{"id":1033,"date":"2026-02-20T19:54:56","date_gmt":"2026-02-20T11:54:56","guid":{"rendered":"https:\/\/sunshinesurrogacy.wpsite.tw\/?page_id=1033"},"modified":"2026-03-01T13:44:51","modified_gmt":"2026-03-01T05:44:51","slug":"surrogate-application-process","status":"publish","type":"page","link":"https:\/\/sunshinesurrogacy.wpsite.tw\/jp\/surrogate-application-process\/","title":{"rendered":"Surrogate Application Process"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1033\" class=\"elementor elementor-1033\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e2ef814 e-flex e-con-boxed e-con e-parent\" data-id=\"e2ef814\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;shape_divider_bottom&quot;:&quot;waves&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-shape elementor-shape-bottom\" aria-hidden=\"true\" data-negative=\"false\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 1000 100\" preserveAspectRatio=\"none\">\n\t<path class=\"elementor-shape-fill\" d=\"M421.9,6.5c22.6-2.5,51.5,0.4,75.5,5.3c23.6,4.9,70.9,23.5,100.5,35.7c75.8,32.2,133.7,44.5,192.6,49.7\n\tc23.6,2.1,48.7,3.5,103.4-2.5c54.7-6,106.2-25.6,106.2-25.6V0H0v30.3c0,0,72,32.6,158.4,30.5c39.2-0.7,92.8-6.7,134-22.4\n\tc21.2-8.1,52.2-18.2,79.7-24.2C399.3,7.9,411.6,7.5,421.9,6.5z\"\/>\n<\/svg>\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-65662f8 elementor-widget elementor-widget-heading\" data-id=\"65662f8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Surrogate Application<\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8aca3ae e-flex e-con-boxed e-con e-parent\" data-id=\"8aca3ae\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-82580f9 e-con-full e-flex e-con e-child\" data-id=\"82580f9\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8921a76 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"8921a76\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;\\u4e0b\\u4e00\\u7bc7&quot;,&quot;step_previous_label&quot;:&quot;\\u4e0a\\u4e00\\u7bc7&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"\u65b0\u8868\u55ae\" aria-label=\"\u65b0\u8868\u55ae\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1033\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"8921a76\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\tPersonal information\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_56db88e elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_56db88e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName (First, Middle, Last):\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_56db88e]\" id=\"form-field-field_56db88e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ccdd277 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ccdd277\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPrimary Race:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ccdd277]\" id=\"form-field-field_ccdd277\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_a02a598 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a02a598\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_a02a598]\" id=\"form-field-field_a02a598\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_75c8ff7 elementor-col-100\">\n\t\t\t\t\tAddress\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3148e79 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3148e79\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStreet Address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3148e79]\" id=\"form-field-field_3148e79\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_de9b3f4 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_de9b3f4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStreet Address Line 2\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_de9b3f4]\" id=\"form-field-field_de9b3f4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_dcdcb7f elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_dcdcb7f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_dcdcb7f]\" id=\"form-field-field_dcdcb7f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_acdf862 elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_acdf862\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tState\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_acdf862]\" id=\"form-field-field_acdf862\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5674350 elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5674350\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tZip Code\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_5674350]\" id=\"form-field-field_5674350\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1a94384 elementor-col-100\">\n\t\t\t\t\tContact information\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_6bbe31a elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6bbe31a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_6bbe31a]\" id=\"form-field-field_6bbe31a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1defdd1 elementor-col-100\">\n\t\t\t\t\tOthers\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4688715 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4688715\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHeight\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4688715]\" id=\"form-field-field_4688715\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_393acbe elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_393acbe\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWeight\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_393acbe]\" id=\"form-field-field_393acbe\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_453cc8e elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_453cc8e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBMI\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_453cc8e]\" id=\"form-field-field_453cc8e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d728e3d elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d728e3d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOccupation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d728e3d]\" id=\"form-field-field_d728e3d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_db51d03 elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_db51d03\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCurrent Relationship Status\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_db51d03]\" id=\"form-field-field_db51d03\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_f26bb19 elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f26bb19\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow many years have you been together?