var qsProxy = {};
function FrameBuilder(formId,appendTo,initialHeight,iframeCode,title,embedStyleJSON){this.formId=formId;this.initialHeight=initialHeight;this.iframeCode=iframeCode;this.frame=null;this.timeInterval=200;this.appendTo=appendTo||false;this.formSubmitted=0;this.frameMinWidth='100%';this.defaultHeight='';this.init=function(){this.embedURLHash=this.getMD5(window.location.href);if(embedStyleJSON&&(embedStyleJSON[this.embedURLHash]&&embedStyleJSON[this.embedURLHash]['inlineStyle']['embedWidth'])){this.frameMinWidth=embedStyleJSON[this.embedURLHash]['inlineStyle']['embedWidth']+'px';}
if(embedStyleJSON&&(embedStyleJSON[this.embedURLHash])){if(embedStyleJSON[this.embedURLHash]['inlineStyle']&&embedStyleJSON[this.embedURLHash]['inlineStyle']['embedHeight']){this.defaultHeight='data-frameHeight="'+embedStyleJSON[this.embedURLHash]['inlineStyle']['embedHeight']+'"';}}
this.createFrame();this.addFrameContent(this.iframeCode);};this.createFrame=function(){var tmp_is_ie=!!window.ActiveXObject;this.iframeDomId=document.getElementById(this.formId)?this.formId+'_'+new Date().getTime():this.formId;if(typeof $jot!=='undefined'){var iframe=document.getElementById("220505150564042");var parent=$jot(iframe).closest('.jt-feedback.u-responsive-lightbox');if(parent){this.iframeDomId='lightbox-'+this.iframeDomId;}}
var htmlCode="<"+"iframe title=\""+title.replace(/[\\"']/g,'\\$&').replace(/&amp;/g,'&')+"\" src=\"\" allowtransparency=\"true\" allow=\"geolocation; microphone; camera\" allowfullscreen=\"true\" name=\""+this.formId+"\" id=\""+this.iframeDomId+"\" style=\"width: 10px; min-width:"+this.frameMinWidth+"; display: block; overflow: hidden; height:"+this.initialHeight+"px; border: none;\" scrolling=\"no\""+this.defaultHeight+"></if"+"rame>";if(this.appendTo===false){document.write(htmlCode);}else{var tmp=document.createElement('div');tmp.innerHTML=htmlCode;var a=this.appendTo;document.getElementById(a).appendChild(tmp.firstChild);}
this.frame=document.getElementById(this.iframeDomId);if(tmp_is_ie===true){try{var iframe=this.frame;var doc=iframe.contentDocument?iframe.contentDocument:(iframe.contentWindow.document||iframe.document);doc.open();doc.write("");}
catch(err){this.frame.src="javascript:void((function(){document.open();document.domain=\'"+this.getBaseDomain()+"\';document.close();})())";}}
this.addEvent(this.frame,'load',this.bindMethod(this.setTimer,this));var self=this;if(window.chrome!==undefined){this.frame.onload=function(){try{var doc=this.contentWindow.document;var _jotform=this.contentWindow.JotForm;if(doc!==undefined){var form=doc.getElementById(""+self.iframeDomId);self.addEvent(form,"submit",function(){if(_jotform.validateAll()){self.formSubmitted=1;}});}}catch(e){}}}};this.addEvent=function(obj,type,fn){if(obj.attachEvent){obj["e"+type+fn]=fn;obj[type+fn]=function(){obj["e"+type+fn](window.event);};obj.attachEvent("on"+type,obj[type+fn]);}
else{obj.addEventListener(type,fn,false);}};this.addFrameContent=function(string){if(window.location.search&&window.location.search.indexOf('disableSmartEmbed')>-1){string=string.replace(new RegExp('smartEmbed=1(?:&amp;|&)'),'');string=string.replace(new RegExp('isSmartEmbed'),'');}else{var cssLink='stylebuilder/'+this.formId+'.css';var cssPlace=string.indexOf(cssLink);var prepend=string[cssPlace+cssLink.length]==='?'?'&amp;':'?';var embedUrl=prepend+'embedUrl='+window.location.href;if(cssPlace>-1){var positionLastRequestElement=string.indexOf('\"/>',cssPlace);if(positionLastRequestElement>-1){string=string.substr(0,positionLastRequestElement)+embedUrl+string.substr(positionLastRequestElement);string=string.replace(cssLink,'stylebuilder/'+this.formId+'/'+this.embedURLHash+'.css');}}}
string=string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>','gim'),'src="http://api.recaptcha.net/js/recaptcha_ajax.js"></scr'+'ipt><'+'div id="recaptcha_div"><'+'/div>'+'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+' }<'+'/script>');string=string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/,'$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');if(string.match('#sublabel_litemode')){string=string.replace('class="form-all"','class="form-all" style="margin-top:0;"');}
var iframe=this.frame;var doc=iframe.contentDocument?iframe.contentDocument:(iframe.contentWindow.document||iframe.document);doc.open();doc.write(string);setTimeout(function(){doc.close();try{if('JotFormFrameLoaded'in window){JotFormFrameLoaded();}}catch(e){}},200);};this.setTimer=function(){var self=this;this.interval=setTimeout(this.changeHeight.bind(this),this.timeInterval);};this.getBaseDomain=function(){var thn=window.location.hostname;var cc=0;var buff="";for(var i=0;i<thn.length;i++){var chr=thn.charAt(i);if(chr=="."){cc++;}
if(cc==0){buff+=chr;}}
if(cc==2){thn=thn.replace(buff+".","");}
return thn;}
this.changeHeight=function(){var actualHeight=this.getBodyHeight();var currentHeight=this.getViewPortHeight();var skipAutoHeight=(this.frame.contentWindow)?this.frame.contentWindow.document.querySelector('[data-welcome-view="true"]'):null;if(actualHeight===undefined){this.frame.style.height=this.frameHeight;if(!this.frame.style.minHeight){this.frame.style.minHeight="100vh";if(!('nojump'in this.frame.contentWindow.document.get)){window.parent.scrollTo(0,0);}}else if(!this.frame.dataset.parentScrolled){this.frame.dataset.parentScrolled=true;var container=window.parent.document&&window.parent.document.querySelector('.jt-content');if(container&&!('nojump'in window.parent.document.get)){container.scrollTo(0,0);}}}else if(Math.abs(actualHeight-currentHeight)>18&&!skipAutoHeight){this.frame.style.height=(actualHeight)+"px";}
