<!DOCTYPE html><!-- [et_pb_line_break_holder] --><html lang="en"><!-- [et_pb_line_break_holder] --> <head><!-- [et_pb_line_break_holder] --> <meta charset="utf-8"><!-- [et_pb_line_break_holder] --> <meta http-equiv="X-UA-Compatible" content="IE=edge"><!-- [et_pb_line_break_holder] --> <meta name="viewport" content="width=device-width, initial-scale=1"><!-- [et_pb_line_break_holder] --> <link href="https://www.masmedico.es/api/css/bootstrap.min.css" rel="stylesheet"><!-- [et_pb_line_break_holder] --> <link href="https://www.masmedico.es/api/css/bootstrap-multiselect.css" rel="stylesheet"><!-- [et_pb_line_break_holder] --> <style type="text/css"><!-- [et_pb_line_break_holder] --> label{<!-- [et_pb_line_break_holder] --> color: #50a2f8;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> .error{<!-- [et_pb_line_break_holder] --> color: #f00;<!-- [et_pb_line_break_holder] --> height: 9px;<!-- [et_pb_line_break_holder] --> font-size: 13px;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> .mField{<!-- [et_pb_line_break_holder] --> color: #f55;<!-- [et_pb_line_break_holder] --> font-weight: bold;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> .mField:before{<!-- [et_pb_line_break_holder] --> content: '*';<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </style><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <script><!-- [et_pb_line_break_holder] --> (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){<!-- [et_pb_line_break_holder] --> (i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),<!-- [et_pb_line_break_holder] --> m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)<!-- [et_pb_line_break_holder] --> })(window,document,'script','https://www.google-analytics.com/analytics.js','ga');<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> ga('create', 'UA-60537540-4', 'auto');<!-- [et_pb_line_break_holder] --> ga('send', 'pageview');<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </script><!-- [et_pb_line_break_holder] --> </head><!-- [et_pb_line_break_holder] --> <body><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div class="container"><!-- [et_pb_line_break_holder] --> <div class="row"><!-- [et_pb_line_break_holder] --> <div class="col-sm-8 col-xs-12"><h1>CONTACTO</h1></div><!-- [et_pb_line_break_holder] --> <div class="col-sm-4 text-right col-xs-7"><h1><img class="img-responsive" src="https://gestionconsulta.es/wp-content/uploads/2017/06/logotipo.png"></h1></div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> <div class="panel panel-default"><!-- [et_pb_line_break_holder] --> <div class="panel-body"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <form class="form" id="data" method="post"><!-- [et_pb_line_break_holder] --> <h2>Datos usuario</h2><!-- [et_pb_line_break_holder] --> <div class="row"><!-- [et_pb_line_break_holder] --> <div class="col-lg-4 col-md-5 col-sm-7"><!-- [et_pb_line_break_holder] --> <label for="fullname">Nombre y apellidos</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed" name="fullname" id="fullname" tabindex="1" value=""/><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="col-lg-3 col-md-3 col-sm-5"><!-- [et_pb_line_break_holder] --> <label for="nickname">Nickname usuario</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed userNameInput" name="nickname" id="nickname" tabindex="2" placeholder="Mínimo 3 caracteres" value=""/><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="col-lg-3 col-md-2 col-sm-6" tabindex="2"><!-- [et_pb_line_break_holder] --> <label>Especialidad</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <select name="speciality" id="specialities"><!-- [et_pb_line_break_holder] --> <option value="0"> </option><!-- [et_pb_line_break_holder] --> <option value="1" >MEDICINA ESTÉTICA</option><!-- [et_pb_line_break_holder] --> <option value="2" >GINECOLOGO Y OBSTETRA</option><!