{"id":744,"date":"2010-07-29T19:24:04","date_gmt":"2010-07-29T10:24:04","guid":{"rendered":"http:\/\/www.alzheimer.or.jp\/app-def\/wp\/?page_id=744"},"modified":"2026-03-27T14:50:47","modified_gmt":"2026-03-27T05:50:47","slug":"%ef%bc%92%ef%bc%89%e5%85%a5%e4%bc%9a%e7%94%b3%e8%be%bc%e6%9b%b8%e3%82%92%e3%81%8a%e9%80%81%e3%82%8a%e4%b8%8b%e3%81%95%e3%81%84%e3%80%82","status":"publish","type":"page","link":"https:\/\/www.alzheimer.or.jp\/?page_id=744","title":{"rendered":"\u5165\u4f1a\u7533\u3057\u8fbc\u307f\u3092\u3059\u308b"},"content":{"rendered":"<p>\u3053\u3053\u3067\u306f<strong>\u300c\u5165\u4f1a\u7533\u3057\u8fbc\u307f\u300d<\/strong>\u304c\u51fa\u6765\u307e\u3059\u3002<br \/>\u306a\u304a\u3001\u5165\u4f1a\u3092\u7533\u3057\u8fbc\u3080\u306e\u3067\u306f\u306a\u304f<strong>\u300c\u5bb6\u65cf\u306e\u4f1a\u306e\u8cc7\u6599\u3092\u9001\u3063\u3066\u6b32\u3057\u3044\uff08\u8cc7\u6599\u8acb\u6c42\u30fb\u7121\u6599\uff09\u300d\u5834\u5408<\/strong>\u306f\u3001<strong><a href=\"https:\/\/www.alzheimer.or.jp\/?page_id=1893\">\u300c\u8cc7\u6599\u3092\u8acb\u6c42\u3059\u308b\u300d\u306e\u30da\u30fc\u30b8\uff08\u2190\u30af\u30ea\u30c3\u30af\uff09<\/a><\/strong>\u304b\u3089\u304a\u7533\u3057\u8fbc\u307f\u4e0b\u3055\u3044\u3002<\/p>\n<hr \/>\n<p><a href=\"https:\/\/www.alzheimer.or.jp\/?page_id=742\"><strong>\u2190\u5e74\u4f1a\u8cbb\u9001\u91d1\u65b9\u6cd5<\/strong><\/a> \u203b\u3042\u308f\u305b\u3066\u5e74\u4f1a\u8cbb\u3092\u5fc5\u305a\u3054\u9001\u91d1\u304f\u3060\u3055\u3044\u3002<\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f10173-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"10173\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F744#wpcf7-f10173-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=\"10173\" \/>\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-f10173-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"modern-form h-adr\">\n\t<p><span class=\"p-country-name\" style=\"display:none;\">Japan<\/span>\n\t<\/p>\n\t<p class=\"form-intro\">\u5165\u4f1a\u7533\u3057\u8fbc\u307f\u3092\u304a\u9001\u308a\u304f\u3060\u3055\u3044\u3002\u5404\u9805\u76ee\u3092\u3054\u5165\u529b\u306e\u4e0a\u3001\u4e0b\u90e8\u306e\u9001\u4fe1\u30dc\u30bf\u30f3\u3092\u62bc\u3057\u3066\u304f\u3060\u3055\u3044\u3002\n\t<\/p>\n\t<fieldset>\n\t\t<legend>\u4f1a\u54e1\u306e\u533a\u5206\n\t\t<\/legend>\n\t\t<div class=\"field-group-inline\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kaiinnbetsu\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"kaiinnbetsu\" value=\"\u6b63\u4f1a\u54e1\u7528\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u6b63\u4f1a\u54e1\u7528<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"kaiinnbetsu\" value=\"\u8cdb\u52a9\u4f1a\u54e1\u7528\uff08\u4e3b\u306b\u65bd\u8a2d\u30fb\u75c5\u9662\u30fb\u95a2\u9023\u56e3\u4f53\uff09\" \/><span class=\"wpcf7-list-item-label\">\u8cdb\u52a9\u4f1a\u54e1\u7528\uff08\u4e3b\u306b\u65bd\u8a2d\u30fb\u75c5\u9662\u30fb\u95a2\u9023\u56e3\u4f53\uff09<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>\u5165\u4f1a\u7533\u8fbc\u8005\u60c5\u5831\n\t\t<\/legend>\n\t\t<div class=\"field-row\">\n\t\t\t<div class=\"field\">\n\t\t\t\t<p><label>\u304a\u540d\u524d <span class=\"required\">\u5fc5\u9808<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u5c71\u7530 \u592a\u90ce\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"field\">\n\t\t\t\t<p><label>\u30d5\u30ea\u30ac\u30ca\uff08\u5168\u89d2\u30ab\u30ca\uff09<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name-phonetic\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u30e4\u30de\u30c0 \u30bf\u30ed\u30a6\" value=\"\" type=\"text\" name=\"your-name-phonetic\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u6027\u5225<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-sex\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"your-sex\" value=\"\u7537\u6027\" \/><span class=\"wpcf7-list-item-label\">\u7537\u6027<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-sex\" value=\"\u5973\u6027\" \/><span class=\"wpcf7-list-item-label\">\u5973\u6027<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"your-sex\" value=\"\u56e3\u4f53\" \/><span class=\"wpcf7-list-item-label\">\u56e3\u4f53<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9 <span class=\"required\">\u5fc5\u9808<\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"example@domain.com\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u751f\u5e74\u6708\u65e5<\/label><br \/>\n<span class=\"hint\">\u5927\u6b63=T\u3001\u662d\u548c=S\u3001\u5e73\u6210=H\u3001\u4ee4\u548c=R\uff08\u4f8b\uff1aS40\/10\/15 \u307e\u305f\u306f 1965\/10\/25\uff09<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-birthday\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"S40\/10\/15\" value=\"\" type=\"text\" name=\"your-birthday\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u96fb\u8a71\u756a\u53f7<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"15\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"00-0000-0000\" value=\"\" type=\"text\" name=\"tel\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field address-section\">\n\t\t\t<p><label>\u4f4f\u6240 <span class=\"required\">\u5fc5\u9808<\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"address-row-top\">\n\t\t\t\t<p><span class=\"zip-mark\">\u3012<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"zip\"><input size=\"8\" maxlength=\"8\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required p-postal-code\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"000-0000\" value=\"\" type=\"text\" name=\"zip\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"prefectures\"><select class=\"wpcf7-form-control wpcf7-select p-region\" aria-invalid=\"false\" name=\"prefectures\"><option value=\"\">\u90fd\u9053\u5e9c\u770c\u3092\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044<\/option><option value=\"\u5317\u6d77\u9053\">\u5317\u6d77\u9053<\/option><option value=\"\u9752\u68ee\u770c\">\u9752\u68ee\u770c<\/option><option value=\"\u5ca9\u624b\u770c\">\u5ca9\u624b\u770c<\/option><option value=\"\u5bae\u57ce\u770c\">\u5bae\u57ce\u770c<\/option><option value=\"\u79cb\u7530\u770c\">\u79cb\u7530\u770c<\/option><option value=\"\u5c71\u5f62\u770c\">\u5c71\u5f62\u770c<\/option><option value=\"\u798f\u5cf6\u770c\">\u798f\u5cf6\u770c<\/option><option value=\"\u8328\u57ce\u770c\">\u8328\u57ce\u770c<\/option><option value=\"\u6803\u6728\u770c\">\u6803\u6728\u770c<\/option><option value=\"\u7fa4\u99ac\u770c\">\u7fa4\u99ac\u770c<\/option><option value=\"\u57fc\u7389\u770c\">\u57fc\u7389\u770c<\/option><option value=\"\u5343\u8449\u770c\">\u5343\u8449\u770c<\/option><option value=\"\u6771\u4eac\u90fd\">\u6771\u4eac\u90fd<\/option><option value=\"\u795e\u5948\u5ddd\u770c\">\u795e\u5948\u5ddd\u770c<\/option><option value=\"\u65b0\u6f5f\u770c\">\u65b0\u6f5f\u770c<\/option><option value=\"\u5bcc\u5c71\u770c\">\u5bcc\u5c71\u770c<\/option><option value=\"\u77f3\u5ddd\u770c\">\u77f3\u5ddd\u770c<\/option><option value=\"\u798f\u4e95\u770c\">\u798f\u4e95\u770c<\/option><option value=\"\u5c71\u68a8\u770c\">\u5c71\u68a8\u770c<\/option><option value=\"\u9577\u91ce\u770c\">\u9577\u91ce\u770c<\/option><option value=\"\u5c90\u961c\u770c\">\u5c90\u961c\u770c<\/option><option value=\"\u9759\u5ca1\u770c\">\u9759\u5ca1\u770c<\/option><option value=\"\u611b\u77e5\u770c\">\u611b\u77e5\u770c<\/option><option value=\"\u4e09\u91cd\u770c\">\u4e09\u91cd\u770c<\/option><option value=\"\u6ecb\u8cc0\u770c\">\u6ecb\u8cc0\u770c<\/option><option value=\"\u4eac\u90fd\u5e9c\">\u4eac\u90fd\u5e9c<\/option><option value=\"\u5927\u962a\u5e9c\">\u5927\u962a\u5e9c<\/option><option value=\"\u5175\u5eab\u770c\">\u5175\u5eab\u770c<\/option><option value=\"\u5948\u826f\u770c\">\u5948\u826f\u770c<\/option><option value=\"\u548c\u6b4c\u5c71\u770c\">\u548c\u6b4c\u5c71\u770c<\/option><option value=\"\u9ce5\u53d6\u770c\">\u9ce5\u53d6\u770c<\/option><option value=\"\u5cf6\u6839\u770c\">\u5cf6\u6839\u770c<\/option><option value=\"\u5ca1\u5c71\u770c\">\u5ca1\u5c71\u770c<\/option><option value=\"\u5e83\u5cf6\u770c\">\u5e83\u5cf6\u770c<\/option><option value=\"\u5fb3\u5cf6\u770c\">\u5fb3\u5cf6\u770c<\/option><option value=\"\u5c71\u53e3\u770c\">\u5c71\u53e3\u770c<\/option><option value=\"\u9999\u5ddd\u770c\">\u9999\u5ddd\u770c<\/option><option value=\"\u611b\u5a9b\u770c\">\u611b\u5a9b\u770c<\/option><option value=\"\u9ad8\u77e5\u770c\">\u9ad8\u77e5\u770c<\/option><option value=\"\u798f\u5ca1\u770c\">\u798f\u5ca1\u770c<\/option><option value=\"\u4f50\u8cc0\u770c\">\u4f50\u8cc0\u770c<\/option><option value=\"\u9577\u5d0e\u770c\">\u9577\u5d0e\u770c<\/option><option value=\"\u5927\u5206\u770c\">\u5927\u5206\u770c<\/option><option value=\"\u5bae\u5d0e\u770c\">\u5bae\u5d0e\u770c<\/option><option value=\"\u718a\u672c\u770c\">\u718a\u672c\u770c<\/option><option value=\"\u9e7f\u5150\u5cf6\u770c\">\u9e7f\u5150\u5cf6\u770c<\/option><option value=\"\u6c96\u7e04\u770c\">\u6c96\u7e04\u770c<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"address-row-bottom\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"60\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required