this.setTimer();};this.bindMethod=function(method,scope){return function(){method.apply(scope,arguments);};};this.frameHeight=0;this.getBodyHeight=function(){if(this.formSubmitted===1){return;}
var height;var scrollHeight;var offsetHeight;try{if(this.frame.contentWindow.document.height){height=this.frame.contentWindow.document.height;if(this.frame.contentWindow.document.body.scrollHeight){height=scrollHeight=this.frame.contentWindow.document.body.scrollHeight;}
if(this.frame.contentWindow.document.body.offsetHeight){height=offsetHeight=this.frame.contentWindow.document.body.offsetHeight;}}else if(this.frame.contentWindow.document.body){if(this.frame.contentWindow.document.body.offsetHeight){height=offsetHeight=this.frame.contentWindow.document.body.offsetHeight;}
var formWrapper=this.frame.contentWindow.document.querySelector('.form-all');var margin=parseInt(getComputedStyle(formWrapper).marginTop,10);if(!isNaN(margin)){height+=margin;}}}catch(e){}
this.frameHeight=height;return height;};this.getViewPortHeight=function(){if(this.formSubmitted===1){return;}
var height=0;try{if(this.frame.contentWindow.window.innerHeight){height=this.frame.contentWindow.window.innerHeight-18;}else if((this.frame.contentWindow.document.documentElement)&&(this.frame.contentWindow.document.documentElement.clientHeight)){height=this.frame.contentWindow.document.documentElement.clientHeight;}else if((this.frame.contentWindow.document.body)&&(this.frame.contentWindow.document.body.clientHeight)){height=this.frame.contentWindow.document.body.clientHeight;}}catch(e){}
return height;};this.getMD5=function(s){function L(k,d){return(k<<d)|(k>>>(32-d))}function K(G,k){var I,d,F,H,x;F=(G&2147483648);H=(k&2147483648);I=(G&1073741824);d=(k&1073741824);x=(G&1073741823)+(k&1073741823);if(I&d){return(x^2147483648^F^H)}if(I|d){if(x&1073741824){return(x^3221225472^F^H)}else{return(x^1073741824^F^H)}}else{return(x^F^H)}}function r(d,F,k){return(d&F)|((~d)&k)}function q(d,F,k){return(d&k)|(F&(~k))}function p(d,F,k){return(d^F^k)}function n(d,F,k){return(F^(d|(~k)))}function u(G,F,aa,Z,k,H,I){G=K(G,K(K(r(F,aa,Z),k),I));return K(L(G,H),F)}function f(G,F,aa,Z,k,H,I){G=K(G,K(K(q(F,aa,Z),k),I));return K(L(G,H),F)}function D(G,F,aa,Z,k,H,I){G=K(G,K(K(p(F,aa,Z),k),I));return K(L(G,H),F)}function t(G,F,aa,Z,k,H,I){G=K(G,K(K(n(F,aa,Z),k),I));return K(L(G,H),F)}function e(G){var Z;var F=G.length;var x=F+8;var k=(x-(x%64))/64;var I=(k+1)*16;var aa=Array(I-1);var d=0;var H=0;while(H<F){Z=(H-(H%4))/4;d=(H%4)*8;aa[Z]=(aa[Z]|(G.charCodeAt(H)<<d));H++}Z=(H-(H%4))/4;d=(H%4)*8;aa[Z]=aa[Z]|(128<<d);aa[I-2]=F<<3;aa[I-1]=F>>>29;return aa}function B(x){var k="",F="",G,d;for(d=0;d<=3;d++){G=(x>>>(d*8))&255;F="0"+G.toString(16);k=k+F.substr(F.length-2,2)}return k}function J(k){k=k.replace(/rn/g,"n");var d="";for(var F=0;F<k.length;F++){var x=k.charCodeAt(F);if(x<128){d+=String.fromCharCode(x)}else{if((x>127)&&(x<2048)){d+=String.fromCharCode((x>>6)|192);d+=String.fromCharCode((x&63)|128)}else{d+=String.fromCharCode((x>>12)|224);d+=String.fromCharCode(((x>>6)&63)|128);d+=String.fromCharCode((x&63)|128)}}}return d}var C=Array();var P,h,E,v,g,Y,X,W,V;var S=7,Q=12,N=17,M=22;var A=5,z=9,y=14,w=20;var o=4,m=11,l=16,j=23;var U=6,T=10,R=15,O=21;s=J(s);C=e(s);Y=1732584193;X=4023233417;W=2562383102;V=271733878;for(P=0;P<C.length;P+=16){h=Y;E=X;v=W;g=V;Y=u(Y,X,W,V,C[P+0],S,3614090360);V=u(V,Y,X,W,C[P+1],Q,3905402710);W=u(W,V,Y,X,C[P+2],N,606105819);X=u(X,W,V,Y,C[P+3],M,3250441966);Y=u(Y,X,W,V,C[P+4],S,4118548399);V=u(V,Y,X,W,C[P+5],Q,1200080426);W=u(W,V,Y,X,C[P+6],N,2821735955);X=u(X,W,V,Y,C[P+7],M,4249261313);Y=u(Y,X,W,V,C[P+8],S,1770035416);V=u(V,Y,X,W,C[P+9],Q,2336552879);W=u(W,V,Y,X,C[P+10],N,4294925233);X=u(X,W,V,Y,C[P+11],M,2304563134);Y=u(Y,X,W,V,C[P+12],S,1804603682);V=u(V,Y,X,W,C[P+13],Q,4254626195);W=u(W,V,Y,X,C[P+14],N,2792965006);X=u(X,W,V,Y,C[P+15],M,1236535329);Y=f(Y,X,W,V,C[P+1],A,4129170786);V=f(V,Y,X,W,C[P+6],z,3225465664);W=f(W,V,Y,X,C[P+11],y,643717713);X=f(X,W,V,Y,C[P+0],w,3921069994);Y=f(Y,X,W,V,C[P+5],A,3593408605);V=f(V,Y,X,W,C[P+10],z,38016083);W=f(W,V,Y,X,C[P+15],y,3634488961);X=f(X,W,V,Y,C[P+4],w,3889429448);Y=f(Y,X,W,V,C[P+9],A,568446438);V=f(V,Y,X,W,C[P+14],z,3275163606);W=f(W,V,Y,X,C[P+3],y,4107603335);X=f(X,W,V,Y,C[P+8],w,1163531501);Y=f(Y,X,W,V,C[P+13],A,2850285829);V=f(V,Y,X,W,C[P+2],z,4243563512);W=f(W,V,Y,X,C[P+7],y,1735328473);X=f(X,W,V,Y,C[P+12],w,2368359562);Y=D(Y,X,W,V,C[P+5],o,4294588738);V=D(V,Y,X,W,C[P+8],m,2272392833);W=D(W,V,Y,X,C[P+11],l,1839030562);X=D(X,W,V,Y,C[P+14],j,4259657740);Y=D(Y,X,W,V,C[P+1],o,2763975236);V=D(V,Y,X,W,C[P+4],m,1272893353);W=D(W,V,Y,X,C[P+7],l,4139469664);X=D(X,W,V,Y,C[P+10],j,3200236656);Y=D(Y,X,W,V,C[P+13],o,681279174);V=D(V,Y,X,W,C[P+0],m,3936430074);W=D(W,V,Y,X,C[P+3],l,3572445317);X=D(X,W,V,Y,C[P+6],j,76029189);Y=D(Y,X,W,V,C[P+9],o,3654602809);V=D(V,Y,X,W,C[P+12],m,3873151461);W=D(W,V,Y,X,C[P+15],l,530742520);X=D(X,W,V,Y,C[P+2],j,3299628645);Y=t(Y,X,W,V,C[P+0],U,4096336452);V=t(V,Y,X,W,C[P+7],T,1126891415);W=t(W,V,Y,X,C[P+14],R,2878612391);X=t(X,W,V,Y,C[P+5],O,4237533241);Y=t(Y,X,W,V,C[P+12],U,1700485571);V=t(V,Y,X,W,C[P+3],T,2399980690);W=t(W,V,Y,X,C[P+10],R,4293915773);X=t(X,W,V,Y,C[P+1],O,2240044497);Y=t(Y,X,W,V,C[P+8],U,1873313359);V=t(V,Y,X,W,C[P+15],T,4264355552);W=t(W,V,Y,X,C[P+6],R,2734768916);X=t(X,W,V,Y,C[P+13],O,1309151649);Y=t(Y,X,W,V,C[P+4],U,4149444226);V=t(V,Y,X,W,C[P+11],T,3174756917);W=t(W,V,Y,X,C[P+2],R,718787259);X=t(X,W,V,Y,C[P+9],O,3951481745);Y=K(Y,h);X=K(X,E);W=K(W,v);V=K(V,g)}var i=B(Y)+B(X)+B(W)+B(V);return i.toLowerCase()};this.init();}
