{"id":308,"date":"2026-08-27T07:19:25","date_gmt":"2026-08-27T07:19:25","guid":{"rendered":"https:\/\/thepsychologisthub.com\/?page_id=308"},"modified":"2026-09-29T07:15:29","modified_gmt":"2026-09-29T07:15:29","slug":"clinical-profile","status":"publish","type":"page","link":"https:\/\/thepsychologisthub.com\/?page_id=308","title":{"rendered":"Clinical Profile"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"308\" class=\"elementor elementor-308\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d9c1e7f e-flex e-con-boxed e-con e-parent\" data-id=\"d9c1e7f\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-f3ff045 e-con-full e-flex e-con e-child\" data-id=\"f3ff045\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element 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2.2-20.5-8.5v-67H140c-6.6 0-12-5.4-12-12z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Welcome To The Psychologist Hub<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d359531 e-con-full elementor-hidden-mobile e-flex e-con e-child\" data-id=\"d359531\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-525917a elementor-icon-list--layout-inline elementor-align-end elementor-mobile-align-start elementor-tablet-align-end elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"525917a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items elementor-inline-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item 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\n                data-elfsight-contact-form-version=\"2.3.1\"\n                data-elfsight-widget-id=\"elfsight-contact-form-1\">\n            <\/div>\n            <\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0ce8e86 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile e-flex e-con-boxed e-con e-parent\" data-id=\"0ce8e86\" 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-0b1c11a elementor-widget elementor-widget-html\" data-id=\"0b1c11a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<!DOCTYPE html>\r\n<html lang=\"en\">\r\n<head>\r\n<meta charset=\"UTF-8\">\r\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\">\r\n\r\n<title>Professional Practice Intake Form<\/title>\r\n\r\n<script src=\"https:\/\/cdn.tailwindcss.com\"><\/script>\r\n\r\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\r\n<link rel=\"preconnect\" href=\"https:\/\/fonts.gstatic.com\" crossorigin>\r\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Inter:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\r\n\r\n<link rel=\"stylesheet\"\r\nhref=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/font-awesome\/6.5.2\/css\/all.min.css\">\r\n\r\n<style>\r\n\r\n* {\r\n    box-sizing: border-box;\r\n}\r\n\r\nbody {\r\n    margin: 0;\r\n    padding: 0;\r\n    font-family: 'Inter', sans-serif;\r\n    background: #f8fafc;\r\n    color: #111827;\r\n}\r\n\r\n.form-wrapper {\r\n    width: 100%;\r\n    max-width: 1000px;\r\n    margin: 40px auto;\r\n    padding: 20px;\r\n}\r\n\r\n.form-card {\r\n    background: #ffffff;\r\n    border-radius: 18px;\r\n    padding: 35px;\r\n    box-shadow: 0 10px 35px rgba(0,0,0,0.08);\r\n}\r\n\r\n.step {\r\n    display: none;\r\n}\r\n\r\n.step.active {\r\n    display: block;\r\n}\r\n\r\n.step-title {\r\n    font-size: 28px;\r\n    font-weight: 700;\r\n    color: #111827;\r\n    margin-bottom: 8px;\r\n}\r\n\r\n.step-description {\r\n    color: #6b7280;\r\n    font-size: 15px;\r\n    margin-bottom: 30px;\r\n    line-height: 1.7;\r\n}\r\n\r\n.field-group {\r\n    margin-bottom: 22px;\r\n}\r\n\r\n.field-label {\r\n    display: block;\r\n    font-size: 14px;\r\n    font-weight: 600;\r\n    color: #111827;\r\n    margin-bottom: 8px;\r\n}\r\n\r\n.required {\r\n    color: #dc2626;\r\n}\r\n\r\n.input-field,\r\n.select-field,\r\n.textarea-field {\r\n    width: 100%;\r\n    border: 1px solid #d1d5db;\r\n    border-radius: 9px;\r\n    padding: 13px 14px;\r\n    font-size: 15px;\r\n    color: #111827;\r\n    background: #ffffff;\r\n    outline: none;\r\n    transition: 0.2s ease;\r\n}\r\n\r\n.input-field:focus,\r\n.select-field:focus,\r\n.textarea-field:focus {\r\n    border-color: #0077d5;\r\n    box-shadow: 0 0 0 3px rgba(0,119,213,0.10);\r\n}\r\n\r\n.textarea-field {\r\n    min-height: 120px;\r\n    resize: vertical;\r\n}\r\n\r\n.file-field {\r\n    width: 100%;\r\n    border: 2px dashed #cbd5e1;\r\n    border-radius: 12px;\r\n    padding: 25px 15px;\r\n    background: #f8fafc;\r\n    cursor: pointer;\r\n    font-size: 14px;\r\n}\r\n\r\n.file-field:hover {\r\n    border-color: #0077d5;\r\n    background: #f0f8ff;\r\n}\r\n\r\n.file-note {\r\n    margin-top: 7px;\r\n    font-size: 12px;\r\n    color: #6b7280;\r\n}\r\n\r\n.grid-2 {\r\n    display: grid;\r\n    grid-template-columns: 1fr 1fr;\r\n    