{"id":2756,"date":"2018-06-04T14:56:46","date_gmt":"2018-06-04T14:56:46","guid":{"rendered":"http:\/\/www.medelit.com\/uk\/?p=2756"},"modified":"2026-05-18T08:28:31","modified_gmt":"2026-05-18T07:28:31","slug":"nutritional-therapy-home-visit","status":"publish","type":"page","link":"https:\/\/www.medelit.com\/uk\/services\/nutritional-therapy-home-visit\/","title":{"rendered":"Nutritional Therapy Home Visit"},"content":{"rendered":"\n\t\t\t\t<div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-1 mcp-flex-container hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-background-position:right bottom;--mcpb-border-sizes-top:0px;--mcpb-border-sizes-bottom:0px;--mcpb-border-sizes-left:0px;--mcpb-border-sizes-right:0px;--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-padding-bottom:40px;--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-0 mcp_builder_column_1_1 1_1 mcp-flex-column mcp-flex-align-self-flex-start mcp-column-no-min-height\" style=\"--mcpb-padding-top:40px;--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:0px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-1\"><h2 style=\"text-align: center;\"><span style=\"font-size: 24pt;\">Nutritional Therapy Home Visit in London<\/span><\/h2>\n<\/div><\/div><\/div><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-2 mcp-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-background-position:left top;--mcpb-border-sizes-top:0px;--mcpb-border-sizes-bottom:0px;--mcpb-border-sizes-left:0px;--mcpb-border-sizes-right:0px;--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-padding-top:0px;--mcpb-padding-bottom:0px;--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"max-width:calc( 1100px + 0px );margin-left: calc(-0px \/ 2 );margin-right: calc(-0px \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-1 mcp_builder_column_1_6 1_6 mcp-flex-column\" style=\"--mcpb-padding-top:50px;--mcpb-bg-position:left bottom;--mcpb-bg-size:cover;--mcpb-width-large:16.666666666667%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:0px;--mcpb-margin-bottom-large:20px;--mcpb-spacing-left-large:0px;--mcpb-width-medium:16.666666666667%;--mcpb-spacing-right-medium:0px;--mcpb-spacing-left-medium:0px;--mcpb-width-small:100%;--mcpb-spacing-right-small:0px;--mcpb-spacing-left-small:0px;\"><div class=\"mcp-column-wrapper mcp-column-has-shadow mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-image-element \" style=\"--mcpb-caption-title-font-family:var(--h2_typography-font-family);--mcpb-caption-title-font-weight:var(--h2_typography-font-weight);--mcpb-caption-title-font-style:var(--h2_typography-font-style);--mcpb-caption-title-size:var(--h2_typography-font-size);--mcpb-caption-title-transform:var(--h2_typography-text-transform);--mcpb-caption-title-line-height:var(--h2_typography-line-height);--mcpb-caption-title-letter-spacing:var(--h2_typography-letter-spacing);\"><span class=\" mcp-imageframe imageframe-none imageframe-1 hover-type-none\"><img fetchpriority=\"high\" decoding=\"async\" width=\"600\" height=\"600\" title=\"Online Psychologist\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2017\/02\/Online-Psychologist.webp\" data-orig-src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2017\/02\/Online-Psychologist.webp\" alt=\"\" class=\"img-responsive wp-image-4624 lazyautosizes lazyloaded\" srcset=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2017\/02\/Online-Psychologist-150x150.webp 150w, https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2017\/02\/Online-Psychologist.webp 600w\" data-srcset=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2017\/02\/Online-Psychologist-150x150.webp 150w, https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2017\/02\/Online-Psychologist.webp 600w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 640px) 100vw, 600px\" sizes=\"183px\"><\/span><\/div><\/div><\/div><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-2 mcp_builder_column_1_2 1_2 mcp-flex-column\" style=\"--mcpb-padding-top:30px;--mcpb-padding-left:60px;--mcpb-bg-position:left bottom;--mcpb-bg-size:cover;--mcpb-width-large:50%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:0px;--mcpb-margin-bottom-large:20px;--mcpb-spacing-left-large:0px;--mcpb-width-medium:50%;--mcpb-spacing-right-medium:0px;--mcpb-spacing-left-medium:0px;--mcpb-width-small:100%;--mcpb-spacing-right-small:0px;--mcpb-spacing-left-small:0px;\"><div class=\"mcp-column-wrapper mcp-column-has-shadow mcp-flex-justify-content-flex-start mcp-content-layout-column\"><ul style=\"--mcpb-size:15px;--mcpb-line-height:25.5px;--mcpb-icon-width:25.5px;--mcpb-icon-height:25.5px;--mcpb-icon-margin:10.5px;--mcpb-content-margin:36px;--mcpb-circlecolor:#ca1517;--mcpb-circle-yes-font-size:13.2px;\" class=\"mcp-checklist mcp-checklist-1 mcp-checklist-default type-icons\"><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\">\n<h3 style=\"text-align: left;\"><span style=\"color: #ca1517;\">Nutritional Therapist Home Visits<\/span><\/h3>\n<\/div><\/li><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\">\n<h3 style=\"text-align: left;\">A Tailored Plan Built around You<\/h3>\n<\/div><\/li><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\">\n<h3 style=\"text-align: left;\">Prompt, Trusted, High-Touch Care<\/h3>\n<\/div><\/li><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\">\n<h3 style=\"text-align: left;\">Highly Skilled &amp; Experienced Nutritionists<\/h3>\n<\/div><\/li><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\">\n<h3 style=\"text-align: left;\"><span style=\"color: #ca1517;\">We come to you,<\/span> be it&nbsp;your Home or Office<\/h3>\n<\/div><\/li><\/ul><\/div><\/div><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-3 mcp_builder_column_1_3 1_3 mcp-flex-column\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:33.333333333333%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:0px;--mcpb-margin-bottom-large:20px;--mcpb-spacing-left-large:0px;--mcpb-width-medium:33.333333333333%;--mcpb-spacing-right-medium:0px;--mcpb-spacing-left-medium:0px;--mcpb-width-small:100%;--mcpb-spacing-right-small:0px;--mcpb-spacing-left-small:0px;\"><div class=\"mcp-column-wrapper mcp-column-has-shadow mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-2\"><h2 style=\"text-align: center;\"><a href=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2018\/06\/Screen-Shot-2018-06-11-at-19.32.12.webp\" data-caption=\"\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-2966 alignleft lazyloaded\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2018\/06\/Screen-Shot-2018-06-11-at-19.32.12.webp\" data-orig-src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2018\/06\/Screen-Shot-2018-06-11-at-19.32.12.webp\" alt=\"\" width=\"899\" height=\"685\"><\/a><\/h2>\n<h2 style=\"text-align: center;\"><\/h2>\n<\/div><\/div><\/div><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-3 mcp-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-background-position:center bottom;--mcpb-border-sizes-top:0px;--mcpb-border-sizes-bottom:0px;--mcpb-border-sizes-left:0px;--mcpb-border-sizes-right:0px;--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-padding-top:5px;--mcpb-padding-bottom:10px;--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-4 mcp_builder_column_1_1 1_1 mcp-flex-column mcp-flex-align-self-flex-start mcp-column-no-min-height\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:0px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-title title mcp-title-1 mcp-sep-none mcp-title-text mcp-title-size-two\"><h2 class=\"mcp-title-heading title-heading-left\" style=\"margin:0;\"><\/h2><h2><span style=\"color: #ca1517; font-size: 18pt;\">Nutritional Therapy Home Visits<\/span><\/h2><\/div><div class=\"mcp-text mcp-text-3\"><p style=\"text-align: justify;\">Medelit works with highly qualified and experienced Nutritional Therapists. Through specific nutrition plans, we promote health, peak performance and individual care. This service is provided both <strong>at home<\/strong> and virtually, through our <strong>video-consultation<\/strong> platform.<\/p>\n<p style=\"text-align: justify;\">We deliver the highest standards of nutritional therapy directly in the comfort and privacy of your home and according to your needs and preferences.<\/p>\n<p style=\"text-align: justify;\">Our operations team can take your call at 020 36375657, or you can simply request a callback from a member of our team by filling in our enquiry form.