{"id":14306,"date":"2026-02-23T15:56:44","date_gmt":"2026-02-23T12:56:44","guid":{"rendered":"https:\/\/clinicdpc.lt\/registration-form\/"},"modified":"2026-02-23T16:05:33","modified_gmt":"2026-02-23T13:05:33","slug":"registration","status":"publish","type":"page","link":"https:\/\/clinicdpc.lt\/en\/registration\/","title":{"rendered":"Registration form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"14306\" class=\"elementor elementor-14306 elementor-14288\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-141f3ca e-flex e-con-boxed e-con e-parent\" data-id=\"141f3ca\" 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-43f4520 elementor-widget elementor-widget-shortcode\" data-id=\"43f4520\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">    <div class=\"cbw-page\">\n      <div class=\"cbw-container\">\n        <div class=\"cbw-hero\">\n          <h1>Register for a visit<\/h1>\n          <p>Fill out the form in a few simple steps<\/p>\n        <\/div>\n\n                  <div class=\"cbw-steps\" aria-label=\"Progress\">\n            <div class=\"cbw-step is-active\" data-step-dot=\"1\">\n              <div class=\"cbw-dot\">1<\/div>\n              <div class=\"cbw-step-label\">City<\/div>\n            <\/div>\n            <div class=\"cbw-line\"><\/div>\n            <div class=\"cbw-step\" data-step-dot=\"2\">\n              <div class=\"cbw-dot\">2<\/div>\n              <div class=\"cbw-step-label\">Service<\/div>\n            <\/div>\n            <div class=\"cbw-line\"><\/div>\n            <div class=\"cbw-step\" data-step-dot=\"3\">\n              <div class=\"cbw-dot\">3<\/div>\n              <div class=\"cbw-step-label\">Date and contacts<\/div>\n            <\/div>\n          <\/div>\n        \n        \n                <div class=\"cbw-card\">\n          <form class=\"cbw-form\" method=\"post\" action=\"https:\/\/clinicdpc.lt\/wp-admin\/admin-post.php\" novalidate enctype=\"multipart\/form-data\">\n            <input type=\"hidden\" name=\"action\" value=\"cbw_submit\" \/>\n            <input type=\"hidden\" id=\"cbw_nonce\" name=\"cbw_nonce\" value=\"3fd79230c7\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/14306\" \/>\n            <input type=\"hidden\" name=\"city\" id=\"cbw_city\" required \/>\n            <input type=\"hidden\" name=\"city_id\" id=\"cbw_city_id\" \/>\n            <input type=\"hidden\" name=\"address\" id=\"cbw_address\" \/>\n            <input type=\"hidden\" name=\"hours\" id=\"cbw_hours\" \/>\n            <input type=\"hidden\" name=\"service_category_id\" id=\"cbw_service_category_id\" \/>\n            <input type=\"hidden\" name=\"service_id\" id=\"cbw_service_id\" \/>\n            <input type=\"hidden\" name=\"service_category\" id=\"cbw_service_category\" required \/>\n            <input type=\"hidden\" name=\"service_category_parent\" id=\"cbw_service_category_parent\" \/>\n            <input type=\"hidden\" name=\"visit_date\" id=\"cbw_visit_date\" required \/>\n            <input type=\"hidden\" name=\"visit_time\" id=\"cbw_visit_time\" required \/>\n            <input type=\"hidden\" name=\"patient_status\" id=\"cbw_patient_status\" required \/>\n            <input type=\"hidden\" name=\"form_lang\" id=\"cbw_form_lang\" value=\"en\" \/>\n\t\t\t  <input type=\"hidden\" name=\"service_comment\" id=\"cbw_service_comment\" \/>\n\n\n            <!-- STEP 1 -->\n            <section class=\"cbw-panel\" data-panel=\"1\">\n              <div class=\"cbw-panel-head\">\n                <div class=\"cbw-icon-circle\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-map-pin\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M9 11a3 3 0 1 0 6 0a3 3 0 0 0 -6 0\" \/><path d=\"M17.657 16.657l-4.243 4.243a2 2 0 0 1 -2.827 0l-4.244 -4.243a8 8 0 1 1 11.314 0z\" \/><\/svg><\/div>\n                <div>\n                  <h2>Select a city<\/h2>\n                  <p>Select the clinic closest to you<\/p>\n                <\/div>\n              <\/div>\n\n              <label class=\"cbw-label\" for=\"cbw_city_select\">City <span class=\"cbw-req\">*<\/span><\/label>\n              <div class=\"cbw-select\" data-select>\n                <button type=\"button\" class=\"cbw-select-control\" id=\"cbw_city_select\" data-select-toggle aria-haspopup=\"listbox\" aria-expanded=\"false\">\n                  <span data-select-label>Select a city<\/span>\n                  <span class=\"cbw-caret\" aria-hidden=\"true\"><\/span>\n                <\/button>\n                <div class=\"cbw-select-menu\" role=\"listbox\">\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_dFVbj0R9\"\n                      data-city=\"Kaunas (Savanori\u0173 pr.)