{"id":8096,"date":"2023-03-28T19:00:07","date_gmt":"2023-03-29T01:00:07","guid":{"rendered":"https:\/\/newgil.hvega.com\/?page_id=8096"},"modified":"2025-05-14T23:36:32","modified_gmt":"2025-05-15T05:36:32","slug":"contact","status":"publish","type":"page","link":"https:\/\/www.gildentalclinic.com\/en\/contact\/","title":{"rendered":"Contact Us"},"content":{"rendered":"<div class=\"gb-container gb-container-5a6b59a5 alignfull\">\n<div class=\"gb-container gb-container-178f14e4\">\n<h1 class=\"gb-headline gb-headline-78261255 gb-headline-text gb-headline-40250232\">Contact Us<\/h1>\n\n<div class=\"gb-grid-wrapper gb-grid-wrapper-3e169e8d\">\n<div class=\"gb-grid-column gb-grid-column-39c97b53\"><div class=\"gb-container gb-container-39c97b53\">\n\n<figure class=\"gb-block-image gb-block-image-c7088593\"><img loading=\"lazy\" decoding=\"async\" width=\"1200\" height=\"800\" class=\"gb-image gb-image-c7088593\" src=\"https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2022\/01\/clinica-gil-escazu-web-gallery-13.jpg\" alt=\"\" srcset=\"https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2022\/01\/clinica-gil-escazu-web-gallery-13.jpg 1200w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2022\/01\/clinica-gil-escazu-web-gallery-13-300x200.jpg 300w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2022\/01\/clinica-gil-escazu-web-gallery-13-1024x683.jpg 1024w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2022\/01\/clinica-gil-escazu-web-gallery-13-768x512.jpg 768w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/figure>\n\n<\/div><\/div>\n\n<div class=\"gb-grid-column gb-grid-column-00fc457d\"><div class=\"gb-container gb-container-00fc457d\">\n\n<h2 class=\"gb-headline gb-headline-210e6962 gb-headline-text gb-headline-2eca3e58\">Gil Dental Clinic Escaz\u00fa<\/h2>\n\n\n\n<p class=\"gb-headline gb-headline-0807f52e\"><span class=\"gb-icon\"><svg aria-hidden=\"true\" role=\"img\" height=\"1em\" width=\"1em\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill=\"currentColor\" d=\"M172.268 501.67C26.97 291.031 0 269.413 0 192 0 85.961 85.961 0 192 0s192 85.961 192 192c0 77.413-26.97 99.031-172.268 309.67-9.535 13.774-29.93 13.773-39.464 0zM192 272c44.183 0 80-35.817 80-80s-35.817-80-80-80-80 35.817-80 80 35.817 80 80 80z\"><\/path><\/svg><\/span><span class=\"gb-headline-text\"><a href=\"https:\/\/g.page\/gildentalescazu?share\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/g.page\/gildentalescazu?share\" target=\"_blank\" rel=\"noreferrer noopener\">San Rafael de Escaz\u00fa, San Jos\u00e9, Costa Rica. Fuentecantos Building, across Hospital Cima, on Pr\u00f3spero Fern\u00e1ndez&#8217;s alternate road, 300 mts west from gas station Uno<\/a>.<\/span><\/p>\n\n\n\n<p class=\"gb-headline gb-headline-ef801974\"><span class=\"gb-icon\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path d=\"M280 0C408.1 0 512 103.9 512 232c0 13.3-10.7 24-24 24s-24-10.7-24-24c0-101.6-82.4-184-184-184c-13.3 0-24-10.7-24-24s10.7-24 24-24zm8 192a32 32 0 1 1 0 64 32 32 0 1 1 0-64zm-32-72c0-13.3 10.7-24 24-24c75.1 0 136 60.9 136 136c0 13.3-10.7 24-24 24s-24-10.7-24-24c0-48.6-39.4-88-88-88c-13.3 0-24-10.7-24-24zM117.5 1.4c19.4-5.3 39.7 4.6 47.4 23.2l40 96c6.8 16.3 2.1 35.2-11.6 46.3L144 207.3c33.3 70.4 90.3 127.4 160.7 160.7L345 318.7c11.2-13.7 30-18.4 46.3-11.6l96 40c18.6 7.7 28.5 28 23.2 47.4l-24 88C481.8 499.9 466 512 448 512C200.6 512 0 311.4 0 64C0 46 12.1 30.2 29.5 25.4l88-24z\"><\/path><\/svg><\/span><span class=\"gb-headline-text\"><a rel=\"noreferrer noopener\" href=\"tel:+50622886060\" target=\"_blank\">+506 2288-6060<\/a><\/span><\/p>\n\n\n\n<p class=\"gb-headline gb-headline-38a6aecc\"><span class=\"gb-icon\"><svg aria-hidden=\"true\" role=\"img\" height=\"1em\" width=\"1em\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill=\"currentColor\" d=\"M380.9 97.1C339 55.1 283.2 32 223.9 32c-122.4 0-222 99.6-222 222 0 39.1 10.2 77.3 29.6 111L0 480l117.7-30.9c32.4 17.7 68.9 27 106.1 27h.1c122.3 0 224.1-99.6 224.1-222 0-59.3-25.2-115-67.1-157zm-157 341.6c-33.2 0-65.7-8.9-94-25.7l-6.7-4-69.8 18.3L72 359.2l-4.4-7c-18.5-29.4-28.2-63.3-28.2-98.2 0-101.7 82.8-184.5 184.6-184.5 49.3 0 95.6 19.2 130.4 54.1 34.8 34.9 56.2 81.2 56.1 130.5 0 101.8-84.9 184.6-186.6 