gap: 20px;\r\n}\r\n\r\n.grid-3 {\r\n    display: grid;\r\n    grid-template-columns: 1fr 1fr 1fr;\r\n    gap: 20px;\r\n}\r\n\r\n.checkbox-grid {\r\n    display: grid;\r\n    grid-template-columns: repeat(2, 1fr);\r\n    gap: 12px;\r\n}\r\n\r\n.checkbox-item {\r\n    display: flex;\r\n    align-items: center;\r\n    gap: 9px;\r\n    padding: 12px;\r\n    border: 1px solid #e5e7eb;\r\n    border-radius: 8px;\r\n    background: #fafafa;\r\n}\r\n\r\n.checkbox-item input {\r\n    width: 17px;\r\n    height: 17px;\r\n}\r\n\r\n.checkbox-item label {\r\n    font-size: 14px;\r\n    color: #374151;\r\n    cursor: pointer;\r\n}\r\n\r\n.progress-area {\r\n    margin-bottom: 35px;\r\n}\r\n\r\n.progress-top {\r\n    display: flex;\r\n    justify-content: space-between;\r\n    align-items: center;\r\n    margin-bottom: 10px;\r\n}\r\n\r\n.progress-text {\r\n    font-size: 13px;\r\n    font-weight: 600;\r\n    color: #374151;\r\n}\r\n\r\n.progress-bar {\r\n    width: 100%;\r\n    height: 8px;\r\n    background: #e5e7eb;\r\n    border-radius: 20px;\r\n    overflow: hidden;\r\n}\r\n\r\n.progress-fill {\r\n    height: 100%;\r\n    width: 14.28%;\r\n    background: #0077d5;\r\n    border-radius: 20px;\r\n    transition: width 0.3s ease;\r\n}\r\n\r\n.navigation {\r\n    display: flex;\r\n    justify-content: space-between;\r\n    gap: 15px;\r\n    margin-top: 35px;\r\n    padding-top: 25px;\r\n    border-top: 1px solid #e5e7eb;\r\n}\r\n\r\n.btn {\r\n    border: none;\r\n    border-radius: 8px;\r\n    padding: 13px 24px;\r\n    font-size: 14px;\r\n    font-weight: 600;\r\n    cursor: pointer;\r\n    transition: 0.2s ease;\r\n}\r\n\r\n.btn-prev {\r\n    background: #e5e7eb;\r\n    color: #374151;\r\n}\r\n\r\n.btn-prev:hover {\r\n    background: #d1d5db;\r\n}\r\n\r\n.btn-next,\r\n.btn-submit {\r\n    background: #0077d5;\r\n    color: #ffffff;\r\n}\r\n\r\n.btn-next:hover,\r\n.btn-submit:hover {\r\n    background: #005fa8;\r\n}\r\n\r\n.btn:disabled {\r\n    opacity: 0.6;\r\n    cursor: not-allowed;\r\n}\r\n\r\n.section-heading {\r\n    font-size: 18px;\r\n    font-weight: 700;\r\n    color: #111827;\r\n    margin-top: 30px;\r\n    margin-bottom: 15px;\r\n}\r\n\r\n.hidden-field {\r\n    display: none !important;\r\n}\r\n\r\n.success-message {\r\n    display: none;\r\n    text-align: center;\r\n    padding: 50px 20px;\r\n}\r\n\r\n.success-icon {\r\n    width: 70px;\r\n    height: 70px;\r\n    background: #dcfce7;\r\n    color: #16a34a;\r\n    border-radius: 50%;\r\n    display: flex;\r\n    align-items: center;\r\n    justify-content: center;\r\n    margin: 0 auto 20px;\r\n    font-size: 30px;\r\n}\r\n\r\n.success-message h2 {\r\n    font-size: 28px;\r\n    font-weight: 700;\r\n    margin-bottom: 10px;\r\n}\r\n\r\n.success-message p {\r\n    color: #6b7280;\r\n    line-height: 1.7;\r\n}\r\n\r\n.error-message {\r\n    display: none;\r\n    background: #fee2e2;\r\n    color: #991b1b;\r\n    border: 1px solid #fecaca;\r\n    border-radius: 8px;\r\n    padding: 12px 15px;\r\n    margin-top: 15px;\r\n    font-size: 14px;\r\n}\r\n\r\n.loading-text {\r\n    display: none;\r\n    margin-left: 8px;\r\n}\r\n\r\n@media(max-width: 768px) {\r\n\r\n    .form-wrapper {\r\n        margin: 15px auto;\r\n        padding: 10px;\r\n    }\r\n\r\n    .form-card {\r\n        padding: 22px 18px;\r\n        border-radius: 12px;\r\n    }\r\n\r\n    .step-title {\r\n        font-size: 23px;\r\n    }\r\n\r\n    .grid-2,\r\n    .grid-3,\r\n    .checkbox-grid {\r\n        grid-template-columns: 1fr;\r\n    }\r\n\r\n    .navigation {\r\n        flex-direction: column-reverse;\r\n    }\r\n\r\n    .btn {\r\n        width: 100%;\r\n    }\r\n}\r\n\r\n<\/style>\r\n<\/head>\r\n\r\n<body>\r\n\r\n<div class=\"form-wrapper\">\r\n\r\n<div class=\"form-card\">\r\n\r\n<!-- ========================================= -->\r\n<!-- PROGRESS -->\r\n<!-- ========================================= -->\r\n\r\n<div class=\"progress-area\">\r\n\r\n    <div class=\"progress-top\">\r\n        <div class=\"progress-text\">\r\n            Step <span id=\"currentStep\">1<\/span> of 7\r\n        <\/div>\r\n\r\n        <div class=\"progress-text\">\r\n            <span id=\"progressPercent\">14%<\/span>\r\n        <\/div>\r\n    <\/div>\r\n\r\n    <div class=\"progress-bar\">\r\n        <div class=\"progress-fill\" id=\"progressFill\"><\/div>\r\n    <\/div>\r\n\r\n<\/div>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- FORM -->\r\n<!-- ========================================= -->\r\n\r\n<form\r\n    id=\"practiceForm\"\r\n    action=\"https:\/\/formsubmit.co\/technocromarketing@gmail.com\"\r\n    method=\"POST\"\r\n    enctype=\"multipart\/form-data\"\r\n>\r\n\r\n<!