{"id":5586,"date":"2025-05-22T12:02:11","date_gmt":"2025-05-22T03:02:11","guid":{"rendered":"https:\/\/www.mens-life-clinic.com\/w\/?page_id=5586"},"modified":"2025-06-26T11:18:40","modified_gmt":"2025-06-26T02:18:40","slug":"contact_afi6","status":"publish","type":"page","link":"https:\/\/www.mens-life-clinic.com\/w\/inquiry\/contact_afi6\/","title":{"rendered":"\u7121\u6599\u30ab\u30a6\u30f3\u30bb\u30ea\u30f3\u30b0\u4e88\u7d04afi6"},"content":{"rendered":"\t<section id=\"page\">\r\n\t<div class=\"sub_main contact\">\r\n\t\t<div class=\"inner\">\r\n\t\t\t<div>\r\n\t\t\t\t<div class=\"h1_box\">\r\n\t\t\t\t\t<div>\r\n\t\t\t\t\t\t<p class=\"h1_txt\">CONTACT<\/p>\r\n\t\t\t\t\t\t<h1>\u7121\u6599\u30ab\u30a6\u30f3\u30bb\u30ea\u30f3\u30b0\u4e88\u7d04<\/h1>\r\n\t\t\t\t\t\t<p class=\"txt\">\u5305\u830e\u6cbb\u7642\/\u624b\u8853\u30fbED\u6cbb\u7642\uff5c\u7537\u6027\u7dcf\u5408\u533b\u7642\u3092\u63d0\u4f9b\u3059\u308b<br class=\"pcnone\">\u30e1\u30f3\u30ba\u30e9\u30a4\u30d5\u30af\u30ea\u30cb\u30c3\u30af<br class=\"pcnone\">\uff08\u65e7\u6771\u4eac\u30b9\u30ab\u30a4\u30af\u30ea\u30cb\u30c3\u30af\uff09\u3010\u516c\u5f0f\u3011<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"pankz\">\r\n\t\t\t\t<ul>\r\n\t\t\t\t\t<li>&nbsp;<\/li>\r\n\t\t\t\t<\/ul>\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n\t<div class=\"mail form\">\r\n\t\t<div class=\"inner\">\r\n<script>\r\n    function addUrlParam(value, targetUrl){\r\n        if (targetUrl.match(\/(\\?.*)\/g)){\r\n            return targetUrl.replace(\/(\\?.*)\/, '$1&'+value);\r\n        }else{\r\n            return targetUrl.replace(\/($)\/, '?'+value);\r\n        }\r\n    }\r\n    let selectedParams = ''; \/\/ \u9078\u629e\u3055\u308c\u305f\u30d1\u30e9\u30e1\u30fc\u30bf\u3092\u4fdd\u5b58\u3059\u308b\u5909\u6570\r\n\r\n    \/\/ name=\"treatment_content\" \u306e\u30c1\u30a7\u30c3\u30af\u30dc\u30c3\u30af\u30b9\u306b\u30a4\u30d9\u30f3\u30c8\u3092\u8a2d\u5b9a\r\n\r\n    function reloadTreatmentContent(){\r\n        \/\/ \u30c1\u30a7\u30c3\u30af\u3055\u308c\u305f\u30c1\u30a7\u30c3\u30af\u30dc\u30c3\u30af\u30b9\u3092\u53d6\u5f97\r\n        const checkboxes = document.querySelectorAll('input[name=\"treatment_content[]\"]:checked');\r\n        let params = [];\r\n\r\n        checkboxes.forEach(function(checkbox) {\r\n            params.push(checkbox.value.replace('(\u30ad\u30e3\u30f3\u30da\u30fc\u30f3)',''));\r\n        });\r\n        console.log(params);\r\n\r\n        \/\/ \u9078\u629e\u3055\u308c\u305f\u30d1\u30e9\u30e1\u30fc\u30bf\u3092\u4fdd\u5b58\r\n        selectedParams = params.length > 0 ? `treatment_ids=${params.join('__')}` : '';\r\n\r\n        \/\/ \u30b3\u30f3\u30bd\u30fc\u30eb\u306b\u8868\u793a\uff08\u30c7\u30d0\u30c3\u30b0\u7528\uff09\r\n        console.log('\u73fe\u5728\u306e\u30d1\u30e9\u30e1\u30fc\u30bf:', selectedParams);\r\n    }\r\n            console.log('treatment-redirect\u306a\u3057');\r\n        document.addEventListener( 'wpcf7mailsent', function( event ) {\r\n            let thanksUrl = '';\r\n            location = thanksUrl;\r\n        },false);\r\n    <\/script>\r\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f5962-o1\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"5962\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/w\/wp-json\/wp\/v2\/pages\/5586#wpcf7-f5962-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"5962\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.5\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f5962-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:5962,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;group-if_diabates&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;medical_history&quot;,&quot;operator&quot;:&quot;not