\"\n                      data-address=\"Savanori\u0173 pr. 314 A\"\n                      data-hours=\"Pr-Pn 8:00-20:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Kaunas (Savanori\u0173 pr.)<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_aPFciJis\"\n                      data-city=\"Kaunas (\u0160ilainiai)\"\n                      data-address=\"\u017demai\u010di\u0173 pl. 23A-1, Kaunas\"\n                      data-hours=\"Mon-Fri 9:00-18:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Kaunas (\u0160ilainiai)<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_Gl414Hzj\"\n                      data-city=\"Vilnius\"\n                      data-address=\"Mindaugo g. 14A\"\n                      data-hours=\"Mon, Tue, Wed 9:00-18:00, Thu, Fri 10:00-19:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Vilnius<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_g16QVGry\"\n                      data-city=\"Klaip\u0117da\"\n                      data-address=\"H.Manto g.3 \/ Vytauto g. 28\"\n                      data-hours=\"Mon, Tue, Wed 9:00-18:00, Thu, Fri 10:00-19:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Klaip\u0117da<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_onYezlUW\"\n                      data-city=\"\u0160iauliai\"\n                      data-address=\"R\u016bd\u0117s g. 17\"\n                      data-hours=\"Mon\u2013Fri 09:00\u201318:00. Sat 08:00\u201319:00, Sun 08:00\u201318:00.\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">\u0160iauliai<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_ZXVJ3B3I\"\n                      data-city=\"Panev\u0117\u017eys\"\n                      data-address=\"Auk\u0161tai\u010di\u0173 g. 80-5\"\n                      data-hours=\"Mon, Tue, Wed 9:00-18:00, Thu, Fri 10:00-19:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Panev\u0117\u017eys<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_EzR1zwug\"\n                      data-city=\"Alytus\"\n                      data-address=\"Pulko g. 5\"\n                      data-hours=\"Mon-Fri 9:00-18:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Alytus<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_Xk9g1ED1\"\n                      data-city=\"Ma\u017eeikiai\"\n                      data-address=\"Naftinink\u0173 g. 5-22A\"\n                      data-hours=\"Mon, Tue, Wed 9:00-18:00, Thu, Fri 10:00-19:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Ma\u017eeikiai<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_qrftaYhy\"\n                      data-city=\"Utena\"\n                      data-address=\"Au\u0161ros g. 14\"\n                      data-hours=\"Mon, Tue, Wed 9:00-18:00, Thu, Fri 10:00-19:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Utena<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_b41Ixywg\"\n                      data-city=\"K\u0117dainiai\"\n                      data-address=\"J. Basanavi\u010diaus g. 55A\"\n                      data-hours=\"Mon, Tue, Wed 9:00-18:00, Thu, Fri 10:00-19:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">K\u0117dainiai<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_8WQUpU1d\"\n                      data-city=\"Jurbarkas\"\n                      data-address=\"Vytauto Did\u017eiojo g. 5B\"\n                      data-hours=\"Mon-Fri 9:00-18:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Jurbarkas<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_Up5xTnAz\"\n                      data-city=\"Raseiniai\"\n                      data-address=\"Vai\u017eganto g. 1-3\"\n                      data-hours=\"Mon, Tue, Wed 9:00-18:00, Thu, Fri 10:00-19:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Raseiniai<\/span>\n                    <\/button>\n                                      <button\n                      type=\"button\"\n                      role=\"option\"\n                      class=\"cbw-option\"\n                      data-city-id=\"c_nkREngLN\"\n                      data-city=\"Anyk\u0161\u010diai\"\n                      data-address=\"\u0160altupio g. 1\"\n                      data-hours=\"Mon, Tue, Wed 9:00-18:00, Thu, Fri 10:00-19:00\">\n                      <span class=\"cbw-option-check\" aria-hidden=\"true\">\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                      <\/span>\n                      <span class=\"cbw-option-label\">Anyk\u0161\u010diai<\/span>\n                    <\/button>\n                                  <\/div>\n              <\/div>\n\n<!