<\/p>\n<p style=\"text-align: justify;\">Before your nutritional therapy home visit we will send you a health questionnaire to better understand your health conditions, your symptoms, lifestyle, goals and&nbsp;current diet and medications and\/or supplements. This will help your nutritionist build a picture of your health history, and any lifestyle or dietary habits that may play a role in any health or weight issues you may be experiencing.<\/p>\n<h2 style=\"text-align: justify;\"><span style=\"color: #ca1517;\">Our Nutritional Therapy:<\/span><\/h2>\n<p style=\"text-align: justify;\">Our Nutritional Therapist will work&nbsp;with you to build&nbsp;a personalised dietary plan aimed at promoting your good health and alleviating and\/or prevent illnesses and disease.<\/p>\n<p style=\"text-align: justify;\">Nutrition, lifestyle changes, and supplementation together with the latest research results are at the basis of our nutritionists\u2019 work.<\/p>\n<p style=\"text-align: justify;\">Our nutritional therapists are fully registered and highly qualified and offer a comprehensive, holistic approach to weight management, digestion, stress, autoimmunity&nbsp;and hormone imbalance.<\/p>\n<p style=\"text-align: justify;\">We offer private consultations directly in your home and via our virtual consultation channel. Therefore, if&nbsp;you do live in area we do not usually cover, it is also possible to have a skype consultation with our Nutrional Therapist.<\/p>\n<\/div><div class=\"mcp-separator mcp-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:20px;margin-bottom:20px;width:100%;\"><div class=\"mcp-separator-border sep-shadow\" style=\"--mcpb-height:20px;--mcpb-amount:20px;--mcpb-sep-color:#ca1517;background:radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);background:-webkit-radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);background:-moz-radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);background:-o-radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);\"><\/div><\/div><\/div><\/div><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-5 mcp_builder_column_1_1 1_1 mcp-flex-column\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:20px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-4\"><h2 style=\"text-align: center;\"><span style=\"color: #ca1517; font-size: 18pt;\">Request a Nutritional Therapist Home Visit in London Now<\/span><\/h2>\n<p style=\"text-align: center;\"><span style=\"color: #ffffff;\">nutritional therapist london<\/span><\/p>\n<\/div><div style=\"text-align:center;\"><a class=\"mcp-button button-flat button-medium button-default mcp-button-default button-1 mcp-button-span-no mcp-button-default-type\" style=\"--button-border-radius-top-left:2px;--button-border-radius-top-right:2px;--button-border-radius-bottom-right:2px;--button-border-radius-bottom-left:2px;\" target=\"_self\" href=\"#\" data-medelit-modal-open=\"booking\"><span class=\"mcp-button-text mcpb-button__text mcpb-button__text--default\">Book a Home Visit<\/span><\/a><\/div><div class=\"mcp-text mcp-text-5\"><p><span style=\"color: #ffffff;\">online nutritional therapist<\/span><\/p>\n<\/div><div style=\"text-align:center;\"><a class=\"mcp-button button-flat button-medium button-default mcp-button-default button-2 mcp-button-span-no mcp-button-default-type\" style=\"--button-border-radius-top-left:2px;--button-border-radius-top-right:2px;--button-border-radius-bottom-right:2px;--button-border-radius-bottom-left:2px;\" target=\"_self\" href=\"https:\/\/www.medelit.com\/uk\/contact-us\/book-your-virtual-visit\/\"><span class=\"mcp-button-text mcpb-button__text mcpb-button__text--default\">Book a Video-Consultation<\/span><\/a><\/div><\/div><\/div><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-4 mcp-flex-container hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-overflow:visible;--mcpb-margin-top:20px;--mcpb-margin-bottom:20px;--mcpb-background-color:rgba(255,255,255,0);--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-6 mcp_builder_column_1_1 1_1 mcp-flex-column mcp-flex-align-self-flex-start mcp-column-no-min-height\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:0px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-separator mcp-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"mcp-separator-border sep-shadow\" style=\"--mcpb-height:20px;--mcpb-amount:20px;--mcpb-sep-color:#ca1517;background:radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);background:-webkit-radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);background:-moz-radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);background:-o-radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-5 mcp-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-background-position:center bottom;--mcpb-border-sizes-top:0px;--mcpb-border-sizes-bottom:0px;--mcpb-border-sizes-left:0px;--mcpb-border-sizes-right:0px;--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-padding-top:40px;--mcpb-padding-bottom:30px;--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-7 mcp_builder_column_2_5 2_5 mcp-flex-column\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:40%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:3.84%;--mcpb-margin-bottom-large:20px;--mcpb-spacing-left-large:4.8%;--mcpb-width-medium:40%;--mcpb-spacing-right-medium:3.84%;--mcpb-spacing-left-medium:4.8%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-6\"><p><a href=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2018\/05\/Nutritional-Therapy.webp\" data-caption=\"\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-2765 aligncenter lazyloaded\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2018\/05\/Nutritional-Therapy.webp\" data-orig-src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2018\/05\/Nutritional-Therapy.webp\" alt=\"Nutritional Therapy\" width=\"1334\" height=\"1178\"><\/a><\/p>\n<\/div><\/div><\/div><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-8 mcp_builder_column_3_5 3_5 mcp-flex-column\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:60%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:3.2%;--mcpb-margin-bottom-large:20px;--mcpb-spacing-left-large:3.84%;--mcpb-width-medium:60%;--mcpb-spacing-right-medium:3.2%;--mcpb-spacing-left-medium:3.84%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-7\"><h2 style=\"text-align: justify;\"><span style=\"color: #ca1517;\">How Does Medelit\u2019s Nutritional Therapy work?<\/span><\/h2>\n<p style=\"text-align: justify;\">Our nutritionist will come to your home or office and will meet with you for a one-to-one 60-90 minute consultation. Moreover it is also possible to have a Skype consultation with our practitioner. The questionnaire you have filled before the home visit will be used as a starting point for further investigation of your health conditions and history, lifestyle and current diet.<\/p>\n<p style=\"text-align: justify;\">You will be able to talk to your nutritional therapist about your goals and you will agree together for a tailor-made programme for you to follow accordingly.<\/p>\n<p style=\"text-align: justify;\">Your Nutritional Therapist will use a wide range of methods to identify any potential nutritional imbalances that may be contributing to your specific symptoms and health issues. Specific nutritional imbalances will then be specifically&nbsp;addressed to support the body towards its healthiest condition.<\/p>\n<p style=\"text-align: justify;\">The Nutritional therapist will examine your full situation and will then provide a full explanation of how certain foods in your diet may be contributing to the issues you may be having. They will then suggest some foods or supplements that may help reduce your symptoms and explain how and why they do so.<\/p>\n<\/div><\/div><\/div><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-9 mcp_builder_column_1_1 1_1 mcp-flex-column mcp-flex-align-self-flex-start mcp-column-no-min-height\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:0px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-8\"><p style=\"text-align: justify;\">You will also be able to discuss the possibility of carrying out any useful further tests that may be able to identify an underlying intolerance or allergy.<\/p>\n<p style=\"text-align: justify;\">Follow up consultations will enable you to fully review your programme with your nutritional therapist and see any lab results together as well as identify which of the dietary recommendations have worked best for you and whether&nbsp;you have had any changes in your symptoms\/conditions.