-- [et_pb_line_break_holder] --> <option value="3" >TRAUMATOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="4" >DERMATOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="5" >PEDIATRA</option><!-- [et_pb_line_break_holder] --> <option value="6" >MEDICO GENERAL</option><!-- [et_pb_line_break_holder] --> <option value="7" >DIETISTA - NUTRICIONISTA</option><!-- [et_pb_line_break_holder] --> <option value="8" >DIGESTIVO</option><!-- [et_pb_line_break_holder] --> <option value="9" >ENDOCRINO</option><!-- [et_pb_line_break_holder] --> <option value="10" >INTERNISTA</option><!-- [et_pb_line_break_holder] --> <option value="11" >MEDICO DEL DEPORTE</option><!-- [et_pb_line_break_holder] --> <option value="12" >ACUPUNTOR</option><!-- [et_pb_line_break_holder] --> <option value="13" >ALERGOLOGO E INMUNOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="14" >ANALISTA CLINICO</option><!-- [et_pb_line_break_holder] --> <option value="15" >ANATOMOPATOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="16" >ANESTESISTA</option><!-- [et_pb_line_break_holder] --> <option value="17" >ATS DUES</option><!-- [et_pb_line_break_holder] --> <option value="18" >CARDIOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="19" >CIRUJANO CARDIOVASCULAR</option><!-- [et_pb_line_break_holder] --> <option value="20" >CIRUJANO GENERAL</option><!-- [et_pb_line_break_holder] --> <option value="21" >CIRUJANO MAXILOFACIAL</option><!-- [et_pb_line_break_holder] --> <option value="22" >CIRUJANO PEDIATRICO</option><!-- [et_pb_line_break_holder] --> <option value="23" >CIRUJANO PLASTICO</option><!-- [et_pb_line_break_holder] --> <option value="24" >CIRUJANO TORACICO</option><!-- [et_pb_line_break_holder] --> <option value="25" >CIRUJANO VASCULAR</option><!-- [et_pb_line_break_holder] --> <option value="26" >DIAGNOSTICO IMAGEN</option><!-- [et_pb_line_break_holder] --> <option value="27" >ESPECIALISTA MEDICINA NUCLEAR</option><!-- [et_pb_line_break_holder] --> <option value="28" >FISIOTERAPEUTA</option><!-- [et_pb_line_break_holder] --> <option value="29" >GERIATRA</option><!-- [et_pb_line_break_holder] --> <option value="30" >HEMATOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="31" >HOMEOPATA</option><!-- [et_pb_line_break_holder] --> <option value="32" >HOSPITALIZACION AMBULATORIA</option><!-- [et_pb_line_break_holder] --> <option value="33" >HOSPITALIZACION GENERAL</option><!-- [et_pb_line_break_holder] --> <option value="34" >LOGOFONIATRA</option><!-- [et_pb_line_break_holder] --> <option value="35" >LOGOPEDA</option><!-- [et_pb_line_break_holder] --> <option value="36" >MATRONA</option><!-- [et_pb_line_break_holder] --> <option value="37" >MEDICO DE URGENCIAS</option><!-- [et_pb_line_break_holder] --> <option value="38" >NEFROLOGO</option><!-- [et_pb_line_break_holder] --> <option value="39" >NEUMOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="40" >NEUROCIRUJANO</option><!-- [et_pb_line_break_holder] --> <option value="41" >NEUROFISIOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="42" >NEUROLOGO</option><!-- [et_pb_line_break_holder] --> <option value="43" >ODONTOESTOMATOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="44" >OFTALMOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="45" >ONCOLOGO </option><!-- [et_pb_line_break_holder] --> <option value="46" >ONCOLOGO RADIO</option><!-- [et_pb_line_break_holder] --> <option value="47" >OTORRINO</option><!-- [et_pb_line_break_holder] --> <option value="48" >PODOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="49" >PSICOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="50" >PSIQUIATRA</option><!-- [et_pb_line_break_holder] --> <option value="51" >PUERICULTOR</option><!-- [et_pb_line_break_holder] --> <option value="52" >RADIOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="53" >REHABILITADOR</option><!