{"id":8,"date":"2026-08-28T19:22:43","date_gmt":"2026-08-28T19:22:43","guid":{"rendered":"https:\/\/hotpink-rhinoceros-715115.hostingersite.com\/?page_id=8"},"modified":"2026-09-02T12:15:42","modified_gmt":"2026-09-02T12:15:42","slug":"hospital-registration-form","status":"publish","type":"page","link":"https:\/\/hospitals4you.com\/index.php\/hospital-registration-form\/","title":{"rendered":"Hospital Registration Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"8\" class=\"elementor elementor-8\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-22ab42e e-flex e-con-boxed e-con e-parent\" data-id=\"22ab42e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1e82a33 elementor-widget elementor-widget-html\" data-id=\"1e82a33\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<style>\r\n\r\n\/* =========================================================\r\n   HOSPITAL REGISTRATION FORM\r\n   Professional & Classy Healthcare Design\r\n========================================================= *\/\r\n\r\n.hospital-registration-page {\r\n    --hospital-primary: #1f6b5c;\r\n    --hospital-primary-dark: #164f45;\r\n    --hospital-secondary: #dceee9;\r\n    --hospital-accent: #b8955b;\r\n    --hospital-text: #263633;\r\n    --hospital-muted: #6d7d79;\r\n    --hospital-border: #dfe8e5;\r\n    --hospital-background: #f5f8f7;\r\n    --hospital-white: #ffffff;\r\n\r\n    font-family: \"Poppins\", sans-serif;\r\n    color: var(--hospital-text);\r\n    background: var(--hospital-background);\r\n    padding: 60px 20px;\r\n}\r\n\r\n\/* =========================================================\r\n   MAIN CONTAINER\r\n========================================================= *\/\r\n\r\n.hospital-form-container {\r\n    max-width: 1100px;\r\n    margin: 0 auto;\r\n}\r\n\r\n\/* =========================================================\r\n   INTRODUCTION\r\n========================================================= *\/\r\n\r\n.hospital-form-intro {\r\n    text-align: center;\r\n    max-width: 760px;\r\n    margin: 0 auto 45px;\r\n}\r\n\r\n.hospital-form-kicker {\r\n    display: inline-block;\r\n    color: var(--hospital-primary);\r\n    font-size: 13px;\r\n    font-weight: 600;\r\n    letter-spacing: 2px;\r\n    text-transform: uppercase;\r\n    margin-bottom: 12px;\r\n}\r\n\r\n.hospital-form-intro h1 {\r\n    margin: 0 0 15px;\r\n    font-size: 38px;\r\n    line-height: 1.25;\r\n    font-weight: 600;\r\n    color: var(--hospital-primary-dark);\r\n}\r\n\r\n.hospital-form-intro p {\r\n    margin: 0;\r\n    font-size: 15px;\r\n    line-height: 1.8;\r\n    color: var(--hospital-muted);\r\n}\r\n\r\n\/* Decorative line *\/\r\n\r\n.hospital-heading-line {\r\n    width: 55px;\r\n    height: 3px;\r\n    background: var(--hospital-accent);\r\n    margin: 22px auto;\r\n    border-radius: 10px;\r\n}\r\n\r\n\/* =========================================================\r\n   FORM CARD\r\n========================================================= *\/\r\n\r\n.hospital-form-card {\r\n    background: var(--hospital-white);\r\n    border: 1px solid var(--hospital-border);\r\n    border-radius: 18px;\r\n    padding: 45px;\r\n    box-shadow: 0 15px 45px rgba(31, 75, 66, 0.08);\r\n}\r\n\r\n\/* =========================================================\r\n   FLUENT FORMS\r\n========================================================= *\/\r\n\r\n.hospital-form-card .fluentform {\r\n    margin: 0 !important;\r\n}\r\n\r\n\/* =========================================================\r\n   SECTION HEADINGS\r\n========================================================= *\/\r\n\r\n.hospital-form-card .ff-el-group {\r\n    margin-bottom: 24px;\r\n}\r\n\r\n\/*\r\n   If you use HTML\/Section Break fields inside Fluent Forms,\r\n   this styles them as elegant section headers.