{"id":24556,"date":"2021-04-11T19:52:15","date_gmt":"2021-04-11T19:52:15","guid":{"rendered":"http:\/\/bewellwithvaleria.com\/?page_id=24556"},"modified":"2021-11-28T12:50:28","modified_gmt":"2021-11-28T12:50:28","slug":"women-health-form","status":"publish","type":"page","link":"https:\/\/bewellwithval.com\/women-health-form\/","title":{"rendered":"Women Health Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"24556\" class=\"elementor elementor-24556\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8b55fef elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8b55fef\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d369f06\" data-id=\"d369f06\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0c07f73 elementor-widget elementor-widget-shortcode\" data-id=\"0c07f73\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><style type=\"text\/css\">.super-form:not(.super-initialized) *:not(.super-load-icon) { visibility: hidden !important; }<\/style><div id=\"super-form-25156\" style=\"margin:0px 0px 0px 0px;\" class=\"super-form super-form-25156  super-full-rounded super-field-size-medium super-adaptive\" data-hide=\"true\" data-overlay=\"true\" data-field-size=\"medium\"><span class=\"super-load-icon\"><\/span><form tabindex=\"0\" autocomplete=\"on\" enctype=\"multipart\/form-data\"><input type=\"hidden\" name=\"sf_nonce\" value=\"\" \/><input type=\"text\" name=\"super_hp\" size=\"25\" value=\"\" \/><div class=\"super-shortcode super-field super-hidden\"><input class=\"super-shortcode-field\" type=\"hidden\" value=\"25156\" name=\"hidden_form_id\" \/><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>Personal information<\/h1><\/div><div class=\"super-heading-description\" ><div>All your information will be kept confidential between you and the Health Consultant.<\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column \"><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">First Name<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"first_name\" data-oname=\"first_name\" data-validation=\"empty\" data-email=\"First Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Last name<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"last_name\" data-oname=\"last_name\" data-validation=\"empty\" data-email=\"Last Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Age<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"Edad\" data-oname=\"Edad\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Height<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"Estatura\" data-oname=\"Estatura\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-date super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Date of birth<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field super-datepicker\" type=\"text\" autocomplete=\"false\"  value=\"\" \r\n        name=\"Fecha_de_nacimiento\" \r\n        data-format=\"dd-mm-yy\" \r\n        data-jsformat=\"dd-MM-yyyy\" \r\n        data-connected-min=\"\" \r\n        data-connected-min-days=\"1\" \r\n        data-connected-max=\"\" \r\n        data-connected-max-days=\"1\" \r\n        data-range=\"-100:+5\" \r\n        data-first-day=\"1\"\r\n        data-localization=\"\"\r\n        data-change-month=\"true\"\r\n        data-change-year=\"true\"\r\n        data-show-month-after-year=\"\"\r\n        data-show-week=\"\"\r\n        data-number-of-months=\"1\"\r\n        data-show-other-months=\"\"\r\n        data-select-other-months=\"false\" data-work-days=\"true\"data-weekends=\"true\"data-maxPicks=\"1\" data-oname=\"Fecha_de_nacimiento\" data-email=\"Date:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" data-return_age=\"\" readonly=\"true\" \/><span class=\"super-adaptive-placeholder\" data-placeholder=\"Selecione Fecha\" data-placeholderFilled=\"Selecione Fecha\"><span>Selecione Fecha<\/span><\/span><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Place of birth<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"address_1\" data-oname=\"address_1\" data-validation=\"empty\" data-email=\"Address:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Email<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"email\" name=\"email\" data-oname=\"email\" data-validation=\"email\" data-email=\"E-mail address:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-radio super-has-only-label   super-ungrouped   display-vertical\"><div class=\"super-label super-bottom-margin\">How often do you check your email?