{"id":8804,"date":"2016-04-27T09:45:10","date_gmt":"2016-04-27T09:45:10","guid":{"rendered":"http:\/\/www.medelit.com\/it-en\/?page_id=8804"},"modified":"2026-06-16T16:06:23","modified_gmt":"2026-06-16T14:06:23","slug":"contact-us","status":"publish","type":"page","link":"https:\/\/www.medelit.com\/it-en\/contact-us\/","title":{"rendered":"Contact Us"},"content":{"rendered":"<div class=\"mdl-fullwidth fullwidth-box mdl-builder-row-1 mdl-parallax-none nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mdlb-background-position: left top; --mdlb-padding-top: 120px; --mdlb-padding-bottom: 120px; --mdlb-background-size: cover; --mdlb-flex-wrap: wrap; background-image: url(&quot;https:\/\/www.medelit.com\/it-en\/wp-content\/uploads\/sites\/4\/2016\/02\/Screen-Shot-2016-04-25-at-11.29.33.webp&quot;);\" data-bg=\"https:\/\/www.medelit.com\/it-en\/wp-content\/uploads\/sites\/4\/2016\/02\/Screen-Shot-2016-04-25-at-11.29.33.webp\">\n<div class=\"mdl-row\">\n<div class=\"mdl-layout-column mdl_builder_column mdl_builder_column_1_1\">\n<div class=\"mdl-column-wrapper\">\n<h1 style=\"text-align: center;\"><span style=\" font-size: 55pt; font-family: georgia, palatino, serif;\">CONTACT US<\/span><\/h1>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p style=\"text-align: center;\"><span style=\"font-size: 36pt; font-family: symbol;\">MAKE AN ENQUIRY:<\/span><\/p>\n<p>\u00a0<\/p>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_9' style='display:none'><style>#gform_wrapper_9[data-form-index=\"0\"].gform-theme{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: 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var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-btn-bg-color-hover-tertiary: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_9' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">INFO REQUEST<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_9'  action='\/it-en\/wp-json\/wp\/v2\/pages\/8804#gf_9' data-formid='9' novalidate>\n        <div id='gf_progressbar_wrapper_9' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_9_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_9_13\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_9_13' class='gfield_label gform-field-label' for='input_9_13'><span class='gform-field-label__text'>URL<\/span><\/label><div class='ginput_container'><input name='input_13' id='input_9_13' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_9_13'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_9_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"913c8382\" data-field-span=\"12\"><label id='gfield_label_9_1' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>I AM A<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_1'>\n\t\t\t<li class='gchoice gchoice_9_1_0'>\n\t\t\t\t<input name='input_1' type='radio' value='Returning Patient'  id='choice_9_1_0'    \/>\n\t\t\t\t<label for='choice_9_1_0' id='label_9_1_0' class='gform-field-label gform-field-label--type-inline'>Returning Patient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_1_1'>\n\t\t\t\t<input name='input_1' type='radio' value='New Patient'  id='choice_9_1_1'    \/>\n\t\t\t\t<label for='choice_9_1_1' id='label_9_1_1' class='gform-field-label gform-field-label--type-inline'>New Patient<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_2\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"53223501\" data-field-span=\"12\"><label id='gfield_label_9_2' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_9_2'>\n                            <span id='input_9_2_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >\n                                                    <select name='input_2.2' id='input_9_2_2'    aria-required='false'   aria-labelledby=\"input_9_2_2_label gfield_label_9_2\">\n                          <option value=''><\/option><option value='Dr' >Dr<\/option><option value='Miss' >Miss<\/option><option value='Mr' >Mr<\/option><option value='Mrs' >Mrs<\/option><option value='Ms' >Ms<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_9_2_2' id='input_9_2_2_label' class='gform-field-label gform-field-label--type-sub '>Prefix<\/label>\n                                                  <\/span>\n                            <span id='input_9_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_9_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_9_2_3' id='input_9_2_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_9_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_9_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_9_2_6' id='input_9_2_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_9_3\" class=\"gfield gfield--type-phone gfield--phone-format-international gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"50c9c4ff\" data-field-span=\"12\"><label id='gfield_label_9_3' class='gfield_label gform-field-label' for='input_9_3'><span class='gform-field-label__text'>Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_9_3' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/li><li id=\"field_9_9\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"e29571a8\" data-field-span=\"12\"><label id='gfield_label_9_9' class='gfield_label gform-field-label' for='input_9_9'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_9_9' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_9_8' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_2' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_9_2' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_9_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"88a7aa03\" data-field-span=\"12\"><label id='gfield_label_9_4' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>In am Enquiring about a<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_4'>\n\t\t\t<li class='gchoice gchoice_9_4_0'>\n\t\t\t\t<input name='input_4' type='radio' value='Home Visit'  id='choice_9_4_0'    \/>\n\t\t\t\t<label for='choice_9_4_0' id='label_9_4_0' class='gform-field-label gform-field-label--type-inline'>Home Visit<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_4_1'>\n\t\t\t\t<input name='input_4' type='radio' value='Online Consultation'  id='choice_9_4_1'    \/>\n\t\t\t\t<label for='choice_9_4_1' id='label_9_4_1' class='gform-field-label gform-field-label--type-inline'>Online Consultation<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"db4bed8b\" data-field-span=\"12\"><label id='gfield_label_9_5' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Please select the Home Visit you are interested in:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_5'>\n\t\t\t<li class='gchoice gchoice_9_5_0'>\n\t\t\t\t<input name='input_5' type='radio' value='General Practice'  id='choice_9_5_0'    \/>\n\t\t\t\t<label for='choice_9_5_0' id='label_9_5_0' class='gform-field-label gform-field-label--type-inline'>General