{"id":3824,"date":"2024-06-07T15:41:20","date_gmt":"2024-06-07T15:41:20","guid":{"rendered":"https:\/\/medveterapia.utad.pt\/?page_id=3824"},"modified":"2024-06-07T15:52:54","modified_gmt":"2024-06-07T15:52:54","slug":"pacform","status":"publish","type":"page","link":"https:\/\/medveterapia.utad.pt\/?page_id=3824","title":{"rendered":"PACFORM"},"content":{"rendered":"<style type=\"text\/css\">#ipt_fsqm_form_wrap_2 .ipt_fsqm_form_logo img,\n\t#ipt_fsqm_form_wrap_2 .ipt-eform-width-restrain,\n\t#ipt_fsqm_form_wrap_2 .ipt_fsqm_form_message_restore,\n\t#ipt_fsqm_form_wrap_2 .ipt_fsqm_form_message_success,\n\t#ipt_fsqm_form_wrap_2 .ipt_fsqm_form_message_error,\n\t#ipt_fsqm_form_wrap_2 .ipt_fsqm_form_message_process,\n\t#ipt_fsqm_form_wrap_2 .ipt_fsqm_form_validation_error,\n\t#ipt_fsqm_form_wrap_2 .eform-ui-estimator {\n\t\tmax-width: 980px;\n\t\tmin-width: 240px;\n\t}\n\n\t\/**\/<\/style><div\nid=\"ipt_fsqm_form_wrap_2\"\nclass=\"ipt_uif_front ipt_uif_common ipt_fsqm_form type_2 ui-front eform-ltr eform-override-element-boxy eform-override-alignment-inherit\"\ndata-fsqmsayt=\"{&quot;auto_save&quot;:false,&quot;show_restore&quot;:true,&quot;restore&quot;:false,&quot;admin_override&quot;:false,&quot;user_update&quot;:false,&quot;interval_save&quot;:false,&quot;interval&quot;:&quot;30&quot;}\"\ndata-ui-type=\"2\"\ndata-ui-theme=\"[&quot;https:\\\/\\\/medveterapia.utad.pt\\\/wp-content\\\/uploads\\\/eform-custom-material\\\/form-theme-2.css?checksum=4077540025&amp;ver=4.17.0&quot;]\"\ndata-ui-theme-id=\"material-custom\"\ndata-eformanim=\"1\"\ndata-fsqmga=\"{&quot;enabled&quot;:false,&quot;manual_load&quot;:false,&quot;tracking_id&quot;:&quot;&quot;,&quot;cookie&quot;:&quot;auto&quot;,&quot;user_update&quot;:false,&quot;name&quot;:&quot;PACFORM&quot;,&quot;form_id&quot;:&quot;2&quot;}\"\ndata-fsqmreset=\"{&quot;reset&quot;:false,&quot;delay&quot;:10}\"\ndata-eformreg=\"{&quot;enabled&quot;:false,&quot;username_id&quot;:&quot;ipt_fsqm_form_2_pinfo_&quot;,&quot;password_id&quot;:&quot;ipt_fsqm_form_2_pinfo_&quot;,&quot;hide_pinfo&quot;:false,&quot;hide_meta&quot;:false,&quot;meta&quot;:[]}\"\ndata-eformscroll=\"{&quot;progress&quot;:true,&quot;message&quot;:true,&quot;offset&quot;:&quot;0&quot;,&quot;scrollOnError&quot;:true}\"\ndata-eform-cookie=\"0\"\ndata-subscription-form=\"false\"\ndata-instant-subscription=\"{&quot;doable&quot;:true,&quot;config&quot;:{&quot;enabled&quot;:false,&quot;min_tab&quot;:&quot;&quot;,&quot;debounce&quot;:&quot;3000&quot;},&quot;nonce&quot;:&quot;ce0e9e4617&quot;}\"\n>\n<noscript><div\nclass=\"ipt_fsqm_form_message_noscript ui-widget ui-widget-content ui-corner-all\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div>Javascript is disabled<\/div><\/div><div\nclass=\"ui-widget-content ui-corner-bottom\"><p>Javascript is disabled on your browser. Please enable it in order to use this form.<\/p><\/div><\/div>\n<\/noscript><style type=\"text\/css\">.ipt_uif_ajax_loader,\n\t\t\t.ipt_uif_ajax_loader *,\n\t\t\tipt_uif_ajax_loader *::before,\n\t\t\tipt_uif_ajax_loader *::after {\n\t\t\t\tbox-sizing: border-box;\n\t\t\t}<\/style><div\nclass=\"ipt_uif_init_loader ipt-eform-preloader-inline ipt_uif_ajax_loader\"><div\nclass=\"ipt-eform-preloader-inner\"><div\nclass=\"ipt-eform-preloader-circle\"><div\nclass=\"preloader-wrapper active\"><div\nclass=\"spinner-layer spinner-blue\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-red\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-yellow\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-green\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><\/div><\/div><div\nclass=\"ipt-eform-preloader-text\"><div\nclass=\"ipt-eform-preloader-text-inner ipt_uif_ajax_loader_text\">Loading<\/div><\/div><div\nclass=\"clear\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_uif_conditional_logic\" id=\"ipt_uif_conditional_logic_2\" value=\"{&quot;logics&quot;:[],&quot;indexes&quot;:[],&quot;base&quot;:&quot;2&quot;}\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_timer_data\" id=\"ipt_fsqm_timer_data_2\" value=\"{&quot;type&quot;:&quot;none&quot;}\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_epoc_data\" id=\"ipt_fsqm_epoc_data_2\" value=\"{&quot;CURRENTYEAR&quot;:2026,&quot;CURRENTDATE&quot;:1778208026000,&quot;CURRENTDAY&quot;:8,&quot;CURRENTMONTH&quot;:5,&quot;CURRENTHOUR&quot;:2,&quot;CURRENTMINUTE&quot;:40,&quot;CURRENTSECOND&quot;:26,&quot;CURRENTWEEK&quot;:19,&quot;CURRENTEPOC&quot;:20581}\" \/><div\nstyle=\"display: none;\" class=\"ipt_uif_hidden_init\"><form\nmethod=\"post\" action=\"\" class=\"ipt_uif_validate_form ipt_fsqm_main_form\" id=\"ipt_fsqm_form_2\" autocomplete=\"on\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"action\" id=\"action\" value=\"ipt_fsqm_save_form\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_epoc\" class=\"eform-epoc-value\" value=\"1778208026\" \/>\n<input\ntype=\"hidden\" class=\"ipt_fsqm_form_tab_pos\" name=\"fsqm_form2_tab_pos\" value=\"0\" id=\"fsqm_form2_tab_pos\" \/>\n<input\ntype=\"hidden\" id=\"ipt_fsqm_form_data_save\" name=\"ipt_fsqm_form_data_save\" value=\"5c436e9253\" data-sayt-exclude \/>\t\t\t<input\ntype=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F3824\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"form_id\" value=\"2\" \/><div\nclass=\"ipt-eform-width-restrain\"><div\nclass=\"ipt-eform-content \"><div\ndata-settings=\"{&quot;can_previous&quot;:true,&quot;show_progress_bar&quot;:false,&quot;progress_bar_bottom&quot;:false,&quot;block_previous&quot;:false,&quot;any_tab&quot;:false,&quot;type&quot;:&quot;2&quot;,&quot;scroll&quot;:true,&quot;decimal_point&quot;:2,&quot;auto_progress&quot;:false,&quot;auto_progress_delay&quot;:&quot;1500&quot;,&quot;auto_submit&quot;:false,&quot;hidden_buttons&quot;:false,&quot;scroll_on_error&quot;:true}\" class=\"ipt_fsqm_main_tab ipt_uif_tabs horizontal\"><div\nclass=\"ipt-eform-tab-nav-wrap\"><ul><li\nid=\"ipt_fsqm_form_2_tab_0_control_li\"><a\nclass=\"eform-ripple\" href=\"#ipt_fsqm_form_2_tab_0\"><span\nclass=\"eform-tab-labels\"> <\/span><\/a><\/li><\/ul>\n<i\nclass=\"eform-tab-nav eform-tab-nav-right ipt-icomoon-angle-right disabled eform-ripple\"><\/i>\n<i\nclass=\"eform-tab-nav eform-tab-nav-left ipt-icomoon-angle-left disabled eform-ripple\"><\/i>\n<span\nclass=\"eform-tab-passive-notifier\"><\/span>\n<span\nclass=\"eform-tab-active-notifier\"><\/span><\/div><div\nid=\"ipt_fsqm_form_2_tab_0\" class=\"ipt_fsqm_form_tab_panel\"><div\nid=\"ipt_fsqm_form_2_layout_0_inner\" class=\"ipt-eform-layout-wrapper\"><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][42][m_type]\" id=\"ipt_fsqm_form_2_design_42_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][42][type]\" id=\"ipt_fsqm_form_2_design_42_type\" value=\"richtext\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional\" id=\"ipt_fsqm_form_2_design_42\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_richtext\"><p><strong>Prescri\u00e7\u00e3o Animal de Companhia<\/strong><\/p><p><img\nclass=\"alignnone wp-image-4071 size-full\" src=\"http:\/\/localhost\/vetcard\/wp-content\/uploads\/2022\/05\/logovete-2.png\" alt=\"\" width=\"201\" height=\"64\" \/><\/p><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][0][m_type]\" id=\"ipt_fsqm_form_2_design_0_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][0][type]\" id=\"ipt_fsqm_form_2_design_0_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_0\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][1][m_type]\" id=\"ipt_fsqm_form_2_freetype_1_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][1][type]\" id=\"ipt_fsqm_form_2_freetype_1_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_2_freetype_1\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_1_value\">Detentor<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_2[freetype][1][value]\"\nid=\"ipt_fsqm_form_2_freetype_1_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe7fd;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[pinfo][0][m_type]\" id=\"ipt_fsqm_form_2_pinfo_0_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[pinfo][0][type]\" id=\"ipt_fsqm_form_2_pinfo_0_type\" value=\"phone\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_phone\" id=\"ipt_fsqm_form_2_pinfo_0\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_pinfo_0_value\">Telefone<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required,custom[phone]] ipt_uif_text\"\ntype=\"tel\"\nname=\"ipt_fsqm_form_2[pinfo][0][value]\"\nid=\"ipt_fsqm_form_2_pinfo_0_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe1e0;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][3][m_type]\" id=\"ipt_fsqm_form_2_freetype_3_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][3][type]\" id=\"ipt_fsqm_form_2_freetype_3_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_2_freetype_3\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_3_value\">Explora\u00e7\u00e3o<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_2[freetype][3][value]\"\nid=\"ipt_fsqm_form_2_freetype_3_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][4][m_type]\" id=\"ipt_fsqm_form_2_freetype_4_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][4][type]\" id=\"ipt_fsqm_form_2_freetype_4_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_2_freetype_4\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_4_value\">Identifica\u00e7\u00e3o<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_2[freetype][4][value]\"\nid=\"ipt_fsqm_form_2_freetype_4_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][1][m_type]\" id=\"ipt_fsqm_form_2_design_1_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][1][type]\" id=\"ipt_fsqm_form_2_design_1_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_1\