{"id":5358,"date":"2021-03-29T11:05:03","date_gmt":"2021-03-29T11:05:03","guid":{"rendered":"https:\/\/www.medelit.com\/uk\/?p=5358"},"modified":"2026-07-17T11:02:57","modified_gmt":"2026-07-17T10:02:57","slug":"home-speech-therapy-children","status":"publish","type":"post","link":"https:\/\/www.medelit.com\/uk\/services\/home-speech-therapy-children\/","title":{"rendered":"Home Speech Therapy for Children"},"content":{"rendered":"\r\n\r\n\r\n<h3 style=\"text-align: left;\"><span style=\"color: #ca1517;\"><span style=\"color: #333333;\">Speech Therapy for Children directly at<\/span>\u00a0Home<\/span><\/h3>\r\n\r\n<h3 style=\"text-align: left;\">No Stress for your Kids, We come to You<\/h3>\r\n\r\n<h3 style=\"text-align: left;\">With the Best Speech Therapists for Children<\/h3>\r\n\r\n<h3 style=\"text-align: left;\"><span style=\"color: #ca1517;\">All the Time Dedicated and a Tailored Approach<\/span><\/h3>\r\n\r\n\r\n<a href=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2020\/12\/speech-therapy-for-children-at-home.webp\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-5657\" title=\"home speech therapy for children\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2020\/12\/speech-therapy-for-children-at-home.webp\" alt=\"speech therapy for children at home\" width=\"597\" height=\"416\" \/><\/a>\r\n\r\n\r\n<h2 style=\"text-align: center;\"><span style=\"color: #ca1517;\"><strong>Book Your Home Visit Today:<\/strong><\/span><\/h2>\r\n<img loading=\"lazy\" decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2023\/10\/arrow-2.gif\" alt=\"\" width=\"99\" height=\"110\" \/>\n<div class=\"it-cta-wrap\" style=\"text-align:center;margin:8px 0 20px\"><a href=\"#\" role=\"button\" class=\"it-cta-btn\" data-medelit-modal-open=\"booking\">Check Availability &amp; Fees<\/a><\/div>\n\r\n<h2><strong><span style=\"color: #ca1517;\">Home Speech Therapy for Children<\/span><\/strong><\/h2>\r\nIf your child is showing signs of a speech disorder, or if you&#8217;ve already received a diagnosis and are seeking rehabilitation, Medelit offers specialized, in-home Speech Therapy for Children. This convenient service is readily available across <strong>London and Greater London<\/strong>.\r\n\r\nExperience the advantage of having your child receive <strong>personalized, interactive speech therapy in the comfort of your own home<\/strong>, a setting where they feel most at ease. We schedule appointments at times that suit your family&#8217;s routine, including late afternoons and weekends. This flexibility means less time spent traveling and more time for your family, reducing the stress of navigating the city.\r\n\r\nMedelit\u2019s Speech Therapists are not only fully qualified and board-certified but also bring a wealth of experience in dealing with children and young adults of various ages. They specialize in a wide range of services, from treating learning and developmental disorders to addressing s<strong>peech, communication, and social difficulties<\/strong>.\r\n\r\nWith Medelit, you&#8217;re choosing a service that is <strong>as effective as it is convenient<\/strong>.\r\n<h2><strong><span style=\"color: #ca1517;\">What to Expect<\/span><\/strong><\/h2>\r\nWhen our therapists visit your home for your child&#8217;s first appointment, they will perform both formal and informal assessments tailored to your child&#8217;s age and specific needs. This approach helps us accurately determine the areas where your child requires assistance.\r\n<p style=\"text-align: justify;\">After this initial home visit, you can arrange for regular follow-up sessions with the same speech therapist right at your doorstep. This continuity not only ensures convenience for your family but also significantly enhances the effectiveness of the therapy.<\/p>\r\n<p style=\"text-align: justify;\">Additionally, our therapist will design a <strong>customized program for your child<\/strong>, which includes exercises that can be practiced at home between visits. This continuous engagement is crucial for steady progress. Should your family wish to be actively involved in the therapy process, our therapists are ready to equip parents with effective strategies and skills to support and supplement your child\u2019s therapy at home.<\/p>\r\nWe offer attractive discounts for our follow-up package bookings and our speech therapists are available every day, including <strong>weekends and bank holidays. <\/strong>You can easily book our services through our online booking system for your convenience.