{"id":10554,"date":"2026-07-09T10:31:58","date_gmt":"2026-07-09T03:01:58","guid":{"rendered":"https:\/\/vfc.digitalnex.com\/?page_id=10554"},"modified":"2026-09-28T13:45:44","modified_gmt":"2026-09-28T06:15:44","slug":"appointment","status":"publish","type":"page","link":"https:\/\/v-ivf.com\/zh-hant\/appointment\/","title":{"rendered":"Appointment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"10554\" class=\"elementor elementor-10554\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3a059b1 e-con-full e-flex tm-col-stretched-none tm-bg-color-over-image e-con e-parent\" data-id=\"3a059b1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c05c245 elementor-widget elementor-widget-template\" data-id=\"c05c245\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"template.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-template\">\n\t\t\t\t\t<div data-elementor-type=\"container\" data-elementor-id=\"11459\" class=\"elementor elementor-11459\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t<div class=\"elementor-element elementor-element-aa47a7f e-con-full e-flex tm-col-stretched-none tm-bg-color-over-image e-con e-parent\" data-id=\"aa47a7f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-9069af7 e-con-full tm-col-stretched-none e-flex tm-bg-color-over-image e-con e-child\" data-id=\"9069af7\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-ee01cdc e-con-full tm-col-stretched-none e-grid service-image tm-bg-color-over-image e-con e-child\" data-id=\"ee01cdc\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9e348a5 elementor-widget elementor-widget-theme-post-featured-image elementor-widget-image\" data-id=\"9e348a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"theme-post-featured-image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"930\" height=\"600\" src=\"https:\/\/v-ivf.com\/wp-content\/uploads\/2026\/08\/banner-d-appointment.jpg\" class=\"attachment-full size-full wp-image-11893\" alt=\"\" srcset=\"https:\/\/v-ivf.com\/wp-content\/uploads\/2026\/08\/banner-d-appointment.jpg 930w, https:\/\/v-ivf.com\/wp-content\/uploads\/2026\/08\/banner-d-appointment-300x194.jpg 300w, https:\/\/v-ivf.com\/wp-content\/uploads\/2026\/08\/banner-d-appointment-768x495.jpg 768w, https:\/\/v-ivf.com\/wp-content\/uploads\/2026\/08\/banner-d-appointment-600x387.jpg 600w\" sizes=\"(max-width: 930px) 100vw, 930px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-9030e4d tm-col-stretched-none service-content e-flex e-con-boxed tm-bg-color-over-image e-con e-child\" data-id=\"9030e4d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-c7fa5a1 e-con-full tm-col-stretched-none e-flex tm-bg-color-over-image e-con e-child\" data-id=\"c7fa5a1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6d890f7 elementor-widget elementor-widget-heading\" data-id=\"6d890f7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">Book Appointment Online<\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b4a7f3e elementor-widget elementor-widget-heading\" data-id=\"b4a7f3e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Book an Appointment Online<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f0edbcb elementor-widget elementor-widget-text-editor\" data-id=\"f0edbcb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\tThis doctor\u2019s appointment service is not suitable for emergency cases and cannot be scheduled on the same day as the doctor\u2019s visit. In case of an emergency, please contact us by phone at <a href=\"tel:+6682-903-2035\" style=\"color: #fff\">+6682-903-2035<\/a>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-356fced0 e-flex e-con-boxed tm-col-stretched-none tm-bg-color-over-image e-con e-parent\" data-id=\"356fced0\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-e97e3da e-flex e-con-boxed tm-col-stretched-none tm-bg-color-over-image e-con e-child\" data-id=\"e97e3da\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-766916ba e-con-full tm-col-stretched-none e-flex tm-bg-color-over-image e-con e-child\" data-id=\"766916ba\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-7b86d539 e-con-full tm-col-stretched-none e-flex tm-bg-color-over-image elementor-invisible e-con e-child\" data-id=\"7b86d539\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;animation&quot;:&quot;fadeInUp&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-14e2c532 elementor-widget elementor-widget-heading\" data-id=\"14e2c532\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Book an Appointment in Just 2 Easy Steps<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-240ac144 elementor-widget elementor-widget-text-editor\" data-id=\"240ac144\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>This doctor\u2019s appointment service is not suitable for emergency cases and cannot be scheduled on the same day as the doctor\u2019s visit. 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class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/zh-hant\/wp-json\/wp\/v2\/pages\/10554#gf_3' data-formid='3' novalidate>\n        <div id='gf_progressbar_wrapper_3' 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'>2<\/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_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_3_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_3' class='gform_fields top_label form_sublabel_above description_above validation_above'><div id=\"field_3_51\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><style>\n.appointment-step-header {\n    --appointment-step-blue: #0347a4;\n    --appointment-step-text: #7b7b7b;\n\n    display: flex !important;\n    align-items: center !important;\n    justify-content: flex-start !important;\n    gap: 40px !important;\n    width: 100% !important;\n    margin: 0 !important;\n    padding: 0 !important;\n    box-sizing: border-box !important;\n}\n\n.appointment-step-header *,\n.appointment-step-header *::before,\n.appointment-step-header *::after {\n    box-sizing: border-box !important;\n}\n\n.appointment-step-header .appointment-step-item {\n    display: flex !important;\n    align-items: center !important;\n    gap: 18px !important;\n    margin: 0 !important;\n    padding: 0 !important;\n}\n\n.appointment-step-header .appointment-step-number {\n    display: flex !important;\n    align-items: center !important;\n    justify-content: center !important;\n\n    flex: 0 0 40px !important;\n    width: 40px !important;\n    min-width: 40px !important;\n    max-width: 40px !important;\n\n    height: 40px !important;\n    min-height: 40px !important;\n    max-height: 40px !important;\n\n    margin: 0 !important;\n    padding: 0 !important;\n\n    border: 2px solid var(--appointment-step-blue) !important;\n    border-radius: 50px !important;\n\n    background-color: #fff !important;\n    color: var(--appointment-step-blue) !important;\n\n    font-family: inherit !important;\n    font-size: 20px !important;\n    font-weight: 400 !important;\n    line-height: 1 !important;\n    text-align: center !important;\n\n    box-shadow: none !important;\n}\n\n\/* Active *\/\n\n.appointment-step-header\n.appointment-step-item.is-active\n.appointment-step-number {\n    border-color: var(--appointment-step-blue) !important;\n    background-color: var(--appointment-step-blue) !important;\n    color: #fff !important;\n}\n\n\/* Label *\/\n\n.appointment-step-header .appointment-step-label {\n    margin: 0 !important;\n    padding: 0 !important;\n\n    color: var(--appointment-step-text) !important;\n    white-space: nowrap !important;\n}\n\n\/* Mobile *\/\n\n@media (max-width: 767px) {\n    .appointment-step-header {\n        align-items: flex-start !important;\n        gap: 18px !important;\n    }\n\n    .appointment-step-header .appointment-step-item {\n        flex: 1 1 0 !important;\n        gap: 10px !important;\n    }\n\n    .appointment-step-header .appointment-step-number {\n        flex-basis: 34px !important;\n        width: 34px !important;\n        min-width: 34px !important;\n        max-width: 34px !important;\n\n        height: 34px !important;\n        min-height: 34px !important;\n        max-height: 34px !important;\n\n        font-size: 17px !important;\n    }\n\n    .appointment-step-header .appointment-step-label {\n        font-size: 14px !important;\n        line-height: 1.35 !important;\n        white-space: normal !important;\n    }\n}\n\n@media (max-width: 480px) {\n    .appointment-step-header {\n        gap: 12px !important;\n    }\n\n    .appointment-step-header .appointment-step-item {\n        gap: 8px !important;\n    }\n\n    .appointment-step-header .appointment-step-label {\n        font-size: 12px !important;\n    }\n}\n<\/style><\/div><div id=\"field_3_62\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><div class=\"appointment-step-header\">\n    <div class=\"appointment-step-item is-active\">\n        <div class=\"appointment-step-number\">1<\/div>\n        <h5 class=\"appointment-step-label\">\n            Preferred Appointment\n        <\/h5>\n    <\/div>\n\n    <div class=\"appointment-step-item\">\n        <div class=\"appointment-step-number\">2<\/div>\n        <h5 class=\"appointment-step-label\">\n            Additional Service Information\n        <\/h5>\n    <\/div>\n<\/div><\/div><div id=\"field_3_48\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_48'><span class='gform-field-label__text'>Consultation Topic<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_48' id='input_3_48' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select a consultation topic<\/option><option value='fertility-assessment' >Infertility testing<\/option><option value='ivf-icsi' >IVF \/ ICSI<\/option><option value='egg-freezing' >Egg freezing, Sperm and Embryo Cryopreservation<\/option><option value='genetic-carrier-screening' >Genetic carrier screening<\/option><option value='recurrent-pregnancy-loss' >Recurrent Pregnancy Loss<\/option><option value='hysteroscopy' >Hysteroscopy<\/option><option value='sperm-retrieval' >PESA \/ TESE<\/option><option value='other' >Other<\/option><\/select><\/div><\/div><div id=\"field_3_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_54'><span class='gform-field-label__text'>\u0e42\u0e1b\u0e23\u0e14\u0e23\u0e30\u0e1a\u0e38\u0e40\u0e23\u0e37\u0e48\u0e2d\u0e07\u0e17\u0e35\u0e48\u0e15\u0e49\u0e2d\u0e07\u0e01\u0e32\u0e23\u0e15\u0e34\u0e14\u0e15\u0e48\u0e2d<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_3_54' type='text' value='' class='large'    placeholder='\u0e42\u0e1b\u0e23\u0e14\u0e23\u0e30\u0e1a\u0e38\u0e40\u0e23\u0e37\u0e48\u0e2d\u0e07\u0e17\u0e35\u0e48\u0e15\u0e49\u0e2d\u0e07\u0e01\u0e32\u0e23\u0e15\u0e34\u0e14\u0e15\u0e48\u0e2d'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_47\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-half