{"id":12434,"date":"2026-10-04T21:08:45","date_gmt":"2026-10-05T00:08:45","guid":{"rendered":"https:\/\/all-vet.cl\/?page_id=12434"},"modified":"2026-10-04T22:34:49","modified_gmt":"2026-10-05T01:34:49","slug":"datos-requeridos-para-ficha-clinica","status":"publish","type":"page","link":"https:\/\/all-vet.cl\/en\/datos-requeridos-para-ficha-clinica\/","title":{"rendered":"DATOS REQUERIDOS PARA FICHA CL\u00cdNICA"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"12434\" class=\"elementor elementor-12434\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4656789 e-flex e-con-boxed e-con e-parent\" data-id=\"4656789\" 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-fe46494 elementor-widget elementor-widget-sureforms_form\" data-id=\"fe46494\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"sureforms_form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"srfm-form-container srfm-form-container-12430 srfm-form-container-12430-elementor-fe46494 srfm-bg-color\">\n\t\t\t\t\t\t<style>\n\t\t\t\t\/* Need to check and remove the input variables related to the Style Tab. *\/\n\t\t\t\t.srfm-form-container-12430-elementor-fe46494 {\n\t\t\t\t\t\t\t\t\t\t\/* New test variables *\/\n\t\t\t\t\t--srfm-color-scheme-primary: #082398;\n\t\t\t\t\t--srfm-color-scheme-text-on-primary: #ffffff;\n\t\t\t\t\t--srfm-color-scheme-text: #082398;\n\t\t\t\t\t--srfm-quill-editor-color: #082398;\n\n\t\t\t\t\t--srfm-color-input-label: #082398;\n\t\t\t\t\t--srfm-color-input-description: hsl( from #082398 h s l \/ 0.65 );\n\t\t\t\t\t--srfm-color-input-placeholder: hsl( from #082398 h s l \/ 0.5 );\n\t\t\t\t\t--srfm-color-input-text: #082398;\n\t\t\t\t\t--srfm-color-input-prefix: hsl( from #082398 h s l \/ 0.65 );\n\t\t\t\t\t--srfm-color-input-background: hsl( from #082398 h s l \/ 0.02 );\n\t\t\t\t\t--srfm-color-input-background-hover: hsl( from #082398 h s l \/ 0.05 );\n\t\t\t\t\t--srfm-color-input-background-disabled: hsl( from #082398 h s l \/ 0.07 );\n\t\t\t\t\t--srfm-color-input-border: hsl( from #082398 h s l \/ 0.25 );\n\t\t\t\t\t--srfm-color-input-border-disabled: hsl( from #082398 h s l \/ 0.15 );\n\t\t\t\t\t--srfm-color-multi-choice-svg: hsl( from #082398 h s l \/ 0.7 );\n\t\t\t\t\t--srfm-color-input-border-hover: hsl( from #082398 h s l \/ 0.65 );\n\t\t\t\t\t--srfm-color-input-border-focus-glow: hsl( from #082398 h s l \/ 0.15 );\n\t\t\t\t\t--srfm-color-input-selected: hsl( from #082398 h s l \/ 0.1 );\n\t\t\t\t\t--srfm-btn-color-hover: hsl( from #082398 h s l \/ 0.9 );\n\t\t\t\t\t--srfm-btn-color-disabled: hsl( from #082398 h s l \/ 0.25 );\n\n\t\t\t\t\t\/* Dropdown Variables *\/\n\t\t\t\t\t--srfm-dropdown-input-background-hover: hsl( from #082398 h s l \/ 0.05 );\n\t\t\t\t\t--srfm-dropdown-option-background-hover: hsl( from #082398 h s l \/ 0.10 );\n\t\t\t\t\t--srfm-dropdown-option-background-selected: hsl( from #082398 h s l \/ 0.05 );\n\t\t\t\t\t--srfm-dropdown-option-selected-icon: hsl( from #082398 h s l \/ 0.65 );\n\t\t\t\t\t--srfm-dropdown-option-text-color: hsl( from #082398 h s l \/ 0.80 );\n\t\t\t\t\t--srfm-dropdown-option-selected-text: #082398;\n\t\t\t\t\t--srfm-dropdown-badge-background: hsl( from #082398 h s l \/ 0.05 );\n\t\t\t\t\t--srfm-dropdown-badge-background-hover: hsl( from #082398 h s l \/ 0.10 );\n\t\t\t\t\t--srfm-dropdown-menu-border-color: hsl( from #082398 h s l \/ 0.10 );\n\t\t\t\t\t--srfm-dropdown-placeholder-color: hsl( from #082398 h s l \/ 0.50 );\n\t\t\t\t\t--srfm-dropdown-icon-color: hsl( from #082398 h s l \/ 0.65 );\n\t\t\t\t\t--srfm-dropdown-icon-disabled: hsl( from #082398 h s l \/ 0.25 );\n\n\t\t\t\t\t\/* Background Control Variables *\/\n\t\t\t\t\t\t--srfm-instant-form-padding-top: 32px;--srfm-instant-form-padding-right: 32px;--srfm-instant-form-padding-bottom: 32px;--srfm-instant-form-padding-left: 32px;--srfm-instant-form-border-radius-top: 0px;--srfm-instant-form-border-radius-right: 0px;--srfm-instant-form-border-radius-bottom: 0px;--srfm-instant-form-border-radius-left: 0px;--srfm-form-padding-top: 0px;--srfm-form-padding-right: 0px;--srfm-form-padding-bottom: 0px;--srfm-form-padding-left: 0px;--srfm-form-border-radius-top: 0px;--srfm-form-border-radius-right: 0px;--srfm-form-border-radius-bottom: 0px;--srfm-form-border-radius-left: 0px;--srfm-bg-color: #ffffff;--srfm-bg-overlay-opacity: 