{"id":620,"date":"2025-02-21T11:09:01","date_gmt":"2025-02-21T02:09:01","guid":{"rendered":"https:\/\/www.keijinkai.com\/iryou\/?page_id=620"},"modified":"2025-03-31T13:32:15","modified_gmt":"2025-03-31T04:32:15","slug":"coverage_form","status":"publish","type":"page","link":"https:\/\/www.keijinkai.com\/iryou\/coverage_form\/","title":{"rendered":"\u53d6\u6750\u7533\u3057\u8fbc\u307f\u30d5\u30a9\u30fc\u30e0"},"content":{"rendered":"<section>\n<div class=\"container\">\n<div class=\"row\">\n<div class=\"col-md-12\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f626-o1\" lang=\"ja\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/iryou\/wp-json\/wp\/v2\/pages\/620#wpcf7-f626-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"626\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.8.5\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f626-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<ul class=\"con_box\">\n\t<li>\n\t\t<p><b>\u53d6\u6750\u5e0c\u671b\u65bd\u8a2d<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"syuzai_place\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"syuzai_place\"><option value=\"\u6cd5\u4eba\u672c\u90e8\">\u6cd5\u4eba\u672c\u90e8<\/option><option value=\"\u624b\u7a32\u6e13\u4ec1\u4f1a\u75c5\u9662\">\u624b\u7a32\u6e13\u4ec1\u4f1a\u75c5\u9662<\/option><option value=\"\u672d\u5e4c\u6e13\u4ec1\u4f1a\u30ea\u30cf\u30d3\u30ea\u30c6\u30fc\u30b7\u30e7\u30f3\u75c5\u9662\">\u672d\u5e4c\u6e13\u4ec1\u4f1a\u30ea\u30cf\u30d3\u30ea\u30c6\u30fc\u30b7\u30e7\u30f3\u75c5\u9662<\/option><option value=\"\u672d\u5e4c\u897f\u5186\u5c71\u75c5\u9662\">\u672d\u5e4c\u897f\u5186\u5c71\u75c5\u9662<\/option><option value=\"\u5b9a\u5c71\u6e13\u75c5\u9662\">\u5b9a\u5c71\u6e13\u75c5\u9662<\/option><option value=\"\u6e13\u4ec1\u4f1a\u5186\u5c71\u30af\u30ea\u30cb\u30c3\u30af\">\u6e13\u4ec1\u4f1a\u5186\u5c71\u30af\u30ea\u30cb\u30c3\u30af<\/option><option value=\"\u305d\u306e\u4ed6\u65bd\u8a2d\">\u305d\u306e\u4ed6\u65bd\u8a2d<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u4f1a\u793e\u540d<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"inc_name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u25cb\u25cb\u682a\u5f0f\u4f1a\u793e\" value=\"\" type=\"text\" name=\"inc_name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u6240\u5c5e\u90e8\u7f72<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"syozoku_busyo\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u25cb\u25cb\u90e8\u25cb\u25cb\u8ab2\" value=\"\" type=\"text\" name=\"syozoku_busyo\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u7533\u8acb\u8005\u540d<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"shinsei_name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u6e13\u4ec1 \u592a\u90ce\" value=\"\" type=\"text\" name=\"shinsei_name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u6240\u5728\u5730<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"address01\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09123-4567\" value=\"\" type=\"text\" name=\"address01\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address02\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u672d\u5e4c\u5e02\u624b\u7a32\u533a\u524d\u75301\u676112\u4e01\u76ee1\u756a40\u53f7\" value=\"\" type=\"text\" name=\"address02\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u96fb\u8a71\u756a\u53f7<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"tel_num\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09011-681-8111\" value=\"\" type=\"tel\" name=\"tel_num\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email01\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09teine@keijinkai.com\" value=\"\" type=\"email\" name=\"email01\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<br \/>\n\uff08\u78ba\u8a8d\u7528\uff09<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email02\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email02\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u53d6\u6750\u5f62\u5f0f<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio_syuzai_way\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio_syuzai_way\" value=\"\u5bfe\u9762\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u5bfe\u9762<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio_syuzai_way\" value=\"WEB\" \/><span class=\"wpcf7-list-item-label\">WEB<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio_syuzai_way\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t\t<p>\u203b\u300c\u305d\u306e\u4ed6\u300d\u3092\u9078\u629e\u3055\u308c\u305f\u5834\u5408\u306f\u3001\u4e0b\u8a18\u306e\u300c\u4f01\u753b\u5185\u5bb9\u30fb\u76ee\u7684\u300d\u6b04\u306b\u3054\u5e0c\u671b\u306e\u53d6\u6750\u5f62\u5f0f\u3082\u8a18\u8f09\u3057\u3066\u304f\u3060\u3055\u3044\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u5e0c\u671b\u65e5\u6642<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article