{"id":1368,"date":"2020-01-30T00:04:36","date_gmt":"2020-01-29T21:04:36","guid":{"rendered":"https:\/\/www.keslerclinic.com\/?page_id=1368"},"modified":"2020-01-30T23:44:29","modified_gmt":"2020-01-30T20:44:29","slug":"randevu-al","status":"publish","type":"page","link":"https:\/\/www.keslerclinic.com\/en\/randevu-al\/","title":{"rendered":"Make An Appointment"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:calc( 1170px + 0px );margin-left: calc(-0px \/ 2 );margin-right: calc(-0px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:0px;--awb-margin-bottom-large:30px;--awb-spacing-left-large:0px;--awb-width-medium:100%;--awb-spacing-right-medium:0px;--awb-spacing-left-medium:0px;--awb-width-small:100%;--awb-spacing-right-small:0px;--awb-spacing-left-small:0px;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1435-o1\" lang=\"tr-TR\" dir=\"ltr\" data-wpcf7-id=\"1435\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/1368#wpcf7-f1435-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u0130leti\u015fim Formu\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1435\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"tr_TR\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1435-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<div class=\"clearfix\">\n\t<h2>Personal Information\n\t<\/h2>\n\t<p><label> Name, Surname (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ad\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Name, Surname\" value=\"\" type=\"text\" name=\"ad\" \/><\/span><\/label>\n\t<\/p>\n\t<p><label> Date of Birth (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dogumtarihi\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Date of Birth\" value=\"\" type=\"text\" name=\"dogumtarihi\" \/><\/span><\/label>\n\t<\/p>\n\t<p><label> Your Job (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"meslek\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"What is your job?\" value=\"\" type=\"text\" name=\"meslek\" \/><\/span><\/label>\n\t<\/p>\n\t<p><label> Your Physical Properties (required)<\/label>\n\t<\/p>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kilo\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your weight (kg)\" value=\"\" type=\"text\" name=\"kilo\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"boy\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your lenght (cm)\" value=\"\" type=\"text\" name=\"boy\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><label> Your Contact Information (required)<\/label>\n\t<\/p>\n\t<div id=\"left\">\n\t\t<p><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\" placeholder=\"Email address\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"telefon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone number\" value=\"\" type=\"tel\" name=\"telefon\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><label> Your Address Information (required)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ulke\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Country\" value=\"\" type=\"text\" name=\"ulke\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"adres\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Address\" value=\"\" type=\"text\" name=\"adres\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<h2>Your Health History\n\t<\/h2>\n\t<p><label> Have you been operated before? If yes<\/label>\n\t<\/p>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyat1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"What surgery did you have? (1)\" value=\"\" type=\"text\" name=\"ameliyat1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyattarihi1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Which date? (1)\" value=\"\" type=\"text\" name=\"ameliyattarihi1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyat2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"What surgery did you have? (2)\" value=\"\" type=\"text\" name=\"ameliyat2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyattarihi2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Which date? (2)\" value=\"\" type=\"text\" name=\"ameliyattarihi2\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyat3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"What surgery did you have? (3)\" value=\"\" type=\"text\" name=\"ameliyat3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyattarihi3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Which date? (3)\" value=\"\" type=\"text\" name=\"ameliyattarihi3\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyat4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"What surgery did you have? (4)\" value=\"\" type=\"text\" name=\"ameliyat4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyattarihi4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Which date? (4)\" value=\"\" type=\"text\" name=\"ameliyattarihi4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyat5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"What surgery did you have? (5)\" value=\"\" type=\"text\" name=\"ameliyat5\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyattarihi5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Which date? (5)\" value=\"\" type=\"text\" name=\"ameliyattarihi5\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><label> Did You Have A Major Injury, An Accident or A Broken Bone?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"yaralanma1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Can you explain briefly?\" value=\"\" type=\"text\" name=\"yaralanma1\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"yaralanma2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Can you explain briefly?\" value=\"\" type=\"text\" name=\"yaralanma2\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"yaralanma3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Can you explain briefly?\" value=\"\" type=\"text\" name=\"yaralanma3\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label> Have You Been Blood Transfusions?