1;\t\t\t\t\t\t--srfm-row-gap-between-blocks: 20px;--srfm-address-label-font-size: 18px;--srfm-address-label-line-height: 28px;--srfm-address-description-font-size: 16px;--srfm-address-description-line-height: 24px;--srfm-col-gap-between-fields: 16px;--srfm-row-gap-between-fields: 20px;--srfm-gap-below-address-label: 16px;--srfm-dropdown-font-size: 16px;--srfm-dropdown-gap-between-input-menu: 6px;--srfm-dropdown-badge-padding: 6px 6px;--srfm-dropdown-multiselect-font-size: 14px;--srfm-dropdown-multiselect-line-height: 20px;--srfm-dropdown-padding-right: 14px;--srfm-dropdown-padding-right-icon: calc( var( --srfm-dropdown-padding-right ) + 20px );--srfm-dropdown-multiselect-padding: 8px var( --srfm-dropdown-padding-right-icon ) 8px 8px;--srfm-input-height: 48px;--srfm-input-field-padding: 10px 14px;--srfm-input-field-font-size: 18px;--srfm-input-field-line-height: 28px;--srfm-input-field-margin-top: 8px;--srfm-input-field-margin-bottom: 8px;--srfm-checkbox-label-font-size: 18px;--srfm-checkbox-label-line-height: 28px;--srfm-checkbox-description-font-size: 16px;--srfm-checkbox-description-line-height: 24px;--srfm-check-ctn-width: 20px;--srfm-check-ctn-height: 20px;--srfm-check-svg-size: 14px;--srfm-checkbox-margin-top-frontend: 4px;--srfm-checkbox-margin-top-editor: 5px;--srfm-check-gap: 10px;--srfm-checkbox-description-margin-left: 30px;--srfm-flag-section-padding: 10px 0 10px 12px;--srfm-gap-between-icon-text: 8px;--srfm-label-font-size: 18px;--srfm-label-line-height: 28px;--srfm-description-font-size: 16px;--srfm-description-line-height: 24px;--srfm-btn-padding: 10px 14px;--srfm-btn-font-size: 18px;--srfm-btn-line-height: 28px;--srfm-multi-choice-horizontal-padding: 24px;--srfm-multi-choice-vertical-padding: 24px;--srfm-multi-choice-internal-option-gap: 12px;--srfm-multi-choice-vertical-svg-size: 48px;--srfm-multi-choice-horizontal-image-size: 28px;--srfm-multi-choice-vertical-image-size: 140px;--srfm-multi-choice-outer-padding: 4px;\t\t\t\t}\n\t\t\t<\/style>\n\t\t\t\t\t\t\t\t\t\t<form method=\"post\" enctype=\"multipart\/form-data\" id=\"srfm-form-12430\" class=\"srfm-form \"\n\t\t\t\tform-id=\"12430\" after-submission=\"hide form\" message-type=\"same page\" success-url=\"\" ajaxurl=\"https:\/\/all-vet.cl\/wp-admin\/admin-ajax.php\" data-submit-token=\"9dfaf386a9e971453c1af3239e8bc39f5446b80bde91368236992f2239d25c83\" data-view-token=\"8ca3004d7793f5d8865841e67cebb0c67e7b64b3fe0535deff32edd20fda00f4\"\t\t\t\t>\n\t\t\t\t\n\t\t\t\t<input type=\"hidden\" value=\"12430\" name=\"form-id\">\n\t\t\t\t\t\t\t\t<input type=\"hidden\" value=\"\" name=\"srfm-form-language\">\n\t\t\t\t<input type=\"hidden\" value=\"\" name=\"srfm-sender-email-field\" id=\"srfm-sender-email\">\n\t\t\t\t<input type=\"hidden\" value=\"\" id=\"srfm-page-break\">\n\t\t\t\t\t\t<p id=\"srfm-error-message\" class=\"srfm-common-error-message srfm-error-message srfm-head-error\" hidden>\t\t<span class=\"srfm-icon\" aria-hidden=\"true\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" fill=\"none\"><path d=\"M9.99935 18.3327C14.6017 18.3327 18.3327 14.6017 18.3327 9.99935C18.3327 5.39698 14.6017 1.66602 9.99935 1.66602C5.39698 1.66602 1.66602 5.39698 1.66602 9.99935C1.66602 14.6017 5.39698 18.3327 9.99935 18.3327Z\" stroke=\"currentColor\" stroke-width=\"1.5\" stroke-linecap=\"round\" stroke-linejoin=\"round\" \/><path d=\"M10 6.66602V9.99935\" stroke=\"currentColor\" stroke-width=\"1.5\" stroke-linecap=\"round\" stroke-linejoin=\"round\" \/><path d=\"M10 13.334H10.0083\" stroke=\"currentColor\" stroke-width=\"1.5\" stroke-linecap=\"round\" stroke-linejoin=\"round\" \/><\/svg>\t\t<\/span>\n\t\t<span class=\"srfm-error-content\">There was an error trying to submit your form. Please try again.<\/span><\/p>\n\t\t\t\t\t\t<header data-block-id=\"4190ddf1\" class=\"wp-block-uagb-advanced-heading uagb-block uagb-block-4190ddf1 12430 \" >\n\t\t\t\t\t<h4 class=\"uagb-heading-text\">DATOS REQUERIDOS  PARA FICHA CL\u00cdNICA<\/h4><div class=\"uagb-separator\"><\/div>\t\t\t\t<\/header>\n\t\t\t\n\n\t\t\t\t<header data-block-id=\"f92370ec\" class=\"wp-block-uagb-advanced-heading uagb-block uagb-block-f92370ec 12430 \" >\n\t\t\t\t\t<h4 class=\"uagb-heading-text\">Datos de Propietario<\/h4><div class=\"uagb-separator\"><\/div>\t\t\t\t<\/header>\n\t\t\t\n\n\t\t\t<div data-block-id=\"4b85550f\" class=\"srfm-block-single srfm-block srfm-email-block srf-email-4b85550f-block  srfm-block-width-100 srfm-slug-correo-electronico 12430 srfm-email-block-wrap\">\n\t\t\t\t<div class=\"srfm-email-block srf-email-4b85550f-block\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-description\" id=\"srfm-description-4b85550f\">\n\t\t\t\t\t\tProporciona un correo electr\u00f3nico v\u00e1lido.