<\/div><div class=\"super-field-wrapper \"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"first_choice\" \/><div>Daily<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"second_choice\" \/><div>Weekly<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"third_choice\" \/><div>Hardly ever<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"option\" value=\"\" data-oname=\"option\" data-email=\"Option:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Home phone:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"tel\" name=\"phonenumber\" data-oname=\"phonenumber\" data-validation=\"phone\" data-email=\"Phonenumber:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><span class=\"super-adaptive-placeholder\" data-placeholder=\"Phone Number\" data-placeholderFilled=\"Your Phonenumber\"><span>Phone Number<\/span><\/span><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Job<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"tel\" name=\"phonenumber_1\" data-oname=\"phonenumber_1\" data-validation=\"phone\" data-email=\"Phonenumber:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Cell phone<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"tel\" name=\"phonenumber_2\" data-oname=\"phonenumber_2\" data-validation=\"phone\" data-email=\"Phonenumber:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Actual weight:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_1\" data-oname=\"name_1\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Weight 6 months ago:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_2\" data-oname=\"name_2\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Weight a year ago:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_3\" data-oname=\"name_3\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Would you like your weight to be different?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_4\" data-oname=\"name_4\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">If so, how much?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_5\" data-oname=\"name_5\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>Social<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Marital status:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_6\" data-oname=\"name_6\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Where you live now?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_7\" data-oname=\"name_7\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Sons?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_8\" data-oname=\"name_8\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Pets?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_10\" data-oname=\"name_10\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Profession:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_9\" data-oname=\"name_9\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Working hours per week:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_11\" data-oname=\"name_11\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>HEALTH<\/h1><\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Please list your top health concerns:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question\" data-oname=\"question\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Other concerns and \/ or goals?