{"id":1040,"date":"2026-05-20T05:15:37","date_gmt":"2026-05-20T05:15:37","guid":{"rendered":"https:\/\/dymmedicalclinic.id\/en\/?page_id=1040"},"modified":"2026-05-20T05:16:27","modified_gmt":"2026-05-20T05:16:27","slug":"booking-confirm","status":"publish","type":"page","link":"https:\/\/dymmedicalclinic.id\/en\/mcu\/booking-confirm\/","title":{"rendered":"booking-confirm"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1038-o1\" lang=\"ja\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/1040#wpcf7-f1038-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1038\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1038-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Gender\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform sex]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Name (in Roman letters)\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform familyname]&nbsp;[multiform firstname]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Date of birth\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput birthday_box\">\n\t\t<p>[multiform birth_year]\/[multiform birth_month]\/[multiform birth_day]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Mobile phone number\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform tel]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Email address\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform email]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Email address (confirmation)\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform email_confirm]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Preferred appointment date and time\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput hopeday_box\">\n\t\t<div>\n\t\t\t<p>First preference\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>[multiform kibou1]\u3000[multiform kibou1-2]\n\t\t<\/p>\n\t\t<div>\n\t\t\t<p>Second preference\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p>[multiform kibou2]\u3000[multiform kibou2-2]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Plan\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n <!-- <p class=\"chui_company\" style=\"color: #ff0000; font-size: 16px; padding: 5px;\" >\u203b2025\u5e745\u6708\u3088\u308a\u30d1\u30c3\u30b1\u30fc\u30b8\u5185\u5bb9\u3092\u4e00\u90e8\u5909\u66f4\u3044\u305f\u3057\u307e\u3057\u305f\u3002<\/p> -->\n\t<\/div>\n\t<div class=\"forminput brelement checks no-breaks\">\n\t\t<p>[multiform plan]\n\t\t<\/p>\n\t\t<p>[multiform plan2]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Optional tests\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Optional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput brelement checks\">\n\t\t<p>[multiform option]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Visit history at our clinic\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform history]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Payment method (plan fee)\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require\">\n\t\t\t<p>Required\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput checks\">\n\t\t<p>[multiform payment]\n\t\t<\/p>\n\t\t<p>[multiform payment-other]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Payment method (optional tests)\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Optional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput checks\">\n\t\t<p>[multiform payment2]\n\t\t<\/p>\n\t\t<p>[multiform payment2-other]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Company name\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Optional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform company_address]\n\t\t<\/p>\n\t\t<p class=\"chui_company\">\u203bPlease be sure to enter this if using company billing.\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Company address\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Optional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform company_address]\n\t\t<\/p>\n\t\t<p class=\"chui_company\">\u203bPlease be sure to enter this if using company billing.\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Name of Indonesian accounting contact\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Optional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform keiri_name]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Telephone number of Indonesian accounting contact\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Optional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform keiri_tel]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Email address of Indonesian accounting contact\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Optional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform keiri_mail]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<!