{"id":6304,"date":"2023-11-17T18:25:37","date_gmt":"2023-11-17T18:25:37","guid":{"rendered":"https:\/\/www.themindbydesign.com\/?page_id=6304"},"modified":"2023-12-28T17:15:08","modified_gmt":"2023-12-28T17:15:08","slug":"billing-payments-insurance","status":"publish","type":"page","link":"https:\/\/www.themindbydesign.com\/billing-payments-insurance\/","title":{"rendered":"Billing | Payments | Insurance"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6304\" class=\"elementor elementor-6304\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-22a5b441 header-banner-overlay e-con-full e-flex e-con e-parent\" data-id=\"22a5b441\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-1f1d5e49 e-con-full hero-mobile-section e-flex e-con e-child\" data-id=\"1f1d5e49\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-92d6e8 elementor-hidden-desktop elementor-widget elementor-widget-image\" data-id=\"92d6e8\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"534\" src=\"https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/12\/iStock-1222945800-1024x683.jpg\" class=\"attachment-large size-large wp-image-9703\" alt=\"\" srcset=\"https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/12\/iStock-1222945800-1024x683.jpg 1024w, https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/12\/iStock-1222945800-300x200.jpg 300w, https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/12\/iStock-1222945800-768x512.jpg 768w, https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/12\/iStock-1222945800-1536x1024.jpg 1536w, https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/12\/iStock-1222945800-2048x1365.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-39d6f361 text-balance-class elementor-widget elementor-widget-heading\" data-id=\"39d6f361\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h1 class=\"elementor-heading-title elementor-size-default\">Billing, Payments & <span class=\"brand-60\">Insurance<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-48b90487 e-flex e-con-boxed e-con e-parent\" data-id=\"48b90487\" data-element_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-5ccfccc6 e-con-full e-flex e-con e-child\" data-id=\"5ccfccc6\" data-element_type=\"container\" id=\"brain-icon-section\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7455d0ba elementor-widget__width-inherit elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"7455d0ba\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-question-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119.043 8 8 119.083 8 256c0 136.997 111.043 248 248 248s248-111.003 248-248C504 119.083 392.957 8 256 8zm0 448c-110.532 0-200-89.431-200-200 0-110.495 89.472-200 200-200 110.491 0 200 89.471 200 200 0 110.53-89.431 200-200 200zm107.244-255.2c0 67.052-72.421 68.084-72.421 92.863V300c0 6.627-5.373 12-12 12h-45.647c-6.627 0-12-5.373-12-12v-8.659c0-35.745 27.1-50.034 47.579-61.516 17.561-9.845 28.324-16.541 28.324-29.579 0-17.246-21.999-28.693-39.784-28.693-23.189 0-33.894 10.977-48.942 29.969-4.057 5.12-11.46 6.071-16.666 2.124l-27.824-21.098c-5.107-3.872-6.251-11.066-2.644-16.363C184.846 131.491 214.94 112 261.794 112c49.071 0 101.45 38.304 101.45 88.8zM298 368c0 23.159-18.841 42-42 42s-42-18.841-42-42 18.841-42 42-42 42 18.841 42 42z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-365d56aa e-con-full e-flex e-con e-child\" data-id=\"365d56aa\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-069f2a9 elementor-widget elementor-widget-heading\" data-id=\"069f2a9\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Insurance: What You Need to Know<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-47e89a42 elementor-widget elementor-widget-text-editor\" data-id=\"47e89a42\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p><span style=\"font-weight: 400;\">Mind by Design, like other practices that offer similar services, is considered an out-of-network provider by insurance companies. As a result, we do not accept insurance directly. However, your health insurance company may reimburse some or all of your child&#8217;s services.<\/span><\/p><p><span style=\"font-weight: 400;\">To determine if you have coverage through your insurance carrier, we recommend giving them a call to ask some questions like:<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d2b7b62 elementor-align-left elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"d2b7b62\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<link rel=\"stylesheet\" href=\"https:\/\/www.themindbydesign.com\/wp-content\/plugins\/elementor\/assets\/css\/widget-icon-list.min.css\">\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Do I have coverage for [Service with ____ CPT code]?