{"id":128,"date":"2022-12-28T21:39:40","date_gmt":"2022-12-28T16:09:40","guid":{"rendered":"https:\/\/pharmoclock.com\/order\/?page_id=128"},"modified":"2024-06-17T11:24:32","modified_gmt":"2024-06-17T05:54:32","slug":"order-medicines-online-with-free-delivery-pharmoclock","status":"publish","type":"page","link":"https:\/\/pharmoclock.com\/order\/","title":{"rendered":"Order Medicines Online with Free Delivery! PharmO&#8217;Clock"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"128\" class=\"elementor elementor-128\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b1ec150 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b1ec150\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-251114c\" data-id=\"251114c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-70448a0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"70448a0\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-be070cb\" data-id=\"be070cb\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-00a64ff elementor-widget elementor-widget-image\" data-id=\"00a64ff\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.9.2 - 21-12-2022 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/pharmoclock.com\/\">\n\t\t\t\t\t\t\t<img decoding=\"async\" src=\"https:\/\/pharmoclock.com\/order\/wp-content\/uploads\/2022\/12\/logo.png\" title=\"logo\" alt=\"logo\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-489a23c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"489a23c\" data-element_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-f40c493\" data-id=\"f40c493\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-369fbe6 elementor-widget elementor-widget-image-carousel\" data-id=\"369fbe6\" data-element_type=\"widget\" data-settings=\"{&quot;slides_to_show&quot;:&quot;1&quot;,&quot;navigation&quot;:&quot;none&quot;,&quot;autoplay&quot;:&quot;yes&quot;,&quot;pause_on_hover&quot;:&quot;yes&quot;,&quot;pause_on_interaction&quot;:&quot;yes&quot;,&quot;autoplay_speed&quot;:5000,&quot;infinite&quot;:&quot;yes&quot;,&quot;effect&quot;:&quot;slide&quot;,&quot;speed&quot;:500}\" data-widget_type=\"image-carousel.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.9.2 - 21-12-2022 *\/\n.elementor-widget-image-carousel .swiper-container{position:static}.elementor-widget-image-carousel .swiper-container .swiper-slide figure{line-height:inherit}.elementor-widget-image-carousel .swiper-slide{text-align:center}.elementor-image-carousel-wrapper:not(.swiper-container-initialized) .swiper-slide{max-width:calc(100% \/ var(--e-image-carousel-slides-to-show, 3))}<\/style>\t\t<div class=\"elementor-image-carousel-wrapper swiper-container\" dir=\"ltr\">\n\t\t\t<div class=\"elementor-image-carousel swiper-wrapper swiper-image-stretch\">\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/pharmoclock.com\/order\/wp-content\/uploads\/2022\/12\/order-banner-01.jpg\" alt=\"Order Form Carousel\" \/><\/figure><\/div>\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9bfd478 elementor-widget elementor-widget-heading\" data-id=\"9bfd478\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.9.2 - 21-12-2022 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">Online Order Form<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e74f710 elementor-widget elementor-widget-shortcode\" data-id=\"e74f710\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f14-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/order\/wp-json\/wp\/v2\/pages\/128#wpcf7-f14-o1\" method=\"post\" class=\"wpcf7-form init\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"14\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.6.4\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f14-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"content-column one_half\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input type=\"text\" name=\"your-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Billing Name\/Patient Name*\" \/><\/span>\n<\/div>\n<div class=\"content-column one_half last_column\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"doctor-name\"><input type=\"text\" name=\"doctor-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Doctor&#039;s Name*\" \/><\/span>\n<\/div>\n<div class=\"content-column one_half\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input type=\"tel\" name=\"your-phone\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Contact No.