{"id":27,"date":"2023-06-22T17:56:18","date_gmt":"2023-06-22T08:56:18","guid":{"rendered":"http:\/\/shirahama-lo.jp\/kotsujiko\/?page_id=27"},"modified":"2026-07-06T14:29:05","modified_gmt":"2026-07-06T05:29:05","slug":"contact","status":"publish","type":"page","link":"https:\/\/shirahama-lo.jp\/kotsujiko\/contact\/","title":{"rendered":"\u304a\u554f\u3044\u5408\u308f\u305b"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f558-o1\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"558\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/kotsujiko\/wp-json\/wp\/v2\/pages\/27#wpcf7-f558-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"558\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f558-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p class=\"midashi\">\u4ea4\u901a\u4e8b\u6545\u306b\u95a2\u3059\u308b\u304a\u554f\u3044\u5408\u308f\u305b\u306f\u3001\u4ee5\u4e0b\u304a\u96fb\u8a71\u307e\u305f\u306f\u30d5\u30a9\u30fc\u30e0\u304b\u3089\u304a\u9858\u3044\u3044\u305f\u3057\u307e\u3059\u3002<\/p>\n<div class=\"contact_choice\">\n<b class=\"tit\">\u304a\u96fb\u8a71<\/b>\n<div class=\"box\">\n<a href=\"tel:075-223-3444\">TEL 075-223-3444<\/a>\n<span>\uff08\u53d7\u4ed8\u6642\u9593\uff1a9\u6642\uff5e18\u6642 \u571f\u65e5\u795d\u3092\u9664\u304f\uff09<\/span>\n<\/div>\n<\/div>\n\n<div class=\"input\">\n<div class=\"form_all\">\n<b class=\"tit\">\u304a\u554f\u3044\u5408\u308f\u305b\u30d5\u30a9\u30fc\u30e0<\/b>\n<p class=\"form_m\">\u4e0b\u8a18\u9805\u76ee\u3092\u3054\u5165\u529b\u3044\u305f\u3060\u304d\u3001\u78ba\u8a8d\u753b\u9762\u3078\u3092\u30af\u30ea\u30c3\u30af\u3057\u3066\u304f\u3060\u3055\u3044\u3002<br>\n<span>*<\/span>\u3000\u306f\u5165\u529b\u5fc5\u9808\u9805\u76ee\u3067\u3059\u3002<\/p>\n<\/div>\n<div class=\"cate\">\n<b>\u304a\u5ba2\u69d8\u60c5\u5831<\/b>\n<table>\n<tr>\n<th class=\"must\">\u304a\u540d\u524d<\/th>\n<td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"60\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"your-name\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/td>\n<\/tr>\n<tr>\n<th class=\"must\">\u3054\u9023\u7d61\u5148\u3000\u96fb\u8a71\u756a\u53f7<\/th>\n<td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" id=\"your-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-tel\" \/><\/span><\/td>\n<\/tr>\n<tr>\n<th class=\"must\">\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<\/th>\n<td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"60\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" id=\"your-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><\/td>\n<\/tr>\n<\/table>\n<\/div>\n<div class=\"cate\">\n<b>\u4e8b\u6545\u306b\u95a2\u3059\u308b\u60c5\u5831<\/b>\n<table>\n<tr>\n<th>\u4e8b\u6545\u65e5<\/th>\n<td>\u897f\u66a6 <span class=\"wpcf7-form-control-wrap\" data-name=\"accident-year\"><input size=\"20\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text short\" id=\"accident-year\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"accident-year\" \/><\/span><span>\u5e74<\/span><br class=\"sp\"><span class=\"wpcf7-form-control-wrap\" data-name=\"accident-month\"><input size=\"20\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text short\" id=\"accident-month\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"accident-month\" \/><\/span><span>\u6708<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"accident-day\"><input size=\"20\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text short\" id=\"accident-day\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"accident-day\" \/><\/span>\u65e5 \u3054\u308d<\/td>\n<\/tr>\n<tr>\n<th>\u4e8b\u6545\u306e\u5834\u6240<br