gfield_html gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><div class=\"custom-appointment-calendar\" id=\"customAppointmentCalendar\">\n    <div class=\"appointment-calendar-card\">\n        <div class=\"appointment-calendar-header\">\n            <button\n                type=\"button\"\n                class=\"appointment-calendar-nav\"\n                id=\"appointmentCalendarPrev\"\n            ><\/button>\n\n            <div\n                class=\"appointment-calendar-title\"\n                id=\"appointmentCalendarTitle\"\n            ><\/div>\n\n            <button\n                type=\"button\"\n                class=\"appointment-calendar-nav\"\n                id=\"appointmentCalendarNext\"\n            ><\/button>\n        <\/div>\n\n        <div class=\"appointment-calendar-body\">\n            <div\n                class=\"appointment-calendar-weekdays\"\n                id=\"appointmentCalendarWeekdays\"\n            ><\/div>\n\n            <div\n                class=\"appointment-calendar-days\"\n                id=\"appointmentCalendarDays\"\n            ><\/div>\n        <\/div>\n    <\/div>\n\n    <div\n        class=\"appointment-validation-error\"\n        id=\"appointmentDateValidationError\"\n    ><\/div>\n<\/div><\/div><div id=\"field_3_27\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><div\n    class=\"custom-appointment-time\"\n    id=\"customAppointmentTime\"\n>\n    <div class=\"appointment-time-card\">\n        <div\n            class=\"appointment-time-header\"\n            id=\"appointmentTimeHeader\"\n        ><\/div>\n\n        <div class=\"appointment-time-body\">\n            <div\n                class=\"appointment-selected-date\"\n                id=\"appointmentSelectedDate\"\n            ><\/div>\n\n            <div\n                class=\"appointment-time-slots\"\n                id=\"appointmentTimeSlots\"\n            ><\/div>\n        <\/div>\n    <\/div>\n\n    <div\n        class=\"appointment-time-note\"\n        id=\"appointmentTimeNote\"\n    ><\/div>\n\n    <div\n        class=\"appointment-validation-error\"\n        id=\"appointmentTimeValidationError\"\n    ><\/div>\n<\/div><\/div><div id=\"field_3_57\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_57' id='input_3_57' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_3_58\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_58' id='input_3_58' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_3_18' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Continue Appointment<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_2' class='gform_page' data-js='page-field-id-18' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_3_2' class='gform_fields top_label form_sublabel_above description_above validation_above'><div id=\"field_3_49\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_hidden\"  ><style>\n#customAppointmentCalendar,\n#customAppointmentTime {\n    --appointment-primary: #0347A4;\n    --appointment-primary-hover: #06458f;\n    --appointment-border: #bfc3c9;\n    --appointment-disabled-bg: #ededed;\n    --appointment-disabled-border: #d9dce0;\n    --appointment-disabled-text: #b8b8b8;\n\n    width: 100% !important;\n    font-family: inherit !important;\n    color: #222 !important;\n    box-sizing: border-box !important;\n}\n\n#customAppointmentCalendar *,\n#customAppointmentTime * {\n    box-sizing: border-box !important;\n}\n\n\/* Cards *\/\n#customAppointmentCalendar .appointment-calendar-card,\n#customAppointmentTime .appointment-time-card {\n    overflow: hidden !important;\n    width: 100% !important;\n    border: 1px solid var(--appointment-border) !important;\n    border-radius: 14px !important;\n    background: #fff !important;\n    box-shadow: none !important;\n}\n\n\/* Calendar header *\/\n#customAppointmentCalendar .appointment-calendar-header {\n    display: flex !important;\n    align-items: center !important;\n    justify-content: space-between !important;\n    min-height: 64px !important;\n    padding: 10px 28px !important;\n    margin: 0 !important;\n    background: var(--appointment-primary) !important;\n    color: #fff !important;\n    border: 0 !important;\n}\n\n#customAppointmentCalendar .appointment-calendar-title {\n    flex: 1 1 auto !important;\n    padding: 0 12px !important;\n    margin: 0 !important;\n    color: #fff !important;\n    font-size: 18px !important;\n    font-weight: 500 !important;\n    line-height: 1.4 !important;\n    text-align: center !important;\n}\n\n#customAppointmentCalendar button.appointment-calendar-nav {\n    display: inline-flex !important;\n    align-items: center !important;\n    justify-content: center !important;\n    flex: 0 0 38px !important;\n    width: 38px !important;\n    min-width: 38px !important;\n    max-width: 38px !important;\n    height: 38px !important;\n    min-height: 38px !important;\n    max-height: 38px !important;\n    padding: 0 !important;\n    margin: 0 !important;\n    border: 0 !important;\n    border-radius: 50% !important;\n    background: #fff !important;\n    color: #d49a45 !important;\n    font-family: inherit !important;\n    font-size: 26px !important;\n    font-weight: 400 !important;\n    line-height: 1 !important;\n    text-align: center !important;\n    text-transform: none !important;\n    box-shadow: none !important;\n    cursor: pointer !important;\n    appearance: none !important;\n    -webkit-appearance: none !important;\n    transition: background-color .2s ease, opacity .2s ease, transform .2s ease !important;\n}\n\n#customAppointmentCalendar button.appointment-calendar-nav:hover:not(:disabled) {\n    background: #f5f5f5 !important;\n    color: #d49a45 !important;\n    transform: scale(1.04) !important;\n}\n\n#customAppointmentCalendar button.appointment-calendar-nav:disabled {\n    opacity: .45 !important;\n    cursor: not-allowed !important;\n    transform: none !important;\n}\n\n\/* Calendar body *\/\n#customAppointmentCalendar .appointment-calendar-body {\n    padding: 20px 24px 22px !important;\n    margin: 0 !important;\n    background: #fff !important;\n}\n\n#customAppointmentCalendar .appointment-calendar-weekdays,\n#customAppointmentCalendar .appointment-calendar-days {\n    display: grid !important;\n    grid-template-columns: repeat(7, minmax(0, 1fr)) !important;\n    gap: 12px 8px !important;\n    width: 100% !important;\n    margin: 0 !important;\n    padding: 0 !important;\n}\n\n#customAppointmentCalendar .appointment-calendar-weekdays {\n    margin-bottom: 9px !important;\n}\n\n#customAppointmentCalendar .appointment-calendar-weekdays span {\n    display: flex !important;\n    align-items: center !important;\n    justify-content: center !important;\n    min-height: 30px !important;\n    margin: 0 !important;\n    padding: 0 !important;\n    color: #111 !important;\n    background: transparent !important;\n    font-size: 15px !important;\n    font-weight: 500 !important;\n    line-height: 1 !important;\n    text-align: center !important;\n}\n\n\/* Date buttons *\/\n#customAppointmentCalendar button.appointment-calendar-day {\n    display: inline-flex !important;\n    align-items: center !important;\n    justify-content: center !important;\n    width: 38px !important;\n    min-width: 38px !important;\n    max-width: 38px !important;\n    height: 38px !important;\n    min-height: 38px !important;\n    max-height: 38px !important;\n    margin: auto !important;\n    padding: 0 !important;\n    border: 1px solid #e4e7eb !important;\n    border-radius: 50% !important;\n    background: #fff !important;\n    color: #222 !important;\n    font-family: inherit !important;\n    font-size: 12px !important;\n    font-weight: 400 !important;\n    line-height: 1 !important;\n    text-align: center !important;\n    text-transform: none !important;\n    text-decoration: none !important;\n    box-shadow: none !important;\n    cursor: pointer !important;\n    appearance: none !important;\n    -webkit-appearance: none !important;\n    opacity: 1 !important;\n    transition:\n        background-color .2s ease,\n        border-color .2s ease,\n        color .2s ease,\n        opacity .2s ease,\n        transform .2s ease !important;\n}\n\n#customAppointmentCalendar button.appointment-calendar-day:hover:not(:disabled):not(.is-selected) {\n    background: #fff !important;\n    border-color: var(--appointment-primary) !important;\n    color: var(--appointment-primary) !important;\n    transform: translateY(-1px) !important;\n}\n\n#customAppointmentCalendar button.appointment-calendar-day.is-selected,\n#customAppointmentCalendar button.appointment-calendar-day.is-selected:hover {\n    background: var(--appointment-primary) !important;\n    border-color: var(--appointment-primary) !important;\n    color: #fff !important;\n    opacity: 1 !important;\n    transform: none !important;\n}\n\n#customAppointmentCalendar button.appointment-calendar-day:disabled,\n#customAppointmentCalendar button.appointment-calendar-day.is-disabled {\n    background: var(--appointment-disabled-bg) !important;\n    border-color: var(--appointment-disabled-border) !important;\n    color: var(--appointment-disabled-text) !important;\n    opacity: 1 !important;\n    cursor: not-allowed !important;\n    pointer-events: none !important;\n    transform: none !important;\n    box-shadow: none !important;\n}\n\n#customAppointmentCalendar button.appointment-calendar-day.is-outside-month:not(:disabled):not(.is-selected) {\n    background: #fff !important;\n    border-color: #e4e7eb !important;\n    color: #222 !important;\n    opacity: .5 !important;\n}\n\n#customAppointmentCalendar button.appointment-calendar-day.is-outside-month:disabled,\n#customAppointmentCalendar button.appointment-calendar-day.is-outside-month.is-disabled {\n    background: var(--appointment-disabled-bg) !important;\n    border-color: var(--appointment-disabled-border) !important;\n    color: var(--appointment-disabled-text) !important;\n    opacity: .8 !important;\n}\n\n#customAppointmentCalendar button.appointment-calendar-day.is-today {\n    font-weight: 400 !important;\n}\n\n\/* Time header *\/\n#customAppointmentTime .appointment-time-header {\n    display: flex !important;\n    align-items: center !important;\n    justify-content: center !important;\n    min-height: 58px !important;\n    padding: 10px 20px !important;\n    margin: 0 !important;\n    background: var(--appointment-primary) !important;\n    color: #fff !important;\n    border: 0 !important;\n    font-size: 16px !important;\n    font-weight: 500 !important;\n    line-height: 1.4 !important;\n    