Practice<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_1'>\n\t\t\t\t<input name='input_5' type='radio' value='Specialistic Medicine'  id='choice_9_5_1'    \/>\n\t\t\t\t<label for='choice_9_5_1' id='label_9_5_1' class='gform-field-label gform-field-label--type-inline'>Specialistic Medicine<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_2'>\n\t\t\t\t<input name='input_5' type='radio' value='COVID 19 Test'  id='choice_9_5_2'    \/>\n\t\t\t\t<label for='choice_9_5_2' id='label_9_5_2' class='gform-field-label gform-field-label--type-inline'>COVID 19 Test<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_3'>\n\t\t\t\t<input name='input_5' type='radio' value='Blood Test'  id='choice_9_5_3'    \/>\n\t\t\t\t<label for='choice_9_5_3' id='label_9_5_3' class='gform-field-label gform-field-label--type-inline'>Blood Test<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_4'>\n\t\t\t\t<input name='input_5' type='radio' value='Nursing Care'  id='choice_9_5_4'    \/>\n\t\t\t\t<label for='choice_9_5_4' id='label_9_5_4' class='gform-field-label gform-field-label--type-inline'>Nursing Care<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_5'>\n\t\t\t\t<input name='input_5' type='radio' value='Physiotherapy'  id='choice_9_5_5'    \/>\n\t\t\t\t<label for='choice_9_5_5' id='label_9_5_5' class='gform-field-label gform-field-label--type-inline'>Physiotherapy<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_6'>\n\t\t\t\t<input name='input_5' type='radio' value='Speech Therapy'  id='choice_9_5_6'    \/>\n\t\t\t\t<label for='choice_9_5_6' id='label_9_5_6' class='gform-field-label gform-field-label--type-inline'>Speech Therapy<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_7'>\n\t\t\t\t<input name='input_5' type='radio' value='Psychology'  id='choice_9_5_7'    \/>\n\t\t\t\t<label for='choice_9_5_7' id='label_9_5_7' class='gform-field-label gform-field-label--type-inline'>Psychology<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_8'>\n\t\t\t\t<input name='input_5' type='radio' value='Dentistry'  id='choice_9_5_8'    \/>\n\t\t\t\t<label for='choice_9_5_8' id='label_9_5_8' class='gform-field-label gform-field-label--type-inline'>Dentistry<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_9'>\n\t\t\t\t<input name='input_5' type='radio' value='Midwifery'  id='choice_9_5_9'    \/>\n\t\t\t\t<label for='choice_9_5_9' id='label_9_5_9' class='gform-field-label gform-field-label--type-inline'>Midwifery<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_10'>\n\t\t\t\t<input name='input_5' type='radio' value='Podiatry'  id='choice_9_5_10'    \/>\n\t\t\t\t<label for='choice_9_5_10' id='label_9_5_10' class='gform-field-label gform-field-label--type-inline'>Podiatry<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_11'>\n\t\t\t\t<input name='input_5' type='radio' value='Caregiver'  id='choice_9_5_11'    \/>\n\t\t\t\t<label for='choice_9_5_11' id='label_9_5_11' class='gform-field-label gform-field-label--type-inline'>Caregiver<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_12'>\n\t\t\t\t<input name='input_5' type='radio' value='Diagnostic Service (Scan, EKG, etc)'  id='choice_9_5_12'    \/>\n\t\t\t\t<label for='choice_9_5_12' id='label_9_5_12' class='gform-field-label gform-field-label--type-inline'>Diagnostic Service (Scan, EKG, etc)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_5_13'>\n\t\t\t\t<input name='input_5' type='radio' value='Other'  id='choice_9_5_13'    \/>\n\t\t\t\t<label for='choice_9_5_13' id='label_9_5_13' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"5a067766\" data-field-span=\"12\"><label id='gfield_label_9_7' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Which Online Service are you Enquiring about?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_7'>\n\t\t\t<li class='gchoice gchoice_9_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='General Practice'  id='choice_9_7_0'    \/>\n\t\t\t\t<label for='choice_9_7_0' id='label_9_7_0' class='gform-field-label gform-field-label--type-inline'>General Practice<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='Specialistic Medicine'  id='choice_9_7_1'    \/>\n\t\t\t\t<label for='choice_9_7_1' id='label_9_7_1' class='gform-field-label gform-field-label--type-inline'>Specialistic Medicine<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_7_2'>\n\t\t\t\t<input name='input_7' type='radio' value='Speech &amp; Language Therapy'  id='choice_9_7_2'    \/>\n\t\t\t\t<label for='choice_9_7_2' id='label_9_7_2' class='gform-field-label gform-field-label--type-inline'>Speech &amp; Language Therapy<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_7_3'>\n\t\t\t\t<input name='input_7' type='radio' value='Psychology'  id='choice_9_7_3'    \/>\n\t\t\t\t<label for='choice_9_7_3' id='label_9_7_3' class='gform-field-label gform-field-label--type-inline'>Psychology<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_7_4'>\n\t\t\t\t<input name='input_7' type='radio' value='Physiotherapy'  id='choice_9_7_4'    \/>\n\t\t\t\t<label for='choice_9_7_4' id='label_9_7_4' class='gform-field-label gform-field-label--type-inline'>Physiotherapy<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_7_5'>\n\t\t\t\t<input name='input_7' type='radio' value='Midwifery'  id='choice_9_7_5'    \/>\n\t\t\t\t<label for='choice_9_7_5' id='label_9_7_5' class='gform-field-label gform-field-label--type-inline'>Midwifery<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_6\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"65d20c41\" data-field-span=\"12\"><label id='gfield_label_9_6' class='gfield_label gform-field-label' for='input_9_6'><span class='gform-field-label__text'>Which Specialist do you need to see?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_9_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_9_10\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a6984656\" data-field-span=\"12\"><label id='gfield_label_9_10' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>At what Address do you Need the Visit?