FrameBuilder.get=qsProxy||[];var i220505150564042=new FrameBuilder("220505150564042",false,"","<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html lang=\"en-US\"  class=\"supernova\"><head><script>console.warn(\"Server Side Rendering => render-from: frontend\");<\/script>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<link rel=\"alternate\" type=\"application\/json+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=json&amp;url=https%3A%2F%2Fform.jotform.com%2F220505150564042\" title=\"oEmbed Form\">\n<link rel=\"alternate\" type=\"text\/xml+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=xml&amp;url=https%3A%2F%2Fform.jotform.com%2F220505150564042\" title=\"oEmbed Form\">\n<meta property=\"og:title\" content=\"NL Wellness Contact Form\" >\n<meta property=\"og:url\" content=\"https:\/\/form.jotform.com\/220505150564042\" >\n<meta property=\"og:description\" content=\"Please click the link to complete this form.\" >\n<meta name=\"slack-app-id\" content=\"AHNMASS8M\">\n<link rel=\"shortcut icon\" href=\"https:\/\/cdn.jotfor.ms\/assets\/img\/favicons\/favicon-2021.svg\">\n<meta property=\"og:image\" content=\"https:\/\/cdn.jotfor.ms\/assets\/img\/favicons\/favicon-2021.svg\" \/>\n<link rel=\"canonical\" href=\"https:\/\/form.jotform.com\/220505150564042\" \/>\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=2.0, user-scalable=1\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>NL Wellness Contact Form<\/title>\n<link href=\"https:\/\/cdn01.jotfor.ms\/static\/formCss.css?3.3.35594\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">@media print{.form-section{display:inline!important}.form-pagebreak{display:none!important}.form-section-closed{height:auto!important}.page-section{position:initial!important}}<\/style>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn02.jotfor.ms\/css\/styles\/nova.css?3.3.35594\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn03.jotfor.ms\/themes\/CSS\/566a91c2977cdfcd478b4567.css?themeRevisionID=5f6c4c83346ec05354558fe8\"\/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn01.jotfor.ms\/css\/styles\/payment\/payment_styles.css?3.3.35594\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn02.jotfor.ms\/css\/styles\/payment\/payment_feature.css?3.3.35594\" \/>\n<style type=\"text\/css\">\n@import (css) '@{buttonFontLink}';\n\n    .form-label-left{\n        width:150px;\n    }\n    .form-line{\n        padding-top:12px;\n        padding-bottom:12px;\n    }\n    .form-label-right{\n        width:150px;\n    }\n    body, html{\n        margin:0;\n        padding:0;\n        background:rgb(255, 255, 255);\n    }\n\n    .form-all{\n        margin:0px auto;\n        padding-top:20px;\n        width:690px;\n        color:rgb(17, 67, 101) !important;\n        font-family:'Varela Round';\n        font-size:15px;\n    }\n<\/style>\n\n<style type=\"text\/css\" id=\"form-designer-style\">\n    \/* Injected CSS Code *\/\n@import \"https:\/\/fonts.googleapis.com\/css?family=Varela Round:light,lightitalic,normal,italic,bold,bolditalic\";\n@import \"\/\/eu.jotform.com\/themes\/css\/buttons\/form-submit-button-simple_white.css\";\n.form-all:after {\n  content: \"\";\n  display: table;\n  clear: both;\n}\n.form-all {\n  font-family: \"Varela Round\", sans-serif;\n}\n.form-all {\n  width: 690px;\n}\n.form-label-left,\n.form-label-right {\n  width: 150px;\n}\n.form-label {\n  white-space: normal;\n}\n.form-label.form-label-auto {\n  display: block;\n  float: none;\n  word-break: break-word;\n  text-align: left;\n}\n.form-label-left {\n  display: inline-block;\n  white-space: normal;\n  float: left;\n  text-align: left;\n}\n.form-label-right {\n  display: inline-block;\n  white-space: normal;\n  float: left;\n  text-align: right;\n}\n.form-label-top {\n  white-space: normal;\n  display: block;\n  float: none;\n  text-align: left;\n}\n.form-radio-item label:before {\n  top: 0;\n}\n.form-all {\n  font-size: 15px;\n}\n.form-label {\n  font-weight: bold;\n}\n.form-checkbox-item label,\n.form-radio-item label {\n  font-weight: normal;\n}\n.supernova {\n  background-color: #ffffff;\n}\n.supernova body {\n  background-color: transparent;\n}\n\/*\n@width30: (unit(@formWidth, px) + 60px);\n@width60: (unit(@formWidth, px)+ 120px);\n@width90: (unit(@formWidth, px)+ 180px);\n*\/\n\/* | *\/\n@media screen and (min-width: 480px) {\n  .supernova .form-all {\n    border: 1px solid #e6e6e6;\n    box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (max-width: 480px) {\n  .jotform-form .form-all {\n    margin: 0;\n    width: 100%;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 480px) and (max-width: 767px) {\n  .jotform-form .form-all {\n    margin: 0;\n    width: 100%;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 480px) and (max-width: 689px) {\n  .jotform-form .form-all {\n    margin: 0;\n    width: 100%;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 768px) {\n  .jotform-form {\n    padding: 60px 0;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (max-width: 689px) {\n  .jotform-form .form-all {\n    margin: 0;\n    width: 100%;\n  }\n}\n\/* | *\/\n.supernova .form-all,\n.form-all {\n  background-color: #ffffff;\n  border: 1px solid transparent;\n}\n.form-header-group {\n  border-color: #e6e6e6;\n}\n.form-matrix-table tr {\n  border-color: #e6e6e6;\n}\n.form-matrix-table tr:nth-child(2n) {\n  background-color: #f2f2f2;\n}\n.form-all {\n  color: #114365;\n}\n.form-header-group .form-header {\n  color: #114365;\n}\n.form-header-group .form-subHeader {\n  color: #186091;\n}\n.form-sub-label {\n  color: #186091;\n}\n.form-label-top,\n.form-label-left,\n.form-label-right,\n.form-html {\n  color: #213c59;\n}\n.form-checkbox-item