{"id":21193,"date":"2024-08-30T19:05:30","date_gmt":"2024-08-30T17:05:30","guid":{"rendered":"https:\/\/telemedi.com\/?page_id=21193"},"modified":"2024-10-15T11:56:26","modified_gmt":"2024-10-15T09:56:26","slug":"formularz-umawiania-wizyt","status":"publish","type":"page","link":"https:\/\/telemedi.com\/pl\/formularz-umawiania-wizyt\/","title":{"rendered":"Formularz umawiania wizyt"},"content":{"rendered":"\n<style>body { background-color: #f6f5f2; }<\/style>\n<script src=\"https:\/\/telemedi.com\/wp-content\/themes\/telemedico-home-page\/src\/js\/libraries\/tailwind\/tailwind.js\" data-cookieconsent=\"ignore\"><\/script>\n    <script>\n        tailwind.config = {\n            theme: {\n                extend: {\n                    colors: {\n                        primary: '#20a869',\n                    },\n                },\n            },\n        }\n    <\/script>\n    <noscript>\n        <div class=\"bg-red-500 text-white p-4 text-center\">\n            <p>Do poprawnego dzia\u0142ania formularza niezb\u0119dny jest w\u0142\u0105czony JavaScript. Je\u015bli jest wy\u0142\u0105czony, w\u0142\u0105cz go lub u\u017cyj innej przegl\u0105darki. Aby w\u0142\u0105czy\u0107 JavaScript na Androidzie, przejd\u017a do ustawie\u0144 przegl\u0105darki, znajd\u017a opcj\u0119 &#8222;JavaScript&#8221; lub &#8222;Ustawienia witryny&#8221;, a nast\u0119pnie aktywuj odpowiedni prze\u0142\u0105cznik.<\/p>\n        <\/div>\n    <\/noscript>\n    <div id=\"formContainer\" class=\"container mx-auto max-w-2xl p-6\" style=\"display: none;\">\n        <form id=\"patientForm\" class=\"bg-white shadow-md rounded px-8 pt-6 pb-8 mb-4\">\n            <input type=\"text\" name=\"name\" placeholder=\"Imi\u0119 i nazwisko pacjenta\" required class=\"shadow appearance-none border rounded w-full py-2 px-3 text-gray-700 leading-tight focus:outline-none focus:shadow-outline mb-4\">\n            <label for=\"pesel\">Data Urodzenia:<\/label>\n            <input type=\"date\" name=\"pesel\" placeholder=\"Data Urodzenia\" required class=\"shadow appearance-none border rounded w-full py-2 px-3 text-gray-700 leading-tight focus:outline-none focus:shadow-outline mb-4\">\n            <input type=\"tel\" name=\"phone\" placeholder=\"Numer kontaktowy\" required class=\"shadow appearance-none border rounded w-full py-2 px-3 text-gray-700 leading-tight focus:outline-none focus:shadow-outline mb-4\">\n            <input type=\"email\" name=\"email\" placeholder=\"Adres e-mail\" required class=\"shadow appearance-none border rounded w-full py-2 px-3 text-gray-700 leading-tight focus:outline-none focus:shadow-outline mb-4\">\n            \n            <input type=\"text\" name=\"city\" placeholder=\"Wpisz miasto\" required class=\"shadow appearance-none border rounded w-full py-2 px-3 text-gray-700 leading-tight focus:outline-none focus:shadow-outline mb-4\">\n            \n            <input type=\"text\" name=\"postalCode\" placeholder=\"Kod pocztowy\" required class=\"shadow appearance-none border rounded w-full py-2 px-3 text-gray-700 leading-tight focus:outline-none focus:shadow-outline mb-4\">\n            \n            <input type=\"text\" name=\"specialization\" placeholder=\"Wpisz us\u0142ug\u0119 (np. lekarz internista, usg brzucha)\" required class=\"shadow appearance-none border rounded w-full py-2 px-3 text-gray-700 leading-tight focus:outline-none focus:shadow-outline mb-4\">\n            \n            <p class=\"mb-2 font-bold\">Preferowane godziny:<\/p>\n            <div class=\"flex flex-wrap gap-4 mb-4\">\n                <label class=\"inline-flex items-center\"><input type=\"checkbox\" name=\"time\" value=\"rano\" class=\"form-checkbox h-5 w-5 text-blue-600\"><span class=\"ml-2\">Rano<\/span><\/label>\n                <label class=\"inline-flex items-center\"><input type=\"checkbox\" name=\"time\" value=\"poludnie\" class=\"form-checkbox h-5 w-5 text-blue-600\"><span class=\"ml-2\">Po\u0142udnie<\/span><\/label>\n                <label class=\"inline-flex items-center\"><input type=\"checkbox\" name=\"time\" value=\"popoludnie\" class=\"form-checkbox h-5 w-5 text-blue-600\"><span class=\"ml-2\">Popo\u0142udnie<\/span><\/label>\n                <label class=\"inline-flex items-center\"><input type=\"checkbox\" name=\"time\" value=\"wieczor\" class=\"form-checkbox h-5 w-5 text-blue-600\"><span class=\"ml-2\">Wiecz\u00f3r<\/span><\/label>\n            <\/div>\n            \n            <p class=\"mb-2 font-bold\">Wybierz preferowane daty:<\/p>\n            <div id=\"dates\" class=\"mb-4 space-y-2\"><\/div>\n            \n            <textarea name=\"comment\" placeholder=\"Dodatkowe uwagi(szczeg\u00f3\u0142y, daty, itp.)