{"id":1264,"date":"2023-06-23T11:24:13","date_gmt":"2023-06-23T11:24:13","guid":{"rendered":"https:\/\/www.toplinemd.com\/orchid-obgyn\/?page_id=1264"},"modified":"2023-06-23T11:24:14","modified_gmt":"2023-06-23T11:24:14","slug":"request-appointment","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/orchid-obgyn\/request-appointment\/","title":{"rendered":"Request an Appointment"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container fusion-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-background-position:center bottom;--awb-background-blend-mode:overlay;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:10%;--awb-padding-bottom:10%;--awb-background-color:rgba(255,255,255,0.35);--awb-background-image:url(&quot;https:\/\/www.toplinemd.com\/orchid-obgyn\/wp-content\/uploads\/sites\/94\/2020\/08\/Contact-background.png&quot;);--awb-background-size:cover;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-justify-content-center fusion-flex-content-wrap\" style=\"max-width:1352px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_3_5 3_5 fusion-flex-column fusion-animated\" style=\"--awb-padding-top:1px;--awb-bg-color:rgba(140,53,139,0.63);--awb-bg-color-hover:rgba(140,53,139,0.63);--awb-bg-size:cover;--awb-width-large:60%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.2%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.2%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-animationType=\"fadeInDown\" data-animationDuration=\"0.6\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-one\" style=\"--awb-text-color:#ffffff;--awb-margin-top:30px;--awb-margin-bottom:30px;--awb-margin-top-small:20px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h1 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:63;line-height:1.1;\">Request an Appointment<\/h1><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling padding-wrapper\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:3%;--awb-padding-bottom:3%;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last\" style=\"--awb-bg-size:cover;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-two\" style=\"--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h2 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:47;line-height:1.2;\"><p style=\"text-align: center;\">Request an Appointment<\/p><\/h2><\/div><div class=\"fusion-text fusion-text-1 fusion-text-no-margin\" style=\"--awb-margin-bottom:30px;\"><p style=\"text-align: center;\">By filling out your details below, you are not guaranteed an appointment. A member of our staff will be in contact with you to confirm your appointment time.<\/p>\n<\/div>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f863-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"863\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/orchid-obgyn\/wp-json\/wp\/v2\/pages\/1264#wpcf7-f863-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"863\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f863-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"app-form\">\n\t<div class=\"section1\">\n\t\t<div class=\"app cf7-patient third\">\n\t\t\t<p><label> New Patient? * <span class=\"wpcf7-form-control-wrap\" data-name=\"new-patient\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"new-patient\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-first-name third\">\n\t\t\t<p><label> First Name: * <span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name *\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-last-name third\">\n\t\t\t<p><label> Last Name: * <span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name *\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"section2\">\n\t\t<div class=\"app cf7-phone half left\">\n\t\t\t<p><label> Phone: * <span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone *\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-email half right\">\n\t\t\t<p><label> Email: * <span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email *\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"section3\">\n\t\t<div class=\"app cf7-phone half left\">\n\t\t\t<p><label> Preferred Time: <span class=\"wpcf7-form-control-wrap\" data-name=\"preferred-time\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"preferred-time\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"ASAP\">ASAP<\/option><option value=\"AM\">AM<\/option><option value=\"PM\">PM<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-phone half right\">\n\t\t\t<p><label> Date Selection: <span class=\"wpcf7-form-control-wrap\" data-name=\"select-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" min=\"2026-07-27\" aria-invalid=\"false\" placeholder=\"Select Date\" value=\"\" type=\"date\" name=\"select-date\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"section4\">\n\t\t<div class=\"app cf7-phone third\">\n\t\t\t<p><label> Insurance: * <span class=\"wpcf7-form-control-wrap\" data-name=\"insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Insurance\" value=\"\" type=\"text\" name=\"insurance\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-phone third\">\n\t\t\t<p><label> Gender: <span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"gender\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"M\">M<\/option><option value=\"F\">F<\/option><option value=\"Prefer not to share\">Prefer not to share<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"app