\r\n\r\nIf you&#8217;re located outside our home visit coverage area or currently abroad, our Online Speech Therapy Consultations for children offer a convenient solution. Accessible from anywhere, these sessions provide the same high-quality care as face-to-face appointments but with added benefits. <a href=\"https:\/\/www.medelit.com\/uk\/online-doctors-uk\/online-speech-therapy-children-adults\/\">Online therapy<\/a> is not only more cost-effective and flexible, but it also significantly reduces waiting times for appointments and is generally very effective even with smaller children.\r\n\r\n\r\n<h2><strong><span style=\"color: #ca1517;\">What Can We Treat<\/span><\/strong><\/h2>\r\nWe assess and manage children with the following conditions:\r\n\r\n<h3>Main Language Disorders<\/h3>\r\n<p style=\"text-align: justify;\"><strong>Articulation Disorders<\/strong><\/p>\r\n<p style=\"text-align: justify;\">An articulation disorder is the inability to properly form certain word sounds. A child with this speech disorder may drop, swap, distort, or add word sounds. An example of distorting a word would be saying \u201cthith\u201d instead of \u201cthis\u201d.<\/p>\r\n<p style=\"text-align: justify;\"><strong>Resonance Disorders<\/strong><\/p>\r\n<p style=\"text-align: justify;\">A resonance disorder occurs when a blockage or obstruction of regular airflow in the nasal or oral cavities alters the vibrations responsible for voice quality. It can also happen if the velopharyngeal valve doesn\u2019t close properly. Resonance disorders are often associated with cleft palate, neurological disorders, and swollen tonsils.<\/p>\r\n<p style=\"text-align: justify;\"><strong>Receptive Disorders<\/strong><\/p>\r\n<p style=\"text-align: justify;\">A person with receptive language disorder has trouble understanding and processing what others say. This can cause you to seem uninterested when someone is speaking, have trouble following directions, or have a limited vocabulary. Other language disorders, autism, hearing loss, and a head injury can lead to a receptive language disorder.<\/p>\r\n<p style=\"text-align: justify;\"><strong>Expressive Disorders<\/strong><\/p>\r\n<p style=\"text-align: justify;\">Expressive language disorder is difficulty conveying or expressing information. If you have an expressive disorder, you may have trouble forming accurate sentences, such as using incorrect verb tense. It\u2019s associated with developmental impairments, such as Down syndrome and hearing loss. It can also result from head trauma or a medical condition.<\/p>\r\n<h3>Stammering &amp; Fluency Disorders<\/h3>\r\n<p style=\"text-align: justify;\">Stuttering, also known as <a href=\"https:\/\/www.medelit.com\/uk\/portfolio-items\/stammering-in-children\/?portfolioCats=3\">stammering<\/a> and dysphemia, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words, or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds.<\/p>\r\n<p style=\"text-align: justify;\">Stuttering and cluttering are fluency disorders. A fluency disorder affects the flow, speed, and rhythm of speech. A person with stuttering has trouble getting out a sound and may have speech that is blocked or interrupted, or may repeat part of all of a word. A person with cluttering often speaks very fast and merges words together.<\/p>\r\n<h3>Dysphagia &amp; Swallowing Difficulties<\/h3>\r\n<p style=\"text-align: justify;\">Dyspaghia is otherwise knowsn as any difficulty with swallowing, eating and drinking. This can be caused by a variety of factors in childhood. Our therapists can help identify the cause and help each child to swallow safely and effectively.<\/p>\r\n<h3>Autism Spectrum Disorder<\/h3>\r\n<p style=\"text-align: justify;\">Autism spectrum disorder can affect a child\u2019s speech, social communication skills, their ability to understand others and their ability to express what they are thinking or feeling appropriately. Autism is classed as a spectrum disorder and therefore the severity and diversity of difficulties may differ between children.<\/p>\r\n<h3>Aphasia &amp; Apraxia<\/h3>\r\n<p style=\"text-align: justify;\">These are an acquired communication disorder that affects a person\u2019s ability to speak and understand others. It also often affects a person\u2019s ability to read and write.<\/p>\r\n<p style=\"text-align: justify;\">Aphasia is when a person has a problem understanding or using words. This can make it hard to speak, read, or write. But apraxia is when someone has a hard time making the movements to speak because of a problem with their muscles.<\/p>\r\n<h3>Cognitive-Communication Disorders<\/h3>\r\n<p style=\"text-align: justify;\">Difficulty communicating because of an injury to the part of the brain that controls your ability to think is referred to as cognitive-communication disorder. It can result in memory issues, problem solving, and difficulty speaking, or listening. It can be caused by biological problems, such abnormal brain development, certain neurological conditions or a brain injury.