[pb_contact_form component_description="Contact form" debug="0" reset="1" recipient_name="The Social Clinic" recipient_email="contactus@thesocialclinic.net" sender_name="The Social Clinic" sender_email="contactus@thesocialclinic.net" sender_smtp_username="contactus@thesocialclinic.net" sender_smtp_password="Ctsc123!@#" sender_smtp_host="mail.thesocialclinic.net" sender_smtp_port="546" sender_smtp_secure_connection_type="SSL" notice_success="Your message has been sent. We will check it out and get back to you as soon as possible. Thank you for contacting us!" notice_error="We cannot send this message. There has been an error, please check all fields."][pb_contact_form_message][pb_contact_form_message_subject]Message from The Social Clinic Website[/pb_contact_form_message_subject][pb_contact_form_message_content]

Name: [name] E-mail address: [email] Phone: [phone] Message: [message]

[/pb_contact_form_message_content][/pb_contact_form_message][pb_contact_form_field type="text" mandatory="1" name="name" label="Name *" notice="Please enter your name"][/pb_contact_form_field][pb_contact_form_field type="email" mandatory="1" name="email" label="E-mail *" notice="Please enter a valid e-mail address"][/pb_contact_form_field][pb_contact_form_field type="text" mandatory="1" name="phone" label="Phone/Mobile*" notice="Please enter a valid phone or mobile number"][/pb_contact_form_field][pb_contact_form_field type="textarea" mandatory="1" name="message" label="Message *" notice="Please enter a message"][/pb_contact_form_field][pb_contact_form_field type="submit" name="submit" label="Submit"][/pb_contact_form_field][/pb_contact_form]