{"id":86823,"date":"2026-10-20T16:13:06","date_gmt":"2026-10-20T16:13:06","guid":{"rendered":"https:\/\/dentakademiglobal.com\/?page_id=86823"},"modified":"2026-10-20T16:14:11","modified_gmt":"2026-10-20T16:14:11","slug":"patient-feedback-form","status":"publish","type":"page","link":"https:\/\/dentakademiglobal.com\/es\/patient-feedback-form\/","title":{"rendered":"Formulario de opini\u00f3n del paciente"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"86823\" class=\"elementor elementor-86823\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-84b1a75 e-flex e-con-boxed e-con e-parent\" data-id=\"84b1a75\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4f48761 elementor-widget elementor-widget-shortcode\" data-id=\"4f48761\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><style>\r\n.dak-fb{max-width:760px;margin:0 auto;font-size:16px;line-height:1.5;color:#1f2937}\r\n.dak-fb h2{font-size:26px;margin:0 0 8px}\r\n.dak-fb h3{font-size:19px;margin:24px 0 4px}\r\n.dak-fb .dak-top{display:flex;justify-content:flex-end;margin-bottom:8px}\r\n.dak-fb .dak-top a{font-size:14px;text-decoration:underline}\r\n.dak-fb .dak-intro,.dak-fb .dak-note{color:#4b5563;margin:0 0 16px}\r\n.dak-fb .dak-note{font-style:italic;font-size:14px}\r\n.dak-fb .dak-row{display:grid;grid-template-columns:1fr 1fr 1fr;gap:16px}\r\n.dak-fb .dak-f{margin-bottom:16px}\r\n.dak-fb label{display:block;font-weight:600;margin-bottom:6px}\r\n.dak-fb input[type=text],.dak-fb input[type=tel],.dak-fb input[type=email],.dak-fb input[type=date],.dak-fb input[type=time],.dak-fb textarea{width:100%;box-sizing:border-box;padding:10px 12px;border:1px solid #d1d5db;border-radius:8px;font:inherit;background:#fff}\r\n.dak-fb textarea{min-height:150px;resize:vertical}\r\n.dak-fb input:focus,.dak-fb textarea:focus{outline:2px solid #2563eb33;border-color:#2563eb}\r\n.dak-fb .dak-radios{display:flex;flex-wrap:wrap;gap:18px}\r\n.dak-fb .dak-radios label,.dak-fb .dak-consent label{font-weight:400;display:flex;align-items:flex-start;gap:8px;margin:0}\r\n.dak-fb hr{border:0;border-top:1px solid #e5e7eb;margin:24px 0}\r\n.dak-fb .dak-req{color:#dc2626}\r\n.dak-fb button{background:#0f172a;color:#fff;border:0;border-radius:8px;padding:12px 28px;font:inherit;font-weight:600;cursor:pointer}\r\n.dak-fb button:hover{opacity:.9}\r\n.dak-fb .dak-msg{padding:14px 16px;border-radius:8px;margin-bottom:20px}\r\n.dak-fb .dak-ok{background:#ecfdf5;border:1px solid #10b981;color:#065f46}\r\n.dak-fb .dak-err{background:#fef2f2;border:1px solid #ef4444;color:#991b1b}\r\n.dak-fb .dak-hp{position:absolute!important;left:-9999px!important;height:0;overflow:hidden}\r\n@media(max-width:640px){.dak-fb .dak-row{grid-template-columns:1fr}}\r\n<\/style>\r\n<div class=\"dak-fb\" id=\"dak-fb\" dir=\"ltr\" lang=\"es\" data-no-translation>\r\n\t\t<div class=\"dak-top\"><a href=\"https:\/\/www.dentakademi.com.tr\/dilek-oneri-ve-sikayet-formu\/\" hreflang=\"tr\">T\u00fcrk\u00e7e<\/a><\/div>\r\n\t\t<h2>Formulario de solicitudes, sugerencias y quejas<\/h2>\r\n\t<p class=\"dak-intro\">Sus comentarios nos ayudan a mejorar la calidad de nuestros servicios. Todas las solicitudes son revisadas por nuestra Unidad de Calidad.<\/p>\r\n\r\n\t\r\n\t<form method=\"post\" action=\"\/es\/wp-json\/wp\/v2\/pages\/86823\" novalidate>\r\n\t\t<div class=\"dak-row\">\r\n\t\t\t<div class=\"dak-f\"><label for=\"dak_date\">Fecha<\/label><input type=\"date\" id=\"dak_date\" name=\"dak_date\"><\/div>\r\n\t\t\t<div class=\"dak-f\"><label for=\"dak_time\">Hora<\/label><input type=\"time\" id=\"dak_time\" name=\"dak_time\"><\/div>\r\n\t\t\t<div class=\"dak-f\"><label for=\"dak_ref\">N.