--               <div class=\"cbw-separator\" aria-hidden=\"true\"><\/div> -->\n\n              \n\n              <div class=\"cbw-note cbw-note-neutral\">\n                <div class=\"cbw-note-icon\">\u2139\ufe0f<\/div>\n                <p>This is a request form, not a final registration. A customer service manager will contact you to confirm the final time.<\/p>\n              <\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"cbw-city-card is-hidden\" data-selected-city>\n                <div class=\"cbw-city-card-icon\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-map-pin\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M9 11a3 3 0 1 0 6 0a3 3 0 0 0 -6 0\" \/><path d=\"M17.657 16.657l-4.243 4.243a2 2 0 0 1 -2.827 0l-4.244 -4.243a8 8 0 1 1 11.314 0z\" \/><\/svg><\/div>\n                <div class=\"cbw-city-card-body\">\n                  <div class=\"cbw-city-card-title\">Selected city: <span data-summary-city>\u2013<\/span><\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-address>\u2013<\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-hours>\u2013<\/div>\n                <\/div>\n              <\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"cbw-actions cbw-actions-split\">\n                <button type=\"button\" class=\"cbw-btn cbw-btn-primary cbw-full-width\" data-next disabled>Continue<\/button>\n              <\/div>\n            <\/section>\n\n            <!-- STEP 2A -->\n            <section class=\"cbw-panel is-hidden\" data-panel=\"2a\">\n              <div class=\"cbw-panel-head\">\n                <div>\n                  <h2>Select a category<\/h2>\n                  <p>First, select a category<\/p>\n                <\/div>\n              <\/div>\n\n                            <div class=\"cbw-grid cbw-grid-2 cbw-categories\" data-category-list>\n                                                    <button type=\"button\" class=\"cbw-choice\" data-choice=\"category\" data-category-id=\"cat_Sa2mOfdl\" data-category-name=\"Consultations\">\n                    <div class=\"cbw-choice-emoji\">\ud83e\ude7a<\/div>\n                    <div class=\"cbw-choice-main\">\n                      <div class=\"cbw-choice-title\">Consultations<\/div>\n                      <div class=\"cbw-choice-desc\">Dental treatment consultations and procedures<\/div>\n                    <\/div>\n                    <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                      <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                    <\/span>\n                  <\/button>\n                                                    <button type=\"button\" class=\"cbw-choice\" data-choice=\"category\" data-category-id=\"cat_l5PyBzQQ\" data-category-name=\"Procedures\">\n                    <div class=\"cbw-choice-emoji\">\ud83e\uddb7<\/div>\n                    <div class=\"cbw-choice-main\">\n                      <div class=\"cbw-choice-title\">Procedures<\/div>\n                      <div class=\"cbw-choice-desc\">Hygiene and treatment procedures<\/div>\n                    <\/div>\n                    <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                      <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                    <\/span>\n                  <\/button>\n                              <\/div>\n\n              <div class=\"cbw-actions cbw-actions-split\">\n                <button type=\"button\" class=\"cbw-btn cbw-btn-secondary cbw-btn-width-20\" data-back><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-arrow-left\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l14 0\" \/><path d=\"M5 12l6 6\" \/><path d=\"M5 12l6 -6\" \/><\/svg>Back<\/button>\n                <button type=\"button\" class=\"cbw-btn cbw-btn-primary cbw-btn-width-80\" data-next disabled>Continue<\/button>\n              <\/div>\n\n              <div class=\"cbw-separator\" aria-hidden=\"true\"><\/div>\n\n              <div class=\"cbw-city-card cbw-city-card-inline is-hidden\" aria-live=\"polite\" data-selected-city>\n                <div class=\"cbw-city-card-icon\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-map-pin\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M9 11a3 3 0 1 0 6 0a3 3 0 0 0 -6 0\" \/><path d=\"M17.657 16.657l-4.243 4.243a2 2 0 0 1 -2.827 0l-4.244 -4.243a8 8 0 1 1 11.314 0z\" \/><\/svg><\/div>\n                <div class=\"cbw-city-card-body\">\n                  <div class=\"cbw-city-card-title\">Selected city: <span data-summary-city>\u2013<\/span><\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-address>\u2013<\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-hours>\u2013<\/div>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-note cbw-note-neutral\">\n                <div class=\"cbw-note-icon\">\u2139\ufe0f<\/div>\n                <p>This is a request form, not a final registration. A customer service manager will contact you to confirm the final time.