{"id":52,"date":"2025-05-30T11:40:34","date_gmt":"2025-05-30T02:40:34","guid":{"rendered":"https:\/\/racoo6.heteml.net\/jikosapo\/?page_id=52"},"modified":"2026-04-15T16:43:45","modified_gmt":"2026-04-15T07:43:45","slug":"application","status":"publish","type":"page","link":"https:\/\/jikosapo.co.jp\/test\/application","title":{"rendered":"\u7533\u8acb\u30d5\u30a9\u30fc\u30e0"},"content":{"rendered":"<section class=\"form-wrapper\">\r\n\t<div class=\"section_inner\">\r\n\t\t<div class=\"form_block\">\r\n\t\t\t\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f51-o1\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"51\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<script type=\"text\/javascript\" charset=\"UTF-8\" src=\"https:\/\/zipaddr.github.io\/zipaddrx.js?v=1.42\"><\/script><script defer src=\"data:text\/javascript;base64,ZnVuY3Rpb24gemlwYWRkcl9vd25iKCl7WlAuZGxpPSctJztaUC53cD0nMSc7WlAudXZlcj0nMTYwMzQuMjExOTguOTI2NDQnO1pQLnN5c2lkPSdDb250YWN0Rm9ybTcnO30=\"><\/script><script type=\"text\/javascript\" charset=\"UTF-8\" src=\"https:\/\/zipaddr.github.io\/contactform7.js\"><\/script><form action=\"\/test\/wp-json\/wp\/v2\/pages\/52#wpcf7-f51-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"51\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f51-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:51,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;-1&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;-1&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u3042\\u308a&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false}}\" \/>\n<\/fieldset>\n<table class=\"form-section\">\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u533b\u9662\u540d<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"clinic_name_display\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" readonly=\"readonly\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"clinic_name_display\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u304a\u540d\u524d<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your_name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u3075\u308a\u304c\u306a<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your_name_kana\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your_name_kana\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u96fb\u8a71\u756a\u53f7<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your_tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your_tel\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your_mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your_mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9\uff08\u78ba\u8a8d\u7528\uff09<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your_mail_confirm\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4e0a\u8a18\u3068\u540c\u3058\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9\u3092\u5165\u529b\u3057\u3066\u304f\u3060\u3055\u3044\u3002\" value=\"\" type=\"email\" name=\"your_mail_confirm\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u901a\u9662\u65e5\u6570\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td class=\"size14\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"clinic-days\"><span class=\"wpcf7-form-control wpcf7-radio vertical-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"clinic-days\" value=\"10\u301c20\u65e5\" \/><span class=\"wpcf7-list-item-label\">10\u301c20\u65e5<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"clinic-days\" value=\"21\uff5e40\u65e5\" \/><span class=\"wpcf7-list-item-label\">21\uff5e40\u65e5<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"clinic-days\" value=\"41\uff5e60\u65e5\" \/><span class=\"wpcf7-list-item-label\">41\uff5e60\u65e5<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"clinic-days\" value=\"61\u65e5\u4ee5\u4e0a\" \/><span class=\"wpcf7-list-item-label\">61\u65e5\u4ee5\u4e0a<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"clinic-days\" value=\"\u308f\u304b\u3089\u306a\u3044\" \/><span class=\"wpcf7-list-item-label\">\u308f\u304b\u3089\u306a\u3044<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u6700\u7d42\u6cbb\u7642\u65e5<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td class=\"size14 dateWidth-short\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"last_date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"last_date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u304a\u898b\u821e\u91d1\u306e\u53d7\u53d6\u53e3\u5ea7\u540d\u7fa9(\u30ab\u30bf\u30ab\u30ca)<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"account-holder-kana\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"account-holder-kana\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u91d1\u878d\u6a5f\u95a2\u30b3\u30fc\u30c9\u203b\uff08\u534a\u89d2\u6570\u5b574\u6841\uff09<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"bank-code\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number