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t\t\t<input class=\"srfm-input-common srfm-input-email\" type=\"email\" name=\"srfm-email-4b85550f-lbl-Q29ycmVvIEVsZWN0csOzbmljbw-correo-electronico\" id=\"srfm-email-4b85550f-lbl-Q29ycmVvIEVsZWN0csOzbmljbw\"\n\t\t\t\t\t\taria-describedby='srfm-error-4b85550f srfm-description-4b85550f'\t\t\t\t\t\tdata-required=\"true\" aria-required=\"true\" data-unique=\"false\" value=\"\"  placeholder=\"Correo Electr\u00f3nico *\"   \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-4b85550f\" data-error-msg=\"This field is required.\" data-unique-msg=\"Value needs to be unique.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"f0093090\" class=\"srfm-block-single srfm-block srfm-input-block srf-input-f0093090-block  srfm-block-width-100 srfm-slug-nombre-completo 12430\" >\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-description\" id=\"srfm-description-f0093090\">\n\t\t\t\t\t\tIntroduce tu nombre completo.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<input class=\"srfm-input-common srfm-input-input\" type=\"text\" name=\"srfm-input-f0093090-lbl-Tm9tYnJlIHkgQXBlbGxpZG8gZGVsIFByb3BpZXRhZHJpbw-nombre-completo\" id=\"srfm-input-f0093090-lbl-Tm9tYnJlIHkgQXBlbGxpZG8gZGVsIFByb3BpZXRhZHJpbw\"\n\t\t\t\t\taria-describedby='srfm-error-f0093090 srfm-description-f0093090'\t\t\t\t\tdata-required=\"true\" aria-required=\"true\" data-unique=\"false\" maxlength=\"100\" value=\"\"  placeholder=\"Nombre y Apellido del Propietadrio *\"  data-srfm-mask=\"none\"   \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-f0093090\" data-error-msg=\"This field is required.\" data-unique-msg=\"Value needs to be unique.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"0d3795f6\" class=\"srfm-block-single srfm-block srfm-number-block srf-number-0d3795f6-block  srfm-block-width-100 srfm-slug-rut-propietario 12430\" >\n\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t\t<div class=\"srfm-input-content\">\n\t\t\t\t\t\t\t\t\t\t\t\t<input class=\"srfm-input-common srfm-input-number\" type=\"text\" name=\"srfm-number-0d3795f6-lbl-UlVUIFByb3BpZXRhcmlv-rut-propietario\" id=\"srfm-number-0d3795f6-lbl-UlVUIFByb3BpZXRhcmlv\"\n\t\t\t\t\t\taria-describedby='srfm-error-0d3795f6'\t\t\t\t\t\tdata-required=\"false\" aria-required=\"false\"  placeholder=\"RUT Propietario\"  format-type=\"us-style\"   \/>\n\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=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\n\t\t<div data-block-id=\"7272b479\" class=\"srfm-block-single srfm-block srfm-phone-block srf-phone-7272b479-block srfm-block-width-100 12430\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-description\" id=\"srfm-description-7272b479\">\n\t\t\t\t\t\tIntroduce tu n\u00famero de tel\u00e9fono.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<input type=\"tel\"\n\t\t\t\t\tclass=\"srfm-input-common srfm-input-phone\"\n\t\t\t\t\tname=\"srfm-phone-7272b479-lbl-TsO6bWVybyBkZSBUZWzDqWZvbm8-numero-de-telefono\"\n\t\t\t\t\tid=\"srfm-phone-7272b479-lbl-TsO6bWVybyBkZSBUZWzDqWZvbm8\"\n\t\t\t\t\taria-describedby='srfm-error-7272b479 srfm-description-7272b479'\t\t\t\t\tdata-required=\"true\"\n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\tdefault-country=\"cl\"\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tdata-enable-country-filter=\"true\"\n\t\t\t\t\t\tdata-country-filter-type=\"include\"\n\t\t\t\t\t\t\t\t\t\t\t\t\tdata-include-countries=\"[&quot;cl&quot;]\"\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tvalue=\"\"\n\t\t\t\t\t placeholder=\"N\u00famero de Tel\u00e9fono *\" \t\t\t\t\tdata-unique=\"false\">\n\t\t\t<\/div>\n\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-7272b479\" data-error-msg=\"This field is required.\" data-unique-msg=\"Value needs to be unique.