text-align: center !important;\n}\n\n#customAppointmentTime .appointment-required {\n    margin-left: 2px !important;\n    color: #f00 !important;\n}\n\n\/* Time body *\/\n#customAppointmentTime .appointment-time-body {\n    padding: 14px 28px 18px !important;\n    margin: 0 !important;\n    background: #fff !important;\n}\n\n#customAppointmentTime .appointment-selected-date {\n    display: none !important;\n    margin: 0 0 14px !important;\n    padding: 0 !important;\n    color: var(--appointment-primary) !important;\n    font-size: 13px !important;\n    font-weight: 600 !important;\n    line-height: 1.4 !important;\n    text-align: center !important;\n}\n\n#customAppointmentTime .appointment-selected-date.is-visible {\n    display: block !important;\n}\n\n#customAppointmentTime .appointment-time-slots {\n    display: grid !important;\n    grid-template-columns: repeat(2, minmax(0, 1fr)) !important;\n    gap: 14px 16px !important;\n    width: 100% !important;\n    margin: 0 !important;\n    padding: 0 !important;\n}\n\n#customAppointmentTime button.appointment-time-slot {\n    display: inline-flex !important;\n    align-items: center !important;\n    justify-content: center !important;\n    width: 100% !important;\n    min-height: 38px !important;\n    padding: 8px 12px !important;\n    margin: 0 !important;\n    border: 1px solid #e3e5e8 !important;\n    border-radius: 999px !important;\n    background: #fff !important;\n    color: #222 !important;\n    font-family: inherit !important;\n    font-size: 12px !important;\n    font-weight: 400 !important;\n    line-height: 1.3 !important;\n    text-align: center !important;\n    text-transform: none !important;\n    text-decoration: none !important;\n    box-shadow: none !important;\n    cursor: pointer !important;\n    appearance: none !important;\n    -webkit-appearance: none !important;\n    transition:\n        background-color .2s ease,\n        border-color .2s ease,\n        color .2s ease,\n        transform .2s ease !important;\n}\n\n#customAppointmentTime button.appointment-time-slot:hover:not(:disabled):not(.is-selected) {\n    background: #fff !important;\n    border-color: var(--appointment-primary) !important;\n    color: var(--appointment-primary) !important;\n    transform: translateY(-1px) !important;\n}\n\n#customAppointmentTime button.appointment-time-slot.is-selected,\n#customAppointmentTime button.appointment-time-slot.is-selected:hover {\n    background: var(--appointment-primary) !important;\n    border-color: var(--appointment-primary) !important;\n    color: #fff !important;\n    transform: none !important;\n}\n\n#customAppointmentTime button.appointment-time-slot:disabled,\n#customAppointmentTime button.appointment-time-slot.is-disabled {\n    background: #ededed !important;\n    border-color: #d9dce0 !important;\n    color: #b8b8b8 !important;\n    cursor: not-allowed !important;\n    pointer-events: none !important;\n    transform: none !important;\n    box-shadow: none !important;\n}\n\n#customAppointmentTime .appointment-time-empty {\n    grid-column: 1 \/ -1 !important;\n    padding: 28px 15px !important;\n    margin: 0 !important;\n    color: #888 !important;\n    background: transparent !important;\n    font-size: 13px !important;\n    line-height: 1.5 !important;\n    text-align: center !important;\n}\n\n#customAppointmentTime .appointment-time-note {\n    margin: 20px 0 0 !important;\n    padding: 0 !important;\n    color: #888 !important;\n    background: transparent !important;\n    font-size: 13px !important;\n    font-weight: 400 !important;\n    line-height: 1.8 !important;\n}\n\n#customAppointmentTime .appointment-validation-error {\n    display: none !important;\n    margin: 10px 0 0 !important;\n    padding: 0 !important;\n    color: #d63638 !important;\n    background: transparent !important;\n    font-size: 13px !important;\n    line-height: 1.5 !important;\n}\n\n#customAppointmentTime .appointment-validation-error.is-visible {\n    display: block !important;\n}\n\n#customAppointmentCalendar button:focus-visible,\n#customAppointmentTime button:focus-visible {\n    outline: 2px solid var(--appointment-primary) !important;\n    outline-offset: 2px !important;\n}\n\n@media (max-width: 767px) {\n    #customAppointmentCalendar .appointment-calendar-header {\n        min-height: 58px !important;\n        padding: 10px 16px !important;\n    }\n\n    #customAppointmentCalendar .appointment-calendar-title {\n        font-size: 16px !important;\n    }\n\n    #customAppointmentCalendar button.appointment-calendar-nav {\n        width: 34px !important;\n        min-width: 34px !important;\n        max-width: 34px !important;\n        height: 34px !important;\n        min-height: 34px !important;\n        max-height: 34px !important;\n        flex-basis: 34px !important;\n        font-size: 23px !important;\n    }\n\n    #customAppointmentCalendar .appointment-calendar-body {\n        padding: 18px 10px 20px !important;\n    }\n\n    #customAppointmentCalendar .appointment-calendar-weekdays,\n    #customAppointmentCalendar .appointment-calendar-days {\n        gap: 8px 4px !important;\n    }\n\n    #customAppointmentCalendar button.appointment-calendar-day {\n        width: 34px !important;\n        min-width: 34px !important;\n        max-width: 34px !important;\n        height: 34px !important;\n        min-height: 34px !important;\n        max-height: 34px !important;\n        font-size: 11px !important;\n    }\n\n    #customAppointmentTime .appointment-time-body {\n        padding: 16px 14px 20px !important;\n    }\n\n    #customAppointmentTime .appointment-time-slots {\n        gap: 10px !important;\n    }\n\n    #customAppointmentTime button.appointment-time-slot {\n        padding: 8px 5px !important;\n        font-size: 10px !important;\n    }\n}\n\n@media (max-width: 380px) {\n    #customAppointmentCalendar button.appointment-calendar-day {\n        width: 31px !important;\n        min-width: 31px !important;\n        max-width: 31px !important;\n        height: 31px !important;\n        min-height: 31px !important;\n        max-height: 31px !important;\n    }\n\n    #customAppointmentTime .appointment-time-slots {\n        grid-template-columns: 1fr !important;\n    }\n}\n#field_1_57,\n#field_1_58 {\n    position: absolute !important;\n    width: 1px !important;\n    height: 1px !important;\n    overflow: hidden !important;\n    clip: rect(0, 0, 0, 0) !important;\n    white-space: nowrap !important;\n}\n\n.appointment-validation-error {\n    margin-top: 10px;\n    font-size: 14px;\n    color: #d63638;\n}\n\n.appointment-validation-error:empty {\n    display: none;\n}\n\n.appointment-validation-error.is-visible {\n    display: block;\n}\n.gfield_consent_description_text b, .gfield_consent_description_text strong {\nfont-weight: bolder !important;\n}\n<\/style><\/div><div id=\"field_3_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Your Personal Information<\/h3><\/div><div id=\"field_3_52\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><div class=\"appointment-step-header\">\n    <div class=\"appointment-step-item is-active\">\n        <div class=\"appointment-step-number\">1<\/div>\n        <h5 class=\"appointment-step-label\">\n            Preferred Appointment\n        <\/h5>\n    <\/div>\n\n    <div class=\"appointment-step-item is-active\">\n        <div class=\"appointment-step-number\">2<\/div>\n        <h5 class=\"appointment-step-label\">\n            Additional Service Information\n        <\/h5>\n    <\/div>\n<\/div><\/div><div id=\"field_3_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_32'><span class='gform-field-label__text'>First Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_3_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_33'><span class='gform-field-label__text'>Last Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_3_33' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_35\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_35'><span class='gform-field-label__text'>Date of Birth<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_3_35'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_35'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_3_35' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_3_35' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_3_35' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_3_36\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-horizontal\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Gender<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_36'>\n\t\t\t<div class='gchoice gchoice_3_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Male'  id='choice_3_36_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_36_0' id='label_3_36_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Female'  id='choice_3_36_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_36_1' id='label_3_36_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_36_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Prefer Not to Answer'  id='choice_3_36_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_36_2' id='label_3_36_2' class='gform-field-label gform-field-label--type-inline'>Prefer Not to Answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_10\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_10'><span class='gform-field-label__text'>Contact Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_3_10' type='tel' value='' class='large'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_3_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_2'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_3_2' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                        <\/div><\/div><div id=\"field_3_37\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_37'><span class='gform-field-label__text'>Nationality<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_3_37' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='AFGHAN \/ \u0e2d\u0e31\u0e1f\u0e01\u0e32\u0e19\u0e34\u0e2a\u0e16\u0e32\u0e19' >Afghan<\/option><option value='AFRICAN \/ \u0e41\u0e2d\u0e1f\u0e23\u0e34\u0e01\u0e32' >African<\/option><option value='ALBANIAN \/ \u0e41\u0e2d\u0e25\u0e40\u0e1a\u0e40\u0e19\u0e35\u0e22' >Albanian<\/option><option value='ALGERIAN \/ \u0e41\u0e2d\u0e25\u0e08\u0e35\u0e40\u0e23\u0e35\u0e22' >Algerian<\/option><option value='AMERICAN \/ \u0e2d\u0e40\u0e21\u0e23\u0e34\u0e01\u0e32' >American<\/option><option value='ANDORRAN \/ \u0e2d\u0e31\u0e19\u0e14\u0e2d\u0e23\u0e4c\u0e23\u0e32' >Andorran<\/option><option value='ANGOLAN \/ \u0e41\u0e2d\u0e07\u0e42\u0e01\u0e25\u0e32' >Angolan<\/option><option value='ARAB EMIRATES \/ \u0e2a\u0e2b\u0e23\u0e31\u0e10\u0e2d\u0e32\u0e2b\u0e23\u0e31\u0e1a\u0e40\u0e2d\u0e21\u0e34\u0e40\u0e23\u0e15\u0e2a\u0e4c' >Arab Emirates<\/option><option value='ARGENTINIAN \/ \u0e2d\u0e32\u0e23\u0e4c\u0e40\u0e08\u0e19\u0e15\u0e34\u0e19\u0e32' >Argentinian<\/option><option value='ARMENIAN \/ \u0e2d\u0e32\u0e23\u0e4c\u0e40\u0e21\u0e40\u0e19\u0e35\u0e22' >Armenian<\/option><option value='AUSTRALIAN \/ \u0e2d\u0e2d\u0e2a\u0e40\u0e15\u0e23\u0e40\u0e25\u0e35\u0e22' >Australian<\/option><option value='AUSTRIAN \/ \u0e2d\u0e2d\u0e2a\u0e40\u0e15\u0e23\u0e35\u0e22' >Austrian<\/option><option value='AZERBAIJAN \/ \u0e2d\u0e32\u0e40\u0e0b\u0e2d\u0e23\u0e4c\u0e42\u0e1a\u0e08\u0e32\u0e19' >Azerbaijan<\/option><option value='BAHAMIAN \/ \u0e1a\u0e32\u0e2e\u0e32\u0e21\u0e31\u0e2a' >Bahamian<\/option><option value='BAHRAINI \/ \u0e1a\u0e32\u0e2b\u0e4c\u0e40\u0e23\u0e19' >Bahraini<\/option><option value='BANGLADESHI \/ \u0e1a\u0e31\u0e07\u0e04\u0e25\u0e32\u0e40\u0e17\u0e28' >Bangladeshi<\/option><option value='BARBADIAN \/ \u0e1a\u0e32\u0e40\u0e1a\u0e42\u0e14\u0e2a' >Barbadian<\/option><option value='BELARUS \/ \u0e40\u0e1a\u0e25\u0e32\u0e23\u0e38\u0e2a' >Belarus<\/option><option value='BELGIUM\/ \u0e40\u0e1a\u0e25\u0e40\u0e22\u0e35\u0e22\u0e21' >Belgium<\/option><option value='BELIZEAN \/ \u0e40\u0e1a\u0e25\u0e35\u0e0b' >Belizean<\/option><option value='BERMUDIAN \/ \u0e40\u0e1a\u0e2d\u0e23\u0e4c\u0e21\u0e34\u0e27\u0e14\u0e32' >Bermudian<\/option><option value='BHUTANI \/ \u0e20\u0e39\u0e0f\u0e32\u0e19' >Bhutani<\/option><option value='BOLIVIAN \/ \u0e42\u0e1a\u0e25\u0e34\u0e40\u0e27\u0e35\u0e22' >Bolivian<\/option><option value='BOSNAI AND HERZEGOVINA \/ \u0e1a\u0e2d\u0e2a\u0e40\u0e19\u0e35\u0e22' >Bosnai And Herzegovina<\/option><option value='BOTSWANA \/ \u0e2a\u0e32\u0e18\u0e32\u0e23\u0e13\u0e23\u0e31\u0e10\u0e1a\u0e2d\u0e15\u0e2a\u0e27\u0e32\u0e19\u0e32' >Botswana<\/option><option value='BRAZILIAN \/ \u0e1a\u0e23\u0e32\u0e0b\u0e34\u0e25' >Brazilian<\/option><option value='BRITISH \/ \u0e2d\u0e31\u0e07\u0e01\u0e24\u0e29' >British<\/option><option value='BRUNEIAN \/ \u0e1a\u0e23\u0e39\u0e44\u0e19' >Bruneian<\/option><option value='BULGARIA \/ \u0e1a\u0e31\u0e25\u0e41\u0e01\u0e40\u0e23\u0e35\u0e22' >Bulgaria<\/option><option value='BURKINABE \/ \u0e1a\u0e39\u0e23\u0e4c\u0e01\u0e34\u0e19\u0e32\u0e1f\u0e32\u0e42\u0e0b' >Burkinabe<\/option><option value='CAMBODIAN \/ \u0e01\u0e31\u0e21\u0e1e\u0e39\u0e0a\u0e32' >Cambodian<\/option><option value='CAMEROONIAN \/ \u0e41\u0e04\u0e40\u0e21\u0e2d\u0e23\u0e39\u0e19' >Cameroonian<\/option><option value='CANADIAN \/ \u0e41\u0e04\u0e19\u0e32\u0e14\u0e32' >Canadian<\/option><option value='CHADIAN \/ \u0e0a\u0e32\u0e14' >Chadian<\/option><option value='CHILEAN \/ \u0e0a\u0e34\u0e25\u0e35' >Chilean<\/option><option value='CHINESE \/ \u0e08\u0e35\u0e19' >Chinese<\/option><option value='COLOMBIAN \/ \u0e42\u0e04\u0e25\u0e31\u0e21\u0e40\u0e1a\u0e35\u0e22' >Colombian<\/option><option value='Comores \/ Comoros' >Comores<\/option><option value='CONGOLESE \/ \u0e04\u0e2d\u0e07\u0e42\u0e01' >Congolese<\/option><option value='COSTA RICAN \/ \u0e04\u0e2d\u0e2a\u0e15\u0e32\u0e23\u0e34\u0e01\u0e32' >Costa Rican<\/option><option value='CROATIAN \/ \u0e42\u0e04\u0e23\u0e40\u0e2d\u0e40\u0e0a\u0e35\u0e22' >Croatian<\/option><option value='CUBAN \/ \u0e04\u0e34\u0e27\u0e1a\u0e32' >Cuban<\/option><option value='CYPRIOT \/ \u0e44\u0e0b\u0e1b\u0e23\u0e31\u0e2a' >Cypriot<\/option><option value='CZECH \/ \u0e2a\u0e32\u0e18\u0e32\u0e23\u0e13\u0e23\u0e31\u0e10\u0e40\u0e0a\u0e4a\u0e04' >Czech<\/option><option value='DANISH \/ \u0e40\u0e14\u0e19\u0e21\u0e32\u0e23\u0e4c\u0e01' >Danish<\/option><option value='Deutsch(German)' >Deutsch(German)<\/option><option value='Djibouti' >Djibouti<\/option><option value='DOMINICAN \/\u0e42\u0e14\u0e21\u0e34\u0e19\u0e34\u0e01\u0e32' >Dominican<\/option><option value='DUBAI \/ \u0e14\u0e39\u0e44\u0e1a' >Dubai<\/option><option value='DUTCH \/ \u0e40\u0e19\u0e40\u0e18\u0e2d\u0e23\u0e4c\u0e41\u0e25\u0e19\u0e14\u0e4c' >Dutch<\/option><option value='ECUADORIAN \/ \u0e40\u0e2d\u0e01\u0e27\u0e32\u0e14\u0e2d\u0e23\u0e4c' >Ecuadorian<\/option><option value='EGYPTIAN \/ \u0e2d\u0e35\u0e22\u0e34\u0e1b\u0e15\u0e4c' >Egyptian<\/option><option value='EL SALVADOR \/ \u0e40\u0e2d\u0e25\u0e0b\u0e31\u0e25\u0e27\u0e32\u0e14\u0e2d\u0e23\u0e4c' >El Salvador<\/option><option value='EQUATORIAL GUINEA \/ \u0e01\u0e34\u0e27\u0e19\u0e35' >Equatorial Guinea<\/option><option value='Eritrea \/ \u0e40\u0e2d\u0e23\u0e34\u0e40\u0e17\u0e23\u0e35\u0e22' >Eritrea<\/option><option value='ESTONIA \/ \u0e40\u0e2d\u0e2a\u0e42\u0e17\u0e40\u0e19\u0e35\u0e22' >Estonia<\/option><option value='ETHIOPIAN \/ \u0e40\u0e2d\u0e18\u0e34\u0e42\u0e2d\u0e40\u0e1b\u0e35\u0e22' >Ethiopian<\/option><option value='FIJIAN \/ \u0e1f\u0e34\u0e08\u0e34' >Fijian<\/option><option value='FILIPINO \/ \u0e1f\u0e34\u0e25\u0e34\u0e1b\u0e1b\u0e34\u0e19\u0e2a\u0e4c' >Filipino<\/option><option value='FINNISH \/ \u0e1f\u0e34\u0e19\u0e41\u0e25\u0e19\u0e14\u0e4c' >Finnish<\/option><option value='FRENCH \/ \u0e1d\u0e23\u0e31\u0e48\u0e07\u0e40\u0e28\u0e2a' >French<\/option><option value='GABONESE \/ \u0e01\u0e32\u0e1a\u0e2d\u0e19\u0e19\u0e34\u0e2a' >Gabonese<\/option><option value='GAMBIAN \/ \u0e41\u0e01\u0e21\u0e40\u0e1a\u0e35\u0e22' >Gambian<\/option><option value='GEORGIAN \/ \u0e08\u0e2d\u0e23\u0e4c\u0e40\u0e08\u0e35\u0e22' >Georgian<\/option><option value='GHANAIAN \/ \u0e01\u0e32\u0e19\u0e32' >Ghanaian<\/option><option value='GREEK \/ \u0e01\u0e23\u0e35\u0e0b' >Greek<\/option><option value='GREENLANDER \/ \u0e01\u0e23\u0e35\u0e19\u0e41\u0e25\u0e19\u0e14\u0e4c' >Greenlander<\/option><option value='Guam' >Guam<\/option><option value='GUATEMALAN \/ \u0e01\u0e31\u0e25\u0e40\u0e15\u0e21\u0e32\u0e25\u0e32' >Guatemalan<\/option><option value='GUINEA' >Guinea<\/option><option value='GUYANESE \/ \u0e01\u0e39\u0e22\u0e32\u0e40\u0e19\u0e2a' >Guyanese<\/option><option value='HAITIAN \/ \u0e40\u0e2e\u0e15\u0e34' >Haitian<\/option><option value='HONDURAN \/ \u0e2e\u0e2d\u0e19\u0e14\u0e39\u0e23\u0e31\u0e2a' >Honduran<\/option><option value='HONG KONG \/ \u0e2e\u0e48\u0e2d\u0e07\u0e01\u0e07' >Hong Kong<\/option><option value='HUNGARIAN \/ \u0e2e\u0e31\u0e07\u0e01\u0e32\u0e23\u0e35' >Hungarian<\/option><option value='IBERIAN \/ \u0e44\u0e2d\u0e1a\u0e35\u0e40\u0e23\u0e35\u0e22' >Iberian<\/option><option value='ICELANDIC \/ \u0e44\u0e2d\u0e0b\u0e4c\u0e41\u0e25\u0e19\u0e14\u0e4c' >Icelandic<\/option><option value='INDIAN \/ \u0e2d\u0e34\u0e19\u0e40\u0e14\u0e35\u0e22' >Indian<\/option><option value='INDONESIAN \/ \u0e2d\u0e34\u0e19\u0e42\u0e14\u0e19\u0e35\u0e40\u0e0b\u0e35\u0e22' >Indonesian<\/option><option value='IRANIAN \/ \u0e2d\u0e34\u0e2b\u0e23\u0e48\u0e32\u0e19' >Iranian<\/option><option value='IRAQI \/ \u0e2d\u0e34\u0e23\u0e31\u0e01' >Iraqi<\/option><option value='IRELAND \/ \u0e44\u0e2d\u0e23\u0e4c\u0e41\u0e25\u0e19\u0e14\u0e4c' >Ireland<\/option><option value='IRISH \/ \u0e2a\u0e32\u0e18\u0e32\u0e23\u0e13\u0e23\u0e31\u0e10\u0e44\u0e2d\u0e23\u0e4c\u0e41\u0e25\u0e19\u0e14\u0e4c' >Irish<\/option><option value='ISRAELI \/ \u0e2d\u0e34\u0e2a\u0e23\u0e32\u0e40\u0e2d\u0e25' >Israeli<\/option><option value='ITALIAN \/ \u0e2d\u0e34\u0e15\u0e32\u0e25\u0e35' >Italian<\/option><option value='IVORY COAST (C&#039;TE D&#039;IVOIRE) \/ \u0e42\u0e01\u0e15\u0e14\u0e34\u0e27\u0e31\u0e27\u0e23\u0e4c' >Ivory Coast (C&#039;Te D&#039;Ivoire)<\/option><option value='JAMAICAN \/ \u0e08\u0e32\u0e40\u0e21\u0e01\u0e32' >Jamaican<\/option><option value='JAMHUURIYADDA SOOMAALI' >Jamhuuriyadda Soomaali<\/option><option value='JAPANESE \/ \u0e0d\u0e35\u0e48\u0e1b\u0e38\u0e48\u0e19' >Japanese<\/option><option value='JORDANIAN \/ \u0e08\u0e2d\u0e23\u0e4c\u0e41\u0e14\u0e19' >Jordanian<\/option><option value='KAZAK \/ \u0e04\u0e32\u0e0b\u0e31\u0e01\u0e2a\u0e16\u0e32\u0e19' >Kazak<\/option><option value='KENYAN \/ \u0e40\u0e04\u0e19\u0e22\u0e32' >Kenyan<\/option><option value='KIRGHIZ \/ \u0e04\u0e35\u0e23\u0e4c\u0e01\u0e34\u0e0b\u0e2a\u0e16\u0e32\u0e19' >Kirghiz<\/option><option value='KOREAN (NORTH) \/ \u0e40\u0e01\u0e32\u0e2b\u0e25\u0e35\u0e40\u0e2b\u0e19\u0e37\u0e2d' >Korean (North)<\/option><option value='KOREAN (SOUTH) \/ \u0e40\u0e01\u0e32\u0e2b\u0e25\u0e35\u0e43\u0e15\u0e49' >Korean (South)<\/option><option value='KUWAITI \/ \u0e04\u0e39\u0e40\u0e27\u0e47\u0e15' >Kuwaiti<\/option><option value='LAOTIAN \/ \u0e25\u0e32\u0e27' >Laotian<\/option><option value='LATVIAN \/ \u0e25\u0e31\u0e15\u0e40\u0e27\u0e35\u0e22' >Latvian<\/option><option value='LEBANESE \/ \u0e40\u0e25\u0e1a\u0e32\u0e19\u0e2d\u0e19' >Lebanese<\/option><option value='LESOTHO \/ \u0e40\u0e25\u0e42\u0e0b\u0e42\u0e17' >Lesotho<\/option><option value='LIBERIAN \/ \u0e44\u0e25\u0e1a\u0e35\u0e40\u0e23\u0e35\u0e22' >Liberian<\/option><option value='LIBYAN \/ \u0e25\u0e34\u0e40\u0e1a\u0e35\u0e22' >Libyan<\/option><option value='LITHUANIAN \/ \u0e25\u0e34\u0e17\u0e31\u0e27\u0e40\u0e19\u0e35\u0e22' >Lithuanian<\/option><option value='LUXEMBOURGER \/ \u0e25\u0e31\u0e01\u0e41\u0e0b\u0e21\u0e40\u0e1a\u0e34\u0e23\u0e4c\u0e01' >Luxembourger<\/option><option value='MALAGASY \/ \u0e21\u0e32\u0e14\u0e32\u0e01\u0e31\u0e2a\u0e01\u0e32\u0e23\u0e4c' >Malagasy<\/option><option value='MALAWIAN \/ \u0e21\u0e32\u0e25\u0e32\u0e27\u0e35' >Malawian<\/option><option value='MALAYSIAN \/ \u0e21\u0e32\u0e40\u0e25\u0e40\u0e0b\u0e36\u0e22' >Malaysian<\/option><option value='MALDIVIAN \/ \u0e21\u0e31\u0e25\u0e14\u0e35\u0e1f\u0e2a\u0e4c' >Maldivian<\/option><option value='MALIAN \/ \u0e21\u0e32\u0e25\u0e35' >Malian<\/option><option value='MALTESE \/ \u0e21\u0e2d\u0e25\u0e15\u0e32' >Maltese<\/option><option value='MAURETANIAN \/ \u0e21\u0e2d\u0e23\u0e34\u0e40\u0e15\u0e40\u0e19\u0e35\u0e22' >Mauretanian<\/option><option value='MAURITIAN \/ \u0e21\u0e32\u0e23\u0e34\u0e40\u0e15\u0e40\u0e19\u0e35\u0e22' >Mauritian<\/option><option value='MEXICAN \/ \u0e40\u0e21\u0e47\u0e01\u0e0b\u0e34\u0e42\u0e01' >Mexican<\/option><option value='MICRONESIAN \/ \u0e44\u0e21\u0e42\u0e04\u0e23\u0e19\u0e35\u0e40\u0e0b\u0e35\u0e22\u0e19' >Micronesian<\/option><option value='MOLDAVAN \/ \u0e42\u0e21\u0e42\u0e14\u0e27\u0e32' >Moldavan<\/option><option value='MONGOLIAN \/ \u0e21\u0e2d\u0e07\u0e42\u0e01\u0e40\u0e25\u0e35\u0e22' >Mongolian<\/option><option value='MOROCCAN \/ \u0e42\u0e21\u0e23\u0e4a\u0e2d\u0e01\u0e42\u0e01' >Moroccan<\/option><option value='MOZAMBICAN \/ \u0e42\u0e21\u0e0b\u0e31\u0e21\u0e1a\u0e34\u0e01' >Mozambican<\/option><option value='MYANMAR \/ \u0e1e\u0e21\u0e48\u0e32' >Myanmar<\/option><option value='NEPALESE \/ \u0e40\u0e19\u0e1b\u0e32\u0e25' >Nepalese<\/option><option value='NETHERLANDS \/ \u0e40\u0e19\u0e40\u0e18\u0e2d\u0e23\u0e4c\u0e41\u0e25\u0e19\u0e14\u0e4c' >Netherlands<\/option><option value='NEW