{"id":63,"date":"2024-06-10T09:52:07","date_gmt":"2024-06-09T23:52:07","guid":{"rendered":"https:\/\/forms.thai-remedial.com.au\/?page_id=63"},"modified":"2024-06-11T18:09:28","modified_gmt":"2024-06-11T08:09:28","slug":"follow-up","status":"publish","type":"page","link":"https:\/\/beta.forms.thai-remedial.com.au\/core\/follow-up\/","title":{"rendered":"Client Follow up Form + SOAP Report"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of 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                      <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/core\/wp-json\/wp\/v2\/pages\/63' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_3_70\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full exclude gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><style>\ncanvas#gfds_signature_25 {\n    border: 1px solid #c6c8cb;\n    margin-bottom: 10px;\n}\n\ninput[type=\"button\"], input[type=\"submit\"] {\n    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!important;\n    --gf-form-gap-y: 20px;\n}\n\nbody {\n    --wp--preset--font-family--body: \"Lato\", sans-serif;\n    font-weight: 300;\n}\n\n.gform-theme--foundation .gform_page_footer {\n    margin-top: 20px !important;\n    justify-content: center;\n}\n@media screen and (min-width:991px){\n.gform-theme--framework .gfield--type-choice .gfield_radio {\n    flex-direction: row;\n}\n}\n@media screen and (max-width:639px) {\n.gform-theme--framework .gfield--type-choice .gfield_radio#input_1_72 {\n    flex-direction: column;\n}\n}\n\n.gform-theme--framework .gfield--type-choice .gfield_radio#input_1_88 {\n    flex-direction: row;\n    flex-wrap: wrap;\n    justify-content: flex-start;\n    align-content: flex-start;}\n\n.separator {\n    padding: 0 !important;\n    border: 0 !important;\n}\n\n.separator>h3 {\n    display:none !important;\n}\n\nlegend.gfield_label.gform-field-label {\n    display: inline;\n}\n\nspan.gfield_required:not(.gfield_required_asterisk) {\n    margin-left: 5px;\n}\n\n.gform-field-label[for=\"input_1_25\"] {\n    display: none;\n}\n.uppercase>div>input {\ntext-transform:uppercase\n}\n@media screen and (max-width:1279px) {\n#field_1_93, #sig-text {\ndisplay:none;\n}\n}\n\n#field_1_53 {\n    margin-top: -10px;\n}\n\n\n#gform_wrapper_3[data-form-index=\"0\"].gform-theme {\n--gf-ctrl-label-color-primary: #716864 !important;\n}\n<\/style><\/div><div id=\"field_3_69\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><table width=\"100%\">\n<tbody>\n<tr>\n<td align=\"left\" width=\"70%\"><h1>Client Follow up Form + SOAP Report<\/h1><\/td>\n<td align=\"right\">\n<p style=\"float:right\">Date: 18\/05\/2026<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div><fieldset id=\"field_3_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Client&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_1'>\n                            \n                            <span id='input_3_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_3_1_3' value=''   aria-required='true'   placeholder='First name' autocomplete=\"given-name\" \/>\n                                                    <label for='input_3_1_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>First name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_3_1_6' value=''   aria-required='true'   placeholder='Last name' autocomplete=\"family-name\" \/>\n                                                    <label for='input_3_1_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Last name<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_102\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_102'>Date of visit<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_102' id='input_3_102' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_3_102_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_3_102_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_3_102' class='gform_hidden' value='https:\/\/beta.forms.thai-remedial.com.au\/core\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_3_18\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_18'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_18' id='input_3_18' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_90\" class=\"gfield gfield--type-section gfield--input-type-section gsection exclude separator field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_3_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_20'>Health fund provider name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_3_20' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='AAMI' >AAMI<\/option><option value='ACA Health Benefits Fund' >ACA Health Benefits Fund<\/option><option value='AHM Health Insurance' >AHM Health Insurance<\/option><option value='AIA Health Insurance' >AIA Health Insurance<\/option><option value='Apia Health Insurance' >Apia Health Insurance<\/option><option value='Australian Defence Force Family Health' >Australian Defence Force Family Health<\/option><option value='Australian Unity Health Ltd' >Australian Unity Health Ltd<\/option><option value='Bupa Australia' >Bupa Australia<\/option><option value='CBHS Corporate Health Limited' >CBHS Corporate Health Limited<\/option><option value='CBHS Health Fund Limited' >CBHS Health Fund Limited<\/option><option value='CUA Health Limited' >CUA Health Limited<\/option><option value='Defence Health Limited' >Defence Health Limited<\/option><option value='Emergency Services Health' >Emergency Services Health<\/option><option value='Frank Health Insurance' >Frank Health Insurance<\/option><option value='GMHBA Limited' >GMHBA Limited<\/option><option value='Grand United Health' >Grand United Health<\/option><option value='HBF Health Limited' >HBF Health Limited<\/option><option value='HCF Health Care Insurance Ltd' >HCF Health Care Insurance Ltd<\/option><option value='Health Insurance Fund of Australia Ltd (HIF)' >Health Insurance Fund of Australia Ltd (HIF)<\/option><option value='Health Partners' >Health Partners<\/option><option value='Hunter Health Insurance' >Hunter Health Insurance<\/option><option