{"id":3353,"date":"2020-04-21T21:53:03","date_gmt":"2020-04-21T14:53:03","guid":{"rendered":"https:\/\/www.abdiwaluyo.com\/?page_id=3353"},"modified":"2023-05-28T23:36:15","modified_gmt":"2023-05-28T16:36:15","slug":"payment-confirmation","status":"publish","type":"page","link":"https:\/\/abdiwaluyo.com\/en\/facilities-services\/general-facilities\/online-video-consultation\/payment-confirmation\/","title":{"rendered":"Payment confirmation"},"content":{"rendered":"<p class=\"subtitle-content\">Use this form below to submit your payment confirmation for Online Video Consultation with our Doctor.<\/p>\n<div id=\"quform-c30bdf\" class=\"quform quform-15 quform-theme-underlined quform-support-page-caching\"><form id=\"quform-form-c30bdf\" class=\"quform-form quform-form-15\" action=\"\/en\/wp-json\/wp\/v2\/pages\/3353#quform-c30bdf\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-options=\"{&quot;id&quot;:15,&quot;uniqueId&quot;:&quot;c30bdf&quot;,&quot;theme&quot;:&quot;underlined&quot;,&quot;ajax&quot;:true,&quot;logic&quot;:{&quot;logic&quot;:[],&quot;dependents&quot;:[],&quot;elementIds&quot;:[],&quot;dependentElementIds&quot;:[],&quot;animate&quot;:true},&quot;currentPageId&quot;:1,&quot;errorsIcon&quot;:&quot;&quot;,&quot;updateFancybox&quot;:true,&quot;hasPages&quot;:false,&quot;pages&quot;:[1],&quot;pageProgressType&quot;:&quot;numbers&quot;,&quot;tooltipsEnabled&quot;:true,&quot;tooltipClasses&quot;:&quot;qtip-quform-dark qtip-shadow&quot;,&quot;tooltipMy&quot;:&quot;left center&quot;,&quot;tooltipAt&quot;:&quot;right center&quot;,&quot;isRtl&quot;:false,&quot;scrollOffset&quot;:-50,&quot;scrollSpeed&quot;:800}\"><button class=\"quform-default-submit\" name=\"quform_submit\" type=\"submit\" value=\"submit\" aria-hidden=\"true\" tabindex=\"-1\"><\/button><div class=\"quform-form-inner quform-form-inner-15\"><input type=\"hidden\" name=\"quform_form_id\" value=\"15\" \/><input type=\"hidden\" name=\"quform_form_uid\" value=\"c30bdf\" \/><input type=\"hidden\" name=\"quform_count\" value=\"1\" \/><input type=\"hidden\" name=\"form_url\" value=\"https:\/\/abdiwaluyo.com\/en\/wp-json\/wp\/v2\/pages\/3353\" \/><input type=\"hidden\" name=\"referring_url\" value=\"\" \/><input type=\"hidden\" name=\"post_id\" value=\"\" \/><input type=\"hidden\" name=\"post_title\" value=\"\" \/><input type=\"hidden\" name=\"quform_current_page_id\" value=\"1\" \/><input type=\"hidden\" name=\"quform_csrf_token\" value=\"rjsC1nqmgkgb4Goua9sXvwrSLLKcAi8rQ7hjOYH1\" \/><div class=\"quform-elements quform-elements-15 quform-cf quform-responsive-elements-phone-landscape\"><div class=\"quform-element quform-element-page quform-page-1 quform-page-15_1 quform-cf quform-group-style-plain quform-first-page quform-last-page quform-current-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-15_23 quform-cf\"><div class=\"quform-spacer\"><h3><\/h3>\nInput your reservation data accordingly to confirm your payment. Please input the number of your online video consultation reservation according to your email notification.<\/div><\/div><div class=\"quform-element quform-element-group quform-element-15_11 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-15_4 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-15_5\"><div class=\"quform-element quform-element-text quform-element-15_3 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-15_3\"><label class=\"quform-label-text\" for=\"quform_15_3_c30bdf\">Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-15_3\"><div class=\"quform-input quform-input-text quform-input-15_3 quform-cf\"><input type=\"text\" id=\"quform_15_3_c30bdf\" name=\"quform_15_3\" class=\"quform-field quform-field-text quform-field-15_3\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-15_6\"><div class=\"quform-element quform-element-text quform-element-15_7 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-15_7\"><label class=\"quform-label-text\" for=\"quform_15_7_c30bdf\">Mobile Number<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-15_7\"><div class=\"quform-input quform-input-text quform-input-15_7 quform-cf\"><input type=\"text\" id=\"quform_15_7_c30bdf\" name=\"quform_15_7\" class=\"quform-field quform-field-text quform-field-15_7\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-15_8\"><div class=\"quform-element