<\/p>\n              <\/div>\n            <\/section>\n\n            <!-- STEP 2B -->\n            <section class=\"cbw-panel is-hidden\" data-panel=\"2b\">\n              <div class=\"cbw-panel-head\">\n                <div>\n                  <h2>Select a service<\/h2>\n                  <p>Select the desired service from the selected category<\/p>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-services\" data-services-wrapper>\n                <p class=\"cbw-label\">Select a service<\/p>\n                                  <div class=\"cbw-grid cbw-grid-2 cbw-service-list is-hidden\" data-service-list=\"cat_Sa2mOfdl\">\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_qAoVOu1J\"\n  data-service=\"30 min general consultation\"\n  data-service-cat=\"Consultations\"\n  data-category-id=\"cat_Sa2mOfdl\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83d\udcac<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">30 min general consultation<\/div>\n                          <div class=\"cbw-choice-desc\">General dental examination and consultation<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_hWG05HPI\"\n  data-service=\"Dental fillings\"\n  data-service-cat=\"Consultations\"\n  data-category-id=\"cat_Sa2mOfdl\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83e\uddb7<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Dental fillings<\/div>\n                          <div class=\"cbw-choice-desc\">Dental filling consultation<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_uiBvduIZ\"\n  data-service=\"Tooth Extraction\"\n  data-service-cat=\"Consultations\"\n  data-category-id=\"cat_Sa2mOfdl\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83d\udd27<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Tooth Extraction<\/div>\n                          <div class=\"cbw-choice-desc\">Tooth extraction consultation<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_VlvxHHlG\"\n  data-service=\"Teeth straightening\"\n  data-service-cat=\"Consultations\"\n  data-category-id=\"cat_Sa2mOfdl\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83d\udccf<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Teeth straightening<\/div>\n                          <div class=\"cbw-choice-desc\">Orthodontic treatment consultation<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_ZftHgdrv\"\n  data-service=\"Aesthetic filling\"\n  data-service-cat=\"Consultations\"\n  data-category-id=\"cat_Sa2mOfdl\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\u2728<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Aesthetic filling<\/div>\n                          <div class=\"cbw-choice-desc\">Aesthetic filling consultation<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_u5UymmyQ\"\n  data-service=\"ICON procedure\"\n  data-service-cat=\"Consultations\"\n  data-category-id=\"cat_Sa2mOfdl\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83d\udc8e<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">ICON procedure<\/div>\n                          <div class=\"cbw-choice-desc\">ICON procedure consultation<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_Bfby0OTP\"\n  data-service=\"Dental implantation\"\n  data-service-cat=\"Consultations\"\n  data-category-id=\"cat_Sa2mOfdl\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83d\udd29<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Dental implantation<\/div>\n                          <div class=\"cbw-choice-desc\">Dental implant consultation<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_NJcAJTxr\"\n  data-service=\"Children&#039;s consultation\"\n  data-service-cat=\"Consultations\"\n  data-category-id=\"cat_Sa2mOfdl\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83d\udc76<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Children&#039;s consultation<\/div>\n                          <div class=\"cbw-choice-desc\">Consultations on children&#039;s dental care or treatment<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                      <\/div>\n                                  <div class=\"cbw-grid cbw-grid-2 cbw-service-list is-hidden\" data-service-list=\"cat_l5PyBzQQ\">\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_xLcyKTyb\"\n  