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\n\t\t<div data-block-id=\"d2e25421\" class=\"srfm-block-single srfm-block srfm-textarea-block srf-textarea-d2e25421-block  srfm-block-width-100 12430\">\n\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<textarea\n\t\t\t\t\tclass=\"srfm-input-common srfm-input-textarea\"\n\t\t\t\t\tname=\"srfm-textarea-d2e25421-lbl-RGlyZWNjacOzbg-direccion\"\n\t\t\t\t\tid=\"srfm-textarea-d2e25421-lbl-RGlyZWNjacOzbg-1030\"\n\t\t\t\t\taria-describedby='srfm-error-d2e25421'\t\t\t\t\tdata-required=\"true\" aria-required=\"true\"  rows=\"4\"   placeholder=\"Direcci\u00f3n *\" \t\t\t\t\t\t\t\t\t\t\t\t\t\t\t><\/textarea>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-d2e25421\" data-error-msg=\"This field is required.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\n\t\t\n\n\t\t\t<div data-block-id=\"08a16eac\" class=\"srfm-block-single srfm-block srfm-dropdown-block srf-dropdown-08a16eac-block  srfm-block-width-100 srfm-slug-srfm-multi-choice 12430\">\n\t\t\t\t<fieldset>\n\t\t\t\t\t<input class=\"srfm-input-dropdown-hidden\" data-required=\"true\" aria-required=\"true\"  name=\"srfm-dropdown-1-08a16eac-lbl-Q29tdW5h-srfm-multi-choice\" type=\"hidden\" value=\"\"\/>\n\t\t\t\t\t<legend class=\"srfm-block-legend\">\n\t\t\t\t\t\t\t\t\t\t\t<\/legend>\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap srfm-dropdown-common-wrap\">\n\t\t\t\t\t\t\t\t\t\t<select\n\t\t\t\t\t\tclass=\"srfm-dropdown-common srfm-dropdown-input\"\n\t\t\t\t\t\taria-describedby='srfm-error-08a16eac'\t\t\t\tdata-required=\"true\" aria-required=\"true\"  name=\"srfm-dropdown-1-08a16eac-lbl-Q29tdW5h-srfm-multi-choice\" data-multiple=\"false\" data-searchable=\"true\"\n\t\t\t\t\t\t\t\t\t\t\t\ttabindex=\"0\" aria-hidden=\"true\">\n\t\t\t\t\t<option class=\"srfm-dropdown-placeholder\" value=\"\" disabled selected>Comuna<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Conchal\u00ed\" data-icon=\"\"  >Conchal\u00ed<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Huechuraba\" data-icon=\"\"  >Huechuraba<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Independencia\" data-icon=\"\"  >Independencia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"L a Cisterna\" data-icon=\"\"  >L a Cisterna<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"La Florida\" data-icon=\"\"  >La Florida<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"La Reina\" data-icon=\"\"  >La Reina<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Las Condes\" data-icon=\"\"  >Las Condes<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Lo Bernachea\" data-icon=\"\"  >Lo Bernachea<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Macul\" data-icon=\"\"  >Macul<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"\u00d1u\u00f1oa\" data-icon=\"\"  >\u00d1u\u00f1oa<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Pe\u00f1alolen\" data-icon=\"\"  >Pe\u00f1alolen<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Pirque\" data-icon=\"\"  >Pirque<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Providencia\" data-icon=\"\"  >Providencia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Puente Alto\" data-icon=\"\"  >Puente Alto<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Quilicura\" data-icon=\"\"  >Quilicura<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Quinta Normal\" data-icon=\"\"  >Quinta Normal<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Recoleta\" data-icon=\"\"  >Recoleta<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Renca\" data-icon=\"\"  >Renca<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"San Joaqu\u00edn\" data-icon=\"\"  >San Joaqu\u00edn<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"San Miguel\" data-icon=\"\"  >San Miguel<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Santiago Centro\" data-icon=\"\"  >Santiago Centro<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vitacura\" data-icon=\"\"  >Vitacura<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-08a16eac\" data-error-msg=\"This field is required.