Dash REHAB Call Back

[et_pb_section bb_built=”1″ fullwidth=”on” specialty=”off” next_background_color=”#000000″ _builder_version=”3.5.1″][et_pb_fullwidth_image _builder_version=”3.1.1″ src=”https://websterwheelchairs.co.uk/wp-content/uploads/2018/04/RHC_3020-POWERCHAIRS-Slider-MAR18-5.jpg” url=”https://websterwheelchairs.co.uk/contact/” /][/et_pb_section][et_pb_section bb_built=”1″ prev_background_color=”#000000″][et_pb_row _builder_version=”3.5.1″][et_pb_column type=”4_4″][et_pb_contact_form _builder_version=”3.5.1″ text_orientation=”left” title_text_align=”center” form_field_text_align=”center” module_alignment=”center” title=”Looking for more details about our Dash REHAB Power Wheelchairs? Enter your details for a call back.” custom_margin=”50px||50px|” title_level=”h2″ max_width=”80%” title_font=”|700|||||||” title_text_color=”#006d8e” success_message=”We will be in touch within 24 hours. Thanks” email=”sales@websterwheelchairs.com” custom_message=”Name inputted: %%Name%%||et_pb_line_break_holder||Phone number inputted: %%Phone_No%%||et_pb_line_break_holder||Email address inputted: %%Email%%||et_pb_line_break_holder||Prefers to be contacted by %%Would_you_prefer_for_us_to_call_or_email_you?%%||et_pb_line_break_holder||Message: %%message%%||et_pb_line_break_holder||”][et_pb_contact_field field_title=”Name” field_type=”input” field_id=”Name” required_mark=”on” fullwidth_field=”off” _builder_version=”3.5.1″ /][et_pb_contact_field _builder_version=”3.5.1″ field_id=”Phone_No” field_title=”Phone No” field_type=”input” checkbox_checked=”off” checkbox_options=”%91{%22value%22:%22%22,%22checked%22:0}%93″ radio_options=”%91{%22value%22:%22%22,%22checked%22:0}%93″ select_options=”%91{%22value%22:%22%22,%22checked%22:0}%93″ min_length=”0″ max_length=”0″ allowed_symbols=”all” required_mark=”on” conditional_logic=”off” conditional_logic_relation=”off” conditional_logic_rules=”%91{%22field%22:%22name%22,%22condition%22:%22is%22,%22value%22:%22%22}%93″ use_background_color_gradient=”off” background_color_gradient_start=”#2b87da” background_color_gradient_end=”#29c4a9″ background_color_gradient_type=”linear” background_color_gradient_direction=”180deg” background_color_gradient_direction_radial=”center” background_color_gradient_start_position=”0%” background_color_gradient_end_position=”100%” background_color_gradient_overlays_image=”off” parallax=”off” parallax_method=”on” background_size=”cover” background_position=”center” background_repeat=”no-repeat” background_blend=”normal” allow_player_pause=”off” background_video_pause_outside_viewport=”on” fullwidth_field=”off” form_field_text_shadow_style=”none” box_shadow_style=”none” /][et_pb_contact_field field_title=”Email Address” field_type=”email” field_id=”Email” required_mark=”on” fullwidth_field=”off” _builder_version=”3.5.1″ /][et_pb_contact_field _builder_version=”3.5.1″ field_id=”Would_you_prefer_for_us_to_call_or_email_you?” field_title=”Would you prefer for us to call or email you?” field_type=”select” checkbox_checked=”off” checkbox_options=”%91{%22value%22:%22%22,%22checked%22:0}%93″ radio_options=”%91{%22value%22:%22%22,%22checked%22:0}%93″ select_options=”%91{%22value%22:%22Call%22,%22checked%22:0},{%22value%22:%22Email%22,%22checked%22:0}%93″ min_length=”0″ max_length=”0″ allowed_symbols=”all” required_mark=”on” conditional_logic=”off” conditional_logic_relation=”off” conditional_logic_rules=”%91{%22field%22:%22name%22,%22condition%22:%22is%22,%22value%22:%22%22}%93″ use_background_color_gradient=”off” background_color_gradient_start=”#2b87da” background_color_gradient_end=”#29c4a9″ background_color_gradient_type=”linear” background_color_gradient_direction=”180deg” background_color_gradient_direction_radial=”center” background_color_gradient_start_position=”0%” background_color_gradient_end_position=”100%” background_color_gradient_overlays_image=”off” parallax=”off” parallax_method=”on” background_size=”cover” background_position=”center” background_repeat=”no-repeat” background_blend=”normal” allow_player_pause=”off” background_video_pause_outside_viewport=”on” fullwidth_field=”off” form_field_text_shadow_style=”none” box_shadow_style=”none” form_field_text_shadow_horizontal_length=”0em” form_field_text_shadow_vertical_length=”0em” form_field_text_shadow_blur_strength=”0em” max_width=”100%” max_width_tablet=”100%” max_width_phone=”100%” /][et_pb_contact_field field_title=”Message” field_type=”text” field_id=”Message” required_mark=”on” fullwidth_field=”on” _builder_version=”3.5.1″ /][/et_pb_contact_form][/et_pb_column][/et_pb_row][/et_pb_section]

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