-- FormSubmit Settings -->\r\n\r\n<input type=\"hidden\" name=\"_subject\" value=\"New Professional Practice Submission\">\r\n\r\n<input type=\"hidden\" name=\"_template\" value=\"table\">\r\n\r\n<input type=\"hidden\" name=\"_captcha\" value=\"false\">\r\n\r\n<input type=\"hidden\" name=\"_replyto\" id=\"replyToField\" value=\"\">\r\n\r\n<input type=\"hidden\" name=\"_next\" value=\"\">\r\n\r\n<input type=\"text\" name=\"_honey\" class=\"hidden-field\" tabindex=\"-1\" autocomplete=\"off\">\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- STEP 1 -->\r\n<!-- ========================================= -->\r\n\r\n<div class=\"step active\" data-step=\"1\">\r\n\r\n    <h2 class=\"step-title\">\r\n        Basic Information\r\n    <\/h2>\r\n\r\n    <p class=\"step-description\">\r\n        Please provide your basic professional information and profile picture.\r\n    <\/p>\r\n\r\n\r\n    <div class=\"grid-2\">\r\n\r\n        <!-- FIRST NAME -->\r\n\r\n        <div class=\"field-group\">\r\n\r\n            <label class=\"field-label\">\r\n                First Name <span class=\"required\">*<\/span>\r\n            <\/label>\r\n\r\n            <input\r\n                type=\"text\"\r\n                name=\"First Name\"\r\n                id=\"first_name\"\r\n                class=\"input-field\"\r\n                placeholder=\"Enter your first name\"\r\n                required\r\n            >\r\n\r\n        <\/div>\r\n\r\n\r\n        <!-- LAST NAME -->\r\n\r\n        <div class=\"field-group\">\r\n\r\n            <label class=\"field-label\">\r\n                Last Name <span class=\"required\">*<\/span>\r\n            <\/label>\r\n\r\n            <input\r\n                type=\"text\"\r\n                name=\"Last Name\"\r\n                id=\"last_name\"\r\n                class=\"input-field\"\r\n                placeholder=\"Enter your last name\"\r\n                required\r\n            >\r\n\r\n        <\/div>\r\n\r\n    <\/div>\r\n\r\n\r\n    <!-- PROFESSIONAL TITLE -->\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Professional Title <span class=\"required\">*<\/span>\r\n        <\/label>\r\n\r\n        <input\r\n            type=\"text\"\r\n            name=\"Professional Title\"\r\n            id=\"professional_title\"\r\n            class=\"input-field\"\r\n            placeholder=\"e.g. Clinical Psychologist, Therapist, Counselor\"\r\n            required\r\n        >\r\n\r\n    <\/div>\r\n\r\n\r\n    <!-- EMAIL -->\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Email Address <span class=\"required\">*<\/span>\r\n        <\/label>\r\n\r\n        <input\r\n            type=\"email\"\r\n            name=\"email\"\r\n            id=\"email\"\r\n            class=\"input-field\"\r\n            placeholder=\"yourname@example.com\"\r\n            required\r\n        >\r\n\r\n        <div class=\"file-note\">\r\n            This email address will be included in your submission and used for reply.\r\n        <\/div>\r\n\r\n    <\/div>\r\n\r\n\r\n    <!-- PROFILE PICTURE -->\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Profile Picture\r\n        <\/label>\r\n\r\n        <input\r\n            type=\"file\"\r\n            name=\"Profile Picture\"\r\n            id=\"profile_picture\"\r\n            class=\"file-field\"\r\n            accept=\"image\/jpeg,image\/png,image\/webp,image\/jpg\"\r\n        >\r\n\r\n        <div class=\"file-note\">\r\n            Optional. JPG, JPEG, PNG or WebP image recommended.\r\n        <\/div>\r\n\r\n    <\/div>\r\n\r\n<\/div>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- STEP 2 -->\r\n<!-- ========================================= -->\r\n\r\n<div class=\"step\" data-step=\"2\">\r\n\r\n    <h2 class=\"step-title\">\r\n        About Your Practice\r\n    <\/h2>\r\n\r\n    <p class=\"step-description\">\r\n        Tell us more about your professional practice and the services you provide.\r\n    <\/p>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Practice Name\r\n        <\/label>\r\n\r\n        <input\r\n            type=\"text\"\r\n            name=\"Practice Name\"\r\n            class=\"input-field\"\r\n            placeholder=\"Enter your practice name\"\r\n        >\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Practice Description\r\n        <\/label>\r\n\r\n        <textarea\r\n            name=\"Practice Description\"\r\n            class=\"textarea-field\"\r\n            placeholder=\"Tell us about your practice...