{"id":20085,"date":"2024-09-04T22:24:06","date_gmt":"2024-09-04T22:24:06","guid":{"rendered":"https:\/\/alfacurecenter.com\/alfa-booking\/"},"modified":"2024-09-09T20:26:33","modified_gmt":"2024-09-09T20:26:33","slug":"alfa-booking","status":"publish","type":"page","link":"https:\/\/alfacurecenter.com\/en\/alfa-booking\/","title":{"rendered":"Alfa-Booking"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"20085\" class=\"elementor elementor-20085 elementor-20071\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-41ac025 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"41ac025\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a7eeab3\" data-id=\"a7eeab3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ef2cae0 elementor-widget elementor-widget-image\" data-id=\"ef2cae0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"398\" src=\"https:\/\/alfacurecenter.com\/wp-content\/uploads\/2024\/09\/www-copy-1024x398.png\" class=\"attachment-large size-large wp-image-20127\" alt=\"\" srcset=\"https:\/\/alfacurecenter.com\/wp-content\/uploads\/2024\/09\/www-copy-1024x398.png 1024w, https:\/\/alfacurecenter.com\/wp-content\/uploads\/2024\/09\/www-copy-300x117.png 300w, https:\/\/alfacurecenter.com\/wp-content\/uploads\/2024\/09\/www-copy-1536x597.png 1536w, https:\/\/alfacurecenter.com\/wp-content\/uploads\/2024\/09\/www-copy-2048x796.png 2048w, https:\/\/alfacurecenter.com\/wp-content\/uploads\/2024\/09\/www-copy-600x233.png 600w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-72795bd elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"72795bd\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-c85c8a8\" data-id=\"c85c8a8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-68034da\" data-id=\"68034da\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-26670f3 elementor-widget elementor-widget-heading\" data-id=\"26670f3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Request a visit:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-786ff4e elementor-widget elementor-widget-shortcode\" data-id=\"786ff4e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div id=\"bitforms_1_20085_1\" class=\"bit-form BO1 CU1 _frm-bg-b1\">\n      \n          <form novalidate id=\"form-bitforms_1_20085_1\" class=\"BM1 BN1 _frm-b1\" enctype=\"multipart\/form-data\" method='post'>\n              <input type=\"text\" class=\"d-none\" name=\"csrf\" value=\"\/Ayb\/29yaH9bjHv+72U3DRs2XS2AQ\/lbr0hh8zaa3wk=\">\n              <input type=\"text\" class=\"d-none\" name=\"t_identity\" value=\"cnHCXNpRwIaldo6VBTA7+mSWBlrZR0W0aOTaHeJXOaE=\">\n              \n              <input type=\"text\" class=\"d-none\" name=\"bitforms_id\" value=\"bitforms_1\">\n                  <div class=\"btcd-fld-itm b1-2 \">\n        <div \n      \n      class=\"Q1 U1 V1 W1 b1-2-fld-wrp bf-fld-wrp \"\n    >\n            <div \n        \n        class=\"K1 AE1 AI1 b1-2-lbl-wrp bf-lbl-wrp \" \n      >\n              <label \n         \n        class=\"A1 E1 K1 AE1 AF1 AG1 AH1 CN1 b1-2-lbl bf-lbl \"\n        for=\"b1-2-1\">\n        \n        \n        Name\n        \n              <span \n        \n        class=\"AF1 BE1 CN1 b1-2-req-smbl bf-req-smbl \" \n      >\n        *\n      <\/span>\n      <\/label>\n        \n      <\/div>\n      <div \n        \n        class=\"b1-2-inp-wrp bf-inp-wrp \"\n      > \n            <div \n      \n      class=\"W1 b1-2-inp-fld-wrp bf-inp-fld-wrp \"\n    >\n      <input\n        \n        id=\"b1-2-1\"\n        \n        class=\"B1 F1 G1 h1 i1 j1 k1 l1 m1 n1 o1 p1 q1 r1 s1 t1 u1 v1 w1 x1 y1 z1 AA1 AB1 AC1 AD1 CD1 CE1 CF1 CG1 CH1 CI1 CJ1 CK1 CL1 CM1 b1-2-fld bf-fld \"\n        type=\"text\"\n        required\n        \n        \n        placeholder='John Doe'\n        \n        \n        autocomplete='name'\n        \n        name='text-b1-2'\n        \n        \n      \/>\n      \n      \n    <\/div>\n    \n        \n            <div class='R1 S1 T1 b1-2-err-wrp bf-err-wrp' style=\"opacity: 0 !important; height: 0px !important;\">\n    <div class='P1 b1-2-err-inner bf-err-inner'>\n      \n        \n        <div   class=\"A1 E1 X1 Y1 Z1 a1 b1 c1 d1 e1 f1 g1 b1-2-err-msg bf-err-msg  Q1 b1-2-err-txt bf-err-txt \" style='display: none !important;'><\/div>\n        \n      \n      <\/div>\n    <\/div>\n      <\/div>\n    <\/div>\n<\/div><div class=\"btcd-fld-itm b1-5 \">\n        <div \n      \n      class=\"Q1 U1 V1 W1 b1-5-fld-wrp bf-fld-wrp \"\n    >\n            <div \n        \n        class=\"K1 AE1 AI1 b1-5-lbl-wrp bf-lbl-wrp \" \n      >\n              <label \n         \n        class=\"A1 E1 K1 AE1 AF1 AG1 AH1 CN1 b1-5-lbl bf-lbl \"\n        for=\"b1-5-1\">\n        \n        \n        Country\n        \n        \n      <\/label>\n        \n      <\/div>\n      <div \n        \n        class=\"b1-5-inp-wrp bf-inp-wrp \"\n      > \n            <div \n      \n      class=\"W1 b1-5-inp-fld-wrp bf-inp-fld-wrp \"\n    >\n      <input\n        \n        id=\"b1-5-1\"\n        \n        class=\"B1 F1 G1 h1 i1 j1 k1 l1 m1 n1 o1 p1 q1 r1 s1 t1 u1 v1 w1 x1 y1 z1 AA1 AB1 AC1 AD1 CD1 CE1 CF1 CG1 CH1 CI1 CJ1 CK1 CL1 CM1 b1-5-fld bf-fld \"\n        type=\"text\"\n        \n        \n        \n        placeholder='Placeholder...'\n        \n        \n        \n        \n        name='text-1-5'\n        \n        \n      \/>\n      \n      \n    <\/div>\n    \n        \n            <div class='R1 S1 T1 b1-5-err-wrp bf-err-wrp' style=\"opacity: 0 !important; height: 0px !important;\">\n    <div class='P1 b1-5-err-inner bf-err-inner'>\n      \n        \n        <div   class=\"A1 E1 X1 Y1 Z1 a1 b1 c1 d1 e1 f1 g1 b1-5-err-msg bf-err-msg  Q1 b1-5-err-txt bf-err-txt \" style='display: none !important;'><\/div>\n        \n      \n      <\/div>\n    <\/div>\n      <\/div>\n    <\/div>\n<\/div><div class=\"btcd-fld-itm b1-4 \">\n        <div \n      \n      class=\"Q1 U1 V1 W1 b1-4-fld-wrp bf-fld-wrp \"\n    >\n            <div \n        \n        class=\"K1 AE1 AI1 b1-4-lbl-wrp bf-lbl-wrp \" \n      >\n              <label \n         \n        class=\"A1 E1 K1 AE1 AF1 AG1 AH1 CN1 b1-4-lbl bf-lbl \"\n        for=\"b1-4-1\">\n        \n        \n        Email\n        \n              <span \n        \n        class=\"AF1 BE1 CN1 b1-4-req-smbl bf-req-smbl \" \n      >\n        *\n      <\/span>\n      <\/label>\n        \n      <\/div>\n      <div \n        \n        class=\"b1-4-inp-wrp bf-inp-wrp \"\n      > \n            <div \n      \n      class=\"W1 b1-4-inp-fld-wrp bf-inp-fld-wrp \"\n    >\n      <input\n        \n        id=\"b1-4-1\"\n        \n        class=\"B1 F1 G1 h1 i1 j1 k1 l1 m1 n1 o1 p1 q1 r1 s1 t1 u1 v1 w1 x1 y1 z1 AA1 AB1 AC1 AD1 CD1 CE1 CF1 CG1 CH1 CI1 CJ1 CK1 CL1 CM1 b1-4-fld bf-fld \"\n        