{"id":4598,"date":"2020-09-22T12:32:17","date_gmt":"2020-09-22T12:32:17","guid":{"rendered":"http:\/\/myhairtransplantmd.evergenius.co\/?page_id=4598"},"modified":"2022-04-13T17:50:10","modified_gmt":"2022-04-13T17:50:10","slug":"virtual-consultation-request","status":"publish","type":"page","link":"https:\/\/myhairmd.com\/es\/virtual-consultation-request\/","title":{"rendered":"CONSULTA VIRTUAL"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><div class=\"vc_row wpb_row vc_row-fluid xt-banner-inner vc_custom_1585526780636 xt-padding-initial vc_row-has-fill\"><div class=\"xt-container xt-container-center xt-padding-none\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_text_column wpb_content_element xt-white\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h1 style=\"text-align: center;\"><span style=\"color: #125b8b;\">Virtual Consultation Request<\/span><\/h1>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div><\/div><div class=\"vc_row wpb_row vc_row-fluid xt-contact-form xt-padding-large vc_row-o-content-middle vc_row-flex\"><div class=\"xt-container xt-container-center xt-padding-none\"><div class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h2><strong><u>3 Simple Steps To Receive A Quote<\/u><\/strong><\/h2>\n<p><strong><span style=\"font-size: 26px;\">Step #1<\/span> <a href=\"\/submit-your-photos\/\" target=\"_blank\" rel=\"noopener noreferrer\">Submit your photos by clicking here<\/a> \u2026 5 photos of yourself at the angles shown below<\/strong><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-4599\" src=\"\/wp-content\/uploads\/2020\/09\/photo-examples-300x85-1.jpg\" alt=\"\" width=\"300\" height=\"85\" srcset=\"https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/09\/photo-examples-300x85-1.jpg 300w, https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/09\/photo-examples-300x85-1-125x35.jpg 125w, https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/09\/photo-examples-300x85-1-75x21.jpg 75w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p><strong><span style=\"font-size: 26px;\">Step #2<\/span> Complete this form &amp; submit<\/strong><\/p>\n<p><strong><span style=\"font-size: 26px;\">Step #3<\/span> Call 800-262-2017 to schedule your phone appointment; if not done so already<\/strong><\/p>\n<p>&nbsp;<\/p>\n\n\t\t<\/div>\n\t<\/div>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework gf_stylespro_wrapper sp_inherit_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_7' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_7' class=' gf_stylespro sp_inherit ' action='\/es\/wp-json\/wp\/v2\/pages\/4598' data-formid='7' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_7_33\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_33'>URL<\/label><div class='ginput_container'><input name='input_33' id='input_7_33' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_7_33'>Este campo es un campo de validaci\u00f3n y debe quedar sin cambios.<\/div><\/li><li id=\"field_7_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Virtual Consultation Request<\/h2><\/li><li id=\"field_7_3\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_newline o_medium\"  data-field-class=\"gf_newline o_medium\" ><label class='gfield_label gform-field-label' for='input_7_3'>Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_7_3' type='text' value='' class='large full'    placeholder='Name *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_2\" class=\"gfield gfield--type-email gfield--input-type-email gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible o_medium\"  data-field-class=\"o_medium\" ><label class='gfield_label gform-field-label' for='input_7_2'>Email<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_7_2' type='email' value='' class='large full'   placeholder='Email *' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_7_4\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_4'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_7_4' type='text' value='' class='large full'    placeholder='City *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_5\" class=\"gfield gfield--type-text gfield--input-type-text gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_5'>Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_7_5' type='text' value='' class='large full'    placeholder='Zip *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_6\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_third gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_6'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_7_6' type='text' value='' class='large full'    placeholder='Phone *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_9\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">What Method of Contact do You Prefer?