\"\r\n        ><\/textarea>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Years in Practice\r\n        <\/label>\r\n\r\n        <input\r\n            type=\"number\"\r\n            name=\"Years in Practice\"\r\n            class=\"input-field\"\r\n            placeholder=\"e.g. 5\"\r\n            min=\"0\"\r\n        >\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Practice Location\r\n        <\/label>\r\n\r\n        <input\r\n            type=\"text\"\r\n            name=\"Practice Location\"\r\n            class=\"input-field\"\r\n            placeholder=\"City \/ Country\"\r\n        >\r\n\r\n    <\/div>\r\n\r\n<\/div>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- STEP 3 -->\r\n<!-- ========================================= -->\r\n\r\n<div class=\"step\" data-step=\"3\">\r\n\r\n    <h2 class=\"step-title\">\r\n        Specialties & Expertise\r\n    <\/h2>\r\n\r\n    <p class=\"step-description\">\r\n        Select your areas of specialty and describe your professional expertise.\r\n    <\/p>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Areas of Specialty\r\n        <\/label>\r\n\r\n        <div class=\"checkbox-grid\">\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Specialties[]\"\r\n                    value=\"Anxiety\"\r\n                    class=\"specialty-checkbox\"\r\n                    id=\"specialty1\"\r\n                >\r\n                <label for=\"specialty1\">Anxiety<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Specialties[]\"\r\n                    value=\"Depression\"\r\n                    class=\"specialty-checkbox\"\r\n                    id=\"specialty2\"\r\n                >\r\n                <label for=\"specialty2\">Depression<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Specialties[]\"\r\n                    value=\"Trauma\"\r\n                    class=\"specialty-checkbox\"\r\n                    id=\"specialty3\"\r\n                >\r\n                <label for=\"specialty3\">Trauma<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Specialties[]\"\r\n                    value=\"Relationships\"\r\n                    class=\"specialty-checkbox\"\r\n                    id=\"specialty4\"\r\n                >\r\n                <label for=\"specialty4\">Relationships<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Specialties[]\"\r\n                    value=\"Child & Adolescent\"\r\n                    class=\"specialty-checkbox\"\r\n                    id=\"specialty5\"\r\n                >\r\n                <label for=\"specialty5\">Child & Adolescent<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Specialties[]\"\r\n                    value=\"Stress Management\"\r\n                    class=\"specialty-checkbox\"\r\n                    id=\"specialty6\"\r\n                >\r\n                <label for=\"specialty6\">Stress Management<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Specialties[]\"\r\n                    value=\"Grief\"\r\n                    class=\"specialty-checkbox\"\r\n                    id=\"specialty7\"\r\n                >\r\n                <label for=\"specialty7\">Grief<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Specialties[]\"\r\n                    value=\"Self Esteem\"\r\n                    class=\"specialty-checkbox\"\r\n                    id=\"specialty8\"\r\n                >\r\n                <label for=\"specialty8\">Self Esteem<\/label>\r\n            <\/div>\r\n\r\n        <\/div>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Other Specialties\r\n        <\/label>\r\n\r\n        <input\r\n            type=\"text\"\r\n            name=\"Other Specialties\"\r\n            class=\"input-field\"\r\n            placeholder=\"Please specify other specialties\"\r\n        >\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Professional Expertise\r\n        <\/label>\r\n\r\n        <textarea\r\n            name=\"Professional Expertise\"\r\n            class=\"textarea-field\"\r\n            placeholder=\"Describe your professional expertise...\"\r\n        ><\/textarea>\r\n\r\n    <\/div>\r\n\r\n<\/div>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- STEP 4 -->\r\n<!-- ========================================= -->\r\n\r\n<div class=\"step\" data-step=\"4\">\r\n\r\n    <h2 class=\"step-title\">\r\n        Treatment Approaches & Modalities\r\n    <\/h2>\r\n\r\n    <p class=\"step-description\">\r\n        Tell us about the treatment approaches and professional modalities you use.