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][2][m_type]\" id=\"ipt_fsqm_form_2_freetype_2_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][2][type]\" id=\"ipt_fsqm_form_2_freetype_2_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_2_freetype_2\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_2_value\">NIF<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required,custom[number]] ipt_uif_text\"\nmin=\"\" max=\"\" step=\"any\"\t\t\t\ttype=\"number\"\nname=\"ipt_fsqm_form_2[freetype][2][value]\"\nid=\"ipt_fsqm_form_2_freetype_2_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xf09d;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[pinfo][1][m_type]\" id=\"ipt_fsqm_form_2_pinfo_1_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[pinfo][1][type]\" id=\"ipt_fsqm_form_2_pinfo_1_type\" value=\"email\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_email\" id=\"ipt_fsqm_form_2_pinfo_1\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_pinfo_1_value\">Email<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required,custom[email]] ipt_uif_text\"\ntype=\"email\"\nname=\"ipt_fsqm_form_2[pinfo][1][value]\"\nid=\"ipt_fsqm_form_2_pinfo_1_value\"\nvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xf0e0;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][5][m_type]\" id=\"ipt_fsqm_form_2_freetype_5_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][5][type]\" id=\"ipt_fsqm_form_2_freetype_5_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_2_freetype_5\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_5_value\">Esp\u00e9cie<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_2[freetype][5][value]\"\nid=\"ipt_fsqm_form_2_freetype_5_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][2][m_type]\" id=\"ipt_fsqm_form_2_design_2_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][2][type]\" id=\"ipt_fsqm_form_2_design_2_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_2\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[pinfo][2][m_type]\" id=\"ipt_fsqm_form_2_pinfo_2_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[pinfo][2][type]\" id=\"ipt_fsqm_form_2_pinfo_2_type\" value=\"datetime\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_datetime\" id=\"ipt_fsqm_form_2_pinfo_2\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_centered\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_pinfo_2_value\">Emiss\u00e3o<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field eform-dp-input-field has-icon\">\n<input\nclass=\"datepicker ipt_uif_datepicker  check_me validate[required] is-empty ipt_uif_text\"\ndata-dateFormat=\"yy-mm-dd\" data-timeFormat=\"HH:mm:ss\" data-year_range=\"50\"\t\ttype=\"text\"\nreadonly=\"readonly\"\nname=\"ipt_fsqm_form_2[pinfo][2][value]\"\nid=\"ipt_fsqm_form_2_pinfo_2_value\"\nmaxlength=\"524288\"\nvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipt-icomoon-calendar ipticm prefix\"><\/i>\n<a\nhref=\"javascript:;\" class=\"eform-dp-clear\" title=\"Clear\">&times;<\/a><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][30][m_type]\" id=\"ipt_fsqm_form_2_design_30_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][30][type]\" id=\"ipt_fsqm_form_2_design_30_type\" value=\"richtext\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional\" id=\"ipt_fsqm_form_2_design_30\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_richtext\"><div\nclass=\"wpkqcg_qrcode_wrapper\"><input\ntype=\"hidden\" id=\"wpkqcg_qrcode_outputimg_4769fd4d1ad194e38_ecclevel\" value=\"L\" \/><input\ntype=\"hidden\" id=\"wpkqcg_qrcode_outputimg_4769fd4d1ad194e38_size\" value=\"\" \/><input\ntype=\"hidden\" id=\"wpkqcg_qrcode_outputimg_4769fd4d1ad194e38_color\" value=\"\" \/><input\ntype=\"hidden\" id=\"wpkqcg_qrcode_outputimg_4769fd4d1ad194e38_bgcolor\" value=\"\" \/><input\ntype=\"hidden\" id=\"wpkqcg_qrcode_outputimg_4769fd4d1ad194e38_content\" value=\"https:\/\/medveterapia.utad.pt\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F3824#http:\/\/localhost\/vetcard\/index.php\/prescricao-animal-de-companhia\/\" \/><img\nsrc=\"\" id=\"wpkqcg_qrcode_outputimg_4769fd4d1ad194e38\" alt=\"QR Code\" class=\"wpkqcg_qrcode\" style=\"width: auto; height: auto; max-width: 100%;\" ><div\nstyle=\"clear: none;\"><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][32][m_type]\" id=\"ipt_fsqm_form_2_design_32_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][32][type]\" id=\"ipt_fsqm_form_2_design_32_type\" value=\"divider\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_divider\" id=\"ipt_fsqm_form_2_design_32\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"ipt_uif_divider ipt_uif_align_center ipt_uif_divider_no_icon ipt_uif_divider_has_scroll ipt_uif_divider_no_text eform-just-divider\">\n<a\nhref=\"#\" class=\"ipt_uif_scroll_to_top\"><i\nclass=\"ipticm ipt-icomoon-chevron-up