{"id":5023,"date":"2020-11-20T13:10:30","date_gmt":"2020-11-20T13:10:30","guid":{"rendered":"http:\/\/chirogenix.co.za\/practitioner\/log-in\/"},"modified":"2026-06-18T10:43:42","modified_gmt":"2026-06-18T08:43:42","slug":"log-in","status":"publish","type":"page","link":"https:\/\/chirogenix.co.za\/practitioner\/","title":{"rendered":"Log In"},"content":{"rendered":"[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; top_padding=&#8221;5%&#8221; bottom_padding=&#8221;5%&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221; shape_type=&#8221;&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; 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tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; overflow=&#8221;visible&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/6&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][\/vc_column_inner][vc_column_inner column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; overflow=&#8221;visible&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;2\/3&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<h2><span style=\"color: #5b2f64;\">Chiropractor Login<\/span><\/h2>\n<div id=\"wppb-login-wrap\" class=\"wppb-user-forms\">\n\t\t<form name=\"wppb-loginform\" id=\"wppb-loginform\" class=\"\" action=\"https:\/\/chirogenix.co.za\/practitioner\/wp-json\/wp\/v2\/pages\/5023\" method=\"post\">\n\t\t\t\n\t\t\t<p class=\"wppb-form-field login-username\">\n\t\t\t\t<label for=\"wppb_user_login\">Email<\/label>\n\t\t\t\t<input type=\"email\" name=\"log\" id=\"wppb_user_login\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"wppb-form-field login-password\">\n\t\t\t\t<label for=\"wppb_user_pass\">Password<\/label>\n\t\t\t\t<span class=\"wppb-password-field-container\">\n\t\t\t\t    <input type=\"password\" name=\"pwd\" id=\"wppb_user_pass\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t\t     <!-- add the HTML for the visibility toggle -->\n\t\t\t\t<\/span>\n            <\/p>\n\t\t\t\n\t\t\t\n\t\t\t<p class=\"wppb-form-field login-remember\"><input name=\"rememberme\" type=\"checkbox\" id=\"rememberme\" value=\"forever\" \/><label for=\"rememberme\">Remember Me<\/label><\/p>\n\t\t\t<p class=\"login-submit form-submit\">\n\t\t\t\t<input type=\"submit\" name=\"wp-submit\" id=\"wppb-submit\" class=\"button button-primary\" value=\"Log In\" \/>\n\t\t\t\t<input type=\"hidden\" name=\"redirect_to\" value=\"https:\/\/chirogenix.co.za\/practitioner\/wp-json\/wp\/v2\/pages\/5023\" \/>\n\t\t\t<\/p>\n\t\t\t<input type=\"hidden\" name=\"wppb_login\" value=\"true\"\/>\n\t\t\t<input type=\"hidden\" name=\"wppb_form_location\" value=\"widget\"\/>\n\t\t\t<input type=\"hidden\" name=\"wppb_request_url\" value=\"https:\/\/chirogenix.co.za\/practitioner\/wp-json\/wp\/v2\/pages\/5023\"\/>\n\t\t\t<input type=\"hidden\" name=\"wppb_lostpassword_url\" value=\"\"\/>\n\t\t\t<input type=\"hidden\" name=\"wppb_redirect_priority\" value=\"\"\/>\n\t\t\t<input type=\"hidden\" name=\"wppb_referer_url\" value=\"\"\/>\n\t\t\t<input type=\"hidden\" id=\"CSRFToken-wppb\" name=\"CSRFToken-wppb\" value=\"1c071d40a6\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/practitioner\/wp-json\/wp\/v2\/pages\/5023\" \/>\n\t\t\t<input type=\"hidden\" name=\"wppb_redirect_check\" value=\"true\"\/>\n\t\t\t\n\t\t<\/form><script>window.onload = function() { jQuery(document).ready(function($) { $(\"input[name=\\\"log\\\"]\").on(\"keyup\", function() { $(this).val( $.trim($(this).val()) ); }); }); }<\/script><\/div>\n<h2><span style=\"color: #5b2f64;\">Not registered as a Chirogenix reseller?<\/span><\/h2>\n<p><strong>        <div class=\"rmwr-wrapper\"\r\n             data-id=\"rmwr-p5023-1\"\r\n                          data-key=\"p5023-1\"\r\n                          data-post=\"5023\"\r\n                          data-animation=\"none\"\r\n                          data-duration=\"300\"\r\n                          data-mode=\"normal\"\r\n                          data-lazy=\"false\"\r\n                          data-smooth-scroll=\"true\"\r\n                          data-scroll-offset=\"0\"\r\n             >\r\n            <button\r\n                type=\"button\"\r\n                class=\"read-link \"\r\n                id=\"readlinkrmwr-p5023-1\"\r\n                data-open-text=\"Apply Here\"\r\n                data-close-text=\"Apply Here\"\r\n                                aria-expanded=\"false\"\r\n                aria-controls=\"readrmwr-p5023-1\"\r\n            >\r\n                                <span class=\"rmwr-text\">Apply Here<\/span>\r\n            <\/button>\r\n            <div\r\n                class=\"read_div\"\r\n                id=\"readrmwr-p5023-1\"\r\n                aria-hidden=\"true\"\r\n                style=\"display: none;\"\r\n            >\r\n                                    <div class='fluentform ff-default fluentform_wrapper_2 ffs_default_wrap'><form data-form_id=\"2\" id=\"fluentform_2\" class=\"frm-fluent-form fluent_form_2 ff-el-form-top ff_form_instance_2_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_2_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Chiro Registrations<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='5023' \/><input type=\"hidden\" id=\"_fluentform_2_fluentformnonce\" name=\"_fluentform_2_fluentformnonce\" value=\"166703a498\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/practitioner\/wp-json\/wp\/v2\/pages\/5023\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-2_1\" ><h4 class=\"extra_field_heading\">Chiropractor Details<\/h4><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_names_first_name_' id='label_ff_2_names_first_name_'>First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_2_names_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_names_last_name_' id='label_ff_2_names_last_name_'>Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_2_names_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_practice_no' id='label_ff_2_practice_no'>Practice No.<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"practice_no\" class=\"ff-el-form-control\" data-name=\"practice_no\" id=\"ff_2_practice_no\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-left\"><label for='ff_2_vat_no' id='label_ff_2_vat_no'>VAT No.<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"vat_no\" class=\"ff-el-form-control\" data-name=\"vat_no\" id=\"ff_2_vat_no\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_email' id='label_ff_2_email'>Email Address<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_2_email\" class=\"ff-el-form-control\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_cell_no' id='label_ff_2_cell_no'>Cell No.<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"cell_no\" class=\"ff-el-form-control\" data-name=\"cell_no\" id=\"ff_2_cell_no\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_password' id='label_ff_2_password'>Password<\/label><\/div><div class='ff-el-input--content'><input type=\"password\" name=\"password\" id=\"ff_2_password\" class=\"ff-el-form-control\" data-name=\"password\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-2_2\" ><h4 class=\"extra_field_heading\">Practice Details<\/h4><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_practice_name' id='label_ff_2_practice_name'>Practice Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"practice_name\" class=\"ff-el-form-control\" data-name=\"practice_name\" id=\"ff_2_practice_name\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_address' id='label_ff_2_address'>Address<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address\" class=\"ff-el-form-control\" data-name=\"address\" id=\"ff_2_address\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class='ff-el-input--content'><input type=\"text\" name=\"address_2\" class=\"ff-el-form-control\" data-name=\"address_2\" id=\"ff_2_address_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_town_city' id='label_ff_2_town_city'>Town \/ City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"town_city\" class=\"ff-el-form-control\" data-name=\"town_city\" id=\"ff_2_town_city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_province' id='label_ff_2_province'>Province<\/label><\/div><div class='ff-el-input--content'><select name=\"province\" id=\"ff_2_province\" class=\"ff-el-form-control\" data-name=\"province\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_2_province\"><option value=\"\">- Select -<\/option><option value=\"Gauteng\"  >Gauteng<\/option><option value=\"Free State\"  >Free State<\/option><option value=\"KwaZulu-Natal\"  >KwaZulu-Natal<\/option><option value=\"Western Cape\"  >Western Cape<\/option><option value=\"Eastern Cape\"  >Eastern Cape<\/option><option value=\"Northern Cape\"  >Northern Cape<\/option><option value=\"North West\"  >North West<\/option><option value=\"Mpumalanga\"  >Mpumalanga<\/option><option value=\"Limpopo\"  >Limpopo<\/option><\/select><\/div><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-left\"><label for='ff_2_postal_code' id='label_ff_2_postal_code'>Postal Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"postal_code\" class=\"ff-el-form-control\" data-name=\"postal_code\" id=\"ff_2_postal_code\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-2_3\" ><h4 class=\"extra_field_heading\">Rebate Details<\/h4><\/div><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-left\"><label for='ff_2_Account_Holder' id='label_ff_2_Account_Holder'>Account Holder<\/label><\/div><div 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