184.6zm101.2-138.2c-5.5-2.8-32.8-16.2-37.9-18-5.1-1.9-8.8-2.8-12.5 2.8-3.7 5.6-14.3 18-17.6 21.8-3.2 3.7-6.5 4.2-12 1.4-32.6-16.3-54-29.1-75.5-66-5.7-9.8 5.7-9.1 16.3-30.3 1.8-3.7.9-6.9-.5-9.7-1.4-2.8-12.5-30.1-17.1-41.2-4.5-10.8-9.1-9.3-12.5-9.5-3.2-.2-6.9-.2-10.6-.2-3.7 0-9.7 1.4-14.8 6.9-5.1 5.6-19.4 19-19.4 46.3 0 27.3 19.9 53.7 22.6 57.4 2.8 3.7 39.1 59.7 94.8 83.8 35.2 15.2 49 16.5 66.6 13.9 10.7-1.6 32.8-13.4 37.4-26.4 4.6-13 4.6-24.1 3.2-26.4-1.3-2.5-5-3.9-10.5-6.6z\"><\/path><\/svg><\/span><span class=\"gb-headline-text\"><a rel=\"noreferrer noopener\" href=\"https:\/\/wa.me\/50687186060\" target=\"_blank\">+506 8718-6060<\/a><\/span><\/p>\n\n<\/div><\/div>\n<\/div>\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div class=\"gb-grid-wrapper gb-grid-wrapper-8e95097b\">\n<div class=\"gb-grid-column gb-grid-column-4f2fada0\"><div class=\"gb-container gb-container-4f2fada0\">\n\n<figure class=\"gb-block-image gb-block-image-c28f31f2\"><img loading=\"lazy\" decoding=\"async\" width=\"2560\" height=\"1920\" class=\"gb-image gb-image-c28f31f2\" src=\"https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2023\/04\/clinica-san-pedro-2-scaled.jpg\" alt=\"\" title=\"clinica-san-pedro-2\" srcset=\"https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2023\/04\/clinica-san-pedro-2-scaled.jpg 2560w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2023\/04\/clinica-san-pedro-2-300x225.jpg 300w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2023\/04\/clinica-san-pedro-2-1024x768.jpg 1024w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2023\/04\/clinica-san-pedro-2-768x576.jpg 768w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2023\/04\/clinica-san-pedro-2-1536x1152.jpg 1536w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2023\/04\/clinica-san-pedro-2-2048x1536.jpg 2048w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\" \/><\/figure>\n\n<\/div><\/div>\n\n<div class=\"gb-grid-column gb-grid-column-a426e584\"><div class=\"gb-container gb-container-a426e584\">\n\n<h2 class=\"gb-headline gb-headline-8f61d1d1 gb-headline-text gb-headline-2eca3e58\">Gil Dental Clinic San Pedro<\/h2>\n\n\n\n<p class=\"gb-headline gb-headline-542ac2ab\"><span class=\"gb-icon\"><svg aria-hidden=\"true\" role=\"img\" height=\"1em\" width=\"1em\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill=\"currentColor\" d=\"M172.268 501.67C26.97 291.031 0 269.413 0 192 0 85.961 85.961 0 192 0s192 85.961 192 192c0 77.413-26.97 99.031-172.268 309.67-9.535 13.774-29.93 13.773-39.464 0zM192 272c44.183 0 80-35.817 80-80s-35.817-80-80-80-80 35.817-80 80 35.817 80 80 80z\"><\/path><\/svg><\/span><span class=\"gb-headline-text\"><a href=\"https:\/\/g.page\/gildentalsanpedro?share\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/g.page\/gildentalsanpedro?share\" target=\"_blank\" rel=\"noreferrer noopener\">San Pedro de Montes de Oca, San Jos\u00e9, Costa Rica. 300 mts west of Barrio Dent&#8217;s Taco Bell.<\/a>.<\/span><\/p>\n\n\n\n<p class=\"gb-headline gb-headline-3b0ff543\"><span class=\"gb-icon\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path d=\"M280 0C408.1 0 512 103.9 512 232c0 13.3-10.7 24-24 24s-24-10.7-24-24c0-101.6-82.4-184-184-184c-13.3 0-24-10.7-24-24s10.7-24 24-24zm8 192a32 32 0 1 1 0 64 32 32 0 1 1 0-64zm-32-72c0-13.3 10.7-24 24-24c75.1 0 136 60.9 136 136c0 13.3-10.7 24-24 24s-24-10.7-24-24c0-48.6-39.4-88-88-88c-13.3 0-24-10.7-24-24zM117.5 1.4c19.4-5.3 39.7 4.6 47.4 23.2l40 96c6.8 16.3 2.1 35.2-11.6 46.3L144 207.3c33.3 70.4 90.3 127.4 160.7 160.7L345 318.7c11.2-13.7 30-18.4 46.3-11.6l96 40c18.6 7.7 28.5 28 23.2 47.4l-24 88C481.8 499.9 466 512 448 512C200.6 512 0 311.4 0 64C0 46 12.1 30.2 29.5 25.4l88-24z\"><\/path><\/svg><\/span><span class=\"gb-headline-text\"><a href=\"tel:+50622886060\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"tel:+50622830045\" target=\"_blank\" rel=\"noreferrer noopener\">+506 2283-0045<\/a><\/span><\/p>\n\n\n\n<p class=\"gb-headline gb-headline-95540bdb\"><span class=\"gb-icon\"><svg aria-hidden=\"true\" role=\"img\" height=\"1em\" width=\"1em\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill=\"currentColor\" d=\"M380.9 97.1C339 55.1 283.2 32 223.9 32c-122.4 0-222 99.6-222 222 0 39.1 10.2 77.3 29.6 111L0 480l117.7-30.9c32.4 17.7 68.9 27 