<\/h2><\/li><li id=\"field_7_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_4col gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Preferred method of contact<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_10'>\n\t\t\t<li class='gchoice gchoice_7_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='Email'  id='choice_7_10_0'    \/>\n\t\t\t\t<label for='choice_7_10_0' id='label_7_10_0' class='gform-field-label gform-field-label--type-inline'>Email<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='Phone'  id='choice_7_10_1'    \/>\n\t\t\t\t<label for='choice_7_10_1' id='label_7_10_1' class='gform-field-label gform-field-label--type-inline'>Phone<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_10_2'>\n\t\t\t\t<input name='input_10' type='radio' value='Skype'  id='choice_7_10_2'    \/>\n\t\t\t\t<label for='choice_7_10_2' id='label_7_10_2' class='gform-field-label gform-field-label--type-inline'>Skype<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_10_3'>\n\t\t\t\t<input name='input_10' type='radio' value='FaceTime'  id='choice_7_10_3'    \/>\n\t\t\t\t<label for='choice_7_10_3' id='label_7_10_3' class='gform-field-label gform-field-label--type-inline'>FaceTime<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_11\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Best Time to Reach You:<\/h2><\/li><li id=\"field_7_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Best time to reach you<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_23'>\n\t\t\t<li class='gchoice gchoice_7_23_0'>\n\t\t\t\t<input name='input_23' type='radio' value='Before Noon'  id='choice_7_23_0'    \/>\n\t\t\t\t<label for='choice_7_23_0' id='label_7_23_0' class='gform-field-label gform-field-label--type-inline'>Before Noon<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_23_1'>\n\t\t\t\t<input name='input_23' type='radio' value='After Noon'  id='choice_7_23_1'    \/>\n\t\t\t\t<label for='choice_7_23_1' id='label_7_23_1' class='gform-field-label gform-field-label--type-inline'>After Noon<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_13\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Patients Choose Hair Restoration for the Following Reasons (check all that apply):<\/h2><\/li><li id=\"field_7_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_4col gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Reasons for choosing hair restoration<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_15'><li class='gchoice gchoice_7_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='Competition at Work'  id='choice_7_15_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_15_1' id='label_7_15_1' class='gform-field-label gform-field-label--type-inline'>Competition at Work<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='Loss of Confidence'  id='choice_7_15_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_15_2' id='label_7_15_2' class='gform-field-label gform-field-label--type-inline'>Loss of Confidence<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_15_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.3' type='checkbox'  value='Attractiveness'  id='choice_7_15_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_15_3' id='label_7_15_3' class='gform-field-label gform-field-label--type-inline'>Attractiveness<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_15_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.4' type='checkbox'  value='To Avoid Wearing Hats'  id='choice_7_15_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_15_4' id='label_7_15_4' class='gform-field-label gform-field-label--type-inline'>To Avoid Wearing Hats<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_15_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.5' type='checkbox'  value='Stop Aging'  id='choice_7_15_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_15_5' id='label_7_15_5' class='gform-field-label gform-field-label--type-inline'>Stop Aging<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_15_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.6' type='checkbox'  value='Saw a Picture of Yourself'  id='choice_7_15_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_15_6' id='label_7_15_6' class='gform-field-label gform-field-label--type-inline'>Saw a Picture of Yourself<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_15_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.7' type='checkbox'  value='Vanity'  id='choice_7_15_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_15_7' id='label_7_15_7' class='gform-field-label gform-field-label--type-inline'>Vanity<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_15_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.8' type='checkbox'  value='Other'  id='choice_7_15_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_15_8' id='label_7_15_8' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_16\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">What Influences Your Decision?<\/h2><\/li><li id=\"field_7_17\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_3col gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >What Influences your decision?