IS SEVERE CHRONIC PAIN REDUCING YOUR MOBILITY AND LIMITING YOUR STRENGTH?
Join us for a [FREE] seminar and learn about
our regenerative stem cell therapy for chronic pain relief.
Have you been affected by chronic pain that’s due to…
Arthritis / Osteoarthritis or Degenerative Joint Damage
Ligament, Tissue, or Muscle Damage
Damage from Past Injury
Joint Instability or Scar Tissue Build Up
Register NOW for our life-changing, FREE seminar about the revolutionary benefits of stem cell therapy!
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[et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> if (no_error && elem.name == 'email') {<!-- [et_pb_line_break_holder] --> if (!value.match(/^[\+_a-z0-9-'&=]+(\.[\+_a-z0-9-']+)*@[a-z0-9-]+(\.[a-z0-9-]+)*(\.[a-z]{2,})$/i)) {<!-- [et_pb_line_break_holder] --> elem.className = elem.className + ' _has_error';<!-- [et_pb_line_break_holder] --> no_error = false;<!-- [et_pb_line_break_holder] --> tooltip = create_tooltip(elem, "Enter a valid email address.");<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> if (no_error && /date_field/.test(elem.className)) {<!-- [et_pb_line_break_holder] --> if (!value.match(/^\d\d\d\d-\d\d-\d\d$/)) {<!-- [et_pb_line_break_holder] --> elem.className = elem.className + ' _has_error';<!-- [et_pb_line_break_holder] --> no_error = false;<!-- [et_pb_line_break_holder] --> tooltip = create_tooltip(elem, "Enter a valid date.");<!-- [et_pb_line_break_holder] 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[et_pb_line_break_holder] --> e.preventDefault();<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> resize_tooltips();<!-- [et_pb_line_break_holder] --> return no_error;<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> addEvent(window, 'resize', resize_tooltips);<!-- [et_pb_line_break_holder] --> addEvent(window, 'scroll', resize_tooltips);<!-- [et_pb_line_break_holder] --> window._old_serialize = null;<!-- [et_pb_line_break_holder] --> if (typeof serialize !== 'undefined') window._old_serialize = window.serialize;<!-- [et_pb_line_break_holder] --> _load_script("//d3rxaij56vjege.cloudfront.net/form-serialize/0.3/serialize.min.js", function() {<!-- [et_pb_line_break_holder] --> window._form_serialize = window.serialize;<!-- [et_pb_line_break_holder] --> if (window._old_serialize) window.serialize = window._old_serialize;<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> var form_submit = function(e) {<!-- 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The next seminar is:
Date:
Time:
Location:
*FREE Dinner provided!
A Message to Anyone Who Suffers from Serious Chronic Pain:
Chronic pain and limited mobility are terribly frustrating. Limited range of motion and function, along with pain and discomfort, can put a serious damper on day-to-day activities and your ability to enjoy life. For many, it can cause sleepless nights, an inability to work, and extreme difficulty completing simple tasks such as picking up a basket of laundry, carrying groceries, cooking. Not to mention, missing out on spending quality time with your family or friends.
Have you ever wondered why lasting relief is so elusive?
Why haven’t we found a lasting solution for chronic, debilitating pain? With all of the latest breakthroughs in medical treatments for conditions like diabetes, cancer, and even migraines, why is it that effective treatment for chronic pain seemingly does not exist?
It seems as if there is no end to your ongoing battle with chronic pain…
Believing that there is no legitimate relief to look forward to can wear on your psyche; making you feel hopeless. As a last resort, many people turn to surgery or prescription medication to ease the pain, both of which can create a host of additional problems. There has to be a better way to regain mobility, reduce, pain, and improve your quality of life.
Join us and learn about an innovative, revolutionary therapy that is providing countless Chronic Pain Sufferers with long-term, permanent relief from symptoms and complications.
These life-changing seminars are offered at no cost whatsoever.
Chronic Pain Sufferers:
You can finally find relief with our New, Innovative, Non-Surgical, Regenerative Cellular Therapy!
At our office, we have brought in the most innovative treatments and therapies available for pain relief. With Regenerative Cellular Therapy, people all over the world who live in pain just like yourself, are finding relief after only one treatment!
Our office is currently hosting educational seminars on the revolutionary benefits of STEM CELL THERAPY.
