{"id":3439,"date":"2026-09-11T01:00:16","date_gmt":"2026-09-11T01:00:16","guid":{"rendered":"https:\/\/grandgenesisdental.com\/?page_id=3439"},"modified":"2026-09-13T22:00:21","modified_gmt":"2026-09-13T22:00:21","slug":"new-patients","status":"publish","type":"page","link":"https:\/\/grandgenesisdental.com\/tr\/new-patients\/","title":{"rendered":"Yeni Hastalar"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3439\" class=\"elementor elementor-3439\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-63bee65a elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"63bee65a\" data-element_type=\"section\" data-e-type=\"section\" data-settings='{\"background_background\":\"classic\"}'>\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-7634df3d\" data-id=\"7634df3d\" 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-2672c90b elementor-mobile-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"2672c90b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-map-marker\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">9080 Yonge Sok., #10 &amp; #11, Richmond Hill, ON L4C 0Y7<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\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<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-25b35288\" data-id=\"25b35288\" 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-4a1d48bd elementor-align-end elementor-mobile-align-center elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"4a1d48bd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:info@grandgenesisdental.com\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-envelope\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">info@grandgenesisdental.com<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\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<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-4d99c3b6\" data-id=\"4d99c3b6\" 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-5b05c9bf e-grid-align-left e-grid-align-mobile-center elementor-shape-rounded elementor-grid-0 elementor-widget elementor-widget-social-icons\" data-id=\"5b05c9bf\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\" role=\"list\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\" role=\"listitem\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-facebook elementor-repeater-item-eebb9f4\" href=\"https:\/\/www.facebook.com\/profile.php?id=61591890264870\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Facebook<\/span>\n\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fab fa-facebook\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\" role=\"listitem\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-instagram elementor-repeater-item-cd2f176\" href=\"https:\/\/www.instagram.com\/grandgenesisdental\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Instagram<\/span>\n\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fab fa-instagram\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\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-48a0b146 elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"48a0b146\" 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-25 elementor-top-column elementor-element elementor-element-1360eed8\" data-id=\"1360eed8\" 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-69f52aa8 elementor-widget elementor-widget-image\" data-id=\"69f52aa8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"341\" src=\"https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa-1024x341.png\" class=\"attachment-large size-large wp-image-3434\" alt=\"\" srcset=\"https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa-1024x341.png 1024w, https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa-300x100.png 300w, https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa-768x256.png 768w, https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa-1536x512.png 1536w, https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa-2048x683.png 2048w\" sizes=\"(max-width: 1024px) 100vw, 1024px\">\t\t\t\t\t\t\t\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<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-1bef75af\" data-id=\"1bef75af\" 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-43bc6184 elementor-nav-menu--dropdown-tablet elementor-nav-menu__text-align-aside elementor-nav-menu--toggle elementor-nav-menu--burger elementor-widget elementor-widget-nav-menu\" data-id=\"43bc6184\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings='{\"layout\":\"horizontal\",\"submenu_icon\":{\"value\":\"&lt;i class=\\\"fas fa-caret-down\\\" aria-hidden=\\\"true\\\"&gt;&lt;\\\/i&gt;\",\"library\":\"fa-solid\"},\"toggle\":\"burger\"}' data-widget_type=\"nav-menu.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<nav aria-label=\"Men\u00fc\" class=\"elementor-nav-menu--main elementor-nav-menu__container elementor-nav-menu--layout-horizontal e--pointer-underline e--animation-fade\">\n\t\t\t\t<ul id=\"menu-1-43bc6184\" class=\"elementor-nav-menu\"><li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-home menu-item-3871\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/\" class=\"elementor-item\">Ana Sayfa<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3870\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/about-us\/\" class=\"elementor-item\">Hakk\u0131m\u0131zda<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3875\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/our-services\/\" class=\"elementor-item\">Hizmetlerimiz<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3866\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/new-patients\/\" class=\"elementor-item\">Yeni Hastalar<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3867\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/reviews\/\" class=\"elementor-item\">\u0130ncelemeler<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3876\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/contact-us\/\" class=\"elementor-item\">Bize Ula\u015f\u0131n<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\t\t\t\t\t<div class=\"elementor-menu-toggle\" role=\"button\" tabindex=\"0\" aria-label=\"Men\u00fc A\u00e7\/Kapat\" aria-expanded=\"false\">\n\t\t\t<i aria-hidden=\"true\" role=\"presentation\" class=\"elementor-menu-toggle__icon--open eicon-menu-bar\"><\/i><i aria-hidden=\"true\" role=\"presentation\" class=\"elementor-menu-toggle__icon--close eicon-close\"><\/i>\t\t<\/div>\n\t\t\t\t\t<nav class=\"elementor-nav-menu--dropdown elementor-nav-menu__container\" aria-hidden=\"true\">\n\t\t\t\t<ul id=\"menu-2-43bc6184\" class=\"elementor-nav-menu\"><li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-home menu-item-3871\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/\" class=\"elementor-item\" tabindex=\"-1\">Ana Sayfa<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3870\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/about-us\/\" class=\"elementor-item\" tabindex=\"-1\">Hakk\u0131m\u0131zda<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3875\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/our-services\/\" class=\"elementor-item\" tabindex=\"-1\">Hizmetlerimiz<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3866\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/new-patients\/\" class=\"elementor-item\" tabindex=\"-1\">Yeni Hastalar<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3867\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/reviews\/\" class=\"elementor-item\" tabindex=\"-1\">\u0130ncelemeler<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3876\"><a