{"id":233,"date":"2025-08-22T10:19:19","date_gmt":"2025-08-22T17:19:19","guid":{"rendered":"https:\/\/www.augmentwellness.com\/gilbert\/?page_id=233"},"modified":"2025-08-22T13:56:45","modified_gmt":"2025-08-22T20:56:45","slug":"evaluation-form","status":"publish","type":"page","link":"https:\/\/www.augmentwellness.com\/gilbert\/evaluation-form\/","title":{"rendered":"Evaluation Form"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_image=&#8221;http:\/\/www.augmentwellness.com\/tri-cities\/wp-content\/uploads\/2023\/11\/Augments-Infrared-Therapy.jpg&#8221; parallax=&#8221;on&#8221; background_enable_video_mp4=&#8221;off&#8221; min_height=&#8221;631px&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;||0px|||&#8221; global_colors_info=&#8221;{%22gcid-7dc78f5e-8c41-4bae-bf0f-43fcd08e2e6a%22:%91%22border_color_bottom%22%93}&#8221;][et_pb_row _builder_version=&#8221;4.19.2&#8243; _module_preset=&#8221;default&#8221; custom_margin=&#8221;||5vw||false|false&#8221; custom_padding=&#8221;||||false|false&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_image src=&#8221;http:\/\/www.augmentwellness.com\/tri-cities\/wp-content\/uploads\/2023\/11\/AugmentLogoLightGrey.png&#8221; alt=&#8221;Augment Wellness Contact Logo&#8221; title_text=&#8221;AugmentLogoLightGrey&#8221; align=&#8221;center&#8221; _builder_version=&#8221;4.21.2&#8243; _module_preset=&#8221;default&#8221; width=&#8221;50%&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][et_pb_text content_tablet=&#8221;<\/p>\n<h2>Augment Evaluation Form<\/h2>\n<p>&#8221; content_phone=&#8221;<\/p>\n<h2>Augment Evaluation Form<\/h2>\n<p>&#8221; content_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; text_font_size=&#8221;22px&#8221; header_2_font=&#8221;Allerta|700||on|||||&#8221; header_2_font_size=&#8221;66px&#8221; text_orientation=&#8221;center&#8221; background_layout=&#8221;dark&#8221; custom_margin=&#8221;||||false|false&#8221; header_2_font_size_tablet=&#8221;46px&#8221; header_2_font_size_phone=&#8221;36px&#8221; header_2_font_size_last_edited=&#8221;on|desktop&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Augment Evaluation Form<\/h2>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Contact Form&#8221; module_id=&#8221;form&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_enable_color=&#8221;off&#8221; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_stops=&#8221;rgba(52,52,51,0.5) 0%|rgba(52,52,51,0.8) 99%&#8221; background_color_gradient_overlays_image=&#8221;on&#8221; background_image=&#8221;http:\/\/www.augmentwellness.com\/tri-cities\/wp-content\/uploads\/2023\/11\/Cold-Tub-Immersion-Therapy-Augment-Phoenix-AZ.jpg&#8221; link_option_url_new_window=&#8221;on&#8221; border_width_all=&#8221;2px&#8221; border_color_all=&#8221;#999999&#8243; locked=&#8221;off&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row make_equal=&#8221;on&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; max_width=&#8221;1270px&#8221; animation_style=&#8221;slide&#8221; animation_direction=&#8221;left&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_layout=&#8221;dark&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2><strong>Health &amp; Longevity <\/strong>Intake Form<\/h2>\n<p>The more honest and detailed you are, the more precise we can be in building your personalized protocol. After submitting the form, an Augment Associate will reach out with a personalized wellness &amp; recovery plan.<\/p>\n<p><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 gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/gilbert\/wp-json\/wp\/v2\/pages\/233#gf_2' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><fieldset id=\"field_2_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_1'>\n                            \n                            <span id='input_2_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_2_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_2_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_2_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_2_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_2_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_5'>Your Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_2_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" \/><\/div><\/div><fieldset id=\"field_2_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_2_2_container'>\n                                <span id='input_2_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_2_2' class='gform-field-label gform-field-label--type-sub '>Email Address<\/label>\n                                    <input class='' type='email' name='input_2' id='input_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_2_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_2_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email Address<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_2_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_2_14\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Are you currently on any medications that affect circulation, blood pressure, or body temperature regulation?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_14'>\n\t\t\t<div class='gchoice gchoice_2_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_2_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_0' id='label_2_14_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_2_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_2_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_1' id='label_2_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_15\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you have any cardiovascular conditions (e.g., high blood pressure, heart disease, arrhythmias)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_15'>\n\t\t\t<div class='gchoice gchoice_2_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Yes'  id='choice_2_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_0' id='label_2_15_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_2_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='No'  