p-locality p-street-address p-extended-address\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u90f5\u4fbf\u756a\u53f7\u304b\u3089\u4f4f\u6240\u304c\u81ea\u52d5\u5165\u529b\u3055\u308c\u307e\u3059\" value=\"\" type=\"text\" name=\"address\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-row\">\n\t\t\t<div class=\"field\">\n\t\t\t\t<p><label>\u5b9b\u5148\u5225<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ad-op\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"ad-op\" value=\"\u81ea\u5b85\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u81ea\u5b85<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"ad-op\" value=\"\u52e4\u52d9\u5148\" \/><span class=\"wpcf7-list-item-label\">\u52e4\u52d9\u5148<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"field\">\n\t\t\t\t<p><label>\u8077\u696d\uff0f\u52e4\u52d9\u5148\u540d<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"syokugyou\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"syokugyou\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<p class=\"notice-text\">\u203b<b>\u6240\u5c5e\u652f\u90e8\u306b\u3064\u3044\u3066<\/b>\uff1a\u5728\u4f4f\u90fd\u9053\u5e9c\u770c\u306e\u652f\u90e8\u306b\u6240\u5c5e\u3059\u308b\u3053\u3068\u3068\u306a\u308a\u307e\u3059\u3002\u5728\u4f4f\u90fd\u9053\u5e9c\u770c\u4ee5\u5916\u306e\u652f\u90e8\u306b\u6240\u5c5e\u5e0c\u671b\u306e\u5834\u5408\u306f\u300c\u305d\u306e\u4ed6\u30e1\u30c3\u30bb\u30fc\u30b8\u300d\u6b04\u306b\u304a\u66f8\u304d\u304f\u3060\u3055\u3044\u3002\n\t\t<\/p>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>\u4ecb\u8b77\u7b49\u306e\u72b6\u6cc1\u30fb\u5165\u4f1a\u7406\u7531\n\t\t<\/legend>\n\t\t<p class=\"notice-text\">\u203b\u8cdb\u52a9\u4f1a\u54e1\u306e\u65b9\u306f\u3001\u4ee5\u4e0b\u306e\u300c\u72b6\u6cc1\u300d\u306f\u5165\u529b\u4e0d\u8981\u3067\u3059\u3002\n\t\t<\/p>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u72b6\u6cc1<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"care\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"care\"><option value=\"\u4ecb\u8b77\u7b49\u306e\u72b6\u6cc1\u3092\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044\u3002\">\u4ecb\u8b77\u7b49\u306e\u72b6\u6cc1\u3092\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/option><option value=\"\uff11\uff0e\u73fe\u5728\u4ecb\u8b77\u4e2d\">\uff11\uff0e\u73fe\u5728\u4ecb\u8b77\u4e2d<\/option><option value=\"\uff12\uff0e\u5143\u4ecb\u8b77\u5bb6\u65cf\">\uff12\uff0e\u5143\u4ecb\u8b77\u5bb6\u65cf<\/option><option value=\"\uff13\uff0e\u672c\u4eba\uff08\u8a8d\u77e5\u75c7\u306e\u4eba\uff09\">\uff13\uff0e\u672c\u4eba\uff08\u8a8d\u77e5\u75c7\u306e\u4eba\uff09<\/option><option value=\"\uff14\uff0e\u533b\u7642\u30fb\u798f\u7949\u5c02\u9580\u8077\">\uff14\uff0e\u533b\u7642\u30fb\u798f\u7949\u5c02\u9580\u8077<\/option><option value=\"\uff15\uff0e\u305d\u306e\u4ed6\uff08\uff11\uff5e\uff14\u4ee5\u5916\uff09\">\uff15\uff0e\u305d\u306e\u4ed6\uff08\uff11\uff5e\uff14\u4ee5\u5916\uff09<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u300c\u305d\u306e\u4ed6\u300d\u307e\u305f\u306f\u5177\u4f53\u7684\u72b6\u6cc1\uff08\u8907\u6570\u8a72\u5f53\u306a\u3069\uff09<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"sonota-care\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"sonota-care\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u5165\u4f1a\u7406\u7531<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Reason\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"Reason\"><option value=\"\u5165\u4f1a\u7406\u7531\u3092\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044\u3002\">\u5165\u4f1a\u7406\u7531\u3092\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/option><option value=\"\uff11\uff0e\u60a9\u307f\u3092\u805e\u3044\u3066\u307b\u3057\u3044\">\uff11\uff0e\u60a9\u307f\u3092\u805e\u3044\u3066\u307b\u3057\u3044<\/option><option value=\"\uff12\uff0e\u8a8d\u77e5\u75c7\u306e\u3053\u3068\u3092\u77e5\u308a\u305f\u3044\">\uff12\uff0e\u8a8d\u77e5\u75c7\u306e\u3053\u3068\u3092\u77e5\u308a\u305f\u3044<\/option><option value=\"\uff13\uff0e\u4ef2\u9593\u3068\u3064\u306a\u304c\u308a\u305f\u3044\">\uff13\uff0e\u4ef2\u9593\u3068\u3064\u306a\u304c\u308a\u305f\u3044<\/option><option value=\"\uff14\uff0e\u652f\u63f4\u3057\u305f\u3044\">\uff14\uff0e\u652f\u63f4\u3057\u305f\u3044<\/option><option value=\"\uff15\uff0e\u305d\u306e\u4ed6\uff08\uff11\uff5e\uff14\u4ee5\u5916\uff09\">\uff15\uff0e\u305d\u306e\u4ed6\uff08\uff11\uff5e\uff14\u4ee5\u5916\uff09<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u5165\u4f1a\u7406\u7531\u3067\u300c\u305d\u306e\u4ed6\u300d\u3092\u9078\u629e\u3057\u305f\u5834\u5408<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"sonota-reason\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"sonota-reason\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset class=\"optional-section\">\n\t\t<legend>\u8a8d\u77e5\u75c7\u306e\u4eba \u3010\u4efb\u610f\u3011\n\t\t<\/legend>\n\t\t<p class=\"hint\">\u203b\u5fc5\u8981\u306b\u5fdc\u3058\u3066\u304a\u66f8\u304d\u304f\u3060\u3055\u3044\n\t\t<\/p>\n\t\t<div class=\"field-row\">\n\t\t\t<div class=\"field\">\n\t\t\t\t<p><label>\u304a\u540d\u524d<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pwd-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pwd-name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"field\">\n\t\t\t\t<p><label>\u6027\u5225<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pwd-sex\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"pwd-sex\" value=\"\u7537\u6027\" \/><span class=\"wpcf7-list-item-label\">\u7537\u6027<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"pwd-sex\" value=\"\u5973\u6027\" \/><span class=\"wpcf7-list-item-label\">\u5973\u6027<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-row\">\n\t\t\t<div class=\"field\">\n\t\t\t\t<p><label>\u7d9a\u67c4\uff08\u4f8b\uff1a\u5b9f\u7236\u3001\u7fa9\u6bcd\u306a\u3069\uff09<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pwd-relation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pwd-relation\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"field\">\n\t\t\t\t<p><label>\u540c\u5c45\u30fb\u5225\u5c45<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pwd-living\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"pwd-living\" value=\"\u540c\u5c45\" \/><span class=\"wpcf7-list-item-label\">\u540c\u5c45<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"pwd-living\" value=\"\u5225\u5c45\" \/><span class=\"wpcf7-list-item-label\">\u5225\u5c45<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u751f\u5e74\u6708\u65e5<\/label><br \/>\n<span class=\"hint\">\u5927\u6b63=T\u3001\u662d\u548c=S\u3001\u5e73\u6210=H\uff08\u4f8b\uff1aS40\/10\/15\uff09<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pwd-birthday\"><input size=\"22\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pwd-birthday\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u75c7\u72b6\u306b\u6c17\u4ed8\u3044\u305f\u6642\u671f \/ \u8a3a\u65ad\u3055\u308c\u305f\u6642\u671f<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"select-pair\">\n\t\t\t\t<p><span>\u6c17\u4ed8\u3044\u305f\uff1a<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"discover-year\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"discover-year\"><option value=\"\">\u5e74\u3092\u9078\u629e<\/option><option value=\"1990\u5e74(\u5e73\u62102\u5e74)\">1990\u5e74(\u5e73\u62102\u5e74)<\/option><option value=\"1991\u5e74(\u5e73\u62103\u5e74)\">1991\u5e74(\u5e73\u62103\u5e74)<\/option><option value=\"1992\u5e74(\u5e73\u62104\u5e74)\">1992\u5e74(\u5e73\u62104\u5e74)<\/option><option value=\"1993\u5e74(\u5e73\u62105\u5e74)\">1993\u5e74(\u5e73\u62105\u5e74)<\/option><option value=\"1994\u5e74(\u5e73\u62106\u5e74)\">1994\u5e74(\u5e73\u62106\u5e74)<\/option><option value=\"1995\u5e74(\u5e73\u62107\u5e74)\">1995\u5e74(\u5e73\u62107\u5e74)<\/option><option value=\"1996\u5e74(\u5e73\u62108\u5e74)\">1996\u5e74(\u5e73\u62108\u5e74)<\/option><option value=\"1997\u5e74(\u5e73\u62109\u5e74)\">1997\u5e74(\u5e73\u62109\u5e74)<\/option><option value=\"1998\u5e74(\u5e73\u621010\u5e74)\">1998\u5e74(\u5e73\u621010\u5e74)<\/option><option value=\"1999\u5e74(\u5e73\u621011\u5e74)\">1999\u5e74(\u5e73\u621011\u5e74)<\/option><option value=\"2000\u5e74(\u5e73\u621012\u5e74)\">2000\u5e74(\u5e73\u621012\u5e74)<\/option><option value=\"2001\u5e74(\u5e73\u621013\u5e74)\">2001\u5e74(\u5e73\u621013\u5e74)<\/option><option value=\"2002\u5e74(\u5e73\u621014\u5e74)\">2002\u5e74(\u5e73\u621014\u5e74)<\/option><option value=\"2003\u5e74(\u5e73\u621015\u5e74)\">2003\u5e74(\u5e73\u621015\u5e74)<\/option><option value=\"2004\u5e74(\u5e73\u621016\u5e74)\">2004\u5e74(\u5e73\u621016\u5e74)<\/option><option value=\"2005\u5e74(\u5e73\u621017\u5e74)\">2005\u5e74(\u5e73\u621017\u5e74)<\/option><option value=\"2006\u5e74(\u5e73\u621018\u5e74)\">2006\u5e74(\u5e73\u621018\u5e74)<\/option><option value=\"2007\u5e74(\u5e73\u621019\u5e74)\">2007\u5e74(\u5e73\u621019\u5e74)<\/option><option value=\"2008\u5e74(\u5e73\u621020\u5e74)\">2008\u5e74(\u5e73\u621020\u5e74)<\/option><option value=\"2009\u5e74(\u5e73\u621021\u5e74)\">2009\u5e74(\u5e73\u621021\u5e74)<\/option><option