{"id":152,"date":"2017-05-22T13:19:49","date_gmt":"2017-05-22T13:19:49","guid":{"rendered":"http:\/\/urologycareinc.com\/public_website\/?page_id=152"},"modified":"2017-05-23T20:28:14","modified_gmt":"2017-05-23T20:28:14","slug":"leave-a-review","status":"publish","type":"page","link":"https:\/\/urologycareinc.com\/public_website\/leave-a-review\/","title":{"rendered":"Leave a Review"},"content":{"rendered":"<h2>Urology Care Inc &#8211; Jefferson City, MO<\/h2>\n<p>Thank you for taking the time to complete this survey. Your feedback is important to us in how we can better improve our service. This survey should only take about 5 minutes of your time. Our survey uses a 1 through 5 rating system. Indicate your overall rating (1\u00a0 indicating that you are not satisfied and 5 that you are extremely satisfied).<\/p>\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-218\"><form id=\"wpforms-form-218\" class=\"wpforms-validate wpforms-form\" data-formid=\"218\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/public_website\/wp-json\/wp\/v2\/pages\/152\" data-token=\"42e7167f1311e950ca990fae257e2f98\" data-token-time=\"1777126459\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-218-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-218-field_1\">Patient Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-218-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" placeholder=\"Please enter your First name and Last Initial\" required><\/div><div id=\"wpforms-218-field_24-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-id=\"24\"><label class=\"wpforms-field-label\">May we publish your review?) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-218-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_24_1\" name=\"wpforms[fields][24]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_24_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_24_2\" name=\"wpforms[fields][24]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_24_2\">No<\/label><\/li><\/ul><div class=\"wpforms-field-description\">By Clicking the \"Yes\" button you agree to allow us to publish your survey on our website and social media channels using your first name and last initial.<\/div><\/div><div id=\"wpforms-218-field_3-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-218-field_3\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-218-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-218-field_25-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-218-field_25\">Doctor <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-218-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Select your Doctor<\/option><option value=\"Dr. Michael Severance M.D.\"  class=\"choice-1 depth-1\"  >Dr. Michael Severance M.D.<\/option><option value=\"Dr. Jerry Trulson M.D.\"  class=\"choice-2 depth-1\"  >Dr. Jerry Trulson M.D.<\/option><option value=\"Dr. Eric Vogt M.D.\"  class=\"choice-3 depth-1\"  >Dr. Eric Vogt M.D.<\/option><option value=\"Dr. Douglas West M.D.\"  class=\"choice-4 depth-1\"  >Dr. Douglas West M.D.<\/option><\/select><\/div><div id=\"wpforms-218-field_26-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-3-columns\" data-field-id=\"26\"><label class=\"wpforms-field-label\">Doctor Rating <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-218-field_26\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_26_1\" name=\"wpforms[fields][26]\" value=\"5\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_26_1\">5<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_26_2\" name=\"wpforms[fields][26]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_26_2\">4<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_26_3\" name=\"wpforms[fields][26]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_26_3\">3<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_26_4\" name=\"wpforms[fields][26]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_26_4\">2<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_26_5\" name=\"wpforms[fields][26]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_26_5\">1<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Our survey uses a 1 through 5 rating system. Indicate your overall rating (1  indicating that you are not satisfied and 5 that you are extremely satisfied)<\/div><\/div><div id=\"wpforms-218-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-3-columns\" data-field-id=\"18\"><label class=\"wpforms-field-label\">Office Staff Rating <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-218-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_18_1\" name=\"wpforms[fields][18]\" value=\"5\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_18_1\">5<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_18_2\" name=\"wpforms[fields][18]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_18_2\">4<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_18_3\" name=\"wpforms[fields][18]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_18_3\">3<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_18_4\" name=\"wpforms[fields][18]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_18_4\">2<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_18_5\" name=\"wpforms[fields][18]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_18_5\">1<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Our survey uses a 1 through 5 rating system. Indicate your overall rating (1  indicating that you are not satisfied and 5 that you are extremely satisfied)<\/div><\/div><div id=\"wpforms-218-field_19-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-3-columns\" data-field-id=\"19\"><label class=\"wpforms-field-label\">Overall Rating <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-218-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_19_1\" name=\"wpforms[fields][19]\" value=\"5\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_19_1\">5<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_19_2\" name=\"wpforms[fields][19]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_19_2\">4<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_19_3\" name=\"wpforms[fields][19]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_19_3\">3<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_19_4\" name=\"wpforms[fields][19]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_19_4\">2<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-218-field_19_5\" name=\"wpforms[fields][19]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-218-field_19_5\">1<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Our survey uses a 1 through 5 rating system. Indicate your overall rating (1  indicating that you are not satisfied and 5 that you are extremely satisfied)<\/div><\/div><div id=\"wpforms-218-field_16-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-218-field_16\">Comments <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-218-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" placeholder=\"Please Fill in your comments here\" required><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-218-field-hp\" class=\"wpforms-field-label\">Comment<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-218-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"218\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/urologycareinc.com\/public_website\/wp-json\/wp\/v2\/pages\/152\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-218\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit Your Review\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit Your Review<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"<p>Urology Care Inc &#8211; Jefferson City, MO Thank you for taking the time to complete this survey. Your feedback is important to us in how we can better improve our service. This survey should only take about 5 minutes of your time. Our survey uses a 1 through 5 rating system. 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