{"id":77,"date":"2014-11-22T07:35:26","date_gmt":"2014-11-22T07:35:26","guid":{"rendered":"http:\/\/osrodekpsychologiczny.com\/?page_id=77"},"modified":"2014-11-22T07:56:08","modified_gmt":"2014-11-22T07:56:08","slug":"zgloszenie","status":"publish","type":"page","link":"https:\/\/osrodekpsychologiczny.com\/?page_id=77","title":{"rendered":"Zg\u0142oszenie"},"content":{"rendered":"\n\n<!-- Fast Secure Contact Form plugin 4.0.52 - begin - FastSecureContactForm.com -->\r\n<div style=\"clear:both;\"><\/div>\n<p style=\"size: 14\">Prosimy wype\u0142ni\u0107 Zg\u0142oszenie.<\/p>\r\n<div id=\"FSContact1\" style=\"width:99%; max-width:555px;\">\r\n<form action=\"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F77#FSContact1\" id=\"fscf_form1\" method=\"post\">\r\n\n<div id=\"fscf_required1\">\n  <span style=\"text-align:left;\">*<\/span> <span style=\"text-align:left;\">Informacja konieczna<\/span>\n<\/div>\n\n\n<div id=\"fscf_div_clear1_0\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_0\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\r\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_f_name1\">Imi\u0119<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\r\n    <div style=\"text-align:left;\">\r\n\t  <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_f_name1\" name=\"f_name\" value=\"\"  \/>\r\n    <\/div>\r\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_l_name1\">Nazwisko<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\r\n    <div style=\"text-align:left;\">\r\n\t  <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_l_name1\" name=\"l_name\" value=\"\"  \/>\r\n    <\/div>\r\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_1\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_1\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_email1\">Email:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_email1\" name=\"email\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_4\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_4\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label1_4\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_4\">Telefon kontaktowy:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:250px;\" type=\"text\" id=\"fscf_field1_4\" name=\"telefon-kontaktowy\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_5\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_5\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label1_5\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_5\">Prosz\u0119 o:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:15px;\" id=\"fscf_field1_5_1\" name=\"prosze_o[1]\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field1_5_1\">og\u00f3lne informacje<\/label><\/span><br \/>\n      <span><input type=\"checkbox\" style=\"width:15px;\" id=\"fscf_field1_5_2\" name=\"prosze_o[2]\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field1_5_2\">termin spotkania<\/label><\/span><br \/>\n      <span><input type=\"checkbox\" style=\"width:15px;\" id=\"fscf_field1_5_3\" name=\"prosze_o[3]\" value=\"3\" \/> <label style=\"display:inline;\" for=\"fscf_field1_5_3\">informacje o p\u0142atno\u015bciach<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_9\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_9\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label1_9\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_9\">Termin:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:15px;\" id=\"fscf_field1_9_1\" name=\"termin\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field1_9_1\">Potrzebuj\u0119 terminu w 48 godzin.<\/label><\/span><br \/>\n      <span><input type=\"radio\" style=\"width:15px;\" id=\"fscf_field1_9_2\" name=\"termin\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field1_9_2\">Potrzebuj\u0119 terminu za 7-10 dni.<\/label><\/span><br \/>\n      <span><input type=\"radio\" style=\"width:15px;\" id=\"fscf_field1_9_3\" name=\"termin\" value=\"3\" \/> <label style=\"display:inline;\" for=\"fscf_field1_9_3\">Nie zale\u017cy mi na czasie.<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_8\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_8\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label1_8\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_8\">Nowy klient:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"radio\" style=\"width:15px;\" id=\"fscf_field1_8_1\" name=\"nowy-klient\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field1_8_1\">To m\u00f3j pierwszy kontakt.<\/label><\/span><br \/>\n      <span><input type=\"radio\" style=\"width:15px;\" id=\"fscf_field1_8_2\" name=\"nowy-klient\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field1_8_2\">By\u0142em w  kontakcie ale bez um\u00f3wienia si\u0119.<\/label><\/span><br \/>\n      <span><input type=\"radio\" style=\"width:15px;\" id=\"fscf_field1_8_3\" name=\"nowy-klient\" value=\"3\" \/> <label style=\"display:inline;\" for=\"fscf_field1_8_3\">By\u0142em ju\u017c klientem w ci\u0105gu ostatniego roku.<\/label><\/span><br \/>\n      <span><input type=\"radio\" style=\"width:15px;\" id=\"fscf_field1_8_4\" name=\"nowy-klient\" value=\"4\" \/> <label style=\"display:inline;\" for=\"fscf_field1_8_4\">By\u0142em ju\u017c klientem ale ponad rok temu.