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_f26bb19]\" id=\"form-field-field_f26bb19\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_e7c43c4 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e7c43c4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName of partner\/spouse(First, Middle, Last)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_e7c43c4]\" id=\"form-field-field_e7c43c4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_1ec8267 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1ec8267\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your level of education?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_1ec8267]\" id=\"form-field-field_1ec8267\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2199c4a elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2199c4a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have any religious or spiritual views?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_2199c4a]\" id=\"form-field-field_2199c4a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_052f344 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_052f344\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you able to attend all local appointments? *\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_052f344-0\" name=\"form_fields[field_052f344]\" required=\"required\"> <label for=\"form-field-field_052f344-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_052f344-1\" name=\"form_fields[field_052f344]\" required=\"required\"> <label for=\"form-field-field_052f344-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_0b8ac43 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0b8ac43\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you actively parenting at least one of your own children?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_0b8ac43-0\" name=\"form_fields[field_0b8ac43]\" required=\"required\"> <label for=\"form-field-field_0b8ac43-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_0b8ac43-1\" name=\"form_fields[field_0b8ac43]\" required=\"required\"> <label for=\"form-field-field_0b8ac43-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_9e19b36 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9e19b36\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your main source of income? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_9e19b36]\" id=\"form-field-field_9e19b36\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f6ce672 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f6ce672\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow soon would you like to begin your Surrogacy journey?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Right away\" id=\"form-field-field_f6ce672-0\" name=\"form_fields[field_f6ce672]\" required=\"required\"> <label for=\"form-field-field_f6ce672-0\">Right away<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"6 months\" id=\"form-field-field_f6ce672-1\" name=\"form_fields[field_f6ce672]\" required=\"required\"> <label for=\"form-field-field_f6ce672-1\">6 months<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"1 year\" id=\"form-field-field_f6ce672-2\" name=\"form_fields[field_f6ce672]\" required=\"required\"> <label for=\"form-field-field_f6ce672-2\">1 year<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_aed3212 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_aed3212\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever applied to any other agencies as a surrogate or egg donor? (if yes what agency?) *\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_aed3212-0\" name=\"form_fields[field_aed3212]\" required=\"required\"> <label for=\"form-field-field_aed3212-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_aed3212-1\" name=\"form_fields[field_aed3212]\" required=\"required\"> <label for=\"form-field-field_aed3212-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_6e4d118 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6e4d118\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre there any other people residing in your home other than your children? or your partner?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_6e4d118-0\" name=\"form_fields[field_6e4d118]\" required=\"required\"> <label for=\"form-field-field_6e4d118-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_6e4d118-1\" name=\"form_fields[field_6e4d118]\" required=\"required\"> <label for=\"form-field-field_6e4d118-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_427167e elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_427167e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you able to travel out of state for 2-3 days? If travel expenses including childcare and lost wages are reimbursed?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_427167e-0\" name=\"form_fields[field_427167e]\" required=\"required\"> <label for=\"form-field-field_427167e-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_427167e-1\" name=\"form_fields[field_427167e]\" required=\"required\"> <label for=\"form-field-field_427167e-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bbdf08f elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bbdf08f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have an existing health insurance policy?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_bbdf08f-0\" name=\"form_fields[field_bbdf08f]\" required=\"required\"> <label for=\"form-field-field_bbdf08f-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_bbdf08f-1\" name=\"form_fields[field_bbdf08f]\" required=\"required\"> <label for=\"form-field-field_bbdf08f-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_093121b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_093121b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, who is your insurance provider?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_093121b]\" id=\"form-field-field_093121b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_eb508f1 elementor-col-100\">\n\t\t\t\t\tBackground\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_61dd35d elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_61dd35d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you drink alcoholic beverages?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_61dd35d-0\" name=\"form_fields[field_61dd35d]\" required=\"required\"> <label for=\"form-field-field_61dd35d-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_61dd35d-1\" name=\"form_fields[field_61dd35d]\" required=\"required\"> <label for=\"form-field-field_61dd35d-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_76d3d04 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_76d3d04\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf so how often?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_76d3d04]\" id=\"form-field-field_76d3d04\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Are you able to attend all local appointments? *\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_70d26e0 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_70d26e0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you or your partner ever been investigated by governmental child protective agency?