suffix\"><\/i><\/a>\n<span\nclass=\"ipt_uif_divider_text\">\n<\/span><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][36][m_type]\" id=\"ipt_fsqm_form_2_design_36_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][36][type]\" id=\"ipt_fsqm_form_2_design_36_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_36\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][37][m_type]\" id=\"ipt_fsqm_form_2_design_37_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][37][type]\" id=\"ipt_fsqm_form_2_design_37_type\" value=\"richtext\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional\" id=\"ipt_fsqm_form_2_design_37\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_richtext\"><p><img\nclass=\"wp-image-3236  aligncenter\" src=\"http:\/\/localhost\/vetcard\/wp-content\/uploads\/2022\/03\/barcode-5.png\" alt=\"\" width=\"155\" height=\"88\" \/><\/p><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][35][m_type]\" id=\"ipt_fsqm_form_2_design_35_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][35][type]\" id=\"ipt_fsqm_form_2_design_35_type\" value=\"col_two_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_two_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_two_third\" id=\"ipt_fsqm_form_2_design_35\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][23][m_type]\" id=\"ipt_fsqm_form_2_freetype_23_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][23][type]\" id=\"ipt_fsqm_form_2_freetype_23_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_2_freetype_23\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_23_value\">M\u00e9dico Veterin\u00e1rio<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_2[freetype][23][value]\"\nid=\"ipt_fsqm_form_2_freetype_23_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xf0fa;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][38][m_type]\" id=\"ipt_fsqm_form_2_design_38_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][38][type]\" id=\"ipt_fsqm_form_2_design_38_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_2_design_38\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][25][m_type]\" id=\"ipt_fsqm_form_2_freetype_25_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][25][type]\" id=\"ipt_fsqm_form_2_freetype_25_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_2_freetype_25\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_25_value\">C\u00e9dula:<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required] ipt_uif_text\"\ntype=\"text\"\nname=\"ipt_fsqm_form_2[freetype][25][value]\"\nid=\"ipt_fsqm_form_2_freetype_25_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe8f7;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][39][m_type]\" id=\"ipt_fsqm_form_2_design_39_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][39][type]\" id=\"ipt_fsqm_form_2_design_39_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_2_design_39\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[pinfo][3][m_type]\" id=\"ipt_fsqm_form_2_pinfo_3_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[pinfo][3][type]\" id=\"ipt_fsqm_form_2_pinfo_3_type\" value=\"p_phone\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_p_phone\" id=\"ipt_fsqm_form_2_pinfo_3\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_pinfo_3_value\">Telefone:<span\nclass=\"ipt_uif_question_required\">*<\/span><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\">\n<input\nclass=\" check_me validate[required,custom[phone]] ipt_uif_text\"\ntype=\"tel\"\nname=\"ipt_fsqm_form_2[pinfo][3][value]\"\nid=\"ipt_fsqm_form_2_pinfo_3_value\"\nmaxlength=\"\"\t\tvalue=\"\" \/>\n<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe08c;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][7][m_type]\" id=\"ipt_fsqm_form_2_design_7_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][7][type]\" id=\"ipt_fsqm_form_2_design_7_type\" value=\"divider\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_divider\" id=\"ipt_fsqm_form_2_design_7\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"ipt_uif_divider ipt_uif_align_center ipt_uif_divider_no_icon ipt_uif_divider_has_scroll ipt_uif_divider_no_text eform-just-divider\">\n<a\nhref=\"#\" class=\"ipt_uif_scroll_to_top\"><i\nclass=\"ipticm ipt-icomoon-chevron-up suffix\"><\/i><\/a>\n<span\nclass=\"ipt_uif_divider_text\">\n<\/span><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][40][m_type]\" id=\"ipt_fsqm_form_2_design_40_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][40][type]\" id=\"ipt_fsqm_form_2_design_40_type\" value=\"collapsible\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_collapsible\" id=\"ipt_fsqm_form_2_design_40\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_container ipt_uif_collapsible ipt_uif_iconbox\" data-opened=\"\"><div\nclass=\"ipt_uif_container_head\"><h3><a\nhref=\"javascript:;\" class=\"ipt_uif_collapsible_handle_anchor\"><span\nclass=\"ipt-icomoon-arrow-down3 