{"id":1517,"date":"2023-07-15T00:48:14","date_gmt":"2023-07-15T00:48:14","guid":{"rendered":"https:\/\/tusalud.biz\/?page_id=1517"},"modified":"2023-07-15T01:30:31","modified_gmt":"2023-07-15T01:30:31","slug":"formulario-de-afiliacion","status":"publish","type":"page","link":"https:\/\/tusalud.biz\/index.php\/formulario-de-afiliacion\/","title":{"rendered":"Formulario de afiliaci\u00f3n"},"content":{"rendered":"\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1521 forminator-design--material  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1521\" data-uid=\"69f61171ecd06\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1521\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1521 forminator-design--material  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1521\"\n\t\t\t\t\n\t\t\t\tdata-design=\"material\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"69f61171ecd06\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><h2 style=\"color: #8dc63f\">Datos del titular<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_69f61171ecd06\" class=\"forminator-label\" id=\"forminator-field-first-name-1_69f61171ecd06-label\">Nombre <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"John\" id=\"forminator-field-first-name-1_69f61171ecd06\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_69f61171ecd06\" class=\"forminator-label\" id=\"forminator-field-last-name-1_69f61171ecd06-label\">Apellido <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"Guti\u00e9rrez\" id=\"forminator-field-last-name-1_69f61171ecd06\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-1521__field--select-4_69f61171ecd06\" id=\"forminator-form-1521__field--select-4_69f61171ecd06-label\" class=\"forminator-label\">Tipo de Documento <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-1521__field--select-4_69f61171ecd06\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Seleccionar\" data-search=\"false\" aria-labelledby=\"forminator-form-1521__field--select-4_69f61171ecd06-label\" aria-describedby=\"forminator-form-1521__field--select-4_69f61171ecd06-description\"><option value=\"\">Seleccionar<\/option><option value=\"one\"  data-calculation=\"0\">CC<\/option><option value=\"two\"  data-calculation=\"0\">RC<\/option><option value=\"CE\"  data-calculation=\"0\">CE<\/option><option value=\"TI\"  data-calculation=\"0\">TI<\/option><option value=\"PA\"  data-calculation=\"0\">PA<\/option><\/select><\/div><\/div><div id=\"number-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_69f61171ecd06\" class=\"forminator-label\" id=\"forminator-field-number-1_69f61171ecd06-label\">N\u00famero Documento de identidad <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"222222222\" id=\"forminator-field-number-1_69f61171ecd06\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69f61171ecd06\" class=\"forminator-label\" id=\"forminator-field-phone-1_69f61171ecd06-label\">Tel\u00e9fono <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"3001234567\" id=\"forminator-field-phone-1_69f61171ecd06\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" maxlength=\"10\" data-validation=\"character_limit\" \/><span id=\"forminator-field-phone-1_69f61171ecd06-description\" class=\"forminator-description\" id=\"forminator-field-phone-1_69f61171ecd06-description\"><span data-limit=\"10\" data-type=\"\">0 \/ 10<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69f61171ecd06\" class=\"forminator-label\" id=\"forminator-field-email-1_69f61171ecd06-label\">E-mail <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"john@doe.com\" id=\"forminator-field-email-1_69f61171ecd06\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69f61171ecd06\" class=\"forminator-label\" id=\"forminator-field-address-1-street_address_69f61171ecd06-label\">Direcci\u00f3n<\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Ej: Calle 123 # 12 -52\" id=\"forminator-field-address-1-street_address_69f61171ecd06\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69f61171ecd06\" class=\"forminator-label\" id=\"forminator-field-address-1-city_69f61171ecd06-label\">Ciudad <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"Ej: Barranquilla\" id=\"forminator-field-address-1-city_69f61171ecd06\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" value=\"\" \/><\/div><\/div><div id=\"address-1-state\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-state_69f61171ecd06\" class=\"forminator-label\" id=\"forminator-field-address-1-state_69f61171ecd06-label\">Barrio<\/label><input type=\"text\" name=\"address-1-state\" placeholder=\"Ej: El Prado\" id=\"forminator-field-address-1-state_69f61171ecd06\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-5\"><h2 style=\"color: #8dc63f\">Planes<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1521__field--select-3_69f61171ecd06\" id=\"forminator-form-1521__field--select-3_69f61171ecd06-label\" class=\"forminator-label\">Planes <span class=\"forminator-required\">*<\/span><\/label><select id=\"forminator-form-1521__field--select-3_69f61171ecd06\" class=\"forminator-select--field forminator-select2\" data-required=\"1\" name=\"select-3\" data-default-value=\"Afiliaci\u00f3n-Gratis-(cobertura-6-meses)\" data-hidden-behavior=\"zero\" data-placeholder=\"Selecciona\" data-search=\"false\" aria-labelledby=\"forminator-form-1521__field--select-3_69f61171ecd06-label\" aria-describedby=\"forminator-form-1521__field--select-3_69f61171ecd06-description\"><option value=\"\">Selecciona<\/option><option value=\"Afiliaci\u00f3n-Gratis-(cobertura-6-meses)\" selected=\"selected\" data-calculation=\"0\">Promoci\u00f3n: Gratis<\/option><option value=\"Afiliaci\u00f3n-Referidos\"  data-calculation=\"0\">Afiliaci\u00f3n Referidos<\/option><option value=\"Afiliaci\u00f3n-anual\"  data-calculation=\"0\">Afiliaci\u00f3n anual<\/option><option value=\"Afiliaci\u00f3n-semestre\"  data-calculation=\"0\">Afiliaci\u00f3n semestre<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-69f61171ecd06-label\"><label id=\"forminator-field-checkbox-1-1-69f61171ecd06-label\" for=\"forminator-field-checkbox-1-1-69f61171ecd06\" class=\"forminator-checkbox\" title=\"Acepto los t\u00e9rminos y condiciones.\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Acepto-los-t\u00e9rminos-y-condiciones.\" id=\"forminator-field-checkbox-1-1-69f61171ecd06\" aria-labelledby=\"forminator-field-checkbox-1-1-69f61171ecd06-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-69f61171ecd06-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Acepto los t\u00e9rminos y condiciones.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-6\"><p><a href=\"https:\/\/tusalud.biz\/index.php\/privacy-policy\/\">Leer los T\u00e9rminos y condiciones<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-7\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-7\"><p>Al dar click en el bot\u00f3n enviar ser\u00e1 direccionado con un asesor para continuar con el registro de beneficiarios<\/p><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit btn_afiliacion\"><span>Enviar y contactar un asesor<\/span><span aria-hidden=\"true\"><\/span><\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"bcca9c1a34\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1517\" \/><input type=\"hidden\" name=\"form_id\" value=\"1521\"><input type=\"hidden\" name=\"page_id\" value=\"1517\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/tusalud.biz\/index.php\/formulario-de-afiliacion\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":"","_joinchat":[]},"_links":{"self":[{"href":"https:\/\/tusalud.biz\/index.php\/wp-json\/wp\/v2\/pages\/1517"}],"collection":[{"href":"https:\/\/tusalud.biz\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/tusalud.biz\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/tusalud.biz\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/tusalud.biz\/index.php\/wp-json\/wp\/v2\/comments?post=1517"}],"version-history":[{"count":3,"href":"https:\/\/tusalud.biz\/index.php\/wp-json\/wp\/v2\/pages\/1517\/revisions"}],"predecessor-version":[{"id":1523,"href":"https:\/\/tusalud.biz\/index.php\/wp-json\/wp\/v2\/pages\/1517\/revisions\/1523"}],"wp:attachment":[{"href":"https:\/\/tusalud.biz\/index.php\/wp-json\/wp\/v2\/media?parent=1517"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}