type=\"email\"\n        required\n        \n        \n        placeholder='example@mail.com'\n        \n        \n        autocomplete='email'\n        \n        name='email-b1-4'\n        \n        \n      \/>\n      \n      \n    <\/div>\n    \n        \n            <div class='R1 S1 T1 b1-4-err-wrp bf-err-wrp' style=\"opacity: 0 !important; height: 0px !important;\">\n    <div class='P1 b1-4-err-inner bf-err-inner'>\n      \n        \n        <div   class=\"A1 E1 X1 Y1 Z1 a1 b1 c1 d1 e1 f1 g1 b1-4-err-msg bf-err-msg  Q1 b1-4-err-txt bf-err-txt \" style='display: none !important;'><\/div>\n        \n      \n      <\/div>\n    <\/div>\n      <\/div>\n    <\/div>\n<\/div><div class=\"btcd-fld-itm b1-11 \">\n        <div \n      \n      class=\"Q1 U1 V1 W1 b1-11-fld-wrp bf-fld-wrp \"\n    >\n            <div \n        \n        class=\"K1 AE1 AI1 b1-11-lbl-wrp bf-lbl-wrp \" \n      >\n              <label \n         \n        class=\"A1 E1 K1 AE1 AF1 AG1 AH1 CN1 b1-11-lbl bf-lbl \"\n        for=\"b1-11-1\">\n        \n        \n        WhatsApp Number\n        \n        \n      <\/label>\n        \n      <\/div>\n      <div \n        \n        class=\"b1-11-inp-wrp bf-inp-wrp \"\n      > \n            <div \n      \n      class=\"W1 b1-11-inp-fld-wrp bf-inp-fld-wrp \"\n    >\n      <input\n        \n        id=\"b1-11-1\"\n        \n        class=\"B1 F1 G1 h1 i1 j1 k1 l1 m1 n1 o1 p1 q1 r1 s1 t1 u1 v1 w1 x1 y1 z1 AA1 AB1 AC1 AD1 CD1 CE1 CF1 CG1 CH1 CI1 CJ1 CK1 CL1 CM1 b1-11-fld bf-fld \"\n        type=\"text\"\n        \n        \n        \n        placeholder='Placeholder...'\n        \n        \n        \n        \n        name='text-1-11'\n        \n        \n      \/>\n      \n      \n    <\/div>\n    \n        \n            <div class='R1 S1 T1 b1-11-err-wrp bf-err-wrp' style=\"opacity: 0 !important; height: 0px !important;\">\n    <div class='P1 b1-11-err-inner bf-err-inner'>\n      \n        \n        <div   class=\"A1 E1 X1 Y1 Z1 a1 b1 c1 d1 e1 f1 g1 b1-11-err-msg bf-err-msg  Q1 b1-11-err-txt bf-err-txt \" style='display: none !important;'><\/div>\n        \n      \n      <\/div>\n    <\/div>\n      <\/div>\n    <\/div>\n<\/div><div class=\"btcd-fld-itm b1-6 \">\n        <div \n      \n      class=\"Q1 U1 V1 W1 Bf1 Bg1 b1-6-fld-wrp bf-fld-wrp \"\n    >\n            <div \n        \n        class=\"K1 AE1 AI1 b1-6-lbl-wrp bf-lbl-wrp \" \n      >\n              <label \n         \n        class=\"A1 E1 K1 AE1 AF1 AG1 AH1 CN1 b1-6-lbl bf-lbl \"\n        for=\"b1-6-1\">\n        \n        \n        Upload Reports\n        \n              <span \n        \n        class=\"AF1 BE1 CN1 b1-6-req-smbl bf-req-smbl \" \n      >\n        *\n      <\/span>\n      <\/label>\n        \n      <\/div>\n      <div \n        \n        class=\"b1-6-inp-wrp bf-inp-wrp \"\n      > \n            <div \n      \n      class=\"b1-6-file-up-container bf-file-up-container \"\n    >\n      <div\n        \n        class=\"b1-6-file-up-wrpr bf-file-up-wrpr   \"\n      >\n        <div\n          \n          class=\"BU1 BV1 BW1 BX1 BY1 BZ1 Ba1 Bb1 Bc1 CX1 CY1 CZ1 Ca1 Cb1 Cc1 b1-6-file-input-wrpr bf-file-input-wrpr \"\n        >\n          <div\n            \n            class=\"A1 E1 W1 BF1 b1-6-btn-wrpr bf-btn-wrpr \"\n          >\n            <button\n              \n              type=\"button\"\n              class=\"A1 B1 C1 D1 G1 I1 J1 L1 M1 N1 O1 AM1 BF1 BG1 Bh1 CC1 Cd1 b1-6-inp-btn bf-inp-btn \"\n            >\n             <img decoding=\"async\"\n  \n  class=\"BJ1 BK1 BL1 b1-6-pre-i bf-pre-i \"\n  src=\"https:\/\/alfacurecenter.com\/wp-content\/plugins\/bit-form\/assets\/..