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/fieldset>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"c482368b\" class=\"srfm-block-single srfm-block srfm-dropdown-block srf-dropdown-c482368b-block  srfm-block-width-100 srfm-slug-indica-tu-solicitud 12430\">\n\t\t\t\t<fieldset>\n\t\t\t\t\t<input class=\"srfm-input-dropdown-hidden\" data-required=\"true\" aria-required=\"true\"  name=\"srfm-dropdown-2-c482368b-lbl-SW5kaWNhIHR1IFNvbGljaXR1ZA-indica-tu-solicitud\" type=\"hidden\" value=\"\"\/>\n\t\t\t\t\t<legend class=\"srfm-block-legend\">\n\t\t\t\t\t\t\t\t\t\t\t<\/legend>\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap srfm-dropdown-common-wrap\">\n\t\t\t\t\t\t\t\t\t\t<select\n\t\t\t\t\t\tclass=\"srfm-dropdown-common srfm-dropdown-input\"\n\t\t\t\t\t\taria-describedby='srfm-error-c482368b'\t\t\t\tdata-required=\"true\" aria-required=\"true\"  name=\"srfm-dropdown-2-c482368b-lbl-SW5kaWNhIHR1IFNvbGljaXR1ZA-indica-tu-solicitud\" data-multiple=\"false\" data-searchable=\"true\"\n\t\t\t\t\t\t\t\t\t\t\t\ttabindex=\"0\" aria-hidden=\"true\">\n\t\t\t\t\t<option class=\"srfm-dropdown-placeholder\" value=\"\" disabled selected>Indica tu Solicitud<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Consulta Veterinaria\" data-icon=\"\"  >Consulta Veterinaria<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Implantaci\u00f3n de Microchip\" data-icon=\"\"  >Implantaci\u00f3n de Microchip<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Servicio de Eutanasia\" data-icon=\"\"  >Servicio de Eutanasia<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vacuna Antirr\u00e1bica\" data-icon=\"\"  >Vacuna Antirr\u00e1bica<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vacuna KC\" data-icon=\"\"  >Vacuna KC<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vacuna Leucemia Felina\" data-icon=\"\"  >Vacuna Leucemia Felina<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\" Vacuna Octuple\" data-icon=\"\"  > Vacuna Octuple<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Vacuna Triple\" data-icon=\"\"  >Vacuna Triple<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Packs Vacunas\" data-icon=\"\"  >Packs Vacunas<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Examenes de Laboratorio y Toma de Muestras\" data-icon=\"\"  >Examenes de Laboratorio y Toma de Muestras<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Suturas Ambulatorias\" data-icon=\"\"  >Suturas Ambulatorias<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Aplicaci\u00f3n de Medicamentos adquiridos en ALL-VET FARMACIA\" data-icon=\"\"  >Aplicaci\u00f3n de Medicamentos adquiridos en ALL-VET FARMACIA<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-c482368b\" data-error-msg=\"This field is required.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/fieldset>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"cd59bf5f\" class=\"srfm-block-single srfm-block srfm-input-block srf-input-cd59bf5f-block  srfm-block-width-100 srfm-slug-numero-de-pedido 12430\" >\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<input class=\"srfm-input-common srfm-input-input\" type=\"text\" name=\"srfm-input-cd59bf5f-lbl-TnVtZXJvIGRlIFBlZGlkbw-numero-de-pedido\" id=\"srfm-input-cd59bf5f-lbl-TnVtZXJvIGRlIFBlZGlkbw\"\n\t\t\t\t\taria-describedby='srfm-error-cd59bf5f'\t\t\t\t\tdata-required=\"false\" aria-required=\"false\" data-unique=\"false\" maxlength=\"100\" value=\"\"  placeholder=\"Numero de Pedido\"  data-srfm-mask=\"none\"   \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-cd59bf5f\" data-error-msg=\"This field is required.\" data-unique-msg=\"Value needs to be unique.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div class = \"wp-block-uagb-separator uagb-block uagb-block-adc78649 wp-block-uagb-separator--none\" style=\"--my-background-image: ;\" >\n\t\t\t\t<div class=\"wp-block-uagb-separator-wrapper\">\n\t\t\t\t\t<div class=\"wp-block-uagb-separator__inner\">\n\t\t\t\t\t\t<div class=\"wp-block-uagb-separator-element\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\n\n\t\t\t\t<div data-block-id=\"7b45b26c\" class=\"wp-block-uagb-icon uagb-block uagb-icon-wrapper uagb-block-7b45b26c\">\n\t\t\t\t\t<span class=\"uagb-svg-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox= \"0 0 384 512\" role=\"graphics-symbol\" aria-hidden=\"false\" aria-label=\"\"><path d=\"M336 64h-53.88C268.9 26.8 233.7 0 192 0S115.1 26.8 101.9 64H48C21.5 64 0 85.48 0 112v352C0 490.5 21.5 512 48 512h288c26.5 0 48-21.48 48-48v-352C384 85.48 362.5 64 336 64zM96 392c-13.25 0-24-10.75-24-24S82.75 344 