collapsible_state\"><\/span>\t\t\t\t\t\t<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe8b6;\"><\/i>\n<span\nclass=\"ipt_uif_container_label\">Seletor de Pesquisa<\/span>\t\t\t<\/a><\/h3><\/div><div\nclass=\"ipt_uif_container_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][41][m_type]\" id=\"ipt_fsqm_form_2_design_41_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][41][type]\" id=\"ipt_fsqm_form_2_design_41_type\" value=\"iconbox\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_iconbox\" id=\"ipt_fsqm_form_2_design_41\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt-eform-material-button-container align-center size-medium ipt_fsqm_form_button_container--flat eform-material-rounded-pb eform-material-alternate-pb\"><div\nclass=\"eform-button-container-inner\">\n<a\nhref=\"https:\/\/medvet.dgav.pt\/\"  class=\"ipt_uif_button eform-material-button eform-ripple eform-icmpopup\" data-height=\"800\" data-width=\"800\">\n<i\nclass=\"ipticm\" data-ipt-icomoon=\"&#xf022;\"><\/i>\t\tMedVet\t<\/a>\n<a\nhref=\"https:\/\/extranet.infarmed.pt\/INFOMED-fo\/\"  class=\"ipt_uif_button eform-material-button eform-ripple eform-icmpopup\" data-height=\"800\" data-width=\"800\">\n<i\nclass=\"ipticm\" data-ipt-icomoon=\"&#xf022;\"><\/i>\t\tINFOMED\t<\/a>\n<a\nhref=\"https:\/\/www.ema.europa.eu\/en\/veterinary-medicines-regulatory-information\"  class=\"ipt_uif_button eform-material-button eform-ripple eform-icmpopup\" data-height=\"800\" data-width=\"800\">\n<i\nclass=\"ipticm\" data-ipt-icomoon=\"&#xf022;\"><\/i>\t\tEMA\t<\/a><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][8][m_type]\" id=\"ipt_fsqm_form_2_design_8_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][8][type]\" id=\"ipt_fsqm_form_2_design_8_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_8\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][6][m_type]\" id=\"ipt_fsqm_form_2_freetype_6_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][6][type]\" id=\"ipt_fsqm_form_2_freetype_6_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_6\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_6_value\"><h5>Nome, Posologia, Notas, Terap\u00eauticas<\/h5><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][6][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_6_value\"><\/textarea><i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe056;\"><\/i>\n<label\nfor=\"ipt_fsqm_form_2_freetype_6_value\">Rx: <\/br> S\/<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][10][m_type]\" id=\"ipt_fsqm_form_2_freetype_10_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][10][type]\" id=\"ipt_fsqm_form_2_freetype_10_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_10\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][10][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_10_value\"><\/textarea><i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe056;\"><\/i>\n<label\nfor=\"ipt_fsqm_form_2_freetype_10_value\">Rx: <\/br> S\/<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][30][m_type]\" id=\"ipt_fsqm_form_2_freetype_30_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][30][type]\" id=\"ipt_fsqm_form_2_freetype_30_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_30\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][30][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_30_value\"><\/textarea><i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe056;\"><\/i>\n<label\nfor=\"ipt_fsqm_form_2_freetype_30_value\">Rx: <\/br> S\/<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][29][m_type]\" id=\"ipt_fsqm_form_2_freetype_29_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][29][type]\" id=\"ipt_fsqm_form_2_freetype_29_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_29\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][29][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_29_value\"><\/textarea><i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe056;\"><\/i>\n<label\nfor=\"ipt_fsqm_form_2_freetype_29_value\">Rx: <\/br> S\/<\/label><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][14][m_type]\" id=\"ipt_fsqm_form_2_design_14_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][14][type]\" id=\"ipt_fsqm_form_2_design_14_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_14\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][15][m_type]\" id=\"ipt_fsqm_form_2_design_15_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][15][type]\" id=\"ipt_fsqm_form_2_design_15_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_15\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][28][m_type]\" id=\"ipt_fsqm_form_2_freetype_28_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][28][type]\" id=\"ipt_fsqm_form_2_freetype_28_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_28\