{"id":1353,"date":"2021-02-19T12:53:18","date_gmt":"2021-02-19T20:53:18","guid":{"rendered":"https:\/\/helloeyelab.com\/?page_id=1353"},"modified":"2021-08-18T18:20:09","modified_gmt":"2021-08-19T01:20:09","slug":"referrals","status":"publish","type":"page","link":"https:\/\/helloeyelab.com\/cn\/referrals\/","title":{"rendered":"\u8f6c\u4ecb"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1353\" class=\"elementor elementor-1353\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5734e5d9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5734e5d9\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2d0ef13\" data-id=\"2d0ef13\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-642593d0 elementor-widget elementor-widget-text-editor\" data-id=\"642593d0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\n<section class=\"eyelab-primary-section text-left\">\n    <div class=\"container\">\n        <div class=\"row mb-4\">\n            <div class=\"col-lg-8 offset-lg-2\">\n                <h1>Doctor Referrals<\/h1>\n                <p>Please fill out the information below.<\/p>\n            <\/div>\n        <\/div>\n        <div class=\"row\">\n            <div class=\"col-lg-8 offset-lg-2\">\n                <div class=\"wpforms-container wpforms-container-full eyelab-form\" id=\"wpforms-1351\"><form id=\"wpforms-form-1351\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1351\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/cn\/wp-json\/wp\/v2\/pages\/1353?wpforms_form_id=1351\" data-token=\"b19984afc784c2c6377d37f50c6842f8\" data-token-time=\"1792757898\"><noscript class=\"wpforms-error-noscript\">\u8bf7\u5728\u6d4f\u89c8\u5668\u4e2d\u542f\u7528JavaScript\u6765\u5b8c\u6210\u6b64\u8868\u5355\u3002<\/noscript><div class=\"wpforms-field-container\">\t\t<div id=\"wpforms-1351-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1351-field_1\" >to Additional Name<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1351-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1351-field_11-container\" class=\"wpforms-field wpforms-field-html eyelab-form-title\" data-field-type=\"html\" data-field-id=\"11\"><div id=\"wpforms-1351-field_11\"><h2>\r\n    <i class=\"fa fa-check-circle text-success mr-3\" aria-hidden=\"true\" style=\"height:20px\"><\/i>\r\n    <span class=\"text-uppercase\" style=\"color: #6E7781\">Patient Referral Form<\/span>\r\n<\/h2><\/div><\/div><div id=\"wpforms-1351-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_12\">Select Referral Type <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1351-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Select Referral Type<\/option><option value=\"Myopia Management Services\"  class=\"choice-3 depth-1\"  >Myopia Management Services<\/option><option value=\"Axial Length Measurement\"  class=\"choice-2 depth-1\"  >Axial Length Measurement<\/option><option value=\"Anti-myopia Glasses\"  class=\"choice-5 depth-1\"  >Anti-myopia Glasses<\/option><option value=\"Vision Therapy Services\"  class=\"choice-4 depth-1\"  >Vision Therapy Services<\/option><option value=\"Dry Eye Services\"  class=\"choice-6 depth-1\"  >Dry Eye Services<\/option><option value=\"Other\"  class=\"choice-7 depth-1\"  >Other<\/option><\/select><\/div><div id=\"wpforms-1351-field_16-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"16\"><h3 id=\"wpforms-1351-field_16\">Patient Information<\/h3><\/div><div id=\"wpforms-1351-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_3\">Full Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1351-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-1351-field_7-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_7\">Phone Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1351-field_7\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][7]\" aria-label=\"Phone Number\" required><\/div><div id=\"wpforms-1351-field_18-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_18\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1351-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1351-field_13-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_13\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1351-field_13\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][13][date]\" placeholder=\"MM\/DD\/YYYY\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-1351-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_22\">Patient Rx (Right Eye)<\/label><input type=\"text\" id=\"wpforms-1351-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" ><\/div><div id=\"wpforms-1351-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_20\">Patient Rx (Left Eye)<\/label><input type=\"text\" id=\"wpforms-1351-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" ><\/div><div id=\"wpforms-1351-field_24-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_24\">Additional Comments<\/label><textarea id=\"wpforms-1351-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" ><\/textarea><\/div><div id=\"wpforms-1351-field_32-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_32\">Upload Exam Files<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"32\"\n\t\tdata-form-id=\"1351\"\n\t\tdata-input-name=\"wpforms_1351_32\"\n\t\tdata-extensions=\"pdf,png,jpeg,jpg\"\n\t\tdata-max-size=\"2146435072\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"2146435072\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1351-field_32\"\n\t\tname=\"wpforms_1351_32\" \t\tvalue=\"\">\n<div class=\"wpforms-field-description\">\u2022 Please attach any relevant exam files if your inquiry is related to Vision Therapy (VT), Myopia, or Dry Eye consultations. This will help us streamline the process and provide better service.