{"id":370,"date":"2022-10-12T13:29:09","date_gmt":"2022-10-12T12:29:09","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/onlinepayments\/?page_id=370"},"modified":"2026-08-26T09:22:40","modified_gmt":"2026-08-26T08:22:40","slug":"dental","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/onlinepayments\/dental\/","title":{"rendered":"Dental"},"content":{"rendered":"\n<style data-wp-block-html=\"css\">\r\n#container {\r\n        display: grid;\r\n        width: 600px;\r\n        border: 1px solid black;\r\n        padding: 10px;\r\n        padding-left: 20px;\r\n        grid-template-columns: auto auto auto;\r\n        border-radius: 5px;\r\n        justify-items: stretch;\r\n        justify-content: space-around;\r\n    }\r\n\r\n    .header {\r\n        grid-column: 1 \/ span 3;\r\n        text-align: center;\r\n        font-weight: bold;\r\n        font-size: larger;\r\n    }\r\n\r\n    .address-container {\r\n        grid-column: 1 \/ span 1;\r\n    }\r\n\r\n    .payment-container {\r\n        grid-column: 2 \/ span 1;\r\n    }\r\n\r\n    .label {\r\n        font-size: 13px !important;\r\n        margin-top: 10px;\r\n        text-align: left;\r\n        font-weight: bold;\r\n        margin-bottom: 5px;\r\n    }\r\n\r\n    .footer {\r\n        grid-column: 1 \/ span 3;\r\n        text-align: center;\r\n        border-top: 1px solid black;\r\n        padding: 5px;\r\n        margin-top: 20px;\r\n        padding-top: 15px;\r\n        display: flex;\r\n        justify-content: space-between;\r\n        background-color: transparent;\r\n    }\r\n\r\n    input[type=\"text\"] {\r\n        width: 200px;\r\n        font-size: small !important;\r\n        height: 30px;\r\n    }\r\n\r\n    textarea {\r\n        width: 200px;\r\n        font-size: small !important;\r\n    }\r\n\r\n    .input-field:hover,\r\n    select:hover,\r\n    textarea:hover {\r\n        border: 2px solid;\r\n    }\r\n\r\n    select {\r\n        width: 210px;\r\n        padding: 3px;\r\n        cursor: pointer;\r\n        font-size: small !important;\r\n        height: 30px;\r\n    }\r\n\r\n    input[type=\"submit\"],\r\n    input[type=\"button\"],\r\n    .btn {\r\n        font-size: small !important;\r\n        width: 60px;\r\n        height: 25px;\r\n        line-height: 0px;\r\n    }\r\n\r\n    @media screen and (max-width: 620px) {\r\n        #container {\r\n            width: 250px;\r\n        }\r\n\r\n        \/* .user-info-container {\r\n        grid-column: 1 \/ span 3;\r\n    } *\/\r\n\r\n        .address-container {\r\n            grid-column: 1 \/ span 3;\r\n        }\r\n\r\n        .payment-container {\r\n            grid-column: 1 \/ span 3;\r\n        }\r\n    }\r\n<\/style>\r\n\r\n<script data-wp-block-html=\"js\">\r\nvar options = [\r\n        \"Duncan Street Dental Centre\",\r\n        \"Howden Health Centre\",\r\n        \"Bonnyrigg Dental Centre\",\r\n        \"Wester Hailes Health Living Centre\",\r\n        \"Chalmers Dental Centre\",\r\n        \"Pennywell All Care Centre\",\r\n        \"Sighthill Health Centre\",\r\n        \"Musselburgh Primary Care Centre\",\r\n        \"Astley Ainslie Hospital\",\r\n        \"Royal Edinburgh Hospital\",\r\n        \"Royal Infirmary of Edinburgh\",\r\n        \"Western General Hospital\",\r\n        \"St John's Hospital\"\r\n    ];\r\n\r\n    \/\/$(document).ready(function () {\r\n   \/\/     for (var i = 0; i < options.length; i++) {\r\n   \/\/         $(\"#ref1\").append(\"<option value=\"\" + options[i] + \"\">\" + options[i] + \"<\/option>\");\r\n   \/\/     }\r\n   \/\/ });\r\n\r\n$(document).ready(function () {\r\n    for (var i = 0; i < options.length; i++) {\r\n        $(\"#ref1\").append('<option value=\"' + options[i] + '\">' + options[i] + '<\/option>');\r\n    }\r\n});\r\n<\/script>\r\n\r\n<form id=\"form\" name=\"form\">\r\n        <div id=\"container\">\r\n            <div class=\"header\">\r\n                <div class=\"label\" style=\"text-align: center;\">\r\n                    <h3>Payment For &#8211; <span id=\"formType\">Dental<\/span><\/h3>\r\n                <\/div>\r\n                <div class=\"label\" colspan=\"3\">* Mandatory field<\/div>\r\n            <\/div>\r\n            <div class=\"address-container\">\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\">Dental Clinic*<\/div>\r\n                    <div class=\"input\">\r\n                        <select id=\"ref1\" name=\"ref1\" required=\"\">\r\n                            <option value=\"\">&#8211; Please Select &#8211;<\/option>\r\n                        <\/select>\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\">Cardholder Name *<\/div>\r\n                    <div class=\"input\">\r\n                        <input class=\"input-field\" type=\"text\" size=\"30\" name=\"name\" id=\"name\" maxlength=\"40\" value=\"\">\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\">Email Address *<\/div>\r\n                    <div class=\"input\">\r\n                        <input class=\"input-field\" type=\"text\" size=\"30\" name=\"email\" id=\"email\" value=\"\">\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\">Telephone *<\/div>\r\n                    <div class=\"input\">\r\n                        <input class=\"input-field\" type=\"text\" size=\"30\" name=\"tel\" id=\"tel\" value=\"\">\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\">Billing Address *<\/div>\r\n                    <div class=\"input\">\r\n                        <input class=\"input-field\" type=\"text\" name=\"address1\" id=\"address1\" value=\"\">\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\"><\/div>\r\n                    <div class=\"input\">\r\n                        <input class=\"input-field\" type=\"text\" name=\"address2\" id=\"address2\" value=\"\">\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\"><\/div>\r\n                    <div class=\"input\">\r\n                        <input class=\"input-field\" type=\"text\" name=\"address3\" id=\"address3\" value=\"\">\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\">Town *<\/div>\r\n                    <div class=\"input\">\r\n                        <input class=\"input-field\" type=\"text\" name=\"town\" id=\"town\" value=\"\">\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\">City *<\/div>\r\n                    <div class=\"input\">\r\n                        <input class=\"input-field\" type=\"text\" name=\"city\" id=\"city\" value=\"\">\r\n                    <\/div>\r\n                    <div class=\"form-item\">\r\n                        <div class=\"label\">Postcode *<\/div>\r\n                        <div class=\"input\">\r\n                            <input class=\"input-field\" type=\"text\" name=\"postcode\" style=\"text-transform:uppercase\" id=\"postcode\" value=\"\">\r\n                        <\/div>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"payment-container\">\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\">Amount *<\/div>\r\n                    <div class=\"input\">\r\n                        <input class=\"input-field\" type=\"text\" name=\"amount\" id=\"amount\" value=\"\">\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"form-item\">\r\n                    <div class=\"label\" style=\"width: 200px; overflow-wrap: break-word;\">Name(s) (if different from cardholder name) and any additional information<\/div>\r\n                    <div class=\"input\">\r\n                        <textarea rows=\"5\" name=\"message\" style=\"resize: none;\"><\/textarea>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"footer\">\r\n                <div class=\"left\">\r\n                    <input class=\"btn-sm\" type=\"button\" onclick=\"history.back();\" style=\"cursor: pointer; border: 1px solid black;\" value=\"Back\">\r\n                    <button class=\"btn-sm\" type=\"reset\" value=\"Reset\" style=\"cursor: pointer; border: 1px solid black;\">Reset<\/button>\r\n                <\/div>\r\n                <div class=\"right\">\r\n                    <input class=\"btn-sm\" id=\"submit\" type=\"submit\" onclick=\"\" style=\"cursor: pointer; border: 1px solid black;\" value=\"Next\">\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/form>\r\n    <a href=\"#\" id=\"custom-trigger\" style=\"display: none;\"><\/a>\r\n    <div id=\"custom-html\"><\/div>\n\n\n","protected":false},"excerpt":{"rendered":"<p>\/\/$(document).ready(function () { \/\/ for (var i = 0; i &lt; options.length; i++) { \/\/ $(&#8220;#ref1&#8221;).append(&#8220;&#8221; + options[i] + &#8220;&#8221;); \/\/ } \/\/ }); $(document).ready(function () { for (var i = 0; i &lt; options.length; i++) { $(&#8220;#ref1&#8243;).append(&#8221; + options[i] + &#8221;); } }); Payment For &ndash; Dental * Mandatory field Dental Clinic* &ndash; Please<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[],"class_list":["post-370","page","type-page","status-publish","hentry"],"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/onlinepayments\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":false,"rttpg_excerpt":"\/\/$(document).ready(function () { \/\/ for (var i = 0; i &lt; options.length; i++) { \/\/ $(\"#ref1\").append(\"\" + options[i] + \"\"); \/\/ } \/\/ }); $(document).ready(function () { for (var i = 0; i &lt; options.length; i++) { $(\"#ref1\").append('' + options[i] + ''); } }); Payment For &ndash; Dental * Mandatory field Dental Clinic* &ndash; Please","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/onlinepayments\/wp-json\/wp\/v2\/pages\/370","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/onlinepayments\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/onlinepayments\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/onlinepayments\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/onlinepayments\/wp-json\/wp\/v2\/comments?post=370"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/onlinepayments\/wp-json\/wp\/v2\/pages\/370\/revisions"}],"predecessor-version":[{"id":589,"href":"https:\/\/apps.nhslothian.scot\/onlinepayments\/wp-json\/wp\/v2\/pages\/370\/revisions\/589"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/onlinepayments\/wp-json\/wp\/v2\/media?parent=370"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/onlinepayments\/wp-json\/wp\/v2\/categories?post=370"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}