\/static\/file-upload\/paperclip.svg\"\n  alt=\"\"\n\/>\n              <span\n                \n                class=\"b1-6-btn-txt bf-btn-txt \"\n              >\n                Attach File\n              <\/span>\n              \n            <\/button>\n                  <div\n        \n        class=\"AF1 BC1 CN1 b1-6-file-select-status bf-file-select-status \"\n      >\n        No Choosen File\n      <\/div>\n            \n            <input\n              \n              type=\"file\"\n              class=\"D1 K1 Q1 Ah1 BG1 BH1 BI1 Be1 b1-6-file-upload-input bf-file-upload-input \"\n              id=\"b1-6-1\"\n              name='file-up-1-6[]'\n              required\n              \n              \n              aria-disabled=\"true\"\n              tabindex=\"-1\"\n            \/>\n          <\/div>\n          <div \n            \n            class=\"err-wrp \"\n          ><\/div>\n        <\/div>\n      <\/div>\n    <\/div>\n        \n            <div class='R1 S1 T1 b1-6-err-wrp bf-err-wrp' style=\"opacity: 0 !important; height: 0px !important;\">\n    <div class='P1 b1-6-err-inner bf-err-inner'>\n      \n        \n        <div   class=\"A1 E1 X1 Y1 Z1 a1 b1 c1 d1 e1 f1 g1 b1-6-err-msg bf-err-msg  Q1 b1-6-err-txt bf-err-txt \" style='display: none !important;'><\/div>\n        \n      \n      <\/div>\n    <\/div>\n      <\/div>\n    <\/div>\n<\/div><div class=\"btcd-fld-itm b1-7 \">\n        <div \n      \n      class=\"Q1 U1 V1 W1 b1-7-fld-wrp bf-fld-wrp \"\n    >\n            <div \n        \n        class=\"K1 AE1 AI1 b1-7-lbl-wrp bf-lbl-wrp \" \n      >\n              <label \n         \n        class=\"A1 E1 K1 AE1 AF1 AG1 AH1 CN1 b1-7-lbl bf-lbl \"\n        for=\"b1-7-1\">\n        \n        \n        Are you in medication for a medical?\n        \n        \n      <\/label>\n        \n      <\/div>\n      <div \n        \n        class=\"b1-7-inp-wrp bf-inp-wrp \"\n      > \n              <div\n        \n        class=\"K1 R1 Ad1 Ae1 Af1 b1-7-cc bf-cc \"\n      >\n                  <div \n            \n            class=\"b1-7-cw bf-cw \"\n          >\n            <input\n              \n              id=\"b1-7-1-chk-0\"\n              type=\"radio\"\n              class=\"Ag1 Ah1 Ai1 Aj1 Ak1 Al1 Am1 An1 Ao1 Ap1 Aq1 Ar1 As1 At1 Au1 Av1 Aw1 CP1 CQ1 CR1 CS1 CT1 b1-7-ci bf-ci \"\n              value=\"Yes\"\n              \n              name='radio-1-7'\n              \n              \n            \/>\n            <label\n              \n              data-cl\n              for=\"b1-7-1-chk-0\"\n              class=\"A1 D1 E1 AF1 BB1 CN1 b1-7-cl bf-cl \"\n            >\n              <span\n                \n                data-bx\n                class=\"A1 H1 W1 a1 AJ1 AK1 AL1 AM1 AN1 AO1 AP1 AQ1 AR1 AS1 AT1 AU1 AV1 AW1 AX1 AY1 AZ1 Aa1 Ab1 Ac1 CO1 b1-7-bx bf-bx \"\n              >\n                <svg width=\"12\" height=\"10\" viewBox=\"0 0 12 10\" class=\"b1-7-svgwrp bf-svgwrp \">\n                  <use data-ck-icn href=#b1-7-ck-svg class=\"b1-7-ck-icn bf-ck-icn \" \/>\n                <\/svg>\n              <\/span>\n              <span\n                \n                class=\"AH1 BC1 BD1 b1-7-ct bf-ct \"\n              >\n                Yes\n              <\/span>\n            <\/label>\n          <\/div>          <div \n            \n            class=\"b1-7-cw bf-cw \"\n          >\n            <input\n              \n              id=\"b1-7-1-chk-1\"\n              type=\"radio\"\n              class=\"Ag1 Ah1 Ai1 Aj1 Ak1 Al1 Am1 An1 Ao1 Ap1 Aq1 Ar1 As1 At1 Au1 Av1 Aw1 CP1 CQ1 CR1 CS1 CT1 b1-7-ci bf-ci \"\n              value=\"No\"\n              \n              name='radio-1-7'\n              \n              \n            \/>\n            <label\n              \n              data-cl\n              for=\"b1-7-1-chk-1\"\n              class=\"A1 D1 E1 AF1 BB1 CN1 b1-7-cl bf-cl \"\n            >\n              <span\n                \n                data-bx\n                class=\"A1 H1 W1 a1 AJ1 AK1 AL1 AM1 AN1 AO1 AP1 AQ1 AR1 AS1 AT1 AU1 AV1 AW1 AX1 AY1 AZ1 Aa1 Ab1 Ac1 CO1 b1-7-bx bf-bx \"\n              >\n                <svg width=\"12\" height=\"10\" viewBox=\"0 0 12 10\" class=\"b1-7-svgwrp bf-svgwrp \">\n                  <use data-ck-icn href=#b1-7-ck-svg class=\"b1-7-ck-icn bf-ck-icn \" \/>\n                <\/svg>\n              <\/span>\n              <span\n                \n                class=\"AH1 BC1 BD1 b1-7-ct bf-ct \"\n              >\n                No\n              <\/span>\n            <\/label>\n          <\/div>\n      <\/div>\n        \n            <div class='R1 S1 T1 b1-7-err-wrp bf-err-wrp' style=\"opacity: 0 !important; height: 0px !important;\">\n    <div class='P1 b1-7-err-inner bf-err-inner'>\n      \n        \n        <div   class=\"A1 E1 X1 Y1 Z1 a1 b1 c1 d1 e1 f1 g1 b1-7-err-msg bf-err-msg  Q1 b1-7-err-txt bf-err-txt \" style='display: none !important;'><\/div>\n        \n      \n      <\/div>\n    <\/div>\n      <\/div>\n    <\/div>\n<\/div><div class=\"btcd-fld-itm b1-10 \">\n        <div \n      \n      class=\"Q1 U1 V1 W1 b1-10-fld-wrp bf-fld-wrp \"\n    >\n            <div \n        \n        class=\"K1 AE1 AI1 b1-10-lbl-wrp bf-lbl-wrp \" \n      >\n              <label \n         \n        class=\"A1 E1 K1 AE1 AF1 AG1 AH1 CN1 b1-10-lbl bf-lbl \"\n        for=\"b1-10-1\">\n        \n        \n        medication for a medical if yes\n        \n        \n      <\/label>\n        \n      <\/div>\n      <div \n        \n        class=\"b1-10-inp-wrp bf-inp-wrp \"\n      > \n            <div \n      \n      class=\"W1 b1-10-inp-fld-wrp bf-inp-fld-wrp \"\n    >\n      <input\n        \n        id=\"b1-10-1\"\n        \n        class=\"B1 F1 G1 h1 i1 j1 k1 l1 m1 n1 o1 p1 q1 r1 s1 t1 u1 v1 w1 x1 y1 z1 AA1 AB1 AC1 AD1 CD1 CE1 CF1 CG1 CH1 CI1 CJ1 CK1 CL1 CM1 b1-10-fld bf-fld \"\n        type=\"text\"\n        \n        \n        \n        placeholder='type here'\n        \n        \n        \n        \n        name='text-1-10'\n        \n        \n      \/>\n      \n      \n    <\/div>\n    \n        \n            <div class='R1 S1 T1 b1-10-err-wrp bf-err-wrp' style=\"opacity: 0 !important; height: 0px !important;\">\n    <div class='P1 b1-10-err-inner bf-err-inner'>\n      \n        \n        <div   class=\"A1 E1 X1 Y1 Z1 a1 b1 c1 d1 e1 f1 g1 b1-10-err-msg bf-err-msg  Q1 b1-10-err-txt bf-err-txt \" style='display: none !important;'><\/div>\n        \n      \n      <\/div>\n    <\/div>\n      <\/div>\n    <\/div>\n<\/div><div class=\"btcd-fld-itm b1-12 \">\n        <div \n      \n      class=\"Q1 U1 V1 W1 b1-12-fld-wrp bf-fld-wrp \"\n    >\n            <div \n        \n        class=\"K1 AE1 AI1 b1-12-lbl-wrp bf-lbl-wrp \" \n      >\n              <label \n         \n        class=\"A1 E1 K1 AE1 AF1 AG1 AH1 CN1 b1-12-lbl bf-lbl \"\n        for=\"b1-12-1\">\n        \n        \n        Do you have a chronic disease (high blood pressure, diabetes, heart problems)?