equals&quot;,&quot;if_value&quot;:&quot;\\u306a\\u3057&quot;}]},{&quot;then_field&quot;:&quot;group-age&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;your_age&quot;,&quot;operator&quot;:&quot;less than or equals&quot;,&quot;if_value&quot;:&quot;19&quot;}]},{&quot;then_field&quot;:&quot;group-diabates_true&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;if_diabetes&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u7cd6\\u5c3f\\u75c5\\u306b\\u7f79\\u60a3\\u3057\\u3066\\u3044\\u308b&quot;}]},{&quot;then_field&quot;:&quot;group-diabates_default&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;if_diabetes&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u7cd6\\u5c3f\\u75c5\\u306b\\u7f79\\u60a3\\u3057\\u3066\\u3044\\u308b&quot;}]},{&quot;then_field&quot;:&quot;group-diabates_default&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;if_diabetes&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;\\u7cd6\\u5c3f\\u75c5\\u306b\\u7f79\\u60a3\\u3057\\u3066\\u3044\\u306a\\u3044&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<\/div>\n<div class=\"mw_wp_form\">\n    <p class=\"txt\" style=\"padding:0; text-align:center;\"><strong class=\"red\">\u672c\u30ad\u30e3\u30f3\u30da\u30fc\u30f3\u3092\u3054\u89a7\u3044\u305f\u3060\u3044\u305f\u3042\u306a\u305f\u9650\u5b9a\uff01<\/strong><\/p>\n    <table class=\"mb-pc-30\">\n        <tr>\n            <th>\u3054\u5e0c\u671b\u306e\u6cbb\u7642<span>\u5fc5\u9808<\/span><\/th>\n            <td>\n                <span class=\"wpcf7-form-control-wrap\" data-name=\"treatment_campaign\"><span class=\"wpcf7-form-control wpcf7-radio input_radio d-flex-column\"><span class=\"wpcf7-list-item first last\"><label><input type=\"radio\" name=\"treatment_campaign\" value=\"\u30ad\u30e3\u30f3\u30da\u30fc\u30f3\u5305\u830e\u6cbb\u7642 \uff0b \u4e80\u982d\u5897\u5927 \/ \u5f37\u5316\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u30ad\u30e3\u30f3\u30da\u30fc\u30f3\u5305\u830e\u6cbb\u7642 \uff0b \u4e80\u982d\u5897\u5927 \/ \u5f37\u5316<\/span><\/label><\/span><\/span><\/span>\n                <p class=\"note f10 text-right\">\u203b\u30b9\u30bf\u30f3\u30c0\u30fc\u30c9\u30ab\u30c3\u30c8\u6cbb\u7642\u3000\u203b\u30bf\u30a4\u30d7H1 (1cc)<\/p>\n            <\/td>\n        <\/tr>\n    <\/table>\n\n    <p class=\"txt\"><strong class=\"red\">\u203b\u5fc5\u9808<\/strong>\u9805\u76ee\u3092\u5165\u529b\u5f8c\u3001\u9001\u4fe1\u30dc\u30bf\u30f3\u3092\u62bc\u3057\u3066\u304f\u3060\u3055\u3044<\/p>\n    <table>\n        <tr>\n            <th>\u305d\u306e\u4ed6\u306b<br class=\"pcVer\">\u3054\u76f8\u8ac7\u3057\u305f\u3044\u6cbb\u7642<br class=\"spnone\">\uff08\u8907\u6570\u9078\u629e\u53ef\uff09<\/th>\n            <td>\n                <span class=\"wpcf7-form-control-wrap\" data-name=\"treatment_content\"><span class=\"wpcf7-form-control wpcf7-checkbox input_check d-flex-row\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"treatment_content[]\" value=\"\u5897\u5927(\u4e80\u982d\u30fb\u9670\u830e)\" \/><span class=\"wpcf7-list-item-label\">\u5897\u5927(\u4e80\u982d\u30fb\u9670\u830e)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"treatment_content[]\" value=\"\u9577\u830e\" \/><span class=\"wpcf7-list-item-label\">\u9577\u830e<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"treatment_content[]\" value=\"\u4ed6\u9662\u4fee\u6b63\" \/><span class=\"wpcf7-list-item-label\">\u4ed6\u9662\u4fee\u6b63<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"treatment_content[]\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><\/span><\/span>\n            <\/td>\n        <\/tr>\n        <tr>\n            <th>\u5e0c\u671b\u9662<span>\u5fc5\u9808<\/span><\/th>\n            <td>\n                <div class=\"flex_select\">\n                    <p><span class=\"wpcf7-form-control-wrap\" data-name=\"hospital\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input_select size_m has_all_hospitals\" aria-required=\"true\" aria-invalid=\"false\" name=\"hospital\"><option value=\"\">\u30af\u30ea\u30cb\u30c3\u30af\u3092\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044<\/option><\/select><\/span><\/p>\n                <\/div>\n            <\/td>\n        <\/tr>\n        <tr>\n            <th rowspan=\"3\">\u3054\u5e0c\u671b\u65e5\u6642<span>\u5fc5\u9808<\/span><\/th>\n            <td>\n                <div class=\"flex_select\">\n                    <p><span class=\"wpcf7-form-control-wrap\" data-name=\"first_day\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input_select size_m\" aria-required=\"true\" aria-invalid=\"false\" name=\"first_day\"><option value=\"\">\u7b2c1\u5e0c\u671b\u65e5<\/option><\/select><\/span><\/p>\n                    <p><span class=\"wpcf7-form-control-wrap\" data-name=\"first_time01\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input_select\" aria-required=\"true\" aria-invalid=\"false\" name=\"first_time01\"><option value=\"\">\u30fc<\/option><option value=\"9\u6642~12\u6642\">9\u6642~12\u6642<\/option><option value=\"12\u6642~15\u6642\">12\u6642~15\u6642<\/option><option value=\"15\u6642~18\u6642\">15\u6642~18\u6642<\/option><\/select><\/span><\/p>\n                <\/div>\n            <\/td>\n        <\/tr>\n        <tr class=\"day_tr\">\n            <td>\n                <div class=\"flex_select\">\n                    <p><span class=\"wpcf7-form-control-wrap\" data-name=\"second_day\"><select class=\"wpcf7-form-control wpcf7-select input_select size_m\" aria-invalid=\"false\" name=\"second_day\"><option value=\"\">\u7b2c2\u5e0c\u671b\u65e5<\/option><\/select><\/span><\/p>\n                    <p><span class=\"wpcf7-form-control-wrap\" data-name=\"second_time01\"><select class=\"wpcf7-form-control wpcf7-select input_select\" aria-invalid=\"false\" name=\"second_time01\"><option value=\"\">\u30fc<\/option><option value=\"9\u6642~12\u6642\">9\u6642~12\u6642<\/option><option value=\"12\u6642~15\u6642\">12\u6642~15\u6642<\/option><option value=\"15\u6642~18\u6642\">15\u6642~18\u6642<\/option><\/select><\/span><\/p>\n                <\/div>\n            <\/td>\n        <\/tr>\n        <tr class=\"day_tr day_third\">\n            <td class=\"day_third_select\">\u203b\u7b2c3\u5e0c\u671b\u65e5\u4ee5\u964d\u306e\u9078\u629e\u3092\u3059\u308b<span class=\"day_third_select_button\"><\/span><\/td>\n            <td class=\"day_third_contents\">\n                <div class=\"flex_select\">\n                    <p><span class=\"wpcf7-form-control-wrap\" data-name=\"third_day\"><select class=\"wpcf7-form-control wpcf7-select input_select size_m\" aria-invalid=\"false\" name=\"third_day\"><option value=\"\">\u7b2c3\u5e0c\u671b\u65e5<\/option><\/select><\/span><\/p>\n                    <p><span class=\"wpcf7-form-control-wrap\" data-name=\"third_time01\"><select class=\"wpcf7-form-control wpcf7-select input_select\" aria-invalid=\"false\" name=\"third_time01\"><option value=\"\">\u30fc<\/option><option value=\"9\u6642~12\u6642\">9\u6642~12\u6642<\/option><option value=\"12\u6642~15\u6642\">12\u6642~15\u6642<\/option><option