<\/p>\n<p style=\"text-align: justify;\">The nutritional programme will be fully reviewed at every follow up and any changes in diet, lifestyle and\/ or supplements will be tailored to suit your changes throughout the program.<\/p>\n<p>Read up! Looking for some useful tips on Nutrition? Try looking <a href=\"https:\/\/www.ion.ac.uk\/nutrition-information\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a>.<\/p>\n<\/div><\/div><\/div><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-6 mcp-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-background-position:left top;--mcpb-border-sizes-top:0px;--mcpb-border-sizes-bottom:0px;--mcpb-border-sizes-left:0px;--mcpb-border-sizes-right:0px;--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-padding-top:120px;--mcpb-padding-bottom:120px;--mcpb-background-color:#737a8d;--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-10 mcp_builder_column_1_1 1_1 mcp-flex-column mcp-flex-align-self-flex-start mcp-column-no-min-height\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:0px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-9\"><h2 style=\"text-align: center;\"><span style=\"font-size: 24pt; color: #ffffff;\">Home Visits Across Central and South West London \u2013 Video Consultations from Wherever you are<\/span><\/h2>\n<\/div><\/div><\/div><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-7 mcp-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-background-position:left center;--mcpb-border-color:#e0dede;--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-padding-top:90px;--mcpb-padding-bottom:90px;--mcpb-background-color:#f8f8f8;--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-11 mcp_builder_column_1_1 1_1 mcp-flex-column mcp-flex-align-self-flex-start mcp-column-no-min-height\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:0px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-10\"><h2 style=\"text-align: center;\"><span style=\"font-size: 24pt;\">Nutritional Therapy as it should be: Designed around You and Directly in Your Home.<\/span><\/h2>\n<\/div><\/div><\/div><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-8 mcp-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-background-position:left top;--mcpb-border-sizes-top:0px;--mcpb-border-sizes-bottom:0px;--mcpb-border-sizes-left:0px;--mcpb-border-sizes-right:0px;--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-padding-top:20px;--mcpb-padding-bottom:20px;--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-9 mcp-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-background-position:left top;--mcpb-border-sizes-top:0px;--mcpb-border-sizes-bottom:0px;--mcpb-border-sizes-left:0px;--mcpb-border-sizes-right:0px;--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-padding-top:20px;--mcpb-padding-bottom:20px;--mcpb-background-color:#f8f8f8;--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-12 mcp_builder_column_1_1 1_1 mcp-flex-column mcp-flex-align-self-flex-start mcp-column-no-min-height\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:0px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-11\"><h2><span style=\"color: #ca1517;\">Advantages:<\/span><\/h2>\n<\/div><\/div><\/div><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-13 mcp_builder_column_1_1 1_1 mcp-flex-column mcp-flex-align-self-flex-start mcp-column-no-min-height\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:0px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><ul style=\"--mcpb-size:15px;--mcpb-line-height:25.5px;--mcpb-icon-width:25.5px;--mcpb-icon-height:25.5px;--mcpb-icon-margin:10.5px;--mcpb-content-margin:36px;--mcpb-circlecolor:#ca1517;--mcpb-circle-yes-font-size:13.2px;\" class=\"mcp-checklist mcp-checklist-2 mcp-checklist-default type-icons\"><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\"><span style=\"font-size: 14pt;\">It can\u2019t get more Private \u2013 Our Nutritional Therapists come to you.<\/span><\/div><\/li><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\"><span style=\"font-size: 14pt;\">Londons\u2019 Leading Nutritional Therapists<\/span><\/div><\/li><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\"><span style=\"font-size: 14pt;\">All the dedicated time you need.<\/span><\/div><\/li><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\"><span style=\"font-size: 14pt;\">No time taken off work or family.<\/span><\/div><\/li><li class=\"mcp-li-item\" style=\"\"><span class=\"icon-wrapper circle-yes\"><i class=\"mcp-li-icon fa fa-check\" aria-hidden=\"true\"><\/i><\/span><div class=\"mcp-li-item-content\"><span style=\"font-size: 14pt;\">A tailored program built around your specific needs and goals.<\/span><\/div><\/li><\/ul><\/div><\/div><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-10 mcp-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-background-position:left top;--mcpb-border-sizes-top:0px;--mcpb-border-sizes-bottom:0px;--mcpb-border-sizes-left:0px;--mcpb-border-sizes-right:0px;--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-padding-top:40px;--mcpb-padding-bottom:40px;--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-14 mcp_builder_column_1_1 1_1 mcp-flex-column\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:20px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-12\"><h2 style=\"text-align: center;\"><span style=\"color: #ca1517;\">Book a Nutritional Therapist Home Visit or a Video Consultation:<\/span><\/h2>\n<\/div><div style=\"text-align:center;\"><a class=\"mcp-button button-flat button-medium button-default mcp-button-default button-3 mcp-button-span-no mcp-button-default-type\" style=\"--button-border-radius-top-left:2px;--button-border-radius-top-right:2px;--button-border-radius-bottom-right:2px;--button-border-radius-bottom-left:2px;\" target=\"_self\" href=\"\/it-en\/request-a-housecall\/\"><span class=\"mcp-button-text mcpb-button__text mcpb-button__text--default\">Book a Home Visit<\/span><\/a><\/div><div class=\"mcp-text mcp-text-13\"><p><span style=\"color: #ffffff; font-size: 10px;\">nutritional therapist w1<\/span><\/p>\n<\/div><div style=\"text-align:center;\"><a class=\"mcp-button button-flat button-medium button-default mcp-button-default button-4 mcp-button-span-no mcp-button-default-type\" style=\"--button-border-radius-top-left:2px;--button-border-radius-top-right:2px;--button-border-radius-bottom-right:2px;--button-border-radius-bottom-left:2px;\" target=\"_self\" href=\"https:\/\/www.medelit.com\/uk\/contact-us\/book-your-virtual-visit\/\"><span class=\"mcp-button-text mcpb-button__text mcpb-button__text--default\">Book an Online Consultation<\/span><\/a><\/div><\/div><\/div><\/div><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-11 mcp-flex-container hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--mcpb-border-radius-top-left:0px;--mcpb-border-radius-top-right:0px;--mcpb-border-radius-bottom-right:0px;--mcpb-border-radius-bottom-left:0px;--mcpb-overflow:visible;--mcpb-background-color:rgba(255,255,255,0);--mcpb-flex-wrap:wrap;\"><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-15 mcp_builder_column_1_1 1_1 mcp-flex-column mcp-flex-align-self-flex-start mcp-column-no-min-height\" style=\"--mcpb-bg-size:cover;--mcpb-width-large:100%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:1.92%;--mcpb-margin-bottom-large:0px;--mcpb-spacing-left-large:1.92%;--mcpb-width-medium:100%;--mcpb-spacing-right-medium:1.92%;--mcpb-spacing-left-medium:1.92%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-separator mcp-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"mcp-separator-border sep-shadow\" style=\"--mcpb-height:20px;--mcpb-amount:20px;--mcpb-sep-color:#ca1517;background:radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);background:-webkit-radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);background:-moz-radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);background:-o-radial-gradient(ellipse at 50% -50% , #ca1517 0px, rgba(255, 255, 255, 0) 80%) repeat scroll 0 0 rgba(0, 0, 0, 0);\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"mcp-bg-parallax\" data-bg-align=\"right center\" data-direction=\"down\" data-mute=\"false\" data-opacity=\"100\" data-velocity=\"-0.4\" data-mobile-enabled=\"false\" data-break_parents=\"0\" data-bg-image=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2016\/11\/night-city-1149601_1920.webp\" data-bg-repeat=\"false\" data-bg-color=\"rgb(255,255,255)\" style=\"display: none;\" data-parallax-index=\"0\"><\/div><div class=\"mcp-fullwidth fullwidth-box mcp-builder-row-12 mcp-flex-container mcp-parallax-down nonhundred-percent-fullwidth non-hundred-percent-height-scrolling bg-parallax-parent lazyloaded\" style=\"--mcpb-background-position: right center; --mcpb-border-sizes-top: 0px; --mcpb-border-sizes-bottom: 0px; --mcpb-border-sizes-left: 0px; --mcpb-border-sizes-right: 0px; --mcpb-border-radius-top-left: 0px; --mcpb-border-radius-top-right: 0px; --mcpb-border-radius-bottom-right: 0px; --mcpb-border-radius-bottom-left: 0px; --mcpb-padding-top: 70px; --mcpb-padding-right: 1px; --mcpb-padding-bottom: 60px; --mcpb-padding-left: 1px; --mcpb-background-color: rgb(255,255,255); --mcpb-background-size: cover; --mcpb-flex-wrap: wrap; position: relative; overflow: hidden; z-index: 1; background-image: none;\" data-bg=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2016\/11\/night-city-1149601_1920.webp\"><div class=\"parallax-inner lazyloaded\" style=\"pointer-events: none; width: 1280px; height: 816px; position: absolute; z-index: -1; top: -320px; left: 0px; opacity: 1; background-position: right center; background-repeat: no-repeat; background-size: cover; background-color: rgb(255, 255, 255); min-height: 150px; transform: translate3d(0px, 266.792px, 0px); background-image: url(&quot;https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2016\/11\/night-city-1149601_1920.webp&quot;);\" data-bg=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2016\/11\/night-city-1149601_1920.webp\"><\/div><div class=\"mcp-builder-row mcp-row mcp-flex-align-items-flex-start mcp-flex-content-wrap\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-16 mcp_builder_column_1_2 1_2 mcp-flex-column\" style=\"--mcpb-padding-top:0px;--mcpb-padding-right:0px;--mcpb-padding-bottom:0px;--mcpb-padding-left:0px;--mcpb-bg-position:left bottom;--mcpb-bg-size:cover;--mcpb-width-large:50%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:3.84%;--mcpb-margin-bottom-large:20px;--mcpb-spacing-left-large:3.84%;--mcpb-width-medium:50%;--mcpb-spacing-right-medium:3.84%;--mcpb-spacing-left-medium:3.84%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-14\"><table style=\"border-color: #ebebeb; height: 346px; background-color: #ffffff;\" border=\"1px\" width=\"100%\" cellspacing=\"3\" cellpadding=\"3px\">\n<tbody>\n<tr style=\"border-color: #000000; background-color: #f8f8f8;\">\n<td><span style=\"color: #ca1517;\"><strong>We\u2019re preferred for our:<\/strong><\/span><\/td>\n<\/tr>\n<tr style=\"background-color: #ffffff;\">\n<td><span style=\"color: #ca1517;\">\u2665<\/span>&nbsp;<b>High Standards<\/b><\/td>\n<\/tr>\n<tr style=\"background-color: #ffffff;\">\n<td><strong><span style=\"color: #ca1517;\">\u2665<\/span>&nbsp;Courtesy<\/strong><\/td>\n<\/tr>\n<tr>\n<td><span style=\"color: #ca1517;\">\u2665<\/span>&nbsp;<strong>Comfort<\/strong><\/td>\n<\/tr>\n<tr>\n<td><span style=\"color: #ca1517;\">\u2665&nbsp;<\/span><b>Promptness<\/b><\/td>\n<\/tr>\n<tr>\n<td><span style=\"color: #ca1517;\">\u2665&nbsp;<\/span><b>Reliability<\/b><\/td>\n<\/tr>\n<tr style=\"background-color: #ffffff;\">\n<td><strong><span style=\"color: #ca1517;\">\u2665&nbsp;<\/span>Dedication<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong><span style=\"color: #ca1517;\">\u2665&nbsp;<\/span><\/strong><strong>Efficiency<\/strong><\/td>\n<\/tr>\n<tr style=\"background-color: #ffffff;\">\n<td><strong><span style=\"color: #ca1517;\">\u2665&nbsp;<\/span><\/strong><strong>Availability<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div><\/div><\/div><div class=\"mcp-layout-column mcp_builder_column mcp-builder-column-17 mcp_builder_column_1_2 1_2 mcp-flex-column\" style=\"--mcpb-bg-position:right bottom;--mcpb-bg-size:cover;--mcpb-width-large:50%;--mcpb-margin-top-large:0px;--mcpb-spacing-right-large:3.84%;--mcpb-margin-bottom-large:20px;--mcpb-spacing-left-large:3.84%;--mcpb-width-medium:50%;--mcpb-spacing-right-medium:3.84%;--mcpb-spacing-left-medium:3.84%;--mcpb-width-small:100%;--mcpb-spacing-right-small:1.92%;--mcpb-spacing-left-small:1.92%;\"><div class=\"mcp-column-wrapper mcp-flex-justify-content-flex-start mcp-content-layout-column\"><div class=\"mcp-text mcp-text-15\"><table style=\"border-color: #ebebeb; height: 346px; background-color: #ffffff;\" border=\"1px\" width=\"100%\" cellspacing=\"3\" cellpadding=\"5px\">\n<tbody>\n<tr style=\"border-color: #000000; background-color: #f8f8f8; height: 33px;\">\n<td style=\"height: 33px;\"><strong><span style=\"color: #ca1517;\">Medelit House Call Services<\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 33px;\">\n<td style=\"height: 33px;\"><strong><span style=\"color: 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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_57' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_57' id='gform_57'  action='\/uk\/wp-json\/wp\/v2\/pages\/2756#gf_57' data-formid='57' 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 id='gf_progressbar_wrapper_57' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>8<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_12' style='width:12%;'><span>12%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_57_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_57' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_57_304\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_304'><span class='gform-field-label__text'>Name<\/span><\/label><div class='ginput_container'><input name='input_304' id='input_57_304' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_57_304'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_57_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\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>I am a\u2026<\/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_57_19'>\n\t\t\t<div class='gchoice gchoice_57_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='New'  id='choice_57_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_57_19_0' id='label_57_19_0' class='gform-field-label gform-field-label--type-inline'>New<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_57_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Returning'  id='choice_57_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_57_19_1' id='label_57_19_1' class='gform-field-label gform-field-label--type-inline'>Returning<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_57_300\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_300'><span class='gform-field-label__text'>Email address (used on your previous booking)<\/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_300' id='input_57_300' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_57_301\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_301'><span class='gform-field-label__text'>Date of birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_57_301'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_301'\n\t\t\t\t value=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_57_301' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_57_301' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_57_301' aria-label='Date of birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_57_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\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_60'><span class='gform-field-label__text'>incomingurl<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_57_60' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_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\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_28'><span class='gform-field-label__text'>actualurl<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_57_28' type='text' value='https:\/\/www.medelit.com\/uk\/wp-json\/wp\/v2\/pages\/2756' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_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\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_61'><span class='gform-field-label__text'>full