{"id":11353,"date":"2024-08-09T13:08:35","date_gmt":"2024-08-09T20:08:35","guid":{"rendered":"https:\/\/affderm.com\/?page_id=11353"},"modified":"2026-01-30T15:12:38","modified_gmt":"2026-01-30T22:12:38","slug":"encuesta","status":"publish","type":"page","link":"https:\/\/affderm.com\/es\/survey\/","title":{"rendered":"Encuesta sobre faltas de asistencia"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"11353\" class=\"elementor elementor-11353\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-42c00b1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"42c00b1\" 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-818bfdb\" data-id=\"818bfdb\" 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-ca90c7c elementor-widget elementor-widget-heading\" data-id=\"ca90c7c\" 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\">Missed Appointment Survey<\/h2>\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-1584f48 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1584f48\" data-element_type=\"section\" data-e-type=\"section\">\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-ba6e248\" data-id=\"ba6e248\" 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-c918f24 elementor-widget elementor-widget-heading\" data-id=\"c918f24\" 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<h3 class=\"elementor-heading-title elementor-size-default\">We missed you!!<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-12acfa6 elementor-widget elementor-widget-text-editor\" data-id=\"12acfa6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>We understand that life happens and we are often forced to miss important medical appointments. We also understand that there may be another reason to skip an appointment. At Affiliated Dermatology, we strive to be as close to perfect as we can be.<\/p><p>Please take a moment and answer the questions below so we can better serve you and all patients. Thank you!!<\/p>\t\t\t\t\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-cc2adc7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"cc2adc7\" data-element_type=\"section\" data-e-type=\"section\">\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-b749dd1\" data-id=\"b749dd1\" 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-aeb6777 elementor-widget elementor-widget-text-editor\" data-id=\"aeb6777\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><script>\nvar 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 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   <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_6' id='gform_6'  action='\/es\/wp-json\/wp\/v2\/pages\/11353#gf_6' data-formid='6' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><div id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_6_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_1'>What is 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_6_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_3'>What is your phone 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_3' id='input_6_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_6_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What was the primary reason you could not attend your appointment?<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_6_4'>\n\t\t\t<div class='gchoice gchoice_6_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='I Forgot'  id='choice_6_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_4_0' id='label_6_4_0' class='gform-field-label gform-field-label--type-inline'>I Forgot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Transportation issues'  id='choice_6_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_4_1' id='label_6_4_1' class='gform-field-label gform-field-label--type-inline'>Transportation issues<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_4_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Felt better'  id='choice_6_4_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_4_2' id='label_6_4_2' class='gform-field-label gform-field-label--type-inline'>Felt better<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_4_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Insurance\/Financial reasons'  id='choice_6_4_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_4_3' id='label_6_4_3' class='gform-field-label gform-field-label--type-inline'>Insurance\/Financial reasons<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_4_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Other (please specify)'  id='choice_6_4_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_4_4' id='label_6_4_4' class='gform-field-label gform-field-label--type-inline'>Other (please specify)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_5'>If other&#8230;<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_6_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_6_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Did you receive our appointment reminder?<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_6_6'>\n\t\t\t<div class='gchoice gchoice_6_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Yes'  id='choice_6_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_6_0' id='label_6_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='No'  id='choice_6_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_6_1' id='label_6_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Would you like to reschedule your missed appointment?<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_6_7'>\n\t\t\t<div class='gchoice gchoice_6_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Yes, please call me'  id='choice_6_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_7_0' id='label_6_7_0' class='gform-field-label gform-field-label--type-inline'>Yes, please call me<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Yes, I will call to reschedule'  id='choice_6_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_7_1' id='label_6_7_1' class='gform-field-label gform-field-label--type-inline'>Yes, I will call to reschedule<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='No, not at this time'  id='choice_6_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_7_2' id='label_6_7_2' class='gform-field-label gform-field-label--type-inline'>No, not at this time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_8\" class=\"gfield 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