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_17'><li class='gchoice gchoice_7_17_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.1' type='checkbox'  value='Price'  id='choice_7_17_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_17_1' id='label_7_17_1' class='gform-field-label gform-field-label--type-inline'>Price<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_17_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.2' type='checkbox'  value='Results'  id='choice_7_17_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_17_2' id='label_7_17_2' class='gform-field-label gform-field-label--type-inline'>Results<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_17_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.3' type='checkbox'  value='Experience'  id='choice_7_17_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_17_3' id='label_7_17_3' class='gform-field-label gform-field-label--type-inline'>Experience<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_18\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Restoration Zone:<\/h2><\/li><li id=\"field_7_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_4col gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Restoration zone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_20'>\n\t\t\t<li class='gchoice gchoice_7_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='Head'  id='choice_7_20_0'    \/>\n\t\t\t\t<label for='choice_7_20_0' id='label_7_20_0' class='gform-field-label gform-field-label--type-inline'>Head<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='Eyebrows'  id='choice_7_20_1'    \/>\n\t\t\t\t<label for='choice_7_20_1' id='label_7_20_1' class='gform-field-label gform-field-label--type-inline'>Eyebrows<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_20_2'>\n\t\t\t\t<input name='input_20' type='radio' value='Facial Hair'  id='choice_7_20_2'    \/>\n\t\t\t\t<label for='choice_7_20_2' id='label_7_20_2' class='gform-field-label gform-field-label--type-inline'>Facial Hair<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_20_3'>\n\t\t\t\t<input name='input_20' type='radio' value='Side Burns'  id='choice_7_20_3'    \/>\n\t\t\t\t<label for='choice_7_20_3' id='label_7_20_3' class='gform-field-label gform-field-label--type-inline'>Side Burns<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_21\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_21'>Under ideal conditions, when could you begin treatment?<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_7_21' type='text' value='' class='large full'    placeholder='Under Ideal Conditions, When Could You Begin Treatment?'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_22\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Procedure Preference:<\/h2><\/li><li id=\"field_7_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Procedure Preference<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_12'>\n\t\t\t<li class='gchoice gchoice_7_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='FUE'  id='choice_7_12_0'    \/>\n\t\t\t\t<label for='choice_7_12_0' id='label_7_12_0' class='gform-field-label gform-field-label--type-inline'>FUE<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='Strip'  id='choice_7_12_1'    \/>\n\t\t\t\t<label for='choice_7_12_1' id='label_7_12_1' class='gform-field-label gform-field-label--type-inline'>Strip<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_25\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Prior Hair Transplant Surgeries?<\/h2><\/li><li id=\"field_7_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Prior hair transplant surgeries?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_28'>\n\t\t\t<li class='gchoice gchoice_7_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='No'  id='choice_7_28_0'    \/>\n\t\t\t\t<label for='choice_7_28_0' id='label_7_28_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='Yes'  id='choice_7_28_1'    \/>\n\t\t\t\t<label for='choice_7_28_1' id='label_7_28_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_26\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_26'>If &quot;yes&quot;, please list<\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_7_26' type='text' value='' class='large full'    placeholder='If &quot;Yes&quot;, Please List:'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_27\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">A Hair Transplant Prevents Continued Hair Loss As You Age?<\/h2><\/li><li id=\"field_7_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >A hair transplant prevents continued hair loss as you age?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_24'>\n\t\t\t<li class='gchoice gchoice_7_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='True'  id='choice_7_24_0'    \/>\n\t\t\t\t<label for='choice_7_24_0' id='label_7_24_0' class='gform-field-label gform-field-label--type-inline'>True<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='False'  id='choice_7_24_1'    \/>\n\t\t\t\t<label for='choice_7_24_1' id='label_7_24_1' class='gform-field-label gform-field-label--type-inline'>False<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_30\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Which Describes Your Hair Loss Best?<\/h2><\/li><li id=\"field_7_29\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_4col gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Which describes your hair loss best?