Sign up now & join us at a FREE seminar!
Date:
Time:
Location:
*FREE Dinner Provided
This breakthrough, life-changing therapyis helping countless of chronic pain sufferers enjoy a pain-free life!
Countless Chronic Pain Sufferers are finding long-lasting, permanent relief from their symptoms and complications with our revolutionary treatment option.
Take a moment and imagine…
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Enjoying your favorite pastimes and outdoor activities again!
Living a Pain Free Life without Complications!
Stop imagining and take action! Enough is enough, stop living in the pain. Take control and improve your quality of life. Register for this revolutionary, complimentary seminar now!
Join us to learn how we can help YOU live a healthier life!
We look forward to seeing you there!
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margin-bottom:10px; font-size:0; max-width:100%; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form_element * { font-size:14px; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form_element._clear { clear:both; width:100%; float:none; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form_element._clear:after { clear:left; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form_element input[type="text"],#_form_9_ ._form_element input[type="date"],#_form_9_ ._form_element select,#_form_9_ ._form_element textarea:not(.g-recaptcha-response) { display:block; width:100%; -webkit-box-sizing:border-box; -moz-box-sizing:border-box; box-sizing:border-box; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._field-wrapper { position:relative; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._inline-style { float:left; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._inline-style input[type="text"] { width:150px; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._inline-style:not(._clear) + ._inline-style:not(._clear) { margin-left:20px; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form_element img._form-image { max-width:100%; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._clear-element { clear:left; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._full_width { width:100%; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form_full_field { display:block; width:100%; margin-bottom:10px; }<!-- [et_pb_line_break_holder] --> #_form_9_ input[type="text"]._has_error,#_form_9_ textarea._has_error { border:#f37c7b 1px solid; }<!-- [et_pb_line_break_holder] --> #_form_9_ input[type="checkbox"]._has_error { outline:#f37c7b 1px solid; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error { display:block; position:absolute; font-size:13px; z-index:10000001; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error._above { padding-bottom:4px; top:-41px; right:0; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error._below { padding-top:4px; top:100%; right:0; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error._above ._error-arrow { bottom:0; right:15px; border-left:5px solid transparent; border-right:5px solid transparent; border-top:5px solid #f37c7b; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error._below ._error-arrow { top:0; right:15px; border-left:5px solid transparent; border-right:5px solid transparent; border-bottom:5px solid #f37c7b; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error-inner { padding:8px 12px; background-color:#f37c7b; font-size:13px; font-family:arial, sans-serif; color:#fff; text-align:center; text-decoration:none; -webkit-border-radius:4px; -moz-border-radius:4px; border-radius:4px; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error-inner._form_error { margin-bottom:5px; text-align:left; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._button-wrapper ._error-inner._form_error { position:static; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error-inner._no_arrow { margin-bottom:10px; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error-arrow { position:absolute; width:0; height:0; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._error-html { margin-bottom:10px; }<!-- [et_pb_line_break_holder] --> .pika-single { z-index:10000001 !important; }<!-- [et_pb_line_break_holder] --> @media all and (min-width:320px) and (max-width:667px) { ::-webkit-scrollbar { display:none; }<!-- [et_pb_line_break_holder] --> #_form_9_ { margin:0; width:100%; min-width:100%; max-width:100%; box-sizing:border-box; }<!