\r\n*\/\r\n\r\n.hospital-form-card .ff-section_break {\r\n    margin: 15px 0 28px !important;\r\n    padding: 0 0 14px !important;\r\n    border-bottom: 1px solid var(--hospital-border);\r\n}\r\n\r\n.hospital-form-card .ff-section_break h3 {\r\n    margin: 0 !important;\r\n    color: var(--hospital-primary-dark);\r\n    font-size: 20px !important;\r\n    font-weight: 600 !important;\r\n}\r\n\r\n\/* =========================================================\r\n   LABELS\r\n========================================================= *\/\r\n\r\n.hospital-form-card .ff-el-form-label {\r\n    color: var(--hospital-text) !important;\r\n    font-size: 14px !important;\r\n    font-weight: 500 !important;\r\n    margin-bottom: 8px !important;\r\n}\r\n\r\n.hospital-form-card .ff-el-form-label .error {\r\n    color: #c0392b;\r\n}\r\n\r\n\/* Required star *\/\r\n\r\n.hospital-form-card .ff-el-form-label .ff-el-is-required {\r\n    color: var(--hospital-primary) !important;\r\n}\r\n\r\n\/* =========================================================\r\n   INPUTS\r\n========================================================= *\/\r\n\r\n.hospital-form-card input[type=\"text\"],\r\n.hospital-form-card input[type=\"email\"],\r\n.hospital-form-card input[type=\"tel\"],\r\n.hospital-form-card input[type=\"url\"],\r\n.hospital-form-card input[type=\"number\"],\r\n.hospital-form-card input[type=\"date\"],\r\n.hospital-form-card input[type=\"password\"],\r\n.hospital-form-card select,\r\n.hospital-form-card textarea {\r\n    width: 100% !important;\r\n    border: 1px solid var(--hospital-border) !important;\r\n    background: #fbfdfc !important;\r\n    border-radius: 9px !important;\r\n    color: var(--hospital-text) !important;\r\n    font-family: \"Poppins\", sans-serif !important;\r\n    font-size: 14px !important;\r\n    padding: 13px 15px !important;\r\n    min-height: 48px;\r\n    box-shadow: none !important;\r\n    transition:\r\n        border-color 0.25s ease,\r\n        box-shadow 0.25s ease,\r\n        background 0.25s ease;\r\n}\r\n\r\n\/* Textarea *\/\r\n\r\n.hospital-form-card textarea {\r\n    min-height: 140px !important;\r\n    resize: vertical;\r\n    line-height: 1.7;\r\n}\r\n\r\n\/* Placeholder *\/\r\n\r\n.hospital-form-card input::placeholder,\r\n.hospital-form-card textarea::placeholder {\r\n    color: #a4b1ae !important;\r\n    opacity: 1;\r\n}\r\n\r\n\/* Focus *\/\r\n\r\n.hospital-form-card input:focus,\r\n.hospital-form-card textarea:focus,\r\n.hospital-form-card select:focus {\r\n    outline: none !important;\r\n    border-color: var(--hospital-primary) !important;\r\n    background: #ffffff !important;\r\n    box-shadow: 0 0 0 3px rgba(31, 107, 92, 0.08) !important;\r\n}\r\n\r\n\/* =========================================================\r\n   TWO COLUMN FIELDS\r\n========================================================= *\/\r\n\r\n\/*\r\n   Fluent Forms columns will automatically use their\r\n   existing layout. This ensures good spacing.\r\n*\/\r\n\r\n.hospital-form-card .ff-t-cell {\r\n    padding-left: 10px !important;\r\n    padding-right: 10px !important;\r\n}\r\n\r\n.hospital-form-card .ff-t-cell:first-child {\r\n    padding-left: 0 !important;\r\n}\r\n\r\n.hospital-form-card .ff-t-cell:last-child {\r\n    padding-right: 0 !important;\r\n}\r\n\r\n\/* =========================================================\r\n   REPEATER FIELDS\r\n========================================================= *\/\r\n\r\n.hospital-form-card .ff-repeater {\r\n    border: 1px solid var(--hospital-border) !important;\r\n    border-radius: 12px !important;\r\n    background: #fbfdfc !important;\r\n    padding: 18px !important;\r\n}\r\n\r\n.hospital-form-card .ff-repeater .ff-el-group {\r\n    margin-bottom: 15px !important;\r\n}\r\n\r\n\/* Repeater input *\/\r\n\r\n.hospital-form-card .ff-repeater input {\r\n    background: #ffffff !important;\r\n}\r\n\r\n\/* Repeater add\/remove buttons *\/\r\n\r\n.hospital-form-card .ff-repeater button {\r\n    transition: all 0.25s ease;\r\n}\r\n\r\n\/* Plus \/ add button *\/\r\n\r\n.hospital-form-card .ff-repeater .ff-add-row {\r\n    background: var(--hospital-primary) !important;\r\n    border-color: var(--hospital-primary) !important;\r\n    color: #ffffff !important;\r\n    border-radius: 7px !important;\r\n}\r\n\r\n.hospital-form-card .ff-repeater .ff-add-row:hover {\r\n    background: var(--hospital-primary-dark) !important;\r\n}\r\n\r\n\/* =========================================================\r\n   CHECKBOX \/ RADIO\r\n========================================================= *\/\r\n\r\n.hospital-form-card input[type=\"checkbox\"],\r\n.hospital-form-card input[type=\"radio\"] {\r\n    accent-color: var(--hospital-primary);\r\n}\r\n\r\n\/* =========================================================\r\n   VALIDATION\r\n========================================================= *\/\r\n\r\n.hospital-form-card .ff-el-is-error input,\r\n.hospital-form-card .ff-el-is-error textarea,\r\n.hospital-form-card .ff-el-is-error select {\r\n    border-color: #d65c50 !important;\r\n}\r\n\r\n.hospital-form-card .error {\r\n    font-size: 12px !important;\r\n    margin-top: 6px !important;\r\n}\r\n\r\n\/* =========================================================\r\n   SUBMIT BUTTON\r\n========================================================= *\/\r\n\r\n.hospital-form-card .ff-btn-submit {\r\n    display: inline-flex !important;\r\n    align-items: center;\r\n    justify-content: center;\r\n\r\n    min-width: 180px;\r\n    min-height: 52px;\r\n\r\n    padding: 14px 30px !important;\r\n\r\n    background: var(--hospital-primary) !important;\r\n    border: 1px solid var(--hospital-primary) !important;\r\n    border-radius: 8px !important;\r\n\r\n    color: #ffffff !important;\r\n    font-family: \"Poppins\", sans-serif !important;\r\n    font-size: 14px !important;\r\n    font-weight: 500 !important;\r\n\r\n    letter-spacing: 0.2px;\r\n\r\n    box-shadow: 0 7px 18px rgba(31, 107, 92, 0.16);\r\n\r\n    transition:\r\n        background 0.25s ease,\r\n        transform 0.25s ease,\r\n        box-shadow 0.25s ease;\r\n}\r\n\r\n.hospital-form-card .ff-btn-submit:hover {\r\n    background: var(--hospital-primary-dark) !important;\r\n    border-color: var(--hospital-primary-dark) !important;\r\n    transform: translateY(-2px);\r\n    box-shadow: 0 10px 25px rgba(31, 107, 92, 0.20);\r\n}\r\n\r\n\/* =========================================================\r\n   SUBMIT AREA\r\n========================================================= *\/\r\n\r\n.hospital-form-card .ff_submit_btn_wrapper {\r\n    margin-top: 30px !important;\r\n    padding-top: 25px;\r\n    border-top: 1px solid var(--hospital-border);\r\n}\r\n\r\n\/* =========================================================\r\n   SUCCESS MESSAGE\r\n========================================================= *\/\r\n\r\n.hospital-form-card .ff-message-success {\r\n    background: #edf8f4 !important;\r\n    border: 1px solid #c7e5dc !important;\r\n    border-radius: 10px !important;\r\n    color: var(--hospital-primary-dark) !important;\r\n    padding: 18px 20px !important;\r\n    font-size: 14px !important;\r\n}\r\n\r\n\/* =========================================================\r\n   MOBILE\r\n========================================================= *\/\r\n\r\n@media (max-width: 767px) {\r\n\r\n    .hospital-registration-page {\r\n        padding: 35px 15px;\r\n    }\r\n\r\n    .hospital-form-intro {\r\n        margin-bottom: 30px;\r\n    }\r\n\r\n    .hospital-form-intro h1 {\r\n        font-size: 28px;\r\n    }\r\n\r\n    .hospital-form-intro p {\r\n        font-size: 14px;\r\n        line-height: 1.7;\r\n    }\r\n\r\n    .hospital-form-card {\r\n        padding: 25px 18px;\r\n        border-radius: 14px;\r\n    }\r\n\r\n    .hospital-form-card .ff-t-cell {\r\n        display: block !important;\r\n        width: 100% !important;\r\n        padding: 0 !important;\r\n    }\r\n\r\n    .hospital-form-card .ff-section_break h3 {\r\n        font-size: 18px !important;\r\n    }\r\n\r\n    .hospital-form-card .ff-btn-submit {\r\n        width: 100%;\r\n    }\r\n\r\n    .hospital-form-card .ff-repeater {\r\n        padding: 14px !important;\r\n    }\r\n}\r\n\r\n\/* =========================================================\r\n   TABLET\r\n========================================================= *\/\r\n\r\n@media (min-width: 768px) and (max-width: 1024px) {\r\n\r\n    .hospital-registration-page {\r\n        padding: 45px 25px;\r\n    }\r\n\r\n    .hospital-form-card {\r\n        padding: 35px;\r\n    }\r\n\r\n}\r\n\r\n<\/style>\r\n\r\n\r\n<div class=\"hospital-registration-page\">\r\n\r\n    <div class=\"hospital-form-container\">\r\n\r\n        <!-- INTRODUCTION -->\r\n\r\n        <div class=\"hospital-form-intro\">\r\n\r\n            <span class=\"hospital-form-kicker\">\r\n                Hospital Registration\r\n            <\/span>\r\n\r\n            <h1>\r\n                Add Your Hospital\r\n            <\/h1>\r\n\r\n            <div class=\"hospital-heading-line\"><\/div>\r\n\r\n            <p>\r\n                Provide your hospital information and healthcare\r\n                services to help patients discover and connect\r\n                with your institution.