value=\"15\u6642~18\u6642\">15\u6642~18\u6642<\/option><\/select><\/span><\/p>\n                <\/div>\n                <div class=\"flex_select\">\n                    <p><span class=\"wpcf7-form-control-wrap\" data-name=\"fourth_day\"><select class=\"wpcf7-form-control wpcf7-select input_select size_m\" aria-invalid=\"false\" name=\"fourth_day\"><option value=\"\">\u7b2c4\u5e0c\u671b\u65e5<\/option><\/select><\/span><\/p>\n                    <p><span class=\"wpcf7-form-control-wrap\" data-name=\"fourth_time01\"><select class=\"wpcf7-form-control wpcf7-select input_select\" aria-invalid=\"false\" name=\"fourth_time01\"><option value=\"\">\u30fc<\/option><option value=\"9\u6642~12\u6642\">9\u6642~12\u6642<\/option><option value=\"12\u6642~15\u6642\">12\u6642~15\u6642<\/option><option value=\"15\u6642~18\u6642\">15\u6642~18\u6642<\/option><\/select><\/span><\/p>\n                <\/div>\n            <\/td>\n        <\/tr>\n        <tr>\n            <th>\u304a\u540d\u524d<span>\u5fc5\u9808<\/span><br class=\"spnone\">\uff08\u30ab\u30bf\u30ab\u30ca\uff09<\/th>\n            <td>\n                <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 input_text\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u30e4\u30de\u30c0\u3000\u30bf\u30ed\u30a6\" value=\"\" type=\"text\" name=\"your_name\" \/><\/span>\n                <p class=\"note\">\u203b\u6c38\u4f4f\u6a29\u304c\u306a\u3044\u5834\u5408\u306f\u53d7\u8a3a\u304c\u3067\u304d\u307e\u305b\u3093\u3002<\/p>\n            <\/td>\n        <\/tr>\n        <tr>\n            <th>\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<span>\u5fc5\u9808<\/span><br class=\"spnone\">\uff08\u534a\u89d2\u82f1\u6570\u5b57\uff09<\/th>\n            <td><span class=\"wpcf7-form-control-wrap\" data-name=\"your_mail\"><input size=\"40\" maxlength=\"60\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email input_text\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09yamadataro\uff20mens-life-clinic.com\" value=\"\" type=\"email\" name=\"your_mail\" \/><\/span><\/td>\n        <\/tr>\n        <tr>\n            <th>\u96fb\u8a71\u756a\u53f7<span>\u5fc5\u9808<\/span><br class=\"spnone\">\uff08\u2015\u30cf\u30a4\u30d5\u30f3\u306a\u3057\uff09<\/th>\n            <td><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 input_text size_m\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff0909012345678\" value=\"\" type=\"tel\" name=\"your_tel\" \/><\/span><\/td>\n        <\/tr>\n        <tr>\n            <th>\u5e74\u9f62<span>\u5fc5\u9808<\/span><\/th>\n            <td>\n                <div class=\"form_age_container\">\n                    <span class=\"select_age\"><span class=\"wpcf7-form-control-wrap\" data-name=\"your_age\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required input_select size_s\" aria-required=\"true\" aria-invalid=\"false\" name=\"your_age\"><option value=\"\">\u5e74\u9f62<\/option><option value=\"16\">16<\/option><option value=\"17\">17<\/option><option value=\"18\">18<\/option><option value=\"19\">19<\/option><option value=\"20\">20<\/option><option value=\"21\">21<\/option><option value=\"22\">22<\/option><option value=\"23\">23<\/option><option value=\"24\">24<\/option><option value=\"25\">25<\/option><option value=\"26\">26<\/option><option value=\"27\">27<\/option><option value=\"28\">28<\/option><option value=\"29\">29<\/option><option value=\"30\">30<\/option><option value=\"31\">31<\/option><option value=\"32\">32<\/option><option value=\"33\">33<\/option><option value=\"34\">34<\/option><option value=\"35\">35<\/option><option value=\"36\">36<\/option><option value=\"37\">37<\/option><option