{"id":715,"date":"2025-08-07T02:52:55","date_gmt":"2025-08-07T02:52:55","guid":{"rendered":"https:\/\/hurtadoplasticsurgery.com\/?page_id=715"},"modified":"2025-08-07T08:35:48","modified_gmt":"2025-08-07T08:35:48","slug":"virtual-consultation","status":"publish","type":"page","link":"https:\/\/hurtadoplasticsurgery.com\/es\/virtual-consultation\/","title":{"rendered":"Consulta virtual"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_heading title=&#8221;Virtual Consultation&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; title_level=&#8221;h3&#8243; title_font=&#8221;&#8211;et_global_body_font|&#8211;et_global_body_font_weight|||||||&#8221; title_text_align=&#8221;center&#8221; title_text_color=&#8221;#250C04&#8243; title_font_size=&#8221;20px&#8221; custom_margin=&#8221;||8px||false|false&#8221; title_text_align_tablet=&#8221;center&#8221; title_text_align_phone=&#8221;center&#8221; title_text_align_last_edited=&#8221;on|desktop&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_heading][et_pb_heading title=&#8221;A better you awaits&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; title_level=&#8221;h2&#8243; title_text_align=&#8221;center&#8221; title_text_color=&#8221;#250C04&#8243; title_font_size=&#8221;48px&#8221; custom_margin=&#8221;||32px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_heading][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#250C04&#8243; custom_margin=&#8221;||20px||false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><span>En nuestra Cl\u00ednica de Cirug\u00eda Pl\u00e1stica, nos complace ofrecerle la comodidad de las consultas virtuales para obtener un presupuesto preciso para el procedimiento que prefiera. Nuestro proceso en l\u00ednea es sencillo y eficiente; solo le tomar\u00e1 unos minutos.<\/span><\/p>\n<p><span>Le invitamos a completar nuestro formulario virtual, donde podr\u00e1 proporcionar su informaci\u00f3n personal junto con una breve descripci\u00f3n del procedimiento que desea. Una vez recibido su formulario, nuestro equipo de cirujanos altamente experimentados revisar\u00e1 cuidadosamente su solicitud y le proporcionar\u00e1 un presupuesto detallado sin costo alguno.<\/span><\/p>\n<p><b>Valoramos la confidencialidad de su informaci\u00f3n y queremos asegurarle que todos los datos proporcionados en el formulario ser\u00e1n tratados con la m\u00e1xima discreci\u00f3n y utilizados exclusivamente con el fin de brindarle la mejor atenci\u00f3n posible.<br \/><\/b><br \/><span>En Hurtado Vidal Plastic Surgery, nos comprometemos a que su consulta sea profesional, confiable y personalizada. Esperamos acompa\u00f1arle en su camino hacia la cirug\u00eda pl\u00e1stica de forma c\u00f3moda y sencilla.<\/span><\/p>\n<p>[\/et_pb_text][et_pb_code _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_css_free_form=&#8221;selector .forminator-button {||  background: transparent !important;||  border: 1px #916F52 solid !important;||\ttext-transform: uppercase;||\ttransition: color 300ms !important;||  padding: 12px 24px !important;||  box-shadow: none !important;||}||||selector .forminator-button:hover, selector .forminator-button:focus {||  background: #916F52 !important;||\ttext-transform: uppercase;||}||||selector label.forminator-label {||  font-weight: 300 !important;||  font-size: 14px !important;||}||||selector .forminator-input {||  border: 1px #916F52 solid !important;||  padding: 16px !important;||  color: rgba(145,111,82,0.58) !important;||}||||selector span.selection .select2-selection {||  background: transparent !important;||\tborder: 1px #916F52 solid !important;||}||||selector span.selection .select2-selection .select2-selection__rendered {||\tpadding: 16px !important;||  font-family: &#8216;Karla&#8217; !important;||  font-weight: 300 !important;||  color: rgba(145,111,82,0.58) !important;||}||||selector textarea.forminator-textarea {||  resize: none !important;||  border: 1px #916F52 solid !important;||}||||selector .forminator-icon-calendar::before {||  content: &#8221; !important;||}&#8221; global_colors_info=&#8221;{}&#8221;]<div class=\"forminator-ui forminator-custom-form forminator-custom-form-718 forminator-design--flat  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-718\" data-uid=\"69e1bf951c2ea\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-718\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-718 forminator-design--flat  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"718\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"theme\" data-design=\"flat\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69e1bf951c2ea\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-0\"\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-0-label\"\n\t\t\t\tdata-step=\"0\"\n\t\t\t\tdata-label=\"Finish\"\n\t\t\t\tdata-actual-label=\"1\"\n\t\t\t\tdata-name=\"page-break-1\"\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69e1bf951c2ea\" id=\"forminator-field-name-1_69e1bf951c2ea-label\" class=\"forminator-label\">Nombre <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_69e1bf951c2ea\" id=\"forminator-field-name-2_69e1bf951c2ea-label\" class=\"forminator-label\">Apellido <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69e1bf951c2ea\" id=\"forminator-field-text-1_69e1bf951c2ea-label\" class=\"forminator-label\">Edad <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-718__field--select-1_69e1bf951c2ea\" id=\"forminator-form-718__field--select-1_69e1bf951c2ea-label\" class=\"forminator-label\">Genero <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-718__field--select-1_69e1bf951c2ea\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"two\" data-hidden-behavior=\"zero\" data-placeholder=\"Please select an option\" data-search=\"false\" data-search-placeholder=\"Please select an option\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-718__field--select-1_69e1bf951c2ea-label\"><option value=\"\"  >Please select an option<\/option><option value=\"two\" selected=\"selected\" data-calculation=\"0\">Femenino<\/option><option value=\"one\"  data-calculation=\"0\">Masculino<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-718__field--select-2_69e1bf951c2ea\" id=\"forminator-form-718__field--select-2_69e1bf951c2ea-label\" class=\"forminator-label\">Idioma de preferencia<\/label><select  id=\"forminator-form-718__field--select-2_69e1bf951c2ea\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-718__field--select-2_69e1bf951c2ea-label\"><option value=\"one\"  data-calculation=\"0\">Ingles<\/option><option value=\"two\"  data-calculation=\"0\">Espa\u00f1ol<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-718__field--select-3_69e1bf951c2ea\" id=\"forminator-form-718__field--select-3_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfC\u00f3mo conoci\u00f3 al Dr. Hurtado Vidal? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-718__field--select-3_69e1bf951c2ea\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"How did you find out about Dr. Hurtado Vidal?