<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_6\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_6\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label1_6\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_6\">Preferuj\u0119 kontakt:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:15px;\" id=\"fscf_field1_6_1\" name=\"preferuje-kontakt[1]\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field1_6_1\">telefoniczny<\/label><\/span><br \/>\n      <span><input type=\"checkbox\" style=\"width:15px;\" id=\"fscf_field1_6_2\" name=\"preferuje-kontakt[2]\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field1_6_2\">przez email<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_7\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_7\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div  id=\"fscf_label1_7\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_7\">Prosz\u0119 o kontakt:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <span><input type=\"checkbox\" style=\"width:15px;\" id=\"fscf_field1_7_1\" name=\"prosze-o-kontakt[1]\" value=\"1\" \/> <label style=\"display:inline;\" for=\"fscf_field1_7_1\">przed po\u0142udniem<\/label><\/span><br \/>\n      <span><input type=\"checkbox\" style=\"width:15px;\" id=\"fscf_field1_7_2\" name=\"prosze-o-kontakt[2]\" value=\"2\" \/> <label style=\"display:inline;\" for=\"fscf_field1_7_2\">mi\u0119dzy 12-6 pm<\/label><\/span><br \/>\n      <span><input type=\"checkbox\" style=\"width:15px;\" id=\"fscf_field1_7_3\" name=\"prosze-o-kontakt[3]\" value=\"3\" \/> <label style=\"display:inline;\" for=\"fscf_field1_7_3\">po 6 pm<\/label><\/span>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_3\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_3\" style=\"clear:left; float:left; width:99%; max-width:550px; margin-right:10px;\">\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_field1_3\">Tre\u015b\u0107 wiadomo\u015bci:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:250px; height:120px;\" id=\"fscf_field1_3\" name=\"message\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\r\n<div style=\"clear:both;\"><\/div>\n\n<div style=\"text-align:left; padding-top:5px;\">\n<\/div>\n<div id=\"fscf_captcha_image_div1\" style=\"width:250px; height:65px; padding-top:2px;\">\n      <img loading=\"lazy\" decoding=\"async\" id=\"fscf_captcha_image1\" style=\"border-style:none; margin:0; padding:0px; padding-right:5px; float:left;\" src=\"https:\/\/osrodekpsychologiczny.com\/wp-content\/plugins\/si-contact-form\/captcha\/securimage_show.php?prefix=GS9aTUT76CpqlGxm\" width=\"175\" height=\"60\" alt=\"Sprawdzamy czy nie jeste\u015b robotem.\" title=\"Sprawdzamy czy nie jeste\u015b robotem.\" \/>\n      <input id=\"fscf_captcha_prefix1\" type=\"hidden\" name=\"fscf_captcha_prefix1\" value=\"GS9aTUT76CpqlGxm\" \/>\n     <div id=\"fscf_captcha_refresh1\">\n        <a href=\"#\" rel=\"nofollow\" title=\"Poka\u017c mi nowy wz\u00f3r\" onclick=\"fscf_captcha_refresh('1','\/wp-content\/plugins\/si-contact-form\/captcha','https:\/\/osrodekpsychologiczny.com\/wp-content\/plugins\/si-contact-form\/captcha\/securimage_show.php?prefix='); return false;\">\n        <img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/osrodekpsychologiczny.com\/wp-content\/plugins\/si-contact-form\/captcha\/images\/refresh.png\" width=\"22\" height=\"20\" alt=\"Poka\u017c mi nowy wz\u00f3r\" style=\"border-style:none; margin:0; padding:0px; vertical-align:bottom;\" onclick=\"this.blur();\" \/><\/a>\r\n     <\/div>\r\n<\/div>\r\n\r\n<div id=\"fscf_captcha_field1\" style=\"text-align:left; padding-top:5px;\">\r\n     <label style=\"text-align:left;\" for=\"fscf_captcha_code1\">Wpisz kod z okienka. Sprawdzamy czy nie jeste\u015b robotem.<span style=\"text-align:left;\">*<\/span><\/label>\r\n<\/div>\r\n<div style=\"text-align:left;\">\n     <input style=\"text-align:left; margin:0; width:100px;\" type=\"text\" value=\"\" autocomplete=\"off\" id=\"fscf_captcha_code1\" name=\"captcha_code\"  \/>\n<\/div>\n        \r\n<div style=\"display:none;\">\r\n     <label for=\"address21\"><small>Leave this field empty<\/small><\/label>\r\n     <input type=\"text\" name=\"address2\" id=\"address21\" value=\"\" \/>\r\n<\/div>\r\n\n<div id=\"fscf_submit_div1\" style=\"text-align:left; clear:both; padding-top:15px;\">\r\n\t\t<input type=\"submit\" id=\"fscf_submit1\" style=\"cursor:pointer; margin:0;\" value=\"Wy\u015blij\"  onclick=\"this.disabled=true; this.value='Wysy\u0142am...'; this.form.submit();\" \/> \n<\/div>\n\n<input type=\"hidden\" name=\"fscf_submitted\" value=\"0\" \/>\n<input type=\"hidden\" name=\"fs_postonce_1\" value=\"6120f15e971e7713ac93032ef1b01fe0,1777861074\" \/>\n<input type=\"hidden\" name=\"si_contact_action\" value=\"send\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"1\" \/>\n<input type=\"hidden\" name=\"mailto_id\" value=\"1\" \/>\n\n<\/form>\n<\/div>\r\n<div style=\"clear:both;\"><\/div>\n\n<!-- Fast Secure Contact Form plugin 4.0.52 - end - FastSecureContactForm.com -->\n\n","protected":false},"excerpt":{"rendered":"<p> &hellip; <a class=\"more-link\" href=\"https:\/\/osrodekpsychologiczny.com\/?page_id=77\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":38,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-77","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=\/wp\/v2\/pages\/77","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=77"}],"version-history":[{"count":4,"href":"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=\/wp\/v2\/pages\/77\/revisions"}],"predecessor-version":[{"id":81,"href":"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=\/wp\/v2\/pages\/77\/revisions\/81"}],"up":[{"embeddable":true,"href":"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=\/wp\/v2\/pages\/38"}],"wp:attachment":[{"href":"https:\/\/osrodekpsychologiczny.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=77"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}