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_70d26e0-0\" name=\"form_fields[field_70d26e0]\" required=\"required\"> <label for=\"form-field-field_70d26e0-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_70d26e0-1\" name=\"form_fields[field_70d26e0]\" required=\"required\"> <label for=\"form-field-field_70d26e0-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_2a876e4 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2a876e4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you or your partner currently have any legal cases or claims pending?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_2a876e4-0\" name=\"form_fields[field_2a876e4]\" required=\"required\"> <label for=\"form-field-field_2a876e4-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_2a876e4-1\" name=\"form_fields[field_2a876e4]\" required=\"required\"> <label for=\"form-field-field_2a876e4-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_e8ccfe1 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e8ccfe1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf Yes, please explain\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_e8ccfe1]\" id=\"form-field-field_e8ccfe1\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e8633c7 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e8633c7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you or your partner ever been involved in any lawsuit?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_e8633c7-0\" name=\"form_fields[field_e8633c7]\" required=\"required\"> <label for=\"form-field-field_e8633c7-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_e8633c7-1\" name=\"form_fields[field_e8633c7]\" required=\"required\"> <label for=\"form-field-field_e8633c7-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_9c24496 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9c24496\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf Yes, please explain\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_9c24496]\" id=\"form-field-field_9c24496\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_6df21d6 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6df21d6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever used illicit drugs (marijuana, cocaine, methamphetamines)?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_6df21d6-0\" name=\"form_fields[field_6df21d6]\" required=\"required\"> <label for=\"form-field-field_6df21d6-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_6df21d6-1\" name=\"form_fields[field_6df21d6]\" required=\"required\"> <label for=\"form-field-field_6df21d6-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_cb76a48 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cb76a48\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you exposed to any second-hand smoke at home or at work?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_cb76a48-0\" name=\"form_fields[field_cb76a48]\" required=\"required\"> <label for=\"form-field-field_cb76a48-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_cb76a48-1\" name=\"form_fields[field_cb76a48]\" required=\"required\"> <label for=\"form-field-field_cb76a48-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f220112 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f220112\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you or your partner ever been arrested? (including DUI arrests)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_f220112-0\" name=\"form_fields[field_f220112]\" required=\"required\"> <label for=\"form-field-field_f220112-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_f220112-1\" name=\"form_fields[field_f220112]\" required=\"required\"> <label for=\"form-field-field_f220112-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_aa67126 elementor-col-100\">\n\t\t\t\t\tMedical\/Reproductive History\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f55cfab elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f55cfab\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever been a surrogate or egg donor before? *\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_f55cfab-0\" name=\"form_fields[field_f55cfab]\" required=\"required\"> <label for=\"form-field-field_f55cfab-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_f55cfab-1\" name=\"form_fields[field_f55cfab]\" required=\"required\"> <label for=\"form-field-field_f55cfab-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_a943e1d elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a943e1d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tUnder what circumstances would you consider termination of pregnancy? (I.E. medical advisement, selective reduction, sever abnormalities?) \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_a943e1d]\" id=\"form-field-field_a943e1d\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_89f09b3 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_89f09b3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow many babies are you willing to carry during this surrogacy journey?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_89f09b3]\" id=\"form-field-field_89f09b3\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_0247134 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0247134\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow many biological children do you have?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_0247134]\" id=\"form-field-field_0247134\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_1ba0909 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1ba0909\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre all of your children living with you currently?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_1ba0909-0\" name=\"form_fields[field_1ba0909]\"> <label for=\"form-field-field_1ba0909-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_1ba0909-1\" name=\"form_fields[field_1ba0909]\"> <label for=\"form-field-field_1ba0909-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_056385a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_056385a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have legal custody of your children?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_056385a-0\" name=\"form_fields[field_056385a]\"> <label for=\"form-field-field_056385a-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_056385a-1\" name=\"form_fields[field_056385a]\"> <label for=\"form-field-field_056385a-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_7b39c2e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7b39c2e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you plan on having more children of your own?