Schedule an Appointment
@media print{*{-webkit-print-color-adjust: exact !important;color-adjust: exact !important;}.form-section{display:inline!important}.form-pagebreak{display:none!important}.form-section-closed{height:auto!important}.page-section{position:initial!important}}
.form-label-left{
width:150px;
}
.form-line{
padding-top:12px;
padding-bottom:12px;
}
.form-label-right{
width:150px;
}
body, html{
margin:0;
padding:0;
background:rgb(255, 255, 255);
}
.form-all{
margin:0px auto;
padding-top:20px;
width:450px;
color:rgb(29, 29, 29) !important;
font-family:'Roboto';
font-size:14px;
}
@import"//fonts.googleapis.com/css?family=Roboto:light,lightitalic,normal,italic,bold,bolditalic";
@import(css)"@{buttonFontLink}";
/* Injected CSS Code */
.form-all:after {
content: "";
display: table;
clear: both;
}
.form-all {
font-family: "Lato", sans-serif;
}
.form-all {
width: 450px;
}
.form-label-left,
.form-label-right {
width: 150px;
}
.form-label {
white-space: normal;
}
.form-label.form-label-auto {
display: block;
float: none;
word-break: break-word;
text-align: left;
}
.form-label-left {
display: inline-block;
white-space: normal;
float: left;
text-align: left;
}
.form-label-right {
display: inline-block;
white-space: normal;
float: left;
text-align: right;
}
.form-label-top {
white-space: normal;
display: block;
float: none;
text-align: left;
}
.form-radio-item label:before {
top: 0;
}
.form-all {
font-size: 14px;
}
.form-label {
position: relative;
}
.form-label:after {
content: 'This label will not be seen on the form.';
background: #FFFFE0;
position: absolute;
left: 0;
top: 110%;
width: 90px;
opacity: 0;
padding: 6px 9px 8px;
border-radius: 3px;
font-size: 10px;
font-weight: normal;
border: 1px solid rgba(0, 0, 0, 0.2);
}
.form-label:hover:after {
opacity: 0.8;
}
.supernova .form-label:after {
display: none;
}
.jotform-form .form-line[data-type="control_textbox"] .form-label,
.jotform-form .form-line[data-type="control_textarea"] .form-label,
.jotform-form .form-line[data-type="control_fullname"] .form-label,
.jotform-form .form-line[data-type="control_email"] .form-label,
.jotform-form .form-line[data-type="control_address"] .form-label,
.jotform-form .form-line[data-type="control_phone"] .form-label {
display: none;
}
.supernova {
background-color: #ffffff;
}
.supernova body {
background-color: transparent;
}
/*
@width30: (unit(@formWidth, px) + 60px);
@width60: (unit(@formWidth, px)+ 120px);
@width90: (unit(@formWidth, px)+ 180px);
*/
@media screen and(min-width:480px){
.supernova .form-all {
border: 1px solid #e6e6e6;
box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);
}
}
@media screen and(max-width: 480px) {
.jotform-form .form-all {
margin: 0;
width: 100%;
}
}
@media screen and(min-width: 480px)and(max-width: 767px) {
.jotform-form .form-all {
margin: 0;
width: 100%;
}
}
@media screen and(min-width: 480px)and(max-width: 449px) {
.jotform-form .form-all {
margin: 0;
width: 100%;
}
}
@media screen and(min-width: 768px) {
.jotform-form {
padding: 60px 0;
}
}
@media screen and(max-width: 449px) {
.jotform-form .form-all {
margin: 0;
width: 100%;
}
}
.supernova .form-all,
.form-all {
background-color: #ffffff;
border: 1px solid transparent;
}
.form-header-group {
border-color: #e6e6e6;
}
.form-matrix-table tr {
border-color: #e6e6e6;
}
.form-matrix-table tr:nth-child(2n) {
background-color: #f2f2f2;
}
.form-all {
color: #1d1d1d;
}
.form-header-group .form-header {
color: #1d1d1d;
}
.form-header-group .form-subHeader {
color: #373737;
}
.form-sub-label {
color: #373737;
}
.form-line.form-line-active {
-webkit-transition-property: all;
-moz-transition-property: all;
-ms-transition-property: all;
-o-transition-property: all;
transition-property: all;
-webkit-transition-duration: 0.3s;
-moz-transition-duration: 0.3s;
-ms-transition-duration: 0.3s;
-o-transition-duration: 0.3s;
transition-duration: 0.3s;
-webkit-transition-timing-function: ease;
-moz-transition-timing-function: ease;
-ms-transition-timing-function: ease;
-o-transition-timing-function: ease;
transition-timing-function: ease;
background-color: #ffffff;
}