\r\n            <\/p>\r\n\r\n        <\/div>\r\n\r\n\r\n        <!-- FORM -->\r\n\r\n        <div class=\"hospital-form-card\">\r\n\r\n            <div class='fluentform ff-default fluentform_wrapper_3 ffs_default_wrap'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_3_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Hospital Registration Form<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='8' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"39c7538e33\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/8\" \/><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text' id='label_ff_3_input_text' aria-label=\"Hospital Name\">Hospital Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_3_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_image-upload_1' id='label_ff_3_image-upload_1' aria-label=\"Upload Logo\">Upload Logo<\/label><\/div><div class='ff-el-input--content'><label for='ff_3_image-upload_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn' tabindex='0'>Choose File<\/span> <input type=\"file\" name=\"image-upload\" id=\"ff_3_image-upload_1\" class=\"ff-el-form-control  ff-screen-reader-element\" accept=\"image\/*\" data-name=\"image-upload\" multiple=\"1\"  aria-invalid='false' aria-required=false><\/label><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_1\" ><h5 style=\"text-align: center\">Contact Details<\/h5><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_phone' id='label_ff_3_phone' aria-label=\"Landline Number\">Landline Number<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Landline Number\" data-name=\"phone\" id=\"ff_3_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'>        <div data-type=\"repeater_field\" data-name=\"repeater_field_2\" class=\"ff-el-group ff-el-repeater js-repeater\" data-root_name=\"repeater_field_2\"  >\n            <div class='ff-el-input--label asterisk-right'><label aria-label='' for=''><\/label><\/div>            <div class='ff-el-input--content'>\n                <table role=\"table\" aria-label=\"Repeater Field\" data-max_repeat=\"\" data-root_name=\"repeater_field_2\" class=\"ff_repeater_table ff_flexible_table\">\n                    <thead>\n                    <tr>\n                                                    <th><div class='ff-el-input--label asterisk-right'><label aria-label='Mobile Number' for=''>Mobile Number<\/label><\/div><\/th>\n                                                <th><\/th>\n                    <\/tr>\n                    <\/thead>\n                    <tbody>\n                    <tr>\n                                                    <td data-label=\"Mobile Number\">\n                                                                <div class='ff-el-group'><div class='ff-el-input--content'><input type=\"number\" placeholder=\"Mobile Number\" aria-label=\"repeater level 1 and field Mobile Number\" name=\"repeater_field_2[0][]\" id=\"ff_3_repeater_field_2_0\" data-repeater_index=\"0\" data-type=\"repeater_item\" data-name=\"repeater_field_2_0_0\" data-error_index=\"repeater_field_2[0]\" inputmode=\"numeric\" step=\"any\" class=\"ff-el-form-control\"  aria-invalid=\"false\" aria-required=false><\/div><\/div>                            <\/td>\n                                                <td class=\"repeat_btn\"><div class=\"ff-el-repeat-buttons-list js-repeat-buttons\"><span role=\"button\" aria-label=\"add repeater\" class=\"repeat-plus\"><svg tabindex=\"0\" width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-86 0 0 86-42 0 0-86-86 0 0-42 86 0 0-86 42 0 0 86 86 0z\"><\/path><\/svg><\/span><span role=\"button\" aria-label=\"remove repeater\" class=\"repeat-minus\"><svg tabindex=\"0\" width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-214 0 0-42 214 0z\"\"><\/path><\/svg><\/span><\/div><\/td>\n                    <\/tr>\n                    <\/tbody>\n                <\/table>\n            <\/div>\n        <\/div>\n        <\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_phone_2' id='label_ff_3_phone_2' aria-label=\"Customer Care Number\">Customer Care Number<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_2\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Customer Care Number\" data-name=\"phone_2\" id=\"ff_3_phone_2\" inputmode=\"tel\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_email' id='label_ff_3_email' aria-label=\"Email