-- [et_pb_line_break_holder] --> <option value="54" >REUMATOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="55" >SERVICIO DE AMBULANCIAS</option><!-- [et_pb_line_break_holder] --> <option value="56" >UROLOGO</option><!-- [et_pb_line_break_holder] --> <option value="57" >NUTRICION BIOREGENERATIVA</option><!-- [et_pb_line_break_holder] --> <option value="58" >MEDICINA BIOLÓGICA</option><!-- [et_pb_line_break_holder] --> <option value="59" >NUTRICIÓN - MED ESTÉTICA - SEXOLOGÍA </option><!-- [et_pb_line_break_holder] --> <option value="60" >CIRUJANO REPARADOR</option><!-- [et_pb_line_break_holder] --> <option value="61" >MEDICINA GENOMICA</option><!-- [et_pb_line_break_holder] --> <option value="62" >FARMACOLOGIA CLINICA</option><!-- [et_pb_line_break_holder] --> <option value="63" >ALERGÓLOGO Y HOMEÓPATA </option><!-- [et_pb_line_break_holder] --> <option value="64" >MEDICINA INTEGRATIVA</option><!-- [et_pb_line_break_holder] --> <option value="65" >ODONTOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="66" >OCULISTA</option><!-- [et_pb_line_break_holder] --> <option value="67" >ENTRENADOR PERSONAL</option><!-- [et_pb_line_break_holder] --> <option value="68" >MEDICINA INTERNA</option><!-- [et_pb_line_break_holder] --> <option value="69" >ENFERMERO</option><!-- [et_pb_line_break_holder] --> <option value="70" >TERAPEUTA</option><!-- [et_pb_line_break_holder] --> <option value="71" >NATUROPATA</option><!-- [et_pb_line_break_holder] --> <option value="72" >NUTRICIONISTA Y PSICONEUROINMUNOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="73" >DIETISTA - NUTRICIONISTA DEPORTIVO</option><!-- [et_pb_line_break_holder] --> <option value="74" >OPTICO OPTOMETRISTA</option><!-- [et_pb_line_break_holder] --> <option value="75" >OSTEOPATA</option><!-- [et_pb_line_break_holder] --> <option value="76" >COACH NUTRICIONAL</option><!-- [et_pb_line_break_holder] --> <option value="77" >DIETISTA, NUTRICIONISTA Y ESPECIALISTA EN TRANSTORNOS DE LA CONDUCTA ALIMENTARIA Y OBESIDAD</option><!-- [et_pb_line_break_holder] --> <option value="78" >MEDICO REHABILITADOR Y OSTEOPATA</option><!-- [et_pb_line_break_holder] --> <option value="79" >MEDICINA FISICA Y REHABILITACION</option><!-- [et_pb_line_break_holder] --> <option value="80" >FISIOTERAPEUTA Y OSTEOPATA</option><!-- [et_pb_line_break_holder] --> <option value="81" >NUTRICIONISTA</option><!-- [et_pb_line_break_holder] --> <option value="82" >DIETISTA</option><!-- [et_pb_line_break_holder] --> <option value="83" >NATUROPATA ESPECIALISTA EN NUTRICION ORTOMOLECULAR</option><!-- [et_pb_line_break_holder] --> <option value="84" >MEDICINA GENERAL-HOMEPATIA</option><!-- [et_pb_line_break_holder] --> <option value="85" >MEDICINA PREVENTIVA Y SALUD PUBLICA</option><!-- [et_pb_line_break_holder] --> <option value="86" >QUIROMASAJISTA</option><!-- [et_pb_line_break_holder] --> <option value="87" >MEDICINA INTEGRATIVA Y MEDICINA ESTETICA</option><!-- [et_pb_line_break_holder] --> <option value="88" >FISIOTERAPEUTA - OSTEOPATA - PSICONEUROINMUNOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="89" >PSICOLOGO - PSICONEUROINMUNOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="90" >FARMACEUTICA ESPECIALISTA EN INTOLERANCIES ALIMENTARIES</option><!-- [et_pb_line_break_holder] --> <option value="91" >ESTETICISTA</option><!-- [et_pb_line_break_holder] --> <option value="92" >MEDICINA DE SISTEMAS</option><!-- [et_pb_line_break_holder] --> <option value="93" >NATUROPATA Y PSICONEUROINMUNOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="94" >PSICOTERAPEUTA</option><!-- [et_pb_line_break_holder] --> <option value="95" >DERMATOLOGIA Y VENEOROLOGIA</option><!-- [et_pb_line_break_holder] --> <option value="96" >HEALTH COACH -PSICONEUROINMUNOLOGO</option><!-- [et_pb_line_break_holder] --> <option value="97" >ASISTENCIA PRIMARIA</option><!