96 344s24 10.75 24 24S109.3 392 96 392zM96 296c-13.25 0-24-10.75-24-24S82.75 248 96 248S120 258.8 120 272S109.3 296 96 296zM192 64c17.67 0 32 14.33 32 32c0 17.67-14.33 32-32 32S160 113.7 160 96C160 78.33 174.3 64 192 64zM304 384h-128C167.2 384 160 376.8 160 368C160 359.2 167.2 352 176 352h128c8.801 0 16 7.199 16 16C320 376.8 312.8 384 304 384zM304 288h-128C167.2 288 160 280.8 160 272C160 263.2 167.2 256 176 256h128C312.8 256 320 263.2 320 272C320 280.8 312.8 288 304 288z\"><\/path><\/svg>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t<\/div>\n\t\t\t\n\n\t\t\t\t<div data-block-id=\"6a73c172\" class=\"wp-block-uagb-advanced-heading uagb-block uagb-block-6a73c172 12430 \" >\n\t\t\t\t\t<h4 class=\"uagb-heading-text\">Datos de Mascotas<\/h4><div class=\"uagb-separator\"><\/div><p class=\"uagb-desc-text\"><\/p>\t\t\t\t<\/div>\n\t\t\t\n\n\t\t\t<div data-block-id=\"9ede35ac\" class=\"srfm-block-single srfm-block srfm-input-block srf-input-9ede35ac-block  srfm-block-width-100 srfm-slug-nombre-de-la-mascota 12430\" >\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<input class=\"srfm-input-common srfm-input-input\" type=\"text\" name=\"srfm-input-9ede35ac-lbl-Tm9tYnJlIGRlIGxhIE1hc2NvdGE-nombre-de-la-mascota\" id=\"srfm-input-9ede35ac-lbl-Tm9tYnJlIGRlIGxhIE1hc2NvdGE\"\n\t\t\t\t\taria-describedby='srfm-error-9ede35ac'\t\t\t\t\tdata-required=\"true\" aria-required=\"true\" data-unique=\"false\" maxlength=\"100\" value=\"\"  placeholder=\"Nombre de la Mascota *\"  data-srfm-mask=\"none\"   \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-9ede35ac\" data-error-msg=\"This field is required.\" data-unique-msg=\"Value needs to be unique.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"aa7ffdae\" class=\"srfm-block-single srfm-block srfm-input-block srf-input-aa7ffdae-block  srfm-block-width-100 srfm-slug-fecha-de-nacimiento-y-o-edad-de-la-mascota 12430\" >\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<input class=\"srfm-input-common srfm-input-input\" type=\"text\" name=\"srfm-input-aa7ffdae-lbl-RmVjaGEgZGUgTmFjaW1pZW50byB5L28gRWRhZCBkZSBsYSBNYXNjb3Rh-fecha-de-nacimiento-y-o-edad-de-la-mascota\" id=\"srfm-input-aa7ffdae-lbl-RmVjaGEgZGUgTmFjaW1pZW50byB5L28gRWRhZCBkZSBsYSBNYXNjb3Rh\"\n\t\t\t\t\taria-describedby='srfm-error-aa7ffdae'\t\t\t\t\tdata-required=\"true\" aria-required=\"true\" data-unique=\"false\" maxlength=\"100\" value=\"\"  placeholder=\"Fecha de Nacimiento y\/o Edad de la Mascota *\"  data-srfm-mask=\"none\"   \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-aa7ffdae\" data-error-msg=\"This field is required.\" data-unique-msg=\"Value needs to be unique.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"d9ea99f9\" class=\"srfm-block-single srfm-block srfm-input-block srf-input-d9ea99f9-block  srfm-block-width-100 srfm-slug-raza 12430\" >\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<input class=\"srfm-input-common srfm-input-input\" type=\"text\" name=\"srfm-input-d9ea99f9-lbl-UmF6YQ-raza\" id=\"srfm-input-d9ea99f9-lbl-UmF6YQ\"\n\t\t\t\t\taria-describedby='srfm-error-d9ea99f9'\t\t\t\t\tdata-required=\"true\" aria-required=\"true\" data-unique=\"false\" maxlength=\"100\" value=\"\"  placeholder=\"Raza *\"  data-srfm-mask=\"none\"   \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-d9ea99f9\" data-error-msg=\"This field is required.\" data-unique-msg=\"Value needs to be unique.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"750ca34f\" class=\"srfm-block-single srfm-block srfm-dropdown-block srf-dropdown-750ca34f-block  srfm-block-width-100 srfm-slug-especie 12430\">\n\t\t\t\t<fieldset>\n\t\t\t\t\t<input class=\"srfm-input-dropdown-hidden\" data-required=\"true\" aria-required=\"true\"  name=\"srfm-dropdown-3-750ca34f-lbl-RXNwZWNpZQ-especie\" type=\"hidden\" value=\"\"\/>\n\t\t\t\t\t<legend class=\"srfm-block-legend\">\n\t\t\t\t\t\t\t\t\t\t\t<\/legend>\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap srfm-dropdown-common-wrap\">\n\t\t\t\t\t\t\t\t\t\t<select\n\t\t\t\t\t\tclass=\"srfm-dropdown-common srfm-dropdown-input\"\n\t\t\t\t\t\taria-describedby='srfm-error-750ca34f'\t\t\t\tdata-required=\"true\" aria-required=\"true\"  name=\"srfm-dropdown-3-750ca34f-lbl-RXNwZWNpZQ-especie\" data-multiple=\"false\" data-searchable=\"true\"\n\t\t\t\t\t\t\t\t\t\t\t\ttabindex=\"0\" aria-hidden=\"true\">\n\t\t\t\t\t<option