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_9_10' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_9_10_1_container' >\n                                        <input type='text' name='input_10.1' id='input_9_10_1' value=''    aria-required='true'    aria-labelledby=\"input_9_10_1_label gfield_label_9_10\"\/>\n                                        <label for='input_9_10_1' id='input_9_10_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_9_10_3_container' >\n                                    <input type='text' name='input_10.3' id='input_9_10_3' value=''    aria-required='true'    \/>\n                                    <label for='input_9_10_3' id='input_9_10_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_10.4' id='input_9_10_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_9_10_5_container' >\n                                    <input type='text' name='input_10.5' id='input_9_10_5' value=''    aria-required='true'    \/>\n                                    <label for='input_9_10_5' id='input_9_10_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_9_10_6_container' >\n                                        <select name='input_10.6' id='input_9_10_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >\u00c5land Islands<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='CV' >Cape Verde<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' selected='selected'>Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom<\/option><option value='US' >United States<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_9_10_6' id='input_9_10_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><input type=\"hidden\" name=\"gpaa_place_10\" class=\"gform_hidden\" value=\"\"><\/li><li id=\"field_9_12\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5fc21750\" data-field-span=\"12\"><label id='gfield_label_9_12' class='gfield_label gform-field-label' for='input_9_12'><span class='gform-field-label__text'>Your enquiry<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_12' id='input_9_12' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_9_11\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"f2ef1a3a\" data-field-span=\"12\"><label id='gfield_label_9_11' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Consent<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_11.1' id='input_9_11_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_9_11\" aria-labelledby=\"input_9_11_1_label gfield_label_9_11\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label id='input_9_11_1_label' class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_9_11_1' ><span class='gform-field-label__text'>I agree to the privacy policy.<\/span><\/label><input type='hidden' name='input_11.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_11.3' value='3' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_9_11'><div class='gfield_consent_description_text gform-theme__no-reset--children' tabindex='0'>By selecting you are confirming that you have read and accepted our privacy policy in regards to treatment of your data.<\/div><\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_9' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='submit' id='gform_submit_button_9' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_9' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_9' id='gform_theme_9' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_9' id='gform_style_settings_9' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='9' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='EUR' value='2LEg17ycnB+PGgRUtZAQedjsL6CZa3UKKohmYtijQboZHe4TueuTy\/NgbZA8QufuhLp09jHrCSTwHj267fQ6vSGtaQnrrypbxDrdvRX94P2YKF0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_9' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div>\n<p style=\"text-align: center;\"><span style=\"font-size: 36pt; font-family: georgia, palatino, serif;\">BOOK A HOME VISIT:<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"\">The house call will be delivered, according to your requests, at your <strong>home, hotel room, office or any other adequate location you consider comfortable<\/strong>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"\">We offer home visits in the cities of <b>Milan, Turin, Genoa, Florence, Rome, Cagliari <\/b>and<b> Naples<\/b> but many of our healthcare professionals are also available for the hinterland of cities.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"\">If you need a house call in the hinterland call us and we will do our best to help you.<\/span><\/p>\n<p><span style=\"\">Booking a house call with a MEDELIT healthcare Professional is very easy.<\/span><\/p>\n<p><span style=\"\">You can fix an appointment directly:<\/span><\/p>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_21' style='display:none'><style>#gform_wrapper_21[data-form-index=\"0\"].gform-theme{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-btn-bg-color-hover-tertiary: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_21' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_21' id='gform_21'  action='\/it-en\/wp-json\/wp\/v2\/pages\/8804#gf_21' data-formid='21' novalidate><input type=\"hidden\" name=\"gpuid_existing_value_24\" id=\"gpuid_existing_value_24\" value=\"7e3e2dc7086e13f14d146a36118ef35a\" \/><input type=\"hidden\" name=\"gpuid_existing_value_50\" id=\"gpuid_existing_value_50\" value=\"7e3e2dc7086e13f14d146a36118ef35a\" \/>\n                        <div class='gform-body gform_body'><div id='gform_page_21_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_21' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_21_198\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_21_198' class='gfield_label gform-field-label' for='input_21_198'><span class='gform-field-label__text'>X\/Twitter<\/span><\/label><div class='ginput_container'><input name='input_198' id='input_21_198' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_21_198'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_21_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"3feb2f7e\" data-field-span=\"12\"><legend id='gfield_label_21_25' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>What would you like to book?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_25'>\n\t\t\t<div class='gchoice gchoice_21_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='A DOMICILIO'  id='choice_21_25_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_21_25_0 gfield_label_21_25\"   \/>\n\t\t\t\t\t<label for='choice_21_25_0' id='label_21_25_0' class='gform-field-label gform-field-label--type-inline'>HOME VISIT<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='In VIDEOCONSULENZA'  id='choice_21_25_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_21_25_1' id='label_21_25_1' class='gform-field-label gform-field-label--type-inline'>VIDEO CONSULTATION<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_60\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"4f4841a7\" data-field-span=\"12\"><label id='gfield_label_21_60' class='gfield_label gform-field-label' for='input_21_60'><span class='gform-field-label__text'>incomingurl<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_21_60' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"94165bc9\" data-field-span=\"12\"><label id='gfield_label_21_28' class='gfield_label gform-field-label' for='input_21_28'><span class='gform-field-label__text'>actualurl<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_21_28' type='text' value='https:\/\/www.medelit.com\/it-en\/wp-json\/wp\/v2\/pages\/8804' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_61\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"e2beb877\" data-field-span=\"12\"><label