-- <div class=\"formpart\">\n  <div class=\"formname\">\n    <div class=\"name\">\u63a1\u8840\u3067\u306e\u3075\u3089\u3064\u304d<\/div>\n    <div class=\"require nini\">\u4efb\u610f<\/div>\n  <\/div>\n  <div class=\"forminput\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"blood\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"blood[]\" value=\"\u3042\u308b(\u8a3a\u7642\u30d9\u30c3\u30c9\u3067\u306e\u63a1\u8840\u3092\u5e0c\u671b)\" \/><span class=\"wpcf7-list-item-label\">\u3042\u308b(\u8a3a\u7642\u30d9\u30c3\u30c9\u3067\u306e\u63a1\u8840\u3092\u5e0c\u671b)<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n<\/div>\n<div class=\"formpart\">\n  <div class=\"formname\">\n    <div class=\"name\">\u691c\u67fb\u30ad\u30c3\u30c8\u306e\u53d7\u3051\u53d6\u308a\u65b9\u6cd5<\/div>\n    <div class=\"require\">\u5fc5\u9808<\/div>\n  <\/div>\n  <div class=\"forminput brelement\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"method\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"method\" value=\"\u691c\u4fbf\u691c\u67fb\u306a\u3057\" \/><span class=\"wpcf7-list-item-label\">\u691c\u4fbf\u691c\u67fb\u306a\u3057<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"method\" value=\"\u3054\u81ea\u5b85\u306b\u90f5\u9001\u5e0c\u671b\" \/><span class=\"wpcf7-list-item-label\">\u3054\u81ea\u5b85\u306b\u90f5\u9001\u5e0c\u671b<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"method\" value=\"\u3054\u52e4\u52d9\u5148\u306b\u90f5\u9001\u5e0c\u671b\" \/><span class=\"wpcf7-list-item-label\">\u3054\u52e4\u52d9\u5148\u306b\u90f5\u9001\u5e0c\u671b<\/span><\/label><\/span><\/span><\/span>\n  <\/div>\n<\/div>\n<div class=\"formpart\">\n  <div class=\"formname\">\n    <div class=\"name\">\u4f4f\u6240(\u691c\u67fb\u30ad\u30c3\u30c8\u9001\u4ed8\u5148)<\/div>\n    <div class=\"require\">\u5fc5\u9808<\/div>\n  <\/div>\n  <div class=\"forminput\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"address_kit\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u306a\u3057\u306e\u5834\u5408\u306f\u306a\u3057\u3068\u3054\u8a18\u5165\u304f\u3060\u3055\u3044\u3002\" value=\"\" type=\"text\" name=\"address_kit\" \/><\/span>\n  <\/div>\n<\/div>\n<div class=\"formpart\">\n  <div class=\"formname\">\n    <div class=\"name\">\u3054\u53d7\u8a3a\u306e\u304d\u3063\u304b\u3051<\/div>\n    <div class=\"require\">\u5fc5\u9808<\/div>\n  <\/div>\n  <div class=\"forminput brelement\">\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"kikkake\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u30db\u30fc\u30e0\u30da\u30fc\u30b8\u3084\u30a4\u30f3\u30bf\u30fc\u30cd\u30c3\u30c8\u691c\u7d22\" \/><span class=\"wpcf7-list-item-label\">\u30db\u30fc\u30e0\u30da\u30fc\u30b8\u3084\u30a4\u30f3\u30bf\u30fc\u30cd\u30c3\u30c8\u691c\u7d22<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u4f1a\u793e\u304b\u3089\u306e\u7d39\u4ecb\" \/><span class=\"wpcf7-list-item-label\">\u4f1a\u793e\u304b\u3089\u306e\u7d39\u4ecb<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u30d5\u30ea\u30fc\u30da\u30fc\u30d1\u30fc\" \/><span class=\"wpcf7-list-item-label\">\u30d5\u30ea\u30fc\u30da\u30fc\u30d1\u30fc<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u304a\u77e5\u308a\u5408\u3044\u304b\u3089\u306e\u3054\u7d39\u4ecb\" \/><span class=\"wpcf7-list-item-label\">\u304a\u77e5\u308a\u5408\u3044\u304b\u3089\u306e\u3054\u7d39\u4ecb<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u9662\u5185\u63b2\u793a\u7269\" \/><span class=\"wpcf7-list-item-label\">\u9662\u5185\u63b2\u793a\u7269<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u6628\u5e74\u5ea6\u304b\u3089\u306e\u7d99\u7d9a\u5229\u7528\" \/><span class=\"wpcf7-list-item-label\">\u6628\u5e74\u5ea6\u304b\u3089\u306e\u7d99\u7d9a\u5229\u7528<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"kikkake\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><\/span><\/span>\n    <span class=\"wpcf7-form-control-wrap\" data-name=\"kikkake2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u305d\u306e\u4ed6\u306e\u5834\u5408\u306f\u3053\u3061\u3089\u306b\u3054\u5165\u529b\u304f\u3060\u3055\u3044\u3002\" value=\"\" type=\"text\" name=\"kikkake2\" \/><\/span>\n  <\/div>\n<\/div> -->\n<div class=\"formpart\">\n\t<div class=\"formname\">\n\t\t<div class=\"name\">\n\t\t\t<p>Remarks\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"require nini\">\n\t\t\t<p>Optional\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"forminput\">\n\t\t<p>[multiform others]\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"submit\">\n\t<p>[multistep multistep-51 send_email \"\/mcu\/booking-thanks\/\"]<br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"submit\" \/><br \/>\n[previous \"Edit Details\"]\n\t<\/p>\n<\/div>\n<div class=\"last_chui\">\n\t<p>\u203bAfter submitting the reservation form, our staff will send you a confirmation email within 3 business days.<br \/>\nIf you do not receive a confirmation email, please kindly contact our clinic at <br class=\"pc\" \/>(<a href=\"tel:02186656830\">021-8665-6830<\/a>).\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":445,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"pages\/booking-confirm.php","meta":{"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/dymmedicalclinic.id\/en\/wp-json\/wp\/v2\/pages\/1040"}],"collection":[{"href":"https:\/\/dymmedicalclinic.id\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dymmedicalclinic.id\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dymmedicalclinic.id\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/dymmedicalclinic.id\/en\/wp-json\/wp\/v2\/comments?post=1040"}],"version-history":[{"count":2,"href":"https:\/\/dymmedicalclinic.id\/en\/wp-json\/wp\/v2\/pages\/1040\/revisions"}],"predecessor-version":[{"id":1043,"href":"https:\/\/dymmedicalclinic.id\/en\/wp-json\/wp\/v2\/pages\/1040\/revisions\/1043"}],"up":[{"embeddable":true,"href":"https:\/\/dymmedicalclinic.id\/en\/wp-json\/wp\/v2\/pages\/445"}],"wp:attachment":[{"href":"https:\/\/dymmedicalclinic.id\/en\/wp-json\/wp\/v2\/media?parent=1040"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}