url<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_57_61' type='text' value='https:\/\/www.medelit.com\/uk\/wp-json\/wp\/v2\/pages\/2756' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_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\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_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_57_43' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_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\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_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_57_58' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_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\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_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_57_62' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_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\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_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_57_63' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_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\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_57_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_57_54' type='text' value='Returning' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_57_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\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>I am interested in\u2026<\/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_57_25'>\n\t\t\t<div class='gchoice gchoice_57_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='HOME VISIT'  id='choice_57_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_57_25_0' id='label_57_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_57_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='VIDEO CONSULTATION'  id='choice_57_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_57_25_1' id='label_57_25_1' class='gform-field-label gform-field-label--type-inline'>VIDEO CONSULTATION<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_57_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_57_2' class='gform_page' data-js='page-field-id-69' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_57_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_57_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\"  ><h3>No patient found in our system<\/h3><p>Please check that your <strong>email address<\/strong> and <strong>date of birth<\/strong> are entered correctly, and that you selected the right option in the New\/Returning Patient field. Use the Back button to correct your details.<\/p><p>If you cannot be found but have visited us before, you can also continue as a New patient \u2014 we will reconcile your records.<\/p><\/div><div id=\"field_57_303\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Welcome back!<\/h3><p>We found your details in our system. Click <strong>Next<\/strong> to continue with your stored information.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_57_68' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Back<\/button> <button type='button' id='gform_next_button_57_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_57_3' class='gform_page' data-js='page-field-id-68' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_57_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_57_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\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the visit address still 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_57_45'>\n\t\t\t<div class='gchoice gchoice_57_45_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='YES'  id='choice_57_45_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_57_45_0' id='label_57_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_57_45_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='NO \/ I&#039;M NOT SURE'  id='choice_57_45_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_57_45_1' id='label_57_45_1' class='gform-field-label gform-field-label--type-inline'>NO \/ I'M NOT SURE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_57_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\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend 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_zip has_country ginput_container_address gform-grid-row' id='input_57_48' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_57_48_1_container' >\n                                        <input type='text' name='input_48.1' id='input_57_48_1' value=''    aria-required='true'    \/>\n                                        <label for='input_57_48_1' id='input_57_48_1_label' class='gform-field-label gform-field-label--type-sub '>Street and HOUSE NUMBER<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_57_48_3_container' >\n                                    <input type='text' name='input_48.3' id='input_57_48_3' value=''    aria-required='true'    \/>\n                                    <label for='input_57_48_3' id='input_57_48_3_label' class='gform-field-label gform-field-label--type-sub '>Town \/ City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_48.4' id='input_57_48_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_57_48_5_container' >\n                                    <input type='text' name='input_48.5' id='input_57_48_5' value=''    aria-required='true'    \/>\n                                    <label for='input_57_48_5' id='input_57_48_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_57_48_6_container' >\n                                        <select name='input_48.6' id='input_57_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' selected='selected'>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_57_48_6' id='input_57_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_57_55' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Back<\/button> <button type='button' id='gform_next_button_57_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_57_4' class='gform_page' data-js='page-field-id-55' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_57_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_57_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\"  ><legend 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_zip has_country ginput_container_address gform-grid-row' id='input_57_15' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_57_15_1_container' >\n                                        <input type='text' name='input_15.1' id='input_57_15_1' value=''   placeholder='Type your visit address here' aria-required='true'    \/>\n                                        <label for='input_57_15_1' id='input_57_15_1_label' class='gform-field-label gform-field-label--type-sub '>Street and HOUSE NUMBER<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_57_15_3_container' >\n                                    <input type='text' name='input_15.3' id='input_57_15_3' value=''    aria-required='true'    \/>\n                                    <label for='input_57_15_3' id='input_57_15_3_label' class='gform-field-label gform-field-label--type-sub '>Town \/ City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_15.4' id='input_57_15_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_57_15_5_container' >\n                                    <input type='text' name='input_15.5' id='input_57_15_5' value=''    aria-required='true'    \/>\n                                    <label for='input_57_15_5' id='input_57_15_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_57_15_6_container' >\n                                        <select name='input_15.6' id='input_57_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' >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' selected='selected'>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_57_15_6' id='input_57_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_57_81' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Back<\/button> <button type='button' id='gform_next_button_57_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_57_5' class='gform_page' data-js='page-field-id-81' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_57_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_57_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\"  ><legend 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_57_47' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_57_47_1_container' >\n                                        <input type='text' name='input_47.1' id='input_57_47_1' value=''    aria-required='true'    \/>\n                                        <label for='input_57_47_1' id='input_57_47_1_label' class='gform-field-label gform-field-label--type-sub '>Street and HOUSE