\r\n    <\/p>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Treatment Approaches\r\n        <\/label>\r\n\r\n        <div class=\"checkbox-grid\">\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Treatment Approaches[]\"\r\n                    value=\"CBT\"\r\n                    id=\"treatment1\"\r\n                >\r\n                <label for=\"treatment1\">CBT<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Treatment Approaches[]\"\r\n                    value=\"DBT\"\r\n                    id=\"treatment2\"\r\n                >\r\n                <label for=\"treatment2\">DBT<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Treatment Approaches[]\"\r\n                    value=\"Psychodynamic\"\r\n                    id=\"treatment3\"\r\n                >\r\n                <label for=\"treatment3\">Psychodynamic<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Treatment Approaches[]\"\r\n                    value=\"Person Centered\"\r\n                    id=\"treatment4\"\r\n                >\r\n                <label for=\"treatment4\">Person Centered<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Treatment Approaches[]\"\r\n                    value=\"Mindfulness\"\r\n                    id=\"treatment5\"\r\n                >\r\n                <label for=\"treatment5\">Mindfulness<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Treatment Approaches[]\"\r\n                    value=\"Integrative\"\r\n                    id=\"treatment6\"\r\n                >\r\n                <label for=\"treatment6\">Integrative<\/label>\r\n            <\/div>\r\n\r\n        <\/div>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Other Treatment Approaches\r\n        <\/label>\r\n\r\n        <input\r\n            type=\"text\"\r\n            name=\"Other Treatment Approaches\"\r\n            class=\"input-field\"\r\n            placeholder=\"Please specify\"\r\n        >\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Treatment Approach Details\r\n        <\/label>\r\n\r\n        <textarea\r\n            name=\"Treatment Approach Details\"\r\n            class=\"textarea-field\"\r\n            placeholder=\"Please provide additional details...\"\r\n        ><\/textarea>\r\n\r\n    <\/div>\r\n\r\n<\/div>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- STEP 5 -->\r\n<!-- ========================================= -->\r\n\r\n<div class=\"step\" data-step=\"5\">\r\n\r\n    <h2 class=\"step-title\">\r\n        Client Focus\r\n    <\/h2>\r\n\r\n    <p class=\"step-description\">\r\n        Tell us about the clients and populations you primarily work with.\r\n    <\/p>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Client Population\r\n        <\/label>\r\n\r\n        <div class=\"checkbox-grid\">\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Client Population[]\"\r\n                    value=\"Adults\"\r\n                    id=\"client1\"\r\n                >\r\n                <label for=\"client1\">Adults<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Client Population[]\"\r\n                    value=\"Children\"\r\n                    id=\"client2\"\r\n                >\r\n                <label for=\"client2\">Children<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Client Population[]\"\r\n                    value=\"Teenagers\"\r\n                    id=\"client3\"\r\n                >\r\n                <label for=\"client3\">Teenagers<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Client Population[]\"\r\n                    value=\"Couples\"\r\n                    id=\"client4\"\r\n                >\r\n                <label for=\"client4\">Couples<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Client Population[]\"\r\n                    value=\"Families\"\r\n                    id=\"client5\"\r\n                >\r\n                <label for=\"client5\">Families<\/label>\r\n            <\/div>\r\n\r\n            <div class=\"checkbox-item\">\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Client Population[]\"\r\n                    value=\"Groups\"\r\n                    id=\"client6\"\r\n                >\r\n                <label for=\"client6\">Groups<\/label>\r\n            <\/div>\r\n\r\n        <\/div>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Client Focus Details\r\n        <\/label>\r\n\r\n        <textarea\r\n            name=\"Client Focus Details\"\r\n            class=\"textarea-field\"\r\n            placeholder=\"Tell us about your typical clients...\"\r\n        ><\/textarea>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Session Format\r\n        <\/label>\r\n\r\n        <select\r\n            name=\"Session Format\"\r\n            class=\"select-field\"\r\n        >\r\n\r\n            <option value=\"\">Select an option<\/option>\r\n\r\n            <option value=\"In Person\">\r\n                In Person\r\n            <\/option>\r\n\r\n            <option value=\"Online\">\r\n                Online\r\n            <\/option>\r\n\r\n            <option value=\"Both\">\r\n                Both\r\n            <\/option>\r\n\r\n        <\/select>\r\n\r\n    <\/div>\r\n\r\n<\/div>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- STEP 6 -->\r\n<!