label,\n.form-radio-item label {\n  color: #2f557e;\n}\n.form-line.form-line-active {\n  -webkit-transition-property: all;\n  -moz-transition-property: all;\n  -ms-transition-property: all;\n  -o-transition-property: all;\n  transition-property: all;\n  -webkit-transition-duration: 0.3s;\n  -moz-transition-duration: 0.3s;\n  -ms-transition-duration: 0.3s;\n  -o-transition-duration: 0.3s;\n  transition-duration: 0.3s;\n  -webkit-transition-timing-function: ease;\n  -moz-transition-timing-function: ease;\n  -ms-transition-timing-function: ease;\n  -o-transition-timing-function: ease;\n  transition-timing-function: ease;\n  background-color: #e8e8e8;\n}\n\/* omer *\/\n.form-radio-item,\n.form-checkbox-item {\n  padding-bottom: 0px !important;\n}\n.form-radio-item:last-child,\n.form-checkbox-item:last-child {\n  padding-bottom: 0;\n}\n\/* omer *\/\n.form-single-column .form-checkbox-item,\n.form-single-column .form-radio-item {\n  width: 100%;\n}\n.form-checkbox-item .editor-container div,\n.form-radio-item .editor-container div {\n  position: relative;\n}\n.form-checkbox-item .editor-container div:before,\n.form-radio-item .editor-container div:before {\n  display: inline-block;\n  vertical-align: middle;\n  box-sizing: border-box;\n  left: 0;\n  width: 18px;\n  height: 18px;\n}\n.form-checkbox-item,\n.form-radio-item {\n  padding-left: 2px;\n}\n.form-checkbox-item input,\n.form-radio-item input {\n  margin-top: 2px;\n}\n.supernova {\n  height: 100%;\n  background-repeat: no-repeat;\n  background-attachment: scroll;\n  background-position: center top;\n  background-repeat: repeat;\n}\n.supernova {\n  background-image: none;\n}\n#stage {\n  background-image: none;\n}\n\/* | *\/\n.form-all {\n  background-repeat: no-repeat;\n  background-attachment: scroll;\n  background-position: center top;\n  background-repeat: repeat;\n}\n.form-header-group {\n  background-repeat: no-repeat;\n  background-attachment: scroll;\n  background-position: center top;\n}\n.form-line {\n  margin-top: 12px;\n  margin-bottom: 12px;\n}\n.form-line {\n  padding: 30px 36px;\n}\n.form-all .form-textbox,\n.form-all .form-radio-other-input,\n.form-all .form-checkbox-other-input,\n.form-all .form-captcha input,\n.form-all .form-spinner input,\n.form-all .form-pagebreak-back,\n.form-all .form-pagebreak-next,\n.form-all .qq-upload-button,\n.form-all .form-error-message {\n  border-radius: 20px;\n}\n.form-all .form-sub-label {\n  margin-left: 3px;\n}\n.form-all .form-textarea {\n  border-radius: 20px;\n  padding: 10px;\n}\n.form-all .form-submit-button,\n.form-all .form-submit-reset,\n.form-all .form-submit-print {\n  border-radius: 100px;\n}\n.form-all .form-sub-label {\n  margin-left: 3px;\n}\n.form-all {\n  border-radius: 20px;\n}\n.form-section:first-child {\n  border-radius: 20px 20px 0 0;\n}\n.form-section:last-child {\n  border-radius: 0 0 20px 20px;\n}\n.form-all .qq-upload-button,\n.form-all .form-submit-button,\n.form-all .form-submit-reset,\n.form-all .form-submit-print {\n  height: 50px;\n  font-size: 1.15em;\n  padding: 12px 18px;\n  display: block;\n  width: 100%;\n  margin: 0;\n  font-family: \"Varela Round\", sans-serif;\n  font-size: 26px;\n  font-weight: normal;\n}\n.form-all .form-buttons-wrapper {\n  margin-left: 0 !important;\n}\n.form-all .form-pagebreak-back-container,\n.form-all .form-pagebreak-next-container {\n  width: 48% !important;\n  padding: 24px 0;\n}\n.form-all .form-pagebreak-next-container {\n  margin-left: 4%;\n}\n.form-all .form-submit-print {\n  margin-left: 0 !important;\n  margin-right: 0 !important;\n}\n.form-all .qq-upload-button,\n.form-all .form-submit-button,\n.form-all .form-submit-reset,\n.form-all .form-submit-print {\n  color: #134b71 !important;\n}\n.form-all .form-pagebreak-back,\n.form-all .form-pagebreak-next {\n  font-size: 1em;\n  padding: 9px 15px;\n  font-family: \"Varela Round\", sans-serif;\n  font-size: 15px;\n  font-weight: normal;\n}\n\/*\n& when ( @buttonFontType = google ) {\n\t@import (css) \"@{buttonFontLink}\";\n}\n*\/\nh2.form-header {\n  line-height: 1.618em;\n  font-size: 1.714em;\n}\nh2 ~ .form-subHeader {\n  line-height: 1.5em;\n  font-size: 1.071em;\n}\n.form-header-group {\n  text-align: left;\n}\n\/*.form-dropdown,\n.form-radio-item,\n.form-checkbox-item,\n.form-radio-other-input,\n.form-checkbox-other-input,*\/\n.form-captcha input,\n.form-spinner input,\n.form-error-message {\n  padding: 4px 3px 2px 3px;\n}\n.form-header-group {\n  font-family: \"Varela Round\", sans-serif;\n}\n.form-section {\n  padding: 3px 0px 3px 0px;\n}\n.form-header-group {\n  margin: 12px 36px 12px 36px;\n}\n.form-header-group {\n  padding: 24px 0px 24px 0px;\n}\n.form-textbox,\n.form-textarea {\n  border-color: #e6e6e6;\n  padding: 21px 3px 19px 3px;\n}\n.form-textbox,\n.form-textarea,\n.form-radio-other-input,\n.form-checkbox-other-input,\n.form-captcha input,\n.form-spinner input {\n  background-color: #ffffff;\n}\n.form-textbox {\n  height: 21px;\n}\n.form-textbox,\n.form-textarea {\n  width: 100%;\n  max-width: 420px;\n  box-sizing: border-box;\n}\n[data-type=\"control_textbox\"] .form-input,\n[data-type=\"control_textarea\"] .form-input,\n[data-type=\"control_fullname\"] .form-input,\n[data-type=\"control_phone\"] .form-input,\n[data-type=\"control_datetime\"] .form-input,\n[data-type=\"control_address\"] .form-input,\n[data-type=\"control_email\"] .form-input,\n[data-type=\"control_passwordbox\"] .form-input,\n[data-type=\"control_autocomp\"] .form-input,\n[data-type=\"control_textbox\"] .form-input-wide,\n[data-type=\"control_textarea\"] .form-input-wide,\n[data-type=\"control_fullname\"] .form-input-wide,\n[data-type=\"control_phone\"] .form-input-wide,\n[data-type=\"control_datetime\"] .form-input-wide,\n[data-type=\"control_address\"] .form-input-wide,\n[data-type=\"control_email\"] .form-input-wide,\n[data-type=\"control_passwordbox\"] .form-input-wide,\n[data-type=\"control_autocomp\"] .form-input-wide {\n  width: 100%;\n  max-width: 420px;\n}\n[data-type=\"control_fullname\"] .form-sub-label-container {\n  box-sizing: border-box;\n  width: 48%;\n  margin-right: 0;\n  float: left;\n}\n[data-type=\"control_fullname\"] .form-sub-label-container:first-child {\n  margin-right: 4%;\n}\n[data-type=\"control_phone\"] .form-sub-label-container {\n  width: 62.5%;\n  margin-left: 2.5%;\n  margin-right: 0;\n  float: left;\n  position: relative;\n}\n[data-type=\"control_phone\"] .form-sub-label-container:first-child {\n  width: 32.5%;\n  margin-right: 2.5%;\n  margin-left: 0;\n}\n[data-type=\"control_phone\"] .form-sub-label-container:first-child [data-component=areaCode] {\n  width: 93%;\n  float: left;\n}\n[data-type=\"control_phone\"] .form-sub-label-container:first-child [data-component=areaCode] ~ .form-sub-label {\n  display: inline-block;\n}\n[data-type=\"control_phone\"] .form-sub-label-container:first-child .phone-separate {\n  position: absolute;\n  top: 0;\n  right: -16%;\n  width: 24%;\n  text-align: center;\n  text-indent: -4px;\n}\n[data-type=\"control_phone\"] .form-sub-label-container .date-separate {\n  visibility: hidden;\n}\n.form-matrix-table {\n  width: 100%;\n  max-width: 420px;\n}\n.form-address-table {\n  width: 100%;\n  max-width: 420px;\n}\n.form-address-table td .form-dropdown {\n  width: 100%;\n}\n.form-address-table td .form-sub-label-container {\n  width: 96%;\n}\n.form-address-table td:last-child .form-sub-label-container {\n  margin-left: 4%;\n}\n.form-address-table td[colspan=\"2\"] .form-sub-label-container {\n  width: 100%;\n  margin: 0;\n}\n.form-matrix-row-headers,\n.form-matrix-column-headers,\n.form-matrix-values {\n  padding: 4px;\n}\n[data-type=\"control_dropdown\"] .form-input,\n[data-type=\"control_dropdown\"] .form-input-wide {\n  width: 150px;\n}\n.form-buttons-wrapper {\n  margin-left: 0 !important;\n  text-align: center;\n}\n.form-label {\n  font-family: \"Varela Round\", sans-serif;\n}\nli[data-type=\"control_image\"] div {\n  text-align: left;\n}\nli[data-type=\"control_image\"] img {\n  border: none;\n  border-width: 0px !important;\n  border-style: solid !important;\n  border-color: false !important;\n}\n.form-line-column {\n  width: auto;\n}\n.form-line-error {\n  background-color: #ffffff;\n}\n.form-line-error .form-sub-label-container {\n  margin-bottom: 16px;\n  position: relative;\n}\n.form-line-error .form-sub-label-container .form-sub-label {\n  position: absolute;\n}\n.form-line-error input:not(#coupon-input),\n.form-line-error textarea,\n.form-line-error .form-validation-error {\n  -webkit-transition-property: none;\n  -moz-transition-property: none;\n  -ms-transition-property: none;\n  -o-transition-property: none;\n  transition-property: none;\n  -webkit-transition-duration: 0.3s;\n  -moz-transition-duration: 0.3s;\n  -ms-transition-duration: 0.3s;\n  -o-transition-duration: 0.3s;\n  transition-duration: 0.3s;\n  -webkit-transition-timing-function: ease;\n  -moz-transition-timing-function: ease;\n  -ms-transition-timing-function: ease;\n  -o-transition-timing-function: ease;\n  transition-timing-function: ease;\n  border-width: -1px;\n  border-style: -1;\n  border-color: #e6e6e6;\n  border-right: 3px solid #e5f7f8;\n  box-shadow: none;\n  padding-right: 1px;\n}\n.form-line-error .form-error-message {\n  margin: 0;\n  position: absolute;\n  color: #fff;\n  box-shadow: none;\n  display: inline-block;\n  right: 0;\n  font-size: 10px;\n  top: 30px;\n  color: #FFF;\n  background: #69e7f3;\n  padding: 0px 5px;\n  opacity: 1;\n  bottom: auto;\n  min-width: 105px;\n  line-height: 12px;\n  -webkit-transition-property: opacity;\n  -moz-transition-property: opacity;\n  -ms-transition-property: opacity;\n  -o-transition-property: opacity;\n  transition-property: opacity;\n  -webkit-transition-duration: 0.3s;\n  -moz-transition-duration: 0.3s;\n  -ms-transition-duration: 0.3s;\n  -o-transition-duration: 0.3s;\n  transition-duration: 0.3s;\n  -webkit-transition-timing-function: ease;\n  -moz-transition-timing-function: ease;\n  -ms-transition-timing-function: ease;\n  -o-transition-timing-function: ease;\n  transition-timing-function: ease;\n  border-radius: 0;\n}\n.form-line-error .form-error-message img,\n.form-line-error .form-error-message .form-error-arrow {\n  display: none;\n}\n.form-line-error .form-error-message:after {\n  width: 22px;\n  height: 22px;\n  content: \"!\";\n  color: #FFF;\n  background: #6e6e6e;\n  position: absolute;\n  text-align: center;\n  left: -23px;\n  top: 0;\n  line-height: 22px;\n}\n.ie-8 .form-all {\n  margin-top: auto;\n  margin-top: initial;\n}\n.ie-8 .form-all:before {\n  display: none;\n}\n[data-type=\"control_clear\"] {\n  display: none;\n}\n\/* | *\/\n@media screen and (max-width: 480px), screen and (max-device-width: 767px) and (orientation: portrait), screen and (max-device-width: 415px) and (orientation: landscape) {\n  .testOne {\n    letter-spacing: 0;\n  }\n  .form-all {\n    border: 0;\n    max-width: initial;\n  }\n  .form-sub-label-container {\n    width: 100%;\n    margin: 0;\n    margin-right: 0;\n    float: left;\n    box-sizing: border-box;\n  }\n  span.form-sub-label-container + span.form-sub-label-container {\n    margin-right: 0;\n  }\n  .form-sub-label {\n    white-space: normal;\n  }\n  .form-address-table td,\n  .form-address-table th {\n    padding: 0 1px 10px;\n  }\n  .form-submit-button,\n  .form-submit-print,\n  .form-submit-reset {\n    width: 100%;\n    margin-left: 0!important;\n  }\n  div[id*=at_] {\n    font-size: 14px;\n    font-weight: 700;\n    height: 8px;\n    margin-top: 6px;\n  }\n  .showAutoCalendar {\n    width: 20px;\n  }\n  img.form-image {\n    max-width: 100%;\n    height: auto;\n  }\n  .form-matrix-row-headers {\n    width: 100%;\n    word-break: break-all;\n    min-width: 80px;\n  }\n  .form-collapse-table,\n  .form-header-group {\n    margin: 0;\n  }\n  .form-collapse-table {\n    height: 100%;\n    display: inline-block;\n    width: 100%;\n  }\n  .form-collapse-hidden {\n    display: none !important;\n  }\n  .form-input {\n    width: 100%;\n  }\n  .form-label {\n    width: 100% !important;\n  }\n  .form-label-left,\n  .form-label-right {\n    display: block;\n    float: none;\n    text-align: left;\n    width: auto!important;\n  }\n  .form-line,\n  .form-line.form-line-column {\n    padding: 2% 5%;\n    box-sizing: border-box;\n  }\n  input[type=text],\n  input[type=email],\n  input[type=tel],\n  textarea {\n    width: 100%;\n    box-sizing: border-box;\n    max-width: initial !important;\n  }\n  .form-radio-other-input,\n  .form-checkbox-other-input {\n    max-width: 55% !important;\n  }\n  .form-dropdown,\n  .form-textarea,\n  .form-textbox {\n    width: 100%!important;\n    box-sizing: border-box;\n  }\n  .form-input,\n  .form-input-wide,\n  .form-textarea,\n  .form-textbox,\n  .form-dropdown {\n    max-width: initial!important;\n  }\n  .form-checkbox-item:not(#foo),\n  .form-radio-item:not(#foo) {\n    width: 100%;\n  }\n  .form-address-city,\n  .form-address-line,\n  .form-address-postal,\n  .form-address-state,\n  .form-address-table,\n  .form-address-table .form-sub-label-container,\n  .form-address-table select,\n  .form-input {\n    width: 100%;\n  }\n  div.form-header-group {\n    padding: 24px 0px !important;\n    margin: 0 12px 2% !important;\n    margin-left: 5%!important;\n    margin-right: 5%!important;\n    box-sizing: border-box;\n  }\n  div.form-header-group.hasImage img {\n    max-width: 100%;\n  }\n  [data-type=\"control_button\"] {\n    margin-bottom: 0 !important;\n  }\n  [data-type=control_fullname] .form-sub-label-container {\n    width: 48%;\n  }\n  [data-type=control_fullname] .form-sub-label-container:first-child {\n    margin-right: 4%;\n  }\n  [data-type=control_phone] .form-sub-label-container {\n    width: 65%;\n    margin-right: 0;\n    margin-left: 0;\n    float: left;\n  }\n  [data-type=control_phone] .form-sub-label-container:first-child {\n    width: 31%;\n    margin-right: 4%;\n  }\n  [data-type=control_datetime] .allowTime-container {\n    width: 100%;\n  }\n  [data-type=control_datetime] .allowTime-container .form-sub-label-container {\n    width: 24%!important;\n    margin-left: 6%;\n    margin-right: 0;\n  }\n  [data-type=control_datetime] .allowTime-container .form-sub-label-container:first-child {\n    margin-left: 0;\n  }\n  [data-type=control_datetime] span + span + span > span:first-child {\n    display: block;\n    width: 100% !important;\n  }\n  [data-type=control_birthdate] .form-sub-label-container,\n  [data-type=control_time] .form-sub-label-container {\n    width: 27.3%!important;\n    margin-right: 6% !important;\n  }\n  [data-type=control_time] .form-sub-label-container:last-child {\n    width: 33.3%!important;\n    margin-right: 0 !important;\n  }\n  .form-pagebreak-back-container,\n  .form-pagebreak-next-container {\n    min-height: 1px;\n    width: 50% !important;\n  }\n  .form-pagebreak-back,\n  .form-pagebreak-next,\n  .form-product-item.hover-product-item {\n    width: 100%;\n  }\n  .form-pagebreak-back-container {\n    padding: 0;\n    text-align: right;\n  }\n  .form-pagebreak-next-container {\n    padding: 0;\n    text-align: left;\n  }\n  .form-pagebreak {\n    margin: 0 auto;\n  }\n  .form-buttons-wrapper {\n    margin: 0!important;\n    margin-left: 0!important;\n  }\n  .form-buttons-wrapper button {\n    width: 100%;\n  }\n  .form-buttons-wrapper .form-submit-print {\n    margin: 0 !important;\n  }\n  table {\n    width: 100%!important;\n    max-width: initial!important;\n  }\n  table td + td {\n    padding-left: 3%;\n  }\n  .form-checkbox-item,\n  .form-radio-item {\n    white-space: normal!important;\n  }\n  .form-checkbox-item input,\n  .form-radio-item input {\n    width: auto;\n  }\n  .form-collapse-table {\n    margin: 0 5%;\n    display: block;\n    zoom: 1;\n    width: auto;\n  }\n  .form-collapse-table:before,\n  .form-collapse-table:after {\n    display: table;\n    content: '';\n    line-height: 0;\n  }\n  .form-collapse-table:after {\n    clear: both;\n  }\n  .fb-like-box {\n    width: 98% !important;\n  }\n  .form-error-message {\n    clear: both;\n    bottom: -10px;\n  }\n  .date-separate,\n  .phone-separate {\n    display: none;\n  }\n  .custom-field-frame,\n  .direct-embed-widgets,\n  .signature-pad-wrapper {\n    width: 100% !important;\n  }\n}\n\/* | *\/\n\n\/*__INSPECT_SEPERATOR__*\/\n\n    \/* Injected CSS Code *\/\n<\/style>\n\n<script src=\"https:\/\/cdn03.jotfor.ms\/static\/prototype.forms.js?3.3.35594\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn01.jotfor.ms\/static\/jotform.forms.js?3.3.35594\" type=\"text\/javascript\"><\/script>\n<script defer src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/punycode\/1.4.1\/punycode.js\"><\/script>\n<script type=\"text\/javascript\">\tJotForm.newDefaultTheme = false;\n\tJotForm.extendsNewTheme = false;\n\tJotForm.newPaymentUIForNewCreatedForms = true;\n\tJotForm.newPaymentUI = true;\n\n var jsTime = setInterval(function(){try{\n   JotForm.jsForm = true;\n\tJotForm.clearFieldOnHide=\"disable\";\n\tJotForm.submitError=\"jumpToFirstError\";\n\n\tJotForm.init(function(){\n\t\/*INIT-START*\/\nif (window.JotForm && JotForm.accessible) $('input_5').setAttribute('tabindex',0);\n      JotForm.setCustomHint( 'input_5', 'Write a short message here' );\n      JotForm.alterTexts(undefined);\n\t\/*INIT-END*\/\n\t});\n\n   clearInterval(jsTime);\n }catch(e){}}, 1000);\n\n   JotForm.prepareCalculationsOnTheFly([null,null,null,{\"description\":\"\",\"name\":\"email\",\"qid\":\"3\",\"subLabel\":\"your@email.com\",\"text\":\"Email\",\"type\":\"control_email\"},{\"description\":\"\",\"name\":\"name\",\"qid\":\"4\",\"text\":\"Name\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"message\",\"qid\":\"5\",\"subLabel\":\"\",\"text\":\"Message\",\"type\":\"control_textarea\"},{\"name\":\"submit\",\"qid\":\"6\",\"text\":\"Submit\",\"type\":\"control_button\"},{\"description\":\"\",\"name\":\"pleaseVerify\",\"qid\":\"7\",\"text\":\"Please verify that you are human\",\"type\":\"control_captcha\"}]);\n   setTimeout(function() {\nJotForm.paymentExtrasOnTheFly([null,null,null,{\"description\":\"\",\"name\":\"email\",\"qid\":\"3\",\"subLabel\":\"your@email.com\",\"text\":\"Email\",\"type\":\"control_email\"},{\"description\":\"\",\"name\":\"name\",\"qid\":\"4\",\"text\":\"Name\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"message\",\"qid\":\"5\",\"subLabel\":\"\",\"text\":\"Message\",\"type\":\"control_textarea\"},{\"name\":\"submit\",\"qid\":\"6\",\"text\":\"Submit\",\"type\":\"control_button\"},{\"description\":\"\",\"name\":\"pleaseVerify\",\"qid\":\"7\",\"text\":\"Please verify that you are human\",\"type\":\"control_captcha\"}]);}, 20); \n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"https:\/\/submit.jotform.com\/submit\/220505150564042\/\" method=\"post\" name=\"form_220505150564042\" id=\"220505150564042\" accept-charset=\"utf-8\" autocomplete=\"on\">\n  <input type=\"hidden\" name=\"formID\" value=\"220505150564042\" \/>\n  <input type=\"hidden\" id=\"JWTContainer\" value=\"\" \/>\n  <input type=\"hidden\" id=\"cardinalOrderNumber\" value=\"\" \/>\n  <div role=\"main\" class=\"form-all\">\n    <ul class=\"form-section page-section\">\n      <li class=\"form-line jf-required\" data-type=\"control_email\" id=\"id_3\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_3\" for=\"input_3\">\n          Email\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_3\" class=\"form-input-wide jf-required\">\n          <span class=\"form-sub-label-container\" style=\"vertical-align:top\">\n            <input type=\"email\" id=\"input_3\" name=\"q3_email\" class=\"form-textbox validate[required, Email]\" data-defaultvalue=\"\" size=\"30\" value=\"\" data-component=\"email\" aria-labelledby=\"label_3 sublabel_input_3\" required=\"\" \/>\n            <label class=\"form-sub-label\" for=\"input_3\" id=\"sublabel_input_3\" style=\"min-height:13px\" aria-hidden=\"false\"> your@email.com <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_4\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_4\" for=\"first_4\">\n          Name\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_4\" class=\"form-input-wide jf-required\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\">\n              <input type=\"text\" id=\"first_4\" name=\"q4_name[first]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"section-input_4 given-name\" size=\"10\" value=\"\" data-component=\"first\" aria-labelledby=\"label_4 sublabel_4_first\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"first_4\" id=\"sublabel_4_first\" style=\"min-height:13px\" aria-hidden=\"false\"> First Name <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\">\n              <input type=\"text\" id=\"last_4\" name=\"q4_name[last]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"section-input_4 family-name\" size=\"15\" value=\"\" data-component=\"last\" aria-labelledby=\"label_4 sublabel_4_last\" required=\"\" \/>\n              <label class=\"form-sub-label\" for=\"last_4\" id=\"sublabel_4_last\" style=\"min-height:13px\" aria-hidden=\"false\"> Last Name <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_textarea\" id=\"id_5\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_5\" for=\"input_5\">\n          Message\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_5\" class=\"form-input-wide jf-required\">\n          <textarea id=\"input_5\" class=\"form-textarea validate[required]\" name=\"q5_message\" cols=\"40\" rows=\"6\" data-component=\"textarea\" required=\"\" aria-labelledby=\"label_5\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line jf-required\" data-type=\"control_captcha\" id=\"id_7\">\n        <label class=\"form-label form-label-top form-label-auto\" id=\"label_7\" for=\"input_7\">\n          Please verify that you are human\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_7\" class=\"form-input-wide jf-required\">\n          <section data-wrapper-react=\"true\">\n            <div id=\"recaptcha_input_7\" data-component=\"recaptcha\" data-callback=\"recaptchaCallbackinput_7\" data-expired-callback=\"recaptchaExpiredCallbackinput_7\">\n            <\/div>\n            <input type=\"hidden\" id=\"input_7\" class=\"hidden validate[required]\" name=\"recaptcha_visible\" required=\"\" \/>\n            <script type=\"text\/javascript\" src=\"https:\/\/www.google.com\/recaptcha\/api.js?render=explicit&amp;onload=recaptchaLoadedinput_7\"><\/script>\n            <script type=\"text\/javascript\">\n                    var recaptchaLoadedinput_7 = function()\n          {\n            window.grecaptcha.render($(\"recaptcha_input_7\"), {\n              sitekey: '6LdU3CgUAAAAAB0nnFM3M3T0sy707slYYU51RroJ',\n            });\n            var grecaptchaBadge = document.querySelector('.grecaptcha-badge');\n            if (grecaptchaBadge)\n            {\n              grecaptchaBadge.style.boxShadow = 'gray 0px 0px 2px';\n            }\n          };\n\n        \/**\n         * Called when the reCaptcha verifies the user is human\n         * For invisible reCaptcha;\n         *   Submit event is stopped after validations and recaptcha is executed.