href=\"https:\/\/grandgenesisdental.com\/tr\/contact-us\/\" class=\"elementor-item\" tabindex=\"-1\">Bize Ula\u015f\u0131n<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\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<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-260298c4\" data-id=\"260298c4\" 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-21dc2928 elementor-position-inline-start elementor-widget__width-initial elementor-view-default elementor-mobile-position-block-start elementor-widget elementor-widget-icon-box\" data-id=\"21dc2928\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"tel:+19055978700\" class=\"elementor-icon\" tabindex=\"-1\" aria-label=\"(905) 597-8700\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-phone-alt\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<a href=\"tel:+19055978700\">\n\t\t\t\t\t\t\t(905) 597-8700\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tBizi Bug\u00fcn Aray\u0131n\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\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<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-d92dcbb\" data-id=\"d92dcbb\" 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-30c9d246 elementor-widget__width-auto elementor-widget elementor-widget-button\" data-id=\"30c9d246\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/tr\/request-appointment\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">K\u0130TAP<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\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<div class=\"elementor-element elementor-element-7b78718 e-flex e-con-boxed e-con e-parent\" data-id=\"7b78718\" data-element_type=\"container\" data-e-type=\"container\" data-settings='{\"background_background\":\"classic\"}'>\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f8a473a elementor-widget elementor-widget-heading\" data-id=\"f8a473a\" 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-default\">Grand Genesis Dental'e ho\u015f geldiniz<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-83562d3 elementor-widget elementor-widget-text-editor\" data-id=\"83562d3\" 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>Yeni hastalar\u0131m\u0131z\u0131 Richmond Hill di\u015f klini\u011fimize a\u011f\u0131rlamaktan mutluluk duyuyoruz. \u0130lk ziyaretinizden \u00f6nce yeni hasta formunuzu \u00e7evrimi\u00e7i doldurarak check-in i\u015flemini basit ve pratik h\u00e2le getirin.<\/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\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-4220b89 e-flex e-con-boxed e-con e-parent\" data-id=\"4220b89\" 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-e471c35 elementor-widget elementor-widget-heading\" data-id=\"e471c35\" 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\">Yeni Hasta Formunuzu Doldurun<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bfccb55 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"bfccb55\" 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>Grand Genesis Dental'e ilk kez geliyorsan\u0131z, l\u00fctfen randevunuzdan \u00f6nce a\u015fa\u011f\u0131daki formu doldurun. Bilgileriniz, ekibimizin ziyaretinizi haz\u0131rlamas\u0131na ve geldi\u011finizde check-in i\u015flemini kolayla\u015ft\u0131rmas\u0131na yard\u0131mc\u0131 olacakt\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ccda2f1 elementor-widget elementor-widget-formidable\" data-id=\"ccda2f1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_4_container\" data-token=\"3cab5a89202e2267ac1757e01f003f5d\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form \" id=\"form_new-patient-registration-form\" data-frm-error-config='{\"includeAlertRole\":false,\"focusFirstError\":false,\"focusErrorSummary\":true}' data-token=\"3cab5a89202e2267ac1757e01f003f5d\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Yeni Hasta Kay\u0131t Formu<\/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=\"4\">\n<input type=\"hidden\" name=\"frm_hide_fields_4\" id=\"frm_hide_fields_4\" value=\"\">\n<input type=\"hidden\" name=\"form_key\" value=\"new-patient-registration-form\">\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\">\n<input type=\"hidden\" id=\"frm_submit_entry_4\" name=\"frm_submit_entry_4\" value=\"63e74166d1\"><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/3439\"><div id=\"frm_field_66_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div style=\"border-bottom:2px solid #C8102E; padding-bottom:10px; margin:15px 0 25px 0;\">\n<h3 style=\"margin:0; color:#111111; font-size:22px; font-weight:600;\">Hasta Bilgileri<\/h3>\n<\/div>\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<div id=\"field_sgrfb_label\" class=\"frm_primary_label\">\u0130sim\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_sgrfb_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\t\u0130sim\t<\/legend>\n\n\t<div class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_22\" data-reqmsg=\"Name cannot be blank.\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div id=\"frm_field_22-first_container\" class=\"frm_form_field form-field frm_form_subfield-first  frm6\" data-sub-field-name=\"first\">\n\t\t\t\t<label for=\"field_sgrfb_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\t\u0130sim\t\t\t\t<\/label>\n\n\t\t\t\t<input type=\"text\" id=\"field_sgrfb_first\" value=\"\" name=\"item_meta[22][first]\" autocomplete=\"given-name\" data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"><div class=\"frm_description\" id=\"frm_field_22_first_desc\">\u0130sim<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div id=\"frm_field_22-last_container\" class=\"frm_form_field form-field frm_form_subfield-last  frm6\" data-sub-field-name=\"last\">\n\t\t\t\t<label for=\"field_sgrfb_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tSoyad\u0131\t\t\t\t<\/label>\n\n\t\t\t\t<input type=\"text\" id=\"field_sgrfb_last\" value=\"\" name=\"item_meta[22][last]\" autocomplete=\"family-name\" data-reqmsg=\"Last Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"><div class=\"frm_description\" id=\"frm_field_22_last_desc\">Soyad\u0131<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_23_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_krvmz\" id=\"field_krvmz_label\" class=\"frm_primary_label\">Do\u011fum Tarihi\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_krvmz\" name=\"item_meta[23]\" value=\"\" data-reqmsg=\"Date of Birth cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date of Birth is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_24_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_x32y1\" id=\"field_x32y1_label\" class=\"frm_primary_label\">Telefon Numaras\u0131\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_x32y1\" name=\"item_meta[24]\" value=\"\" data-reqmsg=\"Phone Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone Number 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\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_25_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_nfil2\" id=\"field_nfil2_label\" class=\"frm_primary_label\">E-posta Adresi\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_nfil2\" name=\"item_meta[25]\" value=\"\" data-reqmsg=\"Email Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email Address is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_mlbf1\" id=\"field_mlbf1_label\" class=\"frm_primary_label\">Ev Adresi\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_mlbf1\" name=\"item_meta[26]\" value=\"\" data-reqmsg=\"Home Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Home Address is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_27_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_xk5go_label\" class=\"frm_primary_label\">Tercih Edilen \u0130leti\u015fim Y\u00f6ntemi\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_xk5go_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_27-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_xk5go-0\" value=\"Phone\" data-reqmsg=\"Preferred Method of Contact cannot be blank.