{"id":384,"date":"2025-06-28T11:30:53","date_gmt":"2025-06-28T09:30:53","guid":{"rendered":"https:\/\/new.fedorowska.pl\/?page_id=384"},"modified":"2026-07-08T15:00:29","modified_gmt":"2026-07-08T13:00:29","slug":"wniosek-o-wsparcie-psychologiczne","status":"publish","type":"page","link":"https:\/\/new.fedorowska.pl\/index.php\/wniosek-o-wsparcie-psychologiczne\/","title":{"rendered":"Wniosek o wsparcie psychologiczne"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; theme_builder_area=&#8221;post_content&#8221; _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221;][et_pb_row _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; type=&#8221;4_4&#8243; theme_builder_area=&#8221;post_content&#8221;][et_pb_text _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h2>INSTRUKCJA PRAWID\u0141OWEGO WYPE\u0141NIENIA WNIOSKU PRZEZ OSOB\u0118 FIZYCZN\u0104<\/h2>\n<p>Celem uruchomienia kontaktu nale\u017cy:<br \/>1. Wype\u0142ni\u0107 wszystkie wymagane pola (je\u015bli dotycz\u0105).<br \/>2. Nacisn\u0105\u0107 WY\u015aLIJ.<br \/>3. Po otrzymaniu Wniosku, nawi\u0105\u017c\u0119 kontakt telefoniczny lub mailowy w celu ustalenia szczeg\u00f3\u0142\u00f3w sprawy i dalszych dzia\u0142a\u0144<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; type=&#8221;4_4&#8243; theme_builder_area=&#8221;post_content&#8221;][et_pb_text _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h2>DANE KONTAKTOWE WNIOSKODAWCY:<\/h2>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<\/p>\n<table class=\"wp-list-table widefat fixed striped table-view-list forms\">\n<tbody id=\"the-list\" data-wp-lists=\"list:form\">\n<tr>\n<td class=\"shortcode column-shortcode\" data-colname=\"Shortcode\"><style id=\"wpforms-css-vars-1320\">\n\t\t\t\t#wpforms-1320 {\n\t\t\t\t--wpforms-field-border-radius: 0px;\n--wpforms-field-border-color: #cccccc;\n--wpforms-field-border-color-spare: #cccccc;\n--wpforms-field-text-color: #444444;\n--wpforms-label-color: #262626;\n--wpforms-label-sublabel-color: #7f7f7f;\n--wpforms-label-error-color: #ff0000;\n--wpforms-button-border-style: solid;\n--wpforms-button-border-radius: 0px;\n--wpforms-button-background-color: #dddddd;\n--wpforms-button-border-color: #cccccc;\n--wpforms-button-text-color: #666666;\n--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-page-break-color: #dddddd;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 14px;\n--wpforms-label-size-line-height: 17px;\n--wpforms-label-size-sublabel-font-size: 13px;\n--wpforms-label-size-sublabel-line-height: 16px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-1320\"><form id=\"wpforms-form-1320\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1320\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/384\" data-token=\"e80ffc4833537d17702fb4252f044c7a\" data-token-time=\"1786089581\"><noscript class=\"wpforms-error-noscript\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1320-field_21-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Potwierd\u017a <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1320-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1320-field_21_1\" name=\"wpforms[fields][21][]\" value=\"Jestem osob\u0105 fizyczn\u0105 i dzia\u0142am tylko w swoim imieniu\" aria-errormessage=\"wpforms-1320-field_21_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1320-field_21_1\">Jestem osob\u0105 fizyczn\u0105 i dzia\u0142am tylko w swoim imieniu<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-1320-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1320-field_3\" >Telefon Imi\u0119 Wyra\u017cam<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1320-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1320-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1320-field_1\">Imi\u0119 i nazwisko wnioskodawcy <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1320-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-1320-field_1-error\" required><\/div><div id=\"wpforms-1320-field_24-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1320-field_24\">Telefon<\/label><input type=\"number\" id=\"wpforms-1320-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" step=\"any\" aria-errormessage=\"wpforms-1320-field_24-error\" ><\/div><div id=\"wpforms-1320-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1320-field_2\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1320-field_2\" class=\"wpforms-field-medium wpforms-field-required\" data-disable-suggestions=\"1\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1320-field_2-error\" required><\/div><div id=\"wpforms-1320-field_22-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Potwierd\u017a <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1320-field_22\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1320-field_22_1\" name=\"wpforms[fields][22][]\" value=\"Zg\u0142aszam potrzeb\u0119 wsparcia psychologicznego\/ kryzysowego i prosz\u0119 o kontakt na powy\u017csze dane\" aria-errormessage=\"wpforms-1320-field_22_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1320-field_22_1\">Zg\u0142aszam