-- [et_pb_line_break_holder] --> <option value="98" >HIGIENISTA</option><!-- [et_pb_line_break_holder] --> <option value="99" >RADIOTERAPEUTA</option><!-- [et_pb_line_break_holder] --> <option value="100" >COMADRONA</option><!-- [et_pb_line_break_holder] --> <option value="101" >MEDICO NUTRICIONISTA</option><!-- [et_pb_line_break_holder] --> <option value="102" >MEDICINA NATURISTA INTEGRATIVA</option><!-- [et_pb_line_break_holder] --> <option value="103" >NUTRICION CELULAR Y DIETETICA</option><!-- [et_pb_line_break_holder] --> <option value="104" >MEDICINA AERONAUTICA</option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="col-lg-2 col-md-2 col-sm-6"><!-- [et_pb_line_break_holder] --> <label>Núm. colegiado</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <input type="text" name="collegiate" value="" class="form-control" maxlength="5" tabindex="3"><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div class="row"><!-- [et_pb_line_break_holder] --> <div class="col-lg-3 col-md-4 col-sm-4"><!-- [et_pb_line_break_holder] --> <label>Móvil</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed numbersOnly" name="mobile" id="mobile" tabindex="4" value=""/><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div class="col-lg-3 col-md-4 col-sm-4"><!-- [et_pb_line_break_holder] --> <label>Email</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed" name="email" id="email" tabindex="5" value=""/><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="col-lg-3 col-md-4 col-sm-4"><!-- [et_pb_line_break_holder] --> <label>Web</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed" name="web" id="web" tabindex="6" value="" placeholder="http://"/><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <hr/><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div class="row"><!-- [et_pb_line_break_holder] --> <div class="col-lg-4 col-md-4 col-sm-9"><!-- [et_pb_line_break_holder] --> <label>Dirección</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed" name="address" id="address" tabindex="7" value=""/><!-- [et_pb_line_break_holder] --> <div class="error" id="error_address"></div><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="col-lg-3 col-md-3 col-sm-4"><!-- [et_pb_line_break_holder] --> <label>Provincia</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <select name="province" class="form-control" tabindex="8"><!-- [et_pb_line_break_holder] --> <option value="0"></option><!-- [et_pb_line_break_holder] --> <option value="1" >A CORUÑA</option><!-- [et_pb_line_break_holder] --> <option value="2" >ÁLAVA</option><!-- [et_pb_line_break_holder] --> <option value="3" >ALBACETE</option><!-- [et_pb_line_break_holder] --> <option value="4" >ALICANTE</option><!-- [et_pb_line_break_holder] --> <option value="5" >ALMERÍA</option><!-- [et_pb_line_break_holder] --> <option value="7" >ASTURIAS</option><!-- [et_pb_line_break_holder] --> <option value="8" >ÁVILA</option><!-- [et_pb_line_break_holder] --> <option value="9" >BADAJOZ</option><!-- [et_pb_line_break_holder] --> <option value="26" >BALEARES</option><!-- [et_pb_line_break_holder] --> <option value="10" >BARCELONA</option><!-- [et_pb_line_break_holder] --> <option value="11" >BURGOS</option><!-- [et_pb_line_break_holder] --> <option value="12" >CÁCERES</option><!-- [et_pb_line_break_holder] --> <option value="13" >CÁDIZ</option><!-- [et_pb_line_break_holder] --> <option value="14" >CANTABRIA</option><!-- [et_pb_line_break_holder] --> <option value="15" >CASTELLÓN</option><!-- [et_pb_line_break_holder] --> <option value="16" >CEUTA</option><!-- [et_pb_line_break_holder] --> <option value="17" >CIUDAD REAL</option><!-- [et_pb_line_break_holder] --> <option value="18" >CÓRDOBA</option><!-- [et_pb_line_break_holder] --> <option value="19" >CUENCA</option><!-- [et_pb_line_break_holder] --> <option value="20" >GIRONA</option><!