data-service=\"Professional oral hygiene\"\n  data-service-cat=\"Procedures\"\n  data-category-id=\"cat_l5PyBzQQ\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83e\udea5<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Professional oral hygiene<\/div>\n                          <div class=\"cbw-choice-desc\">Professional oral hygiene procedure<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_siwIVNnl\"\n  data-service=\"Dental fillings\"\n  data-service-cat=\"Procedures\"\n  data-category-id=\"cat_l5PyBzQQ\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83e\uddb7<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Dental fillings<\/div>\n                          <div class=\"cbw-choice-desc\">Dental filling procedure<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_dAhLmiLg\"\n  data-service=\"Tooth Extraction\"\n  data-service-cat=\"Procedures\"\n  data-category-id=\"cat_l5PyBzQQ\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83d\udd27<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Tooth Extraction<\/div>\n                          <div class=\"cbw-choice-desc\">Tooth extraction procedure<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_l1s9XxLe\"\n  data-service=\"Dental implantation\"\n  data-service-cat=\"Procedures\"\n  data-category-id=\"cat_l5PyBzQQ\"\n  data-requires-comment=\"0\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83d\udd29<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Dental implantation<\/div>\n                          <div class=\"cbw-choice-desc\">Dental implant procedure<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                          <button\n  type=\"button\"\n  class=\"cbw-choice cbw-service\"\n  data-choice=\"service\"\n  data-service-id=\"srv_oRqlTeac\"\n  data-service=\"Other\"\n  data-service-cat=\"Procedures\"\n  data-category-id=\"cat_l5PyBzQQ\"\n  data-requires-comment=\"1\">\n\n                        <div class=\"cbw-choice-emoji\">\ud83d\udcac<\/div>\n                        <div class=\"cbw-choice-main\">\n                          <div class=\"cbw-choice-title\">Other<\/div>\n                          <div class=\"cbw-choice-desc\">Enter the procedure<\/div>\n                        <\/div>\n                        <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                          <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                        <\/span>\n                      <\/button>\n                                      <\/div>\n                              <\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"cbw-field cbw-service-comment is-hidden\" data-service-comment>\n  <label for=\"cbw_service_comment_input\">\n    Komentaras <span class=\"cbw-req\">*<\/span>\n  <\/label>\n  <textarea\n    id=\"cbw_service_comment_input\"\n    rows=\"3\"\n    placeholder=\"\u012era\u0161ykite komentar\u0105...\"\n  ><\/textarea>\n  <p class=\"cbw-help\">\u0160is laukas privalomas pasirinkus \u0161i\u0105 paslaug\u0105.<\/p>\n<\/div>\n\n              <div class=\"cbw-actions cbw-actions-split\">\n                <button type=\"button\" class=\"cbw-btn cbw-btn-secondary cbw-btn-width-20\" data-back><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-arrow-left\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l14 0\" \/><path d=\"M5 12l6 6\" \/><path d=\"M5 12l6 -6\" \/><\/svg>Back<\/button>\n                <button type=\"button\" class=\"cbw-btn cbw-btn-primary cbw-btn-width-80\" data-next disabled>Continue<\/button>\n              <\/div>\n\n              <div class=\"cbw-separator\" aria-hidden=\"true\"><\/div>\n\n              <div class=\"cbw-city-card cbw-city-card-inline is-hidden\" aria-live=\"polite\" data-selected-city>\n                <div class=\"cbw-city-card-icon\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-map-pin\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M9 11a3 3 0 1 0 6 0a3 3 0 0 0 -6 0\" \/><path d=\"M17.657 16.657l-4.243 4.243a2 2 0 0 1 -2.827 0l-4.244 -4.243a8 8 0 1 1 11.314 0z\" \/><\/svg><\/div>\n                <div class=\"cbw-city-card-body\">\n                  <div class=\"cbw-city-card-title\">Selected city: <span data-summary-city>\u2013<\/span><\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-address>\u2013<\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-hours>\u2013<\/div>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-note cbw-note-neutral\">\n                <div class=\"cbw-note-icon\">\u2139\ufe0f<\/div>\n                <p>This is a request form, not a final registration. A customer service manager will contact you to confirm the final time.