{"id":36089,"date":"2025-05-19T11:15:11","date_gmt":"2025-05-19T11:15:11","guid":{"rendered":"https:\/\/myairclinic.com\/app\/?page_id=36089"},"modified":"2025-06-04T09:19:46","modified_gmt":"2025-06-04T09:19:46","slug":"create-account","status":"publish","type":"page","link":"https:\/\/myairclinic.com\/app\/create-account\/","title":{"rendered":"Create Account"},"content":{"rendered":"\n<div id=\"viewCounter\" style=\"position: absolute; top: 10px; right: 10px; font-size: 12px; color: #666;\"><\/div>\n<form id=\"registrationForm\" style=\"background: white; padding: 16px; border-radius: 8px; box-shadow: 0 2px 8px rgba(0,0,0,0.1); width: 100%; max-width: 360px; margin-top: 30px;\">\n  <div style=\"margin-bottom: 12px;\">\n    <label for=\"firstName\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">First Name<\/label>\n    <input type=\"text\" id=\"firstName\" name=\"firstName\" required style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n  <\/div>\n  <div style=\"margin-bottom: 12px;\">\n    <label for=\"lastName\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">Last Name<\/label>\n    <input type=\"text\" id=\"lastName\" name=\"lastName\" required style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n  <\/div>\n  <div style=\"margin-bottom: 12px;\">\n    <label for=\"username\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">Username<\/label>\n    <input type=\"text\" id=\"username\" name=\"username\" required style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n  <\/div>\n  <div style=\"margin-bottom: 12px;\">\n    <label for=\"email\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">Email Address<\/label>\n    <input type=\"email\" id=\"email\" name=\"email\" required style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n  <\/div>\n  <div style=\"margin-bottom: 12px;\">\n    <label for=\"phone\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">Phone Number<\/label>\n    <input type=\"tel\" id=\"phone\" name=\"phone\" required style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n  <\/div>\n  <div style=\"margin-bottom: 12px;\">\n    <label for=\"specialty\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">Specialty Intended<\/label>\n    <select id=\"specialty\" name=\"specialty\" required style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n      <option value=\"\" disabled selected>Select specialty<\/option>\n      <option value=\"Internal Medicine\">Internal Medicine<\/option>\n      <option value=\"Surgery\/Orthopedics\">Surgery\/Orthopedics<\/option>\n      <option value=\"Pediatrics\">Pediatrics<\/option>\n      <option value=\"OBGYN\">OBGYN<\/option>\n      <option value=\"Family Medicine\">Family Medicine<\/option>\n      <option value=\"Ophthalmology\">Ophthalmology<\/option>\n      <option value=\"Dental Surgery\">Dental Surgery<\/option>\n      <option value=\"Pathology\">Pathology<\/option>\n      <option value=\"Anaesthesiology\">Anaesthesiology<\/option>\n      <option value=\"Psychiatry\">Psychiatry<\/option>\n      <option value=\"Radiology\">Radiology<\/option>\n      <option value=\"IELTS\">IELTS<\/option>\n      <option value=\"PLAB1\">PLAB1<\/option>\n      <option value=\"PLAB2\">PLAB2<\/option>\n      <option value=\"Others\">Others<\/option>\n    <\/select>\n  <\/div>\n  <div style=\"margin-bottom: 12px;\">\n    <label for=\"exam\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">Exam Type<\/label>\n    <select id=\"exam\" name=\"exam\" required style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n      <option value=\"\" disabled selected>Select exam type<\/option>\n      <option value=\"International\">International<\/option>\n      <option value=\"Primaries National\">Primaries National<\/option>\n      <option value=\"Primaries West Africa\">Primaries West Africa<\/option>\n      <option value=\"Primaries Both\">Primaries Both<\/option>\n      <option value=\"Residency Part 1\">Residency Part 1<\/option>\n    <\/select>\n  <\/div>\n  <div style=\"margin-bottom: 12px;\">\n    <label for=\"referralSource\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">How did you learn about Air-Clinic?<\/label>\n    <select id=\"referralSource\" name=\"referralSource\" required style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n      <option value=\"\" disabled selected>Select source<\/option>\n      <option value=\"A Colleague\/Friend\">A Colleague\/Friend<\/option>\n      <option value=\"Social Media\">Social Media<\/option>\n      <option value=\"Browsing Google\">Browsing Google<\/option>\n      <option value=\"Others\">Others<\/option>\n    <\/select>\n  <\/div>\n  <div id=\"socialMediaDiv\" style=\"margin-bottom: 12px; display: none;\">\n    <label for=\"socialMediaPlatform\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">Which Social Media?