id='choice_2_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_1' id='label_2_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_16\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you experience anxiety, panic attacks, or breathing difficulties that could be triggered by sudden cold exposure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_16'>\n\t\t\t<div class='gchoice gchoice_2_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Yes'  id='choice_2_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_0' id='label_2_16_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_2_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='No'  id='choice_2_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_1' id='label_2_16_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_17\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Are you concerned or aware of any other contradicting factors that you may possess that may lead to an adverse reaction to a cold plunge?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_17'>\n\t\t\t<div class='gchoice gchoice_2_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Yes'  id='choice_2_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_0' id='label_2_17_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_2_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='No'  id='choice_2_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_1' id='label_2_17_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_3\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_3'>Why is improving your health and wellness important to you at this moment in your life?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_3' id='input_2_3' class='textarea small'  aria-describedby=\"gfield_description_2_3\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_2_3'>What will it allow you to do, feel, or experience?<\/div><\/div><fieldset id=\"field_2_21\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What do you feel is holding you back from getting there?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_21'><div class='gchoice gchoice_2_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Time'  id='choice_2_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_1' id='label_2_21_1' class='gform-field-label gform-field-label--type-inline'>Time<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Discipline'  id='choice_2_21_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_2' id='label_2_21_2' class='gform-field-label gform-field-label--type-inline'>Discipline<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='Not sure what works'  id='choice_2_21_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_3' id='label_2_21_3' class='gform-field-label gform-field-label--type-inline'>Not sure what works<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.4' type='checkbox'  value='Pain\/injury'  id='choice_2_21_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_4' id='label_2_21_4' class='gform-field-label gform-field-label--type-inline'>Pain\/injury<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.5' type='checkbox'  value='Lack of support'  id='choice_2_21_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_5' id='label_2_21_5' class='gform-field-label gform-field-label--type-inline'>Lack of support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.6' type='checkbox'  value='Nothing \u2014 I just need a real plan'  id='choice_2_21_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_6' id='label_2_21_6' class='gform-field-label gform-field-label--type-inline'>Nothing \u2014 I just need a real plan<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.7' type='checkbox'  value='Other'  id='choice_2_21_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_7' id='label_2_21_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_19\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_19'>Other (Please explain)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_2_19' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_26\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_26'>What\u2019s your #1 goal right now for your body or mind?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_2_26' class='textarea small'  aria-describedby=\"gfield_description_2_26\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_2_26'>(Ex: reduce pain, have more energy, sleep better, lose weight, train harder, think sharper)<\/div><\/div><fieldset id=\"field_2_23\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What have you tried before to improve your health or recovery?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_23'><div class='gchoice gchoice_2_23_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.1' type='checkbox'  value='Diet'  id='choice_2_23_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_1' id='label_2_23_1' class='gform-field-label gform-field-label--type-inline'>Diet<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.2' type='checkbox'  value='Training programs'  id='choice_2_23_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_2' id='label_2_23_2' class='gform-field-label gform-field-label--type-inline'>Training programs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.3' type='checkbox'  value='Therapy\/Massage'  id='choice_2_23_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_3' id='label_2_23_3' class='gform-field-label gform-field-label--type-inline'>Therapy\/Massage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.4' type='checkbox'  value='Supplements'  id='choice_2_23_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_4' id='label_2_23_4' class='gform-field-label gform-field-label--type-inline'>Supplements<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.7' type='checkbox'  value='Other'  id='choice_2_23_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_5' id='label_2_23_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_24\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_24'>Other (Please explain)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_2_24' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_25\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_25'>What worked or didn\u2019t work?