{"id":6150,"date":"2026-04-08T17:46:48","date_gmt":"2026-04-08T15:46:48","guid":{"rendered":"https:\/\/www.ordpsicobas.it\/home\/?page_id=6150"},"modified":"2026-04-20T16:35:33","modified_gmt":"2026-04-20T14:35:33","slug":"modulo-segnalazione","status":"publish","type":"page","link":"https:\/\/www.ordpsicobas.it\/home\/modulo-segnalazione\/","title":{"rendered":"Modulo segnalazione"},"content":{"rendered":"<div class=\"forminator-ui forminator-custom-form forminator-custom-form-6627 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-6627\" data-uid=\"6a76d8504de81\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-6627\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-6627 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=\"6627\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a76d8504de81\"\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=\"section-1\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">1. Dati del segnalante<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_6a76d8504de81\" id=\"forminator-field-first-name-1_6a76d8504de81-label\" class=\"forminator-label\">Nome <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"\" id=\"forminator-field-first-name-1_6a76d8504de81\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_6a76d8504de81\" id=\"forminator-field-last-name-1_6a76d8504de81-label\" class=\"forminator-label\">Cognome <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"\" id=\"forminator-field-last-name-1_6a76d8504de81\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a76d8504de81\" id=\"forminator-field-text-1_6a76d8504de81-label\" class=\"forminator-label\">Indirizzo <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a76d8504de81\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-6627__field--select-1_6a76d8504de81\" id=\"forminator-form-6627__field--select-1_6a76d8504de81-label\" class=\"forminator-label\">Qualifica <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-6627__field--select-1_6a76d8504de81\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"Cittadino\" data-hidden-behavior=\"zero\" data-placeholder=\"Please select an option\" data-search=\"false\" data-search-placeholder=\"Please select an option\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-6627__field--select-1_6a76d8504de81-label\"><option value=\"\"  >Please select an option<\/option><option value=\"one\"  data-calculation=\"0\">Psicologo iscritto all\u2019Albo A<\/option><option value=\"two\"  data-calculation=\"0\">Psicologo iscritto all\u2019Albo B<\/option><option value=\"Cittadino\" selected=\"selected\" data-calculation=\"0\">Cittadino<\/option><option value=\"Altro\"  data-calculation=\"0\">Altro<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a76d8504de81\" id=\"forminator-field-text-2_6a76d8504de81-label\" class=\"forminator-label\">Specificare la qualifica <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a76d8504de81\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a76d8504de81\" id=\"forminator-field-text-3_6a76d8504de81-label\" class=\"forminator-label\">Specificare Ordine di appartenenza <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a76d8504de81\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a76d8504de81\" id=\"forminator-field-email-1_6a76d8504de81-label\" class=\"forminator-label\">Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6a76d8504de81\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a76d8504de81\" id=\"forminator-field-email-2_6a76d8504de81-label\" class=\"forminator-label\">Pec<\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"\" id=\"forminator-field-email-2_6a76d8504de81\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">2. Dati della persona segnalata<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a76d8504de81\" id=\"forminator-field-text-4_6a76d8504de81-label\" class=\"forminator-label\">Eventuale titolo professionale dichiarato<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a76d8504de81\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6a76d8504de81\" id=\"forminator-field-text-5_6a76d8504de81-label\" class=\"forminator-label\">Nome e Cognome \/ Denominazione <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6a76d8504de81\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6a76d8504de81\" id=\"forminator-field-text-6_6a76d8504de81-label\" class=\"forminator-label\">Indirizzo \/ sede dell\u2019attivit\u00e0 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6a76d8504de81\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6a76d8504de81\" id=\"forminator-field-text-7_6a76d8504de81-label\" class=\"forminator-label\">Recapito (se noto)<\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6a76d8504de81\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6a76d8504de81\" id=\"forminator-field-text-8_6a76d8504de81-label\" class=\"forminator-label\">Canali di comunicazione utilizzati<\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6a76d8504de81\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">3. Descrizione