\" data-invmsg=\"Preferred Method of Contact is invalid\"> Telefon<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_27-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_xk5go-1\" value=\"Email\" data-reqmsg=\"Preferred Method of Contact cannot be blank.\" data-invmsg=\"Preferred Method of Contact is invalid\"> E-posta<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_28_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_ncnjn\" id=\"field_ncnjn_label\" class=\"frm_primary_label\">Acil Durum \u0130leti\u015fim Ki\u015fisi Ad\u0131\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_ncnjn\" name=\"item_meta[28]\" value=\"\" data-reqmsg=\"Emergency Contact Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact Name is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_29_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_zv9vf\" id=\"field_zv9vf_label\" class=\"frm_primary_label\">Acil Durum \u0130leti\u015fim Telefonu\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_zv9vf\" name=\"item_meta[29]\" value=\"\" data-reqmsg=\"Emergency Contact Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Emergency Contact 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\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_67_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div style=\"border-bottom:2px solid #C8102E; padding-bottom:10px; margin:15px 0 25px 0;\">\n<h3 style=\"margin:0; color:#111111; font-size:22px; font-weight:600;\">Sigorta Bilgileri<\/h3>\n<\/div>\n<\/div>\n<div id=\"frm_field_30_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_hpaeo_label\" class=\"frm_primary_label\">Di\u015f sigortan\u0131z var m\u0131?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_hpaeo_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_30-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[30]\" id=\"field_hpaeo-0\" value=\"Yes\" data-reqmsg=\"Do you have dental insurance? cannot be blank.\" data-invmsg=\"Do you have dental insurance? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_30-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[30]\" id=\"field_hpaeo-1\" value=\"No\" data-reqmsg=\"Do you have dental insurance? cannot be blank.\" data-invmsg=\"Do you have dental insurance? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_31_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_kikkd\" id=\"field_kikkd_label\" class=\"frm_primary_label\">Sigorta \u015eirketi\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_kikkd\" name=\"item_meta[31]\" value=\"\" data-invmsg=\"Insurance Company is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_32_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_cs06p\" id=\"field_cs06p_label\" class=\"frm_primary_label\">Poli\u00e7e \/ Plan Numaras\u0131\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_cs06p\" name=\"item_meta[32]\" value=\"\" data-invmsg=\"Policy \/ Plan Number is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_33_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_llwc7\" id=\"field_llwc7_label\" class=\"frm_primary_label\">\u00dcye \/ Sertifika ID\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_llwc7\" name=\"item_meta[33]\" value=\"\" data-invmsg=\"Member \/ Certificate ID is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_34_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_9oq3o\" id=\"field_9oq3o_label\" class=\"frm_primary_label\">Poli\u00e7e Sahibi Ad\u0131\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_9oq3o\" name=\"item_meta[34]\" value=\"\" data-invmsg=\"Primary Policy Holder Name is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_w37dl\" id=\"field_w37dl_label\" class=\"frm_primary_label\">Sigorta Sahibi ile \u0130li\u015fki\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\t\t<select name=\"item_meta[35]\" id=\"field_w37dl\" data-invmsg=\"Relationship to Policy Holder is invalid\" aria-invalid=\"false\">\n\t\t<option value=\"\" selected> <\/option><option value=\"Self\">Kendim<\/option><option value=\"Spouse\">E\u015f<\/option><option value=\"Child \/ Dependent\">\u00c7ocuk \/ Ba\u011f\u0131ml\u0131<\/option><option value=\"Other\">Di\u011fer<\/option>\t<\/select>\n\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_68_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div style=\"border-bottom:2px solid #C8102E; padding-bottom:10px; margin:15px 0 25px 0;\">\n<h3 style=\"margin:0; color:#111111; font-size:22px; font-weight:600;\">T\u0131bbi Ge\u00e7mi\u015f<\/h3>\n<\/div>\n<\/div>\n<div id=\"frm_field_36_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_gxube_label\" class=\"frm_primary_label\">A\u015fa\u011f\u0131daki t\u0131bbi durumlar\u0131n herhangi birine sahip misiniz?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_gxube_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-0\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-0\" value=\"Heart Disease \/ Heart Problems\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\" aria-required=\"true\"> Kalp Hastal\u0131\u011f\u0131 \/ Kalp Problemleri<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-1\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-1\" value=\"High Blood Pressure\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Y\u00fcksek Kan Bas\u0131nc\u0131<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-2\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-2\" value=\"Low Blood Pressure\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> D\u00fc\u015f\u00fck Kan Bas\u0131nc\u0131<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-3\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-3\" value=\"Stroke\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> \u0130nme<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-4\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-4\" value=\"Diabetes\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Diyabet<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-5\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-5\" value=\"Thyroid Problems\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Tiroid Problemleri<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-6\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-6\" value=\"Asthma\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Ast\u0131m<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-7\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-7\" value=\"Lung Disease \/ Breathing Problems\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Akci\u011fer Hastal\u0131\u011f\u0131 \/ Solunum Problemleri<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-8\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-8\" value=\"Kidney Disease\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> B\u00f6brek