value='La Trobe Health Services' >La Trobe Health Services<\/option><option value='Medibank Private Ltd' >Medibank Private Ltd<\/option><option value='Mildura Health Fund' >Mildura Health Fund<\/option><option value='National Health Benefits Australia Pty Ltd (onemedifund)' >National Health Benefits Australia Pty Ltd (onemedifund)<\/option><option value='Navy Health Limited' >Navy Health Limited<\/option><option value='NIB Health Funds Ltd' >NIB Health Funds Ltd<\/option><option value='Nurses &amp; Midwives Health' >Nurses &amp; Midwives Health<\/option><option value='Peoplecare Health Insurance' >Peoplecare Health Insurance<\/option><option value='Phoenix Health Fund Ltd' >Phoenix Health Fund Ltd<\/option><option value='Police Health' >Police Health<\/option><option value='Qantas Assure Health Insurance' >Qantas Assure Health Insurance<\/option><option value='Queensland Country Health Fund Ltd' >Queensland Country Health Fund Ltd<\/option><option value='Railway and Transport Health Fund Ltd' >Railway and Transport Health Fund Ltd<\/option><option value='Reserve Bank Health Society Limited' >Reserve Bank Health Society Limited<\/option><option value='St.LukesHealth, Suncorp' >St.LukesHealth, Suncorp<\/option><option value='Teachers Health Fund' >Teachers Health Fund<\/option><option value='The Doctors\u2019 Health Fund' >The Doctors\u2019 Health Fund<\/option><option value='Transport Health Pty Ltd' >Transport Health Pty Ltd<\/option><option value='TUH' >TUH<\/option><option value='Uni Health' >Uni Health<\/option><option value='Union Health' >Union Health<\/option><option value='Westfund Ltd' >Westfund Ltd<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_3_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_23'>&quot;Other&quot; health fund provider name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_3_23' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_101\" class=\"gfield gfield--type-section gfield--input-type-section gsection exclude separator field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_3_100\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full exclude gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/div><div id=\"field_3_97\" class=\"gfield gfield--type-section gfield--input-type-section gsection exclude separator field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_3_68\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full exclude gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><strong>Possible areas of soreness<\/strong><img decoding=\"async\" id=\"body-image\" src=\"\/core\/wp-content\/uploads\/2024\/06\/Untitled-design.png\" style=\"\/*margin:0 auto;*\/display:block;max-width: 450px;\"><\/div><fieldset id=\"field_3_24\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_2col gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Treatment Area \/ Areas of soreness<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_3_24'>Select area<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_24'><div class='gchoice gchoice_3_24_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.1' type='checkbox'  value='Achilles Tendon'  id='choice_3_24_1'   aria-describedby=\"gfield_description_3_24\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_1' id='label_3_24_1' class='gform-field-label gform-field-label--type-inline'>Achilles Tendon<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.2' type='checkbox'  value='Back Deltoids'  id='choice_3_24_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_2' id='label_3_24_2' class='gform-field-label gform-field-label--type-inline'>Back Deltoids<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.3' type='checkbox'  value='Back Forearms'  id='choice_3_24_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_3' id='label_3_24_3' class='gform-field-label gform-field-label--type-inline'>Back Forearms<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.4' type='checkbox'  value='Back Gastrocnemius'  id='choice_3_24_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_4' id='label_3_24_4' class='gform-field-label gform-field-label--type-inline'>Back Gastrocnemius<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.5' type='checkbox'  value='Back Gluteal Group'  id='choice_3_24_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_5' id='label_3_24_5' class='gform-field-label gform-field-label--type-inline'>Back Gluteal Group<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.6' type='checkbox'  value='Back Hamstrings'  id='choice_3_24_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_6' id='label_3_24_6' class='gform-field-label gform-field-label--type-inline'>Back Hamstrings<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.7' type='checkbox'  value='Back Latissimus Dorsi'  id='choice_3_24_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_7' id='label_3_24_7' class='gform-field-label gform-field-label--type-inline'>Back Latissimus Dorsi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.8' type='checkbox'  value='Back Trapezius'  id='choice_3_24_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_8' id='label_3_24_8' class='gform-field-label gform-field-label--type-inline'>Back Trapezius<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.9' type='checkbox'  value='Back Triceps Brachii'  id='choice_3_24_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_9' id='label_3_24_9' class='gform-field-label gform-field-label--type-inline'>Back Triceps Brachii<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.11' type='checkbox'  value='Biceps Brachii'  id='choice_3_24_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_11' id='label_3_24_11' class='gform-field-label gform-field-label--type-inline'>Biceps Brachii<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.12' type='checkbox'  value='Brachialis'  id='choice_3_24_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_12' id='label_3_24_12' class='gform-field-label gform-field-label--type-inline'>Brachialis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.13' type='checkbox'  