106.1 27h.1c122.3 0 224.1-99.6 224.1-222 0-59.3-25.2-115-67.1-157zm-157 341.6c-33.2 0-65.7-8.9-94-25.7l-6.7-4-69.8 18.3L72 359.2l-4.4-7c-18.5-29.4-28.2-63.3-28.2-98.2 0-101.7 82.8-184.5 184.6-184.5 49.3 0 95.6 19.2 130.4 54.1 34.8 34.9 56.2 81.2 56.1 130.5 0 101.8-84.9 184.6-186.6 184.6zm101.2-138.2c-5.5-2.8-32.8-16.2-37.9-18-5.1-1.9-8.8-2.8-12.5 2.8-3.7 5.6-14.3 18-17.6 21.8-3.2 3.7-6.5 4.2-12 1.4-32.6-16.3-54-29.1-75.5-66-5.7-9.8 5.7-9.1 16.3-30.3 1.8-3.7.9-6.9-.5-9.7-1.4-2.8-12.5-30.1-17.1-41.2-4.5-10.8-9.1-9.3-12.5-9.5-3.2-.2-6.9-.2-10.6-.2-3.7 0-9.7 1.4-14.8 6.9-5.1 5.6-19.4 19-19.4 46.3 0 27.3 19.9 53.7 22.6 57.4 2.8 3.7 39.1 59.7 94.8 83.8 35.2 15.2 49 16.5 66.6 13.9 10.7-1.6 32.8-13.4 37.4-26.4 4.6-13 4.6-24.1 3.2-26.4-1.3-2.5-5-3.9-10.5-6.6z\"><\/path><\/svg><\/span><span class=\"gb-headline-text\"><a href=\"https:\/\/wa.me\/50687186060\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/api.whatsapp.com\/send\/?phone=50689900045&amp;text&amp;type=phone_number&amp;app_absent=0\" target=\"_blank\" rel=\"noreferrer noopener\">+506 8990-0045<\/a><\/span><\/p>\n\n<\/div><\/div>\n<\/div>\n\n\n<div style=\"height:60px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div class=\"gb-grid-wrapper gb-grid-wrapper-bd12ce17\">\n<div class=\"gb-grid-column gb-grid-column-69afc4ae\"><div class=\"gb-container gb-container-69afc4ae\">\n\n<figure class=\"gb-block-image gb-block-image-8f36d1ed\"><img loading=\"lazy\" decoding=\"async\" width=\"1000\" height=\"750\" class=\"gb-image gb-image-8f36d1ed\" src=\"http:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2024\/05\/clinica-gil-guanacaste.jpg\" alt=\"Cl\u00ednica Gil Guanacaste\" title=\"Cl\u00ednica Gil Guanacaste\" srcset=\"https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2024\/05\/clinica-gil-guanacaste.jpg 1000w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2024\/05\/clinica-gil-guanacaste-300x225.jpg 300w, https:\/\/www.gildentalclinic.com\/wp-content\/uploads\/2024\/05\/clinica-gil-guanacaste-768x576.jpg 768w\" sizes=\"auto, (max-width: 1000px) 100vw, 1000px\" \/><\/figure>\n\n<\/div><\/div>\n\n<div class=\"gb-grid-column gb-grid-column-4574b934\"><div class=\"gb-container gb-container-4574b934\">\n\n<h2 class=\"gb-headline gb-headline-ca85252d gb-headline-text gb-headline-2eca3e58\">Gil Dental Clinic Guanacaste<\/h2>\n\n\n\n<p class=\"gb-headline gb-headline-066ef29a\"><span class=\"gb-icon\"><svg aria-hidden=\"true\" role=\"img\" height=\"1em\" width=\"1em\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill=\"currentColor\" d=\"M172.268 501.67C26.97 291.031 0 269.413 0 192 0 85.961 85.961 0 192 0s192 85.961 192 192c0 77.413-26.97 99.031-172.268 309.67-9.535 13.774-29.93 13.773-39.464 0zM192 272c44.183 0 80-35.817 80-80s-35.817-80-80-80-80 35.817-80 80 35.817 80 80 80z\"><\/path><\/svg><\/span><span class=\"gb-headline-text\"><a href=\"https:\/\/maps.app.goo.gl\/dEbC2hTbzLigf81n6\">Centro Building at Parque Tempisque, 300 meters west of the entrance to Papagayo,<br>next to La Paz Community School.<\/a><\/span><\/p>\n\n\n\n<p class=\"gb-headline gb-headline-f03c2c1b\"><span class=\"gb-icon\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path d=\"M280 0C408.1 0 512 103.9 512 232c0 13.3-10.7 24-24 24s-24-10.7-24-24c0-101.6-82.4-184-184-184c-13.3 0-24-10.7-24-24s10.7-24 24-24zm8 192a32 32 0 1 1 0 64 32 32 0 1 1 0-64zm-32-72c0-13.3 10.7-24 24-24c75.1 0 136 60.9 136 136c0 13.3-10.7 24-24 24s-24-10.7-24-24c0-48.6-39.4-88-88-88c-13.3 0-24-10.7-24-24zM117.5 1.4c19.4-5.3 39.7 4.6 47.4 23.2l40 96c6.8 16.3 2.1 35.2-11.6 46.3L144 207.3c33.3 70.4 90.3 127.4 160.7 160.7L345 318.7c11.2-13.7 30-18.4 46.3-11.6l96 40c18.6 7.7 28.5 28 23.2 47.4l-24 88C481.8 499.9 466 512 448 512C200.6 512 0 311.4 0 64C0 46 12.1 30.2 29.5 25.4l88-24z\"><\/path><\/svg><\/span><span class=\"gb-headline-text\"><a href=\"tel:+50622886060\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"tel:+50624590379\" target=\"_blank\" rel=\"noreferrer noopener\">+506 2459-0379<\/a><\/span><\/p>\n\n\n\n<p class=\"gb-headline gb-headline-d01a36f1\"><span class=\"gb-icon\"><svg aria-hidden=\"true\" role=\"img\" height=\"1em\" width=\"1em\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill=\"currentColor\" d=\"M380.9 97.1C339 55.1 283.2 32 223.9 