<\/p>\r\n<h3>Selective Mutism<\/h3>\r\n<p style=\"text-align: justify;\">Selective mutism is a social anxiety disorder that causes children to only talk in certain environments or to certain people. Speech therapy can support children in overcoming these difficulties.<\/p>\r\n\r\n<h2 style=\"text-align: center;\">Currently available in London and Greater London<\/h2>\r\n\r\n<h2><strong><span style=\"color: #ca1517;\">When do children need Speech Therapy?<\/span><\/strong><\/h2>\r\n<p style=\"text-align: justify;\">There are many situations where a child might be in need of a speech therapist. It is very important to pay attention to your child&#8217;s language development in order to identify any difficulties on time and ensure targeted interventions to provide the child with the help they need. Sometimes a kid has a medical condition that makes speaking harder. Our therapists are experienced in working with a range of communication impairments including:<\/p>\r\n\r\n<ul>\r\n \t<li>hearing impairment<\/li>\r\n \t<li>articulation disorders<\/li>\r\n \t<li>fluency disorders<\/li>\r\n \t<li>voice disorders<\/li>\r\n \t<li>weak muscles around the mouth<\/li>\r\n \t<li>voice loss or hoarse voice<\/li>\r\n \t<li>literacy<\/li>\r\n \t<li>speech production difficulties<\/li>\r\n \t<li>attention and listening difficulties<\/li>\r\n \t<li>language delay<\/li>\r\n \t<li>breathing disorders<\/li>\r\n \t<li>swallowing disorders<\/li>\r\n<\/ul>\r\n\r\n\r\n<a href=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2020\/12\/speech-therapy-for-children.webp\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5663 aligncenter\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2020\/12\/speech-therapy-for-children.webp\" alt=\"speech therapy for children\" width=\"386\" height=\"325\" \/><\/a>\r\n\r\n\r\n<h2><strong><span style=\"color: #ca1517;\">Medelit&#8217;s Approach<\/span><\/strong><\/h2>\r\n<p style=\"text-align: justify;\">Medelit Home Visit Speech Therapy for children service allows an early identification of problems and a Tailored intervention with specialist support recommendations. In fact, the first step of speech therapy home visit is the evaluation. This assessment aims to better understanding the child\u2019s needs. Once the evaluation is complete, a diagnosis will be made and a treatment plan will be developed.<\/p>\r\n<p style=\"text-align: justify;\">Medelit&#8217;s approach combines traditional techniques with more interactive techniques, by using a mix of formal and informal tests in order to involve the child as much as possible. Our specialist Speech &amp; Language Therapists ensure that each and every session is not just fun but effective by using a range of games and fun therapy resources. This can be particularly useful in case of an attention deficit disorder.<\/p>\r\n<p style=\"text-align: justify;\">Effective Speech &amp; Language Therapy also requires parents to support their child\u2019s Speech and Language development at home. For this reason we provide <a href=\"https:\/\/www.medelit.com\/uk\/portfolio-items\/toddlers-speech-delay-how-can-i-help\/\">advice on how the family can support<\/a> and help the therapy.<\/p>\r\n<p style=\"text-align: justify;\">Also, Speech therapists often work closely with teachers, as well as <a href=\"https:\/\/www.medelit.com\/uk\/services\/psychologist-home-visit\/\">Psychologists<\/a>.<\/p>\r\n\r\n<h2 style=\"text-align: justify;\" align=\"JUSTIFY\"><strong><span style=\"color: #ca1517;\">About Our Speech Therapists\u00a0<\/span><\/strong><\/h2>\r\n<p style=\"text-align: justify;\" align=\"JUSTIFY\">All our Speech and Language Therapists are:<\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: justify;\"><a href=\"https:\/\/www.slt.co.uk\/professional-memberships\/hcpc\/\" target=\"_blank\" rel=\"noopener noreferrer\">Fully registered<\/a><\/li>\r\n \t<li style=\"text-align: justify;\">Board Certified<\/li>\r\n \t<li style=\"text-align: justify;\">Vetted with a full background check, reference check and interview with our managing Doctors<\/li>\r\n \t<li style=\"text-align: justify;\">Selected for their highest levels of experience and qualifications<\/li>\r\n \t<li style=\"text-align: justify;\">Proven track record of helping children of all ages overcome their speech issues.