Hastal\u0131\u011f\u0131<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-9\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-9\" value=\"Liver Disease \/ Hepatitis\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Karaci\u011fer Hastal\u0131\u011f\u0131 \/ Hepatit<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-10\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-10\" value=\"Epilepsy \/ Seizures\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Epilepsi \/ N\u00f6betler<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-11\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-11\" value=\"Blood Disease \/ Bleeding Problems\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Kan Hastal\u0131\u011f\u0131 \/ Kanama Sorunlar\u0131<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-12\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-12\" value=\"Cancer\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Kanser<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-13\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-13\" value=\"Tuberculosis\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> T\u00fcberk\u00fcloz<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-14\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-14\" value=\"Arthritis \/ Rheumatism\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Artrit \/ Romatizma<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-15\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-15\" value=\"HIV \/ AIDS\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> HIV \/ AIDS<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-16\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-16\" value=\"Other\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Di\u011fer<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_36-17\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[36][]\" id=\"field_gxube-17\" value=\"None of the Above\" data-reqmsg=\"Do you have any of the following medical conditions? cannot be blank.\" data-invmsg=\"Do you have any of the following medical conditions? is invalid\"> Yukar\u0131dakilerin Hi\u00e7biri<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_37_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_yd3sf_label\" class=\"frm_primary_label\">Sa\u011fl\u0131\u011f\u0131n\u0131z iyi mi?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_yd3sf_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_37-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_yd3sf-0\" value=\"Yes\" data-reqmsg=\"Are you in good health? cannot be blank.\" data-invmsg=\"Are you in good health? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_yd3sf-1\" value=\"No\" data-reqmsg=\"Are you in good health? cannot be blank.\" data-invmsg=\"Are you in good health? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_38_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_arqix_label\" class=\"frm_primary_label\">Ge\u00e7ti\u011fimiz y\u0131l i\u00e7inde genel sa\u011fl\u0131\u011f\u0131n\u0131zda herhangi bir de\u011fi\u015fiklik oldu mu?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_arqix_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_38-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_arqix-0\" value=\"Yes\" data-reqmsg=\"Has there been any change in your general health in the past year? cannot be blank.\" data-invmsg=\"Has there been any change in your general health in the past year? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_arqix-1\" value=\"No\" data-reqmsg=\"Has there been any change in your general health in the past year? cannot be blank.\" data-invmsg=\"Has there been any change in your general health in the past year? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_dvayx\" id=\"field_dvayx_label\" class=\"frm_primary_label\">E\u011fer evet ise, l\u00fctfen a\u00e7\u0131klay\u0131n\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[39]\" id=\"field_dvayx\" rows=\"5\" data-invmsg=\"If yes, please explain is invalid\" aria-invalid=\"false\"><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_rsfe8_label\" class=\"frm_primary_label\">\u015eu anda herhangi bir ila\u00e7, re\u00e7etesiz ila\u00e7 veya bitkisel takviye al\u0131yor musunuz?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_rsfe8_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_40-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[40]\" id=\"field_rsfe8-0\" value=\"Yes\" data-reqmsg=\"Are you currently taking any medication, non-prescription drugs, or herbal supplements of any kind? cannot be blank.\" data-invmsg=\"Are you currently taking any medication, non-prescription drugs, or herbal supplements of any kind? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_40-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[40]\" id=\"field_rsfe8-1\" value=\"No\" data-reqmsg=\"Are you currently taking any medication, non-prescription drugs, or herbal supplements of any kind? cannot be blank.\" data-invmsg=\"Are you currently taking any medication, non-prescription drugs, or herbal supplements of any kind? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_41_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_fqdfi\" id=\"field_fqdfi_label\" class=\"frm_primary_label\">L\u00fctfen ila\u00e7lar\u0131 belirtiniz\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[41]\" id=\"field_fqdfi\" rows=\"5\" data-invmsg=\"Please specify medications is invalid\" aria-invalid=\"false\"><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_dhqlb_label\" class=\"frm_primary_label\">Herhangi bir alerjiniz var m\u0131?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_dhqlb_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_42-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[42]\" id=\"field_dhqlb-0\" value=\"Yes\" data-reqmsg=\"Do you have any allergies? cannot be blank.\" data-invmsg=\"Do you have any allergies? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_42-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[42]\" id=\"field_dhqlb-1\" value=\"No\" data-reqmsg=\"Do you have any allergies? cannot be blank.\" data-invmsg=\"Do you have any allergies? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_43_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_czx50\" id=\"field_czx50_label\" class=\"frm_primary_label\">L\u00fctfen alerjileri belirtiniz\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[43]\" id=\"field_czx50\" rows=\"5\" data-invmsg=\"Please specify allergies is invalid\" aria-invalid=\"false\"><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_me0er_label\" class=\"frm_primary_label\">Hi\u00e7bir hastal\u0131k ya da operasyon nedeniyle hastaneye yat\u0131r\u0131ld\u0131n\u0131z m\u0131?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_me0er_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_44-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_me0er-0\" value=\"Yes\" data-reqmsg=\"Have you ever been hospitalized for any illness or operation? cannot be blank.\" data-invmsg=\"Have you ever been hospitalized for any illness or operation? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_44-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_me0er-1\" value=\"No\" data-reqmsg=\"Have you ever been hospitalized for any illness or operation? cannot be blank.\" data-invmsg=\"Have you ever been hospitalized for any illness or operation? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_45_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_rbajf_label\" class=\"frm_primary_label\">Hi\u00e7 b\u00fcy\u00fck bir hastal\u0131\u011f\u0131n\u0131z veya ciddi bir t\u0131bbi durumunuz oldu mu?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_rbajf_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_45-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[45]\" id=\"field_rbajf-0\" value=\"Yes\" data-reqmsg=\"Have you ever had a major illness or serious medical condition? cannot be blank.\" data-invmsg=\"Have you ever had a major illness or serious medical condition? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_45-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[45]\" id=\"field_rbajf-1\" value=\"No\" data-reqmsg=\"Have you ever had a major illness or serious medical condition? cannot be blank.\" data-invmsg=\"Have you ever had a major illness or serious medical condition? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_46_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_naskt\" id=\"field_naskt_label\" class=\"frm_primary_label\">E\u011fer evet ise, l\u00fctfen a\u00e7\u0131klay\u0131n\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[46]\" id=\"field_naskt\" rows=\"5\" data-invmsg=\"If yes, please explain is invalid\" aria-invalid=\"false\"><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_47_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_l6fau_label\" class=\"frm_primary_label\">Hamile misiniz yoksa hamile olma ihtimaliniz var m\u0131?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_l6fau_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_47-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[47]\" id=\"field_l6fau-0\" value=\"Yes\" data-reqmsg=\"Are you pregnant or is there a possibility that you may be pregnant? cannot be blank.\" data-invmsg=\"Are you pregnant or is there a possibility that you may be pregnant? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_47-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[47]\" id=\"field_l6fau-1\" value=\"No\" data-reqmsg=\"Are you pregnant or is there a possibility that you may be pregnant? cannot be blank.\" data-invmsg=\"Are you pregnant or is there a possibility that you may be pregnant? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_69_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div style=\"border-bottom:2px solid #C8102E; padding-bottom:10px; margin:15px 0 25px 0;\">\n<h3 style=\"margin:0; color:#111111; font-size:22px; font-weight:600;\">Di\u015f Ge\u00e7mi\u015fi<\/h3>\n<\/div>\n<\/div>\n<div id=\"frm_field_48_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_r5rx3_label\" class=\"frm_primary_label\">Daha \u00f6nceki di\u015f tedavisiyle ilgili herhangi bir komplikasyon ya da sorun ya\u015fad\u0131n\u0131z m\u0131?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_r5rx3_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_48-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[48]\" id=\"field_r5rx3-0\" value=\"Yes\" data-reqmsg=\"Have you ever had any complications or problems with previous dental treatment? cannot be blank.\" data-invmsg=\"Have you ever had any complications or problems with previous dental treatment? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_48-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[48]\" id=\"field_r5rx3-1\" value=\"No\" data-reqmsg=\"Have you ever had any complications or problems with previous dental treatment? cannot be blank.\" data-invmsg=\"Have you ever had any complications or problems with previous dental treatment? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_49_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_bpnou\" id=\"field_bpnou_label\" class=\"frm_primary_label\">E\u011fer evet ise, l\u00fctfen a\u00e7\u0131klay\u0131n\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[49]\" id=\"field_bpnou\" rows=\"5\" data-invmsg=\"If yes, please explain is invalid\" aria-invalid=\"false\"><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_50_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_x5rxz_label\" class=\"frm_primary_label\">Ge\u00e7ti\u011fimiz y\u0131l i\u00e7inde di\u015f r\u00f6ntgeni \u00e7ektirdiniz mi?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_x5rxz_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_50-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[50]\" id=\"field_x5rxz-0\" value=\"Yes\" data-reqmsg=\"Have you had dental X-rays taken within the past year? cannot be blank.\" data-invmsg=\"Have you had dental X-rays taken within the past year? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_50-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[50]\" id=\"field_x5rxz-1\" value=\"No\" data-reqmsg=\"Have you had dental X-rays taken within the past year? cannot be blank.\" data-invmsg=\"Have you had dental X-rays taken within the past year? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_51_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_v3aaf\" id=\"field_v3aaf_label\" class=\"frm_primary_label\">Son di\u015f muayeneniz ne zaman oldu?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_v3aaf\" name=\"item_meta[51]\" value=\"\" data-invmsg=\"When was your last dental visit? is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_52_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_nvq3s\" id=\"field_nvq3s_label\" class=\"frm_primary_label\">Di\u015f ziyaretinizin ana nedeni nedir?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[52]\" id=\"field_nvq3s\" rows=\"5\" data-reqmsg=\"What is the main reason for your dental visit? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is the main reason for your dental visit? is invalid\" aria-invalid=\"false\"><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_53_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div id=\"field_banr4_label\" class=\"frm_primary_label\">\u015eu anda a\u015fa\u011f\u0131dakilerden herhangi birini ya\u015f\u0131yor musunuz?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_banr4_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-0\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-0\" value=\"Tooth Pain or Sensitivity\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> Di\u015f A\u011fr\u0131s\u0131 veya Hassasiyet<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-1\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-1\" value=\"Bleeding Gums\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> Kanayan Di\u015f Etleri<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-2\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-2\" value=\"Swollen or Tender Gums\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> \u015ei\u015fmi\u015f veya Hassas Di\u015f Etleri<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-3\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-3\" value=\"Loose Teeth\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> Ge\u015fmi\u015f di\u015fler<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-4\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-4\" value=\"Jaw Pain \/ TMJ Problems\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> \u00c7ene A\u011fr\u0131s\u0131 \/ TMJ Problemleri<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-5\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-5\" value=\"Clicking or Popping of the Jaw\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> \u00c7ene T\u0131klamas\u0131 veya Patlamas\u0131<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-6\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-6\" value=\"Difficulty