ZEALANDER \/ \u0e19\u0e34\u0e27\u0e0b\u0e35\u0e41\u0e25\u0e19\u0e14\u0e4c' >New Zealander<\/option><option value='NICARAGUAN \/ \u0e19\u0e34\u0e01\u0e32\u0e23\u0e32\u0e01\u0e31\u0e27' >Nicaraguan<\/option><option value='NIGERIAN \/ \u0e44\u0e19\u0e08\u0e35\u0e40\u0e23\u0e35\u0e22' >Nigerian<\/option><option value='NORWEGIAN \/ \u0e19\u0e2d\u0e23\u0e4c\u0e40\u0e27\u0e22\u0e4c' >Norwegian<\/option><option value='OMANI \/ \u0e42\u0e2d\u0e21\u0e32\u0e19' >Omani<\/option><option value='PAKISTANI \/ \u0e1b\u0e32\u0e01\u0e35\u0e2a\u0e16\u0e32\u0e19' >Pakistani<\/option><option value='PALESTINIAN \/ \u0e1b\u0e32\u0e40\u0e25\u0e2a\u0e44\u0e15\u0e2a\u0e4c' >Palestinian<\/option><option value='PANAMANIAN \/ \u0e1b\u0e32\u0e19\u0e32\u0e21\u0e32' >Panamanian<\/option><option value='PAPUAN \/ \u0e1b\u0e32\u0e1b\u0e31\u0e27\u0e19\u0e34\u0e27\u0e01\u0e34\u0e19\u0e35' >Papuan<\/option><option value='PARAQUAYAN \/ \u0e1b\u0e32\u0e23\u0e32\u0e01\u0e27\u0e31\u0e22' >Paraquayan<\/option><option value='PERUVIAN \/ \u0e40\u0e1b\u0e23\u0e39' >Peruvian<\/option><option value='POLISH \/ \u0e42\u0e1b\u0e41\u0e25\u0e19\u0e14\u0e4c' >Polish<\/option><option value='PORTUGUES \/ \u0e42\u0e1b\u0e23\u0e15\u0e38\u0e40\u0e01\u0e2a' >Portugues<\/option><option value='PUERTORICAN \/ \u0e40\u0e1b\u0e2d\u0e23\u0e4c\u0e42\u0e15\u0e23\u0e34\u0e42\u0e01' >Puertorican<\/option><option value='PUERTORICO \/ \u0e40\u0e1b\u0e2d\u0e42\u0e15\u0e23\u0e34\u0e42\u0e01' >Puertorico<\/option><option value='QATAR \/ \u0e01\u0e32\u0e23\u0e4c\u0e15\u0e32' >Qatar<\/option><option value='REPUBLIC OF BURUNDI \/ \u0e2a\u0e32\u0e18\u0e32\u0e23\u0e13\u0e23\u0e31\u0e10\u0e1a\u0e38\u0e23\u0e38\u0e19\u0e14\u0e35' >Republic Of Burundi<\/option><option value='REPUBLIC OF NAMIBIA' >Republic Of Namibia<\/option><option value='ROMANIAN \/ \u0e42\u0e23\u0e21\u0e32\u0e40\u0e19\u0e35\u0e22' >Romanian<\/option><option value='RUSSIAN \/ \u0e2a\u0e2b\u0e1e\u0e31\u0e19\u0e18\u0e23\u0e31\u0e10\u0e23\u0e31\u0e2a\u0e40\u0e0b\u0e35\u0e22' >Russian<\/option><option value='RWANDA \/ \u0e23\u0e27\u0e31\u0e19\u0e14\u0e32' >Rwanda<\/option><option value='Saint Kitts And Nevis \/\u0e2a\u0e2b\u0e1e\u0e31\u0e19\u0e18\u0e23\u0e31\u0e10\u0e40\u0e0b\u0e19\u0e15\u0e4c\u0e04\u0e34\u0e15\u0e2a\u0e4c\u0e41\u0e25\u0e30\u0e40\u0e19\u0e27\u0e34\u0e2a' >Saint Kitts And Nevis<\/option><option value='SAINT LUCIAN \/ \u0e40\u0e0b\u0e19\u0e15\u0e4c\u0e25\u0e39\u0e40\u0e0b\u0e35\u0e22' >Saint Lucian<\/option><option value='SAMOAN \/ \u0e0b\u0e32\u0e21\u0e31\u0e27' >Samoan<\/option><option value='SAUDI \/ \u0e0b\u0e32\u0e2d\u0e38\u0e14\u0e35\u0e2d\u0e32\u0e23\u0e30\u0e40\u0e1a\u0e35\u0e22' >Saudi<\/option><option value='SCOTTISH \/ \u0e2a\u0e01\u0e2d\u0e15\u0e41\u0e25\u0e19\u0e14\u0e4c' >Scottish<\/option><option value='SENEGALESE \/ \u0e40\u0e0b\u0e40\u0e19\u0e01\u0e31\u0e25' >Senegalese<\/option><option value='SERB \/ \u0e22\u0e39\u0e42\u0e01\u0e2a\u0e25\u0e32\u0e40\u0e27\u0e35\u0e22' >Serb<\/option><option value='SERBIA' >SERBIA<\/option><option value='SEYCHELLOIS \/ \u0e40\u0e0a\u0e40\u0e0a\u0e25\u0e27\u0e32\u0e0b\u0e4c' >Seychellois<\/option><option value='SIERRA LEONEAN \/ \u0e40\u0e0b\u0e35\u0e22\u0e23\u0e32 \u0e25\u0e35\u0e2d\u0e2d\u0e19' >Sierra Leonean<\/option><option value='SINGAPOREAN \/ \u0e2a\u0e34\u0e07\u0e04\u0e42\u0e1b\u0e23\u0e4c' >Singaporean<\/option><option value='SLOVAK \/ \u0e2a\u0e42\u0e25\u0e27\u0e30\u0e40\u0e01\u0e35\u0e22' >Slovak<\/option><option value='SLOVENE \/ \u0e2a\u0e42\u0e25\u0e27\u0e35\u0e40\u0e19\u0e35\u0e22' >Slovene<\/option><option value='SOMALI \/ \u0e42\u0e0b\u0e21\u0e32\u0e40\u0e25\u0e35\u0e22' >Somali<\/option><option value='SOUTH AFRICAN \/ \u0e41\u0e2d\u0e1f\u0e23\u0e34\u0e01\u0e32\u0e43\u0e15\u0e49' >South African<\/option><option value='SOUTH SUDANESE \/ \u0e0b\u0e39\u0e14\u0e32\u0e19\u0e43\u0e15\u0e49' >South Sudanese<\/option><option value='SPANISH \/ \u0e2a\u0e40\u0e1b\u0e19' >Spanish<\/option><option value='SRILANKAN \/ \u0e28\u0e23\u0e35\u0e25\u0e31\u0e07\u0e01\u0e32' >Srilankan<\/option><option value='SUDANESE \/ \u0e0b\u0e39\u0e14\u0e32\u0e19' >Sudanese<\/option><option value='SWEDISH \/ \u0e2a\u0e27\u0e35\u0e40\u0e14\u0e19' >Swedish<\/option><option value='SWISS \/ \u0e2a\u0e27\u0e34\u0e15\u0e40\u0e0b\u0e2d\u0e23\u0e4c\u0e41\u0e25\u0e19\u0e14\u0e4c' >Swiss<\/option><option value='SYRIAN \/ \u0e0b\u0e35\u0e40\u0e23\u0e35\u0e22' >Syrian<\/option><option value='TAIWANESE \/ \u0e44\u0e15\u0e49\u0e2b\u0e27\u0e31\u0e19' >Taiwanese<\/option><option value='TAJIK \/ \u0e17\u0e32\u0e08\u0e34\u0e2a\u0e16\u0e32\u0e19' >Tajik<\/option><option value='TANZANIAN \/ \u0e41\u0e17\u0e19\u0e0b\u0e32\u0e40\u0e19\u0e35\u0e22' >Tanzanian<\/option><option value='THAI \/ \u0e44\u0e17\u0e22' >Thai<\/option><option value='TIBETAN \/ \u0e17\u0e34\u0e40\u0e1a\u0e15' >Tibetan<\/option><option value='TIMOR LESTE' >Timor Leste<\/option><option value='TOGOLESE \/ \u0e15\u0e2d\u0e07\u0e42\u0e01\u0e25\u0e34\u0e2a' >Togolese<\/option><option value='TONGA \/ \u0e15\u0e2d\u0e07\u0e01\u0e32' >Tonga<\/option><option value='TRINIDADIAN \/ \u0e17\u0e23\u0e34\u0e19\u0e34\u0e40\u0e14\u0e35\u0e22\u0e19' >Trinidadian<\/option><option value='TUNISIAN \/ \u0e15\u0e39\u0e19\u0e34\u0e40\u0e0b\u0e35\u0e22' >Tunisian<\/option><option value='TURKISH \/ \u0e15\u0e38\u0e23\u0e01\u0e35' >Turkish<\/option><option value='TURKMENISTAN \/ \u0e40\u0e15\u0e34\u0e23\u0e4c\u0e01' >Turkmenistan<\/option><option value='UGANDAN \/ \u0e22\u0e39\u0e01\u0e31\u0e19\u0e14\u0e32' >Ugandan<\/option><option value='UKRAINIAN \/ \u0e22\u0e39\u0e40\u0e04\u0e23\u0e19' >Ukrainian<\/option><option value='UNION DES COMO RES' >Union Des Como Res<\/option><option value='URUGUAYAN \/ \u0e2d\u0e38\u0e23\u0e38\u0e01\u0e27\u0e31\u0e22' >Uruguayan<\/option><option value='UZBEK \/ \u0e2d\u0e38\u0e0b\u0e40\u0e1a\u0e01\u0e34\u0e2a\u0e16\u0e32\u0e19' >Uzbek<\/option><option value='VANUATU' >Vanuatu<\/option><option value='VATICANIAN \/ \u0e27\u0e32\u0e15\u0e34\u0e01\u0e31\u0e19\u0e0b\u0e34\u0e15\u0e35\u0e49' >Vaticanian<\/option><option value='VENEZUELAN \/ \u0e40\u0e27\u0e40\u0e19\u0e0b\u0e38\u0e40\u0e2d\u0e25\u0e32' >Venezuelan<\/option><option value='VIETNAMESE \/ \u0e40\u0e27\u0e35\u0e22\u0e14\u0e19\u0e32\u0e21' >Vietnamese<\/option><option value='WELSH \/ \u0e40\u0e27\u0e25\u0e2a\u0e4c' >Welsh<\/option><option value='YEMENI \/ \u0e40\u0e22\u0e40\u0e21\u0e19' >Yemeni<\/option><option value='YUGOSLAVIA \/ \u0e22\u0e39\u0e42\u0e01\u0e2a\u0e25\u0e32\u0e40\u0e27\u0e35\u0e22' >Yugoslavia<\/option><option value='ZAMBIAN \/ \u0e41\u0e0b\u0e21\u0e40\u0e1a\u0e35\u0e22' >Zambian<\/option><option value='ZIMBABWEAN \/ \u0e0b\u0e34\u0e21\u0e1a\u0e31\u0e1a\u0e40\u0e27' >Zimbabwean<\/option><\/select><\/div><\/div><div id=\"field_3_38\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_38'><span class='gform-field-label__text'>Country of Residence<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_38' id='input_3_38' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='THAILAND' >Thailand<\/option><option value='ARUBA' >Aruba<\/option><option value='AFGHANISTAN' >Afghanistan<\/option><option value='ANGOLA' >Angola<\/option><option value='ANGUILLA' >Anguilla<\/option><option value='ALBANIA' >Albania<\/option><option value='ANDORRA' >Andorra<\/option><option value='NETHERLANDS ANTILLES' >Netherlands Antilles<\/option><option value='UNITED ARAB EMIRATE' >United Arab Emirates<\/option><option value='ARGENTINA' >Argentina<\/option><option value='ARMENIA' >Armenia<\/option><option value='AMERICAN SAMOA' >American Samoa<\/option><option value='ANTARCTICA' >Antarctica<\/option><option value='FRENCH SOUTHERN TERRITORIES' >French Southern Territories<\/option><option value='ANTIGUA AND BARBUDA' >Antigua and Barbuda<\/option><option value='AUSTRALIA' >Australia<\/option><option value='AUSTRIA' >Austria<\/option><option value='AZERBAIJAN' >Azerbaijan<\/option><option value='BURUNDI' >Burundi<\/option><option value='BELGIUM' >Belgium<\/option><option value='BENIN' >Benin<\/option><option value='BURKINA FASO' >Burkina Faso<\/option><option value='BANGLADESH' >Bangladesh<\/option><option value='BULGARIA' >Bulgaria<\/option><option value='BAHRAIN' >Bahrain<\/option><option value='BAHAMAS' >Bahamas<\/option><option value='BOSNIA AND HERZEGOVINA' >Bosnia and Herzegovina<\/option><option value='BELARUS' >Belarus<\/option><option value='BELIZE' >Belize<\/option><option value='BERMUDA' >Bermuda<\/option><option value='BOLIVIA' >Bolivia<\/option><option value='BRAZIL' >Brazil<\/option><option value='BARBADOS' >Barbados<\/option><option value='BRUNEI DARUSSALAM' >Brunei Darussalam<\/option><option value='BHUTAN' >Bhutan<\/option><option value='BOUVET ISLAND' >Bouvet Island<\/option><option value='BOTSWANA' >Botswana<\/option><option value='CENTRAL AFRICAN REPUBLIC' >Central African Republic<\/option><option value='CANADA' >Canada<\/option><option value='COCOS (KEELING) ISLANDS' >Cocos (Keeling) Islands<\/option><option value='SWITZERLAND' >Switzerland<\/option><option value='CHILE' >Chile<\/option><option value='CHINA' >China<\/option><option value='COTE D&#039;IVOIRE' >Cote D&#039;Ivoire<\/option><option value='CAMEROON' >Cameroon<\/option><option value='CONGO, THE DEMOCRATIC REPUBLIC' >Congo, The Democratic Republic<\/option><option value='CONGO' >Congo<\/option><option value='COOK ISLANDS' >Cook Islands<\/option><option value='COLOMBIA' >Colombia<\/option><option value='COMOROS' >Comoros<\/option><option value='CAPE VERDE' >Cape Verde<\/option><option value='COSTA RICA' >Costa Rica<\/option><option value='CUBA' >Cuba<\/option><option value='CHRISTMAS ISLAND' >Christmas Island<\/option><option value='CAYMAN ISLANDS' >Cayman Islands<\/option><option value='CYPRUS' >Cyprus<\/option><option value='CZECH REPUBLIC' >Czech Republic<\/option><option value='GERMANY' >Germany<\/option><option value='DJIBOUTI' >Djibouti<\/option><option value='DOMINICA' >Dominica<\/option><option value='DENMARK' >Denmark<\/option><option value='DOMINICAN REPUBLIC' >Dominican Republic<\/option><option value='ALGERIA' >Algeria<\/option><option value='ECUADOR' >Ecuador<\/option><option value='EGYPT' >Egypt<\/option><option value='ERITREA' >Eritrea<\/option><option value='WESTERN SAHARA' >Western Sahara<\/option><option value='SPAIN' >Spain<\/option><option value='ESTONIA' >Estonia<\/option><option value='ETHIOPIA' >Ethiopia<\/option><option value='FINLAND' >Finland<\/option><option value='FIJI' >Fiji<\/option><option value='FALKLAND ISLANDS (MALVINAS)' >Falkland Islands (Malvinas)<\/option><option value='FRANCE' >France<\/option><option value='FAROE ISLANDS' >Faroe Islands<\/option><option value='MICRONESIA, FEDERATED STATES' >Micronesia, Federated States<\/option><option value='GABON' >Gabon<\/option><option value='UNITED