<\/p>\n              <\/div>\n            <\/section>\n\n            <!-- STEP 3A -->\n            <section class=\"cbw-panel is-hidden\" data-panel=\"3a\">\n              <div class=\"cbw-panel-head\">\n                <div class=\"cbw-icon-circle\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-calendar\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M4 7a2 2 0 0 1 2 -2h12a2 2 0 0 1 2 2v12a2 2 0 0 1 -2 2h-12a2 2 0 0 1 -2 -2v-12z\" \/><path d=\"M16 3v4\" \/><path d=\"M8 3v4\" \/><path d=\"M4 11h16\" \/><path d=\"M11 15h1\" \/><path d=\"M12 15v3\" \/><\/svg><\/div>\n                <div>\n                  <h2>Select date and time<\/h2>\n                  <p>Select a date and time for a convenient visit<\/p>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-field\">\n                <label for=\"cbw_date_input\">Date <span class=\"cbw-req\">*<\/span><\/label>\n                <input type=\"text\" id=\"cbw_date_input\" placeholder=\"Select a date\" \/>\n              <\/div>\n\n              <div class=\"cbw-field\">\n                <span class=\"cbw-label\">Convenient time <span class=\"cbw-req\">*<\/span><\/span>\n                <div class=\"cbw-grid cbw-grid-1 cbw-times\" data-time-list>\n                                      <button type=\"button\" class=\"cbw-choice cbw-time\" data-choice=\"time\" data-time=\"9:00 - 12:00\">\n                      <div class=\"cbw-choice-title\">9:00 - 12:00<\/div>\n                    <\/button>\n                                      <button type=\"button\" class=\"cbw-choice cbw-time\" data-choice=\"time\" data-time=\"12:00 - 15:00\">\n                      <div class=\"cbw-choice-title\">12:00 - 15:00<\/div>\n                    <\/button>\n                                      <button type=\"button\" class=\"cbw-choice cbw-time\" data-choice=\"time\" data-time=\"15:00 - 18:00\">\n                      <div class=\"cbw-choice-title\">15:00 - 18:00<\/div>\n                    <\/button>\n                                  <\/div>\n              <\/div>\n\n              <div class=\"cbw-actions cbw-actions-split\">\n                <button type=\"button\" class=\"cbw-btn cbw-btn-secondary cbw-btn-width-20\" data-back><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-arrow-left\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l14 0\" \/><path d=\"M5 12l6 6\" \/><path d=\"M5 12l6 -6\" \/><\/svg>Back<\/button>\n                <button type=\"button\" class=\"cbw-btn cbw-btn-primary cbw-btn-width-80\" data-next disabled>Continue<\/button>\n              <\/div>\n\n              <div class=\"cbw-separator\" aria-hidden=\"true\"><\/div>\n\n              <div class=\"cbw-city-card cbw-city-card-inline is-hidden\" aria-live=\"polite\" data-selected-city>\n                <div class=\"cbw-city-card-icon\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-map-pin\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M9 11a3 3 0 1 0 6 0a3 3 0 0 0 -6 0\" \/><path d=\"M17.657 16.657l-4.243 4.243a2 2 0 0 1 -2.827 0l-4.244 -4.243a8 8 0 1 1 11.314 0z\" \/><\/svg><\/div>\n                <div class=\"cbw-city-card-body\">\n                  <div class=\"cbw-city-card-title\">Selected city: <span data-summary-city>\u2013<\/span><\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-address>\u2013<\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-hours>\u2013<\/div>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-note cbw-note-neutral\">\n                <div class=\"cbw-note-icon\">\u2139\ufe0f<\/div>\n                <p>This is a request form, not a final registration. A customer service manager will contact you to confirm the final time.<\/p>\n              <\/div>\n            <\/section>\n\n            <!-- STEP 3B -->\n            <section class=\"cbw-panel is-hidden\" data-panel=\"3b\">\n              <div class=\"cbw-panel-head\">\n                <div class=\"cbw-icon-circle\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-user-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M8 7a4 4 0 1 0 8 0a4 4 0 0 0 -8 0\" \/><path d=\"M6 21v-2a4 4 0 0 1 4 -4h4\" \/><path d=\"M15 19l2 2l4 -4\" \/><\/svg><\/div>\n                <div>\n                  <h2>Are you our patient?<\/h2>\n                  <p>Have you visited CLINIC|DPC before?