NUMBER<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_57_47_3_container' >\n                                    <input type='text' name='input_47.3' id='input_57_47_3' value=''    aria-required='true'    \/>\n                                    <label for='input_57_47_3' id='input_57_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_57_47_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_57_47_5_container' >\n                                    <input type='text' name='input_47.5' id='input_57_47_5' value=''    aria-required='true'    \/>\n                                    <label for='input_57_47_5' id='input_57_47_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_57_47_6_container' >\n                                        <select name='input_47.6' id='input_57_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' >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' selected='selected'>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_57_47_6' id='input_57_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_57_72' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Back<\/button> <button type='button' id='gform_next_button_57_72' 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_57_6' class='gform_page' data-js='page-field-id-72' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_57_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_57_67\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full sn37uk-fallback gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_67'><span class='gform-field-label__text'>REQUESTED HOME VISIT<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_67' id='input_57_67' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='' >Select a service<\/option><option value='ALM101' >ACUPUNCTURE 1ST VISIT<\/option><option value='MEN105' >DIABETES 1ST VISIT<\/option><option value='MEN101' >ENDOCRINOLOGY 1ST VISIT<\/option><option value='MFE101' >FERTILITY VISIT<\/option><option value='FTM101' >FUNCTIONAL MEDICINE 1ST VISIT HOME VISIT<\/option><option value='MGP101' >GP HOME VISIT<\/option><option value='MGP102' >GP HOME VISIT WITH CERTIFICATE<\/option><option value='MGE101' >GERIATRIC 1ST VISIT<\/option><option value='MGY101' >GYNAECOLOGY VISIT<\/option><option value='MOR101' >ORTHOPAEDIC SURGEON 1ST VISIT<\/option><option value='MPA101' >PALLIATIVE CARE DOCTOR HOME VISIT<\/option><option value='MPR101' >PHYSICAL MED AND REHABILITATION HOME VISIT<\/option><option value='MPR106' >PHYSICAL MED BOTULIN INJECTION<\/option><option value='MPS101' >PSYCHIATRY 1ST VISIT<\/option><option value='NRS104' >BLOOD TEST (INCLUDING LAB TESTS)<\/option><option value='NRS128' >BLOOD TEST (WITHDRAWAL ONLY - NO LAB TRANSPORT)<\/option><option value='NRS120' >ENEMA<\/option><option value='NRS121' >INJECTION<\/option><option value='NRS116' >STANDARD IV DRIP (&lt; 1HR)<\/option><option value='NRS117' >1 - 2 HOUR IV DRIP<\/option><option value='NRS118' >2 - 3 HOUR IV DRIP<\/option><option value='NRS101' >NURSING CARE &lt; 3HRS (FEE\/HR)<\/option><option value='NRS102' >NURSING CARE 3-6 HRS (FEE\/HR)<\/option><option value='NRS103' >NURSING CARE &gt;6 HRS (FEE\/HR)<\/option><option value='NRS126' >EAR IRRIGATION<\/option><option value='NRS127' >PERSONAL HYGIENE<\/option><option value='NRS122' >STOMA CARE<\/option><option value='NRS119' >URINARY CATHETER CARE<\/option><option value='NRS124' >PICC CARE<\/option><option value='NRS123' >PORT-A-CATH CARE<\/option><option value='NRS125' >MIDLINE CARE<\/option><option value='NRS115' >WOUND DRESSING<\/option><option value='NRS129' >TISSUE VIABILITY 1ST VISIT<\/option><option value='NTT101' >NUTRITIONAL THERAPY 1S VISIT<\/option><option value='PGL101' >LYMPHATIC MASSAGE 1ST TREATMENT<\/option><option value='PGE106' >NEURO - PHYSIOTHERAPY FIRST SESSION<\/option><option value='PGE101' >PHYSIO - ORTHOPAEDIC &amp; SPORTS - FIRST SESSION<\/option><option value='PRE101' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY FIRST SESSION<\/option><option value='POD101' >PODIATRY 1ST VISIT<\/option><option value='POD107' >DIABETIC FOOT SCREENING + INITIAL ASSESSMENT<\/option><option value='PSY101' >PSYCHOLOGICAL 1ST CONSULTATION<\/option><option value='SPT101' >SPEECH THERAPY ADULT 1ST VISIT<\/option><option value='SPT107' >SPEECH THERAPY CHILDREN 1ST VISIT<\/option><\/select><\/div><\/div><div id=\"field_57_36\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full sn37uk-fallback gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_36'><span class='gform-field-label__text'>REQUESTED HOME-VISIT SERVICE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_57_36' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='' >Select a service<\/option><option value='ALM101' >ACUPUNCTURE 1ST VISIT<\/option><option value='MEN105' >DIABETES 1ST VISIT<\/option><option value='MEN101' >ENDOCRINOLOGY 1ST VISIT<\/option><option value='MFE101' >FERTILITY VISIT<\/option><option value='FTM101' >FUNCTIONAL MEDICINE 1ST VISIT HOME VISIT<\/option><option value='MGP101' >GP HOME VISIT<\/option><option value='MGP102' >GP HOME VISIT WITH CERTIFICATE<\/option><option value='MGE101' >GERIATRIC 1ST VISIT<\/option><option value='MGY101' >GYNAECOLOGY VISIT<\/option><option value='MOR101' >ORTHOPAEDIC SURGEON 1ST VISIT<\/option><option value='MPA101' >PALLIATIVE CARE DOCTOR HOME VISIT<\/option><option value='MPR101' >PHYSICAL MED AND REHABILITATION HOME VISIT<\/option><option value='MPR106' >PHYSICAL MED BOTULIN INJECTION<\/option><option value='MPS101' >PSYCHIATRY 1ST VISIT<\/option><option value='NRS104' >BLOOD TEST (INCLUDING LAB TESTS)<\/option><option value='NRS128' >BLOOD TEST (WITHDRAWAL ONLY - NO LAB TRANSPORT)<\/option><option value='NRS120' >ENEMA<\/option><option value='NRS121' >INJECTION<\/option><option value='NRS116' >STANDARD IV DRIP (&lt; 1HR)<\/option><option value='NRS117' >1 - 2 HOUR IV DRIP<\/option><option value='NRS118' >2 - 3 HOUR IV DRIP<\/option><option value='NRS101' >NURSING CARE &lt; 3HRS (FEE\/HR)<\/option><option value='NRS102' >NURSING CARE 3-6 HRS (FEE\/HR)<\/option><option value='NRS103' >NURSING CARE &gt;6 HRS (FEE\/HR)<\/option><option value='NRS126' >EAR IRRIGATION<\/option><option value='NRS127' >PERSONAL HYGIENE<\/option><option value='NRS122' >STOMA CARE<\/option><option value='NRS119' >URINARY CATHETER CARE<\/option><option value='NRS124' >PICC CARE<\/option><option value='NRS123' >PORT-A-CATH CARE<\/option><option value='NRS125' >MIDLINE CARE<\/option><option value='NRS115' >WOUND DRESSING<\/option><option value='NRS129' >TISSUE VIABILITY 1ST VISIT<\/option><option value='NTT101' >NUTRITIONAL THERAPY 1S VISIT<\/option><option value='PGL101' >LYMPHATIC MASSAGE 1ST TREATMENT<\/option><option value='PGE106' >NEURO - PHYSIOTHERAPY FIRST SESSION<\/option><option value='PGE101' >PHYSIO - ORTHOPAEDIC &amp; SPORTS - FIRST SESSION<\/option><option value='PRE101' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY FIRST SESSION<\/option><option value='POD101' >PODIATRY 1ST VISIT<\/option><option value='POD107' >DIABETIC FOOT SCREENING + INITIAL ASSESSMENT<\/option><option value='PSY101' >PSYCHOLOGICAL 1ST CONSULTATION<\/option><option value='SPT101' >SPEECH THERAPY ADULT 1ST VISIT<\/option><option value='SPT107' >SPEECH THERAPY CHILDREN 1ST VISIT<\/option><\/select><\/div><\/div><div id=\"field_57_76\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full sn37uk-fallback gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_76'><span class='gform-field-label__text'>REQUESTED VIDEO-CONSULTATION SERVICE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_76' id='input_57_76' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='' >Select a service<\/option><option value='MEN107' >DIABETES VIDEO 1ST<\/option><option value='MEN103' >ENDOCRINOLOGY VIDEO 1ST<\/option><option value='MFE102' >FERTILITY VIDEO CONSULTATION NEW PATIENT<\/option><option value='FTM103' >FUNCTIONAL MEDICINE VIDEO 1ST CONSULTATION<\/option><option value='MGP103' >GP VIDEO CONSULTATION<\/option><option value='MGP104' >GP VIDEO CONSULTATION WITH CERTIFICATE<\/option><option value='MGE103' >GERIATRIC VIDEO 1ST CONSULTATION<\/option><option value='MGY103' >GYNAECOLOGY VIDEO CONSULTATION<\/option><option value='MOR103' >ORTHOPAEDIC SURGEON VIDEO CONSULTATION<\/option><option value='MPA102' >PALLIATIVE CARE DOCTOR VIDEO CONSULTATION<\/option><option value='MPR102' >PHYSICAL MED AND REHABILITATION VIDEO 1ST CONSULTATION<\/option><option value='MPS106' >PSYCHIATRY 1st VISIT VIDEO<\/option><option value='NRS132' >NURSE VIDEO