{"id":191,"date":"2025-10-20T09:19:36","date_gmt":"2025-10-20T07:19:36","guid":{"rendered":"https:\/\/www.fundacjabezblokad.pl\/?page_id=191"},"modified":"2025-10-21T09:09:57","modified_gmt":"2025-10-21T07:09:57","slug":"formularz-kontaktowy","status":"publish","type":"page","link":"https:\/\/www.fundacjabezblokad.pl\/index.php\/formularz-kontaktowy\/","title":{"rendered":"Formularz kontaktowy"},"content":{"rendered":"\n<div style=\"height:0px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Zg\u0142o\u015b si\u0119 do programu \u201eBez Blokad \u2013 dost\u0119p do hipnoterapii\u201d<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Je\u015bli jeste\u015b w trudnej sytuacji \u017cyciowej i potrzebujesz wsparcia psychicznego, a nie mo\u017cesz sobie pozwoli\u0107 na terapi\u0119 \u2013 wype\u0142nij formularz. Skontaktujemy si\u0119 z Tob\u0105, by ustali\u0107 dalsze kroki.<\/p>\n\n\n\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-181 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-181\" data-uid=\"6ad7a7300de78\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-181\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-181 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"181\"\n\t\t\t\t data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6ad7a7300de78\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6ad7a7300de78\" id=\"forminator-field-name-1_6ad7a7300de78-label\" class=\"forminator-label\">Imi\u0119 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6ad7a7300de78\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6ad7a7300de78\" id=\"forminator-field-name-2_6ad7a7300de78-label\" class=\"forminator-label\">Nazwisko <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_6ad7a7300de78\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_6ad7a7300de78\" id=\"forminator-field-name-3_6ad7a7300de78-label\" class=\"forminator-label\">Wiek <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"\" id=\"forminator-field-name-3_6ad7a7300de78\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6ad7a7300de78\" id=\"forminator-field-email-1_6ad7a7300de78-label\" class=\"forminator-label\">Adres e-mail <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6ad7a7300de78\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6ad7a7300de78\" id=\"forminator-field-phone-1_6ad7a7300de78-label\" class=\"forminator-label\">Numer telefonu<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6ad7a7300de78\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_6ad7a7300de78\" id=\"forminator-field-name-4_6ad7a7300de78-label\" class=\"forminator-label\">Miasto\/miejscowo\u015b\u0107 zamieszkania<\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"\" id=\"forminator-field-name-4_6ad7a7300de78\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6ad7a7300de78\" id=\"forminator-field-textarea-2_6ad7a7300de78-label\" class=\"forminator-label\">Opisz kr\u00f3tko swoj\u0105 sytuacj\u0119 i potrzeby <span class=\"forminator-required\">*<\/span><\/label><span id=\"forminator-field-textarea-2_6ad7a7300de78-description\" class=\"forminator-description\"><span data-limit=\"500\" data-type=\"characters\" data-editor=\"\">0 \/ 500<\/span><\/span><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6ad7a7300de78\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"500\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6ad7a7300de78-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6ad7a7300de78-label\" class=\"forminator-label\">Czy korzysta\u0142a\u015b\/e\u015b wcze\u015bniej z terapii? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6ad7a7300de78-label\" for=\"forminator-field-checkbox-1-1-6ad7a7300de78\" class=\"forminator-checkbox\" title=\"Tak\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6ad7a7300de78\" aria-labelledby=\"forminator-field-checkbox-1-1-6ad7a7300de78-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Tak<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6ad7a7300de78-label\" for=\"forminator-field-checkbox-1-2-6ad7a7300de78\" class=\"forminator-checkbox\" title=\"Nie\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6ad7a7300de78\" aria-labelledby=\"forminator-field-checkbox-1-2-6ad7a7300de78-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Nie<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6ad7a7300de78-label\" for=\"forminator-field-checkbox-1-3-6ad7a7300de78\" class=\"forminator-checkbox\" title=\"Inne\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Inne\" id=\"forminator-field-checkbox-1-3-6ad7a7300de78\" aria-labelledby=\"forminator-field-checkbox-1-3-6ad7a7300de78-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Inne<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6ad7a7300de78\" id=\"forminator-field-textarea-3_6ad7a7300de78-label\" class=\"forminator-label\">Sk\u0105d dowiedzia\u0142a\u015b\/e\u015b si\u0119 o Fundacji?<\/label><span id=\"forminator-field-textarea-3_6ad7a7300de78-description\" class=\"forminator-description\"><span data-limit=\"100\" data-type=\"characters\" data-editor=\"\">0 \/ 100<\/span><\/span><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6ad7a7300de78\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" maxlength=\"100\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6ad7a7300de78\" id=\"forminator-field-consent-1_6ad7a7300de78-label\" class=\"forminator-label\">Zgoda <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_6ad7a7300de78__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6ad7a7300de78\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6ad7a7300de78-label\" aria-describedby=\"forminator-field-consent-1_6ad7a7300de78__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6ad7a7300de78__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>Wyra\u017cam zgod\u0119 na przetwarzanie moich danych osobowych w celu kontaktu ze mn\u0105 przez Fundacj\u0119 Bez Blokad oraz realizacji zg\u0142oszenia, zgodnie z polityk\u0105 prywatno\u015bci.<\/p><\/div><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Wy\u015blij<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"44b8e04919\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/191\" \/><input type=\"hidden\" name=\"form_id\" value=\"181\"><input type=\"hidden\" name=\"page_id\" value=\"191\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.fundacjabezblokad.pl\/index.php\/formularz-kontaktowy\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Zg\u0142o\u015b si\u0119 do programu \u201eBez Blokad \u2013 dost\u0119p do hipnoterapii\u201d Je\u015bli jeste\u015b w trudnej sytuacji \u017cyciowej i potrzebujesz wsparcia psychicznego, a nie mo\u017cesz sobie pozwoli\u0107 na terapi\u0119 \u2013 wype\u0142nij formularz. Skontaktujemy si\u0119 z Tob\u0105, by ustali\u0107 dalsze kroki.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"on","footnotes":""},"class_list":["post-191","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.fundacjabezblokad.pl\/index.php\/wp-json\/wp\/v2\/pages\/191","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.fundacjabezblokad.pl\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.fundacjabezblokad.pl\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.fundacjabezblokad.pl\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.fundacjabezblokad.pl\/index.php\/wp-json\/wp\/v2\/comments?post=191"}],"version-history":[{"count":7,"href":"https:\/\/www.fundacjabezblokad.pl\/index.php\/wp-json\/wp\/v2\/pages\/191\/revisions"}],"predecessor-version":[{"id":227,"href":"https:\/\/www.fundacjabezblokad.pl\/index.php\/wp-json\/wp\/v2\/pages\/191\/revisions\/227"}],"wp:attachment":[{"href":"https:\/\/www.fundacjabezblokad.pl\/index.php\/wp-json\/wp\/v2\/media?parent=191"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}