{"id":35167,"date":"2024-01-10T15:55:27","date_gmt":"2024-01-10T20:55:27","guid":{"rendered":"https:\/\/zoskinhealth-circleclub.com\/?page_id=35167"},"modified":"2024-01-10T16:03:47","modified_gmt":"2024-01-10T21:03:47","slug":"form-8","status":"publish","type":"page","link":"https:\/\/zoskinhealth-circleclub.com\/form-8\/","title":{"rendered":"Form 8"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework single-column-form-8_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_8' style='display:none'><div id='gf_8' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_8' id='gform_8' class='single-column-form-8' action='\/wp-json\/wp\/v2\/pages\/35167#gf_8' data-formid='8' novalidate>\n        <div id='gf_progressbar_wrapper_8' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_8_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_8_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_88\" ><label class='gfield_label gform-field-label' for='input_8_88'>Untitled<\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_8_88' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_59\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_59\" ><label class='gfield_label gform-field-label' for='input_8_59'>Practice ID<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_8_59' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_9\" ><label class='gfield_label gform-field-label' for='input_8_9'>Practice Name<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_8_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_8_89' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_8\").val(\"2\");  jQuery(\"#gform_8\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_8\").val(\"2\");  jQuery(\"#gform_8\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_8_2' class='gform_page' data-js='page-field-id-89' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_8_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_8_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_3\" ><legend class='gfield_label gform-field-label' >Circle Club Tier:<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_3'>\n\t\t\t<div class='gchoice gchoice_8_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='blue_diamond'  id='choice_8_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_3_0' id='label_8_3_0' class='gform-field-label gform-field-label--type-inline'>Blue Diamond <span class=\"info\" title=\"If your account has tiered up month prior, please note that tier ups don't process until the 15th of the following month.\"><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='gold'  id='choice_8_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_3_1' id='label_8_3_1' class='gform-field-label gform-field-label--type-inline'>Gold <span class=\"info\" title=\"If your account has tiered up month prior, please note that tier ups don't process until the 15th of the following month.\"><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_3_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='platinum'  id='choice_8_3_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_3_2' id='label_8_3_2' class='gform-field-label gform-field-label--type-inline'>Platinum <span class=\"info\" title=\"If your account has tiered up month prior, please note that tier ups don't process until the 15th of the following month.\"><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_73\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_73\" ><label class='gfield_label gform-field-label' for='input_8_73'>Remaining Co-Op Balance:<\/label><div class='ginput_container ginput_container_number'><input name='input_73' id='input_8_73' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_8_92\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_92\" ><\/div><div id=\"field_8_91\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_91\" ><\/div><div id=\"field_8_87\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_87\" ><label class='gfield_label gform-field-label' for='input_8_87'>Number<\/label><div class='ginput_container ginput_container_number'><input name='input_87' id='input_8_87' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_8_19\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_19\" ><h2>Practice Information<\/h2><\/div><div id=\"field_8_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_58\" ><label class='gfield_label gform-field-label' for='input_8_58'>AE Email<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_8_58' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_72\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_72\" ><label class='gfield_label gform-field-label' for='input_8_72'>Opp<\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_8_72' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_27\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_27\" ><label class='gfield_label gform-field-label' for='input_8_27'>WP ID<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_8_27' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_11\" ><label class='gfield_label gform-field-label' for='input_8_11'>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_11' id='input_8_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_12\" ><label class='gfield_label gform-field-label' for='input_8_12'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_8_12' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select State<\/option><option value='AL' >Alabama<\/option><option value='AK' >Alaska<\/option><option value='AS' >American Samoa<\/option><option value='AR' >Arizona<\/option><option value='AK' >Arkansas<\/option><option value='CA' >California<\/option><option value='CO' >Colorado<\/option><option value='CT' >Connecticut<\/option><option value='DE' >Delaware<\/option><option value='DC' >District of Columbia<\/option><option value='FL' >Florida<\/option><option value='GA' >Georgia<\/option><option value='GU' >Guam<\/option><option value='HI' >Hawaii<\/option><option value='ID' >Idaho<\/option><option value='IL' >Illinois<\/option><option value='IN' >Indiana<\/option><option value='IA' >Iowa<\/option><option value='KS' >Kansas<\/option><option value='KY' >Kentucky<\/option><option value='LA' >Louisiana<\/option><option value='ME' >Maine<\/option><option value='MD' >Maryland<\/option><option value='MA' >Massachusetts<\/option><option value='MI' >Michigan<\/option><option value='MN' >Minnesota<\/option><option value='MS' >Mississippi<\/option><option value='MO' >Missouri<\/option><option value='MT' >Montana<\/option><option value='NE' >Nebraska<\/option><option value='NV' >Nevada<\/option><option value='NH' >New Hampshire<\/option><option value='NJ' >New