<\/label>\n    <select id=\"socialMediaPlatform\" name=\"socialMediaPlatform\" style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n      <option value=\"\" disabled selected>Select platform<\/option>\n      <option value=\"Instagram\">Instagram<\/option>\n      <option value=\"X\">X<\/option>\n      <option value=\"WhatsApp\">WhatsApp<\/option>\n      <option value=\"Telegram\">Telegram<\/option>\n    <\/select>\n  <\/div>\n  <div id=\"referrerDiv\" style=\"margin-bottom: 12px; display: none;\">\n    <label for=\"referrerName\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">Referrer&#8217;s Name<\/label>\n    <input type=\"text\" id=\"referrerName\" name=\"referrerName\" style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n  <\/div>\n  <div id=\"otherSourceDiv\" style=\"margin-bottom: 12px; display: none;\">\n    <label for=\"otherSource\" style=\"display: block; font-size: 14px; margin-bottom: 4px; color: #333;\">Specify Other Source<\/label>\n    <input type=\"text\" id=\"otherSource\" name=\"otherSource\" style=\"width: 100%; padding: 8px; font-size: 14px; border: 1px solid #ddd; border-radius: 4px; box-sizing: border-box;\" onfocus=\"this.style.borderColor='#25D366';\" onblur=\"this.style.borderColor='#ddd';\">\n  <\/div>\n  <button type=\"submit\" style=\"width: 100%; padding: 10px; font-size: 16px; background: #25D366; color: white; border: none; border-radius: 4px; cursor: pointer; transition: background 0.2s;\" onmouseover=\"this.style.background='#1ebe57';\" onmouseout=\"this.style.background='#25D366';\">Submit<\/button>\n<\/form>\n\n<script>\n  \/\/ View counter logic\n  let views = localStorage.getItem('formViews') || 0;\n  views = parseInt(views) + 1;\n  localStorage.setItem('formViews', views);\n  document.getElementById('viewCounter').textContent = `Views: ${views}`;\n\n  \/\/ Conditional field logic\n  const referralSource = document.getElementById('referralSource');\n  const socialMediaDiv = document.getElementById('socialMediaDiv');\n  const referrerDiv = document.getElementById('referrerDiv');\n  const otherSourceDiv = document.getElementById('otherSourceDiv');\n  const socialMediaPlatform = document.getElementById('socialMediaPlatform');\n  const referrerName = document.getElementById('referrerName');\n  const otherSource = document.getElementById('otherSource');\n\n  referralSource.addEventListener('change', function() {\n    socialMediaDiv.style.display = 'none';\n    referrerDiv.style.display = 'none';\n    otherSourceDiv.style.display = 'none';\n    socialMediaPlatform.required = false;\n    referrerName.required = false;\n    otherSource.required = false;\n\n    if (this.value === 'Social Media') {\n      socialMediaDiv.style.display = 'block';\n      socialMediaPlatform.required = true;\n    } else if (this.value === 'A Colleague\/Friend') {\n      referrerDiv.style.display = 'block';\n      referrerName.required = true;\n    } else if (this.value === 'Others') {\n      otherSourceDiv.style.display = 'block';\n      otherSource.required = true;\n    }\n  });\n\n  \/\/ Form submission logic\n  document.getElementById('registrationForm').addEventListener('submit', function(event) {\n    event.preventDefault();\n    const firstName = document.getElementById('firstName').value;\n    const lastName = document.getElementById('lastName').value;\n    const username = document.getElementById('username').value;\n    const email = document.getElementById('email').value;\n    const phone = document.getElementById('phone').value;\n    const specialty = document.getElementById('specialty').value;\n    const exam = document.getElementById('exam').value;\n    const referralSourceValue = document.getElementById('referralSource').value;\n    let referralDetails = '';\n    if (referralSourceValue === 'Social Media') {\n      const platform = document.getElementById('socialMediaPlatform').value;\n      referralDetails = `Social Media Platform: ${encodeURIComponent(platform)}`;\n    } else if (referralSourceValue === 'A Colleague\/Friend') {\n      const referrer = document.getElementById('referrerName').value;\n      referralDetails = `Referrer's Name: ${encodeURIComponent(referrer)}`;\n    } else if (referralSourceValue === 'Others') {\n      const other = document.getElementById('otherSource').value;\n      referralDetails = `Other Source: ${encodeURIComponent(other)}`;\n    }\n    const message = `Registration Details:%0AFirst Name: ${encodeURIComponent(firstName)}%0ALast Name: ${encodeURIComponent(lastName)}%0AUsername: ${encodeURIComponent(username)}%0AEmail: ${encodeURIComponent(email)}%0APhone: ${encodeURIComponent(phone)}%0ASpecialty Intended: ${encodeURIComponent(specialty)}%0AExam Type: ${encodeURIComponent(exam)}%0AHow did you learn about Air-Clinic?: ${encodeURIComponent(referralSourceValue)}${referralDetails ? '%0A' + referralDetails : ''}`;\n    const whatsappUrl = `https:\/\/wa.me\/2347038304302?text=${message}`;\n    window.location.href = whatsappUrl;\n  });\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>First Name Last Name Username Email Address Phone Number Specialty Intended Select specialtyInternal MedicineSurgery\/OrthopedicsPediatricsOBGYNFamily MedicineOphthalmologyDental SurgeryPathologyAnaesthesiologyPsychiatryRadiologyIELTSPLAB1PLAB2Others Exam Type Select exam [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-36089","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/myairclinic.com\/app\/wp-json\/wp\/v2\/pages\/36089","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myairclinic.com\/app\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/myairclinic.com\/app\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/myairclinic.com\/app\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myairclinic.com\/app\/wp-json\/wp\/v2\/comments?post=36089"}],"version-history":[{"count":4,"href":"https:\/\/myairclinic.com\/app\/wp-json\/wp\/v2\/pages\/36089\/revisions"}],"predecessor-version":[{"id":36149,"href":"https:\/\/myairclinic.com\/app\/wp-json\/wp\/v2\/pages\/36089\/revisions\/36149"}],"wp:attachment":[{"href":"https:\/\/myairclinic.com\/app\/wp-json\/wp\/v2\/media?parent=36089"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}