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_2_25' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_22\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_22'>What would it mean to you to feel, look, or perform at your best again?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_2_22' class='textarea small'  aria-describedby=\"gfield_description_2_22\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_2_22'>(Be specific \u2014 work, relationships, mindset, confidence, etc.)<\/div><\/div><fieldset id=\"field_2_27\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >If we built you a custom plan \u2014 how ready are you to follow it?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_27'>\n\t\t\t<div class='gchoice gchoice_2_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='All in \u2014 just need direction'  id='choice_2_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_0' id='label_2_27_0' class='gform-field-label gform-field-label--type-inline'>All in \u2014 just need direction<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='If it fits my time &amp; budget'  id='choice_2_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_1' id='label_2_27_1' class='gform-field-label gform-field-label--type-inline'>If it fits my time &amp; budget<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Not sure yet'  id='choice_2_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_2' id='label_2_27_2' class='gform-field-label gform-field-label--type-inline'>Not sure yet<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_29\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What do you need most from us to help you succeed?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_29'><div class='gchoice gchoice_2_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='Accountability'  id='choice_2_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_1' id='label_2_29_1' class='gform-field-label gform-field-label--type-inline'>Accountability<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.2' type='checkbox'  value='Structure\/routine'  id='choice_2_29_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_2' id='label_2_29_2' class='gform-field-label gform-field-label--type-inline'>Structure\/routine<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.3' type='checkbox'  value='Flexibility'  id='choice_2_29_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_3' id='label_2_29_3' class='gform-field-label gform-field-label--type-inline'>Flexibility<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.4' type='checkbox'  value='Motivation'  id='choice_2_29_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_4' id='label_2_29_4' class='gform-field-label gform-field-label--type-inline'>Motivation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.7' type='checkbox'  value='Education'  id='choice_2_29_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_5' id='label_2_29_5' class='gform-field-label gform-field-label--type-inline'>Education<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.8' type='checkbox'  value='All of the above'  id='choice_2_29_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_6' id='label_2_29_6' class='gform-field-label gform-field-label--type-inline'>All of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_28\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Which of our tools are you most excited about (or curious to try)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_28'><div class='gchoice gchoice_2_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='Cold Plunge'  id='choice_2_28_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_1' id='label_2_28_1' class='gform-field-label gform-field-label--type-inline'>Cold Plunge<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.2' type='checkbox'  value='Infrared Sauna'  id='choice_2_28_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_2' id='label_2_28_2' class='gform-field-label gform-field-label--type-inline'>Infrared Sauna<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.3' type='checkbox'  value='Red Light Therapy'  id='choice_2_28_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_3' id='label_2_28_3' class='gform-field-label gform-field-label--type-inline'>Red Light Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.4' type='checkbox'  value='PEMF'  id='choice_2_28_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_4' id='label_2_28_4' class='gform-field-label gform-field-label--type-inline'>PEMF<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.7' type='checkbox'  value='BrainTap'  id='choice_2_28_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_5' id='label_2_28_5' class='gform-field-label gform-field-label--type-inline'>BrainTap<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.8' type='checkbox'  value='Compression'  id='choice_2_28_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_6' id='label_2_28_6' class='gform-field-label gform-field-label--type-inline'>Compression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.9' type='checkbox'  value='BioCharger'  id='choice_2_28_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_7' id='label_2_28_7' class='gform-field-label gform-field-label--type-inline'>BioCharger<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.11' type='checkbox'  value='Hyperbaric Oxygen'  id='choice_2_28_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_8' id='label_2_28_8' class='gform-field-label gform-field-label--type-inline'>Hyperbaric Oxygen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.12' type='checkbox'  value='All of the above'  id='choice_2_28_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_9' id='label_2_28_9' class='gform-field-label gform-field-label--type-inline'>All of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_30\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Have you used any of these before? Which ones?