\" data-search=\"false\" data-search-placeholder=\"How did you find out about Dr. Hurtado Vidal?\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-718__field--select-3_69e1bf951c2ea-label\"><option value=\"\"  >\u00bfC\u00f3mo conoci\u00f3 al Dr. Hurtado Vidal?<\/option><option value=\"one\"  data-calculation=\"0\">Google<\/option><option value=\"two\"  data-calculation=\"0\">Instagram<\/option><option value=\"Facebook\"  data-calculation=\"0\">Facebook<\/option><option value=\"Tiktok\"  data-calculation=\"0\">Tiktok<\/option><option value=\"Referred-from-another-patient\"  data-calculation=\"0\">Recomendado por otro paciente<\/option><option value=\"I-am-a-returning-patient\"  data-calculation=\"0\">Ya fui su paciente<\/option><option value=\"Other\"  data-calculation=\"0\">Otro<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-1\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-1-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"1\"\n\t\t\t\tdata-label=\"1\"\n\t\t\t\tdata-actual-label=\"2\"\n\t\t\t\tdata-name=\"page-break-2\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69e1bf951c2ea\" id=\"forminator-field-email-1_69e1bf951c2ea-label\" class=\"forminator-label\">Correo <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_69e1bf951c2ea\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69e1bf951c2ea\" id=\"forminator-field-phone-1_69e1bf951c2ea-label\" class=\"forminator-label\">N\u00famero de tel\u00e9fono <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_69e1bf951c2ea\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69e1bf951c2ea\" id=\"forminator-field-phone-2_69e1bf951c2ea-label\" class=\"forminator-label\">Numero de Telefono Adicional<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_69e1bf951c2ea\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69e1bf951c2ea\" id=\"forminator-field-text-2_69e1bf951c2ea-label\" class=\"forminator-label\">Ciudad y estado de residencia <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-2\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-2-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"2\"\n\t\t\t\tdata-label=\"2\"\n\t\t\t\tdata-actual-label=\"3\"\n\t\t\t\tdata-name=\"page-break-3\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69e1bf951c2ea\" id=\"forminator-field-text-3_69e1bf951c2ea-label\" class=\"forminator-label\">Peso (libras o kg.) <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69e1bf951c2ea\" id=\"forminator-field-text-4_69e1bf951c2ea-label\" class=\"forminator-label\">Altura (pies o metros) <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_69e1bf951c2ea\" id=\"forminator-field-text-5_69e1bf951c2ea-label\" class=\"forminator-label\">Masa corporal<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_69e1bf951c2ea\" id=\"forminator-field-text-6_69e1bf951c2ea-label\" class=\"forminator-label\">Grupo sangu\u00edneo (tipo de sangre)<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_69e1bf951c2ea\" id=\"forminator-field-text-7_69e1bf951c2ea-label\" class=\"forminator-label\">Peso m\u00e1ximo que has tenido alguna vez <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-718__field--select-4_69e1bf951c2ea\" id=\"forminator-form-718__field--select-4_69e1bf951c2ea-label\" class=\"forminator-label\">Select <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-718__field--select-4_69e1bf951c2ea\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Have you gained weight lately?\" data-search=\"false\" data-search-placeholder=\"Have you gained weight lately?\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-718__field--select-4_69e1bf951c2ea-label\"><option value=\"\"  >\u00bfHas ganado peso \u00faltimamente?<\/option><option value=\"one\"  data-calculation=\"0\">Si<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_69e1bf951c2ea\" id=\"forminator-field-text-8_69e1bf951c2ea-label\" class=\"forminator-label\">Si es cierto, aproximadamente: \u00bfCu\u00e1nto has ganado en los \u00faltimos 3 meses?<\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69e1bf951c2ea\" id=\"forminator-field-textarea-1_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfTiene alguna discapacidad f\u00edsica? Si es as\u00ed, por favor, menci\u00f3nela.<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_69e1bf951c2ea\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-3\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-3-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"3\"\n\t\t\t\tdata-label=\"3\"\n\t\t\t\tdata-actual-label=\"4\"\n\t\t\t\tdata-name=\"page-break-4\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><label class=\"forminator-label\">Medication and Supplements<\/label><div role=\"listitem\" class=\"Qr7Oae pQK2A\">\n<div role=\"heading\" class=\"KkG9vf mBzBBe\">\n<div class=\"SajZGc RVEQke hN5qnf\">\n<div class=\"aG9Vid vVO4xd  M7eMe\">Nos esforzamos por brindar atenci\u00f3n y servicios de calidad a nuestros pacientes. Durante las consultas virtuales, solicitamos a los pacientes que nos proporcionen toda la informaci\u00f3n m\u00e9dica y complementaria relevante. Esto puede incluir su historial m\u00e9dico, tratamientos m\u00e9dicos actuales, medicamentos que est\u00e9n tomando, alergias e informaci\u00f3n general de salud. Adem\u00e1s, solicitamos cualquier informaci\u00f3n complementaria que pueda ser relevante para la consulta. De esta manera, podemos garantizar que nuestros pacientes reciban la mejor atenci\u00f3n posible.<br><br><b><i>*(incluidos los anticonceptivos hormonales y las terapias hormonales)<\/i><\/b><\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_69e1bf951c2ea\" id=\"forminator-field-text-9_69e1bf951c2ea-label\" class=\"forminator-label\">Informaci\u00f3n m\u00e9dica relevante (medicamentos en uso, marca, dosis y motivo de uso) Si no es as\u00ed, puede dejarlo en blanco.<\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-4\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-4-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"4\"\n\t\t\t\tdata-label=\"4\"\n\t\t\t\tdata-actual-label=\"5\"\n\t\t\t\tdata-name=\"page-break-5\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-69e1bf951c2ea-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-69e1bf951c2ea-label\" class=\"forminator-label\">Enfermedades que has padecido o est\u00e1s padeciendo actualmente.<\/span><span id=\"forminator-field-checkbox-1-69e1bf951c2ea-description\" class=\"forminator-description\">* Seleccione las casillas que correspondan.