32c-122.4 0-222 99.6-222 222 0 39.1 10.2 77.3 29.6 111L0 480l117.7-30.9c32.4 17.7 68.9 27 106.1 27h.1c122.3 0 224.1-99.6 224.1-222 0-59.3-25.2-115-67.1-157zm-157 341.6c-33.2 0-65.7-8.9-94-25.7l-6.7-4-69.8 18.3L72 359.2l-4.4-7c-18.5-29.4-28.2-63.3-28.2-98.2 0-101.7 82.8-184.5 184.6-184.5 49.3 0 95.6 19.2 130.4 54.1 34.8 34.9 56.2 81.2 56.1 130.5 0 101.8-84.9 184.6-186.6 184.6zm101.2-138.2c-5.5-2.8-32.8-16.2-37.9-18-5.1-1.9-8.8-2.8-12.5 2.8-3.7 5.6-14.3 18-17.6 21.8-3.2 3.7-6.5 4.2-12 1.4-32.6-16.3-54-29.1-75.5-66-5.7-9.8 5.7-9.1 16.3-30.3 1.8-3.7.9-6.9-.5-9.7-1.4-2.8-12.5-30.1-17.1-41.2-4.5-10.8-9.1-9.3-12.5-9.5-3.2-.2-6.9-.2-10.6-.2-3.7 0-9.7 1.4-14.8 6.9-5.1 5.6-19.4 19-19.4 46.3 0 27.3 19.9 53.7 22.6 57.4 2.8 3.7 39.1 59.7 94.8 83.8 35.2 15.2 49 16.5 66.6 13.9 10.7-1.6 32.8-13.4 37.4-26.4 4.6-13 4.6-24.1 3.2-26.4-1.3-2.5-5-3.9-10.5-6.6z\"><\/path><\/svg><\/span><span class=\"gb-headline-text\"><a href=\"https:\/\/wa.me\/50687186060\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/api.whatsapp.com\/send\/?phone=50687622080&amp;text&amp;type=phone_number&amp;app_absent=0\" target=\"_blank\" rel=\"noreferrer noopener\">+506 8762-2080<\/a><\/span><\/p>\n\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n<div class=\"gb-container gb-container-6593626f alignfull\">\n<div class=\"gb-container gb-container-0f569c61\">\n\n<p class=\"gb-headline gb-headline-47a69ff9 gb-headline-text\"><strong>Office Hours<\/strong><\/p>\n\n\n\n<p class=\"gb-headline gb-headline-0daa91f4 gb-headline-text\">Monday to Thursday  9:00 a.m. to 6:00 p.m.<\/p>\n\n\n\n<p class=\"gb-headline gb-headline-be16203f gb-headline-text\">Friday 9:00 a.m. to 4:00 p.m.<\/p>\n\n<\/div>\n<\/div>\n\n<div class=\"gb-container gb-container-ee9a86b2 alignfull\">\n<div class=\"gb-container gb-container-acc6c9f8\">\n<style id=\"wpforms-css-vars-7973-block-3a07b2c5-8a04-4494-b964-19e9d54ea036\">\n\t\t\t\t#wpforms-7973.wpforms-block-3a07b2c5-8a04-4494-b964-19e9d54ea036 {\n\t\t\t\t--wpforms-field-text-color: #3d472b;\n--wpforms-button-border-radius: 16px;\n--wpforms-button-background-color: var(--global-color-buttons);\n--wpforms-field-size-input-height: 50px;\n--wpforms-field-size-input-spacing: 20px;\n--wpforms-field-size-font-size: 18px;\n--wpforms-field-size-line-height: 21px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 18px;\n--wpforms-field-size-sublabel-spacing: 10px;\n--wpforms-field-size-icon-size: 1.25;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 20px;\n--wpforms-button-size-height: 48px;\n--wpforms-button-size-padding-h: 20px;\n--wpforms-button-size-margin-top: 15px;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-3a07b2c5-8a04-4494-b964-19e9d54ea036 wpforms-render-modern\" id=\"wpforms-7973\"><form id=\"wpforms-form-7973\" class=\"wpforms-validate wpforms-form\" data-formid=\"7973\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/8096\" data-token=\"58f3955ceeb8d0087d3623f6cc80afd7\" data-token-time=\"1776699642\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-7973-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Full Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-7973-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" placeholder=\"Name *\" aria-errormessage=\"wpforms-7973-field_0-error\" required><label for=\"wpforms-7973-field_0\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-7973-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" placeholder=\"Last name *\" aria-errormessage=\"wpforms-7973-field_0-last-error\" required><label for=\"wpforms-7973-field_0-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-7973-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7973-field_1\" aria-hidden=\"false\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-7973-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" placeholder=\"Email *\" spellcheck=\"false\" aria-errormessage=\"wpforms-7973-field_1-error\" required><\/div><div id=\"wpforms-7973-field_3-container\" class=\"wpforms-field wpforms-field-number wpforms-one-half wpforms-first\" data-field-id=\"3\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7973-field_3\" aria-hidden=\"false\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-7973-field_3\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][3]\" placeholder=\"Phone