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_28_value\"><h5>Unidades<\/h5><p><\/p><\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][28][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_28_value\"><\/textarea><i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe056;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][16][m_type]\" id=\"ipt_fsqm_form_2_design_16_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][16][type]\" id=\"ipt_fsqm_form_2_design_16_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_16\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][17][m_type]\" id=\"ipt_fsqm_form_2_design_17_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][17][type]\" id=\"ipt_fsqm_form_2_design_17_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_17\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][13][m_type]\" id=\"ipt_fsqm_form_2_freetype_13_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][13][type]\" id=\"ipt_fsqm_form_2_freetype_13_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_13\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][13][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_13_value\"><\/textarea><i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe056;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][32][m_type]\" id=\"ipt_fsqm_form_2_freetype_32_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][32][type]\" id=\"ipt_fsqm_form_2_freetype_32_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_32\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][32][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_32_value\"><\/textarea><i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe056;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][31][m_type]\" id=\"ipt_fsqm_form_2_freetype_31_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][31][type]\" id=\"ipt_fsqm_form_2_freetype_31_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_31\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical ipt_uif_question_full\"><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field has-icon\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][31][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_31_value\"><\/textarea><i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe056;\"><\/i><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][19][m_type]\" id=\"ipt_fsqm_form_2_design_19_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][19][type]\" id=\"ipt_fsqm_form_2_design_19_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_19\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][20][m_type]\" id=\"ipt_fsqm_form_2_design_20_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][20][type]\" id=\"ipt_fsqm_form_2_design_20_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_20\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][21][m_type]\" id=\"ipt_fsqm_form_2_design_21_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][21][type]\" id=\"ipt_fsqm_form_2_design_21_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_21\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][9][m_type]\" id=\"ipt_fsqm_form_2_design_9_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][9][type]\" id=\"ipt_fsqm_form_2_design_9_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_9\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][10][m_type]\" id=\"ipt_fsqm_form_2_design_10_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][10][type]\" id=\"ipt_fsqm_form_2_design_10_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_10\"><div\nclass=\"ipt_uif_column_inner\"><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][23][m_type]\" id=\"ipt_fsqm_form_2_design_23_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][23][type]\" id=\"ipt_fsqm_form_2_design_23_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_2_design_23\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][19][m_type]\" id=\"ipt_fsqm_form_2_freetype_19_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][19][type]\" id=\"ipt_fsqm_form_2_freetype_19_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_19\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_19_value\">Advert\u00eancias Especiais:<\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][19][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_19_value\"><\/textarea><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][24][m_type]\" id=\"ipt_fsqm_form_2_design_24_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][24][type]\" id=\"ipt_fsqm_form_2_design_24_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_2_design_24\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][20][m_type]\" id=\"ipt_fsqm_form_2_freetype_20_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][20][type]\" id=\"ipt_fsqm_form_2_freetype_20_type\" value=\"feedback_large\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_large\" id=\"ipt_fsqm_form_2_freetype_20\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_question