only-number\" min=\"0\" max=\"9999\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"bank-code\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u91d1\u878d\u6a5f\u95a2\u540d<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"bank-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"bank-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u652f\u5e97\u756a\u53f7\uff08\u534a\u89d2\u6570\u5b573\u6841\uff09<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"branch-code\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number only-number\" min=\"0\" max=\"999\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"branch-code\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u652f\u5e97\u540d<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"branch-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"branch-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u53e3\u5ea7\u306e\u9810\u91d1\u7a2e\u76ee<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<div class=\"visit-dates\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"account-type\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"account-type\"><option value=\"\u666e\u901a\">\u666e\u901a<\/option><option value=\"\u5f53\u5ea7\">\u5f53\u5ea7<\/option><option value=\"\u8caf\u84c4\">\u8caf\u84c4<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u53e3\u5ea7\u756a\u53f7\uff08\u534a\u89d27\u6841\uff09<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"account-number\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number only-number\" min=\"0\" max=\"9999999\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"account-number\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u53e3\u30b3\u30df<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"review_contents\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"comment\" aria-invalid=\"false\" name=\"review_contents\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<th>\n\t\t\t<p>\u8a55\u4fa1<span class=\"white bg_orange\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/th>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"review_star\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"review_star\"><option value=\"\u2605\u2606\u2606\u2606\u2606\">\u2605\u2606\u2606\u2606\u2606<\/option><option value=\"\u2605\u2605\u2606\u2606\u2606\">\u2605\u2605\u2606\u2606\u2606<\/option><option value=\"\u2605\u2605\u2605\u2606\u2606\">\u2605\u2605\u2605\u2606\u2606<\/option><option value=\"\u2605\u2605\u2605\u2605\u2606\">\u2605\u2605\u2605\u2605\u2606<\/option><option value=\"\u2605\u2605\u2605\u2605\u2605\">\u2605\u2605\u2605\u2605\u2605<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"clinic_name\" \/>\n<div class=\"consent-wrap center size14\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\"><a href=\"https:\/\/jikosapo.co.jp\/privacy\" target=\"_blank\">\u30d7\u30e9\u30a4\u30d0\u30b7\u30fc\u30dd\u30ea\u30b7\u30fc<\/a>\u306b\u540c\u610f\u3059\u308b<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"btn-wrap center size18\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u9001\u4fe1\u3059\u308b\" \/>\n\t<\/p>\n<\/div><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"61\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\r\n\t\t<\/div>\r\n<p class=\"google_review medium red center size20\">\u304a\u898b\u821e\u91d1\u7533\u8acb\u306e\u969b\u3001\u304b\u3089Google\u53e3\u30b3\u30df\u3078\u306e\u8a18\u5165\u3082\u304a\u9858\u3044\u3057\u3066\u304a\u308a\u307e\u3059\u3002<\/p>\r\n\t<\/div>\r\n<\/section>\r\n","protected":false},"excerpt":{"rendered":"\u304a\u898b\u821e\u91d1\u7533\u8acb\u306e\u969b\u3001\u304b\u3089Google\u53e3\u30b3\u30df\u3078\u306e\u8a18\u5165\u3082\u304a\u9858\u3044\u3057\u3066\u304a\u308a\u307e\u3059\u3002","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-52","page","type-page","status-publish","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/jikosapo.co.jp\/test\/wp-json\/wp\/v2\/pages\/52","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jikosapo.co.jp\/test\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jikosapo.co.jp\/test\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jikosapo.co.jp\/test\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jikosapo.co.jp\/test\/wp-json\/wp\/v2\/comments?post=52"}],"version-history":[{"count":12,"href":"https:\/\/jikosapo.co.jp\/test\/wp-json\/wp\/v2\/pages\/52\/revisions"}],"predecessor-version":[{"id":2010,"href":"https:\/\/jikosapo.co.jp\/test\/wp-json\/wp\/v2\/pages\/52\/revisions\/2010"}],"wp:attachment":[{"href":"https:\/\/jikosapo.co.jp\/test\/wp-json\/wp\/v2\/media?parent=52"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}