Jersey<\/option><option value='NM' >New Mexico<\/option><option value='NY' >New York<\/option><option value='NC' >North Carolina<\/option><option value='ND' >North Dakota<\/option><option value='MP' >Northern Mariana Islands<\/option><option value='OH' >Ohio<\/option><option value='OK' >Oklahoma<\/option><option value='OR' >Oregon<\/option><option value='PA' >Pennsylvania<\/option><option value='PR' >Puerto Rico<\/option><option value='RI' >Rhode Island<\/option><option value='SC' >South Carolina<\/option><option value='SD' >South Dakota<\/option><option value='TN' >Tennessee<\/option><option value='TX' >Texas<\/option><option value='UT' >Utah<\/option><option value='VI' >U.S. Virgin Islands<\/option><option value='VT' >Vermont<\/option><option value='VA' >Virginia<\/option><option value='WA' >Washington<\/option><option value='WV' >West Virginia<\/option><option value='WI' >Wisconsin<\/option><option value='WY' >Wyoming<\/option><\/select><\/div><\/div><div id=\"field_8_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_17\" ><label class='gfield_label gform-field-label' for='input_8_17'>Account Executive<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_8_17' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_10\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_10'>Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_8_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_13\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_13'>Postal \/ 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_13' id='input_8_13' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_15\" ><label class='gfield_label gform-field-label' for='input_8_15'>Practice Contact 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_15' id='input_8_15' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_14\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_14\" ><label class='gfield_label gform-field-label' for='input_8_14'>Practice Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_14' id='input_8_14' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_53\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_53\" ><label class='gfield_label gform-field-label' for='input_8_53'>Practice Contact 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_53' id='input_8_53' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_8_18\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_18\" ><p>&nbsp;<\/p><h2 align=\"center\">Choose a Form<\/h2><!--<hr>--><\/div><fieldset id=\"field_8_74\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full buttonized field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_74\" ><legend class='gfield_label gform-field-label' >Buttons<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_74'>\n\t\t\t<div class='gchoice gchoice_8_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='' checked='checked' id='choice_8_74_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_74_0' id='label_8_74_0' class='gform-field-label gform-field-label--type-inline'><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='project_approval'  id='choice_8_74_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_74_1' id='label_8_74_1' class='gform-field-label gform-field-label--type-inline'>SUBMIT PROJECT APPROVAL<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_74_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='project_reimbursement'  id='choice_8_74_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_74_2' id='label_8_74_2' class='gform-field-label gform-field-label--type-inline'>SUBMIT PROJECT REIMBURSEMENT<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_75\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_75\" ><h2>Co-Op Approval Form<\/h2><\/div><div id=\"field_8_76\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_76\" ><label class='gfield_label gform-field-label' for='input_8_76'>Project Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_8_76'>Example Project Name: ZO Skin Centre_Email Blast_Jan 2023. Duplicates are not allowed.<\/div><div class='ginput_container ginput_container_text'><input name='input_76' id='input_8_76' type='text' value='' class='large'  aria-describedby=\"gfield_description_8_76\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_8_77\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_77\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Advertisement Type:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_77'><div class='gchoice gchoice_8_77_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.1' type='checkbox'  value='print'  id='choice_8_77_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_1' id='label_8_77_1' class='gform-field-label gform-field-label--type-inline'>Print<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.2' type='checkbox'  value='digital'  id='choice_8_77_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_2' id='label_8_77_2' class='gform-field-label gform-field-label--type-inline'>Digital<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.3' type='checkbox'  value='co-branded'  id='choice_8_77_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_3' id='label_8_77_3' class='gform-field-label gform-field-label--type-inline'>Co-Branded Items (Event Support, Apparel, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.4' type='checkbox'  value='zo-printzone'  id='choice_8_77_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_4' id='label_8_77_4' class='gform-field-label gform-field-label--type-inline'>ZO\u00ae Print Zone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_77_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.5' type='checkbox'  value='other'  id='choice_8_77_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_77_5' id='label_8_77_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_8_78\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_78\" ><label class='gfield_label gform-field-label' for='input_8_78'>Other<\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_8_78' type='text' value='' class='large'    placeholder='Other'  aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_80\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_80\" ><label class='gfield_label gform-field-label' for='gform_browse_button_8_80'>Advertisement Upload<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_8_80' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_8_80&quot;,&quot;container&quot;:&quot;gform_multifile_upload_8_80&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_8_80&quot;,&quot;filelist&quot;:&quot;gform_preview_8_80&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/?gf_page=fbe6d6f6a370598&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:8,&quot;field_id&quot;:80},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;4&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_8_80&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_8_80' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_8_80' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_8_80\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_8_80'>Accepted file types: jpg, png, pdf, Max. file size: 10 MB, Max. files: 4.