\" class=\"shadow appearance-none border rounded w-full py-2 px-3 text-gray-700 leading-tight focus:outline-none focus:shadow-outline mb-4\"><\/textarea>\n            \n            <select name=\"referral\" required class=\"shadow appearance-none border rounded w-full py-2 px-3 text-gray-700 leading-tight focus:outline-none focus:shadow-outline mb-4\">\n                <option value=\"\">Czy posiadasz skierowanie na us\u0142ug\u0119?<\/option>\n                <option>Tak<\/option>\n                <option>Nie<\/option>\n            <\/select>\n            \n            <label class=\"inline-flex items-center mb-4\">\n                <input type=\"checkbox\" id=\"teleporada\" class=\"form-checkbox h-5 w-5 text-primary\">\n                <span class=\"ml-2 text-sm\">Zgadzam si\u0119 na umowienie teleporady z lekarzem je\u015bli taki termin b\u0119dzie najszybszy &#8211; dotyczy wizyt mo\u017cliwych do realizacji w ramach teleporady<\/span>\n            <\/label>\n            \n            <button type=\"submit\" class=\"bg-primary hover:bg-primary-dark text-white font-bold py-2 px-4 rounded focus:outline-none focus:shadow-outline w-full\">Dalej<\/button>\n        <\/form>\n    <\/div>\n\n    <div id=\"loader\" class=\"hidden fixed inset-0 bg-gray-600 bg-opacity-50 flex items-center justify-center\" style=\"display: none;\">\n        <div class=\"bg-white p-6 rounded-lg flex flex-col items-center\">\n            <div class=\"animate-spin rounded-full h-16 w-16 border-t-4 border-b-4 border-primary mb-4\"><\/div>\n            <p class=\"text-lg font-semibold text-gray-700\">Wysy\u0142anie danych&#8230;<\/p>\n        <\/div>\n    <\/div>\n    <div id=\"successPopup\" class=\"hidden fixed inset-0 bg-gray-600 bg-opacity-50 flex items-center justify-center\" style=\"display: none;\">\n        <div class=\"bg-green-500 text-white p-6 rounded-lg\">\n            <p class=\"text-lg font-semibold\">Formularz zosta\u0142 pomy\u015blnie wys\u0142any!<\/p>\n        <\/div>\n    <\/div>\n\n    <script defer data-cookieconsent=\"ignore\">\n        function generateDates() {\n            const datesContainer = document.getElementById('dates');\n            const days = ['niedziela', 'poniedzia\u0142ek', 'wtorek', '\u015broda', 'czwartek', 'pi\u0105tek', 'sobota'];\n            const months = ['stycznia', 'lutego', 'marca', 'kwietnia', 'maja', 'czerwca', 'lipca', 'sierpnia', 'wrze\u015bnia', 'pa\u017adziernika', 'listopada', 'grudnia'];\n            \n            const today = new Date();\n            \n            for (let i = 0; i < 7; i++) {\n                const date = new Date(today);\n                date.setDate(today.getDate() + i);\n                \n                const dayName = days[date.getDay()];\n                const monthName = months[date.getMonth()];\n                \n                const label = document.createElement('label');\n                label.className = 'flex items-center space-x-2';\n                const checkbox = document.createElement('input');\n                checkbox.type = 'checkbox';\n                checkbox.name = 'date';\n                checkbox.value = `${date.getFullYear()}-${date.getMonth()+1}-${date.getDate()}`;\n                checkbox.className = 'form-checkbox h-5 w-5 text-primary';\n                \n                const span = document.createElement('span');\n                span.textContent = `${dayName}, ${date.getDate()} ${monthName}`;\n                \n                label.appendChild(checkbox);\n                label.appendChild(span);\n                \n                datesContainer.appendChild(label);\n            }\n        }\n        \n        generateDates();\n\n        document.getElementById('patientForm').addEventListener('submit', function(e) {\n            e.preventDefault();\n            \n            \/\/ Walidacja preferowanych godzin\n            const preferredTimes = this.querySelectorAll('input[name=\"time\"]:checked');\n            if (preferredTimes.length === 0) {\n                alert('Prosz\u0119 wybra\u0107 co najmniej jedn\u0105 preferowan\u0105 godzin\u0119.');\n                return;\n            }\n            \n            \/\/ Walidacja preferowanych dat\n            const preferredDates = this.querySelectorAll('input[name=\"date\"]:checked');\n            if (preferredDates.length === 0) {\n                alert('Prosz\u0119 wybra\u0107 co najmniej jedn\u0105 preferowan\u0105 dat\u0119.');\n                return;\n            }\n            \n            \/\/ Zbieranie wszystkich zaznaczonych dat i godzin\n            const times = Array.from(preferredTimes).map(input => input.value).join(', ');\n            const dates = Array.from(preferredDates).map(input => input.value).join(', ');\n\n            \/\/ Dodanie dat i godzin do formularza\n            const timesInput = document.createElement('input');\n            timesInput.type = 'hidden';\n            timesInput.name = 'time';\n            timesInput.value = times;\n            this.appendChild(timesInput);\n\n            const datesInput = document.createElement('input');\n            datesInput.type = 'hidden';\n            datesInput.name = 'date';\n            datesInput.value = dates;\n            this.appendChild(datesInput);\n\n            \/\/ Dodanie checkboxa teleporada do formularza\n            const teleporadaInput = document.createElement('input');\n            teleporadaInput.type = 'hidden';\n            teleporadaInput.name = 'teleporada';\n            teleporadaInput.value = this.elements['teleporada'].checked ? 'Tak' : 'Nie'; \/\/ Warto\u015b\u0107 'tak' lub 'nie'\n            this.appendChild(teleporadaInput);\n            \n            const loader = document.getElementById('loader');\n            const successPopup = document.getElementById('successPopup');\n            \n            loader.style.display = 'block';\n            \n            const formData = new FormData(this);\n            \n            fetch('https:\/\/n8n.tmdi00.com\/webhook\/c99e40a5-6d47-413c-921e-42783c9bfad4', {\n                method: 'POST',\n                body: formData\n            })\n            .then(response => {\n                if (!response.ok) {\n                    throw new Error('Network response was not ok');\n                }\n                return response.json();\n            })\n            .then(data => {\n                loader.style.display = 'none';\n                window.location.href = 'https:\/\/telemedi.com\/pl\/formularz-success-wizyt-domowych\/'; \/\/ Przekierowanie na stron\u0119 success.html\n            })\n            .catch(error => {\n                console.error('Error:', error);\n                loader.style.display = 'none';\n                alert('Wyst\u0105pi\u0142 b\u0142\u0105d podczas wysy\u0142ania formularza. Spr\u00f3buj ponownie p\u00f3\u017aniej.');\n            });\n        });\n    <\/script>\n    <script defer data-cookieconsent=\"ignore\">\n        document.getElementById('formContainer').style.display = 'block'; \/\/ Upewnij si\u0119, \u017ce formularz jest widoczny, gdy JS jest w\u0142\u0105czony\n        \/\/ Ustaw widoczno\u015b\u0107 loadera i popupu sukcesu tylko w przypadku, gdy JS jest w\u0142\u0105czony\n        const loader = document.getElementById('loader');\n        const successPopup = document.getElementById('successPopup');\n        \n        \/\/ Przyk\u0142ad u\u017cycia loadera\n        \/\/ loader.style.display = 'block'; \/\/ U\u017cyj tego w odpowiednim miejscu w kodzie\n        \/\/ successPopup.style.display = 'block'; \/\/ U\u017cyj tego w odpowiednim miejscu w kodzie\n    <\/script>\n","protected":false},"excerpt":{"rendered":"<p>Do poprawnego dzia\u0142ania formularza niezb\u0119dny jest w\u0142\u0105czony JavaScript. Je\u015bli jest wy\u0142\u0105czony, w\u0142\u0105cz go lub u\u017cyj innej przegl\u0105darki. Aby w\u0142\u0105czy\u0107 JavaScript na Androidzie, przejd\u017a do ustawie\u0144 przegl\u0105darki, znajd\u017a opcj\u0119 &#8222;JavaScript&#8221; lub &#8222;Ustawienia witryny&#8221;, a nast\u0119pnie aktywuj odpowiedni prze\u0142\u0105cznik. Data Urodzenia: Preferowane godziny: Rano Po\u0142udnie Popo\u0142udnie Wiecz\u00f3r Wybierz preferowane daty: Czy posiadasz skierowanie na us\u0142ug\u0119?TakNie Zgadzam si\u0119 [&hellip;]<\/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,"content-type":"","footnotes":""},"class_list":["post-21193","page","type-page","status-publish","hentry"],"acf":[],"lang":"pl","translations":{"pl":21193},"_links":{"self":[{"href":"https:\/\/telemedi.com\/tm-api\/wp\/v2\/pages\/21193","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/telemedi.com\/tm-api\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/telemedi.com\/tm-api\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/telemedi.com\/tm-api\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/telemedi.com\/tm-api\/wp\/v2\/comments?post=21193"}],"version-history":[{"count":15,"href":"https:\/\/telemedi.com\/tm-api\/wp\/v2\/pages\/21193\/revisions"}],"predecessor-version":[{"id":23936,"href":"https:\/\/telemedi.com\/tm-api\/wp\/v2\/pages\/21193\/revisions\/23936"}],"wp:attachment":[{"href":"https:\/\/telemedi.com\/tm-api\/wp\/v2\/media?parent=21193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}