\u00ba de seguimiento (opcional)<\/label><input type=\"text\" id=\"dak_ref\" name=\"dak_ref\" maxlength=\"40\"><\/div>\r\n\t\t<\/div>\r\n\t\t<hr>\r\n\t\t<div class=\"dak-f\">\r\n\t\t\t<label>Solicitante<\/label>\r\n\t\t\t<div class=\"dak-radios\">\r\n\t\t\t\t<label><input type=\"radio\" name=\"dak_applicant\" value=\"patient\" checked> Paciente<\/label>\r\n\t\t\t\t<label><input type=\"radio\" name=\"dak_applicant\" value=\"relative\"> Familiar del paciente<\/label>\r\n\t\t\t\t<label><input type=\"radio\" name=\"dak_applicant\" value=\"staff\"> Empleado<\/label>\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t<div class=\"dak-f\"><label for=\"dak_subject\">Asunto de la solicitud <span class=\"dak-req\">*<\/span><\/label><input type=\"text\" id=\"dak_subject\" name=\"dak_subject\" required maxlength=\"200\"><\/div>\r\n\t\t<div class=\"dak-f\"><label for=\"dak_message\">Su solicitud \/ sugerencia \/ queja <span class=\"dak-req\">*<\/span><\/label><textarea id=\"dak_message\" name=\"dak_message\" required maxlength=\"5000\"><\/textarea><\/div>\r\n\t\t<hr>\r\n\t\t<h3>Datos de contacto<\/h3>\r\n\t\t<p class=\"dak-note\">Para que podamos responderle, indique su nombre completo y su n\u00famero de tel\u00e9fono.<\/p>\r\n\t\t<div class=\"dak-f\"><label for=\"dak_name\">Nombre y apellidos <span class=\"dak-req\">*<\/span><\/label><input type=\"text\" id=\"dak_name\" name=\"dak_name\" required maxlength=\"120\" autocomplete=\"name\"><\/div>\r\n\t\t<div class=\"dak-row\" style=\"grid-template-columns:1fr 1fr\">\r\n\t\t\t<div class=\"dak-f\"><label for=\"dak_phone\">Tel\u00e9fono <span class=\"dak-req\">*<\/span><\/label><input type=\"tel\" id=\"dak_phone\" name=\"dak_phone\" required maxlength=\"30\" autocomplete=\"tel\" placeholder=\"+44 7700 900000\" dir=\"ltr\"><\/div>\r\n\t\t\t<div class=\"dak-f\"><label for=\"dak_email\">Correo electr\u00f3nico<\/label><input type=\"email\" id=\"dak_email\" name=\"dak_email\" maxlength=\"120\" autocomplete=\"email\" dir=\"ltr\"><\/div>\r\n\t\t<\/div>\r\n\t\t<div class=\"dak-f dak-consent\"><label><input type=\"checkbox\" name=\"dak_consent\" value=\"1\" required> <span>Doy mi consentimiento para el tratamiento de mis datos personales con el fin de evaluar esta solicitud. <span class=\"dak-req\">*<\/span><\/span><\/label><\/div>\r\n\t\t<div class=\"dak-hp\" aria-hidden=\"true\"><input type=\"text\" name=\"dak_fb_website\" tabindex=\"-1\" autocomplete=\"off\"><\/div>\r\n\t\t<input type=\"hidden\" name=\"dak_fb_t\" value=\"1792625069\">\r\n\t\t<input type=\"hidden\" name=\"dak_fb_submit\" value=\"1\">\r\n\t\t<button type=\"submit\">Enviar<\/button>\r\n\t<\/form>\r\n<\/div>\r\n<script>\r\n(function(){var d=new Date(),p=function(n){return String(n).padStart(2,'0');};\r\nvar de=document.getElementById('dak_date'),te=document.getElementById('dak_time');\r\nif(de&&!de.value){de.value=d.getFullYear()+'-'+p(d.getMonth()+1)+'-'+p(d.getDate());}\r\nif(te&&!te.value){te.value=p(d.getHours())+':'+p(d.getMinutes());}\r\nvar f=document.querySelector('#dak-fb form');if(f){f.addEventListener('submit',function(e){if(!f.checkValidity()){e.preventDefault();f.reportValidity();}});}\r\n})();\r\n<\/script>\r\n\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\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","footnotes":""},"class_list":["post-86823","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - 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