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_8_80'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_8_80' class='ginput_preview_list'><\/div><\/div><div id=\"field_8_81\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_81\" ><h2>Co-Op Reimbursement Form<\/h2><\/div><fieldset id=\"field_8_86\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_86\" ><legend class='gfield_label gform-field-label' >Project Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_86'>\n\t\t\t<div class='gchoice gchoice_8_86_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='1'  id='choice_8_86_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_86_0' id='label_8_86_0' class='gform-field-label gform-field-label--type-inline'>ZO Skin Centre_Email Blast_Jan 2023<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_86_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='2'  id='choice_8_86_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_86_1' id='label_8_86_1' class='gform-field-label gform-field-label--type-inline'>ZO Skin Centre_Email Blast_Jan 2024<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_86_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='3'  id='choice_8_86_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_86_2' id='label_8_86_2' class='gform-field-label gform-field-label--type-inline'>ZO Skin Centre_Email Blast_Dec2023<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_86_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='4'  id='choice_8_86_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_86_3' id='label_8_86_3' class='gform-field-label gform-field-label--type-inline'>test<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_90\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_90\" ><label class='gfield_label gform-field-label' for='input_8_90'>Project Name (Hidden)<\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_8_90' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_83\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_83\" ><label class='gfield_label gform-field-label' for='input_8_83'>Total Invoice Cost:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_83' id='input_8_83' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_8_84\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_84\" ><label class='gfield_label gform-field-label' for='gform_browse_button_8_84'>Invoice Upload<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_8_84' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_8_84&quot;,&quot;container&quot;:&quot;gform_multifile_upload_8_84&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_8_84&quot;,&quot;filelist&quot;:&quot;gform_preview_8_84&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/?gf_page=fbe6d6f6a370598&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:8,&quot;field_id&quot;:84},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;3&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_8_84&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_8_84' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_8_84' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_8_84\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_8_84'>Accepted file types: jpg, png, pdf, Max. file size: 10 MB, Max. files: 3.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_8_84'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_8_84' class='ginput_preview_list'><\/div><\/div><div id=\"field_8_26\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_8_26\" ><\/div><div id=\"field_8_28\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_28\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_28'>Remaining Benefits<\/label><div class='ginput_container ginput_container_number'><input name='input_28' id='input_8_28' type='number' step='any'   value='' class='small'      aria-invalid=\"false\" aria-describedby=\"gfield_description_8_28\" \/><\/div><div class='gfield_description' id='gfield_description_8_28'>benefits remaining<\/div><\/div><fieldset id=\"field_8_2\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_2\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Choose Benefits<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_2'><div class='gchoice gchoice_8_2_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.1' type='checkbox'  value='ZO\u00ae Brand Social Media Feature'  id='choice_8_2_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_2_1' id='label_8_2_1' class='gform-field-label gform-field-label--type-inline'><span>Drive traffic to your practice social media page with an exclusive story + highlight feature on the ZO<sup>\u00ae<\/sup> brand Instagram.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_2_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.2' type='checkbox'  value='1:1 Marketing Consultations'  id='choice_8_2_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_2_2' id='label_8_2_2' class='gform-field-label gform-field-label--type-inline'><span>Focus on practice growth objectives in a 1-hour marketing consultation with an industry expert.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_2_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.3' type='checkbox'  value='Premium Listing on Physician Locator'  id='choice_8_2_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_2_3' id='label_8_2_3' class='gform-field-label gform-field-label--type-inline'><span>Feature your practice social media pages, website and additional information to help reach more potential patients.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_2_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.4' type='checkbox'  value='CO-OP Flex Opportunities'  id='choice_8_2_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_2_4' id='label_8_2_4' class='gform-field-label gform-field-label--type-inline'><span>Take CO-OP Advertising a step further. Opportunities now include PrintZone, ZO<sup>\u00ae<\/sup> branded fixtures and event support.