value=\"2010\u5e74(\u5e73\u621022\u5e74)\">2010\u5e74(\u5e73\u621022\u5e74)<\/option><option value=\"2011\u5e74(\u5e73\u621023\u5e74)\">2011\u5e74(\u5e73\u621023\u5e74)<\/option><option value=\"2012\u5e74(\u5e73\u621024\u5e74)\">2012\u5e74(\u5e73\u621024\u5e74)<\/option><option value=\"2013\u5e74(\u5e73\u621025\u5e74)\">2013\u5e74(\u5e73\u621025\u5e74)<\/option><option value=\"2014\u5e74(\u5e73\u621026\u5e74)\">2014\u5e74(\u5e73\u621026\u5e74)<\/option><option value=\"2015\u5e74(\u5e73\u621027\u5e74)\">2015\u5e74(\u5e73\u621027\u5e74)<\/option><option value=\"2016\u5e74(\u5e73\u621028\u5e74)\">2016\u5e74(\u5e73\u621028\u5e74)<\/option><option value=\"2017\u5e74(\u5e73\u621029\u5e74)\">2017\u5e74(\u5e73\u621029\u5e74)<\/option><option value=\"2018\u5e74(\u5e73\u621030\u5e74)\">2018\u5e74(\u5e73\u621030\u5e74)<\/option><option value=\"2019\u5e74(\u5e73\u621031\u5e74\u3001\u4ee4\u548c\u5143\u5e74)\">2019\u5e74(\u5e73\u621031\u5e74\u3001\u4ee4\u548c\u5143\u5e74)<\/option><option value=\"2020\u5e74(\u4ee4\u548c2\u5e74)\">2020\u5e74(\u4ee4\u548c2\u5e74)<\/option><option value=\"2021\u5e74(\u4ee4\u548c3\u5e74)\">2021\u5e74(\u4ee4\u548c3\u5e74)<\/option><option value=\"2022\u5e74(\u4ee4\u548c4\u5e74)\">2022\u5e74(\u4ee4\u548c4\u5e74)<\/option><option value=\"2023\u5e74(\u4ee4\u548c5\u5e74)\">2023\u5e74(\u4ee4\u548c5\u5e74)<\/option><option value=\"2024\u5e74(\u4ee4\u548c6\u5e74)\">2024\u5e74(\u4ee4\u548c6\u5e74)<\/option><\/select><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"discover-month\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"discover-month\"><option value=\"\">\u6708\u3092\u9078\u629e<\/option><option value=\"1\u6708\">1\u6708<\/option><option value=\"2\u6708\">2\u6708<\/option><option value=\"3\u6708\">3\u6708<\/option><option value=\"4\u6708\">4\u6708<\/option><option value=\"5\u6708\">5\u6708<\/option><option value=\"6\u6708\">6\u6708<\/option><option value=\"7\u6708\">7\u6708<\/option><option value=\"8\u6708\">8\u6708<\/option><option value=\"9\u6708\">9\u6708<\/option><option value=\"10\u6708\">10\u6708<\/option><option value=\"11\u6708\">11\u6708<\/option><option value=\"12\u6708\">12\u6708<\/option><\/select><\/span> \u3054\u308d\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"select-pair\">\n\t\t\t\t<p><span>\u8a3a\u65ad\u65e5\uff1a<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"consult-year\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"consult-year\"><option value=\"\">\u5e74\u3092\u9078\u629e<\/option><option value=\"1990\u5e74(\u5e73\u62102\u5e74)\">1990\u5e74(\u5e73\u62102\u5e74)<\/option><option value=\"1991\u5e74(\u5e73\u62103\u5e74)\">1991\u5e74(\u5e73\u62103\u5e74)<\/option><option value=\"1992\u5e74(\u5e73\u62104\u5e74)\">1992\u5e74(\u5e73\u62104\u5e74)<\/option><option value=\"1993\u5e74(\u5e73\u62105\u5e74)\">1993\u5e74(\u5e73\u62105\u5e74)<\/option><option value=\"1994\u5e74(\u5e73\u62106\u5e74)\">1994\u5e74(\u5e73\u62106\u5e74)<\/option><option value=\"1995\u5e74(\u5e73\u62107\u5e74)\">1995\u5e74(\u5e73\u62107\u5e74)<\/option><option value=\"1996\u5e74(\u5e73\u62108\u5e74)\">1996\u5e74(\u5e73\u62108\u5e74)<\/option><option value=\"1997\u5e74(\u5e73\u62109\u5e74)\">1997\u5e74(\u5e73\u62109\u5e74)<\/option><option value=\"1998\u5e74(\u5e73\u621010\u5e74)\">1998\u5e74(\u5e73\u621010\u5e74)<\/option><option value=\"1999\u5e74(\u5e73\u621011\u5e74)\">1999\u5e74(\u5e73\u621011\u5e74)<\/option><option value=\"2000\u5e74(\u5e73\u621012\u5e74)\">2000\u5e74(\u5e73\u621012\u5e74)<\/option><option value=\"2001\u5e74(\u5e73\u621013\u5e74)\">2001\u5e74(\u5e73\u621013\u5e74)<\/option><option value=\"2002\u5e74(\u5e73\u621014\u5e74)\">2002\u5e74(\u5e73\u621014\u5e74)<\/option><option value=\"2003\u5e74(\u5e73\u621015\u5e74)\">2003\u5e74(\u5e73\u621015\u5e74)<\/option><option value=\"2004\u5e74(\u5e73\u621016\u5e74)\">2004\u5e74(\u5e73\u621016\u5e74)<\/option><option value=\"2005\u5e74(\u5e73\u621017\u5e74)\">2005\u5e74(\u5e73\u621017\u5e74)<\/option><option value=\"2006\u5e74(\u5e73\u621018\u5e74)\">2006\u5e74(\u5e73\u621018\u5e74)<\/option><option value=\"2007\u5e74(\u5e73\u621019\u5e74)\">2007\u5e74(\u5e73\u621019\u5e74)<\/option><option value=\"2008\u5e74(\u5e73\u621020\u5e74)\">2008\u5e74(\u5e73\u621020\u5e74)<\/option><option value=\"2009\u5e74(\u5e73\u621021\u5e74)\">2009\u5e74(\u5e73\u621021\u5e74)<\/option><option value=\"2010\u5e74(\u5e73\u621022\u5e74)\">2010\u5e74(\u5e73\u621022\u5e74)<\/option><option value=\"2011\u5e74(\u5e73\u621023\u5e74)\">2011\u5e74(\u5e73\u621023\u5e74)<\/option><option