{"id":1501,"date":"2017-02-09T14:23:01","date_gmt":"2017-02-09T14:23:01","guid":{"rendered":"http:\/\/consult.loc\/?page_id=1501"},"modified":"2025-12-09T16:56:07","modified_gmt":"2025-12-09T21:56:07","slug":"about-layout-2","status":"publish","type":"page","link":"https:\/\/telossaude.com\/index.php\/about-layout-2\/","title":{"rendered":"Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text]<\/p>\n\r\n<style>\r\n.watermark {\r\n  position: fixed;\r\n  top: 40%;\r\n  left: 50%;\r\n  transform: translate(-50%, -50%) rotate(-30deg);\r\n  font-size: 80px;\r\n  color: rgba(180, 0, 120, 0.12);\r\n  font-weight: 900;\r\n  z-index: 0;\r\n  pointer-events: none;\r\n}\r\n.form-wrapper { \r\n  position: relative; \r\n  z-index: 10; \r\n  background: #fafafa;\r\n  padding: 25px;\r\n  border-radius: 12px;\r\n  border: 2px solid #cba8e0;\r\n  box-shadow: 0 0 15px rgba(0,0,0,0.08);\r\n}\r\nlabel { \r\n  font-weight: bold; \r\n  margin-top: 10px; \r\n  display: block;\r\n  color: #4c2470;\r\n}\r\ninput, textarea, select { \r\n  width: 100%; \r\n  padding: 10px; \r\n  margin-top: 5px; \r\n  border: 1px solid #b5d99c;\r\n  border-radius: 8px;\r\n  background: #ffffff;\r\n}\r\ntextarea { height: 120px; }\r\n.section-title { \r\n  font-size: 22px; \r\n  font-weight: bold; \r\n  margin-top: 30px;\r\n  color: #6a0dad;\r\n  padding-bottom: 5px;\r\n  border-left: 6px solid #ffd84d;\r\n  padding-left: 10px;\r\n}\r\nbutton {\r\n  padding: 14px 22px;\r\n  margin-top: 20px;\r\n  cursor: pointer;\r\n  background: linear-gradient(45deg, #6a0dad, #9be564, #ffd84d);\r\n  border: none;\r\n  border-radius: 10px;\r\n  font-weight: bold;\r\n  color: #fff;\r\n  font-size: 16px;\r\n  transition: 0.3s;\r\n}\r\nbutton:hover {\r\n  opacity: 0.85;\r\n}\r\n<\/style>\r\n\r\n<div class=\"watermark\">CONFIDENTIAL<\/div>\r\n<div class=\"form-wrapper\">\r\n<form method=\"post\" action=\"\">\r\n\r\n<div class=\"section-title\">Parte 1: Dados Individuais<\/div>\r\n<label>Nome Completo:<\/label>\r\n<input type=\"text\" name=\"nome\" required \/>\r\n\r\n<label>Idade:<\/label>\r\n<input type=\"number\" name=\"idade\" required \/>\r\n\r\n<label>Data de Nascimento:<\/label>\r\n<input type=\"date\" name=\"data_nascimento\" \/>\r\n\r\n<label>Local de Nascimento:<\/label>\r\n<input type=\"text\" name=\"local_nascimento\" \/>\r\n\r\n<label>Estado Civil:<\/label>\r\n<input type=\"text\" name=\"estado_civil\" \/>\r\n\r\n<label>N\u00edvel de escolaridade:<\/label>\r\n<input type=\"text\" name=\"escolaridade\" \/>\r\n\r\n<label>Profiss\u00e3o:<\/label>\r\n<input type=\"text\" name=\"profissao\" \/>\r\n\r\n<label>Morada:<\/label>\r\n<input type=\"text\" name=\"morada\" \/>\r\n\r\n<label>Contacto:<\/label>\r\n<input type=\"text\" name=\"contacto\" \/>\r\n\r\n<div class=\"section-title\">Hist\u00f3ria Cl\u00ednica<\/div>\r\n<label>In\u00edcio dos sintomas atuais:<\/label>\r\n<textarea name=\"inicio_sintomas\"><\/textarea>\r\n\r\n<label>H\u00e1 quanto tempo duram:<\/label>\r\n<input type=\"text\" name=\"duracao_sintomas\" \/>\r\n\r\n<label>Caracter\u00edsticas dos sinais e sintomas:<\/label>\r\n<textarea name=\"caracteristicas_sintomas\"><\/textarea>\r\n\r\n<div class=\"section-title\">Hist\u00f3ria Pregressa<\/div>\r\n<label>Sofre de alguma doen\u00e7a cr\u00f4nica?<\/label>\r\n<select name=\"doenca_cronica\">\r\n<option>Sim<\/option>\r\n<option>N\u00e3o<\/option>\r\n<\/select>\r\n\r\n<label>H\u00e1 quanto tempo?<\/label>\r\n<input type=\"text\" name=\"tempo_doenca\" \/>\r\n\r\n<label>Nome da doen\u00e7a:<\/label>\r\n<input type=\"text\" name=\"nome_doenca\" \/>\r\n\r\n<label>Medica\u00e7\u00e3o que est\u00e1 a tomar:<\/label>\r\n<textarea name=\"medicacao_atual\"><\/textarea>\r\n\r\n<label>H\u00e1 quanto tempo?<\/label>\r\n<input type=\"text\" name=\"tempo_medicacao\" \/>\r\n\r\n<label>J\u00e1 teve algum acidente?<\/label>\r\n<input type=\"text\" name=\"acidente\" \/>\r\n\r\n<label>Descri\u00e7\u00e3o do acidente:<\/label>\r\n<textarea name=\"descricao_acidente\"><\/textarea>\r\n\r\n<label>J\u00e1 sofreu alguma cirurgia?<\/label>\r\n<input type=\"text\" name=\"cirurgia\" \/>\r\n\r\n<label>Descri\u00e7\u00e3o da cirurgia:<\/label>\r\n<textarea name=\"descricao_cirurgia\"><\/textarea>\r\n\r\n<button type=\"submit\">Enviar<\/button>\r\n<\/form>\r\n<\/div>\r\n\r\n\n<p>&nbsp;<\/p>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text] &nbsp; [\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1501","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/telossaude.com\/index.php\/wp-json\/wp\/v2\/pages\/1501","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/telossaude.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/telossaude.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/telossaude.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/telossaude.com\/index.php\/wp-json\/wp\/v2\/comments?post=1501"}],"version-history":[{"count":2,"href":"https:\/\/telossaude.com\/index.php\/wp-json\/wp\/v2\/pages\/1501\/revisions"}],"predecessor-version":[{"id":100171,"href":"https:\/\/telossaude.com\/index.php\/wp-json\/wp\/v2\/pages\/1501\/revisions\/100171"}],"wp:attachment":[{"href":"https:\/\/telossaude.com\/index.php\/wp-json\/wp\/v2\/media?parent=1501"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}