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_2_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.5' type='checkbox'  value='ZOSH.com Product Page feature*'  id='choice_8_2_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_2_5' id='label_8_2_5' class='gform-field-label gform-field-label--type-inline'><span>Blue Diamond members can be featured on a product page on ZO\u2019s brand website.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_2_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.6' type='checkbox'  value='ZO\u00ae Brand Social Media Feature with Video'  id='choice_8_2_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_2_6' id='label_8_2_6' class='gform-field-label gform-field-label--type-inline'><span>Blue Diamond members can share an exclusive video in addition to their feature on the ZO<sup>\u00ae<\/sup> brand Instagram.<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_20\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_20\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">Please provide additional information for your chosen benefits:<\/h3><\/div><div id=\"field_8_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_hidden\"  data-js-reload=\"field_8_32\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">ZO\u00ae Brand Social Media Feature<\/h3><\/div><div id=\"field_8_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_33\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_33'>Business\/Office Instagram Handle @<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_8_33' type='text' value='' class='large'    placeholder='Business\/Office Instagram Handle @*' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_34\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_34\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_34'>About Us Statement (300 Characters of Less)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_34' id='input_8_34' class='textarea medium'    placeholder='About Us Statement (300 Characters of Less)*' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_35\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_35\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='gform_browse_button_8_35'>(2-3) In-Office\/Team Images<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_8_35' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_8_35&quot;,&quot;container&quot;:&quot;gform_multifile_upload_8_35&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_8_35&quot;,&quot;filelist&quot;:&quot;gform_preview_8_35&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/?gf_page=fbe6d6f6a370598&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,png&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:8,&quot;field_id&quot;:35},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;3&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_8_35&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_8_35' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_8_35' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_8_35\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_8_35'>Accepted file types: jpg, png, Max. file size: 10 MB, Max. files: 3.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_8_35'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_8_35' class='ginput_preview_list'><\/div><\/div><div id=\"field_8_36\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_36\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='gform_browse_button_8_36'>(1) Business Logo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_8_36' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_8_36&quot;,&quot;container&quot;:&quot;gform_multifile_upload_8_36&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_8_36&quot;,&quot;filelist&quot;:&quot;gform_preview_8_36&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/?gf_page=fbe6d6f6a370598&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;png&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:8,&quot;field_id&quot;:36},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;1&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_8_36&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_8_36' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_8_36' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_8_36\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_8_36'>Accepted file types: png, Max. file size: 10 MB, Max. files: 1.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_8_36'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_8_36' class='ginput_preview_list'><\/div><\/div><fieldset id=\"field_8_54\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_54\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >(2-3) In-Office\/Team Images<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_54'><div class='gchoice gchoice_8_54_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.1' type='checkbox'  value='true'  id='choice_8_54_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_54_1' id='label_8_54_1' class='gform-field-label gform-field-label--type-inline'>true<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_55\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_55\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >(1) Business Logo<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_55'><div class='gchoice gchoice_8_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='true'  id='choice_8_55_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_55_1' id='label_8_55_1' class='gform-field-label gform-field-label--type-inline'>true<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_37\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_37\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">1:1 Marketing Consultations<\/h3><\/div><div id=\"field_8_41\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_41\" ><a href=\"https:\/\/calendly.com\/wendylewisco\/zo-skin-health-marketing-consultation\" target=\"_blank\">CLICK HERE<\/a> to schedule your 1:1 Marketing Consultation<\/div><div id=\"field_8_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_hidden\"  data-js-reload=\"field_8_8\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">Premium Listing on Physician Locator<\/h3><\/div><div id=\"field_8_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_22\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_22'>Practice Website<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_8_22' type='text' value='' class='large'    placeholder='Practice Website*' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_24\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_24'>Custom POS Link<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_8_24' type='text' value='' class='large'    placeholder='Custom POS