{"id":153,"date":"2024-08-27T13:40:34","date_gmt":"2024-08-27T04:40:34","guid":{"rendered":"https:\/\/ternaj.com\/shika\/?page_id=153"},"modified":"2025-10-21T12:18:20","modified_gmt":"2025-10-21T03:18:20","slug":"nurseform","status":"publish","type":"page","link":"https:\/\/ternaj.com\/shika\/contact\/nurseform\/","title":{"rendered":"\u30ca\u30fc\u30b9\u7d39\u4ecb\u30b5\u30fc\u30d3\u30b9"},"content":{"rendered":"<section class=\"clearfix u_first_sec\">\n<div class=\"box850\">\n<p class=\"\">\u300c\u30c6\u30eb\u30ca\u30b8\u30e3\u30d1\u30f3\u300d\u306b\u306f\u3001\u7f8e\u5bb9\u533b\u7642\u5206\u91ce\u306e\u8c4a\u5bcc\u306a\u77e5\u8b58\u3068\u7d4c\u9a13\u3092\u6301\u3064\u770b\u8b77\u5e2b\u304c\u5728\u7c4d\u3057\u3066\u304a\u308a\u3001\u6b6f\u79d1\u533b\u9662\u69d8\u306b\u5f0a\u793e\u6240\u5c5e\u306e\u770b\u8b77\u5e2b\u3092\u3054\u7d39\u4ecb\u3059\u308b\u4e8b\u696d\u3082\u884c\u3063\u3066\u3044\u307e\u3059\u3002<\/p>\n<p class=\"\">\u7f8e\u5bb9\u6a5f\u5668\u306e\u4f7f\u7528\u65b9\u6cd5\u306b\u3064\u3044\u3066\u306e\u6307\u5c0e\u3084\u3001\u70b9\u6ef4\u3092\u5b9f\u65bd\u3059\u308b\u65e5\u3060\u3051\u306e\u52e4\u52d9\u306a\u3069\u3001\u6b6f\u79d1\u533b\u9662\u69d8\u306e\u30cb\u30fc\u30ba\u306b\u5fdc\u3058\u305f\u591a\u69d8\u306a\u30b5\u30dd\u30fc\u30c8\u304c\u53ef\u80fd\u3067\u3059\u3002\u3054\u5e0c\u671b\u3092\u304a\u4f3a\u3044\u3057\u305f\u4e0a\u3067\u6700\u9069\u306a\u30d7\u30e9\u30f3\u3092\u3054\u6848\u5185\u53ef\u80fd\u306a\u306e\u3067\u3001\u7f8e\u5bb9\u533b\u7642\u3092\u5c0e\u5165\u3057\u305f\u3044\u3082\u306e\u306e\u770b\u8b77\u5e2b\u306e\u4e0d\u8db3\u306b\u304a\u60a9\u307f\u306e\u5834\u5408\u306a\u3069\u306f\u3001\u304a\u6c17\u8efd\u306b\u3054\u76f8\u8ac7\u4e0b\u3055\u3044\u3002\n<\/p>\n<\/div>\n<\/section>\n<section class=\"clearfix\">\n<h2>\u3053\u3093\u306a\u304a\u60a9\u307f\u306e\u89e3\u6c7a\u3092\u30c6\u30eb\u30ca\u306e<br \/>\u300c\u30d7\u30ed\u30d5\u30a7\u30b7\u30e7\u30ca\u30eb\u3000\u30ca\u30fc\u30b9\u7d39\u4ecb\u30b5\u30fc\u30d3\u30b9\u300d\u304c\u304a\u624b\u4f1d\u3044\u3044\u305f\u3057\u307e\u3059\u3002<\/h2>\n<div class=\"frame02 mb30\">\n<div class=\"frame02_box_white frame02_box_white02\">\n<ul class=\"list01\">\n<li>\u30b9\u30bf\u30c3\u30d5\uff08\u885b\u751f\u58eb\u30fb\u6b6f\u79d1\u52a9\u624b\uff09\u3078\u306e\u6307\u5c0e\u3092\u3057\u3066\u6b32\u3057\u3044<\/li>\n<p>1:\u70b9\u6ef4\u306e\u6e96\u5099\u3001\u7ba1\u7406\u3001\u6ce8\u610f\u306a\u3069<br \/>\n2:\u30dc\u30c4\u30ea\u30cc\u30b9\u30c8\u30b7\u30f3\u88fd\u5264\u7b49\u306e\u5e0c\u91c8\u65b9\u6cd5\u3001\u4ecb\u52a9\u65b9\u6cd5<br \/>\n3:\u30d2\u30a2\u30eb\u30ed\u30f3\u9178\u6ce8\u5165\u6642\u306e\u4ecb\u52a9\u65b9\u6cd5<br \/>\n4:\u8102\u80aa\u6eb6\u89e3\u6ce8\u5c04\u306e\u6e96\u5099\u3001\u4ecb\u52a9\u65b9\u6cd5<br \/>\n5:\u60a3\u8005\u69d8\u3078\u65bd\u8853\u5f8c\u306e\u6ce8\u610f\u3084\u904e\u3054\u3057\u65b9\u306e\u6307\u5c0e\u65b9\u6cd5<\/p>\n<li>\u70b9\u6ef4\u6cbb\u7642\u5c0e\u5165\u65e5\u306b\u5408\u308f\u305b\u3066\u6765\u3066\u307b\u3057\u3044<\/li>\n<li>\u30d2\u30a2\u30eb\u30ed\u30f3\u9178\u6ce8\u5165\u3084\u30dc\u30c4\u30ea\u30cc\u30b9\u88fd\u5264\u6cbb\u7642\u306b\u3064\u3044\u3066\u30a2\u30c9\u30d0\u30a4\u30b9\u30fb\u4ecb\u52a9\u65b9\u6cd5\u3092\u6559\u3048\u3066\u3057\u3066\u307b\u3057\u3044<\/li>\n<li>\u30b9\u30bf\u30c3\u30d5\u306b\u96c6\u60a3\u306e\u30a2\u30ca\u30a6\u30f3\u30b9\u65b9\u6cd5\u306e\u6559\u3048\u3066\u307b\u3057\u3044<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<p class=\"\">\u203b\u7d39\u4ecb\u65e5\u306b\u3064\u3044\u3066\u306f\u3001\u3054\u5e0c\u671b\u306f\u5909\u66f4\u3092\u304a\u9858\u3044\u3059\u308b\u5834\u5408\u3082\u3054\u3056\u3044\u307e\u3059\u3002<br \/>\u203b\u5730\u57df\u306b\u3088\u3063\u3066\u3001\u524d\u6cca\u304c\u5fc5\u8981\u306a\u5834\u5408\u306f\u3001\u5bbf\u6cca\u6599\u5225\u9014\u5fc5\u8981\u3068\u306a\u308a\u307e\u3059\u3002<\/p>\n<\/section>\n<section class=\"clearfix\">\n<h3>\u30ca\u30fc\u30b9\u3054\u7d39\u4ecb\u306e\u304a\u6642\u9593<\/h3>\n<table class=\"tb_block tb_main center\">\n<tr>\n<th>\u30e9\u30a4\u30c8\u30d7\u30e9\u30f3<\/th>\n<td>2\u6642\u9593<\/td>\n<\/tr>\n<tr>\n<th>\u30b9\u30bf\u30f3\u30c0\u30fc\u30c9\u30d7\u30e9\u30f3<\/th>\n<td>3\u6642\u9593<\/td>\n<\/tr>\n<tr>\n<th>\u30d9\u30fc\u30b7\u30c3\u30af\u30d7\u30e9\u30f3<\/th>\n<td>4\u6642\u9593<\/td>\n<\/tr>\n<tr>\n<th>\u30d7\u30ec\u30df\u30a2\u30e0\u30d7\u30e9\u30f3<\/th>\n<td>5\u6642\u9593<\/td>\n<\/tr>\n<\/table>\n<\/section>\n<section class=\"clearfix\">\n<h2>\u7533\u3057\u8fbc\u307f\u30d5\u30a9\u30fc\u30e0<\/h2>\n<div class=\"box850\">\n<p class=\"\">\u5927\u5909\u304a\u624b\u6570\u304a\u304b\u3051\u3057\u307e\u3059\u304c\u3001\u3054\u5e0c\u671b\u306e\u65b9\u306f\u4ee5\u4e0b\u306e\u30e1\u30fc\u30eb\u3088\u308a\u3001\u5fc5\u8981\u60c5\u5831\u3092\u76f4\u63a5\u5165\u529b\u3044\u305f\u3060\u304d\u304a\u554f\u5408\u305b\u304f\u3060\u3055\u3044\u307e\u305b\u3002<\/p>\n<\/div>\n<div class=\"form_main contact_form_main\">\n<h3 id=\"contact_form\">\u7533\u3057\u8fbc\u307f\u30d5\u30a9\u30fc\u30e0<\/h3>\n<ul class=\"contact_step_list\">\n<li class=\"contact_step_item contact_step_item01 active\">\n<p class=\"item_ttl_en\">STEP<span class=\"num\">01<\/span><\/p>\n<div class=\"item_circle\">\n<div class=\"item_info\">\n<p class=\"item_img\"><img decoding=\"async\" src=\"https:\/\/ternaj.com\/shika\/wp-content\/themes\/ternaj_shika\/images\/contact_step01.svg\" width=\"77\" alt=\"\"><\/p>\n<p class=\"item_ttl\">\u5165\u529b<\/p>\n<\/div>\n<\/div>\n<\/li>\n<li class=\"contact_step_item contact_step_item02\">\n<p class=\"item_ttl_en\">STEP<span class=\"num\">02<\/span><\/p>\n<div class=\"item_circle\">\n<div class=\"item_info\">\n<p class=\"item_img\"><img decoding=\"async\" src=\"https:\/\/ternaj.com\/shika\/wp-content\/themes\/ternaj_shika\/images\/contact_step02.svg\" width=\"70\" alt=\"\"><\/p>\n<p class=\"item_ttl\">\u78ba\u8a8d<\/p>\n<\/div>\n<\/div>\n<\/li>\n<li class=\"contact_step_item contact_step_item03\">\n<p class=\"item_ttl_en\">STEP<span class=\"num\">03<\/span><\/p>\n<div class=\"item_circle\">\n<div class=\"item_info\">\n<p class=\"item_img\"><img decoding=\"async\" src=\"https:\/\/ternaj.com\/shika\/wp-content\/themes\/ternaj_shika\/images\/contact_step03.svg\" width=\"54\" alt=\"\"><\/p>\n<p class=\"item_ttl\">\u9001\u4fe1\u5b8c\u4e86<\/p>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f190-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"190\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/shika\/wp-json\/wp\/v2\/pages\/153#wpcf7-f190-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"190\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f190-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;:190,&quot;conditions&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=\"form_main_white\">\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u30b5\u30fc\u30d3\u30b9\u540d<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd class=\"alignment\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-service\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required checkbox_main checkbox_main02\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"your-service[]\" value=\"\u30e9\u30a4\u30c8\u30d7\u30e9\u30f3\uff082\u6642\u9593\uff09\" \/><span class=\"wpcf7-list-item-label\">\u30e9\u30a4\u30c8\u30d7\u30e9\u30f3\uff082\u6642\u9593\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-service[]\" value=\"\u30b9\u30bf\u30f3\u30c0\u30fc\u30c9\u30d7\u30e9\u30f3\uff083\u6642\u9593\uff09\" \/><span