id='gfield_label_21_61' class='gfield_label gform-field-label' for='input_21_61'><span class='gform-field-label__text'>full url<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_21_61' type='text' value='https:\/\/www.medelit.com\/it-en\/wp-json\/wp\/v2\/pages\/8804' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"f4c51e3d\" data-field-span=\"12\"><label id='gfield_label_21_43' class='gfield_label gform-field-label' for='input_21_43'><span class='gform-field-label__text'>Returning PT ID<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_21_43' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"cf94c778\" data-field-span=\"12\"><label id='gfield_label_21_58' class='gfield_label gform-field-label' for='input_21_58'><span class='gform-field-label__text'>SERV TYPE<\/span><\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_58' id='input_21_58' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_62\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"895e6e4e\" data-field-span=\"12\"><label id='gfield_label_21_62' class='gfield_label gform-field-label' for='input_21_62'><span class='gform-field-label__text'>FIELD<\/span><\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_62' id='input_21_62' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_63\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"1c6c9d02\" data-field-span=\"12\"><label id='gfield_label_21_63' class='gfield_label gform-field-label' for='input_21_63'><span class='gform-field-label__text'>SUBFIELD<\/span><\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_63' id='input_21_63' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"542e307f\" data-field-span=\"12\"><label id='gfield_label_21_54' class='gfield_label gform-field-label' for='input_21_54'><span class='gform-field-label__text'>NEW\/RETURNING PT @new_returning<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_21_54' type='text' value='Di Ritorno' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_21_196' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_2' class='gform_page' data-js='page-field-id-196' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_2' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_21_193\" class=\"gfield gfield--type-html medelit-gw-search-mount gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><div id=\"medelit-gw-search\" data-medelit-gw=\"search\"><\/div><\/div><div id=\"field_21_191\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label_21_191' class='gfield_label gform-field-label' for='input_21_191'><span class='gform-field-label__text'>GW SELECTED SERVCODE<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_191' id='input_21_191' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_192\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label_21_192' class='gfield_label gform-field-label' for='input_21_192'><span class='gform-field-label__text'>GW SELECTED SERVICE NAME<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_192' id='input_21_192' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_21_197' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_21_197' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_3' class='gform_page' data-js='page-field-id-197' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_3' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><fieldset id=\"field_21_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"454e73e4\" data-field-span=\"12\"><legend id='gfield_label_21_19' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you a new or a returning patient?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_19'>\n\t\t\t<div class='gchoice gchoice_21_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Nuovo'  id='choice_21_19_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_21_19_0 gfield_label_21_19\"   \/>\n\t\t\t\t\t<label for='choice_21_19_0' id='label_21_19_0' class='gform-field-label gform-field-label--type-inline'>New patient<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Di Ritorno'  id='choice_21_19_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_21_19_1' id='label_21_19_1' class='gform-field-label gform-field-label--type-inline'>Returning patient<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f9cc38f8\" data-field-span=\"12\"><label id='gfield_label_21_42' class='gfield_label gform-field-label' for='input_21_42'><span class='gform-field-label__text'>CODICE FISCALE (Italian tax code)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_21_42' type='text' value='' class='large'  aria-describedby=\"gfield_description_21_42\"  placeholder='aaaaaa99a99a999a' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"aaaaaa99a99a999a\"\/><\/div><div class='gfield_description' id='gfield_description_21_42'>Or tick the box below if you do not have an Italian tax code.<\/div><\/div><fieldset id=\"field_21_194\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><legend id='gfield_label_21_194' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>I do not have an Italian tax code (Codice Fiscale)<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_21_194'><div class='gchoice gchoice_21_194_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_194.1' type='checkbox'  value='Y'  id='choice_21_194_1'    aria-labelledby=\"label_21_194_1 gfield_label_21_194\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_21_194_1' id='label_21_194_1' class='gform-field-label gform-field-label--type-inline'>I do not have an Italian tax code (Codice Fiscale) \u2014 find me by email<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_21_195\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_21_195' class='gfield_label gform-field-label' for='input_21_195'><span class='gform-field-label__text'>EMAIL ADDRESS used for your previous bookings<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_195' id='input_21_195' type='email' value='' class='large'   placeholder='name@example.com' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_21_195\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_21_195'>We will look you up by this email address. If we cannot find you, please choose \"New patient\".