<\/span><label id=\"forminator-field-checkbox-1-1-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-1-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Cardiovascular disease\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Cardiovascular-disease\" id=\"forminator-field-checkbox-1-1-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-1-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cardiovascular disease<\/span><\/label><label id=\"forminator-field-checkbox-1-2-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-2-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Diabetes type 1\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Diabetes-type-1\" id=\"forminator-field-checkbox-1-2-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-2-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Diabetes type 1<\/span><\/label><label id=\"forminator-field-checkbox-1-3-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-3-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Type 2 diabetes\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Type-2-diabetes\" id=\"forminator-field-checkbox-1-3-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-3-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Type 2 diabetes<\/span><\/label><label id=\"forminator-field-checkbox-1-4-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-4-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Asthma\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Asthma\" id=\"forminator-field-checkbox-1-4-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-4-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Asthma<\/span><\/label><label id=\"forminator-field-checkbox-1-5-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-5-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Cholesterol\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Cholesterol\" id=\"forminator-field-checkbox-1-5-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-5-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cholesterol<\/span><\/label><label id=\"forminator-field-checkbox-1-6-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-6-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Thyroid\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Thyroid\" id=\"forminator-field-checkbox-1-6-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-6-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Thyroid<\/span><\/label><label id=\"forminator-field-checkbox-1-7-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-7-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Arthritis\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Arthritis\" id=\"forminator-field-checkbox-1-7-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-7-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Arthritis<\/span><\/label><label id=\"forminator-field-checkbox-1-8-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-8-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Heart attacks\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Heart-attacks\" id=\"forminator-field-checkbox-1-8-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-8-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Heart attacks<\/span><\/label><label id=\"forminator-field-checkbox-1-9-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-9-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Anemia\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Anemia\" id=\"forminator-field-checkbox-1-9-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-9-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Anemia<\/span><\/label><label id=\"forminator-field-checkbox-1-10-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-10-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Kidney Diseases\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Kidney-Diseases\" id=\"forminator-field-checkbox-1-10-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-10-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Kidney Diseases<\/span><\/label><label id=\"forminator-field-checkbox-1-11-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-11-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Osteoporosis or Osteopenia\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Osteoporosis-or-Osteopenia\" id=\"forminator-field-checkbox-1-11-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-11-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Osteoporosis or Osteopenia<\/span><\/label><label id=\"forminator-field-checkbox-1-12-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-12-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Obesity\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Obesity\" id=\"forminator-field-checkbox-1-12-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-12-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Obesity<\/span><\/label><label id=\"forminator-field-checkbox-1-13-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-13-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Lupus\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Lupus\" id=\"forminator-field-checkbox-1-13-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-13-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lupus<\/span><\/label><label id=\"forminator-field-checkbox-1-14-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-14-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Polycystic ovary syndrome\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Polycystic-ovary-syndrome\" id=\"forminator-field-checkbox-1-14-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-14-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Polycystic ovary syndrome<\/span><\/label><label id=\"forminator-field-checkbox-1-15-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-15-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Bleeding or Clotting Problems\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Bleeding-or-Clotting-Problems\" id=\"forminator-field-checkbox-1-15-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-15-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Bleeding or Clotting Problems<\/span><\/label><label id=\"forminator-field-checkbox-1-16-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-16-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Problems with Anesthesia\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Problems-with-Anesthesia\" id=\"forminator-field-checkbox-1-16-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-16-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Problems with Anesthesia<\/span><\/label><label id=\"forminator-field-checkbox-1-17-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-17-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Allergies\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"allergies\" id=\"forminator-field-checkbox-1-17-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-17-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Allergies<\/span><\/label><label id=\"forminator-field-checkbox-1-18-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-18-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Blood clots\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"blood-clots\" id=\"forminator-field-checkbox-1-18-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-18-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Blood clots<\/span><\/label><label