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_30'><div class='gchoice gchoice_2_30_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.1' type='checkbox'  value='Cold Plunge'  id='choice_2_30_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_1' id='label_2_30_1' class='gform-field-label gform-field-label--type-inline'>Cold Plunge<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.2' type='checkbox'  value='Infrared Sauna'  id='choice_2_30_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_2' id='label_2_30_2' class='gform-field-label gform-field-label--type-inline'>Infrared Sauna<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.3' type='checkbox'  value='Red Light Therapy'  id='choice_2_30_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_3' id='label_2_30_3' class='gform-field-label gform-field-label--type-inline'>Red Light Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.4' type='checkbox'  value='PEMF'  id='choice_2_30_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_4' id='label_2_30_4' class='gform-field-label gform-field-label--type-inline'>PEMF<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.7' type='checkbox'  value='BrainTap'  id='choice_2_30_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_5' id='label_2_30_5' class='gform-field-label gform-field-label--type-inline'>BrainTap<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.8' type='checkbox'  value='Compression'  id='choice_2_30_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_6' id='label_2_30_6' class='gform-field-label gform-field-label--type-inline'>Compression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.9' type='checkbox'  value='BioCharger'  id='choice_2_30_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_7' id='label_2_30_7' class='gform-field-label gform-field-label--type-inline'>BioCharger<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.11' type='checkbox'  value='Hyperbaric Oxygen'  id='choice_2_30_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_8' id='label_2_30_8' class='gform-field-label gform-field-label--type-inline'>Hyperbaric Oxygen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.12' type='checkbox'  value='All of the above'  id='choice_2_30_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_9' id='label_2_30_9' class='gform-field-label gform-field-label--type-inline'>All of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_31\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What\u2019s your weekly availability for self-care or recovery?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_31'>\n\t\t\t<div class='gchoice 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input:checkbox').prop('checked', true);<!-- [et_pb_line_break_holder] -->        }<!-- [et_pb_line_break_holder] -->    });<!-- [et_pb_line_break_holder] -->});<!-- [et_pb_line_break_holder] --><\/script><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><script><!-- [et_pb_line_break_holder] -->jQuery(document).ready(function($) {<!-- [et_pb_line_break_holder] -->    var field = '#input_2_32'; \/\/ change to your form\/field ID<!-- [et_pb_line_break_holder] -->    <!-- [et_pb_line_break_holder] -->    $(field).on('change', 'input[value=\"All of the above\"]', function() {<!-- [et_pb_line_break_holder] -->        if($(this).is(':checked')) {<!-- [et_pb_line_break_holder] -->            $(field + ' input:checkbox').prop('checked', true);<!-- [et_pb_line_break_holder] -->        }<!-- [et_pb_line_break_holder] -->    });<!-- [et_pb_line_break_holder] -->});<!-- [et_pb_line_break_holder] --><\/script><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><script><!-- [et_pb_line_break_holder] -->jQuery(document).ready(function($) {<!-- [et_pb_line_break_holder] -->    var field = '#input_2_30'; \/\/ change to your form\/field ID<!-- [et_pb_line_break_holder] -->    <!-- [et_pb_line_break_holder] -->    $(field).on('change', 'input[value=\"All of the above\"]', function() {<!-- [et_pb_line_break_holder] -->        if($(this).is(':checked')) {<!-- [et_pb_line_break_holder] -->            $(field + ' input:checkbox').prop('checked', true);<!-- [et_pb_line_break_holder] -->        }<!-- [et_pb_line_break_holder] -->    });<!-- [et_pb_line_break_holder] -->});<!-- [et_pb_line_break_holder] --><\/script><!-- [et_pb_line_break_holder] -->[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Augment Evaluation FormHealth &amp; Longevity Intake Form The more honest and detailed you are, the more precise we can be in building your personalized protocol. After submitting the form, an Augment Associate will reach out with a personalized wellness &amp; recovery plan. \n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/gilbert\/wp-json\/wp\/v2\/pages\/233#gf_2' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><fieldset id=\"field_2_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_1'>\n                            \n                            <span id='input_2_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_2_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_2_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_2_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_2_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_2_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_5'>Your Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_2_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\" \/><\/div><\/div><fieldset id=\"field_2_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_2_2_container'>\n                                <span id='input_2_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_2_2' class='gform-field-label gform-field-label--type-sub '>Email Address<\/label>\n                                    <input class='' type='email' name='input_2' id='input_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_2_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_2_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email Address<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_2_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_2_14\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Are you currently on any medications that affect circulation, blood pressure, or body temperature regulation?