class=\"pc\">(\u5e02\u753a\u6751\u307e\u3067\u3067\u53ef)<\/th>\n<td><span class=\"wpcf7-form-control-wrap\" data-name=\"accident-place\"><input size=\"60\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"accident-place\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"accident-place\" \/><\/span><\/td>\n<\/tr>\n<tr>\n<th>\u4e8b\u6545\u306e\u614b\u69d8<\/th>\n<td>\n<ol class=\"list\">\n<li><span class=\"name\">\u76f8\u8ac7\u8005\u69d8<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"accident-type-client\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\" id=\"accident-type-client\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"accident-type-client\" value=\"\u81ea\u52d5\u8eca\" \/><span class=\"wpcf7-list-item-label\">\u81ea\u52d5\u8eca<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"accident-type-client\" value=\"\u81ea\u8ee2\u8eca\" \/><span class=\"wpcf7-list-item-label\">\u81ea\u8ee2\u8eca<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"accident-type-client\" value=\"\u30d0\u30a4\u30af\" \/><span class=\"wpcf7-list-item-label\">\u30d0\u30a4\u30af<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"accident-type-client\" value=\"\u5f92\u6b69\" \/><span class=\"wpcf7-list-item-label\">\u5f92\u6b69<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"accident-type-client\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/span><\/span><\/span><\/li>\n<li><span class=\"name\">\u76f8\u624b\u65b9<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"accident-type-other\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\" id=\"accident-type-other\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"accident-type-other\" value=\"\u81ea\u52d5\u8eca\" \/><span class=\"wpcf7-list-item-label\">\u81ea\u52d5\u8eca<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"accident-type-other\" value=\"\u81ea\u8ee2\u8eca\" \/><span class=\"wpcf7-list-item-label\">\u81ea\u8ee2\u8eca<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"accident-type-other\" value=\"\u30d0\u30a4\u30af\" \/><span class=\"wpcf7-list-item-label\">\u30d0\u30a4\u30af<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"accident-type-other\" value=\"\u5f92\u6b69\" \/><span class=\"wpcf7-list-item-label\">\u5f92\u6b69<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"accident-type-other\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/span><\/span><\/span><\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<\/table>\n<\/div>\n<div class=\"cate\">\n<b>\u305d\u306e\u4ed6\u60c5\u5831 <span>\u203b\u4ee5\u4e0b\u306e\u9805\u76ee\u3092\u6559\u3048\u3066\u3044\u305f\u3060\u3051\u308b\u3068\u76f8\u8ac7\u304c\u30b9\u30e0\u30fc\u30ba\u3067\u3059\u3002<\/span><\/b>\n<table>\n<tr>\n<th>\u5f01\u8b77\u58eb\u8cbb\u7528\u7279\u7d04\u306e\u6709\u7121<\/th>\n<td>\n<div class=\"td_set\">\n<div class=\"radio_set\"><span class=\"wpcf7-form-control-wrap\" data-name=\"lawyer_fee\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox vertical\" id=\"lawyer_fee\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"lawyer_fee\" value=\"\u3042\u308a\" \/><span class=\"wpcf7-list-item-label\">\u3042\u308a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"lawyer_fee\" value=\"\u306a\u3057\" \/><span class=\"wpcf7-list-item-label\">\u306a\u3057<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"lawyer_fee\" value=\"\u308f\u304b\u3089\u306a\u3044\" \/><span class=\"wpcf7-list-item-label\">\u308f\u304b\u3089\u306a\u3044<\/span><\/label><\/span><\/span><\/span><\/div>\n<span class=\"insurance\"><span class=\"plus\">\u4fdd\u967a\u4f1a\u793e\u540d<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"insurance\"><input