{"id":352,"date":"2026-05-03T13:21:04","date_gmt":"2026-05-03T13:21:04","guid":{"rendered":"https:\/\/zanithchc.co.uk\/?page_id=352"},"modified":"2026-05-04T21:46:17","modified_gmt":"2026-05-04T21:46:17","slug":"contact-new-form","status":"publish","type":"page","link":"https:\/\/zanithchc.co.uk\/?page_id=352","title":{"rendered":"contact &#8211; new form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"352\" class=\"elementor elementor-352\">\n\t\t\t\t<div class=\"elementor-element elementor-element-43c432b e-flex e-con-boxed e-con e-parent\" data-id=\"43c432b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3f7d3f6 elementor-widget elementor-widget-heading\" data-id=\"3f7d3f6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Start Your CHC Review<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-64c7ab2 e-flex e-con-boxed e-con e-parent\" data-id=\"64c7ab2\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d031308 elementor-widget elementor-widget-text-editor\" data-id=\"d031308\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p data-start=\"0\" data-end=\"321\">Fill in the form below and a member of our team will get back to you as soon as possible. Once we receive your enquiry, we will carefully review the information provided and ensure it is directed to the appropriate specialist. Our team aims to respond promptly with clear, practical guidance tailored to your situation.\u00a0Whether you are seeking advice on CHC eligibility, need support with an appeal, or want to explore a retrospective claim, we will take the time to understand your circumstances and outline the next steps in a straightforward and supportive manner. All information shared with us is treated with strict confidentiality and handled with the utmost professionalism.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-24084e66 e-flex e-con-boxed e-con e-parent\" data-id=\"24084e66\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2577619b elementor-widget elementor-widget-text-editor\" data-id=\"2577619b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<div class=\"auto-form-builder-wrapper auto-form-builder-1\">\n<div class=\"auto-form-builder-header\">\n<h1 class=\"header-title\">Start your CHC Review<\/h1>\n<\/div>\n<form class=\"auto-form-builder-form\" method=\"post\" enctype=\"multipart\/form-data\" data-form-id=\"1\"><input type=\"hidden\" id=\"auto_form_builder_nonce_1\" name=\"auto_form_builder_nonce_1\" value=\"3c9db77210\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F352\" \/><input type=\"hidden\" name=\"auto_form_builder_id\" value=\"1\"><\/p>\n<div class=\"form-field  required\" id=\"field-field_69f8d2153aaa9\" data-field-id=\"field_69f8d2153aaa9\" data-field-type=\"text\"><label for=\"field_69f8d2153aaa9\">Full Name<\/label><input type=\"text\" name=\"field_69f8d2153aaa9\" id=\"field_69f8d2153aaa9\" placeholder=\"Enter your full name\" required  class=\"form-control field-type-text required-field\"  ><\/div>\n<div class=\"form-field  required\" id=\"field-field_69f8d2153aaaa\" data-field-id=\"field_69f8d2153aaaa\" data-field-type=\"email\"><label for=\"field_69f8d2153aaaa\">Email Address<\/label><input type=\"email\" name=\"field_69f8d2153aaaa\" id=\"field_69f8d2153aaaa\" placeholder=\"Your email address\" required autocomplete=\"email\"><\/div>\n<div class=\"form-field\" id=\"field-field_69f8d2153aaab\" data-field-id=\"field_69f8d2153aaab\" data-field-type=\"phone\"><label for=\"field_69f8d2153aaab\">Phone Number<\/label><input type=\"tel\" name=\"field_69f8d2153aaab\" id=\"field_69f8d2153aaab\"  placeholder=\"Enter your phone number\"  autocomplete=\"off\" class=\"form-field-input phone-field-input\"  data-phone-format=\"international\"><\/div>\n<div class=\"form-field\" id=\"field-1777914798615\" data-field-id=\"1777914798615\" data-field-type=\"radio\"><label for=\"1777914798615\">Relationship to Person Needing CHC<\/label><\/p>\n<div class=\"radio-group radio-container-row\"><label class=\"radio-option\"><input type=\"radio\" name=\"1777914798615\" value=\"self\"> <span>Self<\/span><\/label><label class=\"radio-option\"><input type=\"radio\" name=\"1777914798615\" value=\"spouse_\/_partner\"> <span>Spouse \/ Partner<\/span><\/label><label class=\"radio-option\"><input type=\"radio\" name=\"1777914798615\" value=\"parent\"> <span>Parent<\/span><\/label><label class=\"radio-option\"><input type=\"radio\" name=\"1777914798615\" value=\"child\"> <span>Child<\/span><\/label><label