KINGDOM' >United Kingdom<\/option><option value='GEORGIA' >Georgia<\/option><option value='GHANA' >Ghana<\/option><option value='GIBRALTAR' >Gibraltar<\/option><option value='GUINEA' >Guinea<\/option><option value='GUADELOUPE' >Guadeloupe<\/option><option value='GAMBIA' >Gambia<\/option><option value='GUINEA-BISSAU' >Guinea-Bissau<\/option><option value='EQUATORIAL GUINEA' >Equatorial Guinea<\/option><option value='GREECE' >Greece<\/option><option value='GRENADA' >Grenada<\/option><option value='GREENLAND' >Greenland<\/option><option value='GUATEMALA' >Guatemala<\/option><option value='FRENCH GUIANA' >French Guiana<\/option><option value='GUAM' >Guam<\/option><option value='GUYANA' >Guyana<\/option><option value='HONG KONG' >Hong Kong<\/option><option value='HEARD AND MCDONALD ISLANDS' >Heard and McDonald Islands<\/option><option value='HONDURAS' >Honduras<\/option><option value='CROATIA' >Croatia<\/option><option value='HAITI' >Haiti<\/option><option value='HUNGARY' >Hungary<\/option><option value='INDONESIA' >Indonesia<\/option><option value='INDIA' >India<\/option><option value='BRITISH INDIAN OCEAN TERRITORY' >British Indian Ocean Territory<\/option><option value='IRELAND' >Ireland<\/option><option value='IRAN (ISLAMIC REPUBLIC OF)' >Iran (Islamic Republic Of)<\/option><option value='IRAQ' >Iraq<\/option><option value='ICELAND' >Iceland<\/option><option value='ISRAEL' >Israel<\/option><option value='ITALY' >Italy<\/option><option value='JAMAICA' >Jamaica<\/option><option value='JORDAN' >Jordan<\/option><option value='JAPAN' >Japan<\/option><option value='KAZAKSTAN' >Kazakstan<\/option><option value='KENYA' >Kenya<\/option><option value='KYRGYZSTAN' >Kyrgyzstan<\/option><option value='CAMBODIA' >Cambodia<\/option><option value='KIRIBATI' >Kiribati<\/option><option value='SAINT KITTS AND NEVIS' >Saint Kitts and Nevis<\/option><option value='KOREA, REPUBLIC OF' >Korea, Republic of<\/option><option value='KUWAIT' >Kuwait<\/option><option value='LAO PEOPLE&#039;S DEMOCRATIC REP' >Lao People&#039;s Democratic Rep<\/option><option value='LEBANON' >Lebanon<\/option><option value='LIBERIA' >Liberia<\/option><option value='LIBYAN ARAB JAMAHIRIYA' >Libyan Arab Jamahiriya<\/option><option value='SAINT LUCIA' >Saint Lucia<\/option><option value='LIECHTENSTEIN' >Liechtenstein<\/option><option value='SRI LANKA' >Sri Lanka<\/option><option value='LESOTHO' >Lesotho<\/option><option value='LITHUANIA' >Lithuania<\/option><option value='LUXEMBOURG' >Luxembourg<\/option><option value='LATVIA' >Latvia<\/option><option value='MACAU' >Macau<\/option><option value='MOROCCO' >Morocco<\/option><option value='MONACO' >Monaco<\/option><option value='MOLDOVA, REPUBLIC OF' >Moldova, Republic of<\/option><option value='MADAGASCAR' >Madagascar<\/option><option value='MALDIVES' >Maldives<\/option><option value='MEXICO' >Mexico<\/option><option value='MARSHALL ISLANDS' >Marshall Islands<\/option><option value='FMR YUGOSLAV REP OF MACEDONIA' >Fmr Yugoslav Rep of Macedonia<\/option><option value='MALI' >Mali<\/option><option value='MALTA' >Malta<\/option><option value='MYANMAR' >Myanmar<\/option><option value='MONGOLIA' >Mongolia<\/option><option value='NORTHERN MARIANA ISLANDS' >Northern Mariana Islands<\/option><option value='MOZAMBIQUE' >Mozambique<\/option><option value='MAURITANIA' >Mauritania<\/option><option value='MONTSERRAT' >Montserrat<\/option><option value='MARTINIQUE' >Martinique<\/option><option value='MAURITIUS' >Mauritius<\/option><option value='MALAWI' >Malawi<\/option><option value='MALAYSIA' >Malaysia<\/option><option value='MAYOTTE' >Mayotte<\/option><option value='NAMIBIA' >Namibia<\/option><option value='NEW CALEDONIA' >New Caledonia<\/option><option value='NIGER' >Niger<\/option><option value='NORFOLK ISLAND' >Norfolk Island<\/option><option value='NIGERIA' >Nigeria<\/option><option value='NICARAGUA' >Nicaragua<\/option><option value='NIUE' >Niue<\/option><option value='NETHERLANDS' >Netherlands<\/option><option value='NORWAY' >Norway<\/option><option value='NEPAL' >Nepal<\/option><option value='NAURU' >Nauru<\/option><option value='NEW ZEALAND' >New Zealand<\/option><option value='OMAN' >Oman<\/option><option value='PAKISTAN' >Pakistan<\/option><option value='PANAMA' >Panama<\/option><option value='PITCAIRN' >Pitcairn<\/option><option value='PERU' >Peru<\/option><option value='PHILIPPINES' >Philippines<\/option><option value='PALAU' >Palau<\/option><option value='PAPUA NEW GUINEA' >Papua New Guinea<\/option><option value='POLAND' >Poland<\/option><option value='PUERTO RICO' >Puerto Rico<\/option><option value='KOREA, DEMOCRATIC PEOPLE&#039;S REP' >Korea, Democratic People&#039;s Rep<\/option><option value='PORTUGAL' >Portugal<\/option><option value='PARAGUAY' >Paraguay<\/option><option value='FRENCH POLYNESIA' >French Polynesia<\/option><option value='QATAR' >Qatar<\/option><option value='REUNION' >Reunion<\/option><option value='ROMANIA' >Romania<\/option><option value='RUSSIAN FEDERATION' >Russian Federation<\/option><option value='RWANDA' >Rwanda<\/option><option value='SAUDI ARABIA' >Saudi Arabia<\/option><option value='SUDAN' >Sudan<\/option><option value='SENEGAL' >Senegal<\/option><option value='SINGAPORE' >Singapore<\/option><option value='STH GEORGIA &amp; STH SANDWICH IS' >Sth Georgia &amp; Sth Sandwich Is<\/option><option value='SAINT HELENA' >Saint Helena<\/option><option value='SVALBARD AND JAN MAYEN' >Svalbard and Jan Mayen<\/option><option value='SOLOMON ISLANDS' >Solomon Islands<\/option><option value='SIERRA LEONE' >Sierra Leone<\/option><option value='EL SALVADOR' >El Salvador<\/option><option value='SAN MARINO' >San Marino<\/option><option value='SOMALIA' >Somalia<\/option><option value='SAINT PIERRE AND MIQUELON' >Saint Pierre and Miquelon<\/option><option value='SAO TOME AND PRINCIPE' >Sao Tome and Principe<\/option><option value='SURINAME' >Suriname<\/option><option value='SLOVAKIA' >Slovakia<\/option><option value='SLOVENIA' >Slovenia<\/option><option value='SWEDEN' >Sweden<\/option><option value='SWAZILAND' >Swaziland<\/option><option value='SEYCHELLES' >Seychelles<\/option><option value='SYRIAN ARAB REPUBLIC' >Syrian Arab Republic<\/option><option value='TURKS AND CAICOS ISLANDS' >Turks and Caicos Islands<\/option><option value='CHAD' >Chad<\/option><option value='TOGO' >Togo<\/option><option value='TAJIKISTAN' >Tajikistan<\/option><option value='TOKELAU' >Tokelau<\/option><option value='TURKMENISTAN' >Turkmenistan<\/option><option value='EAST TIMOR' >East Timor<\/option><option value='TONGA' >Tonga<\/option><option value='TRINIDAD AND TOBAGO' >Trinidad and Tobago<\/option><option value='TUNISIA' >Tunisia<\/option><option value='TURKEY' >Turkey<\/option><option value='TUVALU' >Tuvalu<\/option><option value='TAIWAN, PROVINCE OF CHINA' >Taiwan, Province of China<\/option><option value='TANZANIA, UNITED REPUBLIC OF' >Tanzania, United Republic of<\/option><option value='UGANDA' >Uganda<\/option><option value='UKRAINE' >Ukraine<\/option><option value='US MINOR OUTLYING ISLANDS' >US Minor Outlying Islands<\/option><option value='URUGUAY' >Uruguay<\/option><option value='UNITED STATES' >United States<\/option><option value='UZBEKISTAN' >Uzbekistan<\/option><option value='HOLY SEE (VATICAN CITY STATE)' >Holy See (Vatican City State)<\/option><option value='ST VINCENT AND THE GRENADINES' >St Vincent and the Grenadines<\/option><option value='VENEZUELA' >Venezuela<\/option><option value='VIRGIN ISLANDS (BRITISH)' >Virgin Islands (British)<\/option><option value='VIRGIN ISLANDS (U.S.)' >Virgin Islands (U.S.)<\/option><option value='VIET NAM' >Viet Nam<\/option><option value='VANUATU' >Vanuatu<\/option><option value='WALLIS AND FUTUNA ISLANDS' >Wallis and Futuna Islands<\/option><option value='SAMOA' >Samoa<\/option><option value='YEMEN' >Yemen<\/option><option value='YUGOSLAVIA' >Yugoslavia<\/option><option value='SOUTH AFRICA' >South Africa<\/option><option value='ZAMBIA' >Zambia<\/option><option value='ZIMBABWE' >Zimbabwe<\/option><option value='THE UNITED ARAB EMIRATES (UAE)' >The United Arab Emirates (UAE)<\/option><\/select><\/div><\/div><div id=\"field_3_39\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_39'><span class='gform-field-label__text'>Province where you currently live?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_39' id='input_3_39' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='Bangkok' >Bangkok<\/option><option value='Samut Prakan' >Samut Prakan<\/option><option value='Nonthaburi' >Nonthaburi<\/option><option value='Pathum Thani' >Pathum Thani<\/option><option value='Phra Nakhon Si Ayutthaya' >Phra Nakhon Si Ayutthaya<\/option><option value='Ang Thong' >Ang Thong<\/option><option value='Lopburi' >Lopburi<\/option><option value='Sing Buri' >Sing Buri<\/option><option value='Chai Nat' >Chai Nat<\/option><option value='Saraburi' >Saraburi<\/option><option value='Chonburi' >Chonburi<\/option><option value='Rayong' >Rayong<\/option><option value='Chanthaburi' >Chanthaburi<\/option><option value='Trat' >Trat<\/option><option value='Chachoengsao' >Chachoengsao<\/option><option value='Prachinburi' >Prachinburi<\/option><option value='Nakhon Nayok' >Nakhon Nayok<\/option><option value='Nakhon Ratchasima' >Nakhon Ratchasima<\/option><option value='Buriram' >Buriram<\/option><option value='Surin' >Surin<\/option><option value='Sisaket' >Sisaket<\/option><option value='Ubon Ratchathani' >Ubon Ratchathani<\/option><option value='Yasothon' >Yasothon<\/option><option value='Chaiyaphum' >Chaiyaphum<\/option><option value='Khon Kaen' >Khon Kaen<\/option><option value='Udon Thani' >Udon Thani<\/option><option value='Loei' >Loei<\/option><option value='Nong Khai' >Nong Khai<\/option><option value='Maha Sarakham' >Maha Sarakham<\/option><option value='Roi Et' >Roi Et<\/option><option value='Kalasin' >Kalasin<\/option><option value='Sakon Nakhon' >Sakon Nakhon<\/option><option value='Nakhon Phanom' >Nakhon Phanom<\/option><option value='Mukdahan' >Mukdahan<\/option><option value='Chiang Mai' >Chiang Mai<\/option><option value='Lamphun' >Lamphun<\/option><option value='Lampang' >Lampang<\/option><option value='Uttaradit' >Uttaradit<\/option><option value='Phrae' >Phrae<\/option><option value='Nan' >Nan<\/option><option value='Phayao' >Phayao<\/option><option value='Chiang Rai' >Chiang Rai<\/option><option value='Mae Hong Son' >Mae Hong Son<\/option><option value='Nakhon Sawan' >Nakhon Sawan<\/option><option value='Uthai Thani' >Uthai Thani<\/option><option value='Kamphaeng Phet' >Kamphaeng Phet<\/option><option value='Tak' >Tak<\/option><option value='Sukhothai' >Sukhothai<\/option><option value='Phitsanulok' >Phitsanulok<\/option><option value='Phichit' >Phichit<\/option><option value='Phetchabun' >Phetchabun<\/option><option value='Ratchaburi' >Ratchaburi<\/option><option value='Kanchanaburi' >Kanchanaburi<\/option><option value='Suphan Buri' >Suphan Buri<\/option><option value='Nakhon Pathom' >Nakhon Pathom<\/option><option value='Samut Sakhon' >Samut Sakhon<\/option><option value='Samut Songkhram' >Samut Songkhram<\/option><option value='Phetchaburi' >Phetchaburi<\/option><option value='Prachuap Khiri Khan' >Prachuap Khiri Khan<\/option><option value='Nakhon Si Thammarat' >Nakhon Si Thammarat<\/option><option value='Krabi' >Krabi<\/option><option value='Phang Nga' >Phang Nga<\/option><option value='Phuket' >Phuket<\/option><option value='Surat Thani' >Surat Thani<\/option><option value='Ranong' >Ranong<\/option><option value='Chumphon' >Chumphon<\/option><option value='Songkhla' >Songkhla<\/option><option value='Satun' >Satun<\/option><option value='Trang' >Trang<\/option><option value='Phatthalung' >Phatthalung<\/option><option value='Pattani' >Pattani<\/option><option value='Yala' >Yala<\/option><option value='Narathiwat' >Narathiwat<\/option><option value='Sa Kaeo' >Sa Kaeo<\/option><option value='Amnat Charoen' >Amnat Charoen<\/option><option value='Nong Bua Lamphu' >Nong Bua Lamphu<\/option><option value='Not specified' >Not specified<\/option><option value='Bueng Kan' >Bueng Kan<\/option><\/select><\/div><\/div><fieldset id=\"field_3_41\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-horizontal\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Visited Vejthani before?