quform-element-email quform-element-15_10 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-15_10\"><label class=\"quform-label-text\" for=\"quform_15_10_c30bdf\">Email address<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-email quform-inner-15_10\"><div class=\"quform-input quform-input-email quform-input-15_10 quform-cf\"><input type=\"email\" id=\"quform_15_10_c30bdf\" name=\"quform_15_10\" class=\"quform-field quform-field-email quform-field-15_10\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-15_12 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><h3 class=\"quform-group-title\">Appointment Data<\/h3><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-15_20 quform-cf\"><div class=\"quform-spacer\">Time preferred for consultation with <\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-15_13 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-15_14\"><div class=\"quform-element quform-element-text quform-element-15_26 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-15_26\"><label class=\"quform-label-text\" for=\"quform_15_26_c30bdf\">Appointment number<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-15_26\"><div class=\"quform-input quform-input-text quform-input-15_26 quform-cf\"><input type=\"text\" id=\"quform_15_26_c30bdf\" name=\"quform_15_26\" class=\"quform-field quform-field-text quform-field-15_26\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-15_16\"><div class=\"quform-element quform-element-file quform-element-15_27 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-15_27\"><label class=\"quform-label-text\" for=\"quform_15_27_c30bdf\">Upload transfer receipt<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-file quform-inner-15_27\"><p class=\"quform-description quform-description-above\">Attach your payment screenshot\/receipt using file uploader below\n<\/p><div class=\"quform-input quform-input-file quform-input-15_27 quform-cf quform-button-style-theme quform-button-size-fat\"><input type=\"file\" id=\"quform_15_27_c30bdf\" name=\"quform_15_27[]\" class=\"quform-field quform-field-file quform-field-15_27 quform-field-file-enhanced\" data-config=\"{&quot;id&quot;:27,&quot;identifier&quot;:&quot;15_27&quot;,&quot;name&quot;:&quot;quform_15_27&quot;,&quot;max&quot;:1,&quot;size&quot;:1048576,&quot;allowedExtensions&quot;:[&quot;jpg&quot;,&quot;jpeg&quot;,&quot;png&quot;,&quot;gif&quot;,&quot;pdf&quot;],&quot;notAllowedTypeWithFilename&quot;:&quot;File type of &#039;%filename%&#039; is not allowed&quot;,&quot;tooBigWithFilename&quot;:&quot;File &#039;%filename%&#039; exceeds the maximum allowed file size&quot;,&quot;tooMany&quot;:&quot;You cannot upload more than %max% file(s)&quot;,&quot;buttonType&quot;:&quot;button&quot;,&quot;buttonText&quot;:&quot;Browse...&quot;,&quot;buttonIcon&quot;:&quot;qicon-file_upload&quot;,&quot;buttonIconPosition&quot;:&quot;right&quot;}\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-15_2 quform-cf quform-button-style-theme quform-button-size-fat\"><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-15_2\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-text quform-button-submit-text\">Send Payment Confirmation<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element-tree\"><label for=\"quform_15_0_c30bdf\">This field should be left blank<\/label><input type=\"text\" id=\"quform_15_0_c30bdf\" name=\"quform_15_0\" class=\"quform-field quform-field-tree quform-field-15_0\" tabindex=\"-1\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><div class=\"quform-upload-progress-wrap\"><div class=\"quform-upload-progress-bar-wrap\"><div class=\"quform-upload-progress-bar\"><\/div><\/div><div class=\"quform-upload-info quform-cf\"><div class=\"quform-upload-filename\"><\/div><\/div><\/div><\/div><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Use this form below to submit your payment confirmation for Online Video Consultation with our Doctor.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":3335,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"_page-content.php","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.8.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Payment confirmation - Abdi Waluyo Hospital<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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