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_7b39c2e-0\" name=\"form_fields[field_7b39c2e]\"> <label for=\"form-field-field_7b39c2e-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_7b39c2e-1\" name=\"form_fields[field_7b39c2e]\"> <label for=\"form-field-field_7b39c2e-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_240a786 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_240a786\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your current birth control method?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_240a786]\" id=\"form-field-field_240a786\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_847add5 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_847add5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have a regular menstrual cycle?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_847add5-0\" name=\"form_fields[field_847add5]\" required=\"required\"> <label for=\"form-field-field_847add5-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_847add5-1\" name=\"form_fields[field_847add5]\" required=\"required\"> <label for=\"form-field-field_847add5-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_27f6e06 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_27f6e06\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you have any past or current medical issues? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_27f6e06-0\" name=\"form_fields[field_27f6e06]\" required=\"required\"> <label for=\"form-field-field_27f6e06-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_27f6e06-1\" name=\"form_fields[field_27f6e06]\" required=\"required\"> <label for=\"form-field-field_27f6e06-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_7857c5b elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7857c5b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you allergic to any medication?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_7857c5b-0\" name=\"form_fields[field_7857c5b]\" required=\"required\"> <label for=\"form-field-field_7857c5b-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_7857c5b-1\" name=\"form_fields[field_7857c5b]\" required=\"required\"> <label for=\"form-field-field_7857c5b-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_6c293fd elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6c293fd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever been prescribed any medications in the last 5 years?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_6c293fd-0\" name=\"form_fields[field_6c293fd]\" required=\"required\"> <label for=\"form-field-field_6c293fd-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_6c293fd-1\" name=\"form_fields[field_6c293fd]\" required=\"required\"> <label for=\"form-field-field_6c293fd-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_43473d9 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_43473d9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you had any surgeries?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_43473d9-0\" name=\"form_fields[field_43473d9]\" required=\"required\"> <label for=\"form-field-field_43473d9-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_43473d9-1\" name=\"form_fields[field_43473d9]\" required=\"required\"> <label for=\"form-field-field_43473d9-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_e240ddd elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e240ddd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever been diagnosed with :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"TB\/exposed to TB\" id=\"form-field-field_e240ddd-0\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-0\">TB\/exposed to TB<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Cancer\" id=\"form-field-field_e240ddd-1\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-1\">Cancer<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Irregular Heartbeat\" id=\"form-field-field_e240ddd-2\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-2\">Irregular Heartbeat<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Heart Problems\/Congenital Heart defect\" id=\"form-field-field_e240ddd-3\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-3\">Heart Problems\/Congenital Heart defect<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Head Injuries\" id=\"form-field-field_e240ddd-4\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-4\">Head Injuries<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Thyroid\" id=\"form-field-field_e240ddd-5\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-5\">Thyroid<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Problems\" id=\"form-field-field_e240ddd-6\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-6\">Problems<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Seizures\" id=\"form-field-field_e240ddd-7\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-7\">Seizures<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Anemia\" id=\"form-field-field_e240ddd-8\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-8\">Anemia<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Genital Warts Chlamydia Gonorrhea\" id=\"form-field-field_e240ddd-9\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-9\">Genital Warts Chlamydia Gonorrhea<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Genital Herpes\" id=\"form-field-field_e240ddd-10\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-10\">Genital Herpes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Have you ever been diagnosed with Syphilis?\" id=\"form-field-field_e240ddd-11\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-11\">Have you ever been diagnosed with Syphilis?<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"HIV\" id=\"form-field-field_e240ddd-12\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-12\">HIV<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Hepatitis B Hepatitis C\" id=\"form-field-field_e240ddd-13\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-13\">Hepatitis B Hepatitis C<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ovarian Cysts\" id=\"form-field-field_e240ddd-14\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-14\">Ovarian Cysts<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"HPV\" id=\"form-field-field_e240ddd-15\" name=\"form_fields[field_e240ddd][]\"> <label for=\"form-field-field_e240ddd-15\">HPV<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_c4662e2 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c4662e2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever had any miscarriages? This excludes any chemical pregnancies (where the heartbeat was never detected) \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_c4662e2-0\" name=\"form_fields[field_c4662e2]\" required=\"required\"> <label for=\"form-field-field_c4662e2-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_c4662e2-1\" name=\"form_fields[field_c4662e2]\" required=\"required\"> <label for=\"form-field-field_c4662e2-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_705360d elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_705360d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you had any abortions?