CONSULTATION<\/option><option value='NRS133' >TISSUE VIABILITY VIDEO CONSULTATION<\/option><option value='NTT103' >NUTRITIONAL THERAPY VIDEO 1ST VISIT<\/option><option value='PVI101' >PHYSIO VIDEO CONSULTATION<\/option><option value='PSY105' >PSYCHOLOGICY FULL VIDEO\/PHONE CONSULTATION (60 MIN)<\/option><option value='SPT105' >SPEECH THERAPY ADULT VIDEO 1ST VISIT<\/option><option value='SPT111' >SPEECH THERAPY CHILDREN VIDEO 1ST VISIT<\/option><\/select><\/div><\/div><div id=\"field_57_74\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full sn37uk-fallback gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_74'><span class='gform-field-label__text'>REQUESTED VIDEO-CONSULTATION SERVICE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_74' id='input_57_74' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='' >Select a service<\/option><option value='MEN107' >DIABETES VIDEO 1ST<\/option><option value='MEN103' >ENDOCRINOLOGY VIDEO 1ST<\/option><option value='MFE102' >FERTILITY VIDEO CONSULTATION NEW PATIENT<\/option><option value='FTM103' >FUNCTIONAL MEDICINE VIDEO 1ST CONSULTATION<\/option><option value='MGP103' >GP VIDEO CONSULTATION<\/option><option value='MGP104' >GP VIDEO CONSULTATION WITH CERTIFICATE<\/option><option value='MGE103' >GERIATRIC VIDEO 1ST CONSULTATION<\/option><option value='MGY103' >GYNAECOLOGY VIDEO CONSULTATION<\/option><option value='MOR103' >ORTHOPAEDIC SURGEON VIDEO CONSULTATION<\/option><option value='MPA102' >PALLIATIVE CARE DOCTOR VIDEO CONSULTATION<\/option><option value='MPR102' >PHYSICAL MED AND REHABILITATION VIDEO 1ST CONSULTATION<\/option><option value='MPS106' >PSYCHIATRY 1st VISIT VIDEO<\/option><option value='NRS132' >NURSE VIDEO CONSULTATION<\/option><option value='NRS133' >TISSUE VIABILITY VIDEO CONSULTATION<\/option><option value='NTT103' >NUTRITIONAL THERAPY VIDEO 1ST VISIT<\/option><option value='PVI101' >PHYSIO VIDEO CONSULTATION<\/option><option value='PSY105' >PSYCHOLOGICY FULL VIDEO\/PHONE CONSULTATION (60 MIN)<\/option><option value='SPT105' >SPEECH THERAPY ADULT VIDEO 1ST VISIT<\/option><option value='SPT111' >SPEECH THERAPY CHILDREN VIDEO 1ST VISIT<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_57_73' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Back<\/button> <button type='button' id='gform_next_button_57_73' 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_57_7' class='gform_page' data-js='page-field-id-73' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_57_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_57_77\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full sn37uk-fallback gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_77'><span class='gform-field-label__text'>REQUESTED HOME VISIT<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_77' id='input_57_77' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='' >Select a service<\/option><option value='ALM101' >ACUPUNCTURE 1ST VISIT<\/option><option value='ALM103' >ACUPUNCTURE 5 TREATMENT PACKAGE<\/option><option value='ALM102' >ACUPUNCTURE FOLLOW UP<\/option><option value='MEN105' >DIABETES 1ST VISIT<\/option><option value='MEN106' >DIABETES FOLLOW UP<\/option><option value='MEN101' >ENDOCRINOLOGY 1ST VISIT<\/option><option value='MEN102' >ENDOCRINOLOGY FOLLOW UP<\/option><option value='MFE101' >FERTILITY VISIT<\/option><option value='FTM101' >FUNCTIONAL MEDICINE 1ST VISIT HOME VISIT<\/option><option value='FTM102' >FUNCTIONAL MEDICINE FOLLOW UP HOME VISIT<\/option><option value='MGP101' >GP HOME VISIT<\/option><option value='MGP102' >GP HOME VISIT WITH CERTIFICATE<\/option><option value='MGE101' >GERIATRIC 1ST VISIT<\/option><option value='MGY101' >GYNAECOLOGY VISIT<\/option><option value='MOR101' >ORTHOPAEDIC SURGEON 1ST VISIT<\/option><option value='MOR102' >ORTHOPAEDIC SURGEON FOLLOW UP<\/option><option value='MPA101' >PALLIATIVE CARE DOCTOR HOME VISIT<\/option><option value='MPR101' >PHYSICAL MED AND REHABILITATION HOME VISIT<\/option><option value='MPR106' >PHYSICAL MED BOTULIN INJECTION<\/option><option value='MPR105' >PHYSICAL MED AND REHABILITATION MEDICAL-LEGAL (FEE\/HR)<\/option><option value='MPS101' >PSYCHIATRY 1ST VISIT<\/option><option value='MPS102' >PSYCHIATRY FOLLOW UP<\/option><option value='NRS104' >BLOOD TEST (INCLUDING LAB TESTS)<\/option><option value='NRS128' >BLOOD TEST (WITHDRAWAL ONLY - NO LAB TRANSPORT)<\/option><option value='NRS120' >ENEMA<\/option><option value='NRS121' >INJECTION<\/option><option value='NRS116' >STANDARD IV DRIP (&lt; 1HR)<\/option><option value='NRS117' >1 - 2 HOUR IV DRIP<\/option><option value='NRS118' >2 - 3 HOUR IV DRIP<\/option><option value='NRS101' >NURSING CARE &lt; 3HRS (FEE\/HR)<\/option><option value='NRS102' >NURSING CARE 3-6 HRS (FEE\/HR)<\/option><option value='NRS103' >NURSING CARE &gt;6 HRS (FEE\/HR)<\/option><option value='NRS126' >EAR IRRIGATION<\/option><option value='NRS127' >PERSONAL HYGIENE<\/option><option value='NRS122' >STOMA CARE<\/option><option value='NRS119' >URINARY CATHETER CARE<\/option><option value='NRS124' >PICC CARE<\/option><option value='NRS123' >PORT-A-CATH CARE<\/option><option value='NRS125' >MIDLINE CARE<\/option><option value='NRS115' >WOUND DRESSING<\/option><option value='NRS129' >TISSUE VIABILITY 1ST VISIT<\/option><option value='NRS130' >TISSUE VIABILITY FOLLOW UP VISIT<\/option><option value='NRS131' >TISSUE VIABILITY 5 VISIT PACKAGE<\/option><option value='NTT101' >NUTRITIONAL THERAPY 1S VISIT<\/option><option value='NTT102' >NUTRITIONAL THERAPY FOLLOW UP<\/option><option value='PGL101' >LYMPHATIC MASSAGE 1ST TREATMENT<\/option><option value='PGL102' >LYMPHATIC MASSAGE FOLLOW UP<\/option><option value='PGE106' >NEURO - PHYSIOTHERAPY FIRST SESSION<\/option><option value='PGE110' >NEURO-PHYSIOTHERAPY PACKAGE 5 SESSION 60 MIN<\/option><option value='PGE109' >NEURO-PHYSIOTHERAPY PACKAGE 5 SESSIONS 45 MIN<\/option><option value='PGE107' >NEURO - PHYSIOTHERAPY FOLLOW UP (45 MIN)<\/option><option value='PGE108' >NEURO - PHYSIOTHERAPY FOLLOW UP (60 MIN)<\/option><option value='PGE101' >PHYSIO - ORTHOPAEDIC &amp; SPORTS - FIRST SESSION<\/option><option value='PGE104' >PHYSIO - ORTHOPAEDIC &amp; SPORTS - PACKAGE 5 SESSIONS - 45 MIN<\/option><option value='PGE105' >PHYSIO - ORTHOPAEDIC &amp; SPORTS - PACKAGE 5 SESSIONS - 60 MIN<\/option><option value='PGE102' >PHYSIO ORTHOPAEDIC &amp; SPORTS - FOLLOW UP (45 MIN)<\/option><option value='PGE103' >PHYSIO ORTHOPAEDIC &amp; SPORTS - FOLLOW UP (60 MIN)<\/option><option value='PRE101' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY FIRST SESSION<\/option><option value='PRE104' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY PACKAGE 5 SESSION<\/option><option value='PRE102' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY FOLLOW UP (45 MIN)<\/option><option value='PRE103' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY FOLLOW UP (60 MIN)<\/option><option value='POD101' >PODIATRY 1ST VISIT<\/option><option value='POD107' >DIABETIC FOOT SCREENING + INITIAL ASSESSMENT<\/option><option value='POD102' >PODIATRY FOLLOW UP<\/option><option value='POD104' >PODIATRY 5 VISIT PACKAGE<\/option><option value='PSY101' >PSYCHOLOGICAL 1ST CONSULTATION<\/option><option value='PSY102' >PSYCHOLOGICAL FOLLOW UP CONSULTATION<\/option><option value='SPT101' >SPEECH THERAPY ADULT 1ST VISIT<\/option><option value='SPT103' >SPEECH THERAPY ADULT PACKAGE 5 SESSIONS<\/option><option value='SPT102' >SPEECH THERAPY ADULT FOLLOW UP<\/option><option value='SPT107' >SPEECH THERAPY CHILDREN 1ST VISIT<\/option><option value='SPT109' >SPEECH THERAPY CHILDREN PACKAGE 5 SESSIONS<\/option><option value='SPT108' >SPEECH THERAPY CHILDREN FOLLOW UP<\/option><\/select><\/div><\/div><div id=\"field_57_70\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full sn37uk-fallback gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_70'><span class='gform-field-label__text'>REQUESTED HOME-VISIT SERVICE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_70' id='input_57_70' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='' >Select a service<\/option><option value='ALM101' >ACUPUNCTURE 1ST VISIT<\/option><option value='ALM103' >ACUPUNCTURE 5 TREATMENT PACKAGE<\/option><option value='ALM102' >ACUPUNCTURE FOLLOW UP<\/option><option value='MEN105' >DIABETES 1ST VISIT<\/option><option value='MEN106' >DIABETES FOLLOW UP<\/option><option value='MEN101' >ENDOCRINOLOGY 1ST VISIT<\/option><option value='MEN102' >ENDOCRINOLOGY FOLLOW UP<\/option><option value='MFE101' >FERTILITY