<\/label>\n\t<\/p>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kannaklioldum\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"kannaklioldum\" value=\"I have a blood transfusion\" \/><span class=\"wpcf7-list-item-label\">I have a blood transfusion<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"kannaklioldum\" value=\"I haven&#039;t had a blood transfusion\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I haven&#039;t had a blood transfusion<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ameliyattarihi5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"When did you get a blood transfusion?\" value=\"\" type=\"text\" name=\"ameliyattarihi5\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><label> Have you been exposed to a dangerous chemical? <\/label>\n\t<\/p>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kimyasal\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"kimyasal\" value=\"I was exposed to a dangerous chemical.\" \/><span class=\"wpcf7-list-item-label\">I was exposed to a dangerous chemical.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"kimyasal\" value=\"I was not exposed to a dangerous chemical.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I was not exposed to a dangerous chemical.<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kimyasaltarihi\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"When were you exposed to a dangerous chemical?\" value=\"\" type=\"text\" name=\"kimyasaltarihi\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"left\">\n\t<\/div>\n\t<p><label> Did you stay in the hospital on boarding? <\/label>\n\t<\/p>\n\t<div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"hastane1\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"hastane1\" value=\"I stayed in the hospital on boarding.\" \/><span class=\"wpcf7-list-item-label\">I stayed in the hospital on boarding.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"hastane1\" value=\"I didn&#039;t stay in the hospital on boarding.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I didn&#039;t stay in the hospital on boarding.<\/span><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"hastane1nedeni\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"If you stayed in the hospital on boarding, can you explain the reason for this briefly? (1)\" value=\"\" type=\"text\" name=\"hastane1nedeni\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"hastane2nedeni\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"If you stayed in the hospital on boarding, can you explain the reason for this briefly? (2)\" value=\"\" type=\"text\" name=\"hastane2nedeni\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"hastane3nedeni\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"If you stayed in the hospital on boarding, can you explain the reason for this briefly? (3)\" value=\"\" type=\"text\" name=\"hastane3nedeni\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><label> Please list all your available medicines and doses. (Including medicines and supplements.)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ilac1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Medication and dosage (1)\" value=\"\" type=\"text\" name=\"ilac1\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ilac2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Medication and dosage (2)\" value=\"\" type=\"text\" name=\"ilac2\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ilac3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Medication and dosage (3)\" value=\"\" type=\"text\" name=\"ilac3\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ilac4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Medication and dosage (4)\" value=\"\" type=\"text\" name=\"ilac4\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ilac5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Medication and dosage (5)\" value=\"\" type=\"text\" name=\"ilac5\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label> Please list allergies or reactions to drugs.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"alerji1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Allergies or reactions to drugs (1)\" value=\"\" type=\"text\" name=\"alerji1\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"alerji2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Allergies or reactions to drugs (2)\" value=\"\" type=\"text\" name=\"alerji2\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"alerji3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Allergies or reactions to drugs (3)\" value=\"\" type=\"text\" name=\"alerji3\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"alerji4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Allergies or reactions to drugs (4)\" value=\"\" type=\"text\" name=\"alerji4\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"alerji5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Allergies or reactions to drugs (5)\" value=\"\" type=\"text\" name=\"alerji5\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label> Please indicate your current or past illness.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"hastaliklariniz\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"For example; anemia, asthma, rheumatism, thyroid disease, reflux ...\" name=\"hastaliklariniz\"><\/textarea><\/span> <\/label>\n\t<\/p>\n\t<p><label> HIV, AIDS virus, Hepatitis and Other Infectious Diseases...<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"kanhastaliklari\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"If you have any of these blood diseases, just a carrier and the disease is not active in your body, please specify\" value=\"\" type=\"text\" name=\"kanhastaliklari\" \/><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<p><label> Have you ever had a Deep Vein Thrombosis (DVT)?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dvtgecirdinizmi\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"dvtgecirdinizmi\" value=\"I&#039;ve had DVT in the past.\" \/><span class=\"wpcf7-list-item-label\">I&#039;ve had DVT in the past.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"dvtgecirdinizmi\" value=\"I have never had DVT.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I have never had DVT.