value=\"38\">38<\/option><option value=\"39\">39<\/option><option value=\"40\">40<\/option><option value=\"41\">41<\/option><option value=\"42\">42<\/option><option value=\"43\">43<\/option><option value=\"44\">44<\/option><option value=\"45\">45<\/option><option value=\"46\">46<\/option><option value=\"47\">47<\/option><option value=\"48\">48<\/option><option value=\"49\">49<\/option><option value=\"50\">50<\/option><option value=\"51\">51<\/option><option value=\"52\">52<\/option><option value=\"53\">53<\/option><option value=\"54\">54<\/option><option value=\"55\">55<\/option><option value=\"56\">56<\/option><option value=\"57\">57<\/option><option value=\"58\">58<\/option><option value=\"59\">59<\/option><option value=\"60\">60<\/option><option value=\"61\">61<\/option><option value=\"62\">62<\/option><option value=\"63\">63<\/option><option value=\"64\">64<\/option><option value=\"65\">65<\/option><option value=\"66\">66<\/option><option value=\"67\">67<\/option><option value=\"68\">68<\/option><option value=\"69\">69<\/option><option value=\"70\">70<\/option><option value=\"71\">71<\/option><option value=\"72\">72<\/option><option value=\"73\">73<\/option><option value=\"74\">74<\/option><option value=\"75\">75<\/option><option value=\"76\">76<\/option><option value=\"77\">77<\/option><option value=\"78\">78<\/option><option value=\"79\">79<\/option><option value=\"80\">80<\/option><option value=\"81\">81<\/option><option value=\"82\">82<\/option><option value=\"83\">83<\/option><option value=\"84\">84<\/option><option value=\"85\">85<\/option><option value=\"86\">86<\/option><option value=\"87\">87<\/option><option value=\"88\">88<\/option><option value=\"89\">89<\/option><option value=\"90\">90<\/option><option value=\"91\">91<\/option><option value=\"92\">92<\/option><option value=\"93\">93<\/option><option value=\"94\">94<\/option><option value=\"95\">95<\/option><option value=\"96\">96<\/option><option value=\"97\">97<\/option><option value=\"98\">98<\/option><option value=\"99\">99<\/option><\/select><\/span><span class=\"select_age_text\">\u6b73<\/span><\/span>\n                    <div data-id=\"group-age\" data-orig_data_id=\"group-age\"  data-class=\"wpcf7cf_group\">\n                    <span class=\"checkbox_guardian\"><span class=\"wpcf7-form-control-wrap\" data-name=\"guardian\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"guardian[]\" value=\"\u89aa\u6a29\u8005\u304c\u540c\u4f34\u3059\u308b\uff08\u5fc5\u9808\uff09\" \/><span class=\"wpcf7-list-item-label\">\u89aa\u6a29\u8005\u304c\u540c\u4f34\u3059\u308b\uff08\u5fc5\u9808\uff09<\/span><\/label><\/span><\/span><\/span><\/span>\n                    <\/div>\n                <\/div>\n                <p class=\"note\">\u203b20\u6b73\u672a\u6e80\u306e\u65b9\u306f\u3001\u6cd5\u5b9a\u4ee3\u7406\u4eba\uff08\u89aa\u6a29\u8005\u3082\u3057\u304f\u306f\u672a\u6210\u5e74\u5f8c\u898b\u4eba\uff09\u306e\u540c\u4f34\u304c\u5fc5\u8981\u3067\u3059\u3002<br>\u203b\u540c\u4f34\u304c\u306a\u3051\u308c\u3070\u6cbb\u7642\u306e\u3054\u6848\u5185\u304c\u3067\u304d\u304b\u306d\u307e\u3059\u3002<br>\u307e\u305f\u6cbb\u7642\u7533\u8fbc\u6642\u3001\u540c\u610f\u6b04\u306b\u3054\u8a18\u5165\u3092\u3044\u305f\u3060\u304d\u307e\u3059\u3002<\/p>\n            <\/td>\n        <\/tr>\n        <tr>\n            <th>\u3054\u6301\u75c5<span>\u5fc5\u9808<\/span><\/th>\n            <td class=\"td_medical_history\">\n                <div data-aco-input=\"medical_history\">\n                  <span class=\"wpcf7-form-control-wrap\" data-name=\"medical_history\"><span class=\"wpcf7-form-control