cf7-phone third\">\n\t\t\t<p><label> Date of Birth * <span class=\"wpcf7-form-control-wrap\" data-name=\"birth-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" max=\"2026-07-27\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Select Date\" value=\"\" type=\"date\" name=\"birth-date\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"app cf7-comment\" style=\"margin-bottom:15px\">\n\t\t<p><label> Comments: * <span class=\"wpcf7-form-control-wrap\" data-name=\"comment\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Describe the reason for your appointment\" name=\"comment\"><\/textarea><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n\t<\/p>\n<\/div><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"217\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"fusion-alert alert custom alert-custom fusion-alert-center wpcf7-response-output fusion-alert-capitalize awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" style=\"--awb-border-size:1px;--awb-border-top-left-radius:0px;--awb-border-top-right-radius:0px;--awb-border-bottom-left-radius:0px;--awb-border-bottom-right-radius:0px;\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"fusion-alert-content\"><\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div>\n<\/form>\n<\/div>\n<div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:3%;--awb-padding-bottom:3%;--awb-background-color:#f9f9f9;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_3 1_3 fusion-one-third fusion-column-first fusion-animated\" style=\"--awb-bg-size:cover;--awb-margin-top:20px;--awb-margin-bottom:40px;width:33.3333333333%;width:calc(33.3333333333% - ( ( 4% ) * 0.333333333333 ) );margin-right: 4%;\" data-animationType=\"slideInLeft\" data-animationDuration=\"0.6\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-text fusion-title-size-two\" style=\"--awb-margin-bottom:20px;--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h2 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:47;line-height:1.2;\">Our Office<\/h2><\/div><div class=\"fusion-text fusion-text-2\"><div class=\"fusion-text\">\n<p>Address: <a href=\"https:\/\/goo.gl\/maps\/8U6LizHcdiES1hfN9\" target=\"_blank\" rel=\"noopener noreferrer\">3600 Red Road, Suite N404<br \/>\nMiramar, FL 33025<\/a><br \/>\nPhone: <a href=\"tel:+19543681308\">(954) 368-1308<\/a><br \/>\nFax: <a href=\"fax:+19545890902\">(954) 589-0902<\/a><\/p>\n<\/div>\n<\/div><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-two\" style=\"--awb-margin-top:20px;--awb-margin-bottom:20px;--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h2 class=\"fusion-title-heading title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:47;line-height:1.2;\">Office Hours<\/h2><\/div><div class=\"fusion-text fusion-text-3\"><div class=\"fusion-text\">\n<p>Monday: 8:30AM \u2013 4:30PM<br \/>\nTuesday: 8:30AM \u2013 4:30PM<br \/>\nWednesday: 8:30AM \u2013 4:30PM<br \/>\nThursday: 8:30AM \u2013 4:30PM<br \/>\nFriday: Closed<\/p>\n<\/div>\n<\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_2_3 2_3 fusion-two-third fusion-column-last fusion-animated\" style=\"--awb-bg-size:cover;--awb-margin-top:20px;width:66.6666666667%;width:calc(66.6666666667% - ( ( 4% ) * 0.666666666667 ) );\" data-animationType=\"fadeInUp\" data-animationDuration=\"0.6\" data-animationOffset=\"top-into-view\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-column-wrapper-legacy\"><iframe \nsrc=\"https:\/\/www.google.com\/maps\/embed?pb=!1m14!1m8!1m3!1d14347.339972386122!2d-80.29787998545838!3d25.973451444928447!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x0%3A0xc2b2784fc3e83cae!2sOrchid%20OBGYN%2C%20LLC!5e0!3m2!1sen!2srs!4v1673347759030!5m2!1sen!2srs\" \nwidth=\"100%\" \nheight=\"400\" \nstyle=\"border:0;\" \nallowfullscreen=\"\" \nloading=\"lazy\" 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Review<\/span><\/a><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 hundred-percent-fullwidth non-hundred-percent-height-scrolling fusion-equal-height-columns wh2footerlogos\" style=\"--awb-border-sizes-top:0px;--awb-border-sizes-bottom:0px;--awb-border-sizes-left:0px;--awb-border-sizes-right:0px;--awb-border-color:#8C358B;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:0px;--awb-padding-right:0px;--awb-padding-left:0px;--awb-background-color:#f0f3f6;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-column-no-min-height\" 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style=\"--awb-caption-title-font-family:var(--h2_typography-font-family);--awb-caption-title-font-weight:var(--h2_typography-font-weight);--awb-caption-title-font-style:var(--h2_typography-font-style);--awb-caption-title-size:var(--h2_typography-font-size);--awb-caption-title-transform:var(--h2_typography-text-transform);--awb-caption-title-line-height:var(--h2_typography-line-height);--awb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" fusion-imageframe imageframe-none imageframe-1 hover-type-none\"><img decoding=\"async\" width=\"270\" height=\"100\" alt=\"Orchid-OBGYN Logo\" title=\"Orchid-OBGYN\" src=\"https:\/\/www.toplinemd.com\/orchid-obgyn\/wp-content\/uploads\/sites\/94\/2020\/08\/Orchid-OBGYN.png\" class=\"img-responsive wp-image-1193\" srcset=\"https:\/\/www.toplinemd.com\/orchid-obgyn\/wp-content\/uploads\/sites\/94\/2020\/08\/Orchid-OBGYN-200x74.png 200w, 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