value='Brachioradialis'  id='choice_3_24_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_13' id='label_3_24_13' class='gform-field-label gform-field-label--type-inline'>Brachioradialis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.14' type='checkbox'  value='Coracobrachialis'  id='choice_3_24_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_14' id='label_3_24_14' class='gform-field-label gform-field-label--type-inline'>Coracobrachialis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.15' type='checkbox'  value='Deltoid'  id='choice_3_24_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_15' id='label_3_24_15' class='gform-field-label gform-field-label--type-inline'>Deltoid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.16' type='checkbox'  value='Dorsal Interosseous Muscles'  id='choice_3_24_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_16' id='label_3_24_16' class='gform-field-label gform-field-label--type-inline'>Dorsal Interosseous Muscles<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.17' type='checkbox'  value='Erector Spinae'  id='choice_3_24_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_17' id='label_3_24_17' class='gform-field-label gform-field-label--type-inline'>Erector Spinae<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.18' type='checkbox'  value='Flexor Carpi Radialis'  id='choice_3_24_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_18' id='label_3_24_18' class='gform-field-label gform-field-label--type-inline'>Flexor Carpi Radialis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.19' type='checkbox'  value='Front Abdominal Muscles'  id='choice_3_24_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_19' id='label_3_24_19' class='gform-field-label gform-field-label--type-inline'>Front Abdominal Muscles<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.21' type='checkbox'  value='Front Biceps Brachii'  id='choice_3_24_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_21' id='label_3_24_21' class='gform-field-label gform-field-label--type-inline'>Front Biceps Brachii<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.22' type='checkbox'  value='Front Deltoids'  id='choice_3_24_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_22' id='label_3_24_22' class='gform-field-label gform-field-label--type-inline'>Front Deltoids<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.23' type='checkbox'  value='Front Forearms'  id='choice_3_24_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_23' id='label_3_24_23' class='gform-field-label gform-field-label--type-inline'>Front Forearms<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.24' type='checkbox'  value='Front Gastrocnemius'  id='choice_3_24_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_24' id='label_3_24_24' class='gform-field-label gform-field-label--type-inline'>Front Gastrocnemius<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.25' type='checkbox'  value='Front Pectoral Group'  id='choice_3_24_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_25' id='label_3_24_25' class='gform-field-label gform-field-label--type-inline'>Front Pectoral Group<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.26' type='checkbox'  value='Front Quadriceps'  id='choice_3_24_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_26' id='label_3_24_26' class='gform-field-label gform-field-label--type-inline'>Front Quadriceps<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.27' type='checkbox'  value='Front Trapezius'  id='choice_3_24_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_27' id='label_3_24_27' class='gform-field-label gform-field-label--type-inline'>Front Trapezius<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.28' type='checkbox'  value='Gastrocnemius'  id='choice_3_24_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_28' id='label_3_24_28' class='gform-field-label gform-field-label--type-inline'>Gastrocnemius<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.29' type='checkbox'  value='Gluteus Muscle'  id='choice_3_24_29'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_29' id='label_3_24_29' class='gform-field-label gform-field-label--type-inline'>Gluteus Muscle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_31'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.31' type='checkbox'  value='Hamstrings'  id='choice_3_24_31'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_31' id='label_3_24_31' class='gform-field-label gform-field-label--type-inline'>Hamstrings<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_32'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.32' type='checkbox'  value='Infraspinatus'  id='choice_3_24_32'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_32' id='label_3_24_32' class='gform-field-label gform-field-label--type-inline'>Infraspinatus<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_33'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.33' type='checkbox'  value='Latissimus Dorsi'  id='choice_3_24_33'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_33' id='label_3_24_33' class='gform-field-label gform-field-label--type-inline'>Latissimus Dorsi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_34'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.34' type='checkbox'  value='Levator Scapulae'  id='choice_3_24_34'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_34' id='label_3_24_34' class='gform-field-label gform-field-label--type-inline'>Levator Scapulae<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_35'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.35' type='checkbox'  value='Lumbrical Muscle'  id='choice_3_24_35'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_35' id='label_3_24_35' class='gform-field-label gform-field-label--type-inline'>Lumbrical Muscle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_36'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.36' type='checkbox'  value='Masticatory Muscles'  