{"id":585165,"date":"2026-01-29T15:47:29","date_gmt":"2026-01-29T18:47:29","guid":{"rendered":"https:\/\/fgmdentalgroup.com\/?page_id=585165"},"modified":"2026-05-05T17:03:05","modified_gmt":"2026-05-05T20:03:05","slug":"form-prd","status":"publish","type":"page","link":"https:\/\/fgmdentalgroup.com\/latam\/form-prd\/","title":{"rendered":"Form PRD"},"content":{"rendered":"\t\t
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\n\t\t\t\r\n\r\n\r\n \r\n\r\nT\u00cdTULO DO FORMULARIO<\/title>\r\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\">\r\n\r\n<style>\r\n* { \r\n box-sizing: border-box; \r\n font-family: Arial, Helvetica, sans-serif; \r\n}\r\n.header { \r\n background-color: #fcfbfc; \r\n padding: 24px; \r\n text-align: center; \r\n}\r\n.header img { \r\n max-width: 120px; \r\n \r\n}\r\n.container { \r\n background-color: #f2f2f2; \r\n border-radius: 8px; \r\n max-width: 720px; \r\n margin: 0 auto; \r\n padding: 40px 24px; \r\n \r\n}\r\nh2 { \r\n text-align: center; \r\n margin-bottom: 32px; \r\n color: #151515; \r\n font-weight: bold;\r\n}\r\nlabel { \r\n display: block; \r\n margin-bottom: 6px; \r\n font-weight: bold; \r\n color: #3d3d3d; \r\n \r\n}\r\n.input-sfmc, .select-sfmc { \r\n width: 100%; \r\n padding: 12px; \r\n margin-bottom: 20px; \r\n border-radius: 4px; \r\n border: 1px solid #ccc; \r\n font-size: 14px; \r\n \r\n}\r\n .form-row {\r\n display: flex;\r\n gap: 10px;\r\n}\r\n\r\n.form-group {\r\n flex: 1;\r\n display: flex;\r\n flex-direction: column;\r\n}\r\n\r\n\/* Mobile *\/\r\n@media (max-width: 768px) {\r\n .form-row {\r\n flex-direction: column;\r\n }\r\n}\r\n.checkbox-group { \r\n display: flex; \r\n align-items: flex-start; gap: 10px; \r\n margin-bottom: 16px; \r\n font-size: 14px; \r\n color: #ffffff; \r\n}\r\n.checkbox-group input { \r\n width: auto; \r\n margin-top: 3px; \r\n}\r\n .consentimento {\r\n color: #3d3d3d; \r\n }\r\n.legal { \r\n font-size: 16px; \r\n margin: 20px 0; \r\n color: #3d3d3d; \r\n}\r\n.legal a { \r\n color: #004fb6; \r\n text-decoration: underline; \r\n}\r\n.legal-small { \r\n font-size: 12px; \r\n color: #3d3d3d; \r\n margin-top: 20px; \r\n line-height: 1.4; \r\n}\r\n.button-sfmc { \r\n width: 100%; \r\n background-color: #004fb6; \r\n color: #fff; \r\n padding: 14px; \r\n font-size: 16px; \r\n border: none; \r\n border-radius: 4px; \r\n cursor: pointer; \r\n}\r\n.button-sfmc:hover, .button-sfmc:active, .button-sfmc:focus, .button-sfmc:visited { \r\n background-color: #003f91; \r\n}\r\n<\/style>\r\n<\/head>\r\n\r\n<body>\r\n\r\n<div class=\"container\">\r\n <h2>TEMPLATE LATAM<\/h2>\r\n\r\n <!-- atualizar com a URL da Cloudpage -->\r\n <form method=\"post\" action=\"https:\/\/cloud.email.fgmdentalgroup.com\/latam-template-light\" accept-charset=\"UTF-8\">\r\n <!-- atualizar com a URL da Cloudpage -->\r\n <input type=\"hidden\" name=\"submitted\" value=\"true\">\r\n <input type=\"hidden\" name=\"utm_source\" id=\"utm_source\">\r\n <input type=\"hidden\" name=\"utm_medium\" id=\"utm_medium\">\r\n <input type=\"hidden\" name=\"utm_campaign\" id=\"utm_campaign\">\r\n <input type=\"hidden\" name=\"utm_content\" id=\"utm_content\">\r\n <input type=\"hidden\" name=\"gclid\" id=\"gclid\">\r\n <input type=\"hidden\" name=\"fbclid\" id=\"fbclid\">\r\n\r\n\r\n <div class=\"form-row\">\r\n <div class=\"form-group\">\r\n <label>Nombre*<\/label>\r\n <input class=\"input-sfmc\" type=\"text\" name=\"nome\" required>\r\n <\/div>\r\n\r\n <div class=\"form-group\">\r\n <label>Apellido*<\/label>\r\n <input class=\"input-sfmc\" type=\"text\" name=\"sobrenome\" required>\r\n <\/div>\r\n<\/div>\r\n\r\n <label>Correo electr\u00f3nico*<\/label>\r\n <input class=\"input-sfmc\" type=\"email\" name=\"email\" required>\r\n\r\n <label>Celular*<\/label>\r\n <input class=\"input-sfmc\" type=\"tel\" id=\"celular\" name=\"celular\" required >\r\n\r\n <label>Pa\u00eds*<\/label>\r\n <select class=\"select-sfmc\" type=\"text\" name=\"country\" required>\r\n \r\n <option value=\"\" selected disabled>Seleccione<\/option>\r\n\r\n <option value=\"AF\">Afghanistan<\/option>\r\n <option value=\"AL\">Albania<\/option>\r\n <option value=\"DZ\">Algeria<\/option>\r\n <option value=\"AD\">Andorra<\/option>\r\n <option value=\"AO\">Angola<\/option>\r\n <option value=\"AR\">Argentina<\/option>\r\n <option value=\"AM\">Armenia<\/option>\r\n <option value=\"AU\">Australia<\/option>\r\n <option value=\"AT\">Austria<\/option>\r\n <option value=\"AZ\">Azerbaijan<\/option>\r\n <option value=\"BH\">Bahrain<\/option>\r\n <option value=\"BD\">Bangladesh<\/option>\r\n <option value=\"BY\">Belarus<\/option>\r\n <option value=\"BE\">Belgium<\/option>\r\n <option value=\"BZ\">Belize<\/option>\r\n <option value=\"BJ\">Benin<\/option>\r\n <option value=\"BT\">Bhutan<\/option>\r\n <option value=\"BO\">Bolivia<\/option>\r\n <option value=\"BA\">Bosnia and Herzegovina<\/option>\r\n <option value=\"BW\">Botswana<\/option>\r\n <option value=\"BR\">Brazil<\/option>\r\n <option value=\"BN\">Brunei<\/option>\r\n <option value=\"BG\">Bulgaria<\/option>\r\n <option value=\"BF\">Burkina Faso<\/option>\r\n <option value=\"BI\">Burundi<\/option>\r\n <option value=\"KH\">Cambodia<\/option>\r\n <option value=\"CM\">Cameroon<\/option>\r\n <option value=\"CA\">Canada<\/option>\r\n <option value=\"TD\">Chad<\/option>\r\n <option value=\"CL\">Chile<\/option>\r\n <option value=\"CN\">China<\/option>\r\n <option value=\"CO\">Colombia<\/option>\r\n <option value=\"CR\">Costa Rica<\/option>\r\n <option value=\"HR\">Croatia<\/option>\r\n <option value=\"CU\">Cuba<\/option>\r\n <option value=\"CY\">Cyprus<\/option>\r\n <option value=\"CZ\">Czech Republic<\/option>\r\n <option value=\"DK\">Denmark<\/option>\r\n <option value=\"DO\">Dominican Republic<\/option>\r\n <option value=\"EC\">Ecuador<\/option>\r\n <option value=\"EG\">Egypt<\/option>\r\n <option value=\"SV\">El Salvador<\/option>\r\n <option value=\"EE\">Estonia<\/option>\r\n <option value=\"ET\">Ethiopia<\/option>\r\n <option value=\"FI\">Finland<\/option>\r\n <option value=\"FR\">France<\/option>\r\n <option value=\"GE\">Georgia<\/option>\r\n <option value=\"DE\">Germany<\/option>\r\n <option value=\"GH\">Ghana<\/option>\r\n <option value=\"GR\">Greece<\/option>\r\n <option value=\"GT\">Guatemala<\/option>\r\n <option value=\"HN\">Honduras<\/option>\r\n <option value=\"HK\">Hong Kong<\/option>\r\n <option value=\"HU\">Hungary<\/option>\r\n <option value=\"IS\">Iceland<\/option>\r\n <option value=\"IN\">India<\/option>\r\n <option value=\"ID\">Indonesia<\/option>\r\n <option value=\"IR\">Iran<\/option>\r\n <option value=\"IQ\">Iraq<\/option>\r\n <option value=\"IE\">Ireland<\/option>\r\n <option value=\"IL\">Israel<\/option>\r\n <option value=\"IT\">Italy<\/option>\r\n <option value=\"JM\">Jamaica<\/option>\r\n <option value=\"JP\">Japan<\/option>\r\n <option value=\"JO\">Jordan<\/option>\r\n <option value=\"KZ\">Kazakhstan<\/option>\r\n <option value=\"KE\">Kenya<\/option>\r\n <option value=\"KW\">Kuwait<\/option>\r\n <option value=\"KG\">Kyrgyzstan<\/option>\r\n <option value=\"LA\">Laos<\/option>\r\n <option value=\"LV\">Latvia<\/option>\r\n <option value=\"LB\">Lebanon<\/option>\r\n <option value=\"LT\">Lithuania<\/option>\r\n <option value=\"LU\">Luxembourg<\/option>\r\n <option value=\"MY\">Malaysia<\/option>\r\n <option value=\"MV\">Maldives<\/option>\r\n <option value=\"MX\">Mexico<\/option>\r\n <option