class=\"srfm-dropdown-placeholder\" value=\"\" disabled selected>Especie<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Canino\" data-icon=\"\t\t\t\t&lt;svg xmlns=&quot;https:\/\/www.w3.org\/2000\/svg&quot; viewBox= &quot;0 0 576 512&quot;&gt;&lt;path d=&quot;M332.7 19.85C334.6 8.395 344.5 0 356.1 0C363.6 0 370.6 3.52 375.1 9.502L392 32H444.1C456.8 32 469.1 37.06 478.1 46.06L496 64H552C565.3 64 576 74.75 576 88V112C576 156.2 540.2 192 496 192H426.7L421.6 222.5L309.6 158.5L332.7 19.85zM448 64C439.2 64 432 71.16 432 80C432 88.84 439.2 96 448 96C456.8 96 464 88.84 464 80C464 71.16 456.8 64 448 64zM416 256.1V480C416 497.7 401.7 512 384 512H352C334.3 512 320 497.7 320 480V364.8C295.1 377.1 268.8 384 240 384C211.2 384 184 377.1 160 364.8V480C160 497.7 145.7 512 128 512H96C78.33 512 64 497.7 64 480V249.8C35.23 238.9 12.64 214.5 4.836 183.3L.9558 167.8C-3.331 150.6 7.094 133.2 24.24 128.1C41.38 124.7 58.76 135.1 63.05 152.2L66.93 167.8C70.49 182 83.29 191.1 97.97 191.1H303.8L416 256.1z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\n\t\t\t\t\t\"  >Canino<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Felino\" data-icon=\"\t\t\t\t&lt;svg xmlns=&quot;https:\/\/www.w3.org\/2000\/svg&quot; viewBox= &quot;0 0 576 512&quot;&gt;&lt;path d=&quot;M322.6 192C302.4 192 215.8 194 160 278V192c0-53-43-96-96-96C46.38 96 32 110.4 32 128s14.38 32 32 32s32 14.38 32 32v256c0 35.25 28.75 64 64 64h176c8.875 0 16-7.125 16-15.1V480c0-17.62-14.38-32-32-32h-32l128-96v144c0 8.875 7.125 16 16 16h32c8.875 0 16-7.125 16-16V289.9c-10.25 2.625-20.88 4.5-32 4.5C386.2 294.4 334.5 250.4 322.6 192zM480 96h-64l-64-64v134.4c0 53 43 95.1 96 95.1s96-42.1 96-95.1V32L480 96zM408 176c-8.875 0-16-7.125-16-16s7.125-16 16-16s16 7.125 16 16S416.9 176 408 176zM488 176c-8.875 0-16-7.125-16-16s7.125-16 16-16s16 7.125 16 16S496.9 176 488 176z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\n\t\t\t\t\t\"  >Felino<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-750ca34f\" data-error-msg=\"This field is required.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/fieldset>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"57edd5c9\" class=\"srfm-block-single srfm-block srfm-dropdown-block srf-dropdown-57edd5c9-block  srfm-block-width-100 srfm-slug-sexo-mascota 12430\">\n\t\t\t\t<fieldset>\n\t\t\t\t\t<input class=\"srfm-input-dropdown-hidden\" data-required=\"true\" aria-required=\"true\"  name=\"srfm-dropdown-4-57edd5c9-lbl-U2V4byBNYXNjb3Rh-sexo-mascota\" type=\"hidden\" value=\"\"\/>\n\t\t\t\t\t<legend class=\"srfm-block-legend\">\n\t\t\t\t\t\t\t\t\t\t\t<\/legend>\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap srfm-dropdown-common-wrap\">\n\t\t\t\t\t\t\t\t\t\t<select\n\t\t\t\t\t\tclass=\"srfm-dropdown-common srfm-dropdown-input\"\n\t\t\t\t\t\taria-describedby='srfm-error-57edd5c9'\t\t\t\tdata-required=\"true\" aria-required=\"true\"  name=\"srfm-dropdown-4-57edd5c9-lbl-U2V4byBNYXNjb3Rh-sexo-mascota\" data-multiple=\"false\" data-searchable=\"true\"\n\t\t\t\t\t\t\t\t\t\t\t\ttabindex=\"0\" aria-hidden=\"true\">\n\t\t\t\t\t<option class=\"srfm-dropdown-placeholder\" value=\"\" disabled selected>Sexo Mascota<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Hembra\" data-icon=\"\"  >Hembra<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<option value=\"Macho\" data-icon=\"\"  >Macho<\/option>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/select>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-57edd5c9\" data-error-msg=\"This field is required.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/fieldset>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"1d2ea308\" class=\"srfm-block-single srfm-block srfm-input-block srf-input-1d2ea308-block  srfm-block-width-100 srfm-slug-color 12430\" >\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<input class=\"srfm-input-common srfm-input-input\" type=\"text\" name=\"srfm-input-1d2ea308-lbl-Q29sb3I-color\" id=\"srfm-input-1d2ea308-lbl-Q29sb3I\"\n\t\t\t\t\taria-describedby='srfm-error-1d2ea308'\t\t\t\t\tdata-required=\"true\" aria-required=\"true\" data-unique=\"false\" maxlength=\"100\" value=\"\"  placeholder=\"Color *\"  data-srfm-mask=\"none\"   \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-1d2ea308\" data-error-msg=\"This field is required.