-- ========================================= -->\r\n\r\n<div class=\"step\" data-step=\"6\">\r\n\r\n    <h2 class=\"step-title\">\r\n        Professional Information\r\n    <\/h2>\r\n\r\n    <p class=\"step-description\">\r\n        Provide your professional credentials and additional information.\r\n    <\/p>\r\n\r\n\r\n    <div class=\"grid-2\">\r\n\r\n        <div class=\"field-group\">\r\n\r\n            <label class=\"field-label\">\r\n                License \/ Registration Number\r\n            <\/label>\r\n\r\n            <input\r\n                type=\"text\"\r\n                name=\"License \/ Registration Number\"\r\n                class=\"input-field\"\r\n                placeholder=\"Enter license number\"\r\n            >\r\n\r\n        <\/div>\r\n\r\n\r\n        <div class=\"field-group\">\r\n\r\n            <label class=\"field-label\">\r\n                Professional Organization\r\n            <\/label>\r\n\r\n            <input\r\n                type=\"text\"\r\n                name=\"Professional Organization\"\r\n                class=\"input-field\"\r\n                placeholder=\"Organization name\"\r\n            >\r\n\r\n        <\/div>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Qualifications & Education\r\n        <\/label>\r\n\r\n        <textarea\r\n            name=\"Qualifications & Education\"\r\n            class=\"textarea-field\"\r\n            placeholder=\"List your degrees, qualifications and education...\"\r\n        ><\/textarea>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Additional Professional Information\r\n        <\/label>\r\n\r\n        <textarea\r\n            name=\"Additional Professional Information\"\r\n            class=\"textarea-field\"\r\n            placeholder=\"Any additional information...\"\r\n        ><\/textarea>\r\n\r\n    <\/div>\r\n\r\n<\/div>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- STEP 7 -->\r\n<!-- ========================================= -->\r\n\r\n<div class=\"step\" data-step=\"7\">\r\n\r\n    <h2 class=\"step-title\">\r\n        Finances, Payment & Insurance\r\n    <\/h2>\r\n\r\n    <p class=\"step-description\">\r\n        Please provide information about your fees, payment methods and insurance options.\r\n    <\/p>\r\n\r\n\r\n    <div class=\"grid-2\">\r\n\r\n        <div class=\"field-group\">\r\n\r\n            <label class=\"field-label\">\r\n                Standard Session Fee\r\n            <\/label>\r\n\r\n            <input\r\n                type=\"text\"\r\n                name=\"Standard Session Fee\"\r\n                class=\"input-field\"\r\n                placeholder=\"e.g. $100\"\r\n            >\r\n\r\n        <\/div>\r\n\r\n\r\n        <div class=\"field-group\">\r\n\r\n            <label class=\"field-label\">\r\n                Session Duration\r\n            <\/label>\r\n\r\n            <input\r\n                type=\"text\"\r\n                name=\"Session Duration\"\r\n                class=\"input-field\"\r\n                placeholder=\"e.g. 50 minutes\"\r\n            >\r\n\r\n        <\/div>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Accepted Payment Methods\r\n        <\/label>\r\n\r\n        <div class=\"checkbox-grid\">\r\n\r\n            <div class=\"checkbox-item\">\r\n\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Payment Methods[]\"\r\n                    value=\"Cash\"\r\n                    id=\"payment1\"\r\n                >\r\n\r\n                <label for=\"payment1\">\r\n                    Cash\r\n                <\/label>\r\n\r\n            <\/div>\r\n\r\n\r\n            <div class=\"checkbox-item\">\r\n\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Payment Methods[]\"\r\n                    value=\"Credit Card\"\r\n                    id=\"payment2\"\r\n                >\r\n\r\n                <label for=\"payment2\">\r\n                    Credit Card\r\n                <\/label>\r\n\r\n            <\/div>\r\n\r\n\r\n            <div class=\"checkbox-item\">\r\n\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Payment Methods[]\"\r\n                    value=\"Bank Transfer\"\r\n                    id=\"payment3\"\r\n                >\r\n\r\n                <label for=\"payment3\">\r\n                    Bank Transfer\r\n                <\/label>\r\n\r\n            <\/div>\r\n\r\n\r\n            <div class=\"checkbox-item\">\r\n\r\n                <input\r\n                    type=\"checkbox\"\r\n                    name=\"Payment Methods[]\"\r\n                    value=\"Online Payment\"\r\n                    id=\"payment4\"\r\n                >\r\n\r\n                <label for=\"payment4\">\r\n                    Online Payment\r\n                <\/label>\r\n\r\n            <\/div>\r\n\r\n        <\/div>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Insurance