<\/p>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-grid cbw-grid-2 cbw-patient-choices\" data-patient-list>\n                <button type=\"button\" class=\"cbw-choice cbw-choice-patient\" data-choice=\"patient\" data-patient=\"existing\">\n                  <div class=\"cbw-choice-emoji\" aria-hidden=\"true\">\u2705<\/div>\n                  <div class=\"cbw-choice-main\">\n                    <div class=\"cbw-choice-title\">Yes<\/div>\n                    <div class=\"cbw-choice-desc\">I am a current CLINIC|DPC patient<\/div>\n                  <\/div>\n                  <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                    <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                  <\/span>\n                <\/button>\n                <button type=\"button\" class=\"cbw-choice cbw-choice-patient\" data-choice=\"patient\" data-patient=\"new\">\n                  <div class=\"cbw-choice-emoji\" aria-hidden=\"true\">\ud83c\udd95<\/div>\n                  <div class=\"cbw-choice-main\">\n                    <div class=\"cbw-choice-title\">No<\/div>\n                    <div class=\"cbw-choice-desc\">I am a new patient<\/div>\n                  <\/div>\n                  <span class=\"cbw-choice-check\" aria-hidden=\"true\">\n                    <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"20\" height=\"20\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-check\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l5 5l10 -10\" \/><\/svg>\n                  <\/span>\n                <\/button>\n              <\/div>\n\n              <div class=\"cbw-actions cbw-actions-split\">\n                <button type=\"button\" class=\"cbw-btn cbw-btn-secondary cbw-btn-width-20\" data-back><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-arrow-left\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l14 0\" \/><path d=\"M5 12l6 6\" \/><path d=\"M5 12l6 -6\" \/><\/svg>Back<\/button>\n                <button type=\"button\" class=\"cbw-btn cbw-btn-primary cbw-btn-width-80\" data-next disabled>Continue<\/button>\n              <\/div>\n\n              <div class=\"cbw-separator\" aria-hidden=\"true\"><\/div>\n\n              <div class=\"cbw-city-card cbw-city-card-inline is-hidden\" aria-live=\"polite\" data-selected-city>\n                <div class=\"cbw-city-card-icon\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-map-pin\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M9 11a3 3 0 1 0 6 0a3 3 0 0 0 -6 0\" \/><path d=\"M17.657 16.657l-4.243 4.243a2 2 0 0 1 -2.827 0l-4.244 -4.243a8 8 0 1 1 11.314 0z\" \/><\/svg><\/div>\n                <div class=\"cbw-city-card-body\">\n                  <div class=\"cbw-city-card-title\">Selected city: <span data-summary-city>\u2013<\/span><\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-address>\u2013<\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-hours>\u2013<\/div>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-note cbw-note-neutral\">\n                <div class=\"cbw-note-icon\">\u2139\ufe0f<\/div>\n                <p>This is a request form, not a final registration. A customer service manager will contact you to confirm the final time.<\/p>\n              <\/div>\n            <\/section>\n\n            <!-- STEP 3C -->\n            <section class=\"cbw-panel is-hidden\" data-panel=\"3c\">\n              <div class=\"cbw-city-card cbw-city-card-inline is-hidden\" aria-live=\"polite\" data-selected-city>\n                <div class=\"cbw-city-card-icon\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-map-pin\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M9 11a3 3 0 1 0 6 0a3 3 0 0 0 -6 0\" \/><path d=\"M17.657 16.657l-4.243 4.243a2 2 0 0 1 -2.827 0l-4.244 -4.243a8 8 0 1 1 11.314 0z\" \/><\/svg><\/div>\n                <div class=\"cbw-city-card-body\">\n                  <div class=\"cbw-city-card-title\">Selected city: <span data-summary-city>\u2013<\/span><\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-address>\u2013<\/div>\n                  <div class=\"cbw-city-card-line\" data-summary-hours>\u2013<\/div>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-panel-head\">\n                <div>\n                  <h2>Contact information<\/h2>\n                  <p>We will use this information to confirm your visit.