id=\"forminator-field-checkbox-1-19-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-19-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"High pressure\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"High-pressure\" id=\"forminator-field-checkbox-1-19-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-19-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">High pressure<\/span><\/label><label id=\"forminator-field-checkbox-1-20-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-20-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Multiple sclerosis\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Multiple-sclerosis\" id=\"forminator-field-checkbox-1-20-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-20-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Multiple sclerosis<\/span><\/label><label id=\"forminator-field-checkbox-1-21-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-21-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Diagnosed Depression\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Diagnosed-Depression\" id=\"forminator-field-checkbox-1-21-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-21-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Diagnosed Depression<\/span><\/label><label id=\"forminator-field-checkbox-1-22-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-1-22-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Cancer\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Cancer\" id=\"forminator-field-checkbox-1-22-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-1-22-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69e1bf951c2ea-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cancer<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69e1bf951c2ea\" id=\"forminator-field-textarea-2_69e1bf951c2ea-label\" class=\"forminator-label\">Otras condiciones personales<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_69e1bf951c2ea\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_69e1bf951c2ea\" id=\"forminator-field-text-10_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfTiene usted alergias? (Si es as\u00ed, por favor mencione cu\u00e1les)<\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_69e1bf951c2ea\" id=\"forminator-field-text-11_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfSe ha sometido a alguna cirug\u00eda bari\u00e1trica, manga g\u00e1strica, bypass g\u00e1strico o mini bypass g\u00e1strico? De ser as\u00ed, menci\u00f3nelas y sus respectivas fechas.<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_69e1bf951c2ea\" id=\"forminator-field-text-12_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfSe ha puesto inyecciones en los gl\u00fateos? Si es as\u00ed, indique la fecha de la \u00faltima.<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_69e1bf951c2ea\" id=\"forminator-field-text-13_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfSe ha sometido a alguna otra cirug\u00eda anteriormente? Por favor, mencione cu\u00e1les y sus fechas aproximadas (mes y a\u00f1o).<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_69e1bf951c2ea\" id=\"forminator-field-text-14_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfComplicaciones quir\u00fargicas que ha tenido en sus cirug\u00edas pasadas?<\/label><span id=\"forminator-field-text-14_69e1bf951c2ea-description\" class=\"forminator-description\">(Por favor describa)<\/span><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" aria-describedby=\"forminator-field-text-14_69e1bf951c2ea-description\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-5\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-5-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"5\"\n\t\t\t\tdata-label=\"5\"\n\t\t\t\tdata-actual-label=\"6\"\n\t\t\t\tdata-name=\"page-break-6\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><label class=\"forminator-label\">Gyneco-ostetric history<\/label><p><b><u>*Si eres hombre, omite esta secci\u00f3n.<\/u><\/b><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_69e1bf951c2ea\" id=\"forminator-field-date-1-picker_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfHa tenido un embarazo? Si es as\u00ed, indique la fecha de su \u00faltimo embarazo.<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Elija fecha\" id=\"forminator-field-date-1-picker_69e1bf951c2ea\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_69e1bf951c2ea\" id=\"forminator-field-text-15_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfCuantos partos?<\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"\" id=\"forminator-field-text-15_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_69e1bf951c2ea\" id=\"forminator-field-text-16_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfCu\u00e1ntas ces\u00e1reas?<\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"\" id=\"forminator-field-text-16_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_69e1bf951c2ea\" id=\"forminator-field-text-17_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfCuantos abortos?<\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"\" id=\"forminator-field-text-17_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_69e1bf951c2ea\" id=\"forminator-field-text-18_69e1bf951c2ea-label\" class=\"forminator-label\">Menarquia<\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-19\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-19_69e1bf951c2ea\" id=\"forminator-field-text-19_69e1bf951c2ea-label\" class=\"forminator-label\">Ciclo menstrual<\/label><input type=\"text\" name=\"text-19\" value=\"\" placeholder=\"\" id=\"forminator-field-text-19_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-20\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-20_69e1bf951c2ea\" id=\"forminator-field-text-20_69e1bf951c2ea-label\" class=\"forminator-label\">M\u00e9todo anticonceptivo (incluyendo anticonceptivos hormonales y terapias hormonales)<\/label><input type=\"text\" name=\"text-20\" value=\"\" placeholder=\"\" id=\"forminator-field-text-20_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-6\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-6-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"6\"\n\t\t\t\tdata-label=\"6\"\n\t\t\t\tdata-actual-label=\"7\"\n\t\t\t\tdata-name=\"page-break-7\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-3\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-3\"><label class=\"forminator-label\">Personal Habits<\/label><p><b>Aseg\u00farese de no omitir ninguna droga o sustancia.<\/b> Rest assured that you will not be judged for it and having this information will allow our surgical team to act correctly in the event of a complication within the operating room.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-718__field--select-5_69e1bf951c2ea\" id=\"forminator-form-718__field--select-5_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfUsted fuma? <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-718__field--select-5_69e1bf951c2ea\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-5\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Do you smoke?