<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_21_69' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_21_69' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_4' class='gform_page' data-js='page-field-id-69' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_4' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_21_56\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"773616a0\" data-field-span=\"12\"><p style=\"text-align: justify; font-size: 18px; color: #CA1517;\">\n    No patient found on our system - Please check that you have entered your CODICE FISCALE (or the email address used for your previous bookings) correctly and selected the right option under New \/ Returning patient\n<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_21_68' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_21_68' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_5' class='gform_page' data-js='page-field-id-68' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_5' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><fieldset id=\"field_21_45\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"60ac0634\" data-field-span=\"12\"><legend id='gfield_label_21_45' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the visit address the same as last time?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_21_45'>\n\t\t\t<div class='gchoice gchoice_21_45_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='SI'  id='choice_21_45_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_21_45_0 gfield_label_21_45\"   \/>\n\t\t\t\t\t<label for='choice_21_45_0' id='label_21_45_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_21_45_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='NO \/ NON SONO SICURO\/A'  id='choice_21_45_1' onchange='gformToggleRadioOther( this )'     \/>\n\t\t\t\t\t<label for='choice_21_45_1' id='label_21_45_1' class='gform-field-label gform-field-label--type-inline'>NO \/ NOT SURE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_21_48\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"1160782f\" data-field-span=\"12\"><legend id='gfield_label_21_48' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>RETURNING PT SYSTEM VISIT ADDRESS<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_21_48' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_48_1_container' >\n                                        <input type='text' name='input_48.1' id='input_21_48_1' value=''    aria-required='true'    aria-labelledby=\"input_21_48_1_label gfield_label_21_48\"\/>\n                                        <label for='input_21_48_1' id='input_21_48_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_48_3_container' >\n                                    <input type='text' name='input_48.3' id='input_21_48_3' value=''    aria-required='true'    \/>\n                                    <label for='input_21_48_3' id='input_21_48_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_21_48_4_container' >\n                                        <input type='text' name='input_48.4' id='input_21_48_4' value=''      aria-required='true'    \/>\n                                        <label for='input_21_48_4' id='input_21_48_4_label' class='gform-field-label gform-field-label--type-sub '>County \/ State \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_21_48_5_container' >\n                                    <input type='text' name='input_48.5' id='input_21_48_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_48_5' id='input_21_48_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_21_48_6_container' >\n                                        <select name='input_48.6' id='input_21_48_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >\u00c5land Islands<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='CV' >Cape Verde<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom<\/option><option value='US' >United States<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_21_48_6' id='input_21_48_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_21_55' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_21_55' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_6' class='gform_page' data-js='page-field-id-55' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_6' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><fieldset id=\"field_21_15\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"fb03d56d\" data-field-span=\"12\"><legend id='gfield_label_21_15' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>VISIT ADDRESS<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_21_15' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_15_1_container' >\n                                        <input type='text' name='input_15.1' id='input_21_15_1' value=''   placeholder='Type the visit address here' aria-required='true'    aria-labelledby=\"input_21_15_1_label gfield_label_21_15\"\/>\n                                        <label for='input_21_15_1' id='input_21_15_1_label' class='gform-field-label gform-field-label--type-sub '>Street\/Square\/Avenue and HOUSE NUMBER<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_15_3_container' >\n                                    <input type='text' name='input_15.3' id='input_21_15_3' value=''    aria-required='true'    \/>\n                                    <label for='input_21_15_3' id='input_21_15_3_label' class='gform-field-label gform-field-label--type-sub '>Visit town<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_21_15_4_container' >\n                                        <input type='text' name='input_15.4' id='input_21_15_4' value=''      aria-required='true'    \/>\n                                        <label for='input_21_15_4' id='input_21_15_4_label' class='gform-field-label gform-field-label--type-sub '>Visit province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_21_15_5_container' >\n                                    <input type='text' name='input_15.5' id='input_21_15_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_15_5' id='input_21_15_5_label' class='gform-field-label gform-field-label--type-sub '>Visit postcode<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_21_15_6_container' >\n                                        <select name='input_15.6' id='input_21_15_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >\u00c5land Islands<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='CV' >Cape Verde<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' selected='selected'>Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom<\/option><option value='US' >United States<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_21_15_6' id='input_21_15_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><input type=\"hidden\" name=\"gpaa_place_15\" class=\"gform_hidden\" value=\"\"><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_21_81' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_21_81' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_7' class='gform_page' data-js='page-field-id-81' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_7' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><fieldset id=\"field_21_47\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"1454a830\" data-field-span=\"12\"><legend id='gfield_label_21_47' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>CURRENT VISIT