<\/span><\/span><\/span><\/span><br \/>\n<\/label>\n\t<\/p>\n\t<h2>Substance Abuse and Habits\n\t<\/h2>\n\t<p><label> <\/label>\n\t<\/p>\n\t<h3>Smoking\n\t<\/h3>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sigarakullaniyorum\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"sigarakullaniyorum\" value=\"I smoke.\" \/><span class=\"wpcf7-list-item-label\">I smoke.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"sigarakullaniyorum\" value=\"I don&#039;t smoke\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I don&#039;t smoke<\/span><\/span><\/span><\/span>\n\t<\/p>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kacyildirsigaraiciyorsun\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"How many years have you been smoking?\" value=\"\" type=\"text\" name=\"kacyildirsigaraiciyorsun\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"gundekacpaketsigara\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Number of cigarettes smoked per day?\" value=\"\" type=\"text\" name=\"gundekacpaketsigara\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><label> <\/label>\n\t<\/p>\n\t<h3>Alcohol\n\t<\/h3>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"alkolkullaniyorum\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"alkolkullaniyorum\" value=\"I drink alcohol.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I drink alcohol.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"alkolkullaniyorum\" value=\"I drink alcohol.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I drink alcohol.<\/span><\/span><\/span><\/span>\n\t<\/p>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"oncedenalkolkullandim\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"oncedenalkolkullandim\" value=\"I used alcohol in the past.\" \/><span class=\"wpcf7-list-item-label\">I used alcohol in the past.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"oncedenalkolkullandim\" value=\"I have not used alcohol in the past.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I have not used alcohol in the past.<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"alkolkullanimsikligi\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"How often do you use alcohol?\" value=\"\" type=\"text\" name=\"alkolkullanimsikligi\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><label> <\/label>\n\t<\/p>\n\t<h3>Drug\n\t<\/h3>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"uyusturucukullaniyorum\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"uyusturucukullaniyorum\" value=\"I use drugs.\" \/><span class=\"wpcf7-list-item-label\">I use drugs.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"uyusturucukullaniyorum\" value=\"I don&#039;t use drugs\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I don&#039;t use drugs<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"oncedenuyusturucukullandim\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"oncedenuyusturucukullandim\" value=\"I used drugs in the past.\" \/><span class=\"wpcf7-list-item-label\">I used drugs in the past.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"oncedenuyusturucukullandim\" value=\"I&#039;ve never used drugs.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I&#039;ve never used drugs.<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><label> <span class=\"wpcf7-form-control-wrap\" data-name=\"uyusturucuturu\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"What types of drugs?\" value=\"\" type=\"text\" name=\"uyusturucuturu\" \/><\/span><\/label>\n\t<\/p>\n\t<div id=\"left\">\n\t\t<p><label><\/label>\n\t\t<\/p>\n\t\t<h2>Other Informations\n\t\t<\/h2>\n\t<\/div>\n\t<p><label> Your Relative to Contact in Emergency<\/label>\n\t<\/p>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"yakinad\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name, Surname\" value=\"\" type=\"text\" name=\"yakinad\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"yakintelefon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Phone Number\" value=\"\" type=\"text\" name=\"yakintelefon\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"left\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"yakinlikderecesi\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Your relationship with the person\" value=\"\" type=\"text\" name=\"yakinlikderecesi\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"right\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"yakinadres\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Address\" value=\"\" type=\"text\" name=\"yakinadres\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<p><label> Also what you want to specify<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"eknotlar\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Other notes\" name=\"eknotlar\"><\/textarea><\/span> <\/label>\n\t<\/p>\n\t<p><label> Your primary language choice for which you would like to be contacted?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dil\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"dil\" value=\"Turkish\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Turkish<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"dil\" value=\"English\" \/><span class=\"wpcf7-list-item-label\">English<\/span><\/span><\/span><\/span> <\/label><br \/>\n<label><span class=\"wpcf7-form-control-wrap\" data-name=\"kabul\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"kabul[]\" value=\"I accept the accuracy of the information.\" \/><span class=\"wpcf7-list-item-label\">I accept the accuracy of the information.<\/span><\/span><\/span><\/span><\/label>\n\t<\/p>\n<\/div>\n<div style=\"margin-top: 20px\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t<\/p>\n<\/div><div class=\"fusion-alert alert custom alert-custom fusion-alert-center wpcf7-response-output fusion-alert-capitalize awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" style=\"--awb-border-top-left-radius:0px;--awb-border-top-right-radius:0px;--awb-border-bottom-left-radius:0px;--awb-border-bottom-right-radius:0px;\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"fusion-alert-content\"><\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div>\n<\/form>\n<\/div>\n<\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-1368","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ 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