class=\"radio-option\"><input type=\"radio\" name=\"1777914798615\" value=\"sibling\"> <span>Sibling<\/span><\/label><label class=\"radio-option\"><input type=\"radio\" name=\"1777914798615\" value=\"other_family_member\"> <span>Other family Member<\/span><\/label><label class=\"radio-option\"><input type=\"radio\" name=\"1777914798615\" value=\"friend\"> <span>Friend<\/span><\/label><label class=\"radio-option\"><input type=\"radio\" name=\"1777914798615\" value=\"legal_representative\"> <span>Legal Representative<\/span><\/label><label class=\"radio-option\"><input type=\"radio\" name=\"1777914798615\" value=\"care_giver\/support_worker\"> <span>Care Giver\/Support Worker<\/span><\/label><\/div>\n<\/div>\n<div class=\"form-field\" id=\"field-1777915135102\" data-field-id=\"1777915135102\" data-field-type=\"dropdown\"><label for=\"1777915135102\">Preferred Contact Method<\/label><\/p>\n<div id=\"searchable_dropdown_wrapper_1777915135102\" class=\"searchable-dropdown-wrapper\" data-field-id=\"1777915135102\"><input type=\"hidden\" id=\"hidden_input_1777915135102\" name=\"1777915135102\" value=\"\" ><input type=\"text\" id=\"searchable_input_1777915135102\" class=\"searchable-dropdown-input non-searchable\" placeholder=\"How would you prefer us to contact you?\" autocomplete=\"off\" readonly data-field-id=\"1777915135102\" data-enable-search=\"false\"><span class=\"dropdown-arrow\" data-input-color=\"#1e293b\">&#9660;<\/span><\/p>\n<div id=\"searchable_dropdown_1777915135102\" class=\"searchable-dropdown-options\" role=\"listbox\" data-border-color=\"#93c5fd\" data-border-radius=\"10px\">\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"phone\" data-label=\"Phone\" data-field-id=\"1777915135102\" data-is-multiple=\"false\">Phone<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"email\" data-label=\"Email\" data-field-id=\"1777915135102\" data-is-multiple=\"false\">Email<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"either\" data-label=\"Either\" data-field-id=\"1777915135102\" data-is-multiple=\"false\">Either<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"form-field\" id=\"field-1777915215831\" data-field-id=\"1777915215831\" data-field-type=\"dropdown\"><label for=\"1777915215831\">Select Current Stage<\/label><\/p>\n<div id=\"searchable_dropdown_wrapper_1777915215831\" class=\"searchable-dropdown-wrapper\" data-field-id=\"1777915215831\"><input type=\"hidden\" id=\"hidden_input_1777915215831\" name=\"1777915215831\" value=\"just_starting_\/_seeking_information\" ><input type=\"text\" id=\"searchable_input_1777915215831\" class=\"searchable-dropdown-input non-searchable\" placeholder=\"Where are you in the CHC process\" autocomplete=\"off\" readonly data-field-id=\"1777915215831\" data-enable-search=\"false\"><span class=\"dropdown-arrow\" data-input-color=\"#1e293b\">&#9660;<\/span><\/p>\n<div id=\"searchable_dropdown_1777915215831\" class=\"searchable-dropdown-options\" role=\"listbox\" data-border-color=\"#93c5fd\" data-border-radius=\"10px\">\n<div class=\"dropdown-option selected\" role=\"option\" tabindex=\"0\" data-value=\"just_starting_\/_seeking_information\" data-label=\"Just starting \/ Seeking information\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Just starting \/ Seeking information<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"referred_for_chc_assessment\" data-label=\"Referred for CHC assessment\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Referred for CHC assessment<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"checklist_completed\" data-label=\"Checklist completed\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Checklist completed<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"full_assessment_(dst)_pending\" data-label=\"Full assessment (DST) pending\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Full assessment (DST) pending<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"full_assessment_completed_\u2013_awaiting_decision\" data-label=\"Full assessment completed \u2013 awaiting decision\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Full assessment completed \u2013 awaiting decision<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"funding_approved\" data-label=\"Funding approved\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Funding approved<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"funding_declined\" data-label=\"Funding declined\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Funding