id='choice_3_24_36'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_36' id='label_3_24_36' class='gform-field-label gform-field-label--type-inline'>Masticatory Muscles<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_37'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.37' type='checkbox'  value='Muscles Of Foot'  id='choice_3_24_37'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_37' id='label_3_24_37' class='gform-field-label gform-field-label--type-inline'>Muscles Of Foot<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_38'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.38' type='checkbox'  value='Muscles Of Hip'  id='choice_3_24_38'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_38' id='label_3_24_38' class='gform-field-label gform-field-label--type-inline'>Muscles Of Hip<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_39'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.39' type='checkbox'  value='Muscles Of Leg'  id='choice_3_24_39'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_39' id='label_3_24_39' class='gform-field-label gform-field-label--type-inline'>Muscles Of Leg<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_41'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.41' type='checkbox'  value='Muscles Of Thigh'  id='choice_3_24_41'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_41' id='label_3_24_41' class='gform-field-label gform-field-label--type-inline'>Muscles Of Thigh<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_42'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.42' type='checkbox'  value='Obliquus Abdominis'  id='choice_3_24_42'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_42' id='label_3_24_42' class='gform-field-label gform-field-label--type-inline'>Obliquus Abdominis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_43'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.43' type='checkbox'  value='Occipitalis'  id='choice_3_24_43'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_43' id='label_3_24_43' class='gform-field-label gform-field-label--type-inline'>Occipitalis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_44'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.44' type='checkbox'  value='Pectoralis Major'  id='choice_3_24_44'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_44' id='label_3_24_44' class='gform-field-label gform-field-label--type-inline'>Pectoralis Major<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_45'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.45' type='checkbox'  value='Pectoralis Minor'  id='choice_3_24_45'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_45' id='label_3_24_45' class='gform-field-label gform-field-label--type-inline'>Pectoralis Minor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_46'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.46' type='checkbox'  value='Piriformis'  id='choice_3_24_46'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_46' id='label_3_24_46' class='gform-field-label gform-field-label--type-inline'>Piriformis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_47'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.47' type='checkbox'  value='Plantar Interosseous Muscles'  id='choice_3_24_47'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_47' id='label_3_24_47' class='gform-field-label gform-field-label--type-inline'>Plantar Interosseous Muscles<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_48'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.48' type='checkbox'  value='Plantaris'  id='choice_3_24_48'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_48' id='label_3_24_48' class='gform-field-label gform-field-label--type-inline'>Plantaris<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_49'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.49' type='checkbox'  value='Popliteus'  id='choice_3_24_49'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_49' id='label_3_24_49' class='gform-field-label gform-field-label--type-inline'>Popliteus<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_51'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.51' type='checkbox'  value='Quadratus Femoris'  id='choice_3_24_51'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_51' id='label_3_24_51' class='gform-field-label gform-field-label--type-inline'>Quadratus Femoris<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_52'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.52' type='checkbox'  value='Quadratus Lumborum'  id='choice_3_24_52'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_52' id='label_3_24_52' class='gform-field-label gform-field-label--type-inline'>Quadratus Lumborum<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_53'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.53' type='checkbox'  value='Quadriceps Femoris'  id='choice_3_24_53'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_53' id='label_3_24_53' class='gform-field-label gform-field-label--type-inline'>Quadriceps Femoris<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_54'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.54' type='checkbox'  value='Rectus Abdominis'  id='choice_3_24_54'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_54' id='label_3_24_54' class='gform-field-label gform-field-label--type-inline'>Rectus Abdominis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_55'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.55' type='checkbox'  value='Rectus Femoris'  id='choice_3_24_55'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_55' id='label_3_24_55' class='gform-field-label gform-field-label--type-inline'>Rectus Femoris<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_56'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.56' type='checkbox'  value='Rhomboideus Major\/Minor'  id='choice_3_24_56'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_56' id='label_3_24_56' class='gform-field-label gform-field-label--type-inline'>Rhomboideus Major\/Minor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_57'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.57' type='checkbox'  