/* omer */
.form-radio-item,
.form-checkbox-item {
padding-bottom: 0px !important;
}
.form-radio-item:last-child,
.form-checkbox-item:last-child {
padding-bottom: 0;
}
/* omer */
[data-type="control_radio"] .form-input,
[data-type="control_checkbox"] .form-input,
[data-type="control_radio"] .form-input-wide,
[data-type="control_checkbox"] .form-input-wide {
width: 100%;
max-width: 460px;
}
.form-radio-item,
.form-checkbox-item {
width: 100%;
max-width: 460px;
box-sizing: border-box;
}
.form-textbox.form-radio-other-input,
.form-textbox.form-checkbox-other-input {
width: 80%;
margin-left: 3%;
box-sizing: border-box;
}
.form-multiple-column {
width: 100%;
}
.form-multiple-column .form-radio-item,
.form-multiple-column .form-checkbox-item {
width: 10%;
}
.form-multiple-column[data-columncount="1"] .form-radio-item,
.form-multiple-column[data-columncount="1"] .form-checkbox-item {
width: 100%;
}
.form-multiple-column[data-columncount="2"] .form-radio-item,
.form-multiple-column[data-columncount="2"] .form-checkbox-item {
width: 50%;
}
.form-multiple-column[data-columncount="3"] .form-radio-item,
.form-multiple-column[data-columncount="3"] .form-checkbox-item {
width: 33.33333333%;
}
.form-multiple-column[data-columncount="4"] .form-radio-item,
.form-multiple-column[data-columncount="4"] .form-checkbox-item {
width: 25%;
}
.form-multiple-column[data-columncount="5"] .form-radio-item,
.form-multiple-column[data-columncount="5"] .form-checkbox-item {
width: 20%;
}
.form-multiple-column[data-columncount="6"] .form-radio-item,
.form-multiple-column[data-columncount="6"] .form-checkbox-item {
width: 16.66666667%;
}
.form-multiple-column[data-columncount="7"] .form-radio-item,
.form-multiple-column[data-columncount="7"] .form-checkbox-item {
width: 14.28571429%;
}
.form-multiple-column[data-columncount="8"] .form-radio-item,
.form-multiple-column[data-columncount="8"] .form-checkbox-item {
width: 12.5%;
}
.form-multiple-column[data-columncount="9"] .form-radio-item,
.form-multiple-column[data-columncount="9"] .form-checkbox-item {
width: 11.11111111%;
}
.form-single-column .form-checkbox-item,
.form-single-column .form-radio-item {
width: 100%;
}
.form-checkbox-item .editor-container div,
.form-radio-item .editor-container div {
position: relative;
}
.form-checkbox-item .editor-container div:before,
.form-radio-item .editor-container div:before {
display: inline-block;
vertical-align: middle;
box-sizing: border-box;
left: 0;
width: 18px;
height: 18px;
}
.form-checkbox-item,
.form-radio-item {
padding-left: 2px;
}
.form-checkbox-item input,
.form-radio-item input {
margin-top: 2px;
}
.supernova {
height: 100%;
background-repeat: no-repeat;
background-attachment: scroll;
background-position: center top;
background-repeat: repeat;
}
.supernova {
background-image: none;
}
#stage {
background-image: none;
}
.form-all {
background-repeat: no-repeat;
background-attachment: scroll;
background-position: center top;
background-repeat: repeat;
}
.form-header-group {
background-repeat: no-repeat;
background-attachment: scroll;
background-position: center top;
}
.form-line {
margin-top: 0px;
margin-bottom: 0px;
}
.form-line {
padding: 12px 36px;
}
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
border-radius: 0px;
}
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
width: 150px;
font-size: 1em;
padding: 9px 15px;
font-family: "Lato", sans-serif;
font-size: 14px;
font-weight: normal;
}
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
color: #f3f3f3 !important;
background: #49c9da;
box-shadow: none;
text-shadow: none;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next {
font-size: 1em;
padding: 9px 15px;
font-family: "Lato", sans-serif;
font-size: 14px;
font-weight: normal;
}
/*
& when ( @buttonFontType = google ) {
}
*/
h2.form-header {
line-height: 1.618em;
font-size: 1.714em;
}
h2 ~ .form-subHeader {
line-height: 1.5em;
font-size: 1.071em;
}
.form-header-group {
text-align: left;
}
.form-line {
zoom: 1;
}
.form-line:before,
.form-line:after {
display: table;
content: '';
line-height: 0;
}
.form-line:after {
clear: both;
}
