stdClass Object ( [id] => 1611 [parent_id] => 1231 [site_id] => 8 [account_id] => 11 [rank] => 71 [release_kbn] => 1 [release_start_date] => [release_end_date] => [format_type] => formFormat [format_id] => 12 [name] => 看護部お問い合わせフォーム [catch] => [comment] => [meta_description] => [meta_keywords] => [directory_name] => contact-form [template_name] => 1column_nocontainer_fixedFormat.tpl [url] => https://www.jiaikai.or.jp/idzuro-imamura/kango-top/contact-form [page_limit] => 20 [delete_kbn] => [update_date] => 2024-10-30 10:30:55 [created_date] => 2024-02-07 15:32:25 [site_directory] => idzuro-imamura [domain] => [uri] => /var/www/html/site/idzuro-imamura/kango-top/contact-form [structures] => host\cms\repository\pageStructureRepository Object ( [_status] => 1 [_message] => [_valid] => [_invalid] => [_lastId] => [select:host\cms\repository\dbRepository:private] => ps.*, m.module_theme, m.module_type, m.template, ac.name as account_name [from:host\cms\repository\dbRepository:private] => page_structure_tbl ps LEFT JOIN m_page_module_tbl m ON ps.module_id = m.id LEFT JOIN account_tbl ac ON ps.account_id = ac.id [where:host\cms\repository\dbRepository:private] => Array ( [0] => Array ( [0] => ps.delete_kbn IS NULL [1] => ps.site_id = :site_id [2] => ps.navigation_id = :navigation_id [3] => ps.release_kbn = :release_kbn AND (ps.release_start_date IS NULL || DATE_FORMAT(now(), '%Y-%m-%d') >= DATE_FORMAT(ps.release_start_date, '%Y-%m-%d')) AND (ps.release_end_date IS NULL || DATE_FORMAT(now(), '%Y-%m-%d') <= DATE_FORMAT(ps.release_end_date, '%Y-%m-%d')) ) ) [value:host\cms\repository\dbRepository:private] => Array ( [:site_id] => 8 [:navigation_id] => 1611 [:release_kbn] => 1 ) [page] => 0 [limit] => [order:host\cms\repository\dbRepository:private] => ps.rank ASC [group_by:host\cms\repository\dbRepository:private] => [explode_columns:host\cms\repository\dbRepository:private] => [explode_separator:host\cms\repository\dbRepository:private] => [json_decode_columns:host\cms\repository\dbRepository:private] => [rowNumber] => 3 [totalNumber] => 3 [pageNumber] => 0 [pageRange] => Array ( [0] => 0 ) [row] => Array ( [0] => stdClass Object ( [id] => 3657 [site_id] => 8 [navigation_id] => 1611 [module_id] => [account_id] => 11 [rank] => 1 [release_kbn] => 1 [release_start_date] => [release_end_date] => [name] => 看護部お問い合わせフォーム前文 [html] => <div style="text-align: center;">ご利用者の個人情報について、詳しくは「<strong><a href="https://www.jiaikai.or.jp/idzuro-imamura/privacy">プライバシーポリシー</a></strong>」をご確認ください。<br /> ※ご入力内容は、お間違えの無いように入力をお願いいたします。<br /> ※送信後、2~3日(土日祝日除く)過ぎても返信がない場合は、お電話でご連絡ください。</div> [meta_description] => [meta_keywords] => [delete_kbn] => [update_date] => 2024-05-29 18:40:57 [created_date] => 2024-05-29 17:57:57 [module_theme] => [module_type] => [template] => [account_name] => 慈愛会企画部経営企画室 [data] => stdClass Object ( ) ) [1] => stdClass Object ( [id] => 3658 [site_id] => 8 [navigation_id] => 1611 [module_id] => [account_id] => 11 [rank] => 2 [release_kbn] => 1 [release_start_date] => [release_end_date] => [name] => 余白 [html] => <br /> &nbsp; [meta_description] => [meta_keywords] => [delete_kbn] => [update_date] => 2024-05-29 17:59:27 [created_date] => 2024-05-29 17:59:16 [module_theme] => [module_type] => [template] => [account_name] => 慈愛会企画部経営企画室 [data] => stdClass Object ( ) ) [2] => stdClass Object ( [id] => 3656 [site_id] => 8 [navigation_id] => 1611 [module_id] => 411 [account_id] => 11 [rank] => 3 [release_kbn] => 1 [release_start_date] => [release_end_date] => [name] => お問い合わせフォームテンプレート [html] => <div class="container"> <form method="post" class="mb-5"> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> お名前 &nbsp;<span class="badge bg-danger">必須</span> </label> <div class="col-lg-9 mt-md-0"> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> フリガナ &nbsp;<span class="badge bg-danger">必須</span> </label> <div class="col-lg-9 mt-md-0"> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> 生年月日 &nbsp;<span class="badge bg-danger">必須</span> </label> <div class="col-lg-9 mt-md-0"> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> 性別 &nbsp;<span class="badge bg-danger">必須</span> </label> <div