Link*' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_29\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_29'>Instagram<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_8_29' type='text' value='' class='large'    placeholder='Instagram'  aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_30\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_30'>Facebook<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_8_30' type='text' value='' class='large'    placeholder='Facebook'  aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_31\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_31\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_31'>About Us Statement (300 Characters or Less)<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_8_31' class='textarea medium'    placeholder='About Us Statement (300 Characters or Less)*' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_21\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">CO-OP Flex Opportunities<\/h3><\/div><div id=\"field_8_44\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_44\" ><a href=\"https:\/\/zoskinhealth-circleclub.com\/co-op-advertising-program\/\" target=\"_blank\">CLICK HERE<\/a> for the CO-OP approval\/reimbursement forms<\/div><div id=\"field_8_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_45\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">ZOSH.com Product Page feature<\/h3><\/div><div id=\"field_8_46\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_46\" >*ZOSH.com Product Page feature is available for a limited time and subject to availability.<\/div><fieldset id=\"field_8_69\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_69\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label' >Select your feature type:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_69'>\n\t\t\t<div class='gchoice gchoice_8_69_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='physician_spotlight'  id='choice_8_69_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_69_0' id='label_8_69_0' class='gform-field-label gform-field-label--type-inline'>Physician\/Provider Spotlight <em>(Product recommendation from a specific provider at your practice)<\/em><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_69_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='practice_spotlight'  id='choice_8_69_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_69_1' id='label_8_69_1' class='gform-field-label gform-field-label--type-inline'>Practice Spotlight <em>(Product recommendation from your practice as a whole)<\/em><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_61\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_61\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='gform_browse_button_8_61'>(1) Physician\/Provider Headshot<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_8_61' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_8_61&quot;,&quot;container&quot;:&quot;gform_multifile_upload_8_61&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_8_61&quot;,&quot;filelist&quot;:&quot;gform_preview_8_61&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/?gf_page=fbe6d6f6a370598&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,png&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:8,&quot;field_id&quot;:61},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;1&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_8_61&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_8_61' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_8_61' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_8_61\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_8_61'>Accepted file types: jpg, png, Max. file size: 10 MB, Max. files: 1.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_8_61'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_8_61' class='ginput_preview_list'><\/div><\/div><div id=\"field_8_62\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_62\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='gform_browse_button_8_62'>(1) Practice\/In-Office Image<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_8_62' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_8_62&quot;,&quot;container&quot;:&quot;gform_multifile_upload_8_62&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_8_62&quot;,&quot;filelist&quot;:&quot;gform_preview_8_62&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/?gf_page=fbe6d6f6a370598&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,png&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:8,&quot;field_id&quot;:62},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;1&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_8_62&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_8_62' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_8_62' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_8_62\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_8_62'>Accepted file types: jpg, png, Max. file size: 10 MB, Max. files: 1.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_8_62'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_8_62' class='ginput_preview_list'><\/div><\/div><div id=\"field_8_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_70\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_70'>Physician\/Provider 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_70' id='input_8_70' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_71\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_71\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_71'>Practice 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_71' id='input_8_71' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_8_67\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_67\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >(1) Physician\/Provider Headshot<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_67'><div class='gchoice gchoice_8_67_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.1' type='checkbox'  value='true'  id='choice_8_67_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_67_1' id='label_8_67_1' class='gform-field-label gform-field-label--type-inline'>true<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_68\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_68\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >(1) Practice\/In-Office Image<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_68'><div class='gchoice gchoice_8_68_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.1' type='checkbox'  value='true'  id='choice_8_68_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_68_1' id='label_8_68_1' class='gform-field-label