-- [et_pb_line_break_holder] --> #_form_9_ * { -webkit-box-sizing:border-box; -moz-box-sizing:border-box; box-sizing:border-box; font-size:1em; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form-content { margin:0; width:100%; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form-inner { display:block; min-width:100%; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form-title,#_form_9_ ._inline-style { margin-top:0; margin-right:0; margin-left:0; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form-title { font-size:1.2em; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form_element { margin:0 0 20px; padding:0; width:100%; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form-element,#_form_9_ ._inline-style,#_form_9_ input[type="text"],#_form_9_ label,#_form_9_ p,#_form_9_ textarea:not(.g-recaptcha-response) { float:none; display:block; width:100%; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._row._checkbox-radio label { display:inline; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._row,#_form_9_ p,#_form_9_ label { margin-bottom:0.7em; width:100%; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._row input[type="checkbox"],#_form_9_ ._row input[type="radio"] { margin:0 !important; vertical-align:middle !important; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._row input[type="checkbox"] + span label { display:inline; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._row span label { margin:0 !important; width:initial !important; vertical-align:middle !important; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form-image { max-width:100%; height:auto !important; }<!-- [et_pb_line_break_holder] --> #_form_9_ input[type="text"] { padding-left:10px; padding-right:10px; font-size:16px; line-height:1.3em; -webkit-appearance:none; }<!-- [et_pb_line_break_holder] --> #_form_9_ input[type="radio"],#_form_9_ input[type="checkbox"] { display:inline-block; width:1.3em; height:1.3em; font-size:1em; margin:0 0.3em 0 0; vertical-align:baseline; }<!-- [et_pb_line_break_holder] --> #_form_9_ button[type="submit"] { padding:20px; font-size:1.5em; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._inline-style { margin:20px 0 0 !important; }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> #_form_9_ { position:relative; text-align:left; margin:25px auto 0; padding:20px; -webkit-box-sizing:border-box; -moz-box-sizing:border-box; box-sizing:border-box; *zoom:1; background:#eee !important; border:1px solid #b0b0b0 !important; width:400px; -moz-border-radius:10px !important; -webkit-border-radius:10px !important; border-radius:10px !important; color:#000 !important; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form-title { font-size:22px; line-height:22px; font-weight:600; margin-bottom:0; }<!-- [et_pb_line_break_holder] --> #_form_9_:before,#_form_9_:after { content:" "; display:table; }<!-- [et_pb_line_break_holder] --> #_form_9_:after { clear:both; }<!-- [et_pb_line_break_holder] --> #_form_9_._inline-style { width:auto; display:inline-block; }<!-- [et_pb_line_break_holder] --> #_form_9_._inline-style input[type="text"],#_form_9_._inline-style input[type="date"] { padding:10px 12px; }<!-- [et_pb_line_break_holder] --> #_form_9_._inline-style button._inline-style { position:relative; top:27px; }<!-- [et_pb_line_break_holder] --> #_form_9_._inline-style p { margin:0; }<!-- [et_pb_line_break_holder] --> #_form_9_._inline-style ._button-wrapper { position:relative; margin:27px 12.5px 0 20px; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form-thank-you { position:relative; left:0; right:0; text-align:center; font-size:18px; }<!-- [et_pb_line_break_holder] --> @media all and (min-width:320px) and (max-width:667px) { #_form_9_._inline-form._inline-style ._inline-style._button-wrapper { margin-top:20px !important; margin-left:0 !important; }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> #_form_9_ ._submit { font-weight:bold; }<!-- [et_pb_line_break_holder] --> #_form_9_ ._form-title { text-align:center; font-size:20px; }<!-- [et_pb_line_break_holder] --></style><!-- [et_pb_line_break_holder] --><form method="POST" action="https://painarthritisreliefcenter.activehosted.com/proc.php" id="_form_9_" class="_form _form_9 _inline-form _dark" novalidate><!-- [et_pb_line_break_holder] --> <input type="hidden" name="u" value="9" /><!