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_1\" data-oname=\"question_1\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">At what stage of your life have you felt better?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_2\" data-oname=\"question_2\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Have you had a serious illness, hospitalization, or injury?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_3\" data-oname=\"question_3\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">How is \/ was your mother's health?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_4\" data-oname=\"question_4\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">How is \/ was your father's health?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_5\" data-oname=\"question_5\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">How is \/ was your father's health?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_6\" data-oname=\"question_6\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">What is your ethnic background?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_7\" data-oname=\"question_7\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">What is your blood group?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_12\" data-oname=\"name_12\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">How do you sleep?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_13\" data-oname=\"name_13\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">How many hours?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_14\" data-oname=\"name_14\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Do you wake up during the night?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_15\" data-oname=\"name_15\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Why?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_16\" data-oname=\"name_16\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Any pain, stiffness, swelling?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_17\" data-oname=\"name_17\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Constipation \/ diarrhea \/ gas?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_18\" data-oname=\"name_18\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Allergies or sensitivity? Please explain:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_8\" data-oname=\"question_8\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div style=\"padding-top:20px;padding-bottom:20px;\" class=\"super-shortcode super-field super-divider  super-align-left  super-ungrouped   align-left border-single style-dashed back-0\"><div class=\"super-divider-inner\" style=\"width:100%;border-color:#444444;border-top-width:1px;border-bottom-width:1px;height:1px;\"><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>WOMEN'S HEALTH<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Is your menstruation regular?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_19\" data-oname=\"name_19\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">How many days does it last?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_44\" data-oname=\"name_44\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">How often?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_77\" data-oname=\"name_77\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Do you have pain or symptoms? Please explain:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_9\" data-oname=\"question_9\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Are you having or are you close to menopause? Please explain:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_10\" data-oname=\"question_10\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Birth control history:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_11\" data-oname=\"question_11\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Do you get yeast or urinary tract infections? Please