-- [et_pb_line_break_holder] --> <option value="21" >GRANADA</option><!-- [et_pb_line_break_holder] --> <option value="22" >GUADALAJARA</option><!-- [et_pb_line_break_holder] --> <option value="23" >GUIPUZCOA</option><!-- [et_pb_line_break_holder] --> <option value="24" >HUELVA</option><!-- [et_pb_line_break_holder] --> <option value="25" >HUESCA</option><!-- [et_pb_line_break_holder] --> <option value="27" >JAÉN</option><!-- [et_pb_line_break_holder] --> <option value="28" >LA RIOJA</option><!-- [et_pb_line_break_holder] --> <option value="29" >LAS PALMAS</option><!-- [et_pb_line_break_holder] --> <option value="30" >LEÓN</option><!-- [et_pb_line_break_holder] --> <option value="31" >LLEIDA</option><!-- [et_pb_line_break_holder] --> <option value="32" >LUGO</option><!-- [et_pb_line_break_holder] --> <option value="33" >MADRID</option><!-- [et_pb_line_break_holder] --> <option value="34" >MÁLAGA</option><!-- [et_pb_line_break_holder] --> <option value="35" >MELILLA</option><!-- [et_pb_line_break_holder] --> <option value="36" >MURCIA</option><!-- [et_pb_line_break_holder] --> <option value="37" >NAVARRA</option><!-- [et_pb_line_break_holder] --> <option value="38" >OURENSE</option><!-- [et_pb_line_break_holder] --> <option value="39" >PALENCIA</option><!-- [et_pb_line_break_holder] --> <option value="40" >PONTEVEDRA</option><!-- [et_pb_line_break_holder] --> <option value="41" >SALAMANCA</option><!-- [et_pb_line_break_holder] --> <option value="42" >SEGOVIA</option><!-- [et_pb_line_break_holder] --> <option value="43" >SEVILLA</option><!-- [et_pb_line_break_holder] --> <option value="44" >SORIA</option><!-- [et_pb_line_break_holder] --> <option value="46" >TARRAGONA</option><!-- [et_pb_line_break_holder] --> <option value="45" >TENERIFE</option><!-- [et_pb_line_break_holder] --> <option value="47" >TERUEL</option><!-- [et_pb_line_break_holder] --> <option value="48" >TOLEDO</option><!-- [et_pb_line_break_holder] --> <option value="49" >VALENCIA</option><!-- [et_pb_line_break_holder] --> <option value="50" >VALLADOLID</option><!-- [et_pb_line_break_holder] --> <option value="51" >VIZCAYA</option><!-- [et_pb_line_break_holder] --> <option value="52" >ZAMORA</option><!-- [et_pb_line_break_holder] --> <option value="53" >ZARAGOZA</option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div class="col-lg-3 col-md-3 col-sm-5"><!-- [et_pb_line_break_holder] --> <label>Población</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed" name="city" id="city" tabindex="9" value=""/><!-- [et_pb_line_break_holder] --> <div class="error" id="error_city"></div><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="col-lg-2 col-md-2 col-sm-3"><!-- [et_pb_line_break_holder] --> <label>CP</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed numbersOnly" name="cp" id="cp" maxlength="5" tabindex="10" value=""/><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <input type="hidden" name="_token" value="qKLe2reriCqdxuI92N4PcXxDgh4OPaD9g8GwGbKU"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <h2>Datos consulta</h2><!-- [et_pb_line_break_holder] --> <div class="row"><!-- [et_pb_line_break_holder] --> <div class="col-lg-6 col-md-7 col-sm-8"><!-- [et_pb_line_break_holder] --> <label>Nombre completo</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed" name="fullname_co" id="fullname_co" tabindex="11" value=""/><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="col-sm-4 col-md-5 col-sm-4"><!-- [et_pb_line_break_holder] --> <label>Nickname</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control indexed userNameInput" name="nickname_co" id="nickname_co" tabindex="12" value="" placeholder="Mínimo 3 caracteres"/><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <h2>Otros datos</h2><!-- [et_pb_line_break_holder] --> <div class="row"><!