size=\"60\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"insurance\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"insurance\" \/><\/span><\/span>\n<\/div>\n<\/td>\n<\/tr>\n<tr>\n<th>\u602a\u6211\u306e\u6709\u7121<\/th>\n<td>\n<div class=\"td_set\">\n<div class=\"radio_set\"><span class=\"wpcf7-form-control-wrap\" data-name=\"injury\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox vertical\" id=\"injury\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"injury\" value=\"\u3042\u308a\" \/><span class=\"wpcf7-list-item-label\">\u3042\u308a<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"injury\" value=\"\u306a\u3057\" \/><span class=\"wpcf7-list-item-label\">\u306a\u3057<\/span><\/label><\/span><\/span><\/span><\/div>\n<span class=\"diagnosis\"><span class=\"plus\">\u533b\u5e2b\u306e\u8a3a\u65ad\u304c\u3042\u308c\u3070\u8a3a\u65ad\u540d<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"diagnosis\"><input size=\"60\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"diagnosis\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"diagnosis\" \/><\/span><\/span>\n<\/div>\n<\/td>\n<\/tr>\n<tr>\n<th>\u4e8b\u6545\u306e\u76f8\u624b\u65b9\u306e\u4fdd\u967a\u4f1a\u793e<\/th>\n<td>\n<div class=\"td_set\">\n<div class=\"radio_set\"><span class=\"wpcf7-form-control-wrap\" data-name=\"insurance_company\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox vertical\" id=\"insurance_company\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"insurance_company\" value=\"\u4efb\u610f\u4fdd\u967a\" \/><span class=\"wpcf7-list-item-label\">\u4efb\u610f\u4fdd\u967a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"insurance_company\" value=\"\u81ea\u8ce0\u8cac\u4fdd\u967a\" \/><span class=\"wpcf7-list-item-label\">\u81ea\u8ce0\u8cac\u4fdd\u967a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"insurance_company\" value=\"\u7121\u4fdd\u967a\" \/><span class=\"wpcf7-list-item-label\">\u7121\u4fdd\u967a<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"insurance_company\" value=\"\u308f\u304b\u3089\u306a\u3044\" \/><span class=\"wpcf7-list-item-label\">\u308f\u304b\u3089\u306a\u3044<\/span><\/label><\/span><\/span><\/span><\/div>\n<div class=\"input_set\">\n<span class=\"insurance02\"><span class=\"plus\">\u4fdd\u967a\u4f1a\u793e\u540d<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"insurance02\"><input size=\"60\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"insurance02\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"insurance02\" \/><\/span><\/span><br>\n<span class=\"insurance03\"><span class=\"plus\">\u62c5\u5f53\u8005\u3000\u3000<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"manager\"><input size=\"20\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" id=\"manager\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"manager\" \/><\/span><\/span>\n<\/div>\n<\/div>\n<\/td>\n<\/tr>\n<tr>\n<th>\u5f01\u8b77\u58eb\u3078\u306e\u3054\u8cea\u554f<br><small>\uff08\u7279\u306b\u805e\u304d\u305f\u3044\u3053\u3068\u306a\u3069\uff09<\/small><\/th>\n<td><span class=\"wpcf7-form-control-wrap\" data-name=\"your-question\"><textarea cols=\"50\" rows=\"5\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"your-question\" aria-invalid=\"false\" name=\"your-question\"><\/textarea><\/span><\/td>\n<\/tr>\n<\/table>\n<\/div>\n<p class=\"po_check\"><a href=\"\/privacy_policy\">\u30d7\u30e9\u30a4\u30d0\u30b7\u30fc\u30dd\u30ea\u30b7\u30fc<\/a>\u306b\u540c\u610f\u306e\u4e0a\u3001<br class=\"sp\">\u3054\u9001\u4fe1\u304f\u3060\u3055\u3044\u3002<\/p>\n<span class=\"form_button start\">\n<button