value='Sartorius'  id='choice_3_24_57'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_57' id='label_3_24_57' class='gform-field-label gform-field-label--type-inline'>Sartorius<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_58'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.58' type='checkbox'  value='Serratus'  id='choice_3_24_58'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_58' id='label_3_24_58' class='gform-field-label gform-field-label--type-inline'>Serratus<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_59'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.59' type='checkbox'  value='Soleus'  id='choice_3_24_59'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_59' id='label_3_24_59' class='gform-field-label gform-field-label--type-inline'>Soleus<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_61'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.61' type='checkbox'  value='Sternocleidomastoid'  id='choice_3_24_61'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_61' id='label_3_24_61' class='gform-field-label gform-field-label--type-inline'>Sternocleidomastoid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_62'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.62' type='checkbox'  value='Subscapularis'  id='choice_3_24_62'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_62' id='label_3_24_62' class='gform-field-label gform-field-label--type-inline'>Subscapularis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_63'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.63' type='checkbox'  value='Supraspinatus'  id='choice_3_24_63'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_63' id='label_3_24_63' class='gform-field-label gform-field-label--type-inline'>Supraspinatus<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_64'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.64' type='checkbox'  value='Teres Major\/ Minor'  id='choice_3_24_64'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_64' id='label_3_24_64' class='gform-field-label gform-field-label--type-inline'>Teres Major\/ Minor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_24_65'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.65' type='checkbox'  value='Triceps Brachii'  id='choice_3_24_65'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_24_65' id='label_3_24_65' class='gform-field-label gform-field-label--type-inline'>Triceps Brachii<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_99\" class=\"gfield gfield--type-section gfield--input-type-section gsection exclude separator field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_3_43\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_2col gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Massage Technique<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_43'><div class='gchoice gchoice_3_43_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.1' type='checkbox'  value='Articulations Of Joint'  id='choice_3_43_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_1' id='label_3_43_1' class='gform-field-label gform-field-label--type-inline'>Articulations Of Joint<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.2' type='checkbox'  value='Compression'  id='choice_3_43_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_2' id='label_3_43_2' class='gform-field-label gform-field-label--type-inline'>Compression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.3' type='checkbox'  value='Conduction (Heat Packs)'  id='choice_3_43_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_3' id='label_3_43_3' class='gform-field-label gform-field-label--type-inline'>Conduction (Heat Packs)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.4' type='checkbox'  value='Cross Fiber Friction'  id='choice_3_43_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_4' id='label_3_43_4' class='gform-field-label gform-field-label--type-inline'>Cross Fiber Friction<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.5' type='checkbox'  value='Deep Gliding Friction'  id='choice_3_43_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_5' id='label_3_43_5' class='gform-field-label gform-field-label--type-inline'>Deep Gliding Friction<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.6' type='checkbox'  value='Deep Tissue Massage Techniques'  id='choice_3_43_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_6' id='label_3_43_6' class='gform-field-label gform-field-label--type-inline'>Deep Tissue Massage Techniques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.7' type='checkbox'  value='Deep Transverse Friction'  id='choice_3_43_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_7' id='label_3_43_7' class='gform-field-label gform-field-label--type-inline'>Deep Transverse Friction<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.8' type='checkbox'  value='Dry Needling'  id='choice_3_43_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_8' id='label_3_43_8' class='gform-field-label gform-field-label--type-inline'>Dry Needling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.9' type='checkbox'  value='Friction Techniques'  id='choice_3_43_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_9' id='label_3_43_9' class='gform-field-label gform-field-label--type-inline'>Friction Techniques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.11' type='checkbox'  value='Gliding Techniques'  id='choice_3_43_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_11' id='label_3_43_11' class='gform-field-label gform-field-label--type-inline'>Gliding Techniques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.12' type='checkbox'  value='Leading'  id='choice_3_43_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_12' id='label_3_43_12' class='gform-field-label gform-field-label--type-inline'>Leading<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.13' type='checkbox'  value='Manual Lymphatic Drainage'  