Chewing\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> \u00c7i\u011fnemede Zorluk<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-7\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-7\" value=\"Teeth Grinding or Clenching\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> Di\u015f G\u0131c\u0131rdatma veya S\u0131kma<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-8\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-8\" value=\"Bad Breath\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> K\u00f6t\u00fc Nefes<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-9\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-9\" value=\"Broken or Chipped Tooth\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> K\u0131r\u0131k veya \u00c7iplenmi\u015f Di\u015f<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-10\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-10\" value=\"Other\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> Di\u011fer<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_53-11\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[53][]\" id=\"field_banr4-11\" value=\"None of the Above\" data-invmsg=\"Are you currently experiencing any of the following? is invalid\"> Yukar\u0131dakilerin Hi\u00e7biri<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_54_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_ta5e8_label\" class=\"frm_primary_label\">\u015eu anda sigara i\u00e7iyor veya t\u00fct\u00fcn \u00fcr\u00fcnleri kullan\u0131yor musunuz?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ta5e8_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_54-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[54]\" id=\"field_ta5e8-0\" value=\"Yes\" data-reqmsg=\"Do you currently smoke or use tobacco products? cannot be blank.\" data-invmsg=\"Do you currently smoke or use tobacco products? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_54-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[54]\" id=\"field_ta5e8-1\" value=\"No\" data-reqmsg=\"Do you currently smoke or use tobacco products? cannot be blank.\" data-invmsg=\"Do you currently smoke or use tobacco products? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_55_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_mndg1_label\" class=\"frm_primary_label\">Alkoll\u00fc i\u00e7ecek t\u00fcketiyor musunuz?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_mndg1_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_55-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[55]\" id=\"field_mndg1-0\" value=\"Yes\" data-reqmsg=\"Do you consume alcoholic beverages? cannot be blank.\" data-invmsg=\"Do you consume alcoholic beverages? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_55-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[55]\" id=\"field_mndg1-1\" value=\"No\" data-reqmsg=\"Do you consume alcoholic beverages? cannot be blank.\" data-invmsg=\"Do you consume alcoholic beverages? is invalid\"> Hay\u0131r<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_56_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_6sixv_label\" class=\"frm_primary_label\">Ailenizdeki yak\u0131n akrabalar aras\u0131nda diyabet, kalp hastal\u0131\u011f\u0131 veya kanser olan var m\u0131?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_6sixv_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_56-0\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[56]\" id=\"field_6sixv-0\" value=\"Yes\" data-reqmsg=\"Does anyone in your immediate family have diabetes, heart disease, or cancer? cannot be blank.\" data-invmsg=\"Does anyone in your immediate family have diabetes, heart disease, or cancer? is invalid\"> Evet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_56-1\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[56]\" id=\"field_6sixv-1\" value=\"No\" data-reqmsg=\"Does anyone in your immediate family have diabetes, heart disease, or cancer? cannot be blank.\" data-invmsg=\"Does anyone in your immediate family have diabetes, heart disease, or cancer? is invalid\"> Hay\u0131r<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_56-2\">\t\t\t<label>\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[56]\" id=\"field_6sixv-2\" value=\"Not Sure\" data-reqmsg=\"Does anyone in your immediate family have diabetes, heart disease, or cancer? cannot be blank.\" data-invmsg=\"Does anyone in your immediate family have diabetes, heart disease, or cancer? is invalid\"> Emin de\u011filim<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_57_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_dha1z\" id=\"field_dha1z_label\" class=\"frm_primary_label\">Evet ise, l\u00fctfen belirtiniz\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[57]\" id=\"field_dha1z\" rows=\"5\" data-invmsg=\"If yes, please specify is invalid\" aria-invalid=\"false\"><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_58_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_kgaxm\" id=\"field_kgaxm_label\" class=\"frm_primary_label\">\u00d6nceki Di\u015f Hekimi \/ Di\u015f Ofisi\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_kgaxm\" name=\"item_meta[58]\" value=\"\" data-invmsg=\"Name of Previous Dentist \/ Dental Office is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_59_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_1syuu\" id=\"field_1syuu_label\" class=\"frm_primary_label\">\u00d6nceki Di\u015f Hekimi Telefon Numaras\u0131\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_1syuu\" name=\"item_meta[59]\" value=\"\" data-invmsg=\"Previous Dentist Phone Number 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\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_70_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div style=\"border-bottom:2px solid #C8102E; padding-bottom:10px; margin:15px 0 25px 0;\">\n<h3 style=\"margin:0; color:#111111; font-size:22px; font-weight:600;\">R\u0131za ve Yetkilendirme<\/h3>\n<\/div>\n<\/div>\n<div id=\"frm_field_60_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_rj9xh_label\" class=\"frm_primary_label\">Sigorta Yetkilendirmesi\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_rj9xh_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_60-0\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[60][]\" id=\"field_rj9xh-0\" value=\"I authorize the release of information necessary to process my dental insurance claims and authorize payment of applicable insurance benefits to Grand Genesis Dental.\" data-reqmsg=\"Insurance Authorization cannot be blank.\" data-invmsg=\"Insurance Authorization is invalid\" aria-required=\"true\"> Di\u015f sigortas\u0131 taleplerimi i\u015flemek i\u00e7in gerekli bilgilerin a\u00e7\u0131klanmas\u0131n\u0131 ve uygulanabilir sigorta faydalar\u0131n\u0131n Grand Genesis Dental'e \u00f6denmesini yetkilendiriyorum.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_61_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_1rjr1_label\" class=\"frm_primary_label\">Hasta Onay\u0131\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_1rjr1_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_61-0\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[61][]\" id=\"field_1rjr1-0\" value=\"I confirm that the information provided in this form is complete and accurate to the best of my knowledge. I understand that I should inform Grand Genesis Dental of any changes to my health, medications, or personal information.