{"id":27551,"date":"2023-06-06t11:50:50","date_gmt":"2023-06-06t10:50:50","guid":{"rendered":"\/\/www.aselpijama.com\/?page_id=27551"},"modified":"2023-06-27t11:00:15","modified_gmt":"2023-06-27t10:00:15","slug":"please-confirm-your-contact-details-and-preferences","status":"publish","type":"page","link":"\/\/www.aselpijama.com\/please-confirm-your-contact-details-and-preferences\/","title":{"rendered":"please confirm your contact details and preferences"},"content":{"rendered":"<figure class=\"wp-block-image size-large\"><a href=\"\/\/www.aselpijama.com\/app\/uploads\/2023\/06\/mailchimp-data-confirm-1-1.jpg\"><img decoding=\"async\" width=\"1024\" height=\"479\" src=\"\/\/www.aselpijama.com\/app\/uploads\/2023\/06\/mailchimp-data-confirm-1-1-1024x479.jpg\" alt=\"\" class=\"wp-image-27708\" srcset=\"\/\/www.aselpijama.com\/app\/uploads\/2023\/06\/mailchimp-data-confirm-1-1-1024x479.jpg 1024w, \/\/www.aselpijama.com\/app\/uploads\/2023\/06\/mailchimp-data-confirm-1-1-300x140.jpg 300w, \/\/www.aselpijama.com\/app\/uploads\/2023\/06\/mailchimp-data-confirm-1-1-768x360.jpg 768w, \/\/www.aselpijama.com\/app\/uploads\/2023\/06\/mailchimp-data-confirm-1-1-1536x719.jpg 1536w, \/\/www.aselpijama.com\/app\/uploads\/2023\/06\/mailchimp-data-confirm-1-1-600x281.jpg 600w, \/\/www.aselpijama.com\/app\/uploads\/2023\/06\/mailchimp-data-confirm-1-1.jpg 2027w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><\/figure><h2 class=\"wp-block-heading has-purple-color has-text-color\">can we have a moment of your time please? <\/h2><p><\/p><p>as a pha uk member,<strong> <\/strong>it\u2019s really important that the contact details and preferences we hold for you are up-to-date. please take a minute to complete this form. <\/p><p><\/p><script type=\"text\/javascript\">var gform;gform||(document.addeventlistener(\"gform_main_scripts_loaded\",function(){gform.scriptsloaded=!0}),document.addeventlistener(\"gform\/theme\/scripts_loaded\",function(){gform.themescriptsloaded=!0}),window.addeventlistener(\"domcontentloaded\",function(){gform.domloaded=!0}),gform={domloaded:!1,scriptsloaded:!1,themescriptsloaded:!1,isformeditor:()=>\"function\"==typeof initializeeditor,callifloaded:function(o){return!(!gform.domloaded||!gform.scriptsloaded||!gform.themescriptsloaded&&!gform.isformeditor()||(gform.isformeditor()&&console.warn(\"the use of gform.initializeonloaded() is deprecated in the form editor context and will be removed in gravity forms 3.1.\"),o(),0))},initializeonloaded:function(o){gform.callifloaded(o)||(document.addeventlistener(\"gform_main_scripts_loaded\",()=>{gform.scriptsloaded=!0,gform.callifloaded(o)}),document.addeventlistener(\"gform\/theme\/scripts_loaded\",()=>{gform.themescriptsloaded=!0,gform.callifloaded(o)}),window.addeventlistener(\"domcontentloaded\",()=>{gform.domloaded=!0,gform.callifloaded(o)}))},hooks:{action:{},filter:{}},addaction:function(o,r,e,t){gform.addhook(\"action\",o,r,e,t)},addfilter:function(o,r,e,t){gform.addhook(\"filter\",o,r,e,t)},doaction:function(o){gform.dohook(\"action\",o,arguments)},applyfilters:function(o){return gform.dohook(\"filter\",o,arguments)},removeaction:function(o,r){gform.removehook(\"action\",o,r)},removefilter:function(o,r,e){gform.removehook(\"filter\",o,r,e)},addhook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},dohook:function(r,o,e){var t;if(e=array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.foreach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removehook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_chrome gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_67' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">confirming your details<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_67'  action='\/wp-json\/wp\/v2\/pages\/27551' data-formid='67' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_67' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_67_1\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_1\" ><label class='gfield_label gform-field-label' for='input_67_1'>your name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_67_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_67_3\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_3\" ><label class='gfield_label gform-field-label' for='input_67_3'>your address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_67_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_67_4\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_4\" ><label class='gfield_label gform-field-label' for='input_67_4'>your postcode<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_67_4' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_67_5\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_5\" ><label class='gfield_label gform-field-label' for='input_67_5'>your email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_67_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_67_6\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_6\" ><label class='gfield_label gform-field-label' for='input_67_6'>your telephone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_67_6' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_67_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_7\" ><legend class='gfield_label gform-field-label' >which of the following describes you best?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_7'>\n\t\t\t<div class='gchoice gchoice_67_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='i have ph'  id='choice_67_7_0' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_7_0' id='label_67_7_0' class='gform-field-label gform-field-label--type-inline'>i have ph<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='i know \/ care for someone with ph'  id='choice_67_7_1' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_7_1' id='label_67_7_1' class='gform-field-label gform-field-label--type-inline'>i know \/ care for someone with ph<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='i am a healthcare professional'  id='choice_67_7_2' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_7_2' id='label_67_7_2' class='gform-field-label gform-field-label--type-inline'>i am a healthcare professional<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='i have a general interest in ph'  id='choice_67_7_3' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_7_3' id='label_67_7_3' class='gform-field-label gform-field-label--type-inline'>i have a general interest in ph<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_67_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_8\" ><legend class='gfield_label gform-field-label' >where is the specialist ph centre that you (or your loved one) attend?