value=\"MD\">Moldova<\/option>\r\n <option value=\"MN\">Mongolia<\/option>\r\n <option value=\"MA\">Morocco<\/option>\r\n <option value=\"MZ\">Mozambique<\/option>\r\n <option value=\"MM\">Myanmar<\/option>\r\n <option value=\"NA\">Namibia<\/option>\r\n <option value=\"NP\">Nepal<\/option>\r\n <option value=\"NL\">Netherlands<\/option>\r\n <option value=\"NZ\">New Zealand<\/option>\r\n <option value=\"NI\">Nicaragua<\/option>\r\n <option value=\"NE\">Niger<\/option>\r\n <option value=\"NG\">Nigeria<\/option>\r\n <option value=\"NO\">Norway<\/option>\r\n <option value=\"OM\">Oman<\/option>\r\n <option value=\"PK\">Pakistan<\/option>\r\n <option value=\"PA\">Panama<\/option>\r\n <option value=\"PY\">Paraguay<\/option>\r\n <option value=\"PE\">Peru<\/option>\r\n <option value=\"PH\">Philippines<\/option>\r\n <option value=\"PL\">Poland<\/option>\r\n <option value=\"PT\">Portugal<\/option>\r\n <option value=\"QA\">Qatar<\/option>\r\n <option value=\"RO\">Romania<\/option>\r\n <option value=\"RU\">Russia<\/option>\r\n <option value=\"SA\">Saudi Arabia<\/option>\r\n <option value=\"SN\">Senegal<\/option>\r\n <option value=\"RS\">Serbia<\/option>\r\n <option value=\"SG\">Singapore<\/option>\r\n <option value=\"SK\">Slovakia<\/option>\r\n <option value=\"SI\">Slovenia<\/option>\r\n <option value=\"ZA\">South Africa<\/option>\r\n <option value=\"KR\">South Korea<\/option>\r\n <option value=\"ES\">Spain<\/option>\r\n <option value=\"LK\">Sri Lanka<\/option>\r\n <option value=\"SE\">Sweden<\/option>\r\n <option value=\"CH\">Switzerland<\/option>\r\n <option value=\"TH\">Thailand<\/option>\r\n <option value=\"TR\">Turkey<\/option>\r\n <option value=\"UA\">Ukraine<\/option>\r\n <option value=\"AE\">United Arab Emirates<\/option>\r\n <option value=\"GB\">United Kingdom<\/option>\r\n <option value=\"US\">United States<\/option>\r\n <option value=\"UY\">Uruguay<\/option>\r\n <option value=\"UZ\">Uzbekistan<\/option>\r\n <option value=\"VE\">Venezuela<\/option>\r\n <option value=\"VN\">Vietnam<\/option>\r\n <option value=\"YE\">Yemen<\/option>\r\n <option value=\"ZM\">Zambia<\/option>\r\n <option value=\"ZW\">Zimbabwe<\/option>\r\n \r\n <\/select>\r\n\r\n <label>Ciudad*<\/label>\r\n <input class=\"input-sfmc\" type=\"text\" name=\"cidade\" required>\r\n\r\n<label>Especialidad*<\/label>\r\n <select class=\"select-sfmc\" name=\"especialidade\" required>\r\n <option value=\"\">Seleccione<\/option>\r\n <option value=\"Cirurgia Bucomaxilofacial\">Cirug\u00eda y Traumatolog\u00eda Bucomaxilofacial<\/option>\r\n <option value=\"Cl\u00ednico Geral\">Cl\u00ednico General<\/option>\r\n <option value=\"DTM e Dor Orofacial\">DTM y Dolor Orofacial<\/option>\r\n <option value=\"Endodontia\">Endodoncia<\/option>\r\n <option value=\"Estomatologia\">Estomatolog\u00eda<\/option>\r\n <option value=\"Implantodontia\">Implantolog\u00eda<\/option>\r\n <option value=\"Odontogeriatria\">Odontogeriatr\u00eda<\/option>\r\n <option value=\"Odontologia do Esporte\">Odontolog\u00eda del Deporte<\/option>\r\n <option value=\"Odontologia do Trabalho\">Odontolog\u00eda del Trabajo<\/option>\r\n <option value=\"Odontologia Legal\">Odontolog\u00eda Legal<\/option>\r\n <option value=\"Odontopediatria\">Odontopediatr\u00eda<\/option>\r\n <option value=\"Ortodontia\">Ortodoncia<\/option>\r\n <option value=\"Patologia Bucal\">Patolog\u00eda Bucal<\/option>\r\n <option value=\"Periodontia\">Periodoncia<\/option>\r\n <option value=\"Pr\u00f3tese Dent\u00e1ria\">Pr\u00f3tesis Dental<\/option>\r\n <option value=\"Radiologia\">Radiolog\u00eda<\/option>\r\n <option value=\"Outros\">Otros<\/option>\r\n <\/select>\r\n\r\n <div class=\"checkbox-group\">\r\n <input type=\"checkbox\" name=\"consentimento\" value=\"true\">\r\n <span class=\"consentimento\">Acepto recibir comunicaciones<\/span>\r\n <\/div>\r\n\r\n <div class=\"legal\">\r\n Al proporcionar mis datos, acepto la\r\n <a href=\"https:\/\/fgmdentalgroup.com\/latam\/politica-de-privacidad\/\" target=\"_blank\">\r\n Pol\u00edtica de Privacidad\r\n <\/a>.