.form-captcha input,
.form-spinner input {
width: 460px;
}
.form-textbox,
.form-textarea {
width: 100%;
max-width: 460px;
box-sizing: border-box;
}
.form-input,
.form-address-table,
.form-matrix-table {
width: 100%;
max-width: 460px;
}
.form-radio-item,
.form-checkbox-item {
width: 100%;
max-width: 460px;
box-sizing: border-box;
}
.form-textbox.form-radio-other-input,
.form-textbox.form-checkbox-other-input {
width: 80%;
margin-left: 3%;
box-sizing: border-box;
}
.form-multiple-column {
width: 100%;
}
.form-multiple-column .form-radio-item,
.form-multiple-column .form-checkbox-item {
width: 10%;
}
.form-multiple-column[data-columncount="1"] .form-radio-item,
.form-multiple-column[data-columncount="1"] .form-checkbox-item {
width: 100%;
}
.form-multiple-column[data-columncount="2"] .form-radio-item,
.form-multiple-column[data-columncount="2"] .form-checkbox-item {
width: 50%;
}
.form-multiple-column[data-columncount="3"] .form-radio-item,
.form-multiple-column[data-columncount="3"] .form-checkbox-item {
width: 33.33333333%;
}
.form-multiple-column[data-columncount="4"] .form-radio-item,
.form-multiple-column[data-columncount="4"] .form-checkbox-item {
width: 25%;
}
.form-multiple-column[data-columncount="5"] .form-radio-item,
.form-multiple-column[data-columncount="5"] .form-checkbox-item {
width: 20%;
}
.form-multiple-column[data-columncount="6"] .form-radio-item,
.form-multiple-column[data-columncount="6"] .form-checkbox-item {
width: 16.66666667%;
}
.form-multiple-column[data-columncount="7"] .form-radio-item,
.form-multiple-column[data-columncount="7"] .form-checkbox-item {
width: 14.28571429%;
}
.form-multiple-column[data-columncount="8"] .form-radio-item,
.form-multiple-column[data-columncount="8"] .form-checkbox-item {
width: 12.5%;
}
.form-multiple-column[data-columncount="9"] .form-radio-item,
.form-multiple-column[data-columncount="9"] .form-checkbox-item {
width: 11.11111111%;
}
[data-type="control_dropdown"] .form-dropdown {
width: 100% !important;
max-width: 460px;
}
[data-type="control_fullname"] .form-sub-label-container {
box-sizing: border-box;
width: 48%;
}
[data-type="control_fullname"] .form-sub-label-container:first-child {
margin-right: 4%;
}
[data-type="control_phone"] .form-sub-label-container {
width: 62.5%;
margin-left: 2.5%;
margin-right: 0;
float: left;
position: relative;
}
[data-type="control_phone"] .form-sub-label-container:first-child {
width: 32.5%;
margin-right: 2.5%;
margin-left: 0;
}
[data-type="control_phone"] .form-sub-label-container:first-child [data-component=areaCode] {
width: 93%;
float: left;
}
[data-type="control_phone"] .form-sub-label-container:first-child [data-component=areaCode] ~ .form-sub-label {
display: inline-block;
}
[data-type="control_phone"] .form-sub-label-container:first-child .phone-separate {
position: absolute;
top: 0;
right: -16%;
width: 24%;
text-align: center;
text-indent: -4px;
}
[data-type="control_birthdate"] .form-sub-label-container {
width: 22%;
margin-right: 3%;
}
[data-type="control_birthdate"] .form-sub-label-container:first-child {
width: 50%;
}
[data-type="control_birthdate"] .form-sub-label-container:last-child {
margin-right: 0;
}
[data-type="control_birthdate"] .form-sub-label-container .form-dropdown {
width: 100%;
}
[data-type="control_payment"] .form-sub-label-container {
width: auto;
}
[data-type="control_payment"] .form-sub-label-container .form-dropdown {
width: 100%;
}
.form-address-table td .form-dropdown {
width: 100%;
}
.form-address-table td .form-sub-label-container {
width: 96%;
}
.form-address-table td:last-child .form-sub-label-container {
margin-left: 4%;
}
.form-address-table td[colspan="2"] .form-sub-label-container {
width: 100%;
margin: 0;
}
.form-line,
.form-input,
.form-input-wide,
.form-dropdown,
.form-sub-label-container,
.form-address-table,
.form-matrix-table {
box-sizing: border-box;
width: 100%;
max-width: none;
}
.form-textbox,
.form-textarea,
.form-radio-item,
.form-checkbox-item,
.form-captcha input,
.form-spinner input,
.form-error-message {
width: 100%;
max-width: none;
box-sizing: border-box;
}
/*.form-dropdown,