wpcf7-radio input_radio d-flex-column\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"medical_history\" value=\"\u306a\u3057\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u306a\u3057<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"medical_history\" value=\"\u3042\u308a\uff08\u7cd6\u5c3f\u75c5\u3001\u670d\u7528\u85ac\u306a\u3069\uff09\" \/><span class=\"wpcf7-list-item-label\">\u3042\u308a\uff08\u7cd6\u5c3f\u75c5\u3001\u670d\u7528\u85ac\u306a\u3069\uff09<\/span><\/label><\/span><\/span><\/span>\n                <\/div>\n                <div data-id=\"group-if_diabates\" data-orig_data_id=\"group-if_diabates\"  data-class=\"wpcf7cf_group\">\n                  <div class=\"mt20\" data-aco-input=\"if_diabetes\">\n                    <p class=\"input-title u-mb-0\">\u3054\u6301\u75c5\u306e\u78ba\u8a8d<span>\u5fc5\u9808<\/span><\/p>\n                    <span class=\"wpcf7-form-control-wrap\" data-name=\"if_diabetes\"><span class=\"wpcf7-form-control wpcf7-radio input_radio d-flex-column\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"if_diabetes\" value=\"\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\"><\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"if_diabetes\" value=\"\u7cd6\u5c3f\u75c5\u306b\u7f79\u60a3\u3057\u3066\u3044\u306a\u3044\" \/><span class=\"wpcf7-list-item-label\">\u7cd6\u5c3f\u75c5\u306b\u7f79\u60a3\u3057\u3066\u3044\u306a\u3044<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"if_diabetes\" value=\"\u7cd6\u5c3f\u75c5\u306b\u7f79\u60a3\u3057\u3066\u3044\u308b\" \/><span class=\"wpcf7-list-item-label\">\u7cd6\u5c3f\u75c5\u306b\u7f79\u60a3\u3057\u3066\u3044\u308b<\/span><\/label><\/span><\/span><\/span>\n                  <\/div>\n                  <div data-id=\"group-diabates_true\" data-orig_data_id=\"group-diabates_true\"  data-class=\"wpcf7cf_group\">\n                    <div class=\"mt20\" data-aco-input=\"diabetes_true\">\n                      <p class=\"input-title\">\u7cd6\u5c3f\u75c5\u306e\u60a3\u8005\u69d8\u3078\u306e\u4e8b\u524d\u78ba\u8a8d<\/p>\n                      <p class=\"note u-text-blue u-mt-0\">\u4e0b\u8a18\u4e8b\u9805\u3092\u304a\u4f3a\u3044\u3044\u305f\u3057\u307e\u3059\u3002\u3054\u5354\u529b\u304a\u9858\u3044\u3044\u305f\u3057\u307e\u3059\u3002<\/p>\n                      <p class=\"input-title mt20\">HbA1c\uff08\u30d8\u30e2\u30b0\u30ed\u30d3\u30f3\u30a8\u30fc\u30ef\u30f3\u30b7\u30fc\uff09<span>\u5fc5\u9808<\/span><\/p>\n                      <p class=\"note u-text-blue u-mt-0 mb10\">\u203b\u5f53\u9662\u898f\u5b9a\u306b\u3088\u308aHbA1c\u306e\u5024\u304c8.0%\u4ee5\u4e0a\u306e\u65b9\u306f\u304a\u53d7\u3051\u3044\u305f\u3057\u304b\u306d\u307e\u3059\u3002<\/p>\n                      <span class=\"wpcf7-form-control-wrap\" data-name=\"diabetes_per\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number input_text size_s js-number-rounding is-digit-1\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff097.0\" value=\"\" type=\"number\" name=\"diabetes_per\" \/><\/span><span class=\"unit\">%<\/span>\n                      <p class=\"input-title mt20\">\u8eab\u9577<span>\u5fc5\u9808<\/span><\/p>\n                      <span class=\"wpcf7-form-control-wrap\" data-name=\"diabetes_cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number input_text size_s js-number-rounding\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09172\" value=\"\" type=\"number\" name=\"diabetes_cm\" \/><\/span><span class=\"unit\">cm<\/span>\n                      <p class=\"input-title mt20\">\u4f53\u91cd<span>\u5fc5\u9808<\/span><\/p>\n                      <span class=\"wpcf7-form-control-wrap\" data-name=\"diabetes_kg\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number input_text size_s js-number-rounding\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff0965\" value=\"\" type=\"number\" name=\"diabetes_kg\" \/><\/span><span class=\"unit\">kg<\/span>\n                    <\/div>\n                  <\/div>\n                  <div data-id=\"group-diabates_default\" data-orig_data_id=\"group-diabates_default\"  data-class=\"wpcf7cf_group\">\n                    <div class=\"mt20\" data-aco-input=\"diabetes_default\">\n                      <p class=\"input-title u-mb-0\">\u8840\u6db2\u3092\u30b5\u30e9\u30b5\u30e9\u306b\u3059\u308b\u85ac\u306e\u670d\u7528<span>\u5fc5\u9808<\/span><\/p>\n                      <span class=\"wpcf7-form-control-wrap\" data-name=\"diabetes_medicine\"><span class=\"wpcf7-form-control wpcf7-radio input_radio d-flex-column\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"diabetes_medicine\" value=\"\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\"><\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"diabetes_medicine\" value=\"\u3042\u308a\" \/><span class=\"wpcf7-list-item-label\">\u3042\u308a<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"diabetes_medicine\" value=\"\u306a\u3057\" \/><span class=\"wpcf7-list-item-label\">\u306a\u3057<\/span><\/label><\/span><\/span><\/span>\n                      <p class=\"note u-text-blue\">\u203b\u73fe\u5728\u3001\u8840\u6db2\u3092\u30b5\u30e9\u30b5\u30e9\u306b\u3059\u308b\u85ac\u3092\u670d\u7528\u3055\u308c\u3066\u3044\u308b\u5834\u5408\u306f\u3001\u304a\u7533\u3057\u51fa\u304f\u3060\u3055\u3044\u3002<br>\u670d\u7528\u3055\u308c\u3066\u3044\u308b\u5834\u5408\u306f\u3001\u85ac\u3092\u51e6\u65b9\u3057\u3066\u3044\u308b\u4e3b\u6cbb\u533b\u306e\u5148\u751f\u306b\u3054\u76f8\u8ac7\u306e\u4e0a\u3001\u4e88\u7d04\u65e5\u306e1\u9031\u9593\u524d\u3088\u308a\u670d\u7528\u3092\u4e2d\u6b62\u3092\u304a\u9858\u3044\u3044\u305f\u3057\u307e\u3059\u3002<\/p>\n                      <p class=\"input-title\">\u7cd6\u5c3f\u75c5\u3092\u9664\u304f\u3054\u6301\u75c5\u306e\u72b6\u6cc1\u306b\u3064\u3044\u3066<br>\uff08\u75be\u60a3\u540d\u30fb\u670d\u7528\u85ac\u306a\u3069\uff09<\/p>\n                      <p class=\"note u-text-blue u-mt-0 u-mb-05em\">\u8a72\u5f53\u4e8b\u9805\u304c\u3054\u3056\u3044\u307e\u3057\u305f\u3089\u4e0b\u8a18\u306e\u8a18\u5165\u6b04\u3078\u8a18\u8f09\u3044\u305f\u3060\u304d\u3001\u4e8b\u524d\u7533\u544a\u3078\u306e\u3054\u5354\u529b\u3092\u304a\u9858\u3044\u3044\u305f\u3057\u307e\u3059\u3002\uff08\u7a7a\u6b04\u53ef\u80fd\uff09<\/p>\n                      <span class=\"wpcf7-form-control-wrap\" data-name=\"medical_history_detail\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea input_area\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u9ad8\u8840\u5727&#010;\u3000\u3000\u30ea\u30d0\u30bc\u30d6\u9320\u3092\u670d\u7528\u3057\u3066\u3044\u308b\" name=\"medical_history_detail\"><\/textarea><\/span>\n                    <\/div>\n                  <\/div>\n                <\/div>\n            <\/td>\n        <\/tr>\n        <tr>\n            <th>\u3054\u8cea\u554f\u30fb\u3054\u610f\u898b\u7b49<\/th>\n            <td>\n                <span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea input_area\" aria-invalid=\"false\" placeholder=\"\u5177\u4f53\u7684\u306a\u5185\u5bb9\u3084\u3054\u5e0c\u671b\u304c\u3042\u308c\u3070\u3054\u8a18\u5165\u304f\u3060\u3055\u3044\" name=\"text\"><\/textarea><\/span>\n            <\/td>\n        <\/tr>\n    <\/table>\n    <div