class=\"wpcf7-list-item-label\">\u30b9\u30bf\u30f3\u30c0\u30fc\u30c9\u30d7\u30e9\u30f3\uff083\u6642\u9593\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-service[]\" value=\"\u30d9\u30fc\u30b7\u30c3\u30af\u30d7\u30e9\u30f3\uff084\u6642\u9593\uff09\" \/><span class=\"wpcf7-list-item-label\">\u30d9\u30fc\u30b7\u30c3\u30af\u30d7\u30e9\u30f3\uff084\u6642\u9593\uff09<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"your-service[]\" value=\"\u30d7\u30ec\u30df\u30a2\u30e0\u30d7\u30e9\u30f3\uff085\u6642\u9593\uff09\" \/><span class=\"wpcf7-list-item-label\">\u30d7\u30ec\u30df\u30a2\u30e0\u30d7\u30e9\u30f3\uff085\u6642\u9593\uff09<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u8cb4\u9662\u540d<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-clinicname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-clinicname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u5f79\u8077<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-post\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b:\u7406\u4e8b\u9577\u3001\u9662\u9577\u3001\u526f\u9662\u9577\u3001\u52e4\u52d9\u533b\u306a\u3069\u2026\" value=\"\" type=\"text\" name=\"your-post\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u5fa1\u82b3\u540d<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-namepop\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-namepop\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u90f5\u4fbf\u756a\u53f7<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p class=\"box_zipcode\"><span class=\"wpcf7-form-control-wrap\" data-name=\"your-zipcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main input_main02\" id=\"zipcode\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-zipcode\" \/><\/span><span id=\"zipcodeAutoComplete\" class=\"btn_zipcode\">\u4f4f\u6240\u53cd\u6620<\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u90fd\u9053\u5e9c\u770c<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-country\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u5e02\u533a\u753a\u6751<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-ward\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-ward\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u756a\u5730\u30fb\u5efa\u7269\u540d<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-building\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-building\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u96fb\u8a71\u756a\u53f7<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-tel\"><input size=\"40\" maxlength=\"12\" minlength=\"10\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-tel\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>FAX\u756a\u53f7<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-fax\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required input_main\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-fax\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl>\n\t\t<dt>\n\t\t\t<p>\u304a\u652f\u6255\u3044<span class=\"must\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-payment\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required checkbox_main\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"your-payment[]\" value=\"\u30af\u30ec\u30b8\u30c3\u30c8\" \/><span class=\"wpcf7-list-item-label\">\u30af\u30ec\u30b8\u30c3\u30c8<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"your-payment[]\" value=\"\u632f\u8fbc\" \/><span class=\"wpcf7-list-item-label\">\u632f\u8fbc<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<dl class=\"textarea_box\">\n\t\t<dt>\n\t\t\t<p>\u5099\u8003\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span 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