ADDRESS<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_21_47' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_47_1_container' >\n                                        <input type='text' name='input_47.1' id='input_21_47_1' value=''    aria-required='true'    aria-labelledby=\"input_21_47_1_label gfield_label_21_47\"\/>\n                                        <label for='input_21_47_1' id='input_21_47_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_47_3_container' >\n                                    <input type='text' name='input_47.3' id='input_21_47_3' value=''    aria-required='true'    \/>\n                                    <label for='input_21_47_3' id='input_21_47_3_label' class='gform-field-label gform-field-label--type-sub '>Town\/City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_47.4' id='input_21_47_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_47_5_container' >\n                                    <input type='text' name='input_47.5' id='input_21_47_5' value=''    aria-required='true'    \/>\n                                    <label for='input_21_47_5' id='input_21_47_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_21_47_6_container' >\n                                        <select name='input_47.6' id='input_21_47_6'   aria-required='true'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='AX' >\u00c5land Islands<\/option><option value='AL' >Albania<\/option><option value='DZ' >Algeria<\/option><option value='AS' >American Samoa<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctica<\/option><option value='AG' >Antigua and Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaijan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahrain<\/option><option value='BD' >Bangladesh<\/option><option value='BB' >Barbados<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgium<\/option><option value='BZ' >Belize<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermuda<\/option><option value='BT' >Bhutan<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, Sint Eustatius and Saba<\/option><option value='BA' >Bosnia and Herzegovina<\/option><option value='BW' >Botswana<\/option><option value='BV' >Bouvet Island<\/option><option value='BR' >Brazil<\/option><option value='IO' >British Indian Ocean Territory<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodia<\/option><option value='CM' >Cameroon<\/option><option value='CA' >Canada<\/option><option value='CV' >Cape Verde<\/option><option value='KY' >Cayman Islands<\/option><option value='CF' >Central African Republic<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Christmas Island<\/option><option value='CC' >Cocos Islands<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoros<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Democratic Republic of the<\/option><option value='CK' >Cook Islands<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='HR' >Croatia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='CY' >Cyprus<\/option><option value='CZ' >Czechia<\/option><option value='DK' >Denmark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Dominican Republic<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egypt<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Equatorial Guinea<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Eswatini<\/option><option value='ET' >Ethiopia<\/option><option value='FK' >Falkland Islands<\/option><option value='FO' >Faroe Islands<\/option><option value='FJ' >Fiji<\/option><option value='FI' >Finland<\/option><option value='FR' >France<\/option><option value='GF' >French Guiana<\/option><option value='PF' >French Polynesia<\/option><option value='TF' >French Southern Territories<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Germany<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Greece<\/option><option value='GL' >Greenland<\/option><option value='GD' >Grenada<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bissau<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Heard Island and McDonald Islands<\/option><option value='VA' >Holy See<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungary<\/option><option value='IS' >Iceland<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Iraq<\/option><option value='IE' >Ireland<\/option><option value='IM' >Isle of Man<\/option><option value='IL' >Israel<\/option><option value='IT' selected='selected'>Italy<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Japan<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordan<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Korea, Democratic People&#039;s Republic of<\/option><option value='KR' >Korea, Republic of<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kyrgyzstan<\/option><option value='LA' >Lao People&#039;s Democratic Republic<\/option><option value='LV' >Latvia<\/option><option value='LB' >Lebanon<\/option><option value='LS' >Lesotho<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libya<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lithuania<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malawi<\/option><option value='MY' >Malaysia<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Marshall Islands<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauritius<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexico<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldova<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Morocco<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Netherlands<\/option><option value='NC' >New Caledonia<\/option><option value='NZ' >New Zealand<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Norfolk Island<\/option><option value='MK' >North Macedonia<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='NO' >Norway<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PS' >Palestine, State of<\/option><option value='PA' >Panama<\/option><option value='PG' >Papua New Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Philippines<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Poland<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Qatar<\/option><option value='RE' >R\u00e9union<\/option><option value='RO' >Romania<\/option><option value='RU' >Russian Federation<\/option><option value='RW' >Rwanda<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='SH' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='KN' >Saint Kitts and Nevis<\/option><option value='LC' >Saint Lucia<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre and Miquelon<\/option><option value='VC' >Saint Vincent and the Grenadines<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Sao Tome and Principe<\/option><option value='SA' >Saudi Arabia<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapore<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovakia<\/option><option value='SI' >Slovenia<\/option><option value='SB' >Solomon Islands<\/option><option