{"id":8966,"date":"2024-02-07T12:06:49","date_gmt":"2024-02-07T10:06:49","guid":{"rendered":"http:\/\/www.suvag.hr\/?page_id=8966"},"modified":"2025-11-26T11:44:10","modified_gmt":"2025-11-26T09:44:10","slug":"obrazac-za-narucivanje-psiholog-crr","status":"publish","type":"page","link":"https:\/\/www.suvag.hr\/en\/obrazac-za-narucivanje-psiholog-crr\/","title":{"rendered":"OBRAZAC ZA NARU\u010cIVANJE &#8211; ZA PSIHOLO\u0160KU DIJAGNOSTIKU za djecu do navr\u0161ene 4 godine"},"content":{"rendered":"<form  class=\"kaliforms-form-container bootstrap-wrapper  \" data-form-id=\"8965\" style=\"opacity:0\"><h3>(duplicate) (duplicate) (duplicate) (duplicate) (duplicate)<\/h3><div id=\"kaliforms-global-error-message-8965\" class=\"global-error-message\"><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"date16\">Datum ro\u0111enja djeteta <span class=\"kali-required-mark\">*<\/span><\/label><input data-internal-id=\"date16\" type=\"date\" id=\"date16\" name=\"datum-rodjenja\"required  class=\"input\"><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-6 \"><label  for=\"first-name\">Ime djeteta <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox2\" type=\"text\" id=\"first-name\" name=\"ime-djeteta\" data-properties.type=\"text\" required ><\/div><div class=\"col-12 col-md-6 \"><label  for=\"last-name\">Prezime djeteta <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox3\" type=\"text\" id=\"last-name\" name=\"prezime-djeteta\" data-properties.type=\"text\" required ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-4 \"><label  for=\"textbox17\">MBO: <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox17\" type=\"text\" id=\"textbox17\" name=\"MBO\" data-properties.type=\"number\" required ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label class=\"radio-label\" style=\"margin-bottom:15px;display:inline-block\">Oznaka upu\u0107ivanja <span class=\"kali-required-mark\">*<\/span><\/label><label class=\"radio-label\"><input  data-internal-id=\"radio29\" type=\"radio\" id=\"radio290\" name=\"oznaka-upucivanja\" data-flow=\"vertical\" required  class=\"input\"  value=\"A3\">A3<\/label><label class=\"radio-label\"><input  data-internal-id=\"radio29\" type=\"radio\" id=\"radio291\" name=\"oznaka-upucivanja\" data-flow=\"vertical\" required  class=\"input\"  value=\"D1\">D1<\/label><label class=\"radio-label\"><input  data-internal-id=\"radio29\" type=\"radio\" id=\"radio292\" name=\"oznaka-upucivanja\" data-flow=\"vertical\" required  class=\"input\"  value=\"A1\">A1<\/label><label class=\"radio-label\"><input  data-internal-id=\"radio29\" type=\"radio\" id=\"radio293\" name=\"oznaka-upucivanja\" data-flow=\"vertical\" required  class=\"input\"  value=\"C1\">C1<\/label><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label class=\"radio-label\" style=\"margin-bottom:15px;display:inline-block\">Za djelatnost: <span class=\"kali-required-mark\">*<\/span><\/label><label class=\"radio-label\"><input  data-internal-id=\"radio30\" type=\"radio\" id=\"radio29300\" name=\"djelatnost\" data-flow=\"vertical\" required  class=\"input\"  value=\"2070400\">2070400<\/label><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-7 \"><label  for=\"textbox1718\">\u0160ifra uputnice:<\/label><input  data-internal-id=\"textbox18\" type=\"text\" id=\"textbox1718\" name=\"sifra-uputnice\" data-properties.type=\"text\" ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-6 \"><label  for=\"textbox19\">Ime roditelja: <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox19\" type=\"text\" id=\"textbox19\" name=\"ime-roditelja\" data-properties.type=\"text\" required ><\/div><div class=\"col-12 col-md-6 \"><label  for=\"textbox1920\">Prezime roditelja: <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox20\" type=\"text\" id=\"textbox1920\" name=\"prezime-roditelja\" data-properties.type=\"text\" required ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"textbox7\">Ku\u0107na adresa:<\/label><input  data-internal-id=\"textbox7\" type=\"text\" id=\"textbox7\" name=\"adresa\" data-properties.type=\"text\" ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-6 \"><label  for=\"textbox78\">Kontakt telefon: <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox8\" type=\"text\" id=\"textbox78\" name=\"telefon\" data-properties.type=\"text\" required ><\/div><div class=\"col-12 col-md-6 \"><label  for=\"email\">Email (za