ipt_uif_question_vertical\"><div\nclass=\"ipt_uif_question_label\">\n<label\nclass=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_2_freetype_20_value\">Doen\u00e7a a Tratar:<\/label><div\nclass=\"clear-both\"><\/div><\/div><div\nclass=\"ipt_uif_question_content\"><div\nclass=\"input-field\"><textarea class=\"ipt_uif_textarea materialize-textarea  check_me \"\n\t\trows=\"4\"\n\t\t\t\t\t\t\t\tname=\"ipt_fsqm_form_2[freetype][20][value]\"\n\t\tmaxlength=\"\"\t\tid=\"ipt_fsqm_form_2_freetype_20_value\"><\/textarea><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][25][m_type]\" id=\"ipt_fsqm_form_2_design_25_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][25][type]\" id=\"ipt_fsqm_form_2_design_25_type\" value=\"col_two_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_two_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_two_third\" id=\"ipt_fsqm_form_2_design_25\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][29][m_type]\" id=\"ipt_fsqm_form_2_design_29_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][29][type]\" id=\"ipt_fsqm_form_2_design_29_type\" value=\"embed\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_embed\" id=\"ipt_fsqm_form_2_design_29\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_fsqm_embed\"><p\nalign=\"justify\";><b>Notas Legais:<\/b> <small>ESTA RECEITA APENAS PODE SER DISPENSADA NA TOTALIDADE. Em caso da impossibilidade da dispensa eletr\u00f3nica, guardar c\u00f3pia da Receita pelo local de dispensar\/fornecimento. \u00c9 obrigat\u00f3rio que constem na receceita os seguintes dados: Data de emiss\u00e3o da  Receita \/ Dados do Detentor \/ Identifica\u00e7\u00e3o Animal \/ Nome do Medicamento e Subst\u00e2ncias Ativas \/ Forma Farmac\u00eautica e Dosagem \/ N\u00famero de Embalagens \/ Posologia \/ Data m\u00e1xima de dispensa de Medicamentos Veterin\u00e1rios contendo antimicrobianos (5 dias \u00fateis ap\u00f3s a data de emiss\u00e3o). Todas as advert\u00eancias necess\u00e1rias a correta utiliza\u00e7\u00e3o. Declara\u00e7\u00e3o de prescri\u00e7\u00e3o ao abrigo da cascata, caso aplic\u00e1vel. Declara\u00e7\u00e3o de prescri\u00e7\u00e3o de Antimicrobianos para uso profil\u00e1tico ou metafil\u00e1tico, caso aplic\u00e1vel. Indicar o intervalo de seguran\u00e7a ainda que tal seja igual a zero. <\/small><\/p><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][27][m_type]\" id=\"ipt_fsqm_form_2_design_27_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[design][27][type]\" id=\"ipt_fsqm_form_2_design_27_type\" value=\"col_third\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_third ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_third\" id=\"ipt_fsqm_form_2_design_27\"><div\nclass=\"ipt_uif_column_inner\">\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][22][m_type]\" id=\"ipt_fsqm_form_2_freetype_22_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input\ntype=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_2[freetype][22][type]\" id=\"ipt_fsqm_form_2_freetype_22_type\" value=\"signature\" class=\"ipt_fsqm_hf_type\" \/><div\nclass=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_jsignature\" id=\"ipt_fsqm_form_2_freetype_22\"><div\nclass=\"ipt_uif_column_inner side_margin\"><div\nclass=\"ipt_uif_container ipt_uif_iconbox\" data-opened=\"1\"><div\nclass=\"ipt_uif_container_head\"><h3>\t\t\t\t\t\t<i\ntitle=\"\" class=\" ipticm prefix\" data-ipt-icomoon=\"&#xe055;\"><\/i>\n<span\nclass=\"ipt_uif_container_label\">Assinatura<\/span><\/h3><\/div><div\nclass=\"ipt_uif_container_inner\"><div\nclass=\"ipt_uif_jsignature\">\n<input\ntype=\"text\" style=\"height: 0; width: 0; padding: 0; margin: 0; opacity: 0;\" class=\"ipt_uif_jsignature_input check_me validate[funcCall[iptUIFSigVal]]\" name=\"ipt_fsqm_form_2[freetype][22][value]\" id=\"ipt_fsqm_form_2_freetype_22_value\" value=\"\"><div\nclass=\"ipt_uif_jsignature_pad ui-state-active\" style=\"color: #212121;\"><\/div><div\nclass=\" ipt-eform-material-button-container\"><div\nclass=\"eform-button-container-inner\">\n<button\ntype=\"button\" title=\"Undo\" class=\"ipt_uif_button eform-material-button eform-ripple ipt_uif_jsignature_undo ipt_uif_tooltip small primary-button\"> <i\nclass=\"ipticm ipt-icomoon-undo2\"><\/i><\/button>\n<button\ntype=\"button\" title=\"Reset\" class=\"ipt_uif_button eform-material-button eform-ripple ipt_uif_jsignature_reset ipt_uif_tooltip small ipt-ui-button\"> <i\nclass=\"ipticm ipt-icomoon-times\"><\/i><\/button><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><div\nclass=\"clear\"><\/div><div\nid=\"ipt_fsqm_form_2_button_container\" class=\"ipt_fsqm_form_button_container ipt_fsqm_form_button_container--classic ipt-eform-material-button-container\"><div\nclass=\"eform-button-container-inner\">\n<button\ntype=\"submit\" class=\"ipt_uif_button eform-material-button eform-ripple ipt_fsqm_form_button_submit medium primary-button\" name=\"ipt_fsqm_form_2_button_submit\" id=\"ipt_fsqm_form_2_button_submit\"> Submit<\/button><\/div><\/div><div\nclass=\"clear-both\"><\/div><\/div><\/div><\/form><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_success ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><h3><i\ntitle=\"\" class=\" ipt-icomoon-checkmark-circle ipticm prefix\"><\/i>\nYour form has been submitted<\/h3><\/div><div\nclass=\"ui-widget-content ui-corner-all ipt_fsqm_success_wrap\"><p>Thank you %NAME% for taking the quiz\/survey\/feedback.