gform-field-label--type-inline'>true<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_63\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label' >Select one ZO\u00ae Product for your feature:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_63'>\n\t\t\t<div class='gchoice gchoice_8_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='illuminating_aox_serum'  id='choice_8_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_63_0' id='label_8_63_0' class='gform-field-label gform-field-label--type-inline'>Illuminating AOX Serum<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='rozatrol'  id='choice_8_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_63_1' id='label_8_63_1' class='gform-field-label gform-field-label--type-inline'>Rozatrol\u00ae<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_63_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='complexion_clearing_masque'  id='choice_8_63_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_63_2' id='label_8_63_2' class='gform-field-label gform-field-label--type-inline'>Complexion Clearing Masque<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_64\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_64\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_64'>Why do you love recommending this ZO\u00ae product to your patients?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_64' id='input_8_64' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_65\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_65\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_65'>Who is your ideal patient for this ZO\u00ae product?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_65' id='input_8_65' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_66\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_66\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_66'>What other ZO\u00ae products do you recommend your patients pair with this one?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_66' id='input_8_66' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_8_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_47\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">ZO\u00ae Brand Social Media Feature with Video<\/h3><\/div><div id=\"field_8_48\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_48\" >VIDEO REQUIREMENTS: Create a Meet the Expert video, up to 30 seconds in length, with a Provider focus: self-introduction, with role, office and location, etc. Consider however you would like to be featured - is it highlighting your expertise or experience? Or what inspired\/inspires you to do what you do for your patients?<\/div><div id=\"field_8_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_49\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_49'>Featured Provider 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_49' id='input_8_49' type='text' value='' class='large'    placeholder='Featured Provider Name*' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_50\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_8_50'>Business\/office Instagram Handle @<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_8_50' type='text' value='' class='large'    placeholder='Business\/office Instagram Handle @*' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_8_51\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_51\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='gform_browse_button_8_51'>Provider Headshot<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_8_51' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_8_51&quot;,&quot;container&quot;:&quot;gform_multifile_upload_8_51&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_8_51&quot;,&quot;filelist&quot;:&quot;gform_preview_8_51&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/?gf_page=fbe6d6f6a370598&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,png&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:8,&quot;field_id&quot;:51},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;1&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_8_51&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_8_51' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_8_51' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_8_51\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_8_51'>Accepted file types: jpg, png, Max. file size: 10 MB, Max. files: 1.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_8_51'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_8_51' class='ginput_preview_list'><\/div><\/div><div id=\"field_8_52\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_52\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='gform_browse_button_8_52'>Upload Video File<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_8_52' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_8_52&quot;,&quot;container&quot;:&quot;gform_multifile_upload_8_52&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_8_52&quot;,&quot;filelist&quot;:&quot;gform_preview_8_52&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/?gf_page=fbe6d6f6a370598&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/zoskinhealth-circleclub.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;mp4,mov&quot;}],&quot;max_file_size&quot;:&quot;41943040b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:8,&quot;field_id&quot;:52},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;1&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_8_52&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_8_52' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_8_52' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_8_52\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_8_52'>Accepted file types: mp4, mov, Max. file size: 40 MB, Max. files: 1.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_8_52'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_8_52' class='ginput_preview_list'><\/div><\/div><fieldset id=\"field_8_56\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" 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class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Upload Video File<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_8_57'><div class='gchoice gchoice_8_57_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.1' type='checkbox'  value='True'  id='choice_8_57_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_57_1' id='label_8_57_1' class='gform-field-label gform-field-label--type-inline'>True<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_25\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_8_25\" ><div class=\"message\">Questions? 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