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_41'>\n\t\t\t<div class='gchoice gchoice_3_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Yes'  id='choice_3_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_41_0' id='label_3_41_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_3_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='No'  id='choice_3_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_41_1' id='label_3_41_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_42\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible gfield--choice-align-horizontal\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Do you need interpretation?<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_42'><div class='gchoice gchoice_3_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='Yes'  id='choice_3_42_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_42_1' id='label_3_42_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_61\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_3_61'><span class='gform-field-label__text'>Hospital Number (HN)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_3_61' type='text' value='' class='large'    placeholder='Hospital Number (HN)'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_45\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_45'><span class='gform-field-label__text'>Insurance<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_45' id='input_3_45' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='AGL- Assurance Generales du Laos-ZH' >AGL- Assurance Generales du Laos-ZH<\/option><option value='AA International (HK) Ltd.' >AA International (HK) Ltd.<\/option><option value='Abu Dhabi National Insurance Company' >Abu Dhabi National Insurance Company<\/option><option value='Ace Insurance Co.,Ltd.' >Ace Insurance Co.,Ltd.<\/option><option value='Aetna Global Benefits.' >Aetna Global Benefits.<\/option><option value='Aetna Health Insurance Thailand  Public Company Limited' >Aetna Health Insurance Thailand  Public Company Limited<\/option><option value='AGA Services (Thailand)' >AGA Services (Thailand)<\/option><option value='AIG Travel Assist,Inc.' >AIG Travel Assist,Inc.<\/option><option value='Aioi insurance Co.,Ltd.' >Aioi insurance Co.,Ltd.<\/option><option value='Al Koot' >Al Koot<\/option><option value='Allen Medical International' >Allen Medical International<\/option><option value='Alliance International Servicing' >Alliance International Servicing<\/option><option value='Allianz Saudi Fransi' >Allianz Saudi Fransi<\/option><option value='Allianz Woldwide Care' >Allianz Woldwide Care<\/option><option value='Allianz Worldwide Partners (AWP)' >Allianz Worldwide Partners (AWP)<\/option><option value='AP Companies Global Solutions Limited' >AP Companies Global Solutions Limited<\/option><option value='APRIL INTERNATIONAL' >APRIL INTERNATIONAL<\/option><option value='AQA Assistance - UAE' >AQA Assistance - UAE<\/option><option value='ARMS (Asia Rescue &amp; Services Pvt Ltd.)' >ARMS (Asia Rescue &amp; Services Pvt Ltd.)<\/option><option value='Asia Medical Assistance (Thailand) (AMA)' >Asia Medical Assistance (Thailand) (AMA)<\/option><option value='Asia Medical Assistance PVT Ltd.' >Asia Medical Assistance PVT Ltd.<\/option><option value='ASIA-JET AIR AMBULANCE CO.,LTD' >ASIA-JET AIR AMBULANCE CO.,LTD<\/option><option value='Asian Assistance(Thailand)Co.,Ltd.' >Asian Assistance(Thailand)Co.,Ltd.<\/option><option value='Assist International Services' >Assist International Services<\/option><option value='Assistance Alliance (International)Co.,Ltd. (AA INTERNATIONAL)' >Assistance Alliance (International)Co.,Ltd. (AA INTERNATIONAL)<\/option><option value='Assistance Online Group' >Assistance Online Group<\/option><option value='ASSIST-CARD INTERNATIONAL HOLDINGS SA' >ASSIST-CARD INTERNATIONAL HOLDINGS SA<\/option><option value='AXA  INSURANCE (GULF)  B.S.C' >AXA  INSURANCE (GULF)  B.S.C<\/option><option value='AXA Assistance (Thailand) Co.,Ltd' >AXA Assistance (Thailand) Co.,Ltd<\/option><option value='AXA PPP Health Care' >AXA PPP Health Care<\/option><option value='BALT ASSISTANCE' >BALT ASSISTANCE<\/option><option value='Bao Viet Insurance Corporation' >Bao Viet Insurance Corporation<\/option><option value='BEST SERVICE GROUP' >BEST SERVICE GROUP<\/option><option value='CanAm Insurance' >CanAm Insurance<\/option><option value='CEGA Group Services Ltd.' >CEGA Group Services Ltd.<\/option><option value='Cigna International' >Cigna International<\/option><option value='Class - Assistance Limited' >Class - Assistance Limited<\/option><option value='CMN Inc.' >CMN Inc.<\/option><option value='Daman Health Insurance Qatar LLC' >Daman Health Insurance Qatar LLC<\/option><option value='Daman, National Health Insurance Company' >Daman, National Health Insurance Company<\/option><option value='Delaware American Life Insurance Company(DELAM)' >Delaware American Life Insurance Company(DELAM)<\/option><option value='Doctor on Call Company limited' >Doctor on Call Company limited<\/option><option value='eExpedise Healthcare Private Limited' >eExpedise Healthcare Private Limited<\/option><option value='Egy Cross Assistance Europe S.L' >Egy Cross Assistance Europe S.L<\/option><option value='E-Meditek (TPA) Services Limited' >E-Meditek (TPA) Services Limited<\/option><option value='Emergency Assistance Japan (Thailand) Co., Ltd.' >Emergency Assistance Japan (Thailand) Co., Ltd.<\/option><option value='ENS Assistance OU - Ukraine' >ENS Assistance OU - Ukraine<\/option><option value='EUB Finance and Insurance' >EUB Finance and Insurance<\/option><option value='Euro - Center ( Thailand ) Co.,Ltd.' >Euro - Center ( Thailand ) Co.,Ltd.<\/option><option value='Europ Assistance (Thailand) Company Limited' >Europ Assistance (Thailand) Company Limited<\/option><option value='Europ Assistance CEI' >Europ Assistance CEI<\/option><option value='Europ Assistance Russia' >Europ Assistance Russia<\/option><option value='Express Assist Center' >Express Assist Center<\/option><option value='Falck Global Assistance Limited' >Falck Global Assistance Limited<\/option><option value='First Assistance New Zealand' >First Assistance New Zealand<\/option><option value='Global Assistance &amp; Healthcare' >Global Assistance &amp; Healthcare<\/option><option value='Global Benefits Group (GBG)' >Global Benefits Group (GBG)<\/option><option value='Global Services Bulgaria' >Global Services Bulgaria<\/option><option value='Global Voyager Assistance (Cyprus) Ltd.' >Global Voyager Assistance (Cyprus) Ltd.<\/option><option value='Globalhealth Asia Limitedz' >Globalhealth Asia Limitedz<\/option><option value='GMC Services International Administration' >GMC Services International Administration<\/option><option value='GMMI' >GMMI<\/option><option value='GoaClinic Healthcare Ltd.' >GoaClinic Healthcare Ltd.<\/option><option value='Healix International Ltd.' >Healix International Ltd.<\/option><option value='Health Passport' >Health Passport<\/option><option value='Hilz Rescue' >Hilz Rescue<\/option><option value='HSC EXPLORER' >HSC EXPLORER<\/option><option value='HUHG Assist Private Limited' >HUHG Assist Private Limited<\/option><option value='Insmart Joint Stock Company' >Insmart Joint Stock Company<\/option><option value='INTERGLOBAL' >INTERGLOBAL<\/option><option value='LDM-Assistance' >LDM-Assistance<\/option><option value='LGA Medical Treatment Facilitation Services (LGA Assistance) - UAE' >LGA Medical Treatment Facilitation Services (LGA Assistance) - UAE<\/option><option value='Liberty Insurance Limited (Vietnam)' >Liberty Insurance Limited (Vietnam)<\/option><option value='LUMA Care Co., Ltd (International)' >LUMA Care Co., Ltd (International)<\/option><option value='Marm Assistance' >Marm Assistance<\/option><option value='MD Abroad L.L.C' >MD Abroad L.L.C<\/option><option value='Medgate' >Medgate<\/option><option value='Medical Administrators International (MAI)' >Medical Administrators International (MAI)<\/option><option value='MediGuide America' >MediGuide America<\/option><option value='Morgan Price Iternational Healthcare Limited' >Morgan Price Iternational Healthcare Limited<\/option><option value='MSH CHINA Enterprise Services Co.,Ltd.' >MSH CHINA Enterprise Services Co.,Ltd.<\/option><option value='National Health Insurance Company - Daman' >National Health Insurance Company - Daman<\/option><option value='Now Health International (Asia Pacific) Limited' >Now Health International (Asia Pacific) Limited<\/option><option value='NZI Interglobal' >NZI Interglobal<\/option><option value='OOO (CFM)' >OOO (CFM)<\/option><option value='Pacific Cross Insurance Company Ltd.' >Pacific Cross Insurance Company Ltd.<\/option><option value='Paramount Healthcare Mangement' >Paramount Healthcare Mangement<\/option><option value='PT Blue Dot Assistance' >PT Blue Dot Assistance<\/option><option value='PT. AA International Indonesia' >PT. AA International Indonesia<\/option><option value='QLM Life &amp; Medical Insurance Company Q.P.SC' >QLM Life &amp; Medical Insurance Company Q.P.SC<\/option><option value='Remed Assistance' >Remed Assistance<\/option><option value='ROY MEDICAL ASSISTANCE' >ROY MEDICAL ASSISTANCE<\/option><option value='Royal Assist Private Limited' >Royal Assist Private Limited<\/option><option value='Saudi Enaya Cooperative Insurance Company' >Saudi Enaya Cooperative Insurance Company<\/option><option value='Saudi enaya' >Saudi enaya<\/option><option value='Savitar Group' >Savitar Group<\/option><option value='Seven Corners, Inc.' >Seven Corners, Inc.