Address\">Email Address<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_3_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_2\" ><h5 style=\"text-align: center\">Address Details<\/h5><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_1' id='label_ff_3_input_text_1' aria-label=\"Address\">Address<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" placeholder=\"Street \/ Full Address\" data-name=\"input_text_1\" id=\"ff_3_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_2' id='label_ff_3_input_text_2' aria-label=\"Landmark\">Landmark<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" placeholder=\"Landmark\" data-name=\"input_text_2\" id=\"ff_3_input_text_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_4' id='label_ff_3_input_text_4' aria-label=\"District\">District<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" placeholder=\"District\" data-name=\"input_text_4\" id=\"ff_3_input_text_4\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_url_1' id='label_ff_3_url_1' aria-label=\"Google Map\">Google Map<\/label><\/div><div class='ff-el-input--content'><input type=\"url\" name=\"url_1\" class=\"ff-el-form-control\" placeholder=\"https:\/\/maps.google.com\/...\" data-name=\"url_1\" id=\"ff_3_url_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_3' id='label_ff_3_input_text_3' aria-label=\"Village\/Taluk\">Village\/Taluk<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" placeholder=\"Village\/Taluk\" data-name=\"input_text_3\" id=\"ff_3_input_text_3\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_numeric_field' id='label_ff_3_numeric_field' aria-label=\"Pincode\">Pincode<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric_field\" id=\"ff_3_numeric_field\" class=\"ff-el-form-control\" placeholder=\"Pincode\" data-name=\"numeric_field\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_url' id='label_ff_3_url' aria-label=\"Hospital Website\">Hospital Website<\/label><\/div><div class='ff-el-input--content'><input type=\"url\" name=\"url\" class=\"ff-el-form-control\" placeholder=\"URL\" data-name=\"url\" id=\"ff_3_url\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_3\" ><h5 style=\"text-align: center\">Departments<\/h5><\/div>        <div data-type=\"repeater_field\" data-name=\"repeater_field\" class=\"ff-el-group ff-el-repeater js-repeater\" data-root_name=\"repeater_field\"  >\n            <div class='ff-el-input--label asterisk-right'><label aria-label='' for=''><\/label><\/div>            <div class='ff-el-input--content'>\n                <table role=\"table\" aria-label=\"Repeater Field\" data-max_repeat=\"\" data-root_name=\"repeater_field\" class=\"ff_repeater_table ff_flexible_table\">\n                    <thead>\n                    <tr>\n                                                    <th><div class='ff-el-input--label ff-el-is-required asterisk-right'><label aria-label='Departments' for=''>Departments<\/label><\/div><\/th>\n                                                <th><\/th>\n                    <\/tr>\n                    <\/thead>\n                    <tbody>\n     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208-208 0-115-93-208-208-208z m107 229l-86 0 0 86-42 0 0-86-86 0 0-42 86 0 0-86 42 0 0 86 86 0z\"><\/path><\/svg><\/span><span role=\"button\" aria-label=\"remove repeater\" class=\"repeat-minus\"><svg tabindex=\"0\" width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-214 0 0-42 214 0z\"\"><\/path><\/svg><\/span><\/div><\/td>\n                    <\/tr>\n                    <\/tbody>\n                <\/table>\n            <\/div>\n        <\/div>\n        <div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_4\" ><h5 style=\"text-align: center\">Specialities<\/h5><\/div>        <div data-type=\"repeater_field\" data-name=\"repeater_field_1\" class=\"ff-el-group ff-el-repeater js-repeater\" data-root_name=\"repeater_field_1\"  >\n            <div class='ff-el-input--label asterisk-right'><label aria-label='' for=''><\/label><\/div>            <div class='ff-el-input--content'>\n                <table role=\"table\" aria-label=\"Repeater Field\" data-max_repeat=\"\" data-root_name=\"repeater_field_1\" class=\"ff_repeater_table ff_flexible_table\">\n                    <thead>\n                    <tr>\n                                                    <th><div class='ff-el-input--label ff-el-is-required asterisk-right'><label aria-label='Specialities' for=''>Specialities<\/label><\/div><\/th>\n                                                <th><\/th>\n                    <\/tr>\n                    <\/thead>\n                    <tbody>\n                    <tr>\n                                                    <td data-label=\"Specialities\">\n                                                                <div class='ff-el-group'><div class='ff-el-input--content'><input type=\"text\" placeholder=\"Enter speciality name\" aria-label=\"repeater level 1 and field Specialities\" name=\"repeater_field_1[0][]\" id=\"ff_3_repeater_field_1_0\" data-repeater_index=\"0\" data-type=\"repeater_item\" data-name=\"repeater_field_1_0_0\" data-error_index=\"repeater_field_1[0]\" class=\"ff-el-form-control\"  aria-invalid=\"false\" aria-required=true><\/div><\/div>                            <\/td>\n                                                <td class=\"repeat_btn\"><div class=\"ff-el-repeat-buttons-list js-repeat-buttons\"><span role=\"button\" aria-label=\"add repeater\" class=\"repeat-plus\"><svg tabindex=\"0\" width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-86 0 0 86-42 0 0-86-86 0 0-42 86 0 0-86 42 0 0 86 86 0z\"><\/path><\/svg><\/span><span role=\"button\" aria-label=\"remove repeater\" class=\"repeat-minus\"><svg tabindex=\"0\" width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-214 0 0-42 214 0z\"\"><\/path><\/svg><\/span><\/div><\/td>\n                    <\/tr>\n                    <\/tbody>\n                <\/table>\n            <\/div>\n        <\/div>\n        <div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_5\" ><h5 style=\"text-align: center\">Facilities<\/h5><\/div>        <div data-type=\"repeater_field\" data-name=\"repeater_field_3\" class=\"ff-el-group ff-el-repeater js-repeater\" data-root_name=\"repeater_field_3\"  >\n            <div class='ff-el-input--label asterisk-right'><label aria-label='' for=''><\/label><\/div>            <div class='ff-el-input--content'>\n                <table role=\"table\" aria-label=\"Repeater Field\" data-max_repeat=\"\" data-root_name=\"repeater_field_3\" class=\"ff_repeater_table ff_flexible_table\">\n                    <thead>\n                    <tr>\n                                                    <th><div class='ff-el-input--label ff-el-is-required asterisk-right'><label aria-label='Facilities' for=''>Facilities<\/label><\/div><\/th>\n                                                <th><\/th>\n                    <\/tr>\n                    <\/thead>\n                    <tbody>\n                    <tr>\n                                                    <td data-label=\"Facilities\">\n                                                                <div class='ff-el-group'><div class='ff-el-input--content'><input type=\"text\" placeholder=\"Enter Facility name\" aria-label=\"repeater level 1 and field Facilities\" name=\"repeater_field_3[0][]\" id=\"ff_3_repeater_field_3_0\" data-repeater_index=\"0\" data-type=\"repeater_item\" data-name=\"repeater_field_3_0_0\" data-error_index=\"repeater_field_3[0]\" class=\"ff-el-form-control\"  aria-invalid=\"false\" aria-required=true><\/div><\/div>                            <\/td>\n                                                <td class=\"repeat_btn\"><div class=\"ff-el-repeat-buttons-list js-repeat-buttons\"><span role=\"button\" aria-label=\"add repeater\" class=\"repeat-plus\"><svg tabindex=\"0\" width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-86 0 0 86-42 0 0-86-86 0 0-42 86 0 0-86 42 0 0 86 86 0z\"><\/path><\/svg><\/span><span role=\"button\" aria-label=\"remove repeater\" class=\"repeat-minus\"><svg tabindex=\"0\" width=\"20\" height=\"20\" viewBox=\"0 0 512 512\"><path d=\"m256 48c-115 0-208 93-208 208 0 115 93 208 208 208 115 0 208-93 208-208 0-115-93-208-208-208z m107 229l-214 0 0-42 214 0z\"\"><\/path><\/svg><\/span><\/div><\/td>\n                    <\/tr>\n                    <\/tbody>\n                <\/table>\n            <\/div>\n        <\/div>\n        <div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_hospital_featured_image_1' 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