.form-radio-item,
.form-checkbox-item,
.form-radio-other-input,
.form-checkbox-other-input,*/
.form-captcha input,
.form-spinner input,
.form-error-message {
padding: 4px 3px 2px 3px;
}
.form-header-group {
font-family: "Lato", sans-serif;
}
.form-section {
padding: 0px 0px 0px 0px;
}
.form-header-group {
margin: 12px 36px 12px 36px;
}
.form-header-group {
padding: 24px 0px 24px 0px;
}
.form-textbox,
.form-textarea {
border-width: 2px;
border-color: #49c9da;
padding: 9px 8px 7px 8px;
}
.form-textbox,
.form-textarea,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input {
background-color: #ffffff;
}
.form-textbox,
.form-textarea {
width: 100%;
max-width: 460px;
box-sizing: border-box;
}
[data-type="control_textbox"] .form-input,
[data-type="control_textarea"] .form-input,
[data-type="control_fullname"] .form-input,
[data-type="control_phone"] .form-input,
[data-type="control_datetime"] .form-input,
[data-type="control_address"] .form-input,
[data-type="control_email"] .form-input,
[data-type="control_passwordbox"] .form-input,
[data-type="control_autocomp"] .form-input,
[data-type="control_textbox"] .form-input-wide,
[data-type="control_textarea"] .form-input-wide,
[data-type="control_fullname"] .form-input-wide,
[data-type="control_phone"] .form-input-wide,
[data-type="control_datetime"] .form-input-wide,
[data-type="control_address"] .form-input-wide,
[data-type="control_email"] .form-input-wide,
[data-type="control_passwordbox"] .form-input-wide,
[data-type="control_autocomp"] .form-input-wide {
width: 100%;
max-width: 460px;
}
[data-type="control_fullname"] .form-sub-label-container {
box-sizing: border-box;
width: 48%;
margin-right: 0;
float: left;
}
[data-type="control_fullname"] .form-sub-label-container:first-child {
margin-right: 4%;
}
[data-type="control_phone"] .form-sub-label-container {
width: 62.5%;
margin-left: 2.5%;
margin-right: 0;
float: left;
position: relative;
}
[data-type="control_phone"] .form-sub-label-container:first-child {
width: 32.5%;
margin-right: 2.5%;
margin-left: 0;
}
[data-type="control_phone"] .form-sub-label-container:first-child [data-component=areaCode] {
width: 93%;
float: left;
}
[data-type="control_phone"] .form-sub-label-container:first-child [data-component=areaCode] ~ .form-sub-label {
display: inline-block;
}
[data-type="control_phone"] .form-sub-label-container:first-child .phone-separate {
position: absolute;
top: 0;
right: -16%;
width: 24%;
text-align: center;
text-indent: -4px;
}
[data-type="control_phone"] .form-sub-label-container .date-separate {
visibility: hidden;
}
.form-matrix-table {
width: 100%;
max-width: 460px;
}
.form-address-table {
width: 100%;
max-width: 460px;
}
.form-address-table td .form-dropdown {
width: 100%;
}
.form-address-table td .form-sub-label-container {
width: 96%;
}
.form-address-table td:last-child .form-sub-label-container {
margin-left: 4%;
}
.form-address-table td[colspan="2"] .form-sub-label-container {
width: 100%;
margin: 0;
}
.form-matrix-row-headers,
.form-matrix-column-headers,
.form-matrix-values {
padding: 4px;
}
[data-type="control_dropdown"] .form-input,
[data-type="control_birthdate"] .form-input,
[data-type="control_time"] .form-input,
[data-type="control_dropdown"] .form-input-wide,
[data-type="control_birthdate"] .form-input-wide,
[data-type="control_time"] .form-input-wide {
width: 100%;
max-width: 460px;
}
[data-type="control_dropdown"] .form-dropdown {
width: 100% !important;
max-width: 460px;
}
[data-type="control_birthdate"] .form-sub-label-container {
width: 22%;
margin-right: 3%;
}
[data-type="control_birthdate"] .form-sub-label-container:first-child {
width: 50%;
}
[data-type="control_birthdate"] .form-sub-label-container:last-child {
margin-right: 0;
}
[data-type="control_birthdate"] .form-sub-label-container .form-dropdown {
width: 100%;
}
.form-dropdown {
margin: 0;
border-color: #a6a6a6;
appearance: menulist!important;
border-width: 1px;
}
.form-buttons-wrapper {
margin-left: 0 !important;
text-align: center;
}
.form-label {
font-family: "Lato", sans-serif;
}
li[data-type="control_image"] div {
text-align: left;
}