class=\"con_textarea_d3\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kibou_date\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"kibou_date\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t\t<p>\u203b\u65e5\u7a0b\u304a\u3088\u3073\u6642\u9593\u5e2f\uff08\u5348\u524d\u30fb\u5348\u5f8c\u7b49\uff09\u306e\u3054\u5e0c\u671b\u306b\u3064\u3044\u3066\u3001\u7b2c3\u5e0c\u671b\u307e\u3067\u3054\u8a18\u5165\u304f\u3060\u3055\u3044\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u64ae\u5f71\u306e\u6709\u7121<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio_satuei\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio_satuei\" value=\"\u306a\u3057\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u306a\u3057<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio_satuei\" value=\"\u3042\u308a\" \/><span class=\"wpcf7-list-item-label\">\u3042\u308a<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u63b2\u8f09\u30e1\u30c7\u30a3\u30a2<br \/>\n\uff08\u8907\u6570\u9078\u629e\u53ef\uff09<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox_media\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox_media[]\" value=\"\u65b0\u805e\" \/><span class=\"wpcf7-list-item-label\">\u65b0\u805e<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox_media[]\" value=\"\u30c6\u30ec\u30d3\" \/><span class=\"wpcf7-list-item-label\">\u30c6\u30ec\u30d3<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox_media[]\" value=\"\u96d1\u8a8c\" \/><span class=\"wpcf7-list-item-label\">\u96d1\u8a8c<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox_media[]\" value=\"WEB\" \/><span class=\"wpcf7-list-item-label\">WEB<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox_media[]\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"media_other\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u305d\u306e\u4ed6\" value=\"\" type=\"text\" name=\"media_other\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u63b2\u8f09\u5a92\u4f53\u540d<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"baitai_name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"baitai_name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u653e\u9001\u30fb\u63b2\u8f09\u65e5<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"housou_post_date\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"housou_post_date\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u53d6\u6750\u5bfe\u8c61\u8005<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"syuzai_target_name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u6e13\u4ec1\u3000\u592a\u90ce\" value=\"\" type=\"text\" name=\"syuzai_target_name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u4f01\u753b\u5185\u5bb9\u30fb\u76ee\u7684<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"kikaku_purps\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"kikaku_purps\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t\t<p>\u203b\u756a\u7d44\u30fb\u63b2\u8f09\u8a8c\u306e\u8da3\u65e8\u3092\u5177\u4f53\u7684\u306b\u3054\u8a18\u8f09\u304f\u3060\u3055\u3044\u3002<br \/>\n\u203b\u4f01\u753b\u66f8\u304c\u3042\u308b\u5834\u5408\u306f\u5225\u9014\u30e1\u30fc\u30eb\u306a\u3069\u3067\u3042\u308f\u305b\u3066\u3054\u63d0\u51fa\u304f\u3060\u3055\u3044\u3002\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u53d6\u6750\u30fb\u64ae\u5f71\u5185\u5bb9<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"syuzai_satuei_content\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"syuzai_satuei_content\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t\t<p>\u203b\u53d6\u6750\u5bfe\u8c61\u30fb\u8cea\u554f\u4e8b\u9805\u30fb\u64ae\u5f71\u7b87\u6240\u7b49\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u305d\u306e\u4ed6<\/b>\n\t\t<\/p>\n\t\t<article class=\"con_textarea_d2\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sonota\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"sonota\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>\u30a4\u30f3\u30c8\u30e9\u30cd\u30c3\u30c8\u3067\u306e\u7d39\u4ecb<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio_intra_net\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio_intra_net\" value=\"\u53ef\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u53ef<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio_intra_net\" value=\"\u4e0d\u53ef\" \/><span class=\"wpcf7-list-item-label\">\u4e0d\u53ef<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t\t<p class=\"box03s\">\u653e\u9001\u30fb\u63b2\u8f09\u306e\u65e8\u3092\u30a4\u30f3\u30c8\u30e9\u30cd\u30c3\u30c8\u3067\u7d39\u4ecb\u3059\u308b\u3053\u3068\u306f\u53ef\u80fd\u3067\u3057\u3087\u3046\u304b\uff08\u8077\u54e1\u306e\u307f\u95b2\u89a7\u53ef\uff09\n\t\t\t<\/p>\n\t\t<\/article>\n\t<\/li>\n\t<li>\n\t\t<p><b>SNS\u3067\u306e\u7d39\u4ecb<span>\u5fc5\u9808<\/span><\/b>\n\t\t<\/p>\n\t\t<article>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio_sns\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio_sns\" value=\"\u53ef\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">\u53ef<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio_sns\" value=\"\u4e0d\u53ef\" \/><span class=\"wpcf7-list-item-label\">\u4e0d\u53ef<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t\t<p 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