{"id":3453,"date":"2025-03-13T20:51:17","date_gmt":"2025-03-13T23:51:17","guid":{"rendered":"https:\/\/serenamente.uy\/?page_id=3453"},"modified":"2026-06-07T23:51:34","modified_gmt":"2026-06-08T02:51:34","slug":"formulario","status":"publish","type":"page","link":"https:\/\/serenamente.uy\/index.php\/formulario\/","title":{"rendered":"Formulario"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3453\" class=\"elementor elementor-3453\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a2be5e8 e-con-full e-flex e-con e-parent\" data-id=\"a2be5e8\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a66f697 eael-contact-form-7-button-align-center eael-contact-form-7-button-align-center eael-contact-form-7-button-custom elementor-widget elementor-widget-eael-contact-form-7\" data-id=\"a66f697\" data-element_type=\"widget\" data-widget_type=\"eael-contact-form-7.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"eael-contact-form-7-wrapper\">\n                <div class=\"eael-contact-form eael-contact-form-7 eael-contact-form-a66f697 placeholder-show eael-custom-radio-checkbox eael-contact-form-align-default\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3382-o1\" lang=\"es-ES\" dir=\"ltr\" data-wpcf7-id=\"3382\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/3453#wpcf7-f3382-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulario de contacto\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"3382\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"es_ES\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3382-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><label>Nombre Completo<span class=\"wpcf7-form-control-wrap\" data-name=\"nombre\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nombre\" \/><\/span><\/label>\n<\/p>\n<p><label>Correo electr\u00f3nico<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span><\/label>\n<\/p>\n<p><label>Celular<span class=\"wpcf7-form-control-wrap\" data-name=\"telefono\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telefono\" \/><\/span><\/label>\n<\/p>\n<p><label>Fecha de Nacimiento<span class=\"wpcf7-form-control-wrap\" data-name=\"nacimiento\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"nacimiento\" \/><\/span><\/label>\n<\/p>\n<p><label>C\u00e9dula de Identidad<span class=\"wpcf7-form-control-wrap\" data-name=\"ci\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ci\" \/><\/span><\/label>\n<\/p>\n<p><label class=\"fixform\">Departamento<span class=\"wpcf7-form-control-wrap\" data-name=\"departamento\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"departamento\"><option value=\"Montevideo\">Montevideo<\/option><option value=\"Artigas\">Artigas<\/option><option value=\"Canelones\">Canelones<\/option><option value=\"Cerro Largo\">Cerro Largo<\/option><option value=\"Colonia\">Colonia<\/option><option value=\"Durazno\">Durazno<\/option><option value=\"Flores\">Flores<\/option><option value=\"Florida\">Florida<\/option><option value=\"Lavalleja\">Lavalleja<\/option><option value=\"Maldonado\">Maldonado<\/option><option value=\"Paysand\u00fa\">Paysand\u00fa<\/option><option value=\"R\u00edo Negro\">R\u00edo Negro<\/option><option value=\"Rivera\">Rivera<\/option><option value=\"Rocha\">Rocha<\/option><option value=\"Salto\">Salto<\/option><option value=\"San Jos\u00e9\">San Jos\u00e9<\/option><option value=\"Soriano\">Soriano<\/option><option value=\"Tacuaremb\u00f3\">Tacuaremb\u00f3<\/option><option value=\"Treinta y Tres\">Treinta y Tres<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label>Localidad \/ Barrio<span class=\"wpcf7-form-control-wrap\" data-name=\"barrio\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"barrio\" \/><\/span><\/label>\n<\/p>\n<p><label class=\"fixform\">Motivo de Consulta<span class=\"wpcf7-form-control-wrap\" data-name=\"motivo\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"motivo\"><option value=\"Ansiedad\">Ansiedad<\/option><option value=\"Estr\u00e9s\">Estr\u00e9s<\/option><option value=\"Depresi\u00f3n\">Depresi\u00f3n<\/option><option value=\"Duelo\">Duelo<\/option><option value=\"Experiencias Traum\u00e1ticas\">Experiencias Traum\u00e1ticas<\/option><option value=\"Temas laborales\">Temas laborales<\/option><option value=\"V\u00ednculos\">V\u00ednculos<\/option><option value=\"Otros\">Otros<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label>Amplia tu Motivo de Consulta<span class=\"wpcf7-form-control-wrap\" data-name=\"motivo-otros\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"motivo-otros\" \/><\/span><\/label>\n<\/p>\n<p><label class=\"fixform\">\u00bfHas utilizado servicios de salud mental?