value='SO' >Somalia<\/option><option value='ZA' >South Africa<\/option><option value='GS' >South Georgia and the South Sandwich Islands<\/option><option value='SS' >South Sudan<\/option><option value='ES' >Spain<\/option><option value='LK' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Suriname<\/option><option value='SJ' >Svalbard and Jan Mayen<\/option><option value='SE' >Sweden<\/option><option value='CH' >Switzerland<\/option><option value='SY' >Syria Arab Republic<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tajikistan<\/option><option value='TZ' >Tanzania, the United Republic of<\/option><option value='TH' >Thailand<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad and Tobago<\/option><option value='TN' >Tunisia<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Turks and Caicos Islands<\/option><option value='TV' >Tuvalu<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ukraine<\/option><option value='AE' >United Arab Emirates<\/option><option value='GB' >United Kingdom<\/option><option value='US' >United States<\/option><option value='UY' >Uruguay<\/option><option value='UM' >US Minor Outlying Islands<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >Virgin Islands, British<\/option><option value='VI' >Virgin Islands, U.S.<\/option><option value='WF' >Wallis and Futuna<\/option><option value='EH' >Western Sahara<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_21_47_6' id='input_21_47_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><input type=\"hidden\" name=\"gpaa_place_47\" class=\"gform_hidden\" value=\"\"><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_21_79' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Go back<\/button> <button type='button' id='gform_next_button_21_79' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_21_8' class='gform_page' data-js='page-field-id-79' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_21_8' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_21_59\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"eb64c49c\" data-field-span=\"12\"><label id='gfield_label_21_59' class='gfield_label gform-field-label' for='input_21_59'><span class='gform-field-label__text'>Video placeholder address<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_21_59' type='text' value='XXXXVID' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"9362f0fa\" data-field-span=\"12\"><label id='gfield_label_21_37' class='gfield_label gform-field-label' for='input_21_37'><span class='gform-field-label__text'>servcode<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_21_37' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_80\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"8c577d9e\" data-field-span=\"12\"><label id='gfield_label_21_80' class='gfield_label gform-field-label' for='input_21_80'><span class='gform-field-label__text'>YOU HAVE SELECTED THE SERVICE:<\/span><\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_80' id='input_21_80' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_24\" class=\"gfield gfield--type-uid gfield--input-type-uid gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"12d4f624\" data-field-span=\"12\"><label id='gfield_label_21_24' class='gfield_label gform-field-label' for='input_21_24'><span class='gform-field-label__text'>cnn<\/span><\/label><div class='ginput_container ginput_container_hidden'><input name='input_24' id='input_21_24' type='hidden' value=''  \/><\/div><\/div><div id=\"field_21_50\" class=\"gfield gfield--type-uid gfield--input-type-uid gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"771dddea\" data-field-span=\"12\"><label id='gfield_label_21_50' class='gfield_label gform-field-label' for='input_21_50'><span class='gform-field-label__text'>PATIENT ID<\/span><\/label><div class='ginput_container ginput_container_hidden'><input name='input_50' id='input_21_50' type='hidden' value=''  \/><\/div><\/div><div id=\"field_21_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"f9a27dee\" data-field-span=\"12\"><label id='gfield_label_21_40' class='gfield_label gform-field-label' for='input_21_40'><span class='gform-field-label__text'>CONNECTED SERVICES servocde<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_21_40' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"2cb207b8\" data-field-span=\"12\"><label id='gfield_label_21_38' class='gfield_label gform-field-label' for='input_21_38'><span class='gform-field-label__text'>CONNECTED VIDEO servcode<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_21_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_21_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"bf1065ea\" data-field-span=\"12\"><label id='gfield_label_21_32' class='gfield_label 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s=document.createElement(\"script\");s.src=\"https:\/\/challenges.cloudflare.com\/turnstile\/v0\/api.js?render=explicit\";s.async=true;s.defer=true;s.onload=function(){window.medelitTsRender()};document.head.appendChild(s)};var E=[\"pointerdown\",\"touchstart\",\"keydown\",\"mousemove\",\"wheel\"],H=function(){E.forEach(function(e){removeEventListener(e,H,true)});L()};E.forEach(function(e){addEventListener(e,H,{capture:true,passive:true})});}<\/script>\n<p style=\"text-align: center;\"><span style=\"font-size: 36pt; font-family: georgia, palatino, serif;\">TERMS AND CONDITIONS<\/span><\/p>\n<div class=\"accordian mdl-accordian\" style=\"--mdlb-border-size:1px;--mdlb-icon-size:13px;--mdlb-content-font-size:16px;--mdlb-icon-alignment:left;--mdlb-hover-color:#f9f9f9;--mdlb-border-color:#cccccc;--mdlb-background-color:#ffffff;--mdlb-divider-color:#e0dede;--mdlb-divider-hover-color:#e0dede;--mdlb-icon-color:#ffffff;--mdlb-title-color:#ca1517;--mdlb-content-color:#000000;--mdlb-icon-box-color:#333333;--mdlb-toggle-hover-accent-color:#ca1517;--mdlb-title-font-family:&quot;Raleway&quot;;--mdlb-title-font-weight:400;--mdlb-title-font-style:normal;--mdlb-title-font-size:13px;--mdlb-content-font-family:&quot;Raleway&quot;;--mdlb-content-font-style:normal;--mdlb-content-font-weight:200;\">\n<div class=\"panel-group mdl-toggle-icon-boxed\" id=\"accordion-8804-1\">\n<div class=\"mdl-panel panel-default panel-8bdd27f9a1b2c3d4 mdl-toggle-has-divider\">\n<div class=\"panel-heading\">\n<h4 class=\"panel-title toggle\" id=\"toggle_8bdd27f9a1b2c3d4\"><a aria-expanded=\"false\" aria-controls=\"8bdd27f9a1b2c3d4\" role=\"button\" data-toggle=\"collapse\" data-parent=\"#accordion-8804-1\" data-target=\"#8bdd27f9a1b2c3d4\" href=\"#8bdd27f9a1b2c3d4\"><span class=\"mdl-toggle-icon-wrapper\" aria-hidden=\"true\"><i class=\"fa-mdl-box active-icon mdlb-icon-minus\" aria-hidden=\"true\"><\/i><i class=\"fa-mdl-box inactive-icon mdlb-icon-plus\" aria-hidden=\"true\"><\/i><\/span><span class=\"mdl-toggle-heading\">PAYMENT METHODS<\/span><\/a><\/h4>\n<\/div>\n<div id=\"8bdd27f9a1b2c3d4\" class=\"panel-collapse collapse\" aria-labelledby=\"toggle_8bdd27f9a1b2c3d4\">\n<div class=\"panel-body toggle-content mdl-clearfix\">Payment can be made by:<\/p>\n<p>CREDIT CARD:<br \/> By phone, fax or email at the moment of your booking. Your credit card information will be retained securely and will not be billed until after the consultation has taken place.