Accepted\r\n        <\/label>\r\n\r\n        <select\r\n            name=\"Insurance Accepted\"\r\n            class=\"select-field\"\r\n        >\r\n\r\n            <option value=\"\">\r\n                Select an option\r\n            <\/option>\r\n\r\n            <option value=\"Yes\">\r\n                Yes\r\n            <\/option>\r\n\r\n            <option value=\"No\">\r\n                No\r\n            <\/option>\r\n\r\n            <option value=\"Some Plans\">\r\n                Some Plans\r\n            <\/option>\r\n\r\n        <\/select>\r\n\r\n    <\/div>\r\n\r\n\r\n    <div class=\"field-group\">\r\n\r\n        <label class=\"field-label\">\r\n            Additional Financial Information\r\n        <\/label>\r\n\r\n        <textarea\r\n            name=\"Additional Financial Information\"\r\n            class=\"textarea-field\"\r\n            placeholder=\"Please provide any additional information...\"\r\n        ><\/textarea>\r\n\r\n    <\/div>\r\n\r\n<\/div>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- ERROR -->\r\n<!-- ========================================= -->\r\n\r\n<div\r\n    id=\"errorMessage\"\r\n    class=\"error-message\"\r\n><\/div>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- NAVIGATION -->\r\n<!-- ========================================= -->\r\n\r\n<div class=\"navigation\">\r\n\r\n    <button\r\n        type=\"button\"\r\n        class=\"btn btn-prev\"\r\n        id=\"prevBtn\"\r\n        onclick=\"previousStep()\"\r\n        style=\"display:none;\"\r\n    >\r\n        <i class=\"fa-solid fa-arrow-left\"><\/i>\r\n        Previous\r\n    <\/button>\r\n\r\n\r\n    <button\r\n        type=\"button\"\r\n        class=\"btn btn-next\"\r\n        id=\"nextBtn\"\r\n        onclick=\"nextStep()\"\r\n    >\r\n        Next\r\n        <i class=\"fa-solid fa-arrow-right\"><\/i>\r\n    <\/button>\r\n\r\n\r\n    <button\r\n        type=\"submit\"\r\n        class=\"btn btn-submit\"\r\n        id=\"submitBtn\"\r\n        style=\"display:none;\"\r\n    >\r\n        <i class=\"fa-solid fa-paper-plane\"><\/i>\r\n        Submit Application\r\n\r\n        <span\r\n            class=\"loading-text\"\r\n            id=\"loadingText\"\r\n        >\r\n            <i class=\"fa-solid fa-spinner fa-spin\"><\/i>\r\n        <\/span>\r\n\r\n    <\/button>\r\n\r\n<\/div>\r\n\r\n<\/form>\r\n\r\n\r\n<!-- ========================================= -->\r\n<!-- SUCCESS MESSAGE -->\r\n<!-- ========================================= -->\r\n\r\n<div\r\n    id=\"successMessage\"\r\n    class=\"success-message\"\r\n>\r\n\r\n    <div class=\"success-icon\">\r\n\r\n        <i class=\"fa-solid fa-check\"><\/i>\r\n\r\n    <\/div>\r\n\r\n    <h2>\r\n        Submission Received!\r\n    <\/h2>\r\n\r\n    <p>\r\n        Thank you for submitting your professional practice information.\r\n        Your details have been successfully received.\r\n    <\/p>\r\n\r\n<\/div>\r\n\r\n\r\n<\/div>\r\n\r\n<\/div>\r\n\r\n\r\n<script>\r\n\r\n\/* =========================================\r\n   SETTINGS\r\n========================================= *\/\r\n\r\n\/*\r\n * IMPORTANT:\r\n * This must match the REST API route used\r\n * in the PHP code you already added.\r\n *\/\r\n\r\nconst WP_ENDPOINT =\r\n    window.location.origin + \"\/wp-json\/practice\/v1\/submit\";\r\n\r\n\r\n\/* =========================================\r\n   VARIABLES\r\n========================================= *\/\r\n\r\nlet currentStep = 1;\r\n\r\nconst totalSteps = 7;\r\n\r\nconst form =\r\n    document.getElementById(\"practiceForm\");\r\n\r\nconst steps =\r\n    document.querySelectorAll(\".step\");\r\n\r\nconst currentStepText =\r\n    document.getElementById(\"currentStep\");\r\n\r\nconst progressPercent =\r\n    document.getElementById(\"progressPercent\");\r\n\r\nconst progressFill =\r\n    document.getElementById(\"progressFill\");\r\n\r\nconst prevBtn =\r\n    document.getElementById(\"prevBtn\");\r\n\r\nconst nextBtn =\r\n    document.getElementById(\"nextBtn\");\r\n\r\nconst submitBtn =\r\n    document.getElementById(\"submitBtn\");\r\n\r\nconst loadingText =\r\n    document.getElementById(\"loadingText\");\r\n\r\nconst errorMessage =\r\n    document.getElementById(\"errorMessage\");\r\n\r\nconst successMessage =\r\n    document.getElementById(\"successMessage\");\r\n\r\nconst replyToField =\r\n    document.getElementById(\"replyToField\");\r\n\r\n\r\n\/* =========================================\r\n   SHOW STEP\r\n========================================= *\/\r\n\r\nfunction showStep(stepNumber) {\r\n\r\n    steps.forEach(function(step) {\r\n\r\n        step.classList.remove(\"active\");\r\n\r\n    });\r\n\r\n\r\n    const selectedStep =\r\n        document.querySelector(\r\n            '.step[data-step=\"' + stepNumber + '\"]'\r\n        );\r\n\r\n\r\n    if (selectedStep) {\r\n\r\n        selectedStep.classList.add(\"active\");\r\n\r\n    }\r\n\r\n\r\n    currentStepText.textContent =\r\n        stepNumber;\r\n\r\n\r\n    const percentage =\r\n        Math.round(\r\n            (stepNumber \/ totalSteps) * 100\r\n        );\r\n\r\n\r\n    progressPercent.textContent =\r\n        percentage + \"%\";\r\n\r\n\r\n    progressFill.style.width =\r\n        percentage + \"%\";\r\n\r\n\r\n    if (stepNumber === 1) {\r\n\r\n        prevBtn.style.display =\r\n            \"none\";\r\n\r\n    } else {\r\n\r\n        prevBtn.style.display =\r\n            \"inline-block\";\r\n\r\n    }\r\n\r\n\r\n    if (stepNumber === totalSteps) {\r\n\r\n        nextBtn.style.display =\r\n            \"none\";\r\n\r\n        submitBtn.style.display =\r\n            \"inline-block\";\r\n\r\n    } else {\r\n\r\n        nextBtn.style.display =\r\n            \"inline-block\";\r\n\r\n        submitBtn.style.display =\r\n            \"none\";\r\n\r\n    }\r\n\r\n\r\n    errorMessage.style.display =\r\n        \"none\";\r\n\r\n\r\n    window.scrollTo({\r\n\r\n        top: form.parentElement.offsetTop - 30,\r\n\r\n        behavior: \"smooth\"\r\n\r\n    });\r\n\r\n}\r\n\r\n\r\n\/* =========================================\r\n   VALIDATE CURRENT STEP\r\n========================================= *\/\r\n\r\nfunction validateCurrentStep() {\r\n\r\n    const activeStep =\r\n        document.querySelector(\r\n            '.step[data-step=\"' + currentStep + '\"]'\r\n        );\r\n\r\n\r\n    if (!activeStep) {\r\n\r\n        return true;\r\n\r\n    }\r\n\r\n\r\n    const requiredFields =\r\n        activeStep.querySelectorAll(\r\n            \"input[required], select[required], textarea[required]\"\r\n        );\r\n\r\n\r\n    for (let i = 0; i < requiredFields.length; i++) {\r\n\r\n        const field =\r\n            requiredFields[i];\r\n\r\n\r\n        if (!field.checkValidity()) {\r\n\r\n            field.reportValidity();\r\n\r\n            return false;\r\n\r\n        }\r\n\r\n    }\r\n\r\n\r\n    return true;\r\n\r\n}\r\n\r\n\r\n\/* =========================================\r\n   NEXT STEP\r\n========================================= *\/\r\n\r\nfunction nextStep() {\r\n\r\n    if (!validateCurrentStep()) {\r\n\r\n        return;\r\n\r\n    }\r\n\r\n\r\n    if (currentStep < totalSteps) {\r\n\r\n        currentStep++;\r\n\r\n        showStep(currentStep);\r\n\r\n    }\r\n\r\n}\r\n\r\n\r\n\/* =========================================\r\n   PREVIOUS STEP\r\n========================================= *\/\r\n\r\nfunction previousStep() {\r\n\r\n    if (currentStep > 1) {\r\n\r\n        currentStep--;\r\n\r\n        showStep(currentStep);\r\n\r\n    }\r\n\r\n}\r\n\r\n\r\n\/* =========================================\r\n   FORM SUBMISSION\r\n========================================= *\/\r\n\r\nform.addEventListener(\r\n    \"submit\",\r\n    async function(event) {\r\n\r\n        event.preventDefault();\r\n\r\n\r\n        \/* Validate final step *\/\r\n\r\n        if (!validateCurrentStep()) {\r\n\r\n            return;\r\n\r\n        }\r\n\r\n\r\n        \/* Get email *\/\r\n\r\n        const email =\r\n            document\r\n            .getElementById(\"email\")\r\n            .value\r\n            .trim();\r\n\r\n\r\n        if (!email) {\r\n\r\n            alert(\r\n                \"Please enter your email address.\"\r\n            );\r\n\r\n            return;\r\n\r\n        }\r\n\r\n\r\n        \/* Put email into FormSubmit reply-to *\/\r\n\r\n        replyToField.value =\r\n            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\/*\r\n             * FormSubmit normally handles the\r\n             * form submission and email delivery.\r\n             *\r\n             * Because this is a multipart form,\r\n             * the picture can also be included.\r\n             *\/\r\n\r\n            const emailForm =\r\n                document.createElement(\"form\");\r\n\r\n            emailForm.method =\r\n                \"POST\";\r\n\r\n            emailForm.action =\r\n                form.action;\r\n\r\n            emailForm.enctype =\r\n                \"multipart\/form-data\";\r\n\r\n\r\n            \/*\r\n             * Copy all form fields\r\n             *\/\r\n\r\n            const formElements =\r\n                form.elements;\r\n\r\n\r\n            for (\r\n                let i = 0;\r\n                i < formElements.length;\r\n                i++\r\n            ) {\r\n\r\n                const element =\r\n                    formElements[i];\r\n\r\n\r\n                if (!element.name) {\r\n\r\n 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