\" data-reqmsg=\"Patient Acknowledgment cannot be blank.\" data-invmsg=\"Patient Acknowledgment is invalid\" aria-required=\"true\"> Bilgileri en iyi bilgim dahilinde eksiksiz ve do\u011fru bir \u015fekilde sa\u011flad\u0131\u011f\u0131m\u0131 onayl\u0131yorum. Sa\u011fl\u0131k durumumda, ila\u00e7larda veya ki\u015fisel bilgilerimde herhangi bir de\u011fi\u015fiklik oldu\u011funda Grand Genesis Dental'i bilgilendirmem gerekti\u011fini anl\u0131yorum.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_62_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_iea7s_label\" class=\"frm_primary_label\">Tedaviye Onay\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_iea7s_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_62-0\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[62][]\" id=\"field_iea7s-0\" value=\"I consent to the dental examination and treatment considered necessary by the dentist and understand that treatment options, benefits, risks, and alternatives will be discussed with me as appropriate.\" data-reqmsg=\"Consent to Treatment cannot be blank.\" data-invmsg=\"Consent to Treatment is invalid\" aria-required=\"true\"> Di\u015f hekimi taraf\u0131ndan gerekli g\u00f6r\u00fclen di\u015f muayenesi ve tedavisine onay veriyorum ve tedavi se\u00e7eneklerinin, faydalar\u0131n\u0131n, risklerinin ve alternatiflerinin benimle uygun \u015fekilde g\u00f6r\u00fc\u015f\u00fclece\u011fini anl\u0131yorum.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_63_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_cr9oi\" id=\"field_cr9oi_label\" class=\"frm_primary_label\">Hasta \/ Veli veya Vasi Tam Ad\u0131\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_cr9oi\" name=\"item_meta[63]\" value=\"\" data-reqmsg=\"Patient \/ Parent or Guardian Full Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Patient \/ Parent or Guardian Full Name is invalid\" aria-invalid=\"false\">\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_64_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div id=\"field_qyw26_label\" class=\"frm_primary_label\">Elektronik Onay\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_qyw26_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_64-0\">\t\t\t<label>\n\t\t\t<input type=\"checkbox\" name=\"item_meta[64][]\" id=\"field_qyw26-0\" value=\"By submitting this form, I confirm that the name entered above is my own (or that I am the patient\u2019s parent\/legal guardian) and that I am submitting this information electronically to Grand Genesis Dental.\" data-reqmsg=\"Electronic Acknowledgment cannot be blank.\" data-invmsg=\"Electronic Acknowledgment is invalid\" aria-required=\"true\"> Bu formu g\u00f6ndererek, yukar\u0131da girilen ismin kendi ad\u0131m oldu\u011funu (veya hastan\u0131n ebeveyni\/yasal vasisi oldu\u011fumu) ve bu bilgileri elektronik olarak Grand Genesis Dental'e g\u00f6nderdi\u011fimi onayl\u0131yorum.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_65_container\" class=\"frm_form_field form-field  frm_none_container\"><div id=\"field_qw0ei\" class=\"frm-g-recaptcha\" data-sitekey=\"6LdBXSopAAAAAMYO_bgCym0nGajw015YOCE-aSbZ\" data-size=\"normal\" data-theme=\"light\"><\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit\" type=\"submit\">G\u00f6nder<\/button>\r\n\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\">\n\t\t\t<div id=\"frm_field_83_container\">\n\t\t\t<label for=\"field_vzve9\">\n\t\t\t\tE\u011fer insansan\u0131z, bu alan\u0131 bo\u015f b\u0131rak\u0131n.\t\t\t<\/label>\n\t\t\t<input id=\"field_vzve9\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[83]\" value=\"\">\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"JXEW+jYJz7dojBmpe4HIqWDOiQqFdoTp6pG18o8mBro=\"><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-4db8ed9e e-flex e-con-boxed e-con e-parent\" data-id=\"4db8ed9e\" data-element_type=\"container\" data-e-type=\"container\" data-settings='{\"background_background\":\"classic\"}'>\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-23ccb144 e-con-full e-flex e-con e-child\" data-id=\"23ccb144\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-48be3fe2 elementor-widget elementor-widget-image\" data-id=\"48be3fe2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"1024\" height=\"402\" src=\"https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa2-1024x402.png\" class=\"attachment-large size-large wp-image-3460\" alt=\"\" srcset=\"https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa2-1024x402.png 1024w, https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa2-300x118.png 300w, https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa2-768x302.png 768w, https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa2-1536x603.png 1536w, https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa2.png 2001w\" sizes=\"(max-width: 1024px) 100vw, 1024px\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-53702faa elementor-widget elementor-widget-text-editor\" data-id=\"53702faa\" 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>Richmond Hill'da her ya\u015ftan hastalar i\u00e7in \u015fefkatli, modern di\u015f bak\u0131m\u0131.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-23dc0e28 e-con-full e-flex e-con e-child\" data-id=\"23dc0e28\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6f94cb8 elementor-widget elementor-widget-heading\" data-id=\"6f94cb8\" 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<h4 class=\"elementor-heading-title elementor-size-default\">H\u0131zl\u0131 Ba\u011flant\u0131lar<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-25e74901 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"25e74901\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Ana Sayfa<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/about-us\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-times\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Hakk\u0131m\u0131zda<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/our-services\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-dot-circle\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Hizmetlerimiz<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/new-patients\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Yeni Hastalar<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/reviews\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">\u0130ncelemeler<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/contact-us\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Bize Ula\u015f\u0131n<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-36710e5f e-con-full e-flex e-con e-child\" data-id=\"36710e5f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3f8f09b0 elementor-widget elementor-widget-heading\" data-id=\"3f8f09b0\" 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<h4 class=\"elementor-heading-title elementor-size-default\">Di\u015f Hizmetleri<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5452b5f3 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"5452b5f3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/our-services\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Acil Di\u015f Hekimli\u011fi<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/our-services\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-times\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">\u00c7ocuk Di\u015f