-- [et_pb_line_break_holder] --> <div class="col-sm-6 col-xs-12"><!-- [et_pb_line_break_holder] --> <label>¿Cómo nos has conocido?</label><span class="mField"></span><!-- [et_pb_line_break_holder] --> <select name="how_you_knew_us" class="form-control" tabindex="13"><!-- [et_pb_line_break_holder] --> <option value="-1"></option><!-- [et_pb_line_break_holder] --> <option value="1" >Email recibido</option><!-- [et_pb_line_break_holder] --> <option value="2" >WhatsApp recibido</option><!-- [et_pb_line_break_holder] --> <option value="3" >Internet / Buscadores</option><!-- [et_pb_line_break_holder] --> <option value="4" >Recomendado por un amigo</option><!-- [et_pb_line_break_holder] --> <option value="5" >Congresos</option><!-- [et_pb_line_break_holder] --> <option value="6" >Máster</option><!-- [et_pb_line_break_holder] --> <option value="7" >Otros</option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="col-sm-6 col-xs-12"><!-- [et_pb_line_break_holder] --> <label>Comentarios</label><!-- [et_pb_line_break_holder] --> <textarea class="form-control indexed" name="obs" id="obs" rows="1" tabindex="14"></textarea><!-- [et_pb_line_break_holder] --> <div class="error" id="error_obs"></div><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <br/><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div class="row"><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> <div class="col-xs-12"><!-- [et_pb_line_break_holder] --> <button type="submit" id="register" class="btn btn-warning btn-md" ><span class="glyphicon glyphicon-check"></span> Registrarme</button><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </form><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div class="modal fade" id="myModal" tabindex="-1" role="dialog" aria-labelledby="myModalLabel"><!-- [et_pb_line_break_holder] --> <div class="modal-dialog" role="document"><!-- [et_pb_line_break_holder] --> <div class="modal-content"><!-- [et_pb_line_break_holder] --> <div class="modal-header"><!-- [et_pb_line_break_holder] --> <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button><!-- [et_pb_line_break_holder] --> <h4 class="modal-title" id="myModalLabel">Datos registrados correctamente</h4><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="modal-body"><!-- [et_pb_line_break_holder] --> <p>Los datos han sido registrados correctamente. Gracias por su tiempo.</p><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="modal-footer"><!-- [et_pb_line_break_holder] --> <button class="btn" data-dismiss="modal" aria-hidden="true">Continuar</button><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <script src="https://ajax.googleapis.com/ajax/libs/jquery/1.11.3/jquery.min.js"></script><!-- [et_pb_line_break_holder] --> <script src="https://www.masmedico.es/api/js/bootstrap.min.js"></script><!-- [et_pb_line_break_holder] --> <script src="https://www.masmedico.es/api/js/bootstrap-multiselect.js"></script><!-- [et_pb_line_break_holder] --> <script type="text/javascript"><!-- [et_pb_line_break_holder] --> $('#fullname').focus();<!-- [et_pb_line_break_holder] --> $('#specialities').multiselect({includeSelectAllOption: true, buttonWidth: '100%', selectAllText: 'Todas', allSelectedText: 'Todas', 'nSelectedText': 'Seleccionadas', nonSelectedText: 'Ninguna'});<!-- [et_pb_line_break_holder] --> $('.numbersOnly').bind('keyup',function () { <!-- [et_pb_line_break_holder] --> this.value = this.value.replace(/[^0-9\.]/g,''); <!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> $('.userNameInput').bind('keypress', function(e) {<!-- [et_pb_line_break_holder] --> if (e.which == 32) return false;<!-- [et_pb_line_break_holder] --> else if(/[^a-zA-Z0-9]/.test($(this).val())) return false;<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> </script><!-- [et_pb_line_break_holder] --> </body><!-- [et_pb_line_break_holder] --></html>