li[data-type="control_image"] img {
border: none;
border-width: 0px !important;
border-style: solid !important;
border-color: none !important;
}
.form-line-column {
width: auto;
}
.form-line-error {
overflow: hidden;
-webkit-transition-property: none;
-moz-transition-property: none;
-ms-transition-property: none;
-o-transition-property: none;
transition-property: none;
-webkit-transition-duration: 0.3s;
-moz-transition-duration: 0.3s;
-ms-transition-duration: 0.3s;
-o-transition-duration: 0.3s;
transition-duration: 0.3s;
-webkit-transition-timing-function: ease;
-moz-transition-timing-function: ease;
-ms-transition-timing-function: ease;
-o-transition-timing-function: ease;
transition-timing-function: ease;
background-color: #ffffff;
}
.form-line-error .form-error-message {
background-color: #ff3200;
clear: both;
float: none;
}
.form-line-error .form-error-message .form-error-arrow {
border-bottom-color: #ff3200;
}
.form-line-error input:not(#coupon-input),
.form-line-error textarea,
.form-line-error .form-validation-error {
border: 1px solid #ff3200;
box-shadow: 0 0 3px #ff3200;
}
.ie-8 .form-all {
margin-top: auto;
margin-top: initial;
}
.ie-8 .form-all:before {
display: none;
}
[data-type="control_clear"] {
display: none;
}
@media screen and(max-width: 480px),screen and(max-device-width: 767px)and(orientation: portrait),screen and(max-device-width: 415px)and(orientation: landscape) {
.testOne {
letter-spacing: 0;
}
.form-all {
border: 0;
max-width: initial;
}
.form-sub-label-container {
width: 100%;
margin: 0;
margin-right: 0;
float: left;
box-sizing: border-box;
}
span.form-sub-label-container + span.form-sub-label-container {
margin-right: 0;
}
.form-sub-label {
white-space: normal;
}
.form-address-table td,
.form-address-table th {
padding: 0 1px 10px;
}
.form-submit-button,
.form-submit-print,
.form-submit-reset {
width: 100%;
margin-left: 0!important;
}
div[id*=at_] {
font-size: 14px;
font-weight: 700;
height: 8px;
margin-top: 6px;
}
.showAutoCalendar {
width: 20px;
}
img.form-image {
max-width: 100%;
height: auto;
}
.form-matrix-row-headers {
width: 100%;
word-break: break-all;
min-width: 80px;
}
.form-collapse-table,
.form-header-group {
margin: 0;
}
.form-collapse-table {
height: 100%;
display: inline-block;
width: 100%;
}
.form-collapse-hidden {
display: none !important;
}
.form-input {
width: 100%;
}
.form-label {
width: 100% !important;
}
.form-label-left,
.form-label-right {
display: block;
float: none;
text-align: left;
width: auto!important;
}
.form-line,
.form-line.form-line-column {
padding: 2% 5%;
box-sizing: border-box;
}
input[type=text],
input[type=email],
input[type=tel],
textarea {
width: 100%;
box-sizing: border-box;
max-width: initial !important;
}
.form-radio-other-input,
.form-checkbox-other-input {
max-width: 55% !important;
}
.form-dropdown,
.form-textarea,
.form-textbox {
width: 100%!important;
box-sizing: border-box;
}
.form-input,
.form-input-wide,
.form-textarea,
.form-textbox,
.form-dropdown {
max-width: initial!important;
}
.form-checkbox-item:not(#foo),
.form-radio-item:not(#foo) {
width: 100%;
}
.form-address-city,
.form-address-line,
.form-address-postal,
.form-address-state,
.form-address-table,
.form-address-table .form-sub-label-container,
.form-address-table select,
.form-input {
width: 100%;
}
div.form-header-group {
padding: 24px 0px !important;
margin: 0 12px 2% !important;
margin-left: 5%!important;
margin-right: 5%!important;
box-sizing: border-box;
}
div.form-header-group.hasImage img {
max-width: 100%;
}
[data-type="control_button"] {
margin-bottom: 0 !important;
}
[data-type=control_fullname] .form-sub-label-container {
width: 48%;
}
[data-type=control_fullname] .form-sub-label-container:first-child {
margin-right: 4%;
}
[data-type=control_phone] .form-sub-label-container {
width: 65%;
margin-right: 0;
margin-left: 0;
float: left;
}
[data-type=control_phone] .form-sub-label-container:first-child {
width: 31%;
margin-right: 4%;
}
[data-type=control_datetime] .allowTime-container {
width: 100%;
}
[data-type=control_datetime] .allowTime-container .form-sub-label-container {
width: 24%!important;