potrzeb\u0119 wsparcia psychologicznego\/ kryzysowego i prosz\u0119 o kontakt na powy\u017csze dane<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1320-field_18-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1320-field_18\">Kr\u00f3tki opis sytuacji i zg\u0142aszanej potrzeby: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1320-field_18\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"1320\" data-field-id=\"18\" data-text-limit=\"1000\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-1320-field_18-error\" maxlength=\"1000\" required>Opis maksymalnie 1000 znak\u00f3w<\/textarea><\/div><div id=\"wpforms-1320-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Wyra\u017cam zgod\u0119 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1320-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1320-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Deklaruj\u0119 wniesienie op\u0142aty na poczet konsultacji w kwocie 350 z\u0142 + 23 % vat.  najp\u00f3\u017aniej na 5 dni przed ustalonym terminem konsultacji psychologicznej na konto: Credit Agricole nr 47 1940 1076 3083 7232 0000 0000 Dorota Fedorowska, Plac Powsta\u0144c\u00f3w \u015al. 17a, pok. 222, 53-329 Wroc\u0142aw - z dopiskiem: wniosek o konsultacj\u0119 psychologiczn\u0105 (data z\u0142o\u017cenia wniosku)\" aria-errormessage=\"wpforms-1320-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1320-field_20_1\">Deklaruj\u0119 wniesienie op\u0142aty na poczet konsultacji w kwocie 350 z\u0142 + 23 % vat.  najp\u00f3\u017aniej na 5 dni przed ustalonym terminem konsultacji psychologicznej na konto: Credit Agricole nr 47 1940 1076 3083 7232 0000 0000 Dorota Fedorowska, Plac Powsta\u0144c\u00f3w \u015al. 17a, pok. 222, 53-329 Wroc\u0142aw - z dopiskiem: wniosek o konsultacj\u0119 psychologiczn\u0105 (data z\u0142o\u017cenia wniosku)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1320-field_23-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">Wyra\u017cam zgod\u0119 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1320-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1320-field_23_1\" name=\"wpforms[fields][23][]\" value=\"Zaliczka na konsultacj\u0119 psychologiczn\u0105 jest bezzwrotna, w przypadku nie stawienia si\u0119 lub odwo\u0142ania p\u00f3\u017aniej, ni\u017c 72 godziny przed terminem ustalonego spotkania\" aria-errormessage=\"wpforms-1320-field_23_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1320-field_23_1\">Zaliczka na konsultacj\u0119 psychologiczn\u0105 jest bezzwrotna, w przypadku nie stawienia si\u0119 lub odwo\u0142ania p\u00f3\u017aniej, ni\u017c 72 godziny przed terminem ustalonego spotkania<\/label><\/li><\/ul><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1320-field_3-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-1320-field_3-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-1320-field_3-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1320\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/new.fedorowska.pl\/index.php\/wp-json\/wp\/v2\/pages\/384\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1320\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Wy\u015blij wniosek\" aria-live=\"assertive\" value=\"wpforms-submit\">Wy\u015blij wniosek<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/new.fedorowska.pl\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Wczytywanie\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>INSTRUKCJA PRAWID\u0141OWEGO WYPE\u0141NIENIA WNIOSKU PRZEZ OSOB\u0118 FIZYCZN\u0104 Celem uruchomienia kontaktu nale\u017cy:1. Wype\u0142ni\u0107 wszystkie wymagane pola (je\u015bli dotycz\u0105).2. Nacisn\u0105\u0107 WY\u015aLIJ.3. Po otrzymaniu Wniosku, nawi\u0105\u017c\u0119 kontakt telefoniczny lub mailowy w celu ustalenia szczeg\u00f3\u0142\u00f3w sprawy i dalszych dzia\u0142a\u0144DANE KONTAKTOWE WNIOSKODAWCY: <style id=\"wpforms-css-vars-1320\">\n\t\t\t\t#wpforms-1320 {\n\t\t\t\t--wpforms-field-border-radius: 0px;\n--wpforms-field-border-color: #cccccc;\n--wpforms-field-border-color-spare: #cccccc;\n--wpforms-field-text-color: #444444;\n--wpforms-label-color: #262626;\n--wpforms-label-sublabel-color: #7f7f7f;\n--wpforms-label-error-color: #ff0000;\n--wpforms-button-border-style: solid;\n--wpforms-button-border-radius: 0px;\n--wpforms-button-background-color: #dddddd;\n--wpforms-button-border-color: #cccccc;\n--wpforms-button-text-color: #666666;\n--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-page-break-color: #dddddd;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 14px;\n--wpforms-label-size-line-height: 17px;\n--wpforms-label-size-sublabel-font-size: 13px;\n--wpforms-label-size-sublabel-line-height: 16px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-1320\"><form id=\"wpforms-form-1320\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1320\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/384\" data-token=\"e80ffc4833537d17702fb4252f044c7a\" data-token-time=\"1786089581\"><noscript class=\"wpforms-error-noscript\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Aby wype\u0142ni\u0107 ten formularz, w\u0142\u0105cz obs\u0142ug\u0119 JavaScript w przegl\u0105darce.