\n         *   If a challenge is not displayed, this will be called right after grecaptcha.execute()\n         *   If a challenge is displayed, this will be called when the challenge is solved successfully\n         *   Submit is triggered to actually submit the form since it is stopped before.\n         *\/\n        var recaptchaCallbackinput_7 = function()\n          {\n            var isInvisibleReCaptcha = false;\n            var hiddenInput = $(\"input_7\");\n            hiddenInput.setValue(1);\n            if (!isInvisibleReCaptcha)\n            {\n              if (hiddenInput.validateInput)\n              {\n                hiddenInput.validateInput();\n              }\n            }\n            else\n            {\n              triggerSubmit(hiddenInput.form)\n            }\n\n            function triggerSubmit(formElement)\n            {\n              var button = formElement.ownerDocument.createElement('input');\n              button.style.display = 'none';\n              button.type = 'submit';\n              formElement.appendChild(button).click();\n              formElement.removeChild(button);\n            }\n          }\n\n          \/\/ not really required for invisible recaptcha\n        var recaptchaExpiredCallbackinput_7 = function()\n          {\n            var hiddenInput = $(\"input_7\");\n            hiddenInput.writeAttribute(\"value\", false);\n            if (hiddenInput.validateInput)\n            {\n              hiddenInput.validateInput();\n            }\n          }\n            <\/script>\n          <\/section>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_button\" id=\"id_6\">\n        <div id=\"cid_6\" class=\"form-input-wide\">\n          <div style=\"text-align:left\" data-align=\"left\" class=\"form-buttons-wrapper form-buttons-left   jsTest-button-wrapperField\">\n            <button id=\"input_6\" type=\"submit\" class=\"form-submit-button submit-button jf-form-buttons jsTest-submitField\" data-component=\"button\" data-content=\"\">\n              Submit\n            <\/button>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li style=\"display:none\">\n        Should be Empty:\n        <input type=\"text\" name=\"website\" value=\"\" \/>\n      <\/li>\n    <\/ul>\n  <\/div>\n  <script>\n  JotForm.showJotFormPowered = \"0\";\n  <\/script>\n  <script>\n  JotForm.poweredByText = \"Powered by Jotform\";\n  <\/script>\n  <input type=\"hidden\" class=\"simple_spc\" id=\"simple_spc\" name=\"simple_spc\" value=\"220505150564042\" \/>\n  <script type=\"text\/javascript\">\n  var all_spc = document.querySelectorAll(\"form[id='220505150564042'] .si\" + \"mple\" + \"_spc\");\nfor (var i = 0; i < all_spc.length; i++)\n{\n  all_spc[i].value = \"220505150564042-220505150564042\";\n}\n  <\/script>\n<\/form><\/body>\n<\/html>\n","NL Wellness Contact Form",Array);(function(){window.handleIFrameMessage=function(e){if(!e.data||!e.data.split)return;var args=e.data.split(":");if(args[2]!="220505150564042"){return;}
var iframe=document.getElementById("220505150564042");if(!iframe){return};switch(args[0]){case"scrollIntoView":if(!("nojump"in FrameBuilder.get)){iframe.scrollIntoView();}
break;case"setHeight":var height=args[1]+"px";if(window.jfDeviceType==='mobile'&&typeof $jot!=='undefined'){var parent=$jot(iframe).closest('.jt-feedback.u-responsive-lightbox');if(parent){height='100%';}}
iframe.style.height=height
break;case"setMinHeight":iframe.style.minHeight=args[1]+"px";break;case"collapseErrorPage":if(iframe.clientHeight>window.innerHeight){iframe.style.height=window.innerHeight+"px";}
break;case"reloadPage":if(iframe){location.reload();}
break;case"removeIframeOnloadAttr":iframe.removeAttribute("onload");break;case"loadScript":if(!window.isPermitted(e.origin,['jotform.com','jotform.pro'])){break;}
var src=args[1];if(args.length>3){src=args[1]+':'+args[2];}
var script=document.createElement('script');script.src=src;script.type='text/javascript';document.body.appendChild(script);break;case"exitFullscreen":if(window.document.exitFullscreen)window.document.exitFullscreen();else if(window.document.mozCancelFullScreen)window.document.mozCancelFullScreen();else if(window.document.mozCancelFullscreen)window.document.mozCancelFullScreen();else if(window.document.webkitExitFullscreen)window.document.webkitExitFullscreen();else if(window.document.msExitFullscreen)window.document.msExitFullscreen();break;case'setDeviceType':window.jfDeviceType=args[1];break;}};window.isPermitted=function(originUrl,whitelisted_domains){var url=document.createElement('a');url.href=originUrl;var hostname=url.hostname;var result=false;if(typeof hostname!=='undefined'){whitelisted_domains.forEach(function(element){if(hostname.slice((-1*element.length-1))==='.'.concat(element)||hostname===element){result=true;}});return result;}};if(window.addEventListener){window.addEventListener("message",handleIFrameMessage,false);}else if(window.attachEvent){window.attachEvent("onmessage",handleIFrameMessage);}})();