margin-left: 6%;
margin-right: 0;
}
[data-type=control_datetime] .allowTime-container .form-sub-label-container:first-child {
margin-left: 0;
}
[data-type=control_datetime] span + span + span > span:first-child {
display: block;
width: 100% !important;
}
[data-type=control_birthdate] .form-sub-label-container,
[data-type=control_time] .form-sub-label-container {
width: 27.3%!important;
margin-right: 6% !important;
}
[data-type=control_time] .form-sub-label-container:last-child {
width: 33.3%!important;
margin-right: 0 !important;
}
.form-pagebreak-back-container,
.form-pagebreak-next-container {
min-height: 1px;
width: 50% !important;
}
.form-pagebreak-back,
.form-pagebreak-next,
.form-product-item.hover-product-item {
width: 100%;
}
.form-pagebreak-back-container {
padding: 0;
text-align: right;
}
.form-pagebreak-next-container {
padding: 0;
text-align: left;
}
.form-pagebreak {
margin: 0 auto;
}
.form-buttons-wrapper {
margin: 0!important;
margin-left: 0!important;
}
.form-buttons-wrapper button {
width: 100%;
}
.form-buttons-wrapper .form-submit-print {
margin: 0 !important;
}
table {
width: 100%!important;
max-width: initial!important;
}
table td + td {
padding-left: 3%;
}
.form-checkbox-item,
.form-radio-item {
white-space: normal!important;
}
.form-checkbox-item input,
.form-radio-item input {
width: auto;
}
.form-collapse-table {
margin: 0 5%;
display: block;
zoom: 1;
width: auto;
}
.form-collapse-table:before,
.form-collapse-table:after {
display: table;
content: '';
line-height: 0;
}
.form-collapse-table:after {
clear: both;
}
.fb-like-box {
width: 98% !important;
}
.form-error-message {
clear: both;
bottom: -10px;
}
.date-separate,
.phone-separate {
display: none;
}
.custom-field-frame,
.direct-embed-widgets,
.signature-pad-wrapper {
width: 100% !important;
}
}
/*PREFERENCES STYLE*/
.form-all {
font-family: Roboto, sans-serif;
}
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-family: Roboto, sans-serif;
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-family: Roboto, sans-serif;
}
.form-header-group {
font-family: Roboto, sans-serif;
}
.form-label {
font-family: Roboto, sans-serif;
}
.form-label.form-label-auto {
display: block;
float: none;
text-align: left;
width: 100%;
}
.form-line {
margin-top: 12px;
margin-bottom: 12px;
}
.form-all {
max-width: 450px;
width: 100%;
}
.form-label.form-label-left,
.form-label.form-label-right,
.form-label.form-label-left.form-label-auto,
.form-label.form-label-right.form-label-auto {
width: 150px;
}
.form-all {
font-size: 14px
}
.form-all .qq-upload-button,
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
font-size: 14px
}
.form-all .form-pagebreak-back-container,
.form-all .form-pagebreak-next-container {
font-size: 14px
}
.supernova .form-all, .form-all {
background-color: rgb(255, 255, 255);
}
.form-all {
color: rgb(29, 29, 29);
}
.form-header-group .form-header {
color: rgb(29, 29, 29);
}
.form-header-group .form-subHeader {
color: rgb(29, 29, 29);
}
.form-label-top,
.form-label-left,
.form-label-right,
.form-html,
.form-checkbox-item label,
.form-radio-item label {
color: rgb(29, 29, 29);
}
.form-sub-label {
color: 1a1a1a;
}
.supernova {
}
.supernova body {
background: transparent;
}
.form-textbox,
.form-textarea,
.form-dropdown,
.form-radio-other-input,
.form-checkbox-other-input,
.form-captcha input,
.form-spinner input {
}
.supernova {
background-image: none;
}
#stage {
background-image: none;
}
.form-all {
background-image: none;
}
.ie-8 .form-all:before { display: none; }
.ie-8 {
margin-top: auto;
margin-top: initial;
}
/*PREFERENCES STYLE*//*__INSPECT_SEPERATOR__*/
.form-all {
box-shadow : none!important;
}
.form-textbox {
font-family : "Roboto";
}
.form-checkbox-item label {
font-family : Roboto;
}
.form-checkbox-item {
padding-top : 5px;
padding-bottom : 5px;
}
.form-line {
padding : 10px;
}
.form-error-message {
visibility : hidden;
height : 0px;
}
.form-label.form-label-top {
visibility : hidden;
height : 0px;
}
/* Injected CSS Code */
window.enableEventObserver=true
JotForm.newDefaultTheme = false;
JotForm.extendsNewTheme = false;