\" data-unique-msg=\"Value needs to be unique.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\n\t\t\t<div data-block-id=\"3a2a5e21\" class=\"srfm-block-single srfm-block srfm-input-block srf-input-3a2a5e21-block  srfm-block-width-100 srfm-slug-peso-mascota-kg 12430\" >\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<input class=\"srfm-input-common srfm-input-input\" type=\"text\" name=\"srfm-input-3a2a5e21-lbl-UGVzbyBNYXNjb3RhIChLZyk-peso-mascota-kg\" id=\"srfm-input-3a2a5e21-lbl-UGVzbyBNYXNjb3RhIChLZyk\"\n\t\t\t\t\taria-describedby='srfm-error-3a2a5e21'\t\t\t\t\tdata-required=\"true\" aria-required=\"true\" data-unique=\"false\" maxlength=\"100\" value=\"\"  placeholder=\"Peso Mascota (Kg) *\"  data-srfm-mask=\"none\"   \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-error-message\" data-srfm-id=\"srfm-error-3a2a5e21\" data-error-msg=\"This field is required.\" data-unique-msg=\"Value needs to be unique.\">\n\t\t\t\t\t\tThis field is required.\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\n\t\t<div data-block-id=\"3b2c4882\" class=\"srfm-block-single srfm-block srfm-textarea-block srf-textarea-3b2c4882-block  srfm-block-width-100 12430\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"srfm-description\" id=\"srfm-description-3b2c4882\">\n\t\t\t\t\t\tProporciona cualquier detalle adicional que debamos saber sobre su mascota\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"srfm-block-wrap\">\n\t\t\t\t<textarea\n\t\t\t\t\tclass=\"srfm-input-common srfm-input-textarea\"\n\t\t\t\t\tname=\"srfm-textarea-3b2c4882-lbl-Tm90YXMgQWRpY2lvbmFsZXM-notas-adicionales\"\n\t\t\t\t\tid=\"srfm-textarea-3b2c4882-lbl-Tm90YXMgQWRpY2lvbmFsZXM-2358\"\n\t\t\t\t\taria-describedby='srfm-error-3b2c4882 srfm-description-3b2c4882'\t\t\t\t\tdata-required=\"false\" aria-required=\"false\"  rows=\"4\"   placeholder=\"Notas Adicionales\" \t\t\t\t\t\t\t\t\t\t\t\t\t\t\t><\/textarea>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t<div class=\"srfm-error-wrap\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"srfm-submit-container \" style=\"\">\n\t\t\t\t\t\t<div style=\"width: ; text-align: center\" class=\"wp-block-button\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<button style=\"\" id=\"srfm-submit-btn\" class=\"srfm-btn-frontend srfm-button srfm-submit-button\"\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t\t\t\t<div class=\"srfm-submit-wrap\">\n\t\t\t\t\t\t\t\t\tEnviar\t\t\t\t\t\t\t\t<div class=\"srfm-loader\"><\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<p id=\"srfm-error-message\" class=\"srfm-common-error-message srfm-error-message srfm-footer-error\" hidden>\t\t<span class=\"srfm-icon\" aria-hidden=\"true\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" fill=\"none\"><path d=\"M9.99935 18.3327C14.6017 18.3327 18.3327 14.6017 18.3327 9.99935C18.3327 5.39698 14.6017 1.66602 9.99935 1.66602C5.39698 1.66602 1.66602 5.39698 1.66602 9.99935C1.66602 14.6017 5.39698 18.3327 9.99935 18.3327Z\" stroke=\"currentColor\" stroke-width=\"1.5\" stroke-linecap=\"round\" stroke-linejoin=\"round\" \/><path d=\"M10 6.66602V9.99935\" stroke=\"currentColor\" 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Please try again.<\/span><\/p>\n\t\t\t\t\t<\/form>\n\t\t\t<div class=\"srfm-single-form srfm-success-box in-page\">\n\t\t\t\t<div aria-live=\"polite\" aria-atomic=\"true\" role=\"alert\" id=\"srfm-success-message-page-12430\" class=\"srfm-success-box-description\"><\/div>\n\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<style>.wp-block-uagb-advanced-heading .uagb-heading-text{margin:0;word-wrap:break-word}.wp-block-uagb-advanced-heading .uagb-desc-text{margin:0}.wp-block-uagb-advanced-heading .uagb-separator{font-size:0;border-top-style:solid;display:inline-block;margin:0 0 10px 0}.wp-block-uagb-advanced-heading .srfm-highlight{color:#f78a0c;border:0;transition:all 0.3s ease}.uag-highlight-toolbar{border-left:0;border-top:0;border-bottom:0;border-radius:0;border-right-color:#1e1e1e}.uag-highlight-toolbar .components-button{border-radius:0;outline:none}.uag-highlight-toolbar .components-button.is-primary{color:#fff}\n .uagb-block-4190ddf1.wp-block-uagb-advanced-heading 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