kontakt): <span class=\"kali-required-mark\">*<\/span><\/label><input  data-internal-id=\"textbox4\" type=\"text\" id=\"email\" name=\"email\" data-properties.type=\"text\" required ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12\"><hr \/><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"textbox21\">Tko inicira procjenu? (npr. roditelj, pedijatar,stru\u010dna slu\u017eba vrti\u0107a i dr.):<\/label><input  data-internal-id=\"textbox21\" type=\"text\" id=\"textbox21\" name=\"inicira\" data-properties.type=\"text\" ><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label class=\"radio-label\" style=\"margin-bottom:15px;display:inline-block\">Vrsta pregleda: <span class=\"kali-required-mark\">*<\/span><\/label><label class=\"radio-label\"><input  data-internal-id=\"radio14\" type=\"radio\" id=\"radio140\" name=\"vrsta-pregleda\" data-flow=\"vertical\" required  class=\"input\"  value=\"prvi\">prvi<\/label><label class=\"radio-label\"><input  data-internal-id=\"radio14\" type=\"radio\" id=\"radio141\" name=\"vrsta-pregleda\" data-flow=\"vertical\" required  class=\"input\"  value=\"kontrolni\">kontrolni<\/label><label class=\"radio-label\"><input  data-internal-id=\"radio14\" type=\"radio\" id=\"radio142\" name=\"vrsta-pregleda\" data-flow=\"vertical\" required  class=\"input\"  value=\"drugo mi\u0161ljenje\">drugo mi\u0161ljenje<\/label><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12\"><hr \/><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label class=\"radio-label\" style=\"margin-bottom:15px;display:inline-block\">Da li je ve\u0107 ranije izvan Poliklinike SUVAG u\u010dinjeno psiholo\u0161ko ispitivanje? <span class=\"kali-required-mark\">*<\/span><\/label><label class=\"radio-label\"><input  data-internal-id=\"radio15\" type=\"radio\" id=\"radio-150\" name=\"bio-pregled-izvan-suvaga\" data-flow=\"vertical\" required  class=\"input\"  value=\"ne\">NE<\/label><label class=\"radio-label\"><input  data-internal-id=\"radio15\" type=\"radio\" id=\"radio-151\" name=\"bio-pregled-izvan-suvaga\" data-flow=\"vertical\" required  class=\"input\"  value=\"da\">DA<\/label><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"textarea22\">Ako DA, gdje, koje i kada (navesti ustanovu, datum i preporuku iz nalaza)?:<\/label><textarea  data-internal-id=\"textarea22\" type=\"textarea\" id=\"textarea22\" name=\"gdje-i-kada-bio-pregled\" rows=\"3\" class=\"input\"><\/textarea><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12\"><hr \/><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><label  for=\"message\">Razlog radi kojeg se za dijete tra\u017ei psiholo\u0161ko ispitivanje:<\/label><textarea  data-internal-id=\"textarea5\" type=\"textarea\" id=\"message\" name=\"poruka\" rows=\"3\" class=\"input\"><\/textarea><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><div id=\"grecaptcha9\" data-field-type=\"grecaptcha\" data-sitekey=\"6LfNWlMaAAAAAE0CLKhzyhiEQrHUOW801lF-O3jK\"><\/div><\/div><\/div><div class=\"row kali-form-field-row\"><div class=\"col-12 col-md-12 \"><input  data-internal-id=\"submitbutton6\" type=\"submit\" id=\"submit\" data-style=\"default\"  class=\"input\" value=\"Po\u0161alji\" ><\/div><\/div><label class=\"khpfield\" for=\"kf-name-field\"><input class=\"khpfield\" id=\"kf-name-field\" name=\"kf-name-field\" autocomplete=\"off\" type=\"textbox\" \/><\/label><label class=\"khpfield\" for=\"kf-email-field\"><input class=\"khpfield\" id=\"kf-email-field\" name=\"kf-email-field\" autocomplete=\"off\" type=\"textbox\" \/><\/label><input type=\"hidden\" name=\"ip_address\" readonly value=\"216.73.217.40\" \/><!-- This form was built using Kali Forms --><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.suvag.hr\/en\/wp-json\/wp\/v2\/pages\/8966"}],"collection":[{"href":"https:\/\/www.suvag.hr\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.suvag.hr\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.suvag.hr\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.suvag.hr\/en\/wp-json\/wp\/v2\/comments?post=8966"}],"version-history":[{"count":4,"href":"https:\/\/www.suvag.hr\/en\/wp-json\/wp\/v2\/pages\/8966\/revisions"}],"predecessor-version":[{"id":9436,"href":"https:\/\/www.suvag.hr\/en\/wp-json\/wp\/v2\/pages\/8966\/revisions\/9436"}],"wp:attachment":[{"href":"https:\/\/www.suvag.hr\/en\/wp-json\/wp\/v2\/media?parent=8966"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}