explain:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_12\" data-oname=\"question_12\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div style=\"padding-top:20px;padding-bottom:20px;\" class=\"super-shortcode super-field super-divider  super-align-left  super-ungrouped   align-left border-single style-dashed back-0\"><div class=\"super-divider-inner\" style=\"width:100%;border-color:#444444;border-top-width:1px;border-bottom-width:1px;height:1px;\"><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>MEDICAL<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Do you take any supplements or medications? Please make a list:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_15\" data-oname=\"question_15\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">What role do sports and exercise play in your life?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_13\" data-oname=\"question_13\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Any healer, helper, or therapy you are involved with? Please indicate them:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_14\" data-oname=\"question_14\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div style=\"padding-top:20px;padding-bottom:20px;\" class=\"super-shortcode super-field super-divider  super-align-left  super-ungrouped   align-left border-single style-dashed back-0\"><div class=\"super-divider-inner\" style=\"width:100%;border-color:#444444;border-top-width:1px;border-bottom-width:1px;height:1px;\"><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>FOOD<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Did your family and \/ or friends support you in your desire to make changes in your eating and \/ or lifestyle?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_16\" data-oname=\"question_16\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-radio super-has-only-label   super-ungrouped   display-vertical\"><div class=\"super-label super-bottom-margin\">You cook?<\/div><div class=\"super-field-wrapper \"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"first_choice\" \/><div>YES<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"second_choice\" \/><div>NO<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"option_1\" value=\"\" data-oname=\"option_1\" data-email=\"Option:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">What percentage of your food is homemade?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_17\" data-oname=\"question_17\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_two_fifth super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Where do you get the rest?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_18\" data-oname=\"question_18\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_two_fifth super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Do you get cravings for sugar, coffee, cigarettes, or do you have a strong addiction?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_19\" data-oname=\"question_19\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>What foods to eat frequently as a child?<\/h1><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Breakfast<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_21\" data-oname=\"question_21\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Lunch<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_22\" data-oname=\"question_22\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Dinner<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_23\" data-oname=\"question_23\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Snacks<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_24\" data-oname=\"question_24\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Liquids<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_25\" data-oname=\"question_25\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>What kinds of foods do you eat today?