JotForm.singleProduct = false;
JotForm.newPaymentUIForNewCreatedForms = true;
JotForm.texts = {"confirmEmail":"E-mail does not match","pleaseWait":"Please wait...","validateEmail":"You need to validate this e-mail","confirmClearForm":"Are you sure you want to clear the form","lessThan":"Your score should be less than or equal to","incompleteFields":"There are incomplete required fields. Please complete them.","required":"This field is required.","requireOne":"At least one field required.","requireEveryRow":"Every row is required.","requireEveryCell":"Every cell is required.","email":"Enter a valid e-mail address","alphabetic":"This field can only contain letters","numeric":"This field can only contain numeric values","alphanumeric":"This field can only contain letters and numbers.","cyrillic":"This field can only contain cyrillic characters","url":"This field can only contain a valid URL","currency":"This field can only contain currency values.","fillMask":"Field value must fill mask.","uploadExtensions":"You can only upload following files:","noUploadExtensions":"File has no extension file type (e.g. .txt, .png, .jpeg)","uploadFilesize":"File size cannot be bigger than:","uploadFilesizemin":"File size cannot be smaller than:","gradingScoreError":"Score total should only be less than or equal to","inputCarretErrorA":"Input should not be less than the minimum value:","inputCarretErrorB":"Input should not be greater than the maximum value:","maxDigitsError":"The maximum digits allowed is","minCharactersError":"The number of characters should not be less than the minimum value:","maxCharactersError":"The number of characters should not be more than the maximum value:","freeEmailError":"Free email accounts are not allowed","minSelectionsError":"The minimum required number of selections is ","maxSelectionsError":"The maximum number of selections allowed is ","pastDatesDisallowed":"Date must not be in the past.","dateLimited":"This date is unavailable.","dateInvalid":"This date is not valid. The date format is {format}","dateInvalidSeparate":"This date is not valid. Enter a valid {element}.","ageVerificationError":"You must be older than {minAge} years old to submit this form.","multipleFileUploads_typeError":"{file} has invalid extension. Only {extensions} are allowed.","multipleFileUploads_sizeError":"{file} is too large, maximum file size is {sizeLimit}.","multipleFileUploads_minSizeError":"{file} is too small, minimum file size is {minSizeLimit}.","multipleFileUploads_emptyError":"{file} is empty, please select files again without it.","multipleFileUploads_uploadFailed":"File upload failed, please remove it and upload the file again.","multipleFileUploads_onLeave":"The files are being uploaded, if you leave now the upload will be cancelled.","multipleFileUploads_fileLimitError":"Only {fileLimit} file uploads allowed.","dragAndDropFilesHere_infoMessage":"Drag and drop files here","chooseAFile_infoMessage":"Choose a file","maxFileSize_infoMessage":"Max. file size","generalError":"There are errors on the form. Please fix them before continuing.","generalPageError":"There are errors on this page. Please fix them before continuing.","wordLimitError":"Too many words. The limit is","wordMinLimitError":"Too few words. The minimum is","characterLimitError":"Too many Characters. The limit is","characterMinLimitError":"Too few characters. The minimum is","ccInvalidNumber":"Credit Card Number is invalid.","ccInvalidCVC":"CVC number is invalid.","ccInvalidExpireDate":"Expire date is invalid.","ccInvalidExpireMonth":"Expiration month is invalid.","ccInvalidExpireYear":"Expiration year is invalid.","ccMissingDetails":"Please fill up the credit card details.","ccMissingProduct":"Please select at least one product.","ccMissingDonation":"Please enter numeric values for donation amount.","disallowDecimals":"Please enter a whole number.","restrictedDomain":"This domain is not allowed","ccDonationMinLimitError":"Minimum amount is {minAmount} {currency}","requiredLegend":"All fields marked with * are required and must be filled.","geoPermissionTitle":"Permission