<\/p>\n<p>BANK TRANSFER:<br \/> Your booking will be confirmed upon arrival of your payment receipt.<\/p>\n<p>Bank account details:<\/p>\n<p>MEDELIT SRL<br \/> Banca Fideuram<br \/> SWIFT: FIBKITMM<br \/> Iban: IT77 P032 9601 6010 0006 4346 868<\/p>\n<p style=\"text-align: justify;\">T\/T and Credit Card payment will allow us to offer a discount on the price of the consultation thanks to the direct method of payment.<\/p>\n<p style=\"text-align: justify;\">Your invoice will be sent by mail at the address you will leave us at the moment of booking. If requested, we can also send a copy of your invoice by email (pdf).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mdl-panel panel-default panel-8bdd27faa1b2c3d4 mdl-toggle-has-divider\">\n<div class=\"panel-heading\">\n<h4 class=\"panel-title toggle\" id=\"toggle_8bdd27faa1b2c3d4\"><a aria-expanded=\"false\" aria-controls=\"8bdd27faa1b2c3d4\" role=\"button\" data-toggle=\"collapse\" data-parent=\"#accordion-8804-1\" data-target=\"#8bdd27faa1b2c3d4\" href=\"#8bdd27faa1b2c3d4\"><span class=\"mdl-toggle-icon-wrapper\" aria-hidden=\"true\"><i class=\"fa-mdl-box active-icon mdlb-icon-minus\" aria-hidden=\"true\"><\/i><i class=\"fa-mdl-box inactive-icon mdlb-icon-plus\" aria-hidden=\"true\"><\/i><\/span><span class=\"mdl-toggle-heading\">PRICES AND DISCOUNTS<\/span><\/a><\/h4>\n<\/div>\n<div id=\"8bdd27faa1b2c3d4\" class=\"panel-collapse collapse\" aria-labelledby=\"toggle_8bdd27faa1b2c3d4\">\n<div class=\"panel-body toggle-content mdl-clearfix\">\n<div style=\"text-align: justify;\">The costs for a house call are not significantly higher than those requested on average for a consultation in a private clinic or doctor\u2019s office.<\/div>\n<p style=\"text-align: justify;\">The fee is adjusted only so as to ensure coverage for the healthcare professional\u2019s transfer and is equivalent to the costs of taking a cab in the city.<\/p>\n<p style=\"text-align: justify;\">Medelit also provides many forfeit and discounted services.<\/p>\n<p style=\"text-align: justify;\">Call us or send us an email to request further information. We will supply you with information on the best solution available according to your needs.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mdl-panel panel-default panel-8bdd27fba1b2c3d4 mdl-toggle-has-divider\">\n<div class=\"panel-heading\">\n<h4 class=\"panel-title toggle\" id=\"toggle_8bdd27fba1b2c3d4\"><a aria-expanded=\"false\" aria-controls=\"8bdd27fba1b2c3d4\" role=\"button\" data-toggle=\"collapse\" data-parent=\"#accordion-8804-1\" data-target=\"#8bdd27fba1b2c3d4\" href=\"#8bdd27fba1b2c3d4\"><span class=\"mdl-toggle-icon-wrapper\" aria-hidden=\"true\"><i class=\"fa-mdl-box active-icon mdlb-icon-minus\" aria-hidden=\"true\"><\/i><i class=\"fa-mdl-box inactive-icon mdlb-icon-plus\" aria-hidden=\"true\"><\/i><\/span><span class=\"mdl-toggle-heading\">CANCELLATION POLICY<\/span><\/a><\/h4>\n<\/div>\n<div id=\"8bdd27fba1b2c3d4\" class=\"panel-collapse collapse\" aria-labelledby=\"toggle_8bdd27fba1b2c3d4\">\n<div class=\"panel-body toggle-content mdl-clearfix\">\n<div style=\"text-align: justify;\">No cancellation fee will be applied if you cancel your appointment more than 24 hours before the scheduled time.<\/div>\n<p style=\"text-align: justify;\">If you payed by credit card we will simply not proceed in billing; if you payed in advance through T\/T we will transfer the money back to you (excluding bank costs).<\/p>\n<p style=\"text-align: justify;\">A 50% cancellation fee will be applied if you cancel your confirmed appointment between 24 hours and 1 hour before the scheduled time of your appointment.<\/p>\n<p style=\"text-align: justify;\">Please note that Medelit will not apply any reimbursement in the absence of a request for cancellation or when this is communicated to us at less than an hour from the scheduled appointment.<\/p>\n<p style=\"text-align: justify;\">Full payment will be required in these cases, and this includes cash payments which will have to be fully provided either by sending the cash through secured mail or through a bank transfer or credit card payment.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mdl-panel panel-default panel-8bdd27fca1b2c3d4 mdl-toggle-has-divider\">\n<div class=\"panel-heading\">\n<h4 class=\"panel-title toggle\" id=\"toggle_8bdd27fca1b2c3d4\"><a aria-expanded=\"false\" aria-controls=\"8bdd27fca1b2c3d4\" role=\"button\" data-toggle=\"collapse\" data-parent=\"#accordion-8804-1\" data-target=\"#8bdd27fca1b2c3d4\" href=\"#8bdd27fca1b2c3d4\"><span class=\"mdl-toggle-icon-wrapper\" aria-hidden=\"true\"><i class=\"fa-mdl-box active-icon mdlb-icon-minus\" aria-hidden=\"true\"><\/i><i class=\"fa-mdl-box inactive-icon mdlb-icon-plus\" aria-hidden=\"true\"><\/i><\/span><span class=\"mdl-toggle-heading\">HOW TO CONTACT US FOR APPOINTMENT CHANGES<\/span><\/a><\/h4>\n<\/div>\n<div id=\"8bdd27fca1b2c3d4\" class=\"panel-collapse collapse\" aria-labelledby=\"toggle_8bdd27fca1b2c3d4\">\n<div class=\"panel-body toggle-content mdl-clearfix\">\n<div style=\"text-align: justify;\">If you need to request a change or cancel your appointment with us you can <a href=\"\/it-en\/request-house-call\/request-information\/\">contact us through our online enquiry form<\/a>.<\/div>\n<p style=\"text-align: justify;\">If you need a change in your appointment timing we will do our best to fulfil your request.<\/p>\n<p style=\"text-align: justify;\">However, we cannot assure to be able to apply changes when requested with a notice of less than 24 hours from your appointment time. In these cases, if you are unable to keep your appointment timing, a cancellation fee may be applied by the Professional for the late notice.<\/p>\n<div style=\"text-align: justify;\">When you get in touch, please include your name, surname, appointment date and time and any changes required, and we will get back to you as soon as possible.<\/div>\n<div style=\"text-align: justify;\">You can also change or cancel an appointment using the link in your booking confirmation.<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>CONTACT US MAKE AN ENQUIRY: \u00a0 BOOK A HOME VISIT: The house call will be delivered, according to your requests, [&hellip;]<\/p>\n","protected":false},"author":10,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-8804","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - 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