<\/p>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-field-row\">\n                <div class=\"cbw-field no-bottom-margin\">\n                  <label for=\"cbw_first_name\">Name <span class=\"cbw-req\">*<\/span><\/label>\n                  <input id=\"cbw_first_name\" name=\"first_name\" type=\"text\" required autocomplete=\"given-name\" placeholder=\"John\" \/>\n                <\/div>\n                <div class=\"cbw-field no-bottom-margin\">\n                  <label for=\"cbw_last_name\">Surname <span class=\"cbw-req\">*<\/span><\/label>\n                  <input id=\"cbw_last_name\" name=\"last_name\" type=\"text\" required autocomplete=\"family-name\" placeholder=\"Doe\" \/>\n                <\/div>\n              <\/div>\n\n              <div class=\"cbw-field\">\n                <label for=\"cbw_email\">Email <span class=\"cbw-req\">*<\/span><\/label>\n                <input id=\"cbw_email\" name=\"email\" type=\"email\" required autocomplete=\"email\" placeholder=\"name@example.com\" \/>\n              <\/div>\n\n              <div class=\"cbw-field\">\n                <label for=\"cbw_phone\">Phone number <span class=\"cbw-req\">*<\/span><\/label>\n                <input id=\"cbw_phone\" name=\"phone\" type=\"tel\" required autocomplete=\"tel\" placeholder=\"+370 600 12345\" \/>\n              <\/div>\n\n              <div class=\"cbw-field\">\n                <label for=\"cbw_dob\">Date of birth<\/label>\n                <input id=\"cbw_dob\" name=\"dob\" type=\"date\" placeholder=\"Select your date of birth\" autocomplete=\"bday\" \/>\n              <\/div>\n\n              <div class=\"cbw-field\">\n\t\t\t\t  <label for=\"cbw_attachment\">\n\t\t\t\t\tAdd file (max. 5 MB)\t\t\t\t  <\/label>\n\n\t\t\t\t  <label class=\"cbw-file-drop\" for=\"cbw_attachment\">\n\t\t\t\t\t<span class=\"cbw-file-icon\" aria-hidden=\"true\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-upload\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M4 17v2a2 2 0 0 0 2 2h12a2 2 0 0 0 2 -2v-2\" \/><path d=\"M7 9l5 -5l5 5\" \/><path d=\"M12 4l0 12\" \/><\/svg><\/span>\n\t\t\t\t\t<span class=\"cbw-file-text\">\n\t\t\t\t\t  Select file\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<input\n\t\t\t\t\t  id=\"cbw_attachment\"\n\t\t\t\t\t  name=\"attachment\"\n\t\t\t\t\t  type=\"file\"\n\t\t\t\t\t  accept=\".pdf,.doc,.docx,.jpg,.jpeg,.png\"\n\t\t\t\t\t  hidden\n\t\t\t\t\t\/>\n\t\t\t\t  <\/label>\n\n\t\t\t\t  <p class=\"cbw-help\">\n\t\t\t\t\tPDF, DOC, JPG, PNG \u00b7 5 MB max\t\t\t\t  <\/p>\n\n\t\t\t\t  <div class=\"cbw-file-name\" data-file-name><\/div>\n\t\t\t\t<\/div>\n\n              <div class=\"cbw-field\">\n                <label for=\"cbw_message\">Comments (optional)<\/label>\n                <textarea id=\"cbw_message\" name=\"message\" rows=\"4\" placeholder=\"Additional information or requests...\" ><\/textarea>\n              <\/div>\n\n              <div class=\"cbw-terms\">\n                <label class=\"cbw-terms-check\">\n                  <input type=\"checkbox\" id=\"cbw_consent\" name=\"consent\" value=\"1\" required \/>\n                  <span class=\"cbw-terms-mark\" aria-hidden=\"true\"><\/span>\n                  <span class=\"cbw-terms-text\">\n                    I agree with <a href=\"https:\/\/clinicdpc.lt\/privatumo-politika\/\" target=\"_blank\" rel=\"noopener noreferrer\">CLINIC DPC Privacy Policy<\/a> regarding the processing of personal data for the purposes of the inquiry.                    <span class=\"cbw-req\">*<\/span>\n                  <\/span>\n                <\/label>\n              <\/div>\n\n<!--               <div class=\"cbw-separator\" aria-hidden=\"true\"><\/div> -->\n\n              <div class=\"cbw-actions cbw-actions-split\">\n                <button type=\"button\" class=\"cbw-btn cbw-btn-secondary cbw-btn-width-20\" data-back><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"icon icon-tabler icons-tabler-outline icon-tabler-arrow-left\"><path stroke=\"none\" d=\"M0 0h24v24H0z\" fill=\"none\"\/><path d=\"M5 12l14 0\" \/><path d=\"M5 12l6 6\" \/><path d=\"M5 12l6 -6\" \/><\/svg>Back<\/button>\n                <button type=\"submit\" class=\"cbw-btn cbw-btn-primary cbw-btn-width-80\" data-submit disabled>Submit a request<\/button>\n              <\/div>\n\n              <div class=\"cbw-separator\" aria-hidden=\"true\"><\/div>\n\n              <div class=\"cbw-note cbw-note-neutral\">\n                <div class=\"cbw-note-icon\">\u2139\ufe0f<\/div>\n                <p>This is a request form, not a final registration. A customer service manager will contact you to confirm the final time.<\/p>\n              <\/div>\n            <\/section>\n\n          <\/form>\n        <\/div>\n              <\/div>\n    <\/div>\n    <\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-14306","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Registration form | DPC - Dant\u0173 prie\u017ei\u016bros centras<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/clinicdpc.lt\/en\/registration\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Registration form | DPC - 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