<\/option><option value='SOS International' >SOS International<\/option><option value='Tangiers International' >Tangiers International<\/option><option value='Tejani Emergency Assistance' >Tejani Emergency Assistance<\/option><option value='TIECARE INTERNATIONAL,Inc.' >TIECARE INTERNATIONAL,Inc.<\/option><option value='TRAVEL GUARD (USA)' >TRAVEL GUARD (USA)<\/option><option value='Travel Guard Asia Pacific Pte.Ltd.' >Travel Guard Asia Pacific Pte.Ltd.<\/option><option value='UNITED HEALTHCARE INTERNATIONAL' >UNITED HEALTHCARE INTERNATIONAL<\/option><option value='VYV International Assistance' >VYV International Assistance<\/option><option value='William Russell Limited' >William Russell Limited<\/option><option value='WORLDMED ASSISTANCE NEPAL PVT.LTD' >WORLDMED ASSISTANCE NEPAL PVT.LTD<\/option><\/select><\/div><\/div><div id=\"field_3_46\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_46'><span class='gform-field-label__text'>Medical Concern or Request<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea' data-text-counter-max='10000' data-text-counter-template='{current} of {max} max characters'><textarea name='input_46' id='input_3_46' class='textarea small'   maxlength='10000'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_13\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_3_13'><span class='gform-field-label__text'>Attached file<\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_3_13' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_3_13&quot;,&quot;container&quot;:&quot;gform_multifile_upload_3_13&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_3_13&quot;,&quot;filelist&quot;:&quot;gform_preview_3_13&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/v-ivf.com\\\/zh-hant\\\/?gf_page=f65cd468b027ee0&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/v-ivf.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/v-ivf.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;pdf,doc,docx,jpg,gif,png&quot;}],&quot;max_file_size&quot;:&quot;5242880b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:3,&quot;field_id&quot;:13,&quot;_gform_file_upload_nonce_3_13&quot;:&quot;b5d5072cea&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;3&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_3_13&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_3_13' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_3_13' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_3_13\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_13'>Accepted file types: pdf, doc, docx, jpg, gif, png, Max. file size: 5 MB, Max. files: 3.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_3_13'><\/ul> <div id='gform_preview_3_13' class='ginput_preview_list'><\/div><\/div><\/div><fieldset id=\"field_3_22\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_above gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Consent<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_22.1' id='input_3_22_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_3_22\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_3_22_1' ><span class='gform-field-label__text'>I agree to the terms of the Consent Form for Medical Consultation<\/span><\/label><input type='hidden' name='input_22.2' value='I agree to the terms of the Consent Form for Medical Consultation' class='gform_hidden' \/><input type='hidden' name='input_22.3' value='11' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_3_22'><div class='gfield_consent_description_text' tabindex='0'><b>Consent Form for Medical Consultation<\/b><br \/>\n<b>Fertility Technology Center (\"Clinic\")<\/b><br \/>\n<br \/>\nThe Fertility Technology Center (\"Clinic\") will protect the personal data of the service user (\u201cYou\u201d) in accordance with the Personal Data Protection Act B.E. 2562 (2019). Under the measures we have implemented for your benefit, rights, and privacy, the hospital requests your consent to process personal data as follows:<br \/>\n<br \/>\n<b>Personal data collected under the new patient registration service<\/b><br \/>\n<br \/>\nThe types of personal data the hospital collects from you depend on the circumstances of collection and the type of services you request. The personal data collected directly from you or from third parties includes:<br \/>\n- Identification data such as name, photograph, gender, date of birth, passport, ID card number, or other identification numbers.<br \/>\n- Contact information such as address, telephone number, and email.<br \/>\n- Service information such as doctor appointment details, personal data of relatives, requirements regarding room, food, and other additional services.<br \/>\n- Health information, reports concerning physical and mental health, your healthcare, laboratory test results, and diagnoses.<br \/>\n- Information related to your medication use and drug allergies.<br \/>\n<br \/>\n<b>Purpose of collecting personal data<\/b><br \/>\n<br \/>\nThe processing of personal data under the medical consultation service is for the following purposes:<br \/>\n<br \/>\n- To provide medical consultation for your benefit and to complete the services according to the objectives of the visit or the service contract with the hospital. Activities under these objectives cover:<br \/>\nPreparation of treatment plans, provision of services, or delivery of hospital services.<br \/>\nPlanning doctor appointments or receiving prompt assistance from the hospital.<br \/>\nCoordination and transfer of information to expedite the treatment plan.<br \/>\nIdentity verification of patients, relatives, parents, curators, or guardians.<br \/>\nRequesting letters of guarantee for expenses from embassies or insurance companies.<br \/>\nOther activities essential to health and public health services.<br \/>\n- Other purposes that support the above objectives or for which your consent is obtained from time to time.<br \/>\n<br \/>\n<b>Disclosure of Personal Data<\/b><br \/>\n<br \/>\nThe hospital will not allocate, disclose, and\/or transfer the data and personal data of service users or caregivers to any legal entity or person, both in Thailand and abroad, for independent use, unless you or the caregiver have requested and authorized the hospital to disclose it to a legal entity or third party, or you have given consent to the hospital for such disclosure, and\/or you have given consent to a third party and are aware of such personal data delivery, or the disclosure is to fulfill a contract for your benefit, or is in compliance with the law by the hospital.<br \/>\n<br \/>\n<b>Retention periods and Security of personal data<\/b><br \/>\n<br \/>\nThe hospital recognizes the importance of maintaining the security of your personal data. Therefore, the hospital has established appropriate security measures consistent with personal data confidentiality to prevent loss, unauthorized or unlawful access, destruction, use, modification, or disclosure, in accordance with the hospital's Information Technology Security Policy and Guidelines.<br \/>\n<br \/>\nYour personal data will be stored for a period of 10 years or until a request to exercise your rights is submitted, subject to the hospital's regulations and consideration procedures.<br \/>\n<br \/>\n<b>Rights of personal data owner<\/b><br \/>\n<br \/>\nWithin the scope of new patient registration, the hospital wishes to inform you of your legal rights regarding your personal data. The hospital reserves the right to consider your request in accordance with hospital regulations, the law, and the appropriate impact on the rights and freedoms of others. The hospital will notify you of the result of your request within 15 working days via the contact information you provided to the hospital or in the application.<br \/>\n<br \/>\n<b>Inquiries about personal data protection rights<\/b><br \/>\n<br \/>\nYou may inquire and exercise your rights via email at DPO@vejthani.com, by telephone at 02-734-0000, or by contacting the hospital directly. You can study the hospital's Privacy Policy at www.vejthani.com<br \/>\n<br \/>\n<b>Consent to the processing of personal data for marketing purposes<\/b><br \/>\n<br \/>\nYou consent to the hospital processing your personal data for participation in marketing activities, covering the provision of marketing information, offering products and services, answering questions, responding to complaints, providing convenience, presenting benefit programs, public relations, customer relations, customer satisfaction surveys, market research, statistical analysis, processing, and display of information to improve products and services or create new products and services for the greater benefit of hospital service users.<br \/>\n<br \/>\nI acknowledge that personal data protection standards in Thailand and other countries may differ. I have read, acknowledged, and given consent to the hospital to process my personal data for all the above purposes, and confirm that I am free to decide to give consent without affecting my rights to receive healthcare services from the hospital in the future.<\/div><\/div><\/fieldset><div id=\"field_3_53\" class=\"gfield gfield--type-turnstile gfield--input-type-turnstile gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><div class='ginput_container ginput_container_turnstile'><div class=\"cf-turnstile\" id=\"cf-turnstile_3\" data-js-turnstile data-response-field-name=\"cf-turnstile-response_3\" data-theme=\"auto\" data-size=\"normal\" data-sitekey=\"0x4AAAAAAFCEdZtCA2cJMVM_\"><\/div><\/div><\/div><div id=\"field_3_59\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_above gfield--no-description field_description_above field_validation_above gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_59' id='input_3_59' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='zh-hant' \/><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_3' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Back<\/button> <button type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Continue Appointment<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='THB' value='NyqsUQXTdRnBUdSddfVk+DSX8cOI0meyGFIeerKPl7hcDmRb9LMrxHeAXdrZRDhZqi9fJtPPGoTWPkZrQMn0DHDCO17pftRe0wOi2qJVwM9xhrM=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' 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