declined<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"currently_appealing_a_decision\" data-label=\"Currently appealing a decision\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Currently appealing a decision<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"currently_appealing_a_decision\" data-label=\"Currently appealing a decision\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Currently appealing a decision<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"interested_in_retrospective_claim\" data-label=\"Interested in retrospective claim\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Interested in retrospective claim<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"not_sure\" data-label=\"Not sure\" data-field-id=\"1777915215831\" data-is-multiple=\"false\">Not sure<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"form-field\" id=\"field-1777915848793\" data-field-id=\"1777915848793\" data-field-type=\"dropdown\"><label for=\"1777915848793\">Best Time to Contact<\/label><\/p>\n<div id=\"searchable_dropdown_wrapper_1777915848793\" class=\"searchable-dropdown-wrapper\" data-field-id=\"1777915848793\"><input type=\"hidden\" id=\"hidden_input_1777915848793\" name=\"1777915848793\" value=\"\" ><input type=\"text\" id=\"searchable_input_1777915848793\" class=\"searchable-dropdown-input non-searchable\" placeholder=\"Best Time to Contact you\" autocomplete=\"off\" readonly data-field-id=\"1777915848793\" data-enable-search=\"false\"><span class=\"dropdown-arrow\" data-input-color=\"#1e293b\">&#9660;<\/span><\/p>\n<div id=\"searchable_dropdown_1777915848793\" class=\"searchable-dropdown-options\" role=\"listbox\" data-border-color=\"#93c5fd\" data-border-radius=\"10px\">\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"morning\" data-label=\"Morning\" data-field-id=\"1777915848793\" data-is-multiple=\"false\">Morning<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"afternoon\" data-label=\"Afternoon\" data-field-id=\"1777915848793\" data-is-multiple=\"false\">Afternoon<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"evening\" data-label=\"Evening\" data-field-id=\"1777915848793\" data-is-multiple=\"false\">Evening<\/div>\n<div class=\"dropdown-option\" role=\"option\" tabindex=\"0\" data-value=\"anytime\" data-label=\"Anytime\" data-field-id=\"1777915848793\" data-is-multiple=\"false\">Anytime<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"form-field  required\" id=\"field-field_69f8d2153aaac\" data-field-id=\"field_69f8d2153aaac\" data-field-type=\"textarea\"><label for=\"field_69f8d2153aaac\">Tell us briefly about your situation<\/label><textarea name=\"field_69f8d2153aaac\" id=\"field_69f8d2153aaac\" placeholder=\"Any details that will help us understand your situation ...\" required rows=\"5\"><\/textarea><\/div>\n<div class=\"submit-wrapper\"><button type=\"submit\" class=\"auto-form-builder-1-submit form-submit-button auto-form-builder-hover-grow\">Submit Consultation Request<\/button><\/div>\n<\/form>\n<\/div>\n\t\t\t\t\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>Start Your CHC Review Fill in the form below and a member of our team will get back to you as soon as possible. Once we receive your enquiry, we will carefully review the information provided and ensure it is directed to the appropriate specialist. Our team aims to respond promptly with clear, practical guidance [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_glsr_average":0,"_glsr_ranking":0,"_glsr_reviews":0,"footnotes":""},"class_list":["post-352","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/zanithchc.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/352","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/zanithchc.co.uk\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/zanithchc.co.uk\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/zanithchc.co.uk\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/zanithchc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=352"}],"version-history":[{"count":6,"href":"https:\/\/zanithchc.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/352\/revisions"}],"predecessor-version":[{"id":361,"href":"https:\/\/zanithchc.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/352\/revisions\/361"}],"wp:attachment":[{"href":"https:\/\/zanithchc.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=352"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}