-- [et_pb_line_break_holder] --> <input type="hidden" name="f" value="9" /><!-- [et_pb_line_break_holder] --> <input type="hidden" name="s" /><!-- [et_pb_line_break_holder] --> <input type="hidden" name="c" value="0" /><!-- [et_pb_line_break_holder] --> <input type="hidden" name="m" value="0" /><!-- [et_pb_line_break_holder] --> <input type="hidden" name="act" value="sub" /><!-- [et_pb_line_break_holder] --> <input type="hidden" name="v" value="2" /><!-- [et_pb_line_break_holder] --> <div class="_form-content"><!-- [et_pb_line_break_holder] --> <div class="_form_element _x07557504 _full_width _clear" ><!-- [et_pb_line_break_holder] --> <div class="_form-title" style="padding:20px;"><!-- [et_pb_line_break_holder] --> Sign up for our upcoming educational seminar!<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="_form_element _x68158440 _full_width " style="padding-left:20px;" ><!-- [et_pb_line_break_holder] --> <label class="_form-label"><!-- [et_pb_line_break_holder] --> First Name*<!-- [et_pb_line_break_holder] --> </label><!-- [et_pb_line_break_holder] --> <div class="_field-wrapper"><!-- [et_pb_line_break_holder] --> <input type="text" name="firstname" placeholder="Type your first name" size="35" required/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="_form_element _x38716115 _full_width " style="padding-left:20px;" ><!-- [et_pb_line_break_holder] --> <label class="_form-label"><!-- [et_pb_line_break_holder] --> Last Name*<!-- [et_pb_line_break_holder] --> </label><!-- [et_pb_line_break_holder] --> <div class="_field-wrapper"><!-- [et_pb_line_break_holder] --> <input type="text" name="lastname" placeholder="Type your last name" size="35" required/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="_form_element _x70912682 _full_width " style="padding-left:20px;" ><!-- [et_pb_line_break_holder] --> <label class="_form-label"><!-- [et_pb_line_break_holder] --> Phone*<!-- [et_pb_line_break_holder] --> </label><!-- [et_pb_line_break_holder] --> <div class="_field-wrapper"><!-- [et_pb_line_break_holder] --> <input type="text" name="phone" placeholder="Type your phone number" size="35" required/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="_form_element _x82651941 _full_width " style="padding-left:20px;" ><!-- [et_pb_line_break_holder] --> <label class="_form-label"><!-- [et_pb_line_break_holder] --> Email*<!-- [et_pb_line_break_holder] --> </label><!-- [et_pb_line_break_holder] --> <div class="_field-wrapper"><!-- [et_pb_line_break_holder] --> <input type="text" name="email" placeholder="Type your email" size="35" required/><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="_button-wrapper _full_width" style="padding-left:20px;padding-bottom:10px;"><!-- [et_pb_line_break_holder] --> <button id="_form_9_submit" class="_submit" type="submit"><!-- [et_pb_line_break_holder] --> Sign Up Today<!-- [et_pb_line_break_holder] --> </button><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="_clear-element"><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="_form-thank-you" style="display:none;"><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --></form><script type="text/javascript"><!-- [et_pb_line_break_holder] -->window.cfields = [];<!-- [et_pb_line_break_holder] -->window._show_thank_you = function(id, message, trackcmp_url) {<!-- [et_pb_line_break_holder] --> var form = document.getElementById('_form_' + id + '_'), thank_you = form.querySelector('._form-thank-you');<!-- [et_pb_line_break_holder] --> form.querySelector('._form-content').style.display = 'none';<!-- [et_pb_line_break_holder] --> thank_you.innerHTML = message;<!-- [et_pb_line_break_holder] --> thank_you.style.display = 'block';<!-- [et_pb_line_break_holder] --> if (typeof(trackcmp_url) != 'undefined' && trackcmp_url) {<!-- [et_pb_line_break_holder] --> // Site tracking URL to use after inline form submission.<!-- [et_pb_line_break_holder] --> _load_script(trackcmp_url);<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> if (typeof window._form_callback !== 'undefined') window._form_callback(id);<!-- [et_pb_line_break_holder] -->};<!-- [et_pb_line_break_holder] -->window._show_error = function(id, message, html) {<!-- [et_pb_line_break_holder] --> var form = document.getElementById('_form_' + id + '_'), err = document.createElement('div'), button = form.querySelector('button'), old_error = form.querySelector('._form_error');<!