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_29'><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='0'  id='choice_7_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_1' id='label_7_29_1' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/2.jpg' \/><\/div><div class='o_text'>0<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.2' type='checkbox'  value='1'  id='choice_7_29_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_2' id='label_7_29_2' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/2a.jpg' \/><\/div><div class='o_text'>1<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.3' type='checkbox'  value='2'  id='choice_7_29_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_3' id='label_7_29_3' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/3.jpg' \/><\/div><div class='o_text'>2<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.4' type='checkbox'  value='3'  id='choice_7_29_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_4' id='label_7_29_4' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/3-2.jpg' \/><\/div><div class='o_text'>3<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.5' type='checkbox'  value='4'  id='choice_7_29_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_5' id='label_7_29_5' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/3v.jpg' \/><\/div><div class='o_text'>4<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.6' type='checkbox'  value='5'  id='choice_7_29_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_6' id='label_7_29_6' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/4-1.jpg' \/><\/div><div class='o_text'>5<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.7' type='checkbox'  value='6'  id='choice_7_29_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_7' id='label_7_29_7' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/4a.jpg' \/><\/div><div class='o_text'>6<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.8' type='checkbox'  value='7'  id='choice_7_29_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_8' id='label_7_29_8' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/5.jpg' \/><\/div><div class='o_text'>7<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.9' type='checkbox'  value='8'  id='choice_7_29_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_9' id='label_7_29_9' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/5a.jpg' \/><\/div><div class='o_text'>8<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.11' type='checkbox'  value='9'  id='choice_7_29_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_11' id='label_7_29_11' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/5v.jpg' \/><\/div><div class='o_text'>9<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.12' type='checkbox'  value='10'  id='choice_7_29_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_12' id='label_7_29_12' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/6.jpg' \/><\/div><div class='o_text'>10<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.13' type='checkbox'  value='11'  id='choice_7_29_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_13' id='label_7_29_13' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/6.jpg' \/><\/div><div class='o_text'>11<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_7_29_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.14' type='checkbox'  value='12'  id='choice_7_29_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_29_14' id='label_7_29_14' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/myhairmd.com\/wp-content\/uploads\/2020\/10\/7.jpg' \/><\/div><div class='o_text'>12<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_32\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Please Explain Your Goals:<\/h2><\/li><li id=\"field_7_31\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_31'>Please explain your goals<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_7_31' class='textarea large full'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <div class=\"gf-turnstile-container\"> <div id=\"cf-turnstile-gf-7\" class=\"cf-turnstile\" data-callback=\"turnstileGravityCallback\" data-sitekey=\"0x4AAAAAAA9oDmxnLEY_ZSUG\" data-theme=\"light\" data-language=\"auto\" data-size=\"normal\" data-retry=\"auto\" data-retry-interval=\"1000\" data-refresh-expired=\"auto\" data-refresh-timeout=\"auto\" data-action=\"gravity-form-7\" data-callback=\"turnstileGravityCallback\" data-appearance=\"always\"><\/div> <style>.gform_button { pointer-events: none; opacity: 0.5; }<\/style> <script>document.addEventListener(\"DOMContentLoaded\", function() { setTimeout(function(){ var e=document.getElementById(\"cf-turnstile-gf-7\"); if(e&&!e.innerHTML.trim()){turnstile.render(e, {sitekey:\"0x4AAAAAAA9oDmxnLEY_ZSUG\"});} }, 200); });<\/script> <br class=\"cf-turnstile-br cf-turnstile-br-gf-7\"> <style>#cf-turnstile-gf-7 { margin-left: -15px; }<\/style> <\/div> <style> .gf-turnstile-container { width: 100%; } .gform_footer.top_label { display: flex; flex-wrap: wrap; } <\/style> <script>document.addEventListener(\"DOMContentLoaded\", function() {document.addEventListener('gform\/post_render', function handlePostRender(event) {if (event.detail.formId !== 7) {return;}gform.utils.addAsyncFilter('gform\/submission\/pre_submission', async function handlePreSubmission(data) {document.addEventListener('gform\/post_render', function rerenderTurnstile(event) {if (event.detail.formId !== 7) {return;}const turnstileElement = document.getElementById('cf-turnstile-gf-7');if (turnstileElement) {turnstile.remove('#cf-turnstile-gf-7');turnstile.render('#cf-turnstile-gf-7');}document.removeEventListener('gform\/post_render', rerenderTurnstile);});gform.utils.removeFilter('gform\/submission\/pre_submission', handlePreSubmission);return data;});document.removeEventListener('gform\/post_render', handlePostRender);});});<\/script><input type='submit' id='gform_submit_button_7' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' class='gform_hidden' 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