dei fatti<\/h2><h3 class=\"forminator-subtitle\">(Descrivere in modo chiaro e dettagliato l\u2019episodio o la situazione, indicando date, luoghi, modalit\u00e0 e ogni elemento utile alla comprensione del caso)<\/h3><\/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_6a76d8504de81\" id=\"forminator-field-textarea-3_6a76d8504de81-label\" class=\"forminator-label\">Descrizione dei fatti <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a76d8504de81\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">4. Motivazione della segnalazione<\/h2><h3 class=\"forminator-subtitle\">(Indicare perch\u00e9 si ritiene che vi sia un abuso del titolo o dell\u2019esercizio della professione psicologica)<\/h3><\/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_6a76d8504de81\" id=\"forminator-field-textarea-2_6a76d8504de81-label\" class=\"forminator-label\">Motivazione della segnalazione <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a76d8504de81\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-5\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">5. Documentazione allegata<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6a76d8504de81\" id=\"forminator-field-upload-1_6a76d8504de81-label\" class=\"forminator-label\">Allega file<\/label><div class=\"forminator-multi-upload \" data-element=\"upload-1_6a76d8504de81\"><input type=\"file\" name=\"upload-1[]\" id=\"forminator-field-upload-1_6a76d8504de81\" class=\"forminator-input-file forminator-field-upload-1_6a76d8504de81-6627\" multiple=\"multiple\" data-method=\"ajax\" data-limit=\"3\" data-limit-message=\"You can upload a maximum of 3 files.\" data-size=\"8388608\" data-size-message=\"Maximum file size allowed is 8 MB. \"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Trascina qui i file oppure <a class=\"forminator-upload-file--forminator-field-upload-1_6a76d8504de81\" href=\"#\" onclick=\"return false;\">Scegli i file<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-1_6a76d8504de81\"><\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6a76d8504de81\" id=\"forminator-field-text-9_6a76d8504de81-label\" class=\"forminator-label\">Luogo <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6a76d8504de81\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a76d8504de81\" id=\"forminator-field-date-1-picker_6a76d8504de81-label\" class=\"forminator-label\">Data <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"08\/08\/2026\" placeholder=\"Seleziona la data\" id=\"forminator-field-date-1-picker_6a76d8504de81\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/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_6a76d8504de81\" id=\"forminator-field-consent-1_6a76d8504de81-label\" class=\"forminator-label\">Consenso <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_6a76d8504de81__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6a76d8504de81\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6a76d8504de81-label\" aria-describedby=\"forminator-field-consent-1_6a76d8504de81__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6a76d8504de81__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>S\u00ec, sono d'accordo con l'<a href=\"https:\/\/www.ordpsicobas.it\/home\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">informativa sulla privacy<\/a> e i <a href=\"https:\/\/www.ordpsicobas.it\/home\/termini-e-condizioni\/\" target=\"_blank\" rel=\"noopener\">termini e condizioni<\/a>.<\/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\">Invia<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"616abad7a3\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/home\/wp-json\/wp\/v2\/pages\/6150\" \/><input type=\"hidden\" name=\"form_id\" value=\"6627\"><input type=\"hidden\" name=\"page_id\" value=\"6150\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.ordpsicobas.it\/home\/modulo-segnalazione\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":465,"featured_media":4960,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6150","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/www.ordpsicobas.it\/home\/wp-json\/wp\/v2\/pages\/6150","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ordpsicobas.it\/home\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ordpsicobas.it\/home\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ordpsicobas.it\/home\/wp-json\/wp\/v2\/users\/465"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ordpsicobas.it\/home\/wp-json\/wp\/v2\/comments?post=6150"}],"version-history":[{"count":3,"href":"https:\/\/www.ordpsicobas.it\/home\/wp-json\/wp\/v2\/pages\/6150\/revisions"}],"predecessor-version":[{"id":6628,"href":"https:\/\/www.ordpsicobas.it\/home\/wp-json\/wp\/v2\/pages\/6150\/revisions\/6628"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.ordpsicobas.it\/home\/wp-json\/wp\/v2\/media\/4960"}],"wp:attachment":[{"href":"https:\/\/www.ordpsicobas.it\/home\/wp-json\/wp\/v2\/media?parent=6150"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}