value=\"2012\u5e74(\u5e73\u621024\u5e74)\">2012\u5e74(\u5e73\u621024\u5e74)<\/option><option value=\"2013\u5e74(\u5e73\u621025\u5e74)\">2013\u5e74(\u5e73\u621025\u5e74)<\/option><option value=\"2014\u5e74(\u5e73\u621026\u5e74)\">2014\u5e74(\u5e73\u621026\u5e74)<\/option><option value=\"2015\u5e74(\u5e73\u621027\u5e74)\">2015\u5e74(\u5e73\u621027\u5e74)<\/option><option value=\"2016\u5e74(\u5e73\u621028\u5e74)\">2016\u5e74(\u5e73\u621028\u5e74)<\/option><option value=\"2017\u5e74(\u5e73\u621029\u5e74)\">2017\u5e74(\u5e73\u621029\u5e74)<\/option><option value=\"2018\u5e74(\u5e73\u621030\u5e74)\">2018\u5e74(\u5e73\u621030\u5e74)<\/option><option value=\"2019\u5e74(\u5e73\u621031\u5e74\u3001\u4ee4\u548c\u5143\u5e74)\">2019\u5e74(\u5e73\u621031\u5e74\u3001\u4ee4\u548c\u5143\u5e74)<\/option><option value=\"2020\u5e74(\u4ee4\u548c2\u5e74)\">2020\u5e74(\u4ee4\u548c2\u5e74)<\/option><option value=\"2021\u5e74(\u4ee4\u548c3\u5e74)\">2021\u5e74(\u4ee4\u548c3\u5e74)<\/option><option value=\"2022\u5e74(\u4ee4\u548c4\u5e74)\">2022\u5e74(\u4ee4\u548c4\u5e74)<\/option><option value=\"2023\u5e74(\u4ee4\u548c5\u5e74)\">2023\u5e74(\u4ee4\u548c5\u5e74)<\/option><option value=\"2024\u5e74(\u4ee4\u548c6\u5e74)\">2024\u5e74(\u4ee4\u548c6\u5e74)<\/option><\/select><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"consult-month\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"consult-month\"><option value=\"\">\u6708\u3092\u9078\u629e<\/option><option value=\"1\u6708\">1\u6708<\/option><option value=\"2\u6708\">2\u6708<\/option><option value=\"3\u6708\">3\u6708<\/option><option value=\"4\u6708\">4\u6708<\/option><option value=\"5\u6708\">5\u6708<\/option><option value=\"6\u6708\">6\u6708<\/option><option value=\"7\u6708\">7\u6708<\/option><option value=\"8\u6708\">8\u6708<\/option><option value=\"9\u6708\">9\u6708<\/option><option value=\"10\u6708\">10\u6708<\/option><option value=\"11\u6708\">11\u6708<\/option><option value=\"12\u6708\">12\u6708<\/option><\/select><\/span> \u3054\u308d\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u533b\u7642\u6a5f\u95a2\u30fb\u8a3a\u65ad\u540d<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"inline-flex\">\n\t\t\t\t<p><span>\u75c5\u9662\uff1a<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"hospital\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"hospital\" \/><\/span><span>\u53d7\u8a3a\u79d1\uff1a<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"hospital-department\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"hospital-department\"><option value=\"---------\">---------<\/option><option value=\"\u8a8d\u77e5\u75c7\u75be\u60a3\u533b\u7642\u30bb\u30f3\u30bf\u30fc\">\u8a8d\u77e5\u75c7\u75be\u60a3\u533b\u7642\u30bb\u30f3\u30bf\u30fc<\/option><option value=\"\u795e\u7d4c\u5185\u79d1\">\u795e\u7d4c\u5185\u79d1<\/option><option value=\"\u7cbe\u795e\u79d1\">\u7cbe\u795e\u79d1<\/option><option value=\"\u5185\u79d1\">\u5185\u79d1<\/option><option value=\"\u8133\u795e\u7d4c\u5185\u79d1\">\u8133\u795e\u7d4c\u5185\u79d1<\/option><option value=\"\u8133\u795e\u7d4c\u5916\u79d1\">\u8133\u795e\u7d4c\u5916\u79d1<\/option><option value=\"\u305d\u306e\u4ed6\">\u305d\u306e\u4ed6<\/option><\/select><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"inline-flex\">\n\t\t\t\t<p><span>\u8a3a\u65ad\u540d\uff1a<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"diagnosis\"><option value=\"---------\">---------<\/option><option value=\"\u30a2\u30eb\u30c4\u30cf\u30a4\u30de\u30fc\u578b\u8a8d\u77e5\u75c7\">\u30a2\u30eb\u30c4\u30cf\u30a4\u30de\u30fc\u578b\u8a8d\u77e5\u75c7<\/option><option value=\"\u8133\u8840\u7ba1\u6027\u8a8d\u77e5\u75c7\">\u8133\u8840\u7ba1\u6027\u8a8d\u77e5\u75c7<\/option><option value=\"\u30ec\u30d3\u30fc\u5c0f\u4f53\u578b\u8a8d\u77e5\u75c7\">\u30ec\u30d3\u30fc\u5c0f\u4f53\u578b\u8a8d\u77e5\u75c7<\/option><option value=\"\u524d\u982d\u5074\u982d\u8449\u5909\u6027\u75c7\">\u524d\u982d\u5074\u982d\u8449\u5909\u6027\u75c7<\/option><option value=\"\u305d\u306e\u4ed6\">\u305d\u306e\u4ed6<\/option><option value=\"\u8a3a\u65ad\u3092\u53d7\u3051\u3066\u3044\u306a\u3044\">\u8a3a\u65ad\u3092\u53d7\u3051\u3066\u3044\u306a\u3044<\/option><\/select><\/span><br \/>\n\uff08\u8a73\u7d30\uff1a<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis-odher\"><input size=\"25\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"diagnosis-odher\" \/><\/span>\uff09\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u4ecb\u8b77\u4fdd\u967a\uff08\u8a8d\u5b9a\uff09<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"longterminsurance\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"longterminsurance\"><option