number *\" step=\"any\" aria-errormessage=\"wpforms-7973-field_3-error\" required><\/div><div id=\"wpforms-7973-field_4-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-field-select-style-classic\" data-field-id=\"4\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7973-field_4\" aria-hidden=\"false\">Country of Residence<\/label><select id=\"wpforms-7973-field_4\" class=\"wpforms-field-large\" name=\"wpforms[fields][4]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Country of Residence<\/option><option value=\"Afghanistan\"  class=\"choice-4 depth-1\"  >Afghanistan<\/option><option value=\"Albania\"  class=\"choice-5 depth-1\"  >Albania<\/option><option value=\"Algeria\"  class=\"choice-6 depth-1\"  >Algeria<\/option><option value=\"Andorra\"  class=\"choice-7 depth-1\"  >Andorra<\/option><option value=\"Angola\"  class=\"choice-8 depth-1\"  >Angola<\/option><option value=\"Antarctica\"  class=\"choice-9 depth-1\"  >Antarctica<\/option><option value=\"Antigua and Barbuda\"  class=\"choice-10 depth-1\"  >Antigua and Barbuda<\/option><option value=\"Argentina\"  class=\"choice-11 depth-1\"  >Argentina<\/option><option value=\"Armenia\"  class=\"choice-12 depth-1\"  >Armenia<\/option><option value=\"Australia\"  class=\"choice-13 depth-1\"  >Australia<\/option><option value=\"Austria\"  class=\"choice-14 depth-1\"  >Austria<\/option><option value=\"Azerbaijan\"  class=\"choice-15 depth-1\"  >Azerbaijan<\/option><option value=\"Bahamas\"  class=\"choice-16 depth-1\"  >Bahamas<\/option><option value=\"Bahrain\"  class=\"choice-17 depth-1\"  >Bahrain<\/option><option value=\"Bangladesh\"  class=\"choice-18 depth-1\"  >Bangladesh<\/option><option value=\"Barbados\"  class=\"choice-19 depth-1\"  >Barbados<\/option><option value=\"Belarus\"  class=\"choice-20 depth-1\"  >Belarus<\/option><option value=\"Belgium\"  class=\"choice-21 depth-1\"  >Belgium<\/option><option value=\"Belize\"  class=\"choice-22 depth-1\"  >Belize<\/option><option value=\"Benin\"  class=\"choice-23 depth-1\"  >Benin<\/option><option value=\"Bermuda\"  class=\"choice-24 depth-1\"  >Bermuda<\/option><option value=\"Bhutan\"  class=\"choice-25 depth-1\"  >Bhutan<\/option><option value=\"Bolivia\"  class=\"choice-26 depth-1\"  >Bolivia<\/option><option value=\"Bosnia and Herzegovina\"  class=\"choice-27 depth-1\"  >Bosnia and Herzegovina<\/option><option value=\"Botswana\"  class=\"choice-28 depth-1\"  >Botswana<\/option><option value=\"Brazil\"  class=\"choice-29 depth-1\"  >Brazil<\/option><option value=\"Brunei\"  class=\"choice-30 depth-1\"  >Brunei<\/option><option value=\"Bulgaria\"  class=\"choice-31 depth-1\"  >Bulgaria<\/option><option value=\"Burkina Faso\"  class=\"choice-32 depth-1\"  >Burkina Faso<\/option><option value=\"Burma\"  class=\"choice-33 depth-1\"  >Burma<\/option><option value=\"Burundi\"  class=\"choice-34 depth-1\"  >Burundi<\/option><option value=\"Cambodia\"  class=\"choice-35 depth-1\"  >Cambodia<\/option><option value=\"Cameroon\"  class=\"choice-36 depth-1\"  >Cameroon<\/option><option value=\"Canada\"  class=\"choice-37 depth-1\"  >Canada<\/option><option value=\"Cape Verde\"  class=\"choice-38 depth-1\"  >Cape Verde<\/option><option value=\"Central African Republic\"  class=\"choice-39 depth-1\"  >Central African Republic<\/option><option value=\"Chad\"  class=\"choice-40 depth-1\"  >Chad<\/option><option value=\"Chile\"  class=\"choice-41 depth-1\"  >Chile<\/option><option value=\"China\"  class=\"choice-42 depth-1\"  >China<\/option><option value=\"Colombia\"  class=\"choice-43 depth-1\"  >Colombia<\/option><option value=\"Comoros\"  class=\"choice-44 depth-1\"  >Comoros<\/option><option value=\"Congo, Democratic Republic Congo\"  class=\"choice-45 depth-1\"  >Congo, Democratic Republic Congo<\/option><option value=\"Costa Rica\"  class=\"choice-46 depth-1\"  >Costa Rica<\/option><option value=\"Cote d\u2019Ivoire\"  class=\"choice-47 depth-1\"  >Cote d\u2019Ivoire<\/option><option value=\"Croatia\"  class=\"choice-48 depth-1\"  >Croatia<\/option><option value=\"Cuba\"  class=\"choice-49 depth-1\"  >Cuba<\/option><option value=\"Cyprus\"  class=\"choice-50 depth-1\"  >Cyprus<\/option><option value=\"Czech Republic\"  class=\"choice-51 depth-1\"  >Czech