*\" \/><\/span>\n<\/div>\n<div class=\"content-column one_half last_column\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input type=\"email\" name=\"your-email\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email*\" \/><\/span>\n<\/div>\n<div style=\"display: flex; padding: 10px;\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"delivery-address\"><textarea name=\"delivery-address\" cols=\"40\" rows=\"5\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Delivery Address*\"><\/textarea><\/span>\n<\/div>\n<div class=\"content-column one_half\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pincode\"><input type=\"number\" name=\"pincode\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" min=\"380000\" max=\"389999\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Pincode*\" \/><\/span>\n<\/div>\n<div class=\"content-column one_half last_column\">\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pharmoclock-branch\"><select name=\"pharmoclock-branch\" class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" id=\"pharmoclock-branch\" aria-required=\"true\" aria-invalid=\"false\"><option value=\"\">PharmO&#039;Clock Branch*<\/option><option value=\"Mansi Circle\">Mansi Circle<\/option><option value=\"Nikol\">Nikol<\/option><option value=\"Shilaj\">Shilaj<\/option><option value=\"Science City\">Science City<\/option><option value=\"Meghaninagar\">Meghaninagar<\/option><option value=\"Rest of Ahmedabad\">Rest of Ahmedabad<\/option><option value=\"Petlad\">Petlad<\/option><option value=\"Palanpur\">Palanpur<\/option><option value=\"Jahangirpura, Surat\">Jahangirpura, Surat<\/option><\/select><\/span>\n<\/div>\n<div style=\"display: flex; flex-direction: column; padding: 10px;\">\n<strong>Medicines (Enter the name of medicines required and quantity in strips)<\/strong>\n<table>\n  <!--<tr>\n    <th><strong>Item<\/strong><\/th>\n    <th><strong>Qty.<br>(No. of Strips)<\/strong><\/th>\n  <\/tr>-->\n  <tr>\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-01\"><input type=\"text\" name=\"itm-01\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required w-80 mr-20\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-01\"><input type=\"number\" name=\"qty-01\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n  <tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-02\"><input type=\"text\" name=\"itm-02\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-02\"><input type=\"number\" name=\"qty-02\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-03\"><input type=\"text\" name=\"itm-03\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-03\"><input type=\"number\" name=\"qty-03\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-04\"><input type=\"text\" name=\"itm-04\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-04\"><input type=\"number\" name=\"qty-04\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-05\"><input type=\"text\" name=\"itm-05\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-05\"><input type=\"number\" name=\"qty-05\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-06\"><input type=\"text\" name=\"itm-06\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-06\"><input type=\"number\" name=\"qty-06\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-07\"><input type=\"text\" name=\"itm-07\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-07\"><input type=\"number\" name=\"qty-07\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-08\"><input type=\"text\" name=\"itm-08\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-08\"><input type=\"number\" name=\"qty-08\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-09\"><input type=\"text\" name=\"itm-09\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-09\"><input type=\"number\" name=\"qty-09\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-10\"><input type=\"text\" name=\"itm-10\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-10\"><input type=\"number\" name=\"qty-10\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-11\"><input type=\"text\" name=\"itm-11\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-11\"><input type=\"number\" name=\"qty-11\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-12\"><input type=\"text\" name=\"itm-12\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-12\"><input type=\"number\" name=\"qty-12\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-13\"><input type=\"text\" name=\"itm-13\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-13\"><input type=\"number\" name=\"qty-13\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-14\"><input type=\"text\" name=\"itm-14\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-14\"><input type=\"number\" name=\"qty-14\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-15\"><input type=\"text\" name=\"itm-15\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-15\"><input type=\"number\" name=\"qty-15\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-16\"><input type=\"text\" name=\"itm-16\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-16\"><input