\" data-search=\"false\" data-search-placeholder=\"Do you smoke?\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-718__field--select-5_69e1bf951c2ea-label\"><option value=\"\"  >\u00bfUsted fuma?<\/option><option value=\"one\"  data-calculation=\"0\">Si<\/option><option value=\"two\"  data-calculation=\"0\">No<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-21\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-21_69e1bf951c2ea\" id=\"forminator-field-text-21_69e1bf951c2ea-label\" class=\"forminator-label\">Aproximadamente: \u00bfCu\u00e1l es su consumo de alcohol por semana?<\/label><input type=\"text\" name=\"text-21\" value=\"\" placeholder=\"\" id=\"forminator-field-text-21_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-22\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-22_69e1bf951c2ea\" id=\"forminator-field-text-22_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfConsume alguna otra sustancia para uso recreativo? De ser as\u00ed, indique cu\u00e1l.<\/label><input type=\"text\" name=\"text-22\" value=\"\" placeholder=\"\" id=\"forminator-field-text-22_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-7\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-7-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"7\"\n\t\t\t\tdata-label=\"7\"\n\t\t\t\tdata-actual-label=\"8\"\n\t\t\t\tdata-name=\"page-break-8\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_69e1bf951c2ea\" id=\"forminator-field-date-2-picker_69e1bf951c2ea-label\" class=\"forminator-label\">Fecha aproximada de inter\u00e9s para su cirug\u00eda <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Elija fecha\" id=\"forminator-field-date-2-picker_69e1bf951c2ea\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-69e1bf951c2ea-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-69e1bf951c2ea-label\" class=\"forminator-label\">Cirug\u00eda facial<\/span><label id=\"forminator-field-checkbox-2-1-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-2-1-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Blefaroplastia\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-2-1-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Blefaroplastia<\/span><\/label><label id=\"forminator-field-checkbox-2-2-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-2-2-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Neck stretch\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-2-2-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Neck stretch<\/span><\/label><label id=\"forminator-field-checkbox-2-3-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-2-3-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Face lift\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Face-lift\" id=\"forminator-field-checkbox-2-3-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-2-3-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Face lift<\/span><\/label><label id=\"forminator-field-checkbox-2-4-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-2-4-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Chin implant\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Chin-implant\" id=\"forminator-field-checkbox-2-4-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-2-4-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Chin implant<\/span><\/label><label id=\"forminator-field-checkbox-2-5-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-2-5-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Ears \/ Optoplasty\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Ears---Optoplasty\" id=\"forminator-field-checkbox-2-5-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-2-5-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ears \/ Optoplasty<\/span><\/label><label id=\"forminator-field-checkbox-2-6-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-2-6-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Rinoplastia\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Rhinoplasty\" id=\"forminator-field-checkbox-2-6-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-2-6-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Rinoplastia<\/span><\/label><label id=\"forminator-field-checkbox-2-7-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-2-7-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Bichectom\u00eda\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Bichectomy\" id=\"forminator-field-checkbox-2-7-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-2-7-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Bichectom\u00eda<\/span><\/label><label id=\"forminator-field-checkbox-2-8-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-2-8-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Lipo-Double Chin\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Lipo-Double-Chin\" id=\"forminator-field-checkbox-2-8-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-2-8-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lipo-Double Chin<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-69e1bf951c2ea-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-69e1bf951c2ea-label\" class=\"forminator-label\">Cirug\u00eda de mama<\/span><label id=\"forminator-field-checkbox-3-1-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-3-1-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Cirug\u00eda de mama\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-3-1-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Cirug\u00eda de mama<\/span><\/label><label id=\"forminator-field-checkbox-3-2-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-3-2-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Aumento de Senos\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-3-2-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Aumento de Senos<\/span><\/label><label id=\"forminator-field-checkbox-3-3-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-3-3-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Implant Replacement\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Implant-Replacement\" id=\"forminator-field-checkbox-3-3-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-3-3-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Implant Replacement<\/span><\/label><label id=\"forminator-field-checkbox-3-4-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-3-4-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Levantamiento de Busto\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Breast-Lift\" id=\"forminator-field-checkbox-3-4-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-3-4-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Levantamiento de Busto<\/span><\/label><label id=\"forminator-field-checkbox-3-5-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-3-5-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Reducci\u00f3n de