\r\n<br>\u2022 Accepted file formats: PDF, PNG, or JPEG.<\/div><\/div><div id=\"wpforms-1351-field_14-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"14\"><h3 id=\"wpforms-1351-field_14\">Doctor Information<\/h3><\/div><div id=\"wpforms-1351-field_17-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_17\">Referring Doctor <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1351-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" required><\/div><div id=\"wpforms-1351-field_4-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_4\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1351-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1351-field_30-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-1351-field_30\">Have you referred this patient to us before? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1351-field_30\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][30]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Select Referral Type<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-3 depth-1\"  >No<\/option><\/select><\/div><div id=\"wpforms-1351-field_28-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"28\"><div id=\"wpforms-1351-field_28\"><p> <br \/>\r\n\r\n<br \/> Please download the corresponding form as part of the referral process. <br \/>\r\n\r\n<br \/> \r\n<a href=\"https:\/\/helloeyelab.com\/wp-content\/uploads\/2022\/12\/Axial-Length-Referral-Form.pdf\" target=\"blank\"> \r\n<b>Axial Length Measurements<\/b>\r\n<\/a>\r\n\r\n<\/p>\r\n\r\n<\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1351-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-1351-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-1351-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1351\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1792757898.d37476cb061d1a87d0d142602a57864a876c29ff8d4e7e056ffe4af3970524b1\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/helloeyelab.com\/cn\/wp-json\/wp\/v2\/pages\/1353\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1351\" class=\"wpforms-submit btn btn-primary\" data-alt-text=\"Sending Referral...\" data-submit-text=\"Submit Referral\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit Referral<\/button><img decoding=\"async\" src=\"https:\/\/helloeyelab.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"\u52a0\u8f7d\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n            <\/div>\n            <!--<div class=\"col-lg-4 offset-lg-1 text-left\">\n                <h5 class=\"mb-4 mt-lg-0\">Details &amp; Contact Information<\/h5>\n\n                <p class=\"font-weight-bold mb-0\">Doctor Hours<\/p>\n                <p class=\"mb-0\">Mon - Fri 10 am - 6 pm<\/p>\n                <p class=\"mb-0\">Sat 9 am - 4 pm<\/p>\n                <p class=\"mb-0\">Sunday Closed<\/p>\n                <p class=\"mb-2\">Lunch Break 1 pm - 2 pm<\/p>\n\n                <p class=\"font-weight-bold mb-0 mt-4\">Front Desk<\/p>\n                <p class=\"mb-0\"><strong>Tel:<\/strong> <a href=\"tel:+16042601166\">+1 (604) 260 1166<\/a><\/p>\n                <p class=\"mb-0\"><strong>Fax:<\/strong> <a href=\"tel:+16042601166\">+1 (604) 260 1155<\/a><\/p>\n                <p class=\"mb-2\"><strong>Email:<\/strong> <a href=\"mailto:frontdesk@helloeyelab.com\"><u>frontdesk@helloeyelab.com<\/u><\/a><\/p>\n\n                <p class=\"font-weight-bold mt-4 mb-0\">Location<\/p>\n                <p class=\"mb-0\">2369 W 41st Avenue<\/p>\n                <p class=\"mb-0\">Vancouver, BC V6M 2A3<\/p>\n                <p class=\"mb-2\">(Upstairs)<\/p>\n                <iframe src=\"https:\/\/www.google.com\/maps\/embed?pb=!1m18!1m12!1m3!1d2605.1909937217415!2d-123.16318798426985!3d49.23486797932617!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x548673701f519025%3A0x82680e34dc290af7!2sEyelab%2C%20Doctors%20of%20Optometry!5e0!3m2!1sen!2sca!4v1603583362400!5m2!1sen!2sca\" style=\"border:0;\" allowfullscreen=\"\" aria-hidden=\"false\" tabindex=\"0\" width=\"100%\" height=\"300\" frameborder=\"0\"><\/iframe>\n\n                <img decoding=\"async\" class=\"mt-5\" src=\"\/wp-content\/themes\/eyelab\/assets\/images\/page-contact-us\/illo_storefront.svg\">\n            <\/div>-->\n        <\/div>\n    <\/div>\n<\/section>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u533b\u751f\u63a8\u8350 \u8bf7\u586b\u5199\u4ee5\u4e0b\u4fe1\u606f\u3002<\/p>","protected":false},"author":186329203,"featured_media":0,"parent":0,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","_monsterinsights_skip_tracking":false,"_wpcom_ai_launchpad_about_page":false,"_wpcom_ai_launchpad_gallery_page":false,"_wpcom_ai_launchpad_contact_page":false,"_wpcom_ai_launchpad_events_page":false,"_wpcom_ai_launchpad_video_page":false,"_wpcom_ai_launchpad_portfolio_piece":false,"_jetpack_hide_featured_image":false,"_jetpack_featured_image_duplicate_dismissed":0,"footnotes":""},"class_list":["post-1353","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - 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