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_8'>\n\t\t\t<div class='gchoice gchoice_67_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='royal hallamshire hospital'  id='choice_67_8_0' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_0' id='label_67_8_0' class='gform-field-label gform-field-label--type-inline'>royal hallamshire hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='freeman hospital'  id='choice_67_8_1' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_1' id='label_67_8_1' class='gform-field-label gform-field-label--type-inline'>freeman hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='golden jubilee national hospital'  id='choice_67_8_2' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_2' id='label_67_8_2' class='gform-field-label gform-field-label--type-inline'>golden jubilee national hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='great ormond street children\u2019s hospital'  id='choice_67_8_3' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_3' id='label_67_8_3' class='gform-field-label gform-field-label--type-inline'>great ormond street children\u2019s hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_8_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='hammersmith hospital'  id='choice_67_8_4' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_4' id='label_67_8_4' class='gform-field-label gform-field-label--type-inline'>hammersmith hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_8_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='royal papworth hospital'  id='choice_67_8_5' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_5' id='label_67_8_5' class='gform-field-label gform-field-label--type-inline'>royal papworth hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_8_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='royal brompton hospital'  id='choice_67_8_6' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_6' id='label_67_8_6' class='gform-field-label gform-field-label--type-inline'>royal brompton hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_8_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='royal free hospital'  id='choice_67_8_7' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_7' id='label_67_8_7' class='gform-field-label gform-field-label--type-inline'>royal free hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_8_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='mater hospital'  id='choice_67_8_8' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_8' id='label_67_8_8' class='gform-field-label gform-field-label--type-inline'>mater hospital<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_8_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='gf_other_choice'  id='choice_67_8_9' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_8_9' id='label_67_8_9' class='gform-field-label gform-field-label--type-inline'>other<\/label><br \/><input id='input_67_8_other' class='gchoice_other_control' name='input_8_other' type='text' value='other' aria-label='other choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_67_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_9\" ><legend class='gfield_label gform-field-label' >how would you prefer to receive your copy of emphasis?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_9'>\n\t\t\t<div class='gchoice gchoice_67_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='through the post'  id='choice_67_9_0' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_9_0' id='label_67_9_0' class='gform-field-label gform-field-label--type-inline'>through the post<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='via email'  id='choice_67_9_1' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_9_1' id='label_67_9_1' class='gform-field-label gform-field-label--type-inline'>via email<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='both ways please'  id='choice_67_9_2' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_9_2' id='label_67_9_2' class='gform-field-label gform-field-label--type-inline'>both ways please<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_67_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_10\" ><legend class='gfield_label gform-field-label' >would you like to receive our monthly e-newsletter, sent via email to keep you up-to-date with news from our charity and the world of ph?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_10'>\n\t\t\t<div class='gchoice gchoice_67_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='yes please'  id='choice_67_10_0' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_10_0' id='label_67_10_0' class='gform-field-label gform-field-label--type-inline'>yes please<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='no thanks'  id='choice_67_10_1' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_10_1' id='label_67_10_1' class='gform-field-label gform-field-label--type-inline'>no thanks<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_67_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_11\" ><legend class='gfield_label gform-field-label' >would you like to hear about research opportunities, via email, by joining our research forum?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_11'>\n\t\t\t<div class='gchoice gchoice_67_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='yes please'  id='choice_67_11_0' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_11_0' id='label_67_11_0' class='gform-field-label gform-field-label--type-inline'>yes please<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='no thanks'  id='choice_67_11_1' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_11_1' id='label_67_11_1' class='gform-field-label gform-field-label--type-inline'>no thanks<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_67_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_12\" ><legend class='gfield_label gform-field-label' >would you like to hear about opportunities to provide feedback on new ideas or resources, via email, by joining our feedback forum?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_12'>\n\t\t\t<div class='gchoice gchoice_67_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='yes please'  id='choice_67_12_0' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_12_0' id='label_67_12_0' class='gform-field-label gform-field-label--type-inline'>yes please<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='no thanks'  id='choice_67_12_1' onchange='gformtoggleradioother( this )'    \/>\n\t\t\t\t\t<label for='choice_67_12_1' id='label_67_12_1' class='gform-field-label gform-field-label--type-inline'>no thanks<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_67_13\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_13\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >not yet a pha uk member? please tick this box if you&#039;d like to join us for free.<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_67_13'><div class='gchoice gchoice_67_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='yes, i&#039;d like to join the pha 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