{"id":230025,"date":"2025-11-21T18:14:40","date_gmt":"2025-11-21T18:14:40","guid":{"rendered":"https:\/\/develop-my-site.com\/stith2\/?page_id=230025"},"modified":"2025-11-21T18:46:41","modified_gmt":"2025-11-21T18:46:41","slug":"send-referrals","status":"publish","type":"page","link":"https:\/\/develop-my-site.com\/stith2\/send-referrals\/","title":{"rendered":"Send Referrals"},"content":{"rendered":"<div class=\"et_pb_section_0 et_pb_section et_section_regular et_block_section section_has_divider et_pb_bottom_divider\">\n<div class=\"et_pb_row_0 et_pb_row et_pb_gutters3 et_block_row\">\n<div class=\"et_pb_column_0 et_pb_column et_pb_column_4_4 et-last-child et_block_column et_pb_css_mix_blend_mode_passthrough\">\n<div class=\"et_pb_text_0 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module preset--module--divi-text--ba68abc8-9bed-4b7f-8e4b-c61e7fff0296\"><div class=\"et_pb_text_inner\"><h1 class=\"h1_title\">Send Your<\/h1>\n<h1 class=\"h1_title\">Referrals<\/h1>\n<\/div><\/div>\n<\/div>\n<\/div>\n<div class=\"et_pb_bottom_inside_divider et-no-transition\"><\/div><\/div>\n\n<div class=\"et_pb_section_1 et_pb_section et_section_regular et_flex_section\">\n<div class=\"et_pb_row_1 et_pb_row et_flex_row\">\n<div class=\"et_pb_column_1 et_pb_column et-last-child et_flex_column et_pb_css_mix_blend_mode_passthrough et_flex_column_24_24\">\n<div class=\"et_pb_text_1 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module\"><div class=\"et_pb_text_inner\"><h1 class=\"h1_title\" style=\"text-align: center;\">Send Your Referrals<\/h1>\n<\/div><\/div>\n\n<div class=\"et_pb_text_2 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>Each referral brings someone closer to quality care and a better quality of life. If you know a friend or family member who could benefit from our compassionate home healthcare services, let us know. Simply fill out the form below and help us provide the support they deserve!<\/p>\n<\/div><\/div>\n\n<div class=\"et_pb_contact_form_0 et_pb_contact_form_container clearfix et_pb_module et_flex_module\" data-form_unique_num=\"0\" data-form_unique_id=\"cb4716d1-4ab7-45af-a683-d258296e70db\" id=\"et_pb_contact_form_0\"><div class=\"et-pb-contact-message\"><\/div><div class=\"et_pb_contact\"><form class=\"et_pb_contact_form et_flex_module\" method=\"post\" action=\"https:\/\/develop-my-site.com\/stith2\/wp-json\/wp\/v2\/pages\/230025\">\n<div class=\"et_pb_contact_field_0 et_pb_contact_field et_pb_module et_flex_module et_flex_column_12_24\" data-id=\"name_of_referrer\" data-type=\"input\"><label class=\"et_pb_contact_form_label\">Name of Referrer<\/label><input type=\"text\" name=\"et_pb_contact_0_name_of_referrer_0\" id=\"et_pb_contact_0_name_of_referrer_0\" class=\"input\" data-required_mark=\"required\" data-field_type=\"input\" data-original_id=\"name_of_referrer\" placeholder=\"Name of Referrer\" title=\"\" value=\"\" \/><\/div>\n\n<div class=\"et_pb_contact_field_1 et_pb_contact_field et_pb_module et_flex_module et_flex_column_12_24\" data-id=\"email_2\" data-type=\"email\"><label class=\"et_pb_contact_form_label\">Email<\/label><input type=\"text\" name=\"et_pb_contact_0_email_2_1\" id=\"et_pb_contact_0_email_2_1\" class=\"input\" data-required_mark=\"required\" data-field_type=\"email\" data-original_id=\"email_2\" placeholder=\"Email\" title=\"\" value=\"\" \/><\/div>\n\n<div class=\"et_pb_divider_0 et_pb_divider et_pb_space