{"id":4099,"date":"2021-11-29T12:41:29","date_gmt":"2021-11-29T19:41:29","guid":{"rendered":"https:\/\/idahoreproductive.com\/?page_id=4099"},"modified":"2025-02-20T05:56:36","modified_gmt":"2025-02-20T12:56:36","slug":"share-your-story","status":"publish","type":"page","link":"https:\/\/idahoreproductive.com\/zh_hk\/share-your-story\/","title":{"rendered":"\u5206\u4eab\u4f60\u7684\u6545\u4e8b"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4099\" class=\"elementor elementor-4099\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2f028c90 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"2f028c90\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2391adb0\" data-id=\"2391adb0\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-73d7ba96 elementor-widget elementor-widget-heading\" data-id=\"73d7ba96\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-xxl\">SHARE YOUR STORY<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-728abdbb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"728abdbb\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-decb3b4\" data-id=\"decb3b4\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-56aa7c1 elementor-widget elementor-widget-heading\" data-id=\"56aa7c1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Share your Story<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-67e031a1 elementor-widget elementor-widget-shortcode\" data-id=\"67e031a1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_3_container\" data-token=\"1ce256c00449975a801861c739a3ba73\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_share-your-story-form4ce6d4a313\" data-frm-error-config=\"{&quot;includeAlertRole&quot;:false,&quot;focusFirstError&quot;:false,&quot;focusErrorSummary&quot;:true}\" data-token=\"1ce256c00449975a801861c739a3ba73\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Share Your Story Form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"3\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_3\" id=\"frm_hide_fields_3\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"share-your-story-form4ce6d4a313\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_3\" name=\"frm_submit_entry_3\" value=\"2228f76d33\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/zh_hk\/wp-json\/wp\/v2\/pages\/4099\" \/><div id=\"frm_field_37_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_qh4icy2\" id=\"field_qh4icy2_label\" class=\"frm_primary_label\">First Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_qh4icy2\" name=\"item_meta[37]\" value=\"\"  data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_38_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_ocfup12\" id=\"field_ocfup12_label\" class=\"frm_primary_label\">Last Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ocfup12\" name=\"item_meta[38]\" value=\"\"  data-reqmsg=\"Last Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n    <label for=\"field_8nvy3\" id=\"field_8nvy3_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_8nvy3\" name=\"item_meta[39]\" value=\"\"  data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Enter a valid email address, like name@example.com\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\">\r\n    <label for=\"field_4fxnm\" id=\"field_4fxnm_label\" class=\"frm_primary_label\">Phone Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_4fxnm\" name=\"item_meta[40]\" value=\"\"  data-reqmsg=\"Phone Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_41_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_cuj73\" id=\"field_cuj73_label\" class=\"frm_primary_label\">Date of Birth\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_cuj73\" name=\"item_meta[41]\" value=\"\"  maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_d665s\" id=\"field_d665s_label\" class=\"frm_primary_label\">Upload Photo\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-reqmsg=\"Upload Photo cannot be blank.\" data-invmsg=\"File Upload is invalid\" class=\"auto_width\" aria-invalid=\"false\"   name=\"item_meta[42]\"  data-reqmsg=\"Upload Photo cannot be blank.\"  value=\"\" data-frmfile=\"42\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file42_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file42\" id=\"field_d665s\"\n\t\t\t data-reqmsg=\"Upload Photo cannot be blank.\" data-invmsg=\"File Upload is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" aria-hidden=\"true\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Upload Photo. Drop a file here or click to upload. Maximum file size: 10MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Upload Photo. Choose File. Maximum file size: 10MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 10MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_43_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_qv18o\" id=\"field_qv18o_label\" class=\"frm_primary_label\">Photo Caption\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[43]\" id=\"field_qv18o\" rows=\"5\"  data-reqmsg=\"Photo Caption cannot be blank.