-- [et_pb_line_break_holder] --> if (old_error) old_error.parentNode.removeChild(old_error);<!-- [et_pb_line_break_holder] --> err.innerHTML = message;<!-- [et_pb_line_break_holder] --> err.className = '_error-inner _form_error _no_arrow';<!-- [et_pb_line_break_holder] --> var wrapper = document.createElement('div');<!-- [et_pb_line_break_holder] --> wrapper.className = '_form-inner';<!-- [et_pb_line_break_holder] --> wrapper.appendChild(err);<!-- [et_pb_line_break_holder] --> button.parentNode.insertBefore(wrapper, button);<!-- [et_pb_line_break_holder] --> document.querySelector('[id^="_form"][id$="_submit"]').disabled = false;<!-- [et_pb_line_break_holder] --> if (html) {<!-- [et_pb_line_break_holder] --> var div = document.createElement('div');<!-- [et_pb_line_break_holder] --> div.className = '_error-html';<!-- [et_pb_line_break_holder] --> div.innerHTML = html;<!-- [et_pb_line_break_holder] --> err.appendChild(div);<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] -->};<!-- [et_pb_line_break_holder] -->window._load_script = function(url, callback) {<!-- [et_pb_line_break_holder] --> var head = document.querySelector('head'), script = document.createElement('script'), r = false;<!-- [et_pb_line_break_holder] --> script.type = 'text/javascript';<!-- [et_pb_line_break_holder] --> script.charset = 'utf-8';<!-- [et_pb_line_break_holder] --> script.src = url;<!-- [et_pb_line_break_holder] --> if (callback) {<!-- [et_pb_line_break_holder] --> script.onload = script.onreadystatechange = function() {<!-- [et_pb_line_break_holder] --> if (!r && (!this.readyState || this.readyState == 'complete')) {<!-- [et_pb_line_break_holder] --> r = true;<!-- [et_pb_line_break_holder] --> callback();<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> head.appendChild(script);<!-- [et_pb_line_break_holder] -->};<!-- [et_pb_line_break_holder] -->(function() {<!-- [et_pb_line_break_holder] --> if (window.location.search.search("excludeform") !== -1) return false;<!-- [et_pb_line_break_holder] --> var getCookie = function(name) {<!-- [et_pb_line_break_holder] --> var match = document.cookie.match(new RegExp('(^|; )' + name + '=([^;]+)'));<!-- [et_pb_line_break_holder] --> return match ? match[2] : null;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> var setCookie = function(name, value) {<!-- [et_pb_line_break_holder] --> var now = new Date();<!-- [et_pb_line_break_holder] --> var time = now.getTime();<!-- [et_pb_line_break_holder] --> var expireTime = time + 1000 * 60 * 60 * 24 * 365;<!-- [et_pb_line_break_holder] --> now.setTime(expireTime);<!-- [et_pb_line_break_holder] --> document.cookie = name + '=' + value + '; expires=' + now + ';path=/';<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> var addEvent = function(element, event, func) {<!-- [et_pb_line_break_holder] --> if (element.addEventListener) {<!-- [et_pb_line_break_holder] --> element.addEventListener(event, func);<!-- [et_pb_line_break_holder] --> } else {<!-- [et_pb_line_break_holder] --> var oldFunc = element['on' + event];<!-- [et_pb_line_break_holder] --> element['on' + event] = function() {<!-- [et_pb_line_break_holder] --> oldFunc.apply(this, arguments);<!-- [et_pb_line_break_holder] --> func.apply(this, arguments);<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> var _removed = false;<!-- [et_pb_line_break_holder] --> var form_to_submit = document.getElementById('_form_9_');<!-- [et_pb_line_break_holder] --> var allInputs = form_to_submit.querySelectorAll('input, select, textarea'), tooltips = [], submitted = false;<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> var getUrlParam = function(name) {<!-- [et_pb_line_break_holder] --> var regexStr = '[\?&]' + name + '=([^&#]*)';<!-- [et_pb_line_break_holder] --> var results = new RegExp(regexStr, 'i').exec(window.location.href);<!-- [et_pb_line_break_holder] --> return results != undefined ? decodeURIComponent(results[1]) : false;<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> for (var i = 0; i < allInputs.length; i++) {<!-- [et_pb_line_break_holder] --> var regexStr = "field\\[(\\d+)\\]";<!-- [et_pb_line_break_holder] --> var results = new RegExp(regexStr).exec(allInputs[i].name);<!-- [et_pb_line_break_holder] --> if (results != undefined) {<!-- [et_pb_line_break_holder] --> allInputs[i].dataset.name = window.cfields[results[1]];<!