpcf7-list-item-label\">Hot and Dry<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"diet\" value=\"Cold and Moist\" \/><span class=\"wpcf7-list-item-label\">Cold and Moist<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"diet\" value=\"Hot and Moist\" \/><span class=\"wpcf7-list-item-label\">Hot and Moist<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Climatic Preference \u0645\u0648\u0633\u0645\u06cc \u062a\u0631\u062c\u06cc\u062d\u0627\u062a <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"climate-preferance\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"climate-preferance\" value=\"Intolerance to hot &amp; humid conditions, summer &amp; rainy weather\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Intolerance to hot &amp; humid conditions, summer &amp; rainy weather<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"climate-preferance\" value=\"Intolerance to cold &amp; moist conditions, winter &amp; rainy weather\" \/><span class=\"wpcf7-list-item-label\">Intolerance to cold &amp; moist conditions, winter &amp; rainy weather<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"climate-preferance\" value=\"Intolerance to dry conditions, summer &amp; spring\" \/><span class=\"wpcf7-list-item-label\">Intolerance to dry conditions, summer &amp; spring<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"climate-preferance\" value=\"Intolerance to cold &amp; dry conditions, late winter &amp; autumn\" \/><span class=\"wpcf7-list-item-label\">Intolerance to cold &amp; dry conditions, late winter &amp; autumn<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Excretion \u0627\u062e\u0631\u0627\u062c <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"excretion\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"excretion\" value=\"Regular, Soft stool, Golden yellow urine with occasional burning, tends to perspire easily\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Regular, Soft stool, Golden yellow urine with occasional burning, tends to perspire easily<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"excretion\" value=\"The sticky unstable stool, occasional diarrhea, tends to pass excessive, transparent, light yellow urine, low perspiration\" \/><span class=\"wpcf7-list-item-label\">The sticky unstable stool, occasional diarrhea, tends to pass excessive, transparent, light yellow urine, low perspiration<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"excretion\" value=\"Soft, Loose stool, occasional dysentery, tends to pass dark yellow urine, low in quantity with occasional burnnig &amp; tends to perspire easilty\" \/><span class=\"wpcf7-list-item-label\">Soft, Loose stool, occasional dysentery, tends to pass dark yellow urine, low in quantity with occasional burnnig &amp; tends to perspire easilty<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"excretion\" value=\"Hard, dark stool towards constipation tends to pass moderate to excessive urine, low perspiration\" \/><span class=\"wpcf7-list-item-label\">Hard, dark stool towards constipation tends to pass moderate to excessive urine, low perspiration<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Sleep pattern \u0646\u06cc\u0646\u062f \u06a9\u06cc \u062a\u0631\u062a\u06cc\u0628 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"sleep-pattern\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"sleep-pattern\" value=\"Moderate to deep 6-8 hours adequate\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Moderate to deep 6-8 hours adequate<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"sleep-pattern\" value=\"Heavy, prolonged, excessive 8 hours plus tendency to oversleep\" \/><span class=\"wpcf7-list-item-label\">Heavy, prolonged, excessive 8 hours plus tendency to oversleep<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"sleep-pattern\" value=\"Low but sounds 5-6 hours adequate tendency to insomnia\" \/><span class=\"wpcf7-list-item-label\">Low but sounds 5-6 hours adequate tendency to insomnia<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"sleep-pattern\" value=\"interrupted, irregular, tendency towards insomnia\" \/><span class=\"wpcf7-list-item-label\">interrupted, irregular, tendency towards insomnia<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Emotional traits Personality Traits Mental activity \u062c\u0630\u0628\u0627\u062a\u06cc \u062e\u0635\u0644\u062a\u06cc\u06ba \u0634\u062e\u0635\u06cc\u062a \u06a9\u06cc \u062e\u0635\u0648\u0635\u06cc\u0627\u062a \u0630\u06c1\u0646\u06cc \u0633\u0631\u06af\u0631\u0645\u06cc <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"emotional-traits\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"emotional-traits\" value=\"Worry, cheerful, Excited, Bold, persuasive, Sociable, outgoing, talkative, Moderate to active intelligence\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Worry, cheerful, Excited, Bold, persuasive, Sociable, outgoing, talkative, Moderate to active intelligence<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"emotional-traits\" value=\"Fearful, Shy, Self-Content. Calm, accomodating, patient, good listener, slow receptove, cool minded\" \/><span class=\"wpcf7-list-item-label\">Fearful, Shy, Self-Content. Calm, accomodating, patient, good listener, slow receptove, cool minded<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"emotional-traits\" value=\"aggressive, anger irritable, impatient,resourceful, outspoken, dominant, may be short tempered. Aggressive itelligent, sharp minded\" \/><span class=\"wpcf7-list-item-label\">aggressive, anger irritable, impatient,resourceful, outspoken, dominant, may be short tempered. Aggressive itelligent, sharp minded<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"emotional-traits\" value=\"Fearful, insecure suspicious, anxious, thoughtful, logical, analytical, tend to be perfectionist restlessness, enquiring, philosophical, imaginative\" \/><span class=\"wpcf7-list-item-label\">Fearful, insecure suspicious, anxious, thoughtful, logical, analytical, tend to be perfectionist restlessness, enquiring, philosophical, imaginative<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> <\/label>\n<\/p>\n<p><label> <\/label>\n<\/p>\n<p><label> Subject<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-subject\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-subject\" \/><\/span> <\/label>\n<\/p>\n<p><label> Your message (optional)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-131","page","type-page","status-publish"],"_links":{"self":[{"href":"https:\/\/berkhia.org\/index.php\/wp-json\/wp\/v2\/pages\/131","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/berkhia.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/berkhia.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/berkhia.org\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/berkhia.org\/index.php\/wp-json\/wp\/v2\/comments?post=131"}],"version-history":[{"count":2,"href":"https:\/\/berkhia.org\/index.php\/wp-json\/wp\/v2\/pages\/131\/revisions"}],"predecessor-version":[{"id":137,"href":"https:\/\/berkhia.org\/index.php\/wp-json\/wp\/v2\/pages\/131\/revisions\/137"}],"wp:attachment":[{"href":"https:\/\/berkhia.org\/index.php\/wp-json\/wp\/v2\/media?parent=131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}