class=\"wpcf7-form-above-submit\" data-personal-info=\"true\"><\/div>\n    <input class=\"wpcf7-form-control wpcf7-submit has-spinner input_bt\" type=\"submit\" value=\"\u4e0a\u8a18\u306e\u5185\u5bb9\u3092\u9001\u4fe1\u3059\u308b\" \/>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\r\n\t\t\t<\/div>\r\n\t<\/div>\r\n\t<div class=\"mail note\">\r\n\t\t<div class=\"inner\">\r\n\t\t\t<p class=\"txt\">\r\n\t\t\t\t\u203b\u4e88\u7d04\u72b6\u6cc1\u306b\u3088\u308a\u3054\u5e0c\u671b\u306e\u304a\u6642\u9593\u306b\u4e88\u7d04\u3067\u304d\u306a\u3044\u5834\u5408\u306f\u3001\u30e1\u30fc\u30eb\u307e\u305f\u306f\u304a\u96fb\u8a71\u3067\u3054\u9023\u7d61\u3044\u305f\u3057\u307e\u3059\u3002\u3054\u9023\u7d61\u304c\u3064\u304b\u306a\u3044\u5834\u5408\u306f\u30ad\u30e3\u30f3\u30bb\u30eb\u6271\u3044\u3068\u306a\u308a\u307e\u3059\u306e\u3067\u3054\u4e86\u627f\u304f\u3060\u3055\u3044\u3002<br>\r\n\t\t\t\t\u203b\u5f53\u9662\u3088\u308a\u3054\u8fd4\u4fe1\u304c\u306a\u3044\u5834\u5408\u306f\u3001\u304a\u624b\u6570\u3067\u3059\u304c\u30d5\u30ea\u30fc\u30c0\u30a4\u30e4\u30eb0120-391-784\u306b\u3054\u9023\u7d61\u304a\u9858\u3044\u3044\u305f\u3057\u307e\u3059\u3002<br>\r\n\t\t\t\t\u203b20\u6b73\u672a\u6e80\u306e\u65b9\u306f\u6cd5\u5b9a\u4ee3\u7406\u4eba\uff08\u89aa\u6a29\u8005\u3082\u3057\u304f\u306f\u672a\u6210\u5e74\u5f8c\u898b\u4eba\uff09\u306e\u540c\u4f34\u3067\u3054\u53d7\u8a3a\u3092\u304a\u9858\u3044\u3057\u307e\u3059\u3002<br>\r\n\t\t\t\t\u203b\u8ff7\u60d1\u30e1\u30fc\u30eb\u5bfe\u7b56\u3068\u3057\u3066\u3001\u30c9\u30e1\u30a4\u30f3\u6307\u5b9a\u53d7\u4fe1\u8a2d\u5b9a\u3092\u3055\u308c\u3066\u3044\u308b\u5834\u5408\u306f\u53d7\u4fe1\u8a31\u53ef\u30c9\u30e1\u30a4\u30f3\u306b\u300cmens-life-clinic.com\u300d\u306e\u8ffd\u52a0\u3092\u304a\u9858\u3044\u3044\u305f\u3057\u307e\u3059\u3002<br>\r\n\t\t\t\t\u203b\u30d1\u30a4\u30d7\u30ab\u30c3\u30c8\u3092\u5e0c\u671b\u3055\u308c\u308b\u5834\u5408\u306f\u3001\u914d\u5076\u8005\u306e\u540c\u610f\u66f8\u304c\u5fc5\u8981\u3068\u306a\u308a\u307e\u3059\u3002<br>\r\n\t\t\t\t\u3053\u3061\u3089\u306e<a href=\"\/pdf\/pipe.pdf\" target=\"_blank\" rel=\"noopener\" rel=\"noopener noreferrer\">\u300c\u30d1\u30a4\u30d7\u30ab\u30c3\u30c8\u624b\u8853\u540c\u610f\u66f8\u300d<\/a>\u3092\u5370\u5237\u3057\u3066\u3054\u8a18\u5165\u306e\u4e0a\u3001\u3054\u6301\u53c2\u3057\u3066\u304f\u3060\u3055\u3044\u3002\r\n\t\t\t<\/p>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/section>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":3219,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-contact-template.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-5586","page","type-page","status-publish","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.mens-life-clinic.com\/w\/wp-json\/wp\/v2\/pages\/5586"}],"collection":[{"href":"https:\/\/www.mens-life-clinic.com\/w\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.mens-life-clinic.com\/w\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.mens-life-clinic.com\/w\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mens-life-clinic.com\/w\/wp-json\/wp\/v2\/comments?post=5586"}],"version-history":[{"count":3,"href":"https:\/\/www.mens-life-clinic.com\/w\/wp-json\/wp\/v2\/pages\/5586\/revisions"}],"predecessor-version":[{"id":6264,"href":"https:\/\/www.mens-life-clinic.com\/w\/wp-json\/wp\/v2\/pages\/5586\/revisions\/6264"}],"up":[{"embeddable":true,"href":"https:\/\/www.mens-life-clinic.com\/w\/wp-json\/wp\/v2\/pages\/3219"}],"wp:attachment":[{"href":"https:\/\/www.mens-life-clinic.com\/w\/wp-json\/wp\/v2\/media?parent=5586"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}