senos\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Breast-Reduction\" id=\"forminator-field-checkbox-3-5-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-3-5-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Reducci\u00f3n de senos<\/span><\/label><label id=\"forminator-field-checkbox-3-6-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-3-6-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Gynecomastia (reduction of breast volume for men)\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Gynecomastia-(reduction-of-breast-volume-for-men)\" id=\"forminator-field-checkbox-3-6-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-3-6-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Gynecomastia (reduction of breast volume for men)<\/span><\/label><label id=\"forminator-field-checkbox-3-7-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-3-7-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Capsulectomy\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Capsulectomy\" id=\"forminator-field-checkbox-3-7-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-3-7-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Capsulectomy<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-69e1bf951c2ea-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-69e1bf951c2ea-label\" class=\"forminator-label\">Cirug\u00eda corporal<\/span><label id=\"forminator-field-checkbox-4-1-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-1-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Mommy Makeover\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"one\" id=\"forminator-field-checkbox-4-1-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-1-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mommy Makeover<\/span><\/label><label id=\"forminator-field-checkbox-4-2-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-2-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Gluteal Transfer (BBL)\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"two\" id=\"forminator-field-checkbox-4-2-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-2-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Gluteal Transfer (BBL)<\/span><\/label><label id=\"forminator-field-checkbox-4-3-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-3-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Liposucci\u00f3n\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Liposuction\" id=\"forminator-field-checkbox-4-3-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-3-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Liposucci\u00f3n<\/span><\/label><label id=\"forminator-field-checkbox-4-4-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-4-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"360\u00ba Liposculpture with Etching\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"360\u00ba-Liposculpture-with-Etching\" id=\"forminator-field-checkbox-4-4-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-4-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">360\u00ba Liposculpture with Etching<\/span><\/label><label id=\"forminator-field-checkbox-4-5-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-5-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"360\u00ba Liposculpture without Etching\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"360\u00ba-Liposculpture-without-Etching\" id=\"forminator-field-checkbox-4-5-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-5-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">360\u00ba Liposculpture without Etching<\/span><\/label><label id=\"forminator-field-checkbox-4-6-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-6-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Fat Transfer to Buttocks and Hips\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Fat-Transfer-to-Buttocks-and-Hips\" id=\"forminator-field-checkbox-4-6-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-6-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Fat Transfer to Buttocks and Hips<\/span><\/label><label id=\"forminator-field-checkbox-4-7-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-7-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Anterior Lipectomy\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Anterior-Lipectomy\" id=\"forminator-field-checkbox-4-7-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-7-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Anterior Lipectomy<\/span><\/label><label id=\"forminator-field-checkbox-4-8-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-8-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Extended Lipectomy\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Extended-Lipectomy\" id=\"forminator-field-checkbox-4-8-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-8-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Extended Lipectomy<\/span><\/label><label id=\"forminator-field-checkbox-4-9-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-9-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Circular Lipectomy\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Circular-Lipectomy\" id=\"forminator-field-checkbox-4-9-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-9-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Circular Lipectomy<\/span><\/label><label id=\"forminator-field-checkbox-4-10-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-10-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Abdominoplasty\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Abdominoplasty\" id=\"forminator-field-checkbox-4-10-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-10-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Abdominoplasty<\/span><\/label><label id=\"forminator-field-checkbox-4-11-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-11-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Labioplasty\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Labioplasty\" id=\"forminator-field-checkbox-4-11-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-11-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Labioplasty<\/span><\/label><label id=\"forminator-field-checkbox-4-12-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-4-12-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Torsoplasty\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Torsoplasty\" id=\"forminator-field-checkbox-4-12-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-4-12-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Torsoplasty<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-69e1bf951c2ea-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-69e1bf951c2ea-label\" class=\"forminator-label\">Para bajar de peso<\/span><label id=\"forminator-field-checkbox-5-1-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-5-1-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Upper Body Lift\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"one\" id=\"forminator-field-checkbox-5-1-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-5-1-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Upper