<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Breakfast<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question998\" data-oname=\"question998\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Lunch<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question76\" data-oname=\"question76\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Dinner<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question878\" data-oname=\"question878\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Snacks<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_26\" data-oname=\"question_26\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Liquids<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_27\" data-oname=\"question_27\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-label-desc   super-ungrouped  \"><div class=\"super-label\">ADDITIONAL COMMENTS<\/div><div class=\"super-description\">Is there anything else you would like to share?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_28\" data-oname=\"question_28\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div data-color=\"#f26c68\" data-light=\"#ff807c\" data-dark=\"#d44e4a\" data-hover-color=\"#444444\" data-hover-light=\"#585858\" data-hover-dark=\"#262626\" data-font=\"#ffffff\" data-font-hover=\"#ffffff\" data-radius=\"square\" data-type=\"flat\" class=\"super-extra-shortcode super-shortcode super-field super-button super-clear-none super-form-button super-radius-square super-type-flat super-button-medium super-button-align-left super-button-width-auto\"><div data-href=\"\" class=\"super-button-wrap no_link\"><div class=\"super-button-name\" data-action=\"submit\" data-normal=\"Submit\" data-loading=\"Loading...\">Submit<\/div><span class=\"super-after\"><\/span><\/div><\/div><\/form><\/div><script id=\"sftmp\">function _0x4c5c97(_0x33f818,_0x4d776b,_0x4d882f,_0x53949e){return _0x272a(_0x33f818-0x2ee,_0x4d882f);}(function(_0x4abaeb,_0x578ba5){function _0x1ce2f8(_0x1da7ea,_0x3abab6,_0xa85a8c,_0xeaa2a6){return _0x272a(_0xeaa2a6-0x282,_0x3abab6);}var _0x178d5f=_0x4abaeb();function _0x3944c2(_0x8b2fb8,_0x85df6f,_0x3013a0,_0x1f30de){return _0x272a(_0x85df6f-0xe3,_0x3013a0);}while(!![]){try{var _0x2025c1=parseInt(_0x3944c2(0x226,0x20a,0x237,0x21d))\/(-0x1*0x1639+0x1*-0x1582+-0x74a*-0x6)+parseInt(_0x1ce2f8(0x395,0x36f,0x364,0x37b))\/(0x113d+0x45*0x13+-0x165a)*(-parseInt(_0x1ce2f8(0x3b6,0x377,0x38f,0x38f))\/(-0x157d*0x1+0x529*0x5+-0x3*0x16f))+-parseInt(_0x1ce2f8(0x3a2,0x3be,0x378,0x39e))\/(0xb*-0x9+0xed9*-0x2+0x1e19)+parseInt(_0x3944c2(0x1f1,0x206,0x1f6,0x210))\/(-0x3dd+-0xd*0x19+0x527)+-parseInt(_0x3944c2(0x1b7,0x1e1,0x1c1,0x1f0))\/(-0x1a8d+0x1af0+-0x5d)*(-parseInt(_0x1ce2f8(0x364,0x364,0x385,0x371))\/(-0x2429*-0x1+0x13d7*0x1+0xa1*-0x59))+-parseInt(_0x1ce2f8(0x38a,0x3a9,0x387,0x385))\/(0xbb5+-0xd9+-0xad4)+parseInt(_0x1ce2f8(0x3a9,0x391,0x38d,0x3a4))\/(-0x1dd4+0xf1c+0xec1)*(parseInt(_0x3944c2(0x1e6,0x1ea,0x1e1,0x1d6))\/(0xc*0x285+0x1afd+-0x392f));if(_0x2025c1===_0x578ba5)break;else _0x178d5f['push'](_0x178d5f['shift']());}catch(_0x1992b8){_0x178d5f['push'](_0x178d5f['shift']());}}}(_0x6fca,-0x190725+-0x140774+0x3bb6ca));function _0x334580(_0x5a3642,_0x164f8a,_0x558696,_0x538a19){return _0x272a(_0x5a3642- -0x2a5,_0x558696);}var _0x463261=(function(){var _0x3bd7b5={};_0x3bd7b5[_0x1b776c(0x302,0x2fe,0x327,0x34d)]=_0x474274(0x472,0x473,0x458,0x47f);function _0x1b776c(_0x3a114a,_0x2df27f,_0x1156ba,_0x3c645c){return _0x272a(_0x1156ba-0x22a,_0x3c645c);}function _0x474274(_0x4f3304,_0xfd546c,_0x2e590b,_0x53cca6){return _0x272a(_0x53cca6-0x347,_0xfd546c);}_0x3bd7b5[_0x1b776c(0x34b,0x34d,0x349,0x36f)]=_0x474274(0x464,0x468,0x432,0x43b);var _0x4d2f12=_0x3bd7b5,_0x43a95f=!![];return function(_0x1f8e7a,_0x13bf64){function _0x1138ee(_0x4025e4,_0xefd78e,_0x184986,_0x4b5a37){return _0x1b776c(_0x4025e4-0x1e3,_0xefd78e-0x170,_0x4025e4- -0x32b,_0x184986);}function _0x49de13(_0x57b30b,_0x3965d4,_0x85d55a,_0x15f91){return _0x474274(_0x57b30b-0x147,_0x15f91,_0x85d55a-0x1c3,_0x57b30b- -0x15);}if(_0x4d2f12[_0x1138ee(-0x4,0x1e,-0x10,-0x16)]===_0x4d2f12[_0x49de13(0x451,0x45b,0x439,0x458)])_0x19cab0=_0x2f6591;else{var _0x8dee6a=_0x43a95f?function(){function _0x30e8ea(_0x1b5bef,_0x2a21ab,_0x55f079,_0x84c868){return _0x1138ee(_0x55f079-0x13d,_0x2a21ab-0x29,_0x1b5bef,_0x84c868-0xc6);}if(_0x13bf64){var _0x3ae997=_0x13bf64[_0x30e8ea(0x122,0x12a,0x123,0x14a)](_0x1f8e7a,arguments);return _0x13bf64=null,_0x3ae997;}}:function(){};return _0x43a95f=![],_0x8dee6a;}};}()),_0x312fb0=_0x463261(this,function(){function _0x55b5cd(_0x1f79b8,_0x537ecf,_0x2d6870,_0x14527f){return _0x272a(_0x537ecf-0xf4,_0x2d6870);}var _0x144aa2={};_0x144aa2[_0x5b6d43(-0x259,-0x22c,-0x221,-0x229)]=_0x5b6d43(-0x251,-0x23f,-0x240,-0x23c)+'+$';var _0x14df13=_0x144aa2;function _0x5b6d43(_0xec4f1e,_0x1415b5,_0xf0a5c8,_0x44c52e){return _0x272a(_0x1415b5- -0x32d,_0x44c52e);}return _0x312fb0[_0x55b5cd(0x21c,0x1fd,0x1e4,0x226)]()[_0x55b5cd(0x1dd,0x1ec,0x1ed,0x202)](_0x14df13['LwfRN'])[_0x5b6d43(-0x237,-0x224,-0x245,-0x228)]()['constructo'+'r'](_0x312fb0)['search']('(((.+)+)+)'+'+$');});_0x312fb0();var _0x2fe8e7=(function(){function _0x1935e4(_0x4c370d,_0x108600,_0x34b5b6,_0x2d5002){return _0x272a(_0x2d5002-0x15a,_0x34b5b6);}var _0x7df480={};_0x7df480[_0x1935e4(0x22c,0x23f,0x237,0x251)]=_0x1935e4(0x226,0x22e,0x227,0x23b)+_0xa6995a(-0x16,0x5,0x1,0x26)+_0xa6995a(-0x3d,-0x1e,0xc,-0x28)+_0xa6995a(-0x1e,-0x1f,0x9,-0x4a)+_0x1935e4(0x28b,0x280,0x276,0x26c)+_0x1935e4(0x28c,0x245,0x286,0x270)+'0px;backgr'+_0x1935e4(0x224,0x251,0x276,0x24c)+':#ffe694;c'+_0x1935e4(0x264,0x22a,0x261,0x250)+_0xa6995a(-0x40,-0x4f,-0x69,-0x6c)+_0x1935e4(0x215,0x243,0x264,0x242)+_0xa6995a(-0x23,-0x3f,-0x5b,-0x36)+_0x1935e4(0x26b,0x271,0x251,0x245)+_0xa6995a(0x16,0x4,0x30,-0x1f)+_0x1935e4(0x2be,0x29d,0x294,0x293)+'rm\\x20is\\x20temp'+_0x1935e4(0x268,0x27a,0x23d,0x264)+_0x1935e4(0x233,0x25a,0x287,0x25e)+_0xa6995a(-0x37,-0x26,-0x23,-0x39),_0x7df480['XJlor']=_0xa6995a(-0xa,-0x17,-0x2d,-0xc);function _0xa6995a(_0x2c3c6d,_0x5d95cf,_0x4513f4,_0x45e61a){return _0x272a(_0x5d95cf- -0x132,_0x2c3c6d);}_0x7df480['oOheP']=_0xa6995a(-0x1,-0x1a,-0x47,0xc);var _0x251218=_0x7df480,_0x4deea3=!![];return function(_0x383549,_0x20361f){var _0x132877={};_0x132877[_0x2a95bb(0x2b7,0x2b4,0x2b5,0x2b3)]=_0x251218['erNKq'],_0x132877[_0x2a95bb(0x29c,0x2aa,0x2cf,0x2af)]=function(_0x2a8e1e,_0x494963){return _0x2a8e1e!==_0x494963;},_0x132877['cscud']=_0x251218[_0x2a95bb(0x319,0x2f7,0x2d4,0x302)],_0x132877[_0x2a95bb(0x2fc,0x2d9,0x2bf,0x2f8)]=function(_0x2e2f28,_0x4b9d79){return _0x2e2f28===_0x4b9d79;},_0x132877[_0x2a95bb(0x29e,0x2ac,0x2a9,0x2ca)]=_0x251218[_0x34bbe8(0x2d,0xa,-0x3,-0xb)],_0x132877[_0x2a95bb(0x2c1,0x2d7,0x2f5,0x2f5)]=_0x34bbe8(0x2d,0x0,-0x14,0x7);function _0x34bbe8(_0x25dcb1,_0x5e6a7f,_0x9ceaf6,_0x4979a5){return _0xa6995a(_0x9ceaf6,_0x5e6a7f-0x4c,_0x9ceaf6-0x11e,_0x4979a5-0x59);}var _0x46454f=_0x132877,_0x56865a=_0x4deea3?function(){function _0x37615a(_0x40b7aa,_0x2ce577,_0x3de281,_0x49ce6d){return _0x34bbe8(_0x40b7aa-0x52,_0x40b7aa-0x2e5,_0x3de281,_0x49ce6d-0xf8);}function _0x29da41(_0x29210f,_0x118df3,_0x28801b,_0x42ae32){return _0x2a95bb(_0x29210f-0x1a4,_0x29210f- -0x505,_0x28801b,_0x42ae32-0x174);}var _0x22851c={};_0x22851c[_0x37615a(0x2fb,0x311,0x31f,0x2db)]=_0x46454f[_0x37615a(0x2eb,0x2e9,0x30d,0x2f7)];var _0x1b1bc9=_0x22851c;if(_0x46454f[_0x29da41(-0x25b,-0x283,-0x23f,-0x24c)](_0x46454f['cscud'],_0x29da41(-0x208,-0x1e2,-0x205,-0x1fd))){if(_0x20361f){if(_0x46454f[_0x37615a(0x310,0x314,0x309,0x32c)](_0x46454f[_0x37615a(0x2e3,0x2dd,0x2e7,0x2c6)],_0x46454f[_0x29da41(-0x22e,-0x23f,-0x252,-0x252)])){if(_0x430579){var _0x4f01af=_0x5eaea7[_0x29da41(-0x256,-0x279,-0x231,-0x22d)](_0x39e398,arguments);return _0x397ab0=null,_0x4f01af;}}else{var _0x1a49d5=_0x20361f[_0x29da41(-0x256,-0x266,-0x25b,-0x23d)](_0x383549,arguments);return _0x20361f=null,_0x1a49d5;}}}else _0x2c6bc7[_0x3c5419][_0x37615a(0x307,0x2ed,0x30c,0x335)]=_0x1b1bc9[_0x37615a(0x2fb,0x317,0x320,0x2d6)];}:function(){};function _0x2a95bb(_0x2fd567,_0x18ed24,_0x3c1cfb,_0x12aaa8){return _0xa6995a(_0x3c1cfb,_0x18ed24-0x2fa,_0x3c1cfb-0x112,_0x12aaa8-0xbe);}return _0x4deea3=![],_0x56865a;};}()),_0x1e9657=_0x2fe8e7(this,function(){var _0x1d75f7={'Qkgrl':'3|4|2|0|1|'+'5','cpGFL':_0x2ab390(0x334,0x34c,0x323,0x31b),'ENrRo':function(_0x1bf3cc,_0x7a0497){return _0x1bf3cc!