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_14'>\n\t\t\t<div class='gchoice gchoice_2_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_2_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_0' id='label_2_14_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_2_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_2_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_1' id='label_2_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_15\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you have any cardiovascular conditions (e.g., high blood pressure, heart disease, arrhythmias)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_15'>\n\t\t\t<div class='gchoice gchoice_2_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Yes'  id='choice_2_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_0' id='label_2_15_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_2_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='No'  id='choice_2_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_1' id='label_2_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_16\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you experience anxiety, panic attacks, or breathing difficulties that could be triggered by sudden cold exposure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_16'>\n\t\t\t<div class='gchoice gchoice_2_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Yes'  id='choice_2_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_0' id='label_2_16_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_2_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='No'  id='choice_2_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_1' id='label_2_16_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_17\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Are you concerned or aware of any other contradicting factors that you may possess that may lead to an adverse reaction to a cold plunge?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_17'>\n\t\t\t<div class='gchoice gchoice_2_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Yes'  id='choice_2_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_0' id='label_2_17_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_2_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='No'  id='choice_2_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_1' id='label_2_17_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_3\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_3'>Why is improving your health and wellness important to you at this moment in your life?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_3' id='input_2_3' class='textarea small'  aria-describedby=\"gfield_description_2_3\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_2_3'>What will it allow you to do, feel, or experience?<\/div><\/div><fieldset id=\"field_2_21\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What do you feel is holding you back from getting there?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_21'><div class='gchoice gchoice_2_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Time'  id='choice_2_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_1' id='label_2_21_1' class='gform-field-label gform-field-label--type-inline'>Time<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Discipline'  id='choice_2_21_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_2' id='label_2_21_2' class='gform-field-label gform-field-label--type-inline'>Discipline<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='Not sure what works'  id='choice_2_21_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_3' id='label_2_21_3' class='gform-field-label gform-field-label--type-inline'>Not sure what works<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.4' type='checkbox'  value='Pain\/injury'  id='choice_2_21_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_4' id='label_2_21_4' class='gform-field-label gform-field-label--type-inline'>Pain\/injury<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.5' type='checkbox'  value='Lack of support'  id='choice_2_21_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_5' id='label_2_21_5' class='gform-field-label gform-field-label--type-inline'>Lack of support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.6' type='checkbox'  value='Nothing \u2014 I just need a real plan'  id='choice_2_21_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_6' id='label_2_21_6' class='gform-field-label gform-field-label--type-inline'>Nothing \u2014 I just need a real plan<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_21_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.7' type='checkbox'  value='Other'  id='choice_2_21_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_7' id='label_2_21_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_19\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_19'>Other (Please explain)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_2_19' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_26\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_26'>What\u2019s your #1 goal right now for your body or mind?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_2_26' class='textarea small'  aria-describedby=\"gfield_description_2_26\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_2_26'>(Ex: reduce pain, have more energy, sleep better, lose weight, train harder, think sharper)<\/div><\/div><fieldset id=\"field_2_23\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What have you tried before to improve your health or recovery?