\n\n        \n        \n      <\/label>\n        \n      <\/div>\n      <div \n        \n        class=\"b1-12-inp-wrp bf-inp-wrp \"\n      > \n              <div\n        \n        class=\"K1 R1 Ad1 Ae1 Af1 b1-12-cc bf-cc \"\n      >\n                  <div \n            \n            class=\"b1-12-cw bf-cw \"\n          >\n            <input\n              \n              id=\"b1-12-1-chk-0\"\n              type=\"radio\"\n              class=\"Ag1 Ah1 Ai1 Aj1 Ak1 Al1 Am1 An1 Ao1 Ap1 Aq1 Ar1 As1 At1 Au1 Av1 Aw1 CP1 CQ1 CR1 CS1 CT1 b1-12-ci bf-ci \"\n              value=\"Yes\"\n              \n              name='radio-1-12'\n              \n              \n            \/>\n            <label\n              \n              data-cl\n              for=\"b1-12-1-chk-0\"\n              class=\"A1 D1 E1 AF1 BB1 CN1 b1-12-cl bf-cl \"\n            >\n              <span\n                \n                data-bx\n                class=\"A1 H1 W1 a1 AJ1 AK1 AL1 AM1 AN1 AO1 AP1 AQ1 AR1 AS1 AT1 AU1 AV1 AW1 AX1 AY1 AZ1 Aa1 Ab1 Ac1 CO1 b1-12-bx bf-bx \"\n              >\n                <svg width=\"12\" height=\"10\" viewBox=\"0 0 12 10\" class=\"b1-12-svgwrp bf-svgwrp \">\n                  <use data-ck-icn href=#b1-12-ck-svg class=\"b1-12-ck-icn bf-ck-icn \" \/>\n                <\/svg>\n              <\/span>\n              <span\n                \n                class=\"AH1 BC1 BD1 b1-12-ct bf-ct \"\n              >\n                Yes\n              <\/span>\n            <\/label>\n          <\/div>          <div \n            \n            class=\"b1-12-cw bf-cw \"\n          >\n            <input\n              \n              id=\"b1-12-1-chk-1\"\n              type=\"radio\"\n              class=\"Ag1 Ah1 Ai1 Aj1 Ak1 Al1 Am1 An1 Ao1 Ap1 Aq1 Ar1 As1 At1 Au1 Av1 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     \n        name='textarea-b1-3'\n      ><\/textarea>\n      \n      \n    <\/div>\n        \n            <div class='R1 S1 T1 b1-3-err-wrp bf-err-wrp' style=\"opacity: 0 !important; height: 0px !important;\">\n    <div class='P1 b1-3-err-inner bf-err-inner'>\n      \n        \n        <div   class=\"A1 E1 X1 Y1 Z1 a1 b1 c1 d1 e1 f1 g1 b1-3-err-msg bf-err-msg  Q1 b1-3-err-txt bf-err-txt \" style='display: none !important;'><\/div>\n        \n      \n      <\/div>\n    <\/div>\n      <\/div>\n    <\/div>\n<\/div><div class=\"btcd-fld-itm b1-9 \">\n        <div \n      \n      class=\"Q1 U1 V1 W1 b1-9-fld-wrp bf-fld-wrp \"\n    >\n      \n      <div \n        \n        class=\"b1-9-inp-wrp bf-inp-wrp \"\n      > \n              <div\n        \n        class=\"E1 Bl1 b1-9-cc bf-cc \"\n      >\n        <svg class=\"Ah1 Ax1 Ay1 Az1 BA1 b1-9-cks bf-cks\">\n          <symbol id=\"b1-9-ck-svg\" viewBox=\"0 0 12 10\">\n            <polyline\n              class=\"Bp1 b1-9-ck-svgline 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