Republic<\/option><option value=\"Denmark\"  class=\"choice-52 depth-1\"  >Denmark<\/option><option value=\"Djibouti\"  class=\"choice-53 depth-1\"  >Djibouti<\/option><option value=\"Dominica\"  class=\"choice-54 depth-1\"  >Dominica<\/option><option value=\"Dominican Republic\"  class=\"choice-55 depth-1\"  >Dominican Republic<\/option><option value=\"East Timor\"  class=\"choice-56 depth-1\"  >East Timor<\/option><option value=\"Ecuador\"  class=\"choice-57 depth-1\"  >Ecuador<\/option><option value=\"Egypt\"  class=\"choice-58 depth-1\"  >Egypt<\/option><option value=\"El Salvador\"  class=\"choice-59 depth-1\"  >El Salvador<\/option><option value=\"Equatorial Guinea\"  class=\"choice-60 depth-1\"  >Equatorial Guinea<\/option><option value=\"Eritrea\"  class=\"choice-61 depth-1\"  >Eritrea<\/option><option value=\"Estonia\"  class=\"choice-62 depth-1\"  >Estonia<\/option><option value=\"Ethiopia\"  class=\"choice-63 depth-1\"  >Ethiopia<\/option><option value=\"Fiji\"  class=\"choice-64 depth-1\"  >Fiji<\/option><option value=\"Finland\"  class=\"choice-65 depth-1\"  >Finland<\/option><option value=\"France\"  class=\"choice-66 depth-1\"  >France<\/option><option value=\"Gabon\"  class=\"choice-67 depth-1\"  >Gabon<\/option><option value=\"Gambia\"  class=\"choice-68 depth-1\"  >Gambia<\/option><option value=\"Georgia\"  class=\"choice-69 depth-1\"  >Georgia<\/option><option value=\"Germany\"  class=\"choice-70 depth-1\"  >Germany<\/option><option value=\"Ghana\"  class=\"choice-71 depth-1\"  >Ghana<\/option><option value=\"Greece\"  class=\"choice-72 depth-1\"  >Greece<\/option><option value=\"Greenland\"  class=\"choice-73 depth-1\"  >Greenland<\/option><option value=\"Grenada\"  class=\"choice-74 depth-1\"  >Grenada<\/option><option value=\"Guatemala\"  class=\"choice-75 depth-1\"  >Guatemala<\/option><option value=\"Guinea\"  class=\"choice-76 depth-1\"  >Guinea<\/option><option value=\"Guinea-Bissau\"  class=\"choice-77 depth-1\"  >Guinea-Bissau<\/option><option value=\"Guyana\"  class=\"choice-78 depth-1\"  >Guyana<\/option><option value=\"Haiti\"  class=\"choice-79 depth-1\"  >Haiti<\/option><option value=\"Honduras\"  class=\"choice-80 depth-1\"  >Honduras<\/option><option value=\"Hong Kong\"  class=\"choice-81 depth-1\"  >Hong Kong<\/option><option value=\"Hungary\"  class=\"choice-82 depth-1\"  >Hungary<\/option><option value=\"Iceland\"  class=\"choice-83 depth-1\"  >Iceland<\/option><option value=\"India\"  class=\"choice-84 depth-1\"  >India<\/option><option value=\"Indonesia\"  class=\"choice-85 depth-1\"  >Indonesia<\/option><option value=\"Iran\"  class=\"choice-86 depth-1\"  >Iran<\/option><option value=\"Iraq\"  class=\"choice-87 depth-1\"  >Iraq<\/option><option value=\"Ireland\"  class=\"choice-88 depth-1\"  >Ireland<\/option><option value=\"Israel\"  class=\"choice-89 depth-1\"  >Israel<\/option><option value=\"Italy\"  class=\"choice-90 depth-1\"  >Italy<\/option><option value=\"Jamaica\"  class=\"choice-91 depth-1\"  >Jamaica<\/option><option value=\"Japan\"  class=\"choice-92 depth-1\"  >Japan<\/option><option value=\"Jordan\"  class=\"choice-93 depth-1\"  >Jordan<\/option><option value=\"Kazakhstan\"  class=\"choice-94 depth-1\"  >Kazakhstan<\/option><option value=\"Kenya\"  class=\"choice-95 depth-1\"  >Kenya<\/option><option value=\"Kiribati\"  class=\"choice-96 depth-1\"  >Kiribati<\/option><option value=\"Korea, North\"  class=\"choice-97 depth-1\"  >Korea, North<\/option><option value=\"Korea, South\"  class=\"choice-98 depth-1\"  >Korea, South<\/option><option value=\"Kuwait\"  class=\"choice-99 depth-1\"  >Kuwait<\/option><option value=\"Kyrgyzstan\"  class=\"choice-100 depth-1\"  >Kyrgyzstan<\/option><option value=\"Laos\"  class=\"choice-101 depth-1\"  >Laos<\/option><option value=\"Latvia\"  class=\"choice-102 depth-1\"  >Latvia<\/option><option value=\"Lebanon\"  class=\"choice-103 depth-1\"  >Lebanon<\/option><option value=\"Lesotho\"  class=\"choice-104 depth-1\"  >Lesotho<\/option><option value=\"Liberia\"  class=\"choice-105 depth-1\"  >Liberia<\/option><option value=\"Libya\"  class=\"choice-106 depth-1\"  >Libya<\/option><option value=\"Liechtenstein\"  class=\"choice-107 depth-1\"  >Liechtenstein<\/option><option value=\"Lithuania\"  