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_705360d-0\" name=\"form_fields[field_705360d]\" required=\"required\"> <label for=\"form-field-field_705360d-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_705360d-1\" name=\"form_fields[field_705360d]\" required=\"required\"> <label for=\"form-field-field_705360d-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b5ea5fe elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b5ea5fe\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you been vaccinated for covid-19?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_b5ea5fe-0\" name=\"form_fields[field_b5ea5fe]\" required=\"required\"> <label for=\"form-field-field_b5ea5fe-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_b5ea5fe-1\" name=\"form_fields[field_b5ea5fe]\" required=\"required\"> <label for=\"form-field-field_b5ea5fe-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1d97587 elementor-col-100\">\n\t\t\t\t\tPregnancy #1\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_af2375e elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_af2375e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWas this pregnancy for yourself or a surrogacy journey?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Myself\" id=\"form-field-field_af2375e-0\" name=\"form_fields[field_af2375e]\" required=\"required\"> <label for=\"form-field-field_af2375e-0\">Myself<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Surrogacy journey\" id=\"form-field-field_af2375e-1\" name=\"form_fields[field_af2375e]\" required=\"required\"> <label for=\"form-field-field_af2375e-1\">Surrogacy journey<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_e2f39b0 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e2f39b0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of delivery\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_e2f39b0]\" id=\"form-field-field_e2f39b0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ea7c807 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ea7c807\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWeeks of gestation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ea7c807]\" id=\"form-field-field_ea7c807\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_1819543 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1819543\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAny complications?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_1819543-0\" name=\"form_fields[field_1819543]\"> <label for=\"form-field-field_1819543-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_1819543-1\" name=\"form_fields[field_1819543]\"> <label for=\"form-field-field_1819543-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_f355a1c elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f355a1c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNumber of babies delivered?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_f355a1c]\" id=\"form-field-field_f355a1c\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_69ada8a elementor-col-100\">\n\t\t\t\t\tPregnancy #2\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_3fb7ebd elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3fb7ebd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWas this pregnancy for yourself or a surrogacy journey?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Myself\" id=\"form-field-field_3fb7ebd-0\" name=\"form_fields[field_3fb7ebd]\"> <label for=\"form-field-field_3fb7ebd-0\">Myself<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Surrogacy journey\" id=\"form-field-field_3fb7ebd-1\" name=\"form_fields[field_3fb7ebd]\"> <label for=\"form-field-field_3fb7ebd-1\">Surrogacy journey<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c6b627f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c6b627f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of delivery\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_c6b627f]\" id=\"form-field-field_c6b627f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0cb11d9 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0cb11d9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWeeks of gestation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0cb11d9]\" id=\"form-field-field_0cb11d9\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_581db05 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_581db05\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAny complications?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_581db05-0\" name=\"form_fields[field_581db05]\"> <label for=\"form-field-field_581db05-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_581db05-1\" name=\"form_fields[field_581db05]\"> <label for=\"form-field-field_581db05-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_402b2e1 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_402b2e1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNumber of babies delivered?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_402b2e1]\" id=\"form-field-field_402b2e1\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_4dfd94b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4dfd94b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVaginal or C-section?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_4dfd94b-0\" name=\"form_fields[field_4dfd94b]\"> <label for=\"form-field-field_4dfd94b-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_4dfd94b-1\" name=\"form_fields[field_4dfd94b]\"> <label for=\"form-field-field_4dfd94b-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b39a6dc elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b39a6dc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tChilds Birth Weight\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b39a6dc]\" id=\"form-field-field_b39a6dc\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b3e5963 elementor-col-100\">\n\t\t\t\t\tPsychological History\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_5ed10b5 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5ed10b5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you or your partner if applicable ever had psychological counseling?