type=\"number\" name=\"qty-16\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-17\"><input type=\"text\" name=\"itm-17\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-17\"><input type=\"number\" name=\"qty-17\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-18\"><input type=\"text\" name=\"itm-18\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-18\"><input type=\"number\" name=\"qty-18\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-19\"><input type=\"text\" name=\"itm-19\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-19\"><input type=\"number\" name=\"qty-19\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n<tr class=\"hidden-field\">\n    <td style=\"display: flex;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"itm-20\"><input type=\"text\" name=\"itm-20\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text w-80 mr-20\" aria-invalid=\"false\" placeholder=\"Item Name\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"qty-20\"><input type=\"number\" name=\"qty-20\" value=\"\" class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"1\" max=\"10\" aria-invalid=\"false\" placeholder=\"Qty.\" \/><\/span><\/td>   \n  <\/tr>\n\n<\/table>\n<button name=\"additem\" value=\"additem\" type=\"button\" class=\"addtitem secondary-btn\" onclick=\"jQuery('.hidden-field:first').removeClass('hidden-field');if(jQuery('.hidden-field').length == 0) jQuery(this).hide();\">Add Item<\/button>\n<\/div>\n\n<div style=\"display: flex; flex-direction: column; padding: 10px;\">\n<label> Upload Prescription (jpg,png,pdf | File size limit : 5 MB)\n<span class=\"wpcf7-form-control-wrap\" data-name=\"prescription\"><input type=\"file\" name=\"prescription\" size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.jpeg,.png,.pdf\" aria-invalid=\"false\" \/><\/span> <\/label>\n<\/div>\n\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pharmemail\"><input type=\"email\" name=\"pharmemail\" value=\"info.pharmoclock@gmail.com\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email hidden-field\" id=\"pharmemail\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span>\n\n<div style=\"display: flex; flex-direction: column; padding: 10px;\">\n<input type=\"submit\" value=\"Submit\" class=\"wpcf7-form-control has-spinner wpcf7-submit primary-btn\" \/>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8b687b0 elementor-widget elementor-widget-html\" data-id=\"8b687b0\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<script text=\"text\/javascript\">\r\nvar pharmoBranch;\r\njQuery('#pharmoclock-branch').on('change', function() {\r\npharmoBranch = this.value;\r\nif (pharmoBranch == \"Mansi Circle\") {\r\njQuery('#pharmemail').val(\"info.pharmoclock@gmail.com\");\r\n}\r\nelse if (pharmoBranch == \"Jahangirpura, Surat\") {\r\njQuery('#pharmemail').val(\"jahangirpura.poc@gmail.com\");\r\n}\r\nelse if (pharmoBranch == \"Nikol\") {\r\njQuery('#pharmemail').val(\"nikol.Poc@gmail.com\");\r\n}\r\nelse if (pharmoBranch == \"Bopal\") {\r\njQuery('#pharmemail').val(\"southbopal.poc@gmail.com\");\r\n}\r\nelse if (pharmoBranch == \"Shilaj\") {\r\njQuery('#pharmemail').val(\"shilaj.poc@gmail.com\");\r\n}\r\nelse if (pharmoBranch == \"Science City\") {\r\njQuery('#pharmemail').val(\"sciencecity.poc@gmail.com\");\r\n}\r\nelse if (pharmoBranch == \"Rest of Ahmedabad\") {\r\njQuery('#pharmemail').val(\"info.pharmoclock@gmail.com\");\r\n}\r\nelse if (pharmoBranch == \"Petlad\") {\r\njQuery('#pharmemail').val(\"petlad.poc@gmail.com\");\r\n}\r\nelse if (pharmoBranch == \"Meghaninagar\") {\r\njQuery('#pharmemail').val(\"meghaninagar.poc@gmail.com\");\r\n}\r\nelse if (pharmoBranch == \"Palanpur\") {\r\njQuery('#pharmemail').val(\"palanpur.poc@gmail.com\");\r\n}\r\nconsole.log(pharmoBranch);\r\n});\r\n<\/script>\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\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Online Order Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"footnotes":""},"class_list":["post-128","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pharmoclock.com\/order\/wp-json\/wp\/v2\/pages\/128","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmoclock.com\/order\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pharmoclock.com\/order\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pharmoclock.com\/order\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmoclock.com\/order\/wp-json\/wp\/v2\/comments?post=128"}],"version-history":[{"count":58,"href":"https:\/\/pharmoclock.com\/order\/wp-json\/wp\/v2\/pages\/128\/revisions"}],"predecessor-version":[{"id":207,"href":"https:\/\/pharmoclock.com\/order\/wp-json\/wp\/v2\/pages\/128\/revisions\/207"}],"wp:attachment":[{"href":"https:\/\/pharmoclock.com\/order\/wp-json\/wp\/v2\/media?parent=128"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}