\" aria-required=\"true\" data-invmsg=\"Photo Caption is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field  frm_top_container frm_half frm_scroll_box\">\r\n    <label for=\"field_9jv0r12\" id=\"field_9jv0r12_label\" class=\"frm_primary_label\">Testimonial (Optional)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[44]\" id=\"field_9jv0r12\" rows=\"5\"  data-invmsg=\"Testimonial (Optional) is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_45_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\"><span>Terms and Conditions<\/span><\/h3>\r\n\r\n\r\n<div id=\"frm_field_46_container\" class=\"frm_form_field  frm_scroll_box frm12 frm_first frm_html_container form-field\">Idaho Center for Reproductive Medicine, PC<\/p>\n<p>AUTHORIZATION TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION<\/p>\n<p>Description of information to be used or disclosed:<\/p>\n<p>\tTesxt\/Photo<\/p>\n<p>Who is authorized to use or disclose the information:<\/p>\n<p>\tIdaho Center for Reproductive Medicine, PC (\u201cICRM\u201d or the \u201cpractice\u201d)<\/p>\n<p>Reason the information will be used or disclosed (If the patient initiates the authorization, the statement \u201cat the request of the individual\u201d is sufficient):<\/p>\n<p>\tTo be posted on ICRM\u2019s social media platforms such as Facebook, Instagram, and website.<\/p>\n<p>(If the purpose listed above includes \u201cmarketing\u201d, ICRM will not receive payment as a result of using or disclosing this information.  This does not include payment for any services provided to you.)<\/p>\n<p>Expiration date or event:  <\/p>\n<p>\tFive years from the date of this authorization<\/p>\n<p>NOTICE TO PATIENT<\/p>\n<p>-\tYou may refuse to sign this authorization<br \/>\n-\tThe patient or the patient\u2019s representative must read and initial the following statements:<br \/>\n1.\t I understand that I may refuse to sign this form.<br \/>\n2.\tI understand that I can request a copy of this form after I sign it.<br \/>\n3.\tI understand that I may revoke this authorization at any time by notifying ICRM in writing at the address below, but if I do, the revocation will not have any effect on actions the practice has already taken in reliance on this authorization.<\/p>\n<p>I authorize ICRM to use or disclose any medical information specified in this authorization.  I understand that I shall receive no compensation for this authorization and release and waive any right\/title and\/or interest of any kind that I may have in the information or images produced.<\/p><\/div>\n<div id=\"frm_field_47_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container frm12 frm_first vertical_radio\">\r\n    <div  id=\"field_wvdjs_label\" class=\"frm_primary_label\">Terms and conditions\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_wvdjs_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_47-45-0\">\t\t\t<label >\n\t\t\t<input type=\"checkbox\" name=\"item_meta[47][]\" id=\"field_wvdjs-0\" value=\"I agree to the terms and conditions and accept the e-signature below as a valid, legal signature.\"  data-sectionid=\"45\"  data-reqmsg=\"Terms and conditions cannot be blank.\" data-invmsg=\"Terms and conditions is invalid\"   aria-required=\"true\"  \/> I agree to the terms and conditions and accept the e-signature below as a valid, legal signature.<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_48_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_jd88d\" id=\"field_jd88d_label\" class=\"frm_primary_label\">Signature\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    \t\t\t<input  type=\"hidden\" name=\"item_meta[48][delete_saved_image]\" value=\"0\" \/>\n\t\t\t\t\t\t<input  type=\"hidden\" name=\"item_meta[48][content]\" value=\"\" \/>\n\t\t\t<div class=\"sigPad\" id='sigPad48' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#BFC3C8;--bg-color:#ffffff;--active:#579AF6;--inactive:#eaeaea;--active-text:#ffffff;--inactive-text:#3f4b5b;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 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data-sitekey=\"6Lc18_UaAAAAAO1NF9_LgVlSo_PalQ2a8CzUOBzu\" data-size=\"normal\" data-theme=\"light\"><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_67_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_130_container\">\n\t\t\t<label for=\"field_6ya75\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_6ya75\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[130]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"c0nBPMcz6gMCqtX\/TUV1E4tB+yCWp3mS2vgG8zX2ZDBkStlsQs4q2Js6yA4ZLSSP\" 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