type=\"button\" name=\"submitConfirm\" value=\"confirm\" class=\"conf-button\" disabled>\u78ba\u8a8d\u753b\u9762\u3078<\/button>\n<\/span>\n<\/div>\n\n<div class=\"conf\">\n<div class=\"form_all\">\n<b class=\"tit\">\u304a\u554f\u3044\u5408\u308f\u305b\u30d5\u30a9\u30fc\u30e0 \u78ba\u8a8d\u753b\u9762<\/b>\n<p class=\"form_m\">\u4e0b\u8a18\u9805\u76ee\u3092\u3054\u5165\u529b\u3044\u305f\u3060\u304d\u3001\u9001\u4fe1\u30dc\u30bf\u30f3\u3092\u30af\u30ea\u30c3\u30af\u3057\u3066\u304f\u3060\u3055\u3044\u3002<br>\n<\/div>\n<div class=\"cate\">\n<b>\u304a\u5ba2\u69d8\u60c5\u5831<\/b>\n<table>\n<tr>\n<th class=\"must\">\u304a\u540d\u524d<\/th>\n<td><span class=\"conf-your-name\"><\/span><\/td>\n<\/tr>\n<tr>\n<th class=\"must\">\u3054\u9023\u7d61\u5148\u3000\u96fb\u8a71\u756a\u53f7<\/th>\n<td><span class=\"conf-your-tel\"><\/span><\/td>\n<\/tr>\n<tr>\n<th class=\"must\">\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<\/th>\n<td><span class=\"conf-your-email\"><\/span><\/td>\n<\/tr>\n<\/table>\n<\/div>\n<div class=\"cate\">\n<b>\u4e8b\u6545\u306b\u95a2\u3059\u308b\u60c5\u5831<\/b>\n<table>\n<tr>\n<th>\u4e8b\u6545\u65e5<\/th>\n<td>\u897f\u66a6 <span class=\"conf-accident-year\"><\/span><span>\u5e74<\/span><br class=\"sp\"><span class=\"conf-accident-month\"><\/span><span>\u6708<\/span><span class=\"conf-accident-day\"><\/span>\u65e5 \u3054\u308d<\/td>\n<\/tr>\n<tr>\n<th>\u4e8b\u6545\u306e\u5834\u6240<br class=\"pc\">(\u5e02\u753a\u6751\u307e\u3067\u3067\u53ef)<\/th>\n<td><span class=\"conf-accident-place\"><\/span><\/td>\n<\/tr>\n<tr>\n<th>\u4e8b\u6545\u306e\u614b\u69d8<\/th>\n<td>\n<ol class=\"list\">\n<li><span class=\"name\">\u76f8\u8ac7\u8005\u69d8<\/span><span class=\"conf-accident-type-client\"><\/span><\/li>\n<li><span class=\"name\">\u76f8\u624b\u65b9<\/span><span class=\"conf-accident-type-other\"><\/span><\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<\/table>\n<\/div>\n<div class=\"cate\">\n<b>\u305d\u306e\u4ed6\u60c5\u5831 <span>\u203b\u4ee5\u4e0b\u306e\u9805\u76ee\u3092\u6559\u3048\u3066\u3044\u305f\u3060\u3051\u308b\u3068\u76f8\u8ac7\u304c\u30b9\u30e0\u30fc\u30ba\u3067\u3059\u3002<\/span><\/b>\n<table>\n<tr>\n<th>\u5f01\u8b77\u58eb\u8cbb\u7528\u7279\u7d04\u306e\u6709\u7121<\/th>\n<td>\n<div class=\"td_set\">\n<div class=\"radio_set\"><span class=\"conf-lawyer_fee\"><\/span><\/div>\n<span class=\"insurance\"><span class=\"plus\">\u4fdd\u967a\u4f1a\u793e\u540d<\/span><span class=\"conf-insurance\"><\/span><\/span>\n<\/div>\n<\/td>\n<\/tr>\n<tr>\n<th>\u602a\u6211\u306e\u6709\u7121<\/th>\n<td>\n<div class=\"td_set\">\n<div class=\"radio_set\"><span class=\"conf-injury\"><\/span><\/div>\n<span class=\"diagnosis\"><span class=\"plus\">\u533b\u5e2b\u306e\u8a3a\u65ad\u304c\u3042\u308c\u3070\u8a3a\u65ad\u540d<\/span><span class=\"conf-diagnosis\"><\/span><\/span>\n<\/div>\n<\/td>\n<\/tr>\n<tr>\n<th>\u4e8b\u6545\u306e\u76f8\u624b\u65b9\u306e\u4fdd\u967a\u4f1a\u793e<\/th>\n<td>\n<div class=\"td_set\">\n<div class=\"radio_set\"><span class=\"conf-insurance_company\"><\/span><\/div>\n<div class=\"input_set\">\n<span class=\"insurance02\"><span class=\"plus\">\u4fdd\u967a\u4f1a\u793e\u540d<\/span><span class=\"conf-insurance02\"><\/span><\/span><br>\n<span class=\"insurance03\"><span class=\"plus\">\u62c5\u5f53\u8005\u3000\u3000<\/span><span class=\"conf-manager\"><\/span><\/span>\n<\/div>\n<\/div>\n<\/td>\n<\/tr>\n<tr>\n<th>\u5f01\u8b77\u58eb\u3078\u306e\u3054\u8cea\u554f<br><small>\uff08\u7279\u306b\u805e\u304d\u305f\u3044\u3053\u3068\u306a\u3069\uff09<\/small><\/th>\n<td><span class=\"conf-your-question\"><\/span><\/td>\n<\/tr>\n<\/table>\n<\/div>\n<span class=\"form_button go back\">\n<button 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