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_23'><div class='gchoice gchoice_2_23_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.1' type='checkbox'  value='Diet'  id='choice_2_23_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_1' id='label_2_23_1' class='gform-field-label gform-field-label--type-inline'>Diet<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.2' type='checkbox'  value='Training programs'  id='choice_2_23_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_2' id='label_2_23_2' class='gform-field-label gform-field-label--type-inline'>Training programs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.3' type='checkbox'  value='Therapy\/Massage'  id='choice_2_23_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_3' id='label_2_23_3' class='gform-field-label gform-field-label--type-inline'>Therapy\/Massage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.4' type='checkbox'  value='Supplements'  id='choice_2_23_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_4' id='label_2_23_4' class='gform-field-label gform-field-label--type-inline'>Supplements<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.7' type='checkbox'  value='Other'  id='choice_2_23_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_23_5' id='label_2_23_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_24\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_24'>Other (Please explain)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_2_24' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_25\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_25'>What worked or didn\u2019t work?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_2_25' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_22\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_22'>What would it mean to you to feel, look, or perform at your best again?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_2_22' class='textarea small'  aria-describedby=\"gfield_description_2_22\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_2_22'>(Be specific \u2014 work, relationships, mindset, confidence, etc.)<\/div><\/div><fieldset id=\"field_2_27\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >If we built you a custom plan \u2014 how ready are you to follow it?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_27'>\n\t\t\t<div class='gchoice gchoice_2_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='All in \u2014 just need direction'  id='choice_2_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_0' id='label_2_27_0' class='gform-field-label gform-field-label--type-inline'>All in \u2014 just need direction<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='If it fits my time &amp; budget'  id='choice_2_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_1' id='label_2_27_1' class='gform-field-label gform-field-label--type-inline'>If it fits my time &amp; budget<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Not sure yet'  id='choice_2_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_2' id='label_2_27_2' class='gform-field-label gform-field-label--type-inline'>Not sure yet<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_29\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What do you need most from us to help you succeed?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_29'><div class='gchoice gchoice_2_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='Accountability'  id='choice_2_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_1' id='label_2_29_1' class='gform-field-label gform-field-label--type-inline'>Accountability<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.2' type='checkbox'  value='Structure\/routine'  id='choice_2_29_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_2' id='label_2_29_2' class='gform-field-label gform-field-label--type-inline'>Structure\/routine<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.3' type='checkbox'  value='Flexibility'  id='choice_2_29_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_3' id='label_2_29_3' class='gform-field-label gform-field-label--type-inline'>Flexibility<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.4' type='checkbox'  value='Motivation'  id='choice_2_29_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_4' id='label_2_29_4' class='gform-field-label gform-field-label--type-inline'>Motivation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.7' type='checkbox'  value='Education'  id='choice_2_29_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_5' id='label_2_29_5' class='gform-field-label gform-field-label--type-inline'>Education<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_29_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.8' type='checkbox'  value='All of the above'  id='choice_2_29_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_29_6' id='label_2_29_6' class='gform-field-label gform-field-label--type-inline'>All of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_28\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Which of our tools are you most excited about (or curious to try)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_28'><div class='gchoice gchoice_2_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='Cold Plunge'  id='choice_2_28_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_1' id='label_2_28_1' class='gform-field-label gform-field-label--type-inline'>Cold Plunge<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.2' type='checkbox'  value='Infrared Sauna'  id='choice_2_28_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_2' id='label_2_28_2' class='gform-field-label gform-field-label--type-inline'>Infrared Sauna<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.3' type='checkbox'  value='Red Light Therapy'  id='choice_2_28_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_3' id='label_2_28_3' class='gform-field-label gform-field-label--type-inline'>Red Light Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.4' type='checkbox'  value='PEMF'  id='choice_2_28_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_4' id='label_2_28_4' class='gform-field-label gform-field-label--type-inline'>PEMF<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.7' type='checkbox'  value='BrainTap'  id='choice_2_28_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_5' id='label_2_28_5' class='gform-field-label