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_5ed10b5-0\" name=\"form_fields[field_5ed10b5]\" required=\"required\"> <label for=\"form-field-field_5ed10b5-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_5ed10b5-1\" name=\"form_fields[field_5ed10b5]\" required=\"required\"> <label for=\"form-field-field_5ed10b5-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_8b79540 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8b79540\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever been prescribed any psychiatric medications? (including anti-depressants and anti-anxiety medications) *\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_8b79540-0\" name=\"form_fields[field_8b79540]\" required=\"required\"> <label for=\"form-field-field_8b79540-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_8b79540-1\" name=\"form_fields[field_8b79540]\" required=\"required\"> <label for=\"form-field-field_8b79540-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_7e37317 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7e37317\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever been diagnosed with any of the following?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Drug or alcohol addiction\" id=\"form-field-field_7e37317-0\" name=\"form_fields[field_7e37317][]\"> <label for=\"form-field-field_7e37317-0\">Drug or alcohol addiction<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"An eating disorder\" id=\"form-field-field_7e37317-1\" name=\"form_fields[field_7e37317][]\"> <label for=\"form-field-field_7e37317-1\">An eating disorder<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Schizophrenia\" id=\"form-field-field_7e37317-2\" name=\"form_fields[field_7e37317][]\"> <label for=\"form-field-field_7e37317-2\">Schizophrenia<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Depression\" id=\"form-field-field_7e37317-3\" name=\"form_fields[field_7e37317][]\"> <label for=\"form-field-field_7e37317-3\">Depression<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nervous breakdown\" id=\"form-field-field_7e37317-4\" name=\"form_fields[field_7e37317][]\"> <label for=\"form-field-field_7e37317-4\">Nervous breakdown<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Bi-polar disorder\" id=\"form-field-field_7e37317-5\" name=\"form_fields[field_7e37317][]\"> <label for=\"form-field-field_7e37317-5\">Bi-polar disorder<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Personality disorder\" id=\"form-field-field_7e37317-6\" name=\"form_fields[field_7e37317][]\"> <label for=\"form-field-field_7e37317-6\">Personality disorder<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Anxiety\" id=\"form-field-field_7e37317-7\" name=\"form_fields[field_7e37317][]\"> <label for=\"form-field-field_7e37317-7\">Anxiety<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_527a66e elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_527a66e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever been hospitalized for psychiatric care?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_527a66e-0\" name=\"form_fields[field_527a66e]\" required=\"required\"> <label for=\"form-field-field_527a66e-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_527a66e-1\" name=\"form_fields[field_527a66e]\" required=\"required\"> <label for=\"form-field-field_527a66e-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e45fbff elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e45fbff\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever attempted suicide?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_e45fbff-0\" name=\"form_fields[field_e45fbff]\" required=\"required\"> <label for=\"form-field-field_e45fbff-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_e45fbff-1\" name=\"form_fields[field_e45fbff]\" required=\"required\"> <label for=\"form-field-field_e45fbff-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1dc84f9 elementor-col-100\">\n\t\t\t\t\tSurrogacy Questions\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4e58dd1 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4e58dd1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBase fee?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4e58dd1]\" id=\"form-field-field_4e58dd1\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_1e64c90 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1e64c90\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhy do you want to become a surrogate?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_1e64c90]\" id=\"form-field-field_1e64c90\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_7ab9de9 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7ab9de9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat would you like the Intended Parents know about you?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_7ab9de9]\" id=\"form-field-field_7ab9de9\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_d3c6af4 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d3c6af4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat kind of relationship would you like with your IP's during your surrogacy journey? (friendship, very little to NO communication)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_d3c6af4]\" id=\"form-field-field_d3c6af4\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_f080967 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f080967\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat kind of relationship would you like after delivery?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_f080967]\" id=\"form-field-field_f080967\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_ca03986 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ca03986\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWould you be comfortable with the IP's in the delivery room?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_ca03986-0\" name=\"form_fields[field_ca03986]\" required=\"required\"> <label for=\"form-field-field_ca03986-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_ca03986-1\" name=\"form_fields[field_ca03986]\" required=\"required\"> <label for=\"form-field-field_ca03986-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_af7869a elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_af7869a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWould you be willing to pump after delivery?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_af7869a-0\" name=\"form_fields[field_af7869a]\" required=\"required\"> <label for=\"form-field-field_af7869a-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_af7869a-1\" name=\"form_fields[field_af7869a]\" required=\"required\"> <label for=\"form-field-field_af7869a-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_2747ac7 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2747ac7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you comfortable having the IP in the transfer room\/or recording the transfer for the IP?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_2747ac7-0\" name=\"form_fields[field_2747ac7]\" required=\"required\"> <label for=\"form-field-field_2747ac7-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_2747ac7-1\" name=\"form_fields[field_2747ac7]\" required=\"required\"> <label for=\"form-field-field_2747ac7-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_0f750d2 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0f750d2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName at least 3 people who your support system consist of?