class=\"choice-108 depth-1\"  >Lithuania<\/option><option value=\"Luxembourg\"  class=\"choice-109 depth-1\"  >Luxembourg<\/option><option value=\"Macedonia\"  class=\"choice-110 depth-1\"  >Macedonia<\/option><option value=\"Madagascar\"  class=\"choice-111 depth-1\"  >Madagascar<\/option><option value=\"Malawi\"  class=\"choice-112 depth-1\"  >Malawi<\/option><option value=\"Malaysia\"  class=\"choice-113 depth-1\"  >Malaysia<\/option><option value=\"Maldives\"  class=\"choice-114 depth-1\"  >Maldives<\/option><option value=\"Mali\"  class=\"choice-115 depth-1\"  >Mali<\/option><option value=\"Malta\"  class=\"choice-116 depth-1\"  >Malta<\/option><option value=\"Marshall Islands\"  class=\"choice-117 depth-1\"  >Marshall Islands<\/option><option value=\"Mauritania\"  class=\"choice-118 depth-1\"  >Mauritania<\/option><option value=\"Mauritius\"  class=\"choice-119 depth-1\"  >Mauritius<\/option><option value=\"Mexico\"  class=\"choice-120 depth-1\"  >Mexico<\/option><option value=\"Micronesia\"  class=\"choice-121 depth-1\"  >Micronesia<\/option><option value=\"Moldova\"  class=\"choice-122 depth-1\"  >Moldova<\/option><option value=\"Mongolia\"  class=\"choice-123 depth-1\"  >Mongolia<\/option><option value=\"Morocco\"  class=\"choice-124 depth-1\"  >Morocco<\/option><option value=\"Monaco\"  class=\"choice-125 depth-1\"  >Monaco<\/option><option value=\"Mozambique\"  class=\"choice-126 depth-1\"  >Mozambique<\/option><option value=\"Namibia\"  class=\"choice-127 depth-1\"  >Namibia<\/option><option value=\"Nauru\"  class=\"choice-128 depth-1\"  >Nauru<\/option><option value=\"Nepal\"  class=\"choice-129 depth-1\"  >Nepal<\/option><option value=\"Netherlands\"  class=\"choice-130 depth-1\"  >Netherlands<\/option><option value=\"New Zealand\"  class=\"choice-131 depth-1\"  >New Zealand<\/option><option value=\"Nicaragua\"  class=\"choice-132 depth-1\"  >Nicaragua<\/option><option value=\"Niger\"  class=\"choice-133 depth-1\"  >Niger<\/option><option value=\"Nigeria\"  class=\"choice-134 depth-1\"  >Nigeria<\/option><option value=\"Norway\"  class=\"choice-135 depth-1\"  >Norway<\/option><option value=\"Oman\"  class=\"choice-136 depth-1\"  >Oman<\/option><option value=\"Pakistan\"  class=\"choice-137 depth-1\"  >Pakistan<\/option><option value=\"Panama\"  class=\"choice-138 depth-1\"  >Panama<\/option><option value=\"Papua New Guinea\"  class=\"choice-139 depth-1\"  >Papua New Guinea<\/option><option value=\"Paraguay\"  class=\"choice-140 depth-1\"  >Paraguay<\/option><option value=\"Peru\"  class=\"choice-141 depth-1\"  >Peru<\/option><option value=\"Philippines\"  class=\"choice-142 depth-1\"  >Philippines<\/option><option value=\"Poland\"  class=\"choice-143 depth-1\"  >Poland<\/option><option value=\"Portugal\"  class=\"choice-144 depth-1\"  >Portugal<\/option><option value=\"Qatar\"  class=\"choice-145 depth-1\"  >Qatar<\/option><option value=\"Romania\"  class=\"choice-146 depth-1\"  >Romania<\/option><option value=\"Russia\"  class=\"choice-147 depth-1\"  >Russia<\/option><option value=\"Rwanda\"  class=\"choice-148 depth-1\"  >Rwanda<\/option><option value=\"Samoa\"  class=\"choice-149 depth-1\"  >Samoa<\/option><option value=\"San Marino\"  class=\"choice-150 depth-1\"  >San Marino<\/option><option value=\"Sao Tome\"  class=\"choice-151 depth-1\"  >Sao Tome<\/option><option value=\"Saudi Arabia\"  class=\"choice-152 depth-1\"  >Saudi Arabia<\/option><option value=\"Senegal\"  class=\"choice-153 depth-1\"  >Senegal<\/option><option value=\"Serbia and Montenegro\"  class=\"choice-154 depth-1\"  >Serbia and Montenegro<\/option><option value=\"Seychelles\"  class=\"choice-155 depth-1\"  >Seychelles<\/option><option value=\"Sierra Leone\"  class=\"choice-156 depth-1\"  >Sierra Leone<\/option><option value=\"Singapore\"  class=\"choice-157 depth-1\"  >Singapore<\/option><option value=\"Slovakia\"  class=\"choice-158 depth-1\"  >Slovakia<\/option><option value=\"Slovenia\"  class=\"choice-159 depth-1\"  >Slovenia<\/option><option value=\"Solomon Islands\"  class=\"choice-160 depth-1\"  >Solomon Islands<\/option><option value=\"Somalia\"  class=\"choice-161 depth-1\"  >Somalia<\/option><option value=\"South Africa\"  class=\"choice-162 depth-1\"  >South Africa<\/option><option value=\"Spain\"  