Body Lift<\/span><\/label><label id=\"forminator-field-checkbox-5-2-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-5-2-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Lower Body Lift\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"two\" id=\"forminator-field-checkbox-5-2-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-5-2-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lower Body Lift<\/span><\/label><label id=\"forminator-field-checkbox-5-3-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-5-3-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Levantamiento de Muslos\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Thigh-Lift\" id=\"forminator-field-checkbox-5-3-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-5-3-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Levantamiento de Muslos<\/span><\/label><label id=\"forminator-field-checkbox-5-4-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-5-4-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Arm Lift\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Arm-Lift\" id=\"forminator-field-checkbox-5-4-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-5-4-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Arm Lift<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-6-69e1bf951c2ea-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-6-69e1bf951c2ea-label\" class=\"forminator-label\">No quir\u00fargico<\/span><label id=\"forminator-field-checkbox-6-1-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-6-1-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Rellenos\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"one\" id=\"forminator-field-checkbox-6-1-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-6-1-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Rellenos<\/span><\/label><label id=\"forminator-field-checkbox-6-2-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-6-2-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Vaginal Rejuvenation\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"two\" id=\"forminator-field-checkbox-6-2-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-6-2-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Vaginal Rejuvenation<\/span><\/label><label id=\"forminator-field-checkbox-6-3-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-6-3-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Facial Rejuvenation\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Facial-Rejuvenation\" id=\"forminator-field-checkbox-6-3-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-6-3-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Facial Rejuvenation<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-23\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-23_69e1bf951c2ea\" id=\"forminator-field-text-23_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfQu\u00e9 parte de tu cuerpo te gustar\u00eda mejorar principalmente? <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-23\" value=\"\" placeholder=\"\" id=\"forminator-field-text-23_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-24\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-24_69e1bf951c2ea\" id=\"forminator-field-text-24_69e1bf951c2ea-label\" class=\"forminator-label\">\u00bfTiene un presupuesto m\u00e1ximo? De ser as\u00ed, indique su presupuesto m\u00e1ximo estimado. <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-24\" value=\"\" placeholder=\"\" id=\"forminator-field-text-24_69e1bf951c2ea\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-8\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-8-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"8\"\n\t\t\t\tdata-label=\"8\"\n\t\t\t\tdata-actual-label=\"9\"\n\t\t\t\tdata-name=\"page-break-9\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-4\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-4\"><label class=\"forminator-label\">Comments<\/label><div role=\"listitem\" class=\"Qr7Oae pQK2A\">\n<div class=\"vfQisd Q8wTDd OIC90c\">(Preguntas, Consideraciones, Etc.)<\/div>\n<\/div>\n<div role=\"listitem\" class=\"Qr7Oae\">\n<div data-params=\"%.@.[611641667,&quot;Criteria and Comments&quot;,null,0,[[1997090382,null,false,null,null,null,null,null,null,null,[]]],null,null,null,null,null,null,[null,&quot;Criteria and Comments&quot;]],&quot;i1&quot;,&quot;i2&quot;,&quot;i3&quot;,false,&quot;i4&quot;]\">\n<div class=\"geS5n\">\n<div class=\"z12JJ\">\n<div class=\"M4DNQ\">\n<div role=\"heading\" class=\"HoXoMd D1wxyf RjsPE\" id=\"i1\">&nbsp;<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_69e1bf951c2ea\" id=\"forminator-field-textarea-3_69e1bf951c2ea-label\" class=\"forminator-label\">Comentarios y sugerencias<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_69e1bf951c2ea\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-718--page-9\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-718--page-9-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"9\"\n\t\t\t\tdata-label=\"9\"\n\t\t\t\tdata-actual-label=\"Page 10\"\n\t\t\t\tdata-name=\"\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-5\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-5\"><label class=\"forminator-label\">Instrucciones para fotograf\u00edas<\/label><p>Siga las instrucciones para una evaluaci\u00f3n r\u00e1pida y precisa. Exponga completamente las \u00e1reas de inter\u00e9s para que el m\u00e9dico tenga una visi\u00f3n clara para la evaluaci\u00f3n.<\/p>\n<p><b>\u2022 <u>No es necesario capturar su rostro en las im\u00e1genes a menos que sea un \u00e1rea de inter\u00e9s para sus procedimientos.<\/u><\/b><\/p>\n<p><b>\u2022<u> Para la liposucci\u00f3n y abdominoplastia, las fotos deben ser en ropa interior, sin cubrir el abdomen. <\/u><\/b><\/p>\n<div>\n<div>\n<div>\n<div>\n<div>\n<div>\n<div>\n<p>\u2022<u><b> In the case of breast evaluation, without a bra.<\/b><\/u><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-6\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-6\"><label class=\"forminator-label\">Facial procedures<\/label><div class=\"pYfr3c\">\n<div class=\"g53bl\">\n<div dir=\"auto\" class=\"cTDvob D1wxyf RjsPE translation-block\">Ejemplos para procedimientos faciales<\/div>\n<\/div>\n<\/div>\n<p><img decoding=\"async\" alt=\"Profile Picture\" src=\"https:\/\/lh7-rt.googleusercontent.com\/formsz\/AN7BsVDlMoTylW4-JXvIhX3Wsa9vPS-wfOoL3b6sZfA0ZPaCrSvieG1T6USKbyGF4-RMKdzd0-aM3pN0kasQkh78ZuR8dqpwWHslI2U3Obk0e-Gngs_hB7-5COkI81ZpfZC5Kjeb3BvAZiRcIBBfT_WUFR9S=w2320?key=WqTX2oTnCiI_0LaOeui7LA\"><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-7\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-7\"><label class=\"forminator-label\">Vista frontal, vista de perfil y vista posterior con los brazos extendidos.<\/label><div class=\"pYfr3c\">\n<div class=\"g53bl\">\n<div dir=\"auto\" class=\"cTDvob D1wxyf RjsPE\">\n<p><b>Vista frontal,<\/b>&nbsp;<b>vista de perfil<\/b>, y&nbsp;<b>vista trasera<\/b>&nbsp;con los brazos extendidos.