<\/li>\r\n<\/ul>\r\n\r\n<h2><span style=\"color: #ca1517;\">Advantages:<\/span><\/h2>\r\n\r\n<h3>Sit back and relax. Our Speech Therapists come to you<\/h3>\r\n\r\n<h3>Engagement of parents with information and specific programmes<\/h3>\r\n\r\n<h3>Development of skills essential to raise attainment and literacy<\/h3>\r\n\r\n<h3>Receive treatment with a personalised plan, tailored according to children needs<\/h3>\r\n\r\n<h3>One trusted Healthcare service for all your needs<\/h3>\r\n\r\n<table style=\"border-color: #ebebeb; height: 346px; background-color: #ffffff;\" border=\"1px\" width=\"100%\" cellspacing=\"3\" cellpadding=\"3px\">\r\n<tbody>\r\n<tr style=\"border-color: #000000; background-color: #f8f8f8;\">\r\n<td><span style=\"color: #ca1517;\"><strong>We&#8217;re preferred for our:<\/strong><\/span><\/td>\r\n<\/tr>\r\n<tr style=\"background-color: #ffffff;\">\r\n<td><span style=\"color: #ca1517;\">\u2665<\/span>\u00a0<b>High Standards<\/b><\/td>\r\n<\/tr>\r\n<tr style=\"background-color: #ffffff;\">\r\n<td><strong><span style=\"color: #ca1517;\">\u2665<\/span>\u00a0Courtesy<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><span style=\"color: #ca1517;\">\u2665<\/span>\u00a0<strong>Comfort<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><span style=\"color: #ca1517;\">\u2665\u00a0<\/span><b>Promptness<\/b><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><span style=\"color: #ca1517;\">\u2665\u00a0<\/span><b>Reliability<\/b><\/td>\r\n<\/tr>\r\n<tr style=\"background-color: #ffffff;\">\r\n<td><strong><span style=\"color: #ca1517;\">\u2665\u00a0<\/span>Dedication<\/strong><\/td>\r\n<\/tr>\r\n<tr>\r\n<td><strong><span style=\"color: #ca1517;\">\u2665\u00a0<\/span><\/strong><strong>Efficiency<\/strong><\/td>\r\n<\/tr>\r\n<tr style=\"background-color: #ffffff;\">\r\n<td><strong><span style=\"color: #ca1517;\">\u2665\u00a0<\/span><\/strong><strong>Availability<\/strong><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n\r\n<table style=\"border-color: #ebebeb; height: 346px; background-color: #ffffff;\" border=\"1px\" width=\"100%\" cellspacing=\"3\" cellpadding=\"3px\">\r\n<tbody>\r\n<tr style=\"border-color: #000000; background-color: #f8f8f8; height: 33px;\">\r\n<td style=\"height: 33px;\"><span style=\"color: #ca1517;\"><strong>Medelit House Call Services<\/strong><\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 33px;\">\r\n<td style=\"height: 33px;\"><span style=\"color: #ca1517;\"><strong>\u27e9<\/strong><\/span> <a href=\"https:\/\/www.medelit.com\/uk\/services\/doctor-home-visit\/\">Medical Services<\/a><\/td>\r\n<\/tr>\r\n<tr style=\"height: 34px;\">\r\n<td style=\"height: 34px;\"><strong><span style=\"color: #ca1517;\">\u27e9 <\/span><\/strong><a href=\"https:\/\/www.medelit.com\/uk\/services\/physiotherapy-home-visit\/\">Physiotherapy<\/a><\/td>\r\n<\/tr>\r\n<tr style=\"background-color: #f8f8f8; height: 34px;\">\r\n<td style=\"height: 34px;\"><strong><span style=\"color: #ca1517;\">\u27e9\u00a0<\/span><\/strong><a href=\"https:\/\/www.medelit.com\/uk\/services\/visiting-nursing-service\/\">Nursing services<\/a><\/td>\r\n<\/tr>\r\n<tr style=\"height: 34px;\">\r\n<td style=\"height: 34px;\"><strong><span style=\"color: #ca1517;\">\u27e9\u00a0<\/span><\/strong><span style=\"color: #ca1517;\"><a href=\"https:\/\/www.medelit.com\/uk\/services\/acupuncture-home-visit\/\">Acupuncture<\/a><\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 34px;\">\r\n<td style=\"height: 34px;\"><strong><span style=\"color: #ca1517;\">\u27e9<\/span><\/strong><span style=\"color: #ca1517;\"><a style=\"color: #ca1517;\" href=\"https:\/\/www.medelit.com\/uk\/services\/speech-therapy-home-visit\/\">Speech Therapy<\/a><\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 34px;\">\r\n<td style=\"height: 34px;\"><strong><strong><span style=\"color: #ca1517;\">\u27e9<a href=\"https:\/\/www.medelit.com\/uk\/services\/podiatry-home-visit\/\">\u00a0<\/a><\/span><\/strong><\/strong><a href=\"https:\/\/www.medelit.com\/uk\/services\/podiatry-home-visit\/\"><span style=\"color: #ca1517;\">Podiatry<\/span><\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n\r\n<h2 style=\"text-align: center;\"><span style=\"color: #ca1517;\"><strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0You Might also be interested in&#8230; \u00a0<\/strong><\/span><\/h2>\r\n\r\n\r\n<img decoding=\"async\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2017\/01\/nurse-home-visit.webp\" alt=\"Nursing Services at Home\" loading=\"lazy\" style=\"max-width:200px;height:auto;display:block;margin:0 auto 8px\">\n<a href=\"https:\/\/www.medelit.com\/uk\/services\/visiting-nursing-service\/\">Nursing Services at Home<\/a>\r\n\r\n\r\n\r\n<img decoding=\"async\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2016\/05\/psychology-300x186.jpg\" alt=\"Psychology at Home\" loading=\"lazy\" style=\"max-width:200px;height:auto;display:block;margin:0 auto 8px\">\n<a href=\"https:\/\/www.medelit.com\/uk\/services\/psychologist-home-visit\/\">Psychology