class=\"choice-163 depth-1\"  >Spain<\/option><option value=\"Sri Lanka\"  class=\"choice-164 depth-1\"  >Sri Lanka<\/option><option value=\"Sudan\"  class=\"choice-165 depth-1\"  >Sudan<\/option><option value=\"Suriname\"  class=\"choice-166 depth-1\"  >Suriname<\/option><option value=\"Swaziland\"  class=\"choice-167 depth-1\"  >Swaziland<\/option><option value=\"Sweden\"  class=\"choice-168 depth-1\"  >Sweden<\/option><option value=\"Switzerland\"  class=\"choice-169 depth-1\"  >Switzerland<\/option><option value=\"Syria\"  class=\"choice-170 depth-1\"  >Syria<\/option><option value=\"Taiwan\"  class=\"choice-171 depth-1\"  >Taiwan<\/option><option value=\"Tajikistan\"  class=\"choice-172 depth-1\"  >Tajikistan<\/option><option value=\"Tanzania\"  class=\"choice-173 depth-1\"  >Tanzania<\/option><option value=\"Thailand\"  class=\"choice-174 depth-1\"  >Thailand<\/option><option value=\"Togo\"  class=\"choice-175 depth-1\"  >Togo<\/option><option value=\"Tonga\"  class=\"choice-176 depth-1\"  >Tonga<\/option><option value=\"Trinidad and Tobago\"  class=\"choice-177 depth-1\"  >Trinidad and Tobago<\/option><option value=\"Tunisia\"  class=\"choice-178 depth-1\"  >Tunisia<\/option><option value=\"Turkey\"  class=\"choice-179 depth-1\"  >Turkey<\/option><option value=\"Turkmenistan\"  class=\"choice-180 depth-1\"  >Turkmenistan<\/option><option value=\"Uganda\"  class=\"choice-181 depth-1\"  >Uganda<\/option><option value=\"Ukraine\"  class=\"choice-182 depth-1\"  >Ukraine<\/option><option value=\"United Arab Emirates\"  class=\"choice-183 depth-1\"  >United Arab Emirates<\/option><option value=\"United Kingdom\"  class=\"choice-184 depth-1\"  >United Kingdom<\/option><option value=\"United States\"  class=\"choice-185 depth-1\"  >United States<\/option><option value=\"Uruguay\"  class=\"choice-186 depth-1\"  >Uruguay<\/option><option value=\"Uzbekistan\"  class=\"choice-187 depth-1\"  >Uzbekistan<\/option><option value=\"Vanuatu\"  class=\"choice-188 depth-1\"  >Vanuatu<\/option><option value=\"Venezuela\"  class=\"choice-189 depth-1\"  >Venezuela<\/option><option value=\"Vietnam\"  class=\"choice-190 depth-1\"  >Vietnam<\/option><option value=\"Yemen\"  class=\"choice-191 depth-1\"  >Yemen<\/option><option value=\"Zambia\"  class=\"choice-192 depth-1\"  >Zambia<\/option><option value=\"Zimbabwe\"  class=\"choice-193 depth-1\"  >Zimbabwe<\/option><\/select><\/div><div id=\"wpforms-7973-field_5-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-field-select-style-classic\" data-field-id=\"5\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7973-field_5\" aria-hidden=\"false\">Clinic<\/label><select id=\"wpforms-7973-field_5\" class=\"wpforms-field-large\" name=\"wpforms[fields][5]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choice of Clinic<\/option><option value=\"San Pedro\"  class=\"choice-1 depth-1\"  >San Pedro<\/option><option value=\"Escaz\u00fa\"  class=\"choice-2 depth-1\"  >Escaz\u00fa<\/option><option value=\"Guanacaste\"  class=\"choice-3 depth-1\"  >Guanacaste<\/option><\/select><\/div><div id=\"wpforms-7973-field_6-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-field-select-style-classic\" data-field-id=\"6\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7973-field_6\" aria-hidden=\"false\">Reference<\/label><select id=\"wpforms-7973-field_6\" class=\"wpforms-field-large\" name=\"wpforms[fields][6]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>How did you find out about us?<\/option><option value=\"Website\"  class=\"choice-1 depth-1\"  >Website<\/option><option value=\"Facebook\"  class=\"choice-2 depth-1\"  >Facebook<\/option><option value=\"TV \/ Radio Ads\"  class=\"choice-3 depth-1\"  >TV \/ Radio Ads<\/option><option value=\"Print Advertising\"  class=\"choice-4 depth-1\"  >Print Advertising<\/option><\/select><\/div><div id=\"wpforms-7973-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7973-field_2\" aria-hidden=\"false\">Comments <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-7973-field_2\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][2]\" placeholder=\"Comments *\" aria-errormessage=\"wpforms-7973-field_2-error\" required><\/textarea><\/div><\/div><!-- 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