{"id":71667,"date":"2023-11-01T05:34:14","date_gmt":"2023-11-01T09:34:14","guid":{"rendered":"https:\/\/pelvicguru.com\/?page_id=71667"},"modified":"2024-02-14T01:25:43","modified_gmt":"2024-02-14T06:25:43","slug":"professionals-form","status":"publish","type":"page","link":"https:\/\/thebetashow.com\/pelvicglobal_new\/professionals-form\/","title":{"rendered":"Professionals Form"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of 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                      <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1' class='my_forms' action='\/pelvicglobal_new\/wp-json\/wp\/v2\/pages\/71667' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_1'>First Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_1_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_3\" 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_visible\"  ><label class='gfield_label gform-field-label' for='input_1_3'>Last Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_1_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_4\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_4'>Email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_1_4' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_5'>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_1_5' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_6\" 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\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Specialty:Select all that apply<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_1_6'><div class='gchoice gchoice_1_6_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.1' type='checkbox'  value='Physician \/ Physician Assistant'  id='choice_1_6_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_1' id='label_1_6_1' class='gform-field-label gform-field-label--type-inline'>Physician \/ Physician Assistant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.2' type='checkbox'  value='Practice \/Facility'  id='choice_1_6_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_2' id='label_1_6_2' class='gform-field-label gform-field-label--type-inline'>Practice \/Facility<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.3' type='checkbox'  value='Nurse Practitioner'  id='choice_1_6_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_3' id='label_1_6_3' class='gform-field-label gform-field-label--type-inline'>Nurse Practitioner<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.4' type='checkbox'  value='Physical Therapist\/ PTA'  id='choice_1_6_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_4' id='label_1_6_4' class='gform-field-label gform-field-label--type-inline'>Physical Therapist\/ PTA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.5' type='checkbox'  value='Occupational Therapist \/ COTA'  id='choice_1_6_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_5' id='label_1_6_5' class='gform-field-label gform-field-label--type-inline'>Occupational Therapist \/ COTA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.6' type='checkbox'  value='Sex Therapist'  id='choice_1_6_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_6' id='label_1_6_6' class='gform-field-label gform-field-label--type-inline'>Sex Therapist<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.7' type='checkbox'  value='Sex Counselor'  id='choice_1_6_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_7' id='label_1_6_7' class='gform-field-label gform-field-label--type-inline'>Sex Counselor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.8' type='checkbox'  value='Sex Educator'  id='choice_1_6_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_8' id='label_1_6_8' class='gform-field-label gform-field-label--type-inline'>Sex Educator<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.9' type='checkbox'  value='Fitness Pro'  id='choice_1_6_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_9' id='label_1_6_9' class='gform-field-label gform-field-label--type-inline'>Fitness Pro<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.11' type='checkbox'  value='Doula'  id='choice_1_6_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_11' id='label_1_6_11' class='gform-field-label gform-field-label--type-inline'>Doula<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.12' type='checkbox'  value='Midwife'  id='choice_1_6_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_12' id='label_1_6_12' class='gform-field-label gform-field-label--type-inline'>Midwife<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.13' type='checkbox'  value='Psychologist'  id='choice_1_6_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_13' id='label_1_6_13' class='gform-field-label gform-field-label--type-inline'>Psychologist<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.14' type='checkbox'  value='Massage Therapist'  id='choice_1_6_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_14' id='label_1_6_14' class='gform-field-label gform-field-label--type-inline'>Massage Therapist<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.15' type='checkbox'  value='Nutritionist'  id='choice_1_6_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_15' id='label_1_6_15' class='gform-field-label gform-field-label--type-inline'>Nutritionist<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.16' type='checkbox'  value='Chiropractor'  id='choice_1_6_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_16' id='label_1_6_16' class='gform-field-label gform-field-label--type-inline'>Chiropractor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.17' type='checkbox'  value='Instructor \/Educator'  id='choice_1_6_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_17' id='label_1_6_17' class='gform-field-label gform-field-label--type-inline'>Instructor \/Educator<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_6_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.18' type='checkbox'  value='Other'  id='choice_1_6_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_18' id='label_1_6_18' 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_1_7\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_7'>Professional or Patient?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' 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