{"id":177,"date":"2026-05-02T16:04:54","date_gmt":"2026-05-02T06:04:54","guid":{"rendered":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/?page_id=177"},"modified":"2026-05-02T16:41:26","modified_gmt":"2026-05-02T06:41:26","slug":"feedback-form","status":"publish","type":"page","link":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/feedback-form\/","title":{"rendered":"Feedback Form"},"content":{"rendered":"<div class=\"inner-sec mb-5\">\n<div class=\"container\">\n<div class=\"row justify-content-center\">\n<div class=\"col-lg-7 col-md-10 col-sm-12\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f181-o1\" lang=\"en-AU\" dir=\"ltr\" data-wpcf7-id=\"181\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/devsite\/chosen-care\/wp-json\/wp\/v2\/pages\/177#wpcf7-f181-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-no-scroll cf7mls-no-moving-animation\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"181\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_AU\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f181-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:181,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;repeater_remove_button&quot;:&quot;bottom&quot;}}\" \/>\n<\/fieldset>\n<div class=\"ref_form_box mb-4\">\n\t<div class=\"row\">\n\t\t<div class=\"inner-heading\">\n\t\t\t<p>Your Voice, Our Improvement: Share Your Insights and Help Us Grow!\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-lg-6 col-md-6 col-12 mb-3\">\n\t\t\t<div class=\"ref_form_box_label\">\n\t\t\t\t<p>Full Name\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"ref_form_box_input\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-lg-6 col-md-6 col-12 mb-3\">\n\t\t\t<div class=\"ref_form_box_label\">\n\t\t\t\t<p>Email Address\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"ref_form_box_input\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-lg-6 col-md-6 col-12 mb-3\">\n\t\t\t<div class=\"ref_form_box_label\">\n\t\t\t\t<p>Phone Number\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"ref_form_box_input\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"phone\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-lg-6 col-md-6 col-12 mb-3\">\n\t\t\t<div class=\"ref_form_box_label\">\n\t\t\t\t<p>How is your overall experience with us? Rate Our Services from 1 - 10.\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"ref_form_box_input\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"overall-exp\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"overall-exp\"><option value=\"Please Select\">Please Select<\/option><option value=\"10\">10<\/option><option value=\"9\">9<\/option><option value=\"8\">8<\/option><option value=\"7\">7<\/option><option value=\"6\">6<\/option><option value=\"5\">5<\/option><option value=\"4\">4<\/option><option value=\"3\">3<\/option><option value=\"2\">2<\/option><option value=\"1\">1<\/option><option value=\"Other\">Other<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-lg-12 col-md-12 col-12 mb-3\">\n\t\t\t<div class=\"ref_form_box_label\">\n\t\t\t\t<p>To help you make the most of our services, what feedback or suggestions would you like to give us?\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"ref_form_box_input\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"feedback-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Message\" name=\"feedback-message\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-lg-12 col-md-12 col-12 mb-3\">\n\t\t\t<div class=\"ref_form_box_label\">\n\t\t\t\t<p>Consent\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"ref_form_box_radio\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"consent\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"consent\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I agree with the Privacy Policy before submitting this form.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-lg-12 col-md-12 contact-btn mt-3\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/full-width.php","meta":{"footnotes":""},"class_list":["post-177","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/wp-json\/wp\/v2\/pages\/177","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/wp-json\/wp\/v2\/comments?post=177"}],"version-history":[{"count":4,"href":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/wp-json\/wp\/v2\/pages\/177\/revisions"}],"predecessor-version":[{"id":191,"href":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/wp-json\/wp\/v2\/pages\/177\/revisions\/191"}],"wp:attachment":[{"href":"https:\/\/jr-technologiesweb.com\/devsite\/chosen-care\/wp-json\/wp\/v2\/media?parent=177"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}