-- [et_pb_line_break_holder] --> } else {<!-- [et_pb_line_break_holder] --> allInputs[i].dataset.name = allInputs[i].name;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> var fieldVal = getUrlParam(allInputs[i].dataset.name);<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> if (fieldVal) {<!-- [et_pb_line_break_holder] --> if (allInputs[i].type == "radio" || allInputs[i].type == "checkbox") {<!-- [et_pb_line_break_holder] --> if (allInputs[i].value == fieldVal) {<!-- [et_pb_line_break_holder] --> allInputs[i].checked = true;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> } else {<!-- [et_pb_line_break_holder] --> allInputs[i].value = fieldVal;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> var remove_tooltips = function() {<!-- [et_pb_line_break_holder] --> for (var i = 0; i < tooltips.length; i++) {<!-- [et_pb_line_break_holder] --> tooltips[i].tip.parentNode.removeChild(tooltips[i].tip);<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> tooltips = [];<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> var remove_tooltip = function(elem) {<!-- [et_pb_line_break_holder] --> for (var i = 0; i < tooltips.length; i++) {<!-- [et_pb_line_break_holder] --> if (tooltips[i].elem === elem) {<!-- [et_pb_line_break_holder] --> tooltips[i].tip.parentNode.removeChild(tooltips[i].tip);<!-- [et_pb_line_break_holder] --> tooltips.splice(i, 1);<!-- [et_pb_line_break_holder] --> return;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> var create_tooltip = function(elem, text) {<!-- [et_pb_line_break_holder] --> var tooltip = document.createElement('div'), arrow = document.createElement('div'), inner = document.createElement('div'), new_tooltip = {};<!-- [et_pb_line_break_holder] --> if (elem.type != 'radio' && elem.type != 'checkbox') {<!-- [et_pb_line_break_holder] --> tooltip.className = '_error';<!-- [et_pb_line_break_holder] --> arrow.className = '_error-arrow';<!-- [et_pb_line_break_holder] --> inner.className = '_error-inner';<!-- [et_pb_line_break_holder] --> inner.innerHTML = text;<!-- [et_pb_line_break_holder] --> tooltip.appendChild(arrow);<!-- [et_pb_line_break_holder] --> tooltip.appendChild(inner);<!-- [et_pb_line_break_holder] --> elem.parentNode.appendChild(tooltip);<!-- [et_pb_line_break_holder] --> } else {<!-- [et_pb_line_break_holder] --> tooltip.className = '_error-inner _no_arrow';<!-- [et_pb_line_break_holder] --> tooltip.innerHTML = text;<!-- [et_pb_line_break_holder] --> elem.parentNode.insertBefore(tooltip, elem);<!-- [et_pb_line_break_holder] --> new_tooltip.no_arrow = true;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> new_tooltip.tip = tooltip;<!-- [et_pb_line_break_holder] --> new_tooltip.elem = elem;<!-- [et_pb_line_break_holder] --> tooltips.push(new_tooltip);<!-- [et_pb_line_break_holder] --> return new_tooltip;<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> var resize_tooltip = function(tooltip) {<!-- [et_pb_line_break_holder] --> var rect = tooltip.elem.getBoundingClientRect();<!-- [et_pb_line_break_holder] --> var doc = document.documentElement, scrollPosition = rect.top - ((window.pageYOffset || doc.scrollTop) - (doc.clientTop || 0));<!-- [et_pb_line_break_holder] --> if (scrollPosition < 40) {<!-- [et_pb_line_break_holder] --> tooltip.tip.className = tooltip.tip.className.replace(/ ?(_above|_below) ?/g, '') + ' _below';<!-- [et_pb_line_break_holder] --> } else {<!-- [et_pb_line_break_holder] --> tooltip.tip.className = tooltip.tip.className.replace(/ ?(_above|_below) ?/g, '') + ' _above';<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> var resize_tooltips = function() {<!-- [et_pb_line_break_holder] --> if (_removed) return;<!-- [et_pb_line_break_holder] --> for (var i = 0; i < tooltips.length; i++) {<!-- [et_pb_line_break_holder] --> if (!tooltips[i].no_arrow) resize_tooltip(tooltips[i]);<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> var validate_field = function(elem, remove) {<!-- [et_pb_line_break_holder] --> var tooltip = null, value = elem.value, no_error = true;<!-- [et_pb_line_break_holder] --> remove ? remove_tooltip(elem) : false;<!-- [et_pb_line_break_holder] --> if (elem.type != 'checkbox') elem.className = elem.className.replace(/ ?_has_error ?/g, '');<!-- [et_pb_line_break_holder] --> if (elem.getAttribute('required') !== null) {<!