Denied","geoPermissionDesc":"Check your browser's privacy settings.","geoNotAvailableTitle":"Position Unavailable","geoNotAvailableDesc":"Location provider not available. Please enter the address manually.","geoTimeoutTitle":"Timeout","geoTimeoutDesc":"Please check your internet connection and try again.","selectedTime":"Selected Time","formerSelectedTime":"Former Time","cancelAppointment":"Cancel Appointment","cancelSelection":"Cancel Selection","confirmSelection":"Confirm Selection","noSlotsAvailable":"No slots available","slotUnavailable":"{time} on {date} has been selected is unavailable. Please select another slot.","multipleError":"There are {count} errors on this page. Please correct them before moving on.","oneError":"There is {count} error on this page. Please correct it before moving on.","doneMessage":"Well done! All errors are fixed.","invalidTime":"Enter a valid time","doneButton":"Done","reviewSubmitText":"Review and Submit","nextButtonText":"Next","prevButtonText":"Previous","seeErrorsButton":"See Errors","notEnoughStock":"Not enough stock for the current selection","notEnoughStock_remainedItems":"Not enough stock for the current selection ({count} items left)","soldOut":"Sold Out","justSoldOut":"Just Sold Out","selectionSoldOut":"Selection Sold Out","subProductItemsLeft":"({count} items left)","startButtonText":"START","submitButtonText":"Submit","submissionLimit":"Sorry! Only one entry is allowed.
Multiple submissions are disabled for this form.","reviewBackText":"Back to Form","seeAllText":"See All","progressMiddleText":"of","fieldError":"field has an error.","error":"Error"};
JotForm.newPaymentUI = true;
JotForm.isFormViewTrackingAllowed = true;
JotForm.replaceTagTest = true;
JotForm.activeRedirect = "thankurl";
JotForm.uploadServerURL = "https://upload.jotform.com/upload";
JotForm.clearFieldOnHide="disable";
JotForm.submitError="jumpToFirstError";
JotForm.init(function(){
/*INIT-START*/
if (window.JotForm && JotForm.accessible) $('input_4').setAttribute('tabindex',0);
if (window.JotForm && JotForm.accessible) $('input_18').setAttribute('tabindex',0);
if (window.JotForm && JotForm.accessible) $('input_7').setAttribute('tabindex',0);
if (window.JotForm && JotForm.accessible) $('input_6').setAttribute('tabindex',0);
if (window.JotForm && JotForm.accessible) $('input_17').setAttribute('tabindex',0);
JotForm.setCustomHint( 'input_17', 'Type here...' );
/*INIT-END*/
});
setTimeout(function() {
JotForm.paymentExtrasOnTheFly([null,null,{"name":"submit2","qid":"2","text":"Submit","type":"control_button"},null,{"description":"","name":"input4","qid":"4","subLabel":"","text":"","type":"control_textbox"},null,{"description":"","name":"input6","qid":"6","subLabel":"","text":"","type":"control_textbox"},{"description":"","name":"input7","qid":"7","subLabel":"","text":"","type":"control_textbox"},null,null,null,{"description":"","name":"input11","qid":"11","subLabel":"How Did You Hear About Us?","text":"","type":"control_dropdown"},{"description":"","name":"input12","qid":"12","subLabel":"Appointment Type","text":"","type":"control_dropdown"},null,null,null,null,{"description":"","mde":"No","name":"typeA","qid":"17","subLabel":"Message","text":"Type a question","type":"control_textarea","wysiwyg":"Disable"},{"description":"","name":"typeA18","qid":"18","subLabel":"","text":"Type a question","type":"control_textbox"},null,{"description":"","name":"pleaseSelect","qid":"20","subLabel":"Location","text":"Please Select","type":"control_dropdown"},{"description":"","name":"pleaseVerify","qid":"21","text":"Please verify that you are human","type":"control_captcha"},{"name":"pspanStylefontsize","qid":"22","text":"Download New Patient Form – Adult\nDownload New Patient Form – Child","type":"control_text"}]);}, 20);
JotForm.showJotFormPowered = "0";
JotForm.poweredByText = "Powered by Jotform";
var all_spc = document.querySelectorAll("form[id='220586863781265'] .si" + "mple" + "_spc");
for (var i = 0; i < all_spc.length; i++)
{
all_spc[i].value = "220586863781265-220586863781265";
}
JotForm.ownerView=true;JotForm.isNewSACL=true;