VISIT<\/option><option value='FTM101' >FUNCTIONAL MEDICINE 1ST VISIT HOME VISIT<\/option><option value='FTM102' >FUNCTIONAL MEDICINE FOLLOW UP HOME VISIT<\/option><option value='MGP101' >GP HOME VISIT<\/option><option value='MGP102' >GP HOME VISIT WITH CERTIFICATE<\/option><option value='MGE101' >GERIATRIC 1ST VISIT<\/option><option value='MGY101' >GYNAECOLOGY VISIT<\/option><option value='MOR101' >ORTHOPAEDIC SURGEON 1ST VISIT<\/option><option value='MOR102' >ORTHOPAEDIC SURGEON FOLLOW UP<\/option><option value='MPA101' >PALLIATIVE CARE DOCTOR HOME VISIT<\/option><option value='MPR101' >PHYSICAL MED AND REHABILITATION HOME VISIT<\/option><option value='MPR106' >PHYSICAL MED BOTULIN INJECTION<\/option><option value='MPR105' >PHYSICAL MED AND REHABILITATION MEDICAL-LEGAL (FEE\/HR)<\/option><option value='MPS101' >PSYCHIATRY 1ST VISIT<\/option><option value='MPS102' >PSYCHIATRY FOLLOW UP<\/option><option value='NRS104' >BLOOD TEST (INCLUDING LAB TESTS)<\/option><option value='NRS128' >BLOOD TEST (WITHDRAWAL ONLY - NO LAB TRANSPORT)<\/option><option value='NRS120' >ENEMA<\/option><option value='NRS121' >INJECTION<\/option><option value='NRS116' >STANDARD IV DRIP (&lt; 1HR)<\/option><option value='NRS117' >1 - 2 HOUR IV DRIP<\/option><option value='NRS118' >2 - 3 HOUR IV DRIP<\/option><option value='NRS101' >NURSING CARE &lt; 3HRS (FEE\/HR)<\/option><option value='NRS102' >NURSING CARE 3-6 HRS (FEE\/HR)<\/option><option value='NRS103' >NURSING CARE &gt;6 HRS (FEE\/HR)<\/option><option value='NRS126' >EAR IRRIGATION<\/option><option value='NRS127' >PERSONAL HYGIENE<\/option><option value='NRS122' >STOMA CARE<\/option><option value='NRS119' >URINARY CATHETER CARE<\/option><option value='NRS124' >PICC CARE<\/option><option value='NRS123' >PORT-A-CATH CARE<\/option><option value='NRS125' >MIDLINE CARE<\/option><option value='NRS115' >WOUND DRESSING<\/option><option value='NRS129' >TISSUE VIABILITY 1ST VISIT<\/option><option value='NRS130' >TISSUE VIABILITY FOLLOW UP VISIT<\/option><option value='NRS131' >TISSUE VIABILITY 5 VISIT PACKAGE<\/option><option value='NTT101' >NUTRITIONAL THERAPY 1S VISIT<\/option><option value='NTT102' >NUTRITIONAL THERAPY FOLLOW UP<\/option><option value='PGL101' >LYMPHATIC MASSAGE 1ST TREATMENT<\/option><option value='PGL102' >LYMPHATIC MASSAGE FOLLOW UP<\/option><option value='PGE106' >NEURO - PHYSIOTHERAPY FIRST SESSION<\/option><option value='PGE110' >NEURO-PHYSIOTHERAPY PACKAGE 5 SESSION 60 MIN<\/option><option value='PGE109' >NEURO-PHYSIOTHERAPY PACKAGE 5 SESSIONS 45 MIN<\/option><option value='PGE107' >NEURO - PHYSIOTHERAPY FOLLOW UP (45 MIN)<\/option><option value='PGE108' >NEURO - PHYSIOTHERAPY FOLLOW UP (60 MIN)<\/option><option value='PGE101' >PHYSIO - ORTHOPAEDIC &amp; SPORTS - FIRST SESSION<\/option><option value='PGE104' >PHYSIO - ORTHOPAEDIC &amp; SPORTS - PACKAGE 5 SESSIONS - 45 MIN<\/option><option value='PGE105' >PHYSIO - ORTHOPAEDIC &amp; SPORTS - PACKAGE 5 SESSIONS - 60 MIN<\/option><option value='PGE102' >PHYSIO ORTHOPAEDIC &amp; SPORTS - FOLLOW UP (45 MIN)<\/option><option value='PGE103' >PHYSIO ORTHOPAEDIC &amp; SPORTS - FOLLOW UP (60 MIN)<\/option><option value='PRE101' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY FIRST SESSION<\/option><option value='PRE104' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY PACKAGE 5 SESSION<\/option><option value='PRE102' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY FOLLOW UP (45 MIN)<\/option><option value='PRE103' >CARDIOVASCULAR &amp; RESPIRATORY PHYSIOTHERAPY FOLLOW UP (60 MIN)<\/option><option value='POD101' >PODIATRY 1ST VISIT<\/option><option value='POD107' >DIABETIC FOOT SCREENING + INITIAL ASSESSMENT<\/option><option value='POD102' >PODIATRY FOLLOW UP<\/option><option value='POD104' >PODIATRY 5 VISIT PACKAGE<\/option><option value='PSY101' >PSYCHOLOGICAL 1ST CONSULTATION<\/option><option value='PSY102' >PSYCHOLOGICAL FOLLOW UP CONSULTATION<\/option><option value='SPT101' >SPEECH THERAPY ADULT 1ST VISIT<\/option><option value='SPT103' >SPEECH THERAPY ADULT PACKAGE 5 SESSIONS<\/option><option value='SPT102' >SPEECH THERAPY ADULT FOLLOW UP<\/option><option value='SPT107' >SPEECH THERAPY CHILDREN 1ST VISIT<\/option><option value='SPT109' >SPEECH THERAPY CHILDREN PACKAGE 5 SESSIONS<\/option><option value='SPT108' >SPEECH THERAPY CHILDREN FOLLOW UP<\/option><\/select><\/div><\/div><div id=\"field_57_65\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full sn37uk-fallback gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_65'><span class='gform-field-label__text'>REQUESTED VIDEO-CONSULTATION SERVICE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_65' id='input_57_65' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='' >Select a service<\/option><option value='MEN107' >DIABETES VIDEO 1ST<\/option><option value='MEN108' >DIABETES VIDEO FOLLOW UP<\/option><option value='MEN103' >ENDOCRINOLOGY VIDEO 1ST<\/option><option value='MEN104' >ENDOCRINOLOGY VIDEO FOLLOW UP<\/option><option value='MFE103' >FERTILITY VIDEO CONSULTATION FOLLOW UP<\/option><option value='MFE102' >FERTILITY VIDEO CONSULTATION NEW PATIENT<\/option><option value='FTM103' >FUNCTIONAL MEDICINE VIDEO 1ST CONSULTATION<\/option><option value='FTM107' >FUNCTIONAL MEDICINE COACHING PLAN + FUP SKYPE<\/option><option value='FTM104' >FUNCTIONAL MEDICINE VIDEO FOLLOW UP<\/option><option value='MGP103' >GP VIDEO CONSULTATION<\/option><option value='MGP104' >GP VIDEO CONSULTATION WITH CERTIFICATE<\/option><option value='MGE103' >GERIATRIC VIDEO 1ST CONSULTATION<\/option><option value='MGE104' >GERIATRIC VIDEO FOLLOW UP<\/option><option value='MGY103' >GYNAECOLOGY VIDEO CONSULTATION<\/option><option value='MOR103' >ORTHOPAEDIC SURGEON VIDEO CONSULTATION<\/option><option value='MPA102' >PALLIATIVE CARE DOCTOR VIDEO CONSULTATION<\/option><option value='MPR102' >PHYSICAL MED AND REHABILITATION VIDEO 1ST CONSULTATION<\/option><option value='MPR104' >PHYSICAL MED AND REHABILITATION VIDEO FOLLOW UP<\/option><option value='MPS106' >PSYCHIATRY 1st VISIT VIDEO<\/option><option value='MPS105' >PSYCHIATRY FOLLOW UP VIDEO<\/option><option value='NRS132' >NURSE VIDEO CONSULTATION<\/option><option value='NRS133' >TISSUE VIABILITY VIDEO CONSULTATION<\/option><option value='NTT103' >NUTRITIONAL THERAPY VIDEO 1ST VISIT<\/option><option value='NTT104' >NUTRITIONAL THERAPY VIDEO FOLLOW UP<\/option><option value='PVI102' >PHYSIO VIDEO PACKAGE OF 5<\/option><option value='PSY105' >PSYCHOLOGICY FULL VIDEO\/PHONE CONSULTATION (60 MIN)<\/option><option value='PSY106' >PSYCHOLOGY 30 MIN FOLLOW UP VIDEO\/PHONE CONSULTATION<\/option><option value='SPT105' >SPEECH THERAPY ADULT VIDEO 1ST VISIT<\/option><option value='SPT114' >SPEECH THERAPY ADULT VIDEO PACKAGE of 5<\/option><option value='SPT106' >SPEECH THERAPY ADULT VIDEO FOLLOW UP VISIT<\/option><option value='SPT111' >SPEECH THERAPY CHILDREN VIDEO 1ST VISIT<\/option><option value='SPT113' >SPEECH THERAPY CHILDREN VIDEO PACKAGE of 5<\/option><option value='SPT112' >SPEECH THERAPY CHILDREN VIDEO FOLLOW UP VISIT<\/option><\/select><\/div><\/div><div id=\"field_57_49\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full sn37uk-fallback gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_49'><span class='gform-field-label__text'>REQUESTED VIDEO-CONSULTATION SERVICE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_49' id='input_57_49' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='' >Select a service<\/option><option value='MEN107' >DIABETES VIDEO 1ST<\/option><option value='MEN108' >DIABETES VIDEO FOLLOW UP<\/option><option value='MEN103' >ENDOCRINOLOGY VIDEO 1ST<\/option><option value='MEN104' >ENDOCRINOLOGY VIDEO FOLLOW UP<\/option><option value='MFE103' >FERTILITY VIDEO CONSULTATION FOLLOW UP<\/option><option value='MFE102' >FERTILITY VIDEO CONSULTATION NEW PATIENT<\/option><option value='FTM103' >FUNCTIONAL MEDICINE VIDEO 1ST CONSULTATION<\/option><option value='FTM107' >FUNCTIONAL MEDICINE COACHING PLAN + FUP SKYPE<\/option><option value='FTM104' >FUNCTIONAL MEDICINE VIDEO FOLLOW UP<\/option><option value='MGP103' >GP VIDEO CONSULTATION<\/option><option value='MGP104' >GP VIDEO CONSULTATION WITH CERTIFICATE<\/option><option value='MGE103' >GERIATRIC VIDEO 1ST CONSULTATION<\/option><option value='MGE104' >GERIATRIC VIDEO FOLLOW UP<\/option><option value='MGY103' >GYNAECOLOGY VIDEO CONSULTATION<\/option><option value='MOR103' >ORTHOPAEDIC SURGEON VIDEO 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