Hekimli\u011fi<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/our-services\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-dot-circle\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Di\u015f \u0130mplantlar\u0131<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/our-services\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Estetik Di\u015f Hekimli\u011fi<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/our-services\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Kronlar ve K\u00f6pr\u00fcler<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/tr\/our-services\/\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Ortodonti<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-5c6f28a5 e-con-full e-flex e-con e-child\" data-id=\"5c6f28a5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3609e1c9 elementor-widget elementor-widget-heading\" data-id=\"3609e1c9\" 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<h4 class=\"elementor-heading-title elementor-size-default\">Bize Ula\u015f\u0131n<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-64d599aa elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"64d599aa\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-check\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">9080 Yonge Sok., #10 &amp; #11, Richmond Hill, ON L4C 0Y7<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"tel:+19055978700\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-times\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">(905) 597-8700<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:info@grandgenesisdental.com\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-dot-circle\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Bize E-posta G\u00f6nder<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-315e0c39 e-flex e-con-boxed e-con e-parent\" data-id=\"315e0c39\" data-element_type=\"container\" data-e-type=\"container\" data-settings='{\"background_background\":\"classic\"}'>\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-141959ea elementor-widget elementor-widget-text-editor\" data-id=\"141959ea\" 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>\u00a9 2026 Grand Genesis Dental. T\u00fcm Haklar\u0131 Sakl\u0131d\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-74807dd4 elementor-widget elementor-widget-text-editor\" data-id=\"74807dd4\" 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><span style=\"font-size: 12px; letter-spacing: 2px;\">Taraf\u0131ndan tasarland\u0131<\/span> <span style=\"font-size: 20px; font-style: italic; font-weight: 600; color: #c8102e;\">A.A<\/span><\/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\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>9080 Yonge St, #10 &amp; #11, Richmond Hill, ON L4C 0Y7 info@grandgenesisdental.com Facebook Instagram (905) 597-8700 Bizi Aray\u0131n BOOK Grand Genesis Dental'e Ho\u015f Geldiniz Richmond Hill di\u015f ofisimize yeni hastalar\u0131 kabul etmekten mutluyuz. \u0130lk ziyaretinizden \u00f6nce yeni hasta formunuzu \u00e7evrimi\u00e7i doldurarak check-in'i basit ve uygun hale getirin. Doldurun [...]<\/p>\n","protected":false},"author":13,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"footnotes":""},"class_list":["post-3439","page","type-page","status-publish","hentry"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":8}},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>New Patients - Grand Genesis Dental<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/grandgenesisdental.com\/new-patients\/\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"New Patients - Grand Genesis Dental\" \/>\n<meta property=\"og:description\" content=\"9080 Yonge St, #10 &amp; #11, Richmond Hill, ON L4C 0Y7 info@grandgenesisdental.com Facebook Instagram (905) 597-8700 Call Us Today BOOK Welcome to Grand Genesis Dental We\u2019re happy to welcome new patients to our Richmond Hill dental office. Complete your new patient form online before your first visit to help make check-in simple and convenient. Complete [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/grandgenesisdental.com\/new-patients\/\" \/>\n<meta property=\"og:site_name\" content=\"Grand Genesis Dental\" \/>\n<meta property=\"article:modified_time\" content=\"2026-09-13T22:00:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/grandgenesisdental.com\/wp-content\/uploads\/2026\/09\/aa.png\" \/>\n\t<meta property=\"og:image:width\" content=\"2172\" \/>\n\t<meta property=\"og:image:height\" content=\"724\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Tahmini okuma s\u00fcresi\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 dakika\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/new-patients\\\/\",\"url\":\"https:\\\/\\\/grandgenesisdental.com\\\/new-patients\\\/\",\"name\":\"New Patients - Grand Genesis Dental\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/new-patients\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/new-patients\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/grandgenesisdental.com\\\/wp-content\\\/uploads\\\/2026\\\/09\\\/aa-1024x341.png\",\"datePublished\":\"2026-09-11T01:00:16+00:00\",\"dateModified\":\"2026-09-13T22:00:21+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/new-patients\\\/#breadcrumb\"},\"inLanguage\":\"tr\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/grandgenesisdental.com\\\/new-patients\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"tr\",\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/new-patients\\\/#primaryimage\",\"url\":\"https:\\\/\\\/grandgenesisdental.com\\\/wp-content\\\/uploads\\\/2026\\\/09\\\/aa.png\",\"contentUrl\":\"https:\\\/\\\/grandgenesisdental.com\\\/wp-content\\\/uploads\\\/2026\\\/09\\\/aa.png\",\"width\":2172,\"height\":724},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/new-patients\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/grandgenesisdental.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"New Patients\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/#website\",\"url\":\"https:\\\/\\\/grandgenesisdental.com\\\/\",\"name\":\"Grand Genesis Dental\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/grandgenesisdental.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"tr\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/#organization\",\"name\":\"Grand Genesis Dental\",\"url\":\"https:\\\/\\\/grandgenesisdental.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"tr\",\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/grandgenesisdental.com\\\/wp-content\\\/uploads\\\/2023\\\/12\\\/GGD-full.jpg\",\"contentUrl\":\"https:\\\/\\\/grandgenesisdental.com\\\/wp-content\\\/uploads\\\/2023\\\/12\\\/GGD-full.jpg\",\"width\":240,\"height\":164,\"caption\":\"Grand Genesis Dental\"},\"image\":{\"@id\":\"https:\\\/\\\/grandgenesisdental.com\\\/#\\\/schema\\\/logo\\\/image\\\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Yeni Hastalar - Grand Genesis Dental","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/grandgenesisdental.com\/new-patients\/","og_locale":"tr_TR","og_type":"article","og_title":"New Patients - Grand Genesis Dental","og_description":"9080 Yonge St, #10 &amp; #11, Richmond Hill, ON L4C 0Y7 info@grandgenesisdental.com Facebook Instagram (905) 597-8700 Call Us Today BOOK Welcome to Grand Genesis Dental We\u2019re happy to welcome new patients to our Richmond Hill dental office. Complete your new patient form online before your first visit to help make check-in simple and convenient. 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