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_0f750d2]\" id=\"form-field-field_0f750d2\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_2b392b7 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2b392b7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you comfortable with injections and taking oral medication for surrogacy?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_2b392b7-0\" name=\"form_fields[field_2b392b7]\" required=\"required\"> <label for=\"form-field-field_2b392b7-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_2b392b7-1\" name=\"form_fields[field_2b392b7]\" required=\"required\"> <label for=\"form-field-field_2b392b7-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1fef8a0 elementor-col-100\">\n\t\t\t\t\tAbout you\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_a4b9952 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a4b9952\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescribe your personality? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_a4b9952]\" id=\"form-field-field_a4b9952\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_a8b2c24 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a8b2c24\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat does your daily routine consist of?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_a8b2c24]\" id=\"form-field-field_a8b2c24\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_02cf560 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_02cf560\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat do you do for fun?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_02cf560]\" id=\"form-field-field_02cf560\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_bc34014 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bc34014\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat are your hobbies?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_bc34014]\" id=\"form-field-field_bc34014\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_ba2c91f elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ba2c91f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your favorite way to spend time with your family?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_ba2c91f]\" id=\"form-field-field_ba2c91f\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_07bab9c elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_07bab9c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your favorite flower?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_07bab9c]\" id=\"form-field-field_07bab9c\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2b40e82 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2b40e82\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your favorite color?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_2b40e82]\" id=\"form-field-field_2b40e82\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_1d294fe elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1d294fe\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your favorite way to relax?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_1d294fe]\" id=\"form-field-field_1d294fe\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_28a8796 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_28a8796\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your favorite Movie or TV show?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_28a8796]\" id=\"form-field-field_28a8796\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_65f6d8c elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_65f6d8c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your favorite dessert, candy or snack food? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_65f6d8c]\" id=\"form-field-field_65f6d8c\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_9e45b86 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9e45b86\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFavorite type of jewelry? (I.E. rings, necklaces, or bracelets?)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_9e45b86]\" id=\"form-field-field_9e45b86\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_cc1b997 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cc1b997\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow did you hear about us?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_cc1b997]\" id=\"form-field-field_cc1b997\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_77aec6a elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_77aec6a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCan you send us a few pictures of you?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_77aec6a][]\" id=\"form-field-field_77aec6a\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" required=\"required\" multiple=\"multiple\" data-maxsize=\"15\" data-maxsize-message=\"This file exceeds the maximum allowed size.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_735a9e1 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_735a9e1]\" id=\"form-field-field_735a9e1\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_735a9e1\">I swear or affirm that the above and foregoing representations are true and correct to the best of my information, knowledge, and belief.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_fca56c0 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fca56c0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSign date\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_fca56c0]\" id=\"form-field-field_fca56c0\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">\u5bc4\u9001<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Surrogate Application<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-1033","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sunshinesurrogacy.wpsite.tw\/jp\/wp-json\/wp\/v2\/pages\/1033","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sunshinesurrogacy.wpsite.tw\/jp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sunshinesurrogacy.wpsite.tw\/jp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sunshinesurrogacy.wpsite.tw\/jp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sunshinesurrogacy.wpsite.tw\/jp\/wp-json\/wp\/v2\/comments?post=1033"}],"version-history":[{"count":74,"href":"https:\/\/sunshinesurrogacy.wpsite.tw\/jp\/wp-json\/wp\/v2\/pages\/1033\/revisions"}],"predecessor-version":[{"id":1920,"href":"https:\/\/sunshinesurrogacy.wpsite.tw\/jp\/wp-json\/wp\/v2\/pages\/1033\/revisions\/1920"}],"wp:attachment":[{"href":"https:\/\/sunshinesurrogacy.wpsite.tw\/jp\/wp-json\/wp\/v2\/media?parent=1033"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}