gform-field-label--type-inline'>BrainTap<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.8' type='checkbox'  value='Compression'  id='choice_2_28_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_6' id='label_2_28_6' class='gform-field-label gform-field-label--type-inline'>Compression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.9' type='checkbox'  value='BioCharger'  id='choice_2_28_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_7' id='label_2_28_7' class='gform-field-label gform-field-label--type-inline'>BioCharger<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.11' type='checkbox'  value='Hyperbaric Oxygen'  id='choice_2_28_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_8' id='label_2_28_8' class='gform-field-label gform-field-label--type-inline'>Hyperbaric Oxygen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_28_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.12' type='checkbox'  value='All of the above'  id='choice_2_28_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_28_9' id='label_2_28_9' class='gform-field-label gform-field-label--type-inline'>All of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_30\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Have you used any of these before? Which ones?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_30'><div class='gchoice gchoice_2_30_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.1' type='checkbox'  value='Cold Plunge'  id='choice_2_30_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_1' id='label_2_30_1' class='gform-field-label gform-field-label--type-inline'>Cold Plunge<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.2' type='checkbox'  value='Infrared Sauna'  id='choice_2_30_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_2' id='label_2_30_2' class='gform-field-label gform-field-label--type-inline'>Infrared Sauna<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.3' type='checkbox'  value='Red Light Therapy'  id='choice_2_30_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_3' id='label_2_30_3' class='gform-field-label gform-field-label--type-inline'>Red Light Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.4' type='checkbox'  value='PEMF'  id='choice_2_30_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_4' id='label_2_30_4' class='gform-field-label gform-field-label--type-inline'>PEMF<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.7' type='checkbox'  value='BrainTap'  id='choice_2_30_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_5' id='label_2_30_5' class='gform-field-label gform-field-label--type-inline'>BrainTap<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.8' type='checkbox'  value='Compression'  id='choice_2_30_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_6' id='label_2_30_6' class='gform-field-label gform-field-label--type-inline'>Compression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.9' type='checkbox'  value='BioCharger'  id='choice_2_30_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_7' id='label_2_30_7' class='gform-field-label gform-field-label--type-inline'>BioCharger<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.11' type='checkbox'  value='Hyperbaric Oxygen'  id='choice_2_30_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_8' id='label_2_30_8' class='gform-field-label gform-field-label--type-inline'>Hyperbaric Oxygen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_30_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.12' type='checkbox'  value='All of the above'  id='choice_2_30_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_30_9' id='label_2_30_9' class='gform-field-label gform-field-label--type-inline'>All of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_31\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What\u2019s your weekly availability for self-care or recovery?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_31'>\n\t\t\t<div class='gchoice gchoice_2_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='1\u20132 days\/week'  id='choice_2_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_31_0' id='label_2_31_0' class='gform-field-label gform-field-label--type-inline'>1\u20132 days\/week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='3\u20134 days\/week'  id='choice_2_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_31_1' id='label_2_31_1' class='gform-field-label gform-field-label--type-inline'>3\u20134 days\/week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='5+ \u2014 I\u2019m building this into my lifestyle'  id='choice_2_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_31_2' id='label_2_31_2' class='gform-field-label gform-field-label--type-inline'>5+ \u2014 I\u2019m building this into my lifestyle<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_32\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What\u2019s the biggest challenge you face when committing to a wellness program?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_32'><div class='gchoice gchoice_2_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Cost'  id='choice_2_32_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_32_1' id='label_2_32_1' class='gform-field-label gform-field-label--type-inline'>Cost<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_32_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.2' type='checkbox'  value='Time'  id='choice_2_32_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_32_2' id='label_2_32_2' class='gform-field-label gform-field-label--type-inline'>Time<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_32_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.3' type='checkbox'  value='Motivation'  id='choice_2_32_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_32_3' id='label_2_32_3' class='gform-field-label gform-field-label--type-inline'>Motivation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_32_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.4' type='checkbox'  value='Life stress'  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