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p><img decoding=\"async\" alt=\"Profile Picture\" src=\"https:\/\/lh7-rt.googleusercontent.com\/formsz\/AN7BsVD9rR6baOpz9TTHitmLdk875RtKiXTOZieO0ItAVcTbD5afHJjyhQI5eUtnazvVIAPQZK3uzQMmonOKqDlngedF7MF1VCTPGaUPIyqAaCup_hYHWfs3hGpvTawUaRDDCriNsHaZSzTIUJiBJ-9yxyO2SA=w1148?key=WqTX2oTnCiI_0LaOeui7LA\"><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-8\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-8\"><label class=\"forminator-label\">Brazos extendidos como se ve en la imagen.<\/label><div class=\"pYfr3c\">\n<div class=\"g53bl\">\n<div dir=\"auto\" class=\"cTDvob D1wxyf RjsPE\"><span class=\"M7eMe\">Brazos extendidos&nbsp;<b>Como se ve en la imagen<\/b><\/span><\/div>\n<\/div>\n<\/div>\n\n<img decoding=\"async\" alt=\"Profile Picture\" src=\"https:\/\/lh7-rt.googleusercontent.com\/formsz\/AN7BsVBGVkotZp61OQDpCbSyQDTBwq4DJvSUmJwUty57eh1Qe5eEjNqyaTG_0-qRrTyX8J4ZlwbdtxWAYGV9oRqn00osjTw8hd7ABVhDoTW130ouQDOPJ0owfwD5ls84q71RQVprorJ9EMPR1KITpmW3GS6jiw=w1034?key=WqTX2oTnCiI_0LaOeui7LA\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-9\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-9\"><label class=\"forminator-label\">Flexi\u00f3n<\/label><div class=\"pYfr3c\">\n<div class=\"g53bl\">\n<div dir=\"auto\" class=\"cTDvob D1wxyf RjsPE\">\n<p><b>Dos<\/b>&nbsp;fotos adicionales en flexi\u00f3n para observar el grado de flacidez,&nbsp;<b>en ambos perfiles.<\/b><\/p>\n<\/div>\n<\/div>\n<\/div>\n<p><img decoding=\"async\" alt=\"Profile Picture\" src=\"https:\/\/lh7-rt.googleusercontent.com\/formsz\/AN7BsVBVRIOA5YtvI0c5J4xVGjqKh2LgpYBD1LFD7W3vcKZXcyK7i5rYiMKzIjDQRqJgQ-V30ZMAemSgTk7JQx3HpjfZO31WogXwRELRBcjYkB6LMVaE5iBOQ8f3_fIWTHYdfHSJE4_gPH_GcI_oT61yh-dPEg=w854?key=WqTX2oTnCiI_0LaOeui7LA\"><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_69e1bf951c2ea\" id=\"forminator-field-upload-1_69e1bf951c2ea-label\" class=\"forminator-label\">Vista frontal<\/label><div class=\"forminator-file-upload\" data-element=\"upload-1_69e1bf951c2ea\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_69e1bf951c2ea\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-1_69e1bf951c2ea_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_69e1bf951c2ea\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_69e1bf951c2ea\" id=\"forminator-field-upload-2_69e1bf951c2ea-label\" class=\"forminator-label\">Vista lateral<\/label><div class=\"forminator-file-upload\" data-element=\"upload-2_69e1bf951c2ea\"><input type=\"file\" name=\"upload-2\" id=\"forminator-field-upload-2_69e1bf951c2ea\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-2_69e1bf951c2ea_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-2_69e1bf951c2ea\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-3\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-3_69e1bf951c2ea\" id=\"forminator-field-upload-3_69e1bf951c2ea-label\" class=\"forminator-label\">Vista posterior<\/label><div class=\"forminator-file-upload\" data-element=\"upload-3_69e1bf951c2ea\"><input type=\"file\" name=\"upload-3\" id=\"forminator-field-upload-3_69e1bf951c2ea\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-3_69e1bf951c2ea_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-3_69e1bf951c2ea\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-4\" class=\"forminator-field-upload forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-upload-4_69e1bf951c2ea\" id=\"forminator-field-upload-4_69e1bf951c2ea-label\" class=\"forminator-label\">2 vistas en flexi\u00f3n.<\/label><div class=\"forminator-file-upload\" data-element=\"upload-4_69e1bf951c2ea\"><input type=\"file\" name=\"upload-4\" id=\"forminator-field-upload-4_69e1bf951c2ea\" class=\"forminator-input-file\" accept=\".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.heif,.heics,.heifs,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.vtt,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.x-wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.pdf,.class,.tar,.zip,.gz,.gzip,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages\" tabindex=\"-1\"><button id=\"forminator-field-upload-4_69e1bf951c2ea_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-4_69e1bf951c2ea\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_69e1bf951c2ea\" id=\"forminator-field-textarea-4_69e1bf951c2ea-label\" class=\"forminator-label\">Preguntas o comentarios<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_69e1bf951c2ea\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-7-69e1bf951c2ea-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-7-69e1bf951c2ea-label\" class=\"forminator-label\">He le\u00eddo y entiendo que la informaci\u00f3n que proporciono solo se utilizar\u00e1 para la evaluaci\u00f3n de mis procedimientos a menos que se indique lo contrario.<\/span><label id=\"forminator-field-checkbox-7-1-69e1bf951c2ea-label\" for=\"forminator-field-checkbox-7-1-69e1bf951c2ea\" class=\"forminator-checkbox\" title=\"Aceptar\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"one\" id=\"forminator-field-checkbox-7-1-69e1bf951c2ea\" aria-labelledby=\"forminator-field-checkbox-7-1-69e1bf951c2ea-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Aceptar<\/span><\/label><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Enviar<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"cd9489be22\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/715\" \/><input type=\"hidden\" name=\"form_id\" value=\"718\"><input type=\"hidden\" name=\"page_id\" value=\"715\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/hurtadoplasticsurgery.com\/es\/virtual-consultation\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>","protected":false},"excerpt":{"rendered":"<p>In our Plastic Surgery Clinic, we are pleased to offer you the convenience of virtual consultations to obtain an accurate quote for your preferred procedure. Our online process is simple and efficient, requiring only a few minutes of your time. We invite you to complete our virtual form, where you can provide your personal information [&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_joinchat":[],"footnotes":""},"class_list":["post-715","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/hurtadoplasticsurgery.com\/es\/wp-json\/wp\/v2\/pages\/715","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hurtadoplasticsurgery.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/hurtadoplasticsurgery.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/hurtadoplasticsurgery.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hurtadoplasticsurgery.com\/es\/wp-json\/wp\/v2\/comments?post=715"}],"version-history":[{"count":41,"href":"https:\/\/hurtadoplasticsurgery.com\/es\/wp-json\/wp\/v2\/pages\/715\/revisions"}],"predecessor-version":[{"id":810,"href":"https:\/\/hurtadoplasticsurgery.com\/es\/wp-json\/wp\/v2\/pages\/715\/revisions\/810"}],"wp:attachment":[{"href":"https:\/\/hurtadoplasticsurgery.com\/es\/wp-json\/wp\/v2\/media?parent=715"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}