at Home<\/a>\r\n\r\n\r\n\r\n<img decoding=\"async\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2017\/01\/mobile-physiotherapy.webp\" alt=\"Physiotherapy at Home\" loading=\"lazy\" style=\"max-width:200px;height:auto;display:block;margin:0 auto 8px\">\n<a href=\"https:\/\/www.medelit.com\/uk\/services\/physiotherapy-home-visit\/\">Physiotherapy at Home<\/a>\r\n\r\n\r\n\r\n<img decoding=\"async\" src=\"https:\/\/www.medelit.com\/uk\/wp-content\/uploads\/sites\/3\/2017\/07\/Nutritional-Therapy.webp\" alt=\"Nutritional Therapy at Home\" loading=\"lazy\" style=\"max-width:200px;height:auto;display:block;margin:0 auto 8px\">\n<a href=\"https:\/\/www.medelit.com\/uk\/services\/nutritional-therapy-home-visit\/\">Nutritional Therapy at Home<\/a>\r\n\r\n\n\n\n<div class=\"it-modal-overlay\" data-medelit-modal=\"booking\" hidden><div class=\"it-modal\" role=\"dialog\" aria-modal=\"true\" aria-label=\"Check Availability &amp; Fees\"><div class=\"it-modal-head\"><h3>Check 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c=e.target.closest(\"[data-medelit-modal-close]\");if(c||(overlay()&&e.target===overlay())){var v2=overlay();if(v2){v2.hidden=true;document.body.style.overflow=\"\"}}});document.addEventListener(\"keydown\",function(e){if(e.key===\"Escape\"){var v=overlay();if(v&&!v.hidden){v.hidden=true;document.body.style.overflow=\"\"}}});}();<\/script><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_57' style='display:none'><style>#gform_wrapper_57[data-form-index=\"0\"].gform-theme,[data-parent-form=\"57_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 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0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #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\/posts\/5358#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'>Comments<\/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\"  ><legend class='gfield_label gform-field-label' >I am a\u2026<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'>Email address (used on your previous booking)<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'>Date of birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_301' id='input_57_301' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_57_301_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_57_301_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_57_301' class='gform_hidden' value='https:\/\/www.medelit.com\/uk\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/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'>incomingurl<\/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'>actualurl<\/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\/posts\/5358' 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'>full url<\/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\/posts\/5358' 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'>Returning PT ID<\/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'>SERV TYPE<\/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'>FIELD<\/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'>SUBFIELD<\/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'>NEW\/RETURNING PT @new_returning<\/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\"  ><legend class='gfield_label gform-field-label' >I am interested in\u2026<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                         <input 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' value='Next'  \/> \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                        <input 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' value='Back'  \/> <input 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' value='Next'  \/> \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\"  ><legend class='gfield_label gform-field-label' >Is the visit address still the same as last time?<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' >RETURNING PT SYSTEM VISIT ADDRESS<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='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' selected='selected'>United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/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                        <input 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' value='Back'  \/> <input 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' value='Next'  \/> \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' >Visit address<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='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' selected='selected'>United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/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                        <input 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' value='Back'  \/> <input 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' value='Next'  \/> \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' >Current visit address<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='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' selected='selected'>United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/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                        <input 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' value='Back'  \/> <input 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' value='Next'  \/> \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'>REQUESTED HOME VISIT<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;7 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'>REQUESTED HOME-VISIT SERVICE<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;7 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'>REQUESTED VIDEO-CONSULTATION SERVICE<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 1ST + 30 MIN FOLLOWUP<\/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'>REQUESTED VIDEO-CONSULTATION SERVICE<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 1ST + 30 MIN FOLLOWUP<\/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                        <input 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' value='Back'  \/> <input 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' value='Next'  \/> \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'>REQUESTED HOME VISIT<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;7 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'>REQUESTED HOME-VISIT SERVICE<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;7 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'>REQUESTED VIDEO-CONSULTATION SERVICE<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'>REQUESTED VIDEO-CONSULTATION SERVICE<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 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>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_57_79' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_57_79' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_57_8' class='gform_page' data-js='page-field-id-79' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_57_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_57_59\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><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_59'>Video pseudo-address<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_57_59' type='text' value='XXXXVID' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><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_37'>servcode<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_57_37' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_80\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_57_80'>YOU HAVE SELECTED:<\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_80' id='input_57_80' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_24\" class=\"gfield gfield--type-uid gfield--input-type-uid gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_57_24'>cnn<\/label><div class='ginput_container ginput_container_hidden'><input name='input_24' id='input_57_24' type='hidden' value=''  \/><\/div><\/div><div id=\"field_57_50\" class=\"gfield gfield--type-uid gfield--input-type-uid gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_57_50'>PATIENT ID<\/label><div class='ginput_container ginput_container_hidden'><input name='input_50' id='input_57_50' type='hidden' value=''  \/><\/div><\/div><div id=\"field_57_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><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_40'>CONNECTED SERVICES servocde<\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_57_40' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><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_38'>CONNECTED VIDEO servcode<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_57_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><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_32'>GF1 - PASSED<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_57_32' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_57_190\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_190' id='input_57_190' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='N' \/><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_57' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='submit' id='gform_submit_button_57' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' 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