<span class=\"wpcf7-form-control-wrap\" data-name=\"utilizado\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"utilizado\"><option value=\"No\">No<\/option><option value=\"Si\">Si<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label>\u00bfD\u00f3nde?<span class=\"wpcf7-form-control-wrap\" data-name=\"donde\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"donde\" \/><\/span><\/label>\n<\/p>\n<p><label class=\"fixform\">\u00bfEst\u00e1s con alg\u00fan tratamiento en curso?<span class=\"wpcf7-form-control-wrap\" data-name=\"encurso\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"encurso\"><option value=\"No\">No<\/option><option value=\"Si\">Si<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label class=\"fixform\">Horario Preferido<span class=\"wpcf7-form-control-wrap\" data-name=\"horario\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"horario\"><option value=\"8 a 12\">8 a 12<\/option><option value=\"12 a 16\">12 a 16<\/option><option value=\"16 a 18\">16 a 18<\/option><option value=\"18 a 20\">18 a 20<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label class=\"fixform\">Modalidad Preferida<span class=\"wpcf7-form-control-wrap\" data-name=\"modalidad\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"modalidad\"><option value=\"Indistinto\">Indistinto<\/option><option value=\"Virtual\">Virtual<\/option><option value=\"Presencial\">Presencial<\/option><\/select><\/span><\/label>\n<\/p>\n<p><label>Si pertenece a Convenio, \u00bfc\u00faal es?<span class=\"wpcf7-form-control-wrap\" data-name=\"convenio\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"No\" type=\"text\" name=\"convenio\" \/><\/span><\/label>\n<\/p>\n<p><label style=\"width: 100vw;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"tyc\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"tyc\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">LE\u00cd Y ACEPTO CONDICIONES DEL SERVICIO DE SERENAMENTE<\/span><\/label><\/span><\/span><\/span><\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Finalizar\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n            <\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Nombre Completo Correo electr\u00f3nico Celular Fecha de Nacimiento C\u00e9dula de Identidad DepartamentoMontevideoArtigasCanelonesCerro LargoColoniaDuraznoFloresFloridaLavallejaMaldonadoPaysand\u00faR\u00edo NegroRiveraRochaSaltoSan Jos\u00e9SorianoTacuaremb\u00f3Treinta y Tres Localidad \/ Barrio Motivo de ConsultaAnsiedadEstr\u00e9sDepresi\u00f3nDueloExperiencias Traum\u00e1ticasTemas laboralesV\u00ednculosOtros Amplia tu Motivo de Consulta &#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3453","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/serenamente.uy\/index.php\/wp-json\/wp\/v2\/pages\/3453","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/serenamente.uy\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/serenamente.uy\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/serenamente.uy\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/serenamente.uy\/index.php\/wp-json\/wp\/v2\/comments?post=3453"}],"version-history":[{"count":36,"href":"https:\/\/serenamente.uy\/index.php\/wp-json\/wp\/v2\/pages\/3453\/revisions"}],"predecessor-version":[{"id":4603,"href":"https:\/\/serenamente.uy\/index.php\/wp-json\/wp\/v2\/pages\/3453\/revisions\/4603"}],"wp:attachment":[{"href":"https:\/\/serenamente.uy\/index.php\/wp-json\/wp\/v2\/media?parent=3453"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}