id='choice_3_43_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_13' id='label_3_43_13' class='gform-field-label gform-field-label--type-inline'>Manual Lymphatic Drainage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.14' type='checkbox'  value='Myofascial Releasing Techniques'  id='choice_3_43_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_14' id='label_3_43_14' class='gform-field-label gform-field-label--type-inline'>Myofascial Releasing Techniques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.15' type='checkbox'  value='Myofascial Tension Technique'  id='choice_3_43_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_15' id='label_3_43_15' class='gform-field-label gform-field-label--type-inline'>Myofascial Tension Technique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.16' type='checkbox'  value='Passive Joint Movement Techniques'  id='choice_3_43_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_16' id='label_3_43_16' class='gform-field-label gform-field-label--type-inline'>Passive Joint Movement Techniques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.17' type='checkbox'  value='Passive Soft Tissue Movement'  id='choice_3_43_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_17' id='label_3_43_17' class='gform-field-label gform-field-label--type-inline'>Passive Soft Tissue Movement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.18' type='checkbox'  value='Percussion'  id='choice_3_43_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_18' id='label_3_43_18' class='gform-field-label gform-field-label--type-inline'>Percussion<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.19' type='checkbox'  value='Petrissage'  id='choice_3_43_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_19' id='label_3_43_19' class='gform-field-label gform-field-label--type-inline'>Petrissage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.21' type='checkbox'  value='Radiation'  id='choice_3_43_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_21' id='label_3_43_21' class='gform-field-label gform-field-label--type-inline'>Radiation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.22' type='checkbox'  value='Soft Tissue Release'  id='choice_3_43_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_22' id='label_3_43_22' class='gform-field-label gform-field-label--type-inline'>Soft Tissue Release<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.23' type='checkbox'  value='Stretching Techniques'  id='choice_3_43_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_23' id='label_3_43_23' class='gform-field-label gform-field-label--type-inline'>Stretching Techniques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.24' type='checkbox'  value='Swedish'  id='choice_3_43_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_24' id='label_3_43_24' class='gform-field-label gform-field-label--type-inline'>Swedish<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.25' type='checkbox'  value='Topical Applications'  id='choice_3_43_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_25' id='label_3_43_25' class='gform-field-label gform-field-label--type-inline'>Topical Applications<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.26' type='checkbox'  value='Trigger Point Release Techniques'  id='choice_3_43_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_26' id='label_3_43_26' class='gform-field-label gform-field-label--type-inline'>Trigger Point Release Techniques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_43_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.27' type='checkbox'  value='Trigger Point Therapy'  id='choice_3_43_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_43_27' id='label_3_43_27' class='gform-field-label gform-field-label--type-inline'>Trigger Point Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Duration<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_80'>\n\t\t\t<div class='gchoice gchoice_3_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='30\u00a0min'  id='choice_3_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_80_0' id='label_3_80_0' class='gform-field-label gform-field-label--type-inline'>30\u00a0min<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='45\u00a0min'  id='choice_3_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_80_1' id='label_3_80_1' class='gform-field-label gform-field-label--type-inline'>45\u00a0min<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_80_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='60\u00a0min'  id='choice_3_80_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_80_2' id='label_3_80_2' class='gform-field-label gform-field-label--type-inline'>60\u00a0min<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_80_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='90\u00a0min'  id='choice_3_80_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_80_3' id='label_3_80_3' class='gform-field-label gform-field-label--type-inline'>90\u00a0min<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_80_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='120\u00a0min'  id='choice_3_80_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_80_4' id='label_3_80_4' class='gform-field-label gform-field-label--type-inline'>120\u00a0min<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_104\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Client&#039;s Feedback<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_104'><div class='gchoice gchoice_3_104_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.1' type='checkbox'  value='Alleviate Low - Back Pain And Improve Range Of Muscle'  id='choice_3_104_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_1' id='label_3_104_1' class='gform-field-label gform-field-label--type-inline'>Alleviate Low &#8211; Back Pain And Improve Range Of Muscle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.2' type='checkbox'  value='Blood Supply Stimulation'  id='choice_3_104_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_2' id='label_3_104_2' class='gform-field-label gform-field-label--type-inline'>Blood