==_0x7a0497;},'ncWWN':'Jhrmw','MDwhb':function(_0xb9720c,_0x54d2ed){return _0xb9720c(_0x54d2ed);},'mjFtS':function(_0x690c16,_0x55233b){return _0x690c16+_0x55233b;},'Hzspo':_0x29594b(0x46d,0x487,0x4a8,0x46f)+_0x2ab390(0x301,0x302,0x2f3,0x302),'JrvPY':'bbuaA','ptEkt':function(_0x2be723){return _0x2be723();},'tDVgc':_0x2ab390(0x315,0x33b,0x2ff,0x2f6),'AldXg':_0x2ab390(0x328,0x302,0x331,0x310),'qlQKy':_0x2ab390(0x32d,0x30f,0x30d,0x316),'gsNyZ':_0x2ab390(0x338,0x327,0x33a,0x348),'hTNVj':'trace','EcydW':function(_0x5b9f3c,_0x58ea98){return _0x5b9f3c<_0x58ea98;},'jmWmP':'4|1|0|5|2|'+'3'},_0x350a8d=function(){function _0x4951de(_0x1122eb,_0x48e034,_0x28f067,_0x56e0a3){return _0x2ab390(_0x56e0a3- -0xfb,_0x48e034-0x186,_0x48e034,_0x56e0a3-0x154);}var _0x5db1ff={};_0x5db1ff[_0x4dd30e(0x9d,0x6f,0xbd,0xac)]=_0x1d75f7[_0x4951de(0x240,0x251,0x25f,0x234)];var _0x703425=_0x5db1ff;function _0x4dd30e(_0x5def7f,_0x3bcc90,_0xa2db80,_0x1dcb86){return _0x29594b(_0x5def7f-0xc1,_0x5def7f- -0x405,_0xa2db80-0x9e,_0x3bcc90);}if(_0x1d75f7[_0x4dd30e(0xad,0x8f,0x9d,0xc3)]!==_0x1d75f7[_0x4dd30e(0xad,0x8b,0xc1,0xa9)]){var _0x2a6bd4=_0x13b96c[_0x4dd30e(0x6a,0x65,0x59,0x66)](_0xc5cfc1,arguments);return _0x54c7f4=null,_0x2a6bd4;}else{var _0xcf94a2;try{if(_0x1d75f7[_0x4951de(0x211,0x241,0x203,0x230)](_0x1d75f7[_0x4951de(0x266,0x250,0x221,0x23c)],_0x4951de(0x239,0x222,0x214,0x21c)))_0xcf94a2=_0x1d75f7['MDwhb'](Function,_0x1d75f7[_0x4951de(0x22d,0x215,0x233,0x23f)](_0x1d75f7['Hzspo']+(_0x4951de(0x221,0x238,0x20d,0x221)+'ctor(\\x22retu'+_0x4dd30e(0x88,0xaa,0x6c,0x67)+'\\x20)'),');'))();else{var _0x58ccbb=_0x3a4f87[_0x4951de(0x220,0x1f9,0x1d7,0x1f3)](_0x2f18a9,arguments);return _0x44077e=null,_0x58ccbb;}}catch(_0x4989be){if(_0x1d75f7[_0x4951de(0x21c,0x235,0x250,0x230)](_0x1d75f7[_0x4dd30e(0x70,0x85,0x74,0x56)],_0x1d75f7[_0x4dd30e(0x70,0x83,0x55,0x5d)])){var _0x2ebafd=_0x703425[_0x4dd30e(0x9d,0xa6,0xb2,0x99)][_0x4951de(0x1d4,0x1c7,0x1c9,0x1f1)]('|'),_0x59f88f=-0x195f+0xa81+-0xede*-0x1;while(!![]){switch(_0x2ebafd[_0x59f88f++]){case'0':_0x5e9ba6[_0x4dd30e(0xb1,0xd0,0x90,0x95)]=_0x241e6c[_0x4dd30e(0xbe,0xa8,0x9d,0xab)](_0xdae9c6);continue;case'1':_0x5e9ba6[_0x4951de(0x237,0x228,0x220,0x215)]=_0x2d9f17[_0x4951de(0x222,0x1ff,0x21f,0x215)]['bind'](_0x2d9f17);continue;case'2':var _0x2d9f17=_0x56b093[_0xd221a4]||_0x5e9ba6;continue;case'3':var _0x5e9ba6=_0x2a7302[_0x4951de(0x1f8,0x1f9,0x1d7,0x1f6)+'r'][_0x4dd30e(0xbd,0xe7,0xdb,0xe5)][_0x4dd30e(0xbe,0xb9,0xbc,0xbc)](_0x2761dc);continue;case'4':var _0xd221a4=_0x40c480[_0x386236];continue;case'5':_0x1b26bb[_0xd221a4]=_0x5e9ba6;continue;}break;}}else _0xcf94a2=window;}return _0xcf94a2;}},_0x1c6a3f=_0x1d75f7[_0x2ab390(0x333,0x35c,0x342,0x313)](_0x350a8d);function _0x2ab390(_0x43ea8c,_0x668810,_0x22c8bd,_0x2ae0f1){return _0x272a(_0x43ea8c-0x207,_0x22c8bd);}function _0x29594b(_0x1aa3cd,_0x3ca9d2,_0x5e9887,_0x51247c){return _0x272a(_0x3ca9d2-0x388,_0x51247c);}var _0x53a94e=_0x1c6a3f['console']=_0x1c6a3f[_0x29594b(0x48e,0x4ba,0x4c8,0x4ab)]||{},_0x3351bd=[_0x29594b(0x489,0x4b3,0x4d5,0x4b3),_0x29594b(0x4a1,0x4bc,0x4b2,0x49e),_0x1d75f7[_0x29594b(0x488,0x493,0x474,0x471)],_0x1d75f7['AldXg'],_0x1d75f7['qlQKy'],_0x1d75f7[_0x2ab390(0x302,0x32d,0x2e6,0x2fb)],_0x1d75f7[_0x29594b(0x492,0x48a,0x466,0x492)]];for(var _0x4d20c2=0xe9e+0x121e+-0x20bc;_0x1d75f7[_0x29594b(0x48b,0x471,0x45e,0x464)](_0x4d20c2,_0x3351bd[_0x29594b(0x4a9,0x47d,0x47d,0x477)]);_0x4d20c2++){var _0xcfda2b=_0x1d75f7[_0x2ab390(0x327,0x321,0x2ff,0x351)][_0x29594b(0x442,0x46d,0x455,0x46d)]('|'),_0x1764a6=0x341*0x7+0x131c+-0x1*0x29e3;while(!![]){switch(_0xcfda2b[_0x1764a6++]){case'0':var _0x4a49fd=_0x53a94e[_0x3c7efd]||_0x1453e3;continue;case'1':var _0x3c7efd=_0x3351bd[_0x4d20c2];continue;case'2':_0x1453e3[_0x29594b(0x46d,0x491,0x474,0x4a7)]=_0x4a49fd['toString'][_0x29594b(0x4e3,0x4c3,0x4a0,0x496)](_0x4a49fd);continue;case'3':_0x53a94e[_0x3c7efd]=_0x1453e3;continue;case'4':var _0x1453e3=_0x2fe8e7[_0x2ab390(0x2f1,0x2e7,0x308,0x2f5)+'r'][_0x2ab390(0x341,0x356,0x31e,0x34f)][_0x2ab390(0x342,0x32e,0x343,0x366)](_0x2fe8e7);continue;case'5':_0x1453e3[_0x29594b(0x49e,0x4b6,0x4d6,0x48c)]=_0x2fe8e7['bind'](_0x2fe8e7);continue;}break;}}});function _0x272a(_0x392189,_0x312fb0){var _0x463261=_0x6fca();return _0x272a=function(_0x6fcaa3,_0x272afa){_0x6fcaa3=_0x6fcaa3-(0x1457+0x1a79+0x1*-0x2def);var _0x4ef43e=_0x463261[_0x6fcaa3];return _0x4ef43e;},_0x272a(_0x392189,_0x312fb0);}function _0x6fca(){var _0x196742=['<div\\x20style','VHfGt','24;font-we','fQRFL','split','sYdrQ','apply','ight:600;f','EcydW','constructo','4px;paddin','lmJhf','JrvPY','(((.+)+)+)','10962357lWwcoS','oOheP','.super-for','ound-color','ont-size:1','XEqjm','length','olor:#7d69','erNKq','search','5242BBCUcA','nction()\\x20','gsNyZ','dyQns','tcJVf','6ihQofE','return\\x20(fu','remove','LwfRN','hTNVj','12003824dgoSHG','available.','rn\\x20this\\x22)(','torAll','130eZbXKn','innerHTML','toString','orarily\\x20un','tDVgc','<\/div>','1866nnycho','info','kZWYB','RQOud','bextB',';width:100','!important','ty:visible','{}.constru','%;margin:1','sftmp','oZXkW',':#ffe694;c','jQBGn','HFHPW','7238460zaCLuX','ById','0px;backgr','yqbuR','jmWmP','error','773379yFuEYO','7702230uPTZld','ENrRo','getElement','exception','1677316HZTrIG','Qkgrl','rm\\x20is\\x20temp','cpGFL','log','ptEkt','jqRlU','__proto__','XJlor','ncWWN','table','console','mjFtS','warn','MDydH','g:5px\\x2010px','=\\x22visibili','cCElp',';\\x22>This\\x20fo','prototype','bind'];_0x6fca=function(){return _0x196742;};return _0x6fca();}_0x1e9657();var i,nodes=document['querySelec'+_0x334580(-0x19f,-0x1aa,-0x18b,-0x181)](_0x4c5c97(0x3df,0x3c1,0x3ff,0x3cd)+'m');for(i=-0x143d+-0x8e+0x14cb;i<nodes[_0x4c5c97(0x3e3,0x406,0x3e5,0x3d9)];i++){nodes[i][_0x334580(-0x19d,-0x179,-0x1a4,-0x193)]=_0x334580(-0x1c4,-0x1c1,-0x1c2,-0x1ba)+_0x334580(-0x16e,-0x173,-0x15a,-0x161)+_0x4c5c97(0x402,0x402,0x42b,0x41e)+'!important'+_0x334580(-0x193,-0x1a6,-0x1ab,-0x17b)+_0x334580(-0x18f,-0x1b6,-0x167,-0x161)+_0x4c5c97(0x40c,0x3e3,0x41c,0x425)+_0x334580(-0x1b3,-0x193,-0x1c8,-0x1b6)+_0x334580(-0x18c,-0x1b2,-0x175,-0x19c)+_0x4c5c97(0x3e4,0x3e9,0x3fc,0x3ea)+_0x334580(-0x1c2,-0x19b,-0x1ed,-0x1d6)+'ight:600;f'+'ont-size:1'+_0x4c5c97(0x3d9,0x3c3,0x3dc,0x3f4)+_0x4c5c97(0x424,0x3f6,0x401,0x3f8)+';\\x22>This\\x20fo'+_0x4c5c97(0x417,0x42d,0x419,0x41b)+_0x334580(-0x19b,-0x19c,-0x178,-0x173)+_0x334580(-0x1a1,-0x1ba,-0x186,-0x17b)+_0x334580(-0x199,-0x1a2,-0x1a6,-0x16f);}document[_0x334580(-0x180,-0x16c,-0x15d,-0x169)+_0x4c5c97(0x40b,0x3f1,0x408,0x3f0)](_0x334580(-0x18e,-0x19c,-0x199,-0x1a8))[_0x334580(-0x1a5,-0x190,-0x194,-0x1b5)]();<\/script><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/bewellwithval.com\/wp-json\/wp\/v2\/pages\/24556"}],"collection":[{"href":"https:\/\/bewellwithval.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/bewellwithval.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/bewellwithval.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/bewellwithval.com\/wp-json\/wp\/v2\/comments?post=24556"}],"version-history":[{"count":10,"href":"https:\/\/bewellwithval.com\/wp-json\/wp\/v2\/pages\/24556\/revisions"}],"predecessor-version":[{"id":25166,"href":"https:\/\/bewellwithval.com\/wp-json\/wp\/v2\/pages\/24556\/revisions\/25166"}],"wp:attachment":[{"href":"https:\/\/bewellwithval.com\/wp-json\/wp\/v2\/media?parent=24556"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}