-- [et_pb_line_break_holder] --> if (elem.type == 'radio' || (elem.type == 'checkbox' && /any/.test(elem.className))) {<!-- [et_pb_line_break_holder] --> var elems = form_to_submit.elements[elem.name];<!-- [et_pb_line_break_holder] --> if (!(elems instanceof NodeList || elems instanceof HTMLCollection) || elems.length <= 1) {<!-- [et_pb_line_break_holder] --> no_error = elem.checked;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> else {<!-- [et_pb_line_break_holder] --> no_error = false;<!-- [et_pb_line_break_holder] --> for (var i = 0; i < elems.length; i++) {<!-- [et_pb_line_break_holder] --> if (elems[i].checked) no_error = true;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> if (!no_error) {<!-- [et_pb_line_break_holder] --> tooltip = create_tooltip(elem, "Please select an option.");<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> } else if (elem.type =='checkbox') {<!-- [et_pb_line_break_holder] --> var elems = form_to_submit.elements[elem.name], found = false, err = [];<!-- [et_pb_line_break_holder] --> no_error = true;<!-- [et_pb_line_break_holder] --> for (var i = 0; i < elems.length; i++) {<!-- [et_pb_line_break_holder] --> if (elems[i].getAttribute('required') === null) continue;<!-- [et_pb_line_break_holder] --> if (!found && elems[i] !== elem) return true;<!-- [et_pb_line_break_holder] --> found = true;<!-- [et_pb_line_break_holder] --> elems[i].className = elems[i].className.replace(/ ?_has_error ?/g, '');<!-- [et_pb_line_break_holder] --> if (!elems[i].checked) {<!-- [et_pb_line_break_holder] --> no_error = false;<!-- [et_pb_line_break_holder] --> elems[i].className = elems[i].className + ' _has_error';<!-- [et_pb_line_break_holder] --> err.push("Checking %s is required".replace("%s", elems[i].value));<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> if (!no_error) {<!-- [et_pb_line_break_holder] --> tooltip = create_tooltip(elem, err.join('<br/>'));<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> } else if (elem.tagName == 'SELECT') {<!-- [et_pb_line_break_holder] --> var selected = true;<!-- [et_pb_line_break_holder] --> if (elem.multiple) {<!-- [et_pb_line_break_holder] --> selected = false;<!-- [et_pb_line_break_holder] --> for (var i = 0; i < elem.options.length; i++) {<!-- [et_pb_line_break_holder] --> if (elem.options[i].selected) {<!-- [et_pb_line_break_holder] --> selected = true;<!-- [et_pb_line_break_holder] --> break;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> } else {<!-- [et_pb_line_break_holder] --> for (var i = 0; i < elem.options.length; i++) {<!-- [et_pb_line_break_holder] --> if (elem.options[i].selected && !elem.options[i].value) {<!-- [et_pb_line_break_holder] --> selected = false;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> if (!selected) {<!-- [et_pb_line_break_holder] --> elem.className = elem.className + ' _has_error';<!-- [et_pb_line_break_holder] --> no_error = false;<!-- [et_pb_line_break_holder] --> tooltip = create_tooltip(elem, "Please select an option.");<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> } else if (value === undefined || value === null || value === '') {<!-- [et_pb_line_break_holder] --> elem.className = elem.className + ' _has_error';<!-- [et_pb_line_break_holder] --> no_error = false;<!-- [et_pb_line_break_holder] --> tooltip = create_tooltip(elem, "This field is required.");<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> if (no_error && elem.name == 'email') {<!-- [et_pb_line_break_holder] --> if (!value.match(/^[\+_a-z0-9-'&=]+(\.[\+_a-z0-9-']+)*@[a-z0-9-]+(\.[a-z0-9-]+)*(\.[a-z]{2,})$/i)) {<!-- [et_pb_line_break_holder] --> elem.className = elem.className + ' _has_error';<!-- [et_pb_line_break_holder] --> no_error = false;<!-- [et_pb_line_break_holder] --> tooltip = create_tooltip(elem, "Enter a valid email address.");<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> if (no_error && /date_field/.test(elem.className)) {<!-- [et_pb_line_break_holder] --> if (!value.match(/^\d\d\d\d-\d\d-\d\d$/)) {<!-- [et_pb_line_break_holder] --> elem.className = elem.className + ' _has_error';<!-- [et_pb_line_break_holder] --> no_error = false;<!-- [et_pb_line_break_holder] --> tooltip = create_tooltip(elem, "Enter a valid date.");<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> tooltip ? resize_tooltip(tooltip) : false;<!-- [et_pb_line_break_holder] --> return no_error;<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> var needs_validate = function(el) {<!