value=\"\">\u8981\u4ecb\u8b77\u72b6\u614b\u533a\u5206\u3092\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044<\/option><option value=\"\u81ea\u7acb\">\u81ea\u7acb<\/option><option value=\"\u8981\u652f\u63f4\uff11\">\u8981\u652f\u63f4\uff11<\/option><option value=\"\u8981\u652f\u63f4\uff12\">\u8981\u652f\u63f4\uff12<\/option><option value=\"\u8981\u4ecb\u8b77\uff11\">\u8981\u4ecb\u8b77\uff11<\/option><option value=\"\u8981\u4ecb\u8b77\uff12\">\u8981\u4ecb\u8b77\uff12<\/option><option value=\"\u8981\u4ecb\u8b77\uff13\">\u8981\u4ecb\u8b77\uff13<\/option><option value=\"\u8981\u4ecb\u8b77\uff14\">\u8981\u4ecb\u8b77\uff14<\/option><option value=\"\u8981\u4ecb\u8b77\uff15\">\u8981\u4ecb\u8b77\uff15<\/option><option value=\"\u8a8d\u5b9a\u3092\u53d7\u3051\u3066\u3044\u306a\u3044\">\u8a8d\u5b9a\u3092\u53d7\u3051\u3066\u3044\u306a\u3044<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u30b5\u30fc\u30d3\u30b9\u5229\u7528\u72b6\u6cc1\uff08\u5834\u6240\uff0f\u5185\u5bb9\uff09<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"check-box-group\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"jitaku\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"jitaku[]\" value=\"\u81ea\u5b85\" \/><span class=\"wpcf7-list-item-label\">\u81ea\u5b85<\/span><\/label><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"riyou\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"riyou[]\" value=\"\u30c7\u30a4\u30b1\u30a2\u30fb\u30c7\u30a4\u30b5\u30fc\u30d3\u30b9\" \/><span class=\"wpcf7-list-item-label\">\u30c7\u30a4\u30b1\u30a2\u30fb\u30c7\u30a4\u30b5\u30fc\u30d3\u30b9<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"riyou[]\" value=\"\u5c0f\u898f\u6a21\u591a\u6a5f\u80fd\u65bd\u8a2d\" \/><span class=\"wpcf7-list-item-label\">\u5c0f\u898f\u6a21\u591a\u6a5f\u80fd\u65bd\u8a2d<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"riyou[]\" value=\"\u30b7\u30e7\u30fc\u30c8\u30b9\u30c6\u30a4\" \/><span class=\"wpcf7-list-item-label\">\u30b7\u30e7\u30fc\u30c8\u30b9\u30c6\u30a4<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"riyou[]\" value=\"\u30db\u30fc\u30e0\u30d8\u30eb\u30d1\u30fc\" \/><span class=\"wpcf7-list-item-label\">\u30db\u30fc\u30e0\u30d8\u30eb\u30d1\u30fc<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"riyou[]\" value=\"\u30b0\u30eb\u30fc\u30d7\u30db\u30fc\u30e0\" \/><span class=\"wpcf7-list-item-label\">\u30b0\u30eb\u30fc\u30d7\u30db\u30fc\u30e0<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"riyou[]\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"riyou[]\" value=\"\u30b5\u30fc\u30d3\u30b9\u306f\u5229\u7528\u3057\u3066\u3044\u306a\u3044\" \/><span class=\"wpcf7-list-item-label\">\u30b5\u30fc\u30d3\u30b9\u306f\u5229\u7528\u3057\u3066\u3044\u306a\u3044<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"sub-check-group\">\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nyuuin\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"nyuuin[]\" value=\"\u5165\u9662\u30fb\u5165\u6240\" \/><span class=\"wpcf7-list-item-label\">\u5165\u9662\u30fb\u5165\u6240<\/span><\/label><\/span><\/span><\/span> (<span class=\"wpcf7-form-control-wrap\" data-name=\"nyuuin-mei\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"nyuuin-mei\" value=\"\u7279\u990a\" \/><span class=\"wpcf7-list-item-label\">\u7279\u990a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"nyuuin-mei\" value=\"\u8001\u5065\" \/><span class=\"wpcf7-list-item-label\">\u8001\u5065<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"nyuuin-mei\" value=\"\u75c5\u9662\" \/><span class=\"wpcf7-list-item-label\">\u75c5\u9662<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"nyuuin-mei\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><\/span><\/span>)\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sonota\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"sonota[]\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/fieldset>\n\t<fieldset>\n\t\t<legend>\u30e1\u30c3\u30bb\u30fc\u30b8\u30fb\u3054\u610f\u898b\n\t\t<\/legend>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u5165\u4f1a\u306e\u52d5\u6a5f\u3001\u751f\u6d3b\u3084\u4ecb\u8b77\u3067\u304a\u56f0\u308a\u306e\u3053\u3068\u3001\u3054\u8981\u671b\u306a\u3069<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"message\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"field\">\n\t\t\t<p><label>\u4f1a\u5831\u3084HP\u3078\u306e\u63b2\u8f09\u306b\u3064\u3044\u3066\uff08\u500b\u4eba\u7279\u5b9a\u3055\u308c\u306a\u3044\u5f62\uff09<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"keisai_kahi\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"keisai_kahi\" value=\"\u53ef\" \/><span