<br\n\/>\nWe have received your answers. You can view it anytime from this link below:<br\n\/>\n<a\nhref=\"%TRACK_LINK%\">%TRACK_LINK%<\/a><br\n\/>\nWe have also attached a copy of your submission.<\/p><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_message_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-laptop ipticm prefix\"><\/i>\nServer Side Error<\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p>We faced problems while connecting to the server or receiving data from the server. Please wait for a few seconds and try again.<\/p><p>If the problem persists, then check your internet connectivity. If all other sites open fine, then please contact the administrator of this website with the following information.<\/p><p\nclass=\"jqXHR\">\n<strong>TextStatus: <\/strong><span\nclass=\"textStatus\">undefined<\/span><br\n\/>\n<strong>HTTP Error: <\/strong><span\nclass=\"errorThrown\">undefined<\/span><\/p><\/div><\/div><div\nstyle=\"display: none\" class=\"ipt_uif_widget_box ipt_fsqm_form_message_process\"><div\nclass=\"ui-widget ui-widget-header ui-corner-all\"><style type=\"text\/css\">.ipt_uif_ajax_loader,\n\t\t\t.ipt_uif_ajax_loader *,\n\t\t\tipt_uif_ajax_loader *::before,\n\t\t\tipt_uif_ajax_loader *::after {\n\t\t\t\tbox-sizing: border-box;\n\t\t\t}<\/style><div\nclass=\"ipt-eform-preloader-inline ipt_uif_ajax_loader\"><div\nclass=\"ipt-eform-preloader-inner\"><div\nclass=\"ipt-eform-preloader-circle\"><div\nclass=\"preloader-wrapper active\"><div\nclass=\"spinner-layer spinner-blue\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-red\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-yellow\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><div\nclass=\"spinner-layer spinner-green\"><div\nclass=\"circle-clipper left\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"gap-patch\"><div\nclass=\"circle\"><\/div><\/div><div\nclass=\"circle-clipper right\"><div\nclass=\"circle\"><\/div><\/div><\/div><\/div><\/div><div\nclass=\"ipt-eform-preloader-text\"><div\nclass=\"ipt-eform-preloader-text-inner ipt_uif_ajax_loader_text\">Processing your request<\/div><\/div><div\nclass=\"clear\"><\/div><\/div><\/div><\/div><\/div><div\nstyle=\"display: none;\" class=\"ipt_fsqm_form_validation_error ui-widget ui-widget-content ui-corner-all ipt_uif_widget_box\"><div\nclass=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\"><div><i\ntitle=\"\" class=\" ipt-icomoon-warning2 ipticm prefix\"><\/i>\n<span\nclass=\"fsqm_ve_text\">Error<\/span><\/div><\/div><div\nclass=\"ui-widget-content ui-corner-all\"><p\nclass=\"fsqm_ve_msg\">Some error has occured.<\/p><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"Javascript is disabledJavascript is disabled on your browser. Please enable it in order to use this form. Loading Prescri\u00e7\u00e3o Animal de Companhia Detentor* Telefone* Explora\u00e7\u00e3o* Identifica\u00e7\u00e3o* NIF* Email* Esp\u00e9cie* Emiss\u00e3o* &times; M\u00e9dico Veterin\u00e1rio* C\u00e9dula:* Telefone:* Seletor de Pesquisa MedVet INFOMED EMA Nome, Posologia, Notas, Terap\u00eauticas Rx: S\/ Rx: S\/ Rx: S\/ Rx: S\/ Unidades Advert\u00eancias<br class=\"read-more-spacer\"> <a class=\"more-link\" href=\"https:\/\/medveterapia.utad.pt\/?page_id=3824\">Read More<\/a>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/medveterapia.utad.pt\/index.php?rest_route=\/wp\/v2\/pages\/3824"}],"collection":[{"href":"https:\/\/medveterapia.utad.pt\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/medveterapia.utad.pt\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/medveterapia.utad.pt\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medveterapia.utad.pt\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3824"}],"version-history":[{"count":2,"href":"https:\/\/medveterapia.utad.pt\/index.php?rest_route=\/wp\/v2\/pages\/3824\/revisions"}],"predecessor-version":[{"id":3826,"href":"https:\/\/medveterapia.utad.pt\/index.php?rest_route=\/wp\/v2\/pages\/3824\/revisions\/3826"}],"wp:attachment":[{"href":"https:\/\/medveterapia.utad.pt\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3824"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}