-- [et_pb_line_break_holder] --> return el.name == 'email' || el.getAttribute('required') !== null;<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> var validate_form = function(e) {<!-- [et_pb_line_break_holder] --> var err = form_to_submit.querySelector('._form_error'), no_error = true;<!-- [et_pb_line_break_holder] --> if (!submitted) {<!-- [et_pb_line_break_holder] --> submitted = true;<!-- [et_pb_line_break_holder] --> for (var i = 0, len = allInputs.length; i < len; i++) {<!-- [et_pb_line_break_holder] --> var input = allInputs[i];<!-- [et_pb_line_break_holder] --> if (needs_validate(input)) {<!-- [et_pb_line_break_holder] --> if (input.type == 'text') {<!-- [et_pb_line_break_holder] --> addEvent(input, 'blur', function() {<!-- [et_pb_line_break_holder] --> this.value = this.value.trim();<!-- [et_pb_line_break_holder] --> validate_field(this, true);<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> addEvent(input, 'input', function() {<!-- [et_pb_line_break_holder] --> validate_field(this, true);<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> } else if (input.type == 'radio' || input.type == 'checkbox') {<!-- [et_pb_line_break_holder] --> (function(el) {<!-- [et_pb_line_break_holder] --> var radios = form_to_submit.elements[el.name];<!-- [et_pb_line_break_holder] --> for (var i = 0; i < radios.length; i++) {<!-- [et_pb_line_break_holder] --> addEvent(radios[i], 'click', function() {<!-- [et_pb_line_break_holder] --> validate_field(el, true);<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> })(input);<!-- [et_pb_line_break_holder] --> } else if (input.tagName == 'SELECT') {<!-- [et_pb_line_break_holder] --> addEvent(input, 'change', function() {<!-- [et_pb_line_break_holder] --> validate_field(this, true);<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> remove_tooltips();<!-- [et_pb_line_break_holder] --> for (var i = 0, len = allInputs.length; i < len; i++) {<!-- [et_pb_line_break_holder] --> var elem = allInputs[i];<!-- [et_pb_line_break_holder] --> if (needs_validate(elem)) {<!-- [et_pb_line_break_holder] --> if (elem.tagName.toLowerCase() !== "select") {<!-- [et_pb_line_break_holder] --> elem.value = elem.value.trim();<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> validate_field(elem) ? true : no_error = false;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> if (!no_error && e) {<!-- [et_pb_line_break_holder] --> e.preventDefault();<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> resize_tooltips();<!-- [et_pb_line_break_holder] --> return no_error;<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> addEvent(window, 'resize', resize_tooltips);<!-- [et_pb_line_break_holder] --> addEvent(window, 'scroll', resize_tooltips);<!-- [et_pb_line_break_holder] --> window._old_serialize = null;<!-- [et_pb_line_break_holder] --> if (typeof serialize !== 'undefined') window._old_serialize = window.serialize;<!-- [et_pb_line_break_holder] --> _load_script("//d3rxaij56vjege.cloudfront.net/form-serialize/0.3/serialize.min.js", function() {<!-- [et_pb_line_break_holder] --> window._form_serialize = window.serialize;<!-- [et_pb_line_break_holder] --> if (window._old_serialize) window.serialize = window._old_serialize;<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> var form_submit = function(e) {<!-- [et_pb_line_break_holder] --> e.preventDefault();<!-- [et_pb_line_break_holder] --> if (validate_form()) {<!-- [et_pb_line_break_holder] --> // use this trick to get the submit button & disable it using plain javascript<!-- [et_pb_line_break_holder] --> document.querySelector('[id^="_form"][id$="_submit"]').disabled = true;<!-- [et_pb_line_break_holder] --> var serialized = _form_serialize(document.getElementById('_form_9_'));<!-- [et_pb_line_break_holder] --> var err = form_to_submit.querySelector('._form_error');<!-- [et_pb_line_break_holder] --> err ? err.parentNode.removeChild(err) : false;<!-- [et_pb_line_break_holder] --> _load_script('https://painarthritisreliefcenter.activehosted.com/proc.php?' + serialized + '&jsonp=true');<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --> return false;<!-- [et_pb_line_break_holder] --> };<!-- [et_pb_line_break_holder] --> addEvent(form_to_submit, 'submit', form_submit);<!-- [et_pb_line_break_holder] -->})();<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --></script>