Supply Stimulation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.3' type='checkbox'  value='Body Rebalancing'  id='choice_3_104_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_3' id='label_3_104_3' class='gform-field-label gform-field-label--type-inline'>Body Rebalancing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.4' type='checkbox'  value='Calming Of The Peripheral Nerves'  id='choice_3_104_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_4' id='label_3_104_4' class='gform-field-label gform-field-label--type-inline'>Calming Of The Peripheral Nerves<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.5' type='checkbox'  value='Improve Flexibility And Muscle Condition'  id='choice_3_104_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_5' id='label_3_104_5' class='gform-field-label gform-field-label--type-inline'>Improve Flexibility And Muscle Condition<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.6' type='checkbox'  value='Increase Joint Flexibility'  id='choice_3_104_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_6' id='label_3_104_6' class='gform-field-label gform-field-label--type-inline'>Increase Joint Flexibility<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.7' type='checkbox'  value='Joint Mobility'  id='choice_3_104_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_7' id='label_3_104_7' class='gform-field-label gform-field-label--type-inline'>Joint Mobility<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.8' type='checkbox'  value='Lessen Depression And Anxiety'  id='choice_3_104_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_8' id='label_3_104_8' class='gform-field-label gform-field-label--type-inline'>Lessen Depression And Anxiety<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.9' type='checkbox'  value='Muscle Not As Tight As Before'  id='choice_3_104_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_9' id='label_3_104_9' class='gform-field-label gform-field-label--type-inline'>Muscle Not As Tight As Before<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.11' type='checkbox'  value='Muscle Strengthening'  id='choice_3_104_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_11' id='label_3_104_11' class='gform-field-label gform-field-label--type-inline'>Muscle Strengthening<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.12' type='checkbox'  value='Pain Reduction'  id='choice_3_104_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_12' id='label_3_104_12' class='gform-field-label gform-field-label--type-inline'>Pain Reduction<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.13' type='checkbox'  value='Reduce Pain And Swelling'  id='choice_3_104_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_13' id='label_3_104_13' class='gform-field-label gform-field-label--type-inline'>Reduce Pain And Swelling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.14' type='checkbox'  value='Reduce Spasms And Cramping'  id='choice_3_104_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_14' id='label_3_104_14' class='gform-field-label gform-field-label--type-inline'>Reduce Spasms And Cramping<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.15' type='checkbox'  value='Relax And Soften Injured, Tired, And Overused'  id='choice_3_104_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_15' id='label_3_104_15' class='gform-field-label gform-field-label--type-inline'>Relax And Soften Injured, Tired, And Overused<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.16' type='checkbox'  value='Relaxation Skin Nourishment'  id='choice_3_104_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_16' id='label_3_104_16' class='gform-field-label gform-field-label--type-inline'>Relaxation Skin Nourishment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.17' type='checkbox'  value='Relieve Migraine Pain'  id='choice_3_104_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_17' id='label_3_104_17' class='gform-field-label gform-field-label--type-inline'>Relieve Migraine Pain<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.18' type='checkbox'  value='Remove Stiffness'  id='choice_3_104_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_18' id='label_3_104_18' class='gform-field-label gform-field-label--type-inline'>Remove Stiffness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.19' type='checkbox'  value='Swelling Reduction'  id='choice_3_104_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_19' id='label_3_104_19' class='gform-field-label gform-field-label--type-inline'>Swelling Reduction<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_104_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.21' type='checkbox'  value='Toxin Cleaning'  id='choice_3_104_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_104_21' id='label_3_104_21' class='gform-field-label gform-field-label--type-inline'>Toxin Cleaning<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_105\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-seven-twelfths field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_105'>Recommendations<\/label><div class='ginput_container ginput_container_text'><input name='input_105' id='input_3_105' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_103\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-seven-twelfths gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_103'>Therapist&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_3_103'>Practitioner<\/div><div class='ginput_container ginput_container_select'><select name='input_103' id='input_3_103' class='large gfield_select'  aria-describedby=\"gfield_description_3_103\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select name<\/option><option value='Anong Poopanrat' >Anong Poopanrat<\/option><option value='Napharat Prasarnsub' >Napharat Prasarnsub<\/option><\/select><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='SUBMIT'  \/> \n            <input type='hidden' class='gform_hidden' 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