class="col-lg-9 mt-md-0"> <select name="post[143]" class="form-select"> <option value="無回答">無回答</option> <option value="女性">女性</option> <option value="男性">男性</option> </select> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> ご連絡先電話番号 &nbsp;<span class="badge bg-danger">必須</span> </label> <div class="col-lg-9 mt-md-0"> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> メールアドレス &nbsp;<span class="badge bg-danger">必須</span> </label> <div class="col-lg-9 mt-md-0"> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> 郵便番号 &nbsp;<span class="badge bg-danger">必須</span> </label> <div class="col-lg-9 mt-md-0"> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> ご住所 &nbsp;<span class="badge bg-danger">必須</span> </label> <div class="col-lg-9 mt-md-0"> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> 資料請求 or お問い合わせ </label> <div class="col-lg-9 mt-md-0"> <div class="form-inline"> <div class="custom-control custom-radio mr-3"> <label class="custom-control-label" for="radio1370">資料請求</label> </div> <div class="custom-control custom-radio mr-3"> <label class="custom-control-label" for="radio1371">お問い合わせ</label> </div> </div> <small class="form-text text-muted">※「お問い合わせ」にチェックをされた場合、以下のお問い合わせ内容欄にお問い合わせ内容をご記入ください。</small> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> お問い合わせ内容 </label> <div class="col-lg-9 mt-md-0"> </div> </div> <div class="row mb-3"> <label for="" class="col-lg-3 col-form-label"> 個人情報の取り扱いについて &nbsp;<span class="badge bg-danger">必須</span> </label> <div class="col-lg-9 mt-md-0"> <div class="form-inline"> <div class="custom-control custom-checkbox mr-3"> <label class="custom-control-label" for="check1450">同意する</label> </div> </div> <small class="form-text text-muted"><a href="https://www.jiaikai.or.jp/383/413" target="”_blank”">個人情報基本方針を見る</a></small> </div> </div> <div class="row"> <div class="col-10 col-lg-6 mx-auto d-grid gap-2"> <button type="submit" class="btn btn-lg btn-dark">この内容で送信する </button> </div> </div> </form> </div> [meta_description] => [meta_keywords] => [delete_kbn] => [update_date] => 2024-05-29 17:59:27 [created_date] => 2024-05-29 17:46:54 [module_theme] => default [module_type] => template [template] => form_Inquiries.tpl [account_name] => 慈愛会企画部経営企画室 [data] => stdClass Object ( ) ) ) [post] => [id] => [site_id] => 8 [navigation_id] => 1611 [module_id] => [release_kbn] => 1 [site_uri] => [preview_page_post] => [preview_structure_post] => ) [elements] => host\cms\repository\mailFormRepository Object ( [confirm] => [_status] => 1 [_message] => [_valid] => [_invalid] => [_lastId] => [select:host\cms\repository\dbRepository:private] => * [from:host\cms\repository\dbRepository:private] => mail_form_tbl [where:host\cms\repository\dbRepository:private] => Array ( [0] => Array ( [0] => delete_kbn IS NULL [1] => id = :id [2] => site_id = :site_id ) ) [value:host\cms\repository\dbRepository:private] => Array ( [:id] => 12 [:site_id] => 8 ) [page] => 0 [limit] => 1 [order:host\cms\repository\dbRepository:private] => rank ASC [group_by:host\cms\repository\dbRepository:private] => [explode_columns:host\cms\repository\dbRepository:private] => [explode_separator:host\cms\repository\dbRepository:private] => [json_decode_columns:host\cms\repository\dbRepository:private] => [rowNumber] => 1 [totalNumber] => 1 [pageNumber] => 1 [pageRange] => Array ( [0] => 0 ) [row] => Array ( [0] => stdClass Object ( [id] => 12 [site_id] => 8 [rank] => 5 [release_kbn] => 1 [name] => いづろ今村病院 看護部問い合わせフォーム [subject] => いづろ今村病院 看護部へのお問い合わせありがとうございます。 [body] => いづろ今村病院看護部へのお問い合わせありがとうございます。 送信後、1週間を過ぎても返信がない場合は、お電話でご連絡ください。 いづろ今村病院(代表)0992262600 「看護管理室」へ。   {$detail} [from_mail] => idzuro-nurse@jiaikai.jp [from_name] => いづろ今村病院 看護部 [replyto_mail] => [replyto_name] => [cc_mail] => Array ( [0] => idzuro-nurse@jiaikai.jp [1] => ) [g_recaptcha_v3_sitekey] => [g_recaptcha_v3_secretkey] => [delete_kbn] => [update_date] => 2024-10-30 10:06:58 [created_date] => 2024-02-07 14:45:06 [fields] => Array ( [0] => stdClass Object ( [id] => 134 [site_id] => 8 [form_id] => 12 [rank] => 37 [release_kbn] => 1 [name] => お名前 [variable] => [required] => 1 [field_type] => input_text [max_length_limit] => [detail] => [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 14:58:02 ) [1] => stdClass Object ( [id] => 135 [site_id] => 8 [form_id] => 12 [rank] => 38 [release_kbn] => 1 [name] => フリガナ [variable] => [required] => 1 [field_type] => input_text [max_length_limit] => [detail] => [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 14:58:27 ) [2] => stdClass Object ( [id] => 143 [site_id] => 8 [form_id] => 12 [rank] => 39 [release_kbn] => 1 [name] => 性別 [variable] => [required] => 0 [field_type] => select [max_length_limit] => [detail] => Array ( [0] => 無回答 [1] => 女性 [2] => 男性 ) [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 15:07:02 ) [3] => stdClass Object ( [id] => 142 [site_id] => 8 [form_id] => 12 [rank] => 40 [release_kbn] => 1 [name] => 生年月日 [variable] => [required] => 1 [field_type] => input_date [max_length_limit] => [detail] => [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 15:05:21 ) [4] => stdClass Object ( [id] => 141 [site_id] => 8 [form_id] => 12 [rank] => 42 [release_kbn] => 1 [name] => ご連絡先電話番号 [variable] => [required] => 1 [field_type] => input_tel [max_length_limit] => [detail] => [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 15:04:36 ) [5] => stdClass Object ( [id] => 140 [site_id] => 8 [form_id] => 12 [rank] => 43 [release_kbn] => 1 [name] => メールアドレス [variable] => [required] => 1 [field_type] => input_reply_email [max_length_limit] => [detail] => [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 15:04:04 ) [6] => stdClass Object ( [id] => 182 [site_id] => 8 [form_id] => 12 [rank] => 44 [release_kbn] => 1 [name] => 保有資格 [variable] => [required] => 0 [field_type] => input_text [max_length_limit] => [detail] => 例)看護師免許 [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-05-29 18:05:49 ) [7] => stdClass Object ( [id] => 183 [site_id] => 8 [form_id] => 12 [rank] => 45 [release_kbn] => 1 [name] => 現在の状況 [variable] => [required] => 1 [field_type] => select [max_length_limit] => [detail] => Array ( [0] => 勤務中(病院、診療所) [1] => 勤務中(介護関係) [2] => 離職中 [3] => 学生 [4] => その他 ) [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-05-29 18:14:26 ) [8] => stdClass Object ( [id] => 137 [site_id] => 8 [form_id] => 12 [rank] => 46 [release_kbn] => 1 [name] => 資料請求 or お問い合わせ [variable] => [required] => 0 [field_type] => input_radio [max_length_limit] => [detail] => Array ( [0] => 資料請求 [1] => お問い合わせ ) [attention] => ※「お問い合わせ」にチェックをされた場合、下方の「通信欄」にお問い合わせ内容(勤務形態のご相談、病院見学希望、等)をご記入ください。 [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 15:01:22 ) [9] => stdClass Object ( [id] => 139 [site_id] => 8 [form_id] => 12 [rank] => 47 [release_kbn] => 1 [name] => 郵便番号 [variable] => [required] => 0 [field_type] => input_number [max_length_limit] => [detail] => ※資料請求の場合はこちらを記入 [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 15:02:31 ) [10] => stdClass Object ( [id] => 138 [site_id] => 8 [form_id] => 12 [rank] => 48 [release_kbn] => 1 [name] => ご住所 [variable] => [required] => 0 [field_type] => input_text [max_length_limit] => [detail] => ※資料請求の場合はこちらを記入 [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 15:02:04 ) [11] => stdClass Object ( [id] => 136 [site_id] => 8 [form_id] => 12 [rank] => 49 [release_kbn] => 1 [name] => 通信欄 [variable] => [required] => 0 [field_type] => textarea [max_length_limit] => [detail] => ※学生の場合は、学校名と学年をご記入ください。 [attention] => [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 14:59:56 ) [12] => stdClass Object ( [id] => 145 [site_id] => 8 [form_id] => 12 [rank] => 50 [release_kbn] => 1 [name] => 個人情報の取り扱いについて [variable] => [required] => 1 [field_type] => input_checkbox [max_length_limit] => [detail] => Array ( [0] => 同意する ) [attention] => <a href="https://www.jiaikai.or.jp/idzuro-imamura/privacy" target=”_blank” >個人情報基本方針を見る</a> [delete_kbn] => [update_date] => 2024-10-30 10:21:16 [created_date] => 2024-02-07 15:11:13 ) ) ) ) [post] => [id] => 12 [site_id] => 8 [release_kbn] => ) ) 1

看護部お問い合わせフォーム

ご利用者の個人情報について、詳しくは「プライバシーポリシー」をご確認ください。
※ご入力内容は、お間違えの無いように入力をお願いいたします。
※送信後、2~3日(土日祝日除く)過ぎても返信がない場合は、お電話でご連絡ください。

 
※「お問い合わせ」にチェックをされた場合、下方の「通信欄」にお問い合わせ内容(勤務形態のご相談、病院見学希望、等)をご記入ください。