\r\n <\/div>\r\n\r\n <button class=\"button-sfmc\" type=\"submit\">Suscribir<\/button>\r\n\r\n <div class=\"legal-small\">\r\n Communications will be sent by e-mail containing customized offers according to your interest for the period of 12 months. At any moment, it is possible to renew or cancel this agreement by means of the \u201copt out\u201d or through our website fgmdentalgroup.com using the option \u201cRights of the data subject\u201d.\r\n <\/div>\r\n\r\n <\/form>\r\n<\/div>\r\n\r\n<script>\r\n(function () {\r\n const params = new URLSearchParams(window.location.search);\r\n const fields = [\r\n \"utm_source\",\r\n \"utm_medium\",\r\n \"utm_campaign\",\r\n \"utm_content\",\r\n \"gclid\",\r\n \"fbclid\"\r\n ];\r\n\r\n fields.forEach(function(field) {\r\n const input = document.getElementById(field);\r\n if (input && params.get(field)) {\r\n input.value = params.get(field);\r\n }\r\n });\r\n})();\r\n<\/script>\r\n\r\n\r\n<\/body>\r\n<\/html>\r\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>T\u00cdTULO DO FORMULARIO TEMPLATE LATAM Nombre* Apellido* Correo electr\u00f3nico* Celular* Pa\u00eds* SeleccioneAfghanistanAlbaniaAlgeriaAndorraAngolaArgentinaArmeniaAustraliaAustriaAzerbaijanBahrainBangladeshBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaChadChileChinaColombiaCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDominican RepublicEcuadorEgyptEl SalvadorEstoniaEthiopiaFinlandFranceGeorgiaGermanyGhanaGreeceGuatemalaHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKuwaitKyrgyzstanLaosLatviaLebanonLithuaniaLuxembourgMalaysiaMaldivesMexicoMoldovaMongoliaMoroccoMozambiqueMyanmarNamibiaNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPanamaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaSaudi ArabiaSenegalSerbiaSingaporeSlovakiaSloveniaSouth AfricaSouth KoreaSpainSri LankaSwedenSwitzerlandThailandTurkeyUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVenezuelaVietnamYemenZambiaZimbabwe Ciudad* Especialidad* SeleccioneCirug\u00eda y Traumatolog\u00eda BucomaxilofacialCl\u00ednico GeneralDTM y Dolor OrofacialEndodonciaEstomatolog\u00edaImplantolog\u00edaOdontogeriatr\u00edaOdontolog\u00eda del DeporteOdontolog\u00eda del TrabajoOdontolog\u00eda LegalOdontopediatr\u00edaOrtodonciaPatolog\u00eda BucalPeriodonciaPr\u00f3tesis DentalRadiolog\u00edaOtros Acepto recibir comunicaciones Al proporcionar mis datos, acepto la […]<\/p>\n","protected":false},"author":15,"featured_media":0,"parent":0,"menu_order":131,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-585165","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/fgmdentalgroup.com\/latam\/wp-json\/wp\/v2\/pages\/585165"}],"collection":[{"href":"https:\/\/fgmdentalgroup.com\/latam\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/fgmdentalgroup.com\/latam\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/latam\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/fgmdentalgroup.com\/latam\/wp-json\/wp\/v2\/comments?post=585165"}],"version-history":[{"count":6,"href":"https:\/\/fgmdentalgroup.com\/latam\/wp-json\/wp\/v2\/pages\/585165\/revisions"}],"predecessor-version":[{"id":585171,"href":"https:\/\/fgmdentalgroup.com\/latam\/wp-json\/wp\/v2\/pages\/585165\/revisions\/585171"}],"wp:attachment":[{"href":"https:\/\/fgmdentalgroup.com\/latam\/wp-json\/wp\/v2\/media?parent=585165"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}