et_pb_divider_position_top et_pb_module\"><div class=\"et_pb_divider_internal\"><\/div><\/div>\n\n<div class=\"et_pb_text_3 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><h3 style=\"text-align: center;\"><span>Referral(s)<\/span><\/h3>\n<\/div><\/div>\n\n<div class=\"et_pb_contact_field_2 et_pb_contact_field et_pb_module et_flex_module et_flex_column_24_24\" data-id=\"name_of_referral\" data-type=\"input\"><label class=\"et_pb_contact_form_label\">Name of Referral<\/label><input type=\"text\" name=\"et_pb_contact_0_name_of_referral_2\" id=\"et_pb_contact_0_name_of_referral_2\" class=\"input\" data-required_mark=\"not_required\" data-field_type=\"input\" data-original_id=\"name_of_referral\" placeholder=\"Name of Referral\" title=\"\" value=\"\" \/><\/div>\n\n<div class=\"et_pb_contact_field_3 et_pb_contact_field et_pb_module et_flex_module et_flex_column_12_24\" data-id=\"email of referral\" data-type=\"email\"><label class=\"et_pb_contact_form_label\">Email of Referral<\/label><input type=\"text\" name=\"et_pb_contact_0_email of referral_3\" id=\"et_pb_contact_0_email of referral_3\" class=\"input\" data-required_mark=\"required\" data-field_type=\"email\" data-original_id=\"email of referral\" placeholder=\"Email of Referral\" title=\"\" value=\"\" \/><\/div>\n\n<div class=\"et_pb_contact_field_4 et_pb_contact_field et_pb_module et_flex_module et_flex_column_12_24\" data-id=\"phone_number_of_referral\" data-type=\"input\"><label class=\"et_pb_contact_form_label\">Phone Number of Referral<\/label><input type=\"text\" name=\"et_pb_contact_0_phone_number_of_referral_4\" id=\"et_pb_contact_0_phone_number_of_referral_4\" class=\"input\" data-required_mark=\"required\" data-field_type=\"input\" data-original_id=\"phone_number_of_referral\" placeholder=\"Phone Number of Referral\" title=\"\" value=\"\" \/><\/div>\n\n<div class=\"et_pb_contact_field_5 et_pb_contact_field et_pb_module et_flex_module et_flex_column_24_24\" data-id=\"agree_to_terms_2\" data-type=\"checkbox\"><input type=\"hidden\" name=\"et_pb_contact_0_agree_to_terms_2_5\" class=\"et_pb_checkbox_handle\" data-required_mark=\"required\" data-field_type=\"checkbox\" data-original_id=\"agree_to_terms_2\" \/><span class=\"et_pb_contact_field_options_wrapper\"><span class=\"et_pb_contact_field_options_title\"><\/span><span class=\"et_pb_contact_field_options_list\"><span class=\"et_pb_contact_field_checkbox\"><input type=\"checkbox\" id=\"et_pb_contact_0_agree_to_terms_2_5_0\" class=\"input\" value=\"\" data-required_mark=\"required\" data-field_type=\"checkbox\" data-original_id=\"agree_to_terms_2\" \/><label for=\"et_pb_contact_0_agree_to_terms_2_5_0\"><i><\/i><\/label><\/span><\/span><\/span><\/div>\n\n<div class=\"et_pb_text_4 et_pb_text et_pb_bg_layout_light et_pb_module et_flex_module\"><div class=\"et_pb_text_inner\"><p>By submitting this form you agree to the terms of the <a href=\"https:\/\/develop-my-site.com\/stith2\/privacy-policy\/\" title=\"Privacy Policy\">Privacy Policy<\/a>.<\/p>\n<\/div><\/div>\n<input type=\"hidden\" name=\"et_pb_contactform_submit_0\" value=\"et_contact_proccess\" \/><div class=\"et_contact_bottom_container\"><div class=\"et_pb_contact_right et_pb_contact_field\"><p class=\"clearfix\"><span class=\"et_pb_contact_captcha_question\">10 + 9<\/span> = <input type=\"text\" size=\"2\" class=\"input et_pb_contact_captcha\" 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