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1320-field_21-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Potwierd\u017a <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1320-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1320-field_21_1\" name=\"wpforms[fields][21][]\" value=\"Jestem osob\u0105 fizyczn\u0105 i dzia\u0142am tylko w swoim imieniu\" aria-errormessage=\"wpforms-1320-field_21_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1320-field_21_1\">Jestem osob\u0105 fizyczn\u0105 i dzia\u0142am tylko w swoim imieniu<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1320-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1320-field_1\">Imi\u0119 i nazwisko wnioskodawcy <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1320-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-1320-field_1-error\" required><\/div><div id=\"wpforms-1320-field_24-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1320-field_24\">Telefon<\/label><input type=\"number\" id=\"wpforms-1320-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" step=\"any\" aria-errormessage=\"wpforms-1320-field_24-error\" ><\/div><div id=\"wpforms-1320-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1320-field_2\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1320-field_2\" class=\"wpforms-field-medium wpforms-field-required\" data-disable-suggestions=\"1\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1320-field_2-error\" required><\/div><div id=\"wpforms-1320-field_22-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Potwierd\u017a <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1320-field_22\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1320-field_22_1\" name=\"wpforms[fields][22][]\" value=\"Zg\u0142aszam potrzeb\u0119 wsparcia psychologicznego\/ kryzysowego i prosz\u0119 o kontakt na powy\u017csze dane\" aria-errormessage=\"wpforms-1320-field_22_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1320-field_22_1\">Zg\u0142aszam potrzeb\u0119 wsparcia psychologicznego\/ kryzysowego i prosz\u0119 o kontakt na powy\u017csze dane<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-1320-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1320-field_3\" >Potwierd\u017a zgod\u0119 Wyra\u017cam<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1320-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1320-field_18-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1320-field_18\">Kr\u00f3tki opis sytuacji i zg\u0142aszanej potrzeby: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1320-field_18\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"1320\" data-field-id=\"18\" data-text-limit=\"1000\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-1320-field_18-error\" maxlength=\"1000\" required>Opis maksymalnie 1000 znak\u00f3w<\/textarea><\/div><div id=\"wpforms-1320-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Wyra\u017cam zgod\u0119 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1320-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1320-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Deklaruj\u0119 wniesienie op\u0142aty na poczet konsultacji w kwocie 350 z\u0142 + 23 % vat.  najp\u00f3\u017aniej na 5 dni przed ustalonym terminem konsultacji psychologicznej na konto: Credit Agricole nr 47 1940 1076 3083 7232 0000 0000 Dorota Fedorowska, Plac Powsta\u0144c\u00f3w \u015al. 17a, pok. 222, 53-329 Wroc\u0142aw - z dopiskiem: wniosek o konsultacj\u0119 psychologiczn\u0105 (data z\u0142o\u017cenia wniosku)\" aria-errormessage=\"wpforms-1320-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1320-field_20_1\">Deklaruj\u0119 wniesienie op\u0142aty na poczet konsultacji w kwocie 350 z\u0142 + 23 % vat.  najp\u00f3\u017aniej na 5 dni przed ustalonym terminem konsultacji psychologicznej na konto: Credit Agricole nr 47 1940 1076 3083 7232 0000 0000 Dorota Fedorowska, Plac Powsta\u0144c\u00f3w \u015al. 17a, pok. 222, 53-329 Wroc\u0142aw - z dopiskiem: wniosek o konsultacj\u0119 psychologiczn\u0105 (data z\u0142o\u017cenia wniosku)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1320-field_23-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">Wyra\u017cam zgod\u0119 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1320-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1320-field_23_1\" name=\"wpforms[fields][23][]\" value=\"Zaliczka na konsultacj\u0119 psychologiczn\u0105 jest bezzwrotna, w przypadku nie stawienia si\u0119 lub odwo\u0142ania p\u00f3\u017aniej, ni\u017c 72 godziny przed terminem ustalonego spotkania\" aria-errormessage=\"wpforms-1320-field_23_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1320-field_23_1\">Zaliczka na konsultacj\u0119 psychologiczn\u0105 jest bezzwrotna, w przypadku nie stawienia si\u0119 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