class=\"wpcf7-list-item-label\">\u53ef<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"keisai_kahi\" value=\"\u4e0d\u53ef\" \/><span class=\"wpcf7-list-item-label\">\u4e0d\u53ef<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/fieldset>\n\t<div class=\"submit-area\">\n\t\t<p class=\"consent-text\">\u4e0a\u8a18\u306e\u5185\u5bb9\u3067\u5165\u4f1a\u3092\u7533\u3057\u8fbc\u307f\u307e\u3059\u3002\n\t\t<\/p>\n\t\t<div class=\"acceptance-box\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"accept\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"accept\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">\u30c1\u30a7\u30c3\u30af\u3092\u5165\u308c\u3066\u304b\u3089\u9001\u4fe1\u30dc\u30bf\u30f3\u3092\u62bc\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u5165\u4f1a\u3092\u7533\u3057\u8fbc\u3080\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><script src=\"https:\/\/yubinbango.github.io\/yubinbango\/yubinbango.js\" charset=\"UTF-8\"><\/script><br \/>\n<script>\ndocument.addEventListener('DOMContentLoaded', function() {\n const zipInput = document.querySelector('.p-postal-code');\n if (zipInput) {\n zipInput.addEventListener('blur', function() {\n \/\/ \u5168\u89d2\u3092\u534a\u89d2\u306b\u5909\u63db\u3057\u3001\u6570\u5b57\u4ee5\u5916\u3092\u524a\u9664\n let value = this.value.replace(\/[\uff21-\uff3a\uff41-\uff5a\uff10-\uff19]\/g, function(s) {\n return String.fromCharCode(s.charCodeAt(0) - 0xFEE0);\n }).replace(\/[^0-9]\/g, '');\n\n \/\/ 7\u6841\u306a\u3089 000-0000 \u5f62\u5f0f\u306b\u3057\u3066\u518d\u767a\u706b\n if (value.length === 7) {\n this.value = value.substring(0, 3) + '-' + value.substring(3);\n this.dispatchEvent(new Event('keyup', { bubbles: true }));\n }\n });\n }\n});\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<p>\u25b2\u6b63\u5e38\u306b\u9001\u4fe1\u3055\u308c\u305f\u6642\u306f\u3001\u3053\u3053\u306b\u30e1\u30c3\u30bb\u30fc\u30b8\u304c\u8868\u793a\u3055\u308c\u307e\u3059\u3002<\/p>\n<hr \/>\n<p><strong>\u5165\u4f1a\u306e\u304a\u7533\u8fbc\u307f\u3092\u3044\u305f\u3060\u304d\u3042\u308a\u304c\u3068\u3046\u3054\u3056\u3044\u307e\u3059\u3002<\/strong><br \/><strong>\u5408\u308f\u305b\u3066\u3001\u5e74\u4f1a\u8cbb\u306e\u3054\u9001\u91d1\u3092\u3044\u305f\u3060\u304d\u307e\u3057\u3066\u3001\u7533\u8fbc\u624b\u7d9a\u304d\u304c\u5b8c\u4e86\u3068\u306a\u308a\u307e\u3059\u3002<\/strong><\/p>\n<p><a href=\"..\/?page_id=742\"><strong>\u2190\u5e74\u4f1a\u8cbb\u9001\u91d1\u65b9\u6cd5<\/strong><\/a> \u203b\u3042\u308f\u305b\u3066\u5e74\u4f1a\u8cbb\u3092\u5fc5\u305a\u3054\u9001\u91d1\u304f\u3060\u3055\u3044\u3002<\/p>\n\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u3053\u3053\u3067\u306f\u300c\u5165\u4f1a\u7533\u3057\u8fbc\u307f\u300d\u304c\u51fa\u6765\u307e\u3059\u3002\u306a\u304a\u3001\u5165\u4f1a\u3092\u7533\u3057\u8fbc\u3080\u306e\u3067\u306f\u306a\u304f\u300c\u5bb6\u65cf\u306e\u4f1a\u306e\u8cc7\u6599\u3092\u9001\u3063\u3066\u6b32\u3057\u3044\uff08\u8cc7\u6599\u8acb\u6c42\u30fb\u7121\u6599\uff09\u300d\u5834\u5408\u306f\u3001\u300c\u8cc7\u6599\u3092\u8acb\u6c42\u3059\u308b\u300d\u306e\u30da\u30fc\u30b8\uff08\u2190\u30af\u30ea\u30c3\u30af\uff09\u304b\u3089\u304a\u7533\u3057\u8fbc\u307f\u4e0b\u3055\u3044\u3002 \u2190\u5e74\u4f1a\u8cbb\u9001\u91d1\u65b9\u6cd5 \u203b\u3042\u308f\u305b\u3066\u5e74\u4f1a [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":13545,"parent":246,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"vkexunit_cta_each_option":"","footnotes":""},"class_list":["post-744","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/www.alzheimer.or.jp\/index.php?rest_route=\/wp\/v2\/pages\/744"}],"collection":[{"href":"https:\/\/www.alzheimer.or.jp\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.alzheimer.or.jp\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.alzheimer.or.jp\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.alzheimer.or.jp\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=744"}],"version-history":[{"count":0,"href":"https:\/\/www.alzheimer.or.jp\/index.php?rest_route=\/wp\/v2\/pages\/744\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.alzheimer.or.jp\/index.php?rest_route=\/wp\/v2\/pages\/246"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.alzheimer.or.jp\/index.php?rest_route=\/wp\/v2\/media\/13545"}],"wp:attachment":[{"href":"https:\/\/www.alzheimer.or.jp\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=744"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}