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">How much is the coverage amount for [service]?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">How much does my insurance pay for an out-of-network provider?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">What is my deductible, and have I met it this year?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Do I need approval from my primary care physician?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Do I need to complete any paperwork prior to starting with Mind by Design?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fb2abb3 elementor-widget elementor-widget-heading\" data-id=\"fb2abb3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">If you decide to seek reimbursement for our services from your insurance carrier, we\u2019re happy to provide a Superbill to assist you. <\/h2>\t\t<\/div>\n\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<div class=\"elementor-element elementor-element-eccb272 e-flex e-con-boxed e-con e-parent\" data-id=\"eccb272\" data-element_type=\"container\" 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d=\"M550.1,405.5a7.6,7.6,0,0,0-.1-1.5c-3.6-17.6-12.7-30.8-30.4-36.2s-33.4-2-46.3,11.5c-3.3,3.4-4.8,2.5-7.7-.3-11.2-11.1-24.5-16.4-40.4-13.2s-28.4,13.6-34,29.7-3.3,32.4,8.6,45.2c20.4,22,41.6,43.2,62.5,64.6,5,5.1,9,5,14.1-.2,20.4-20.8,40.9-41.5,61.2-62.4A42.9,42.9,0,0,0,550.1,411Zm-22.8,25.7c-14.1,15.5-29.4,29.9-44,45-3.7,3.8-7.3,7.7-10.9,11.6-2,2.3-3.6,2.2-5.7,0-18.3-18.7-36.9-37-54.8-56a30.6,30.6,0,0,1,13.9-50.5c2.5-.7,5-.5,7.6-.7a27.8,27.8,0,0,1,20.9,8.7c2.7,2.9,5.6,5.7,8.4,8.5,5.4,5.4,8.7,5,14.1-.9s12.3-13.4,22-15.4c13.2-2.7,25.8,2.5,32.8,14.4S535.8,421.9,527.3,431.2Z\"><\/path><\/g><\/g><\/g><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ec2907e e-con-full e-flex e-con e-child\" data-id=\"ec2907e\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-59de2a4 elementor-widget elementor-widget-heading\" data-id=\"59de2a4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">What is a <span class=\"brand-60\">Superbill?<\/span><\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c10ffe3 elementor-widget elementor-widget-heading\" data-id=\"c10ffe3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">A Superbill includes diagnosis code(s), dates and minutes of service, and CPT codes for service types. You can submit it directly to your insurance company to receive reimbursement. <\/h2>\t\t<\/div>\n\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<div class=\"elementor-element elementor-element-f9708a6 e-flex e-con-boxed e-con e-parent\" data-id=\"f9708a6\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fee0ba6 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"fee0ba6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">What are <span class=\"brand-60\">CPT Codes?<\/span><\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-93bf73f elementor-widget elementor-widget-text-editor\" data-id=\"93bf73f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>A Current Procedural Terminology code, or CPT code, is a standardized numerical code used across medical service providers and insurance carriers to track and bill medical, surgical, and diagnostic services.<\/p><p>We provide CPT codes for families seeking reimbursement from their insurance carrier for services we provide for their child.<\/p><p>Please note that these services are not covered by insurance, and therefore, we do not have CPT codes for these:<\/p><ul><li>Academic Boost Tutoring<\/li><li>Executive Function Coaching<\/li><li>Parent Coaching<\/li><li>Educational IEP Consulting<\/li><\/ul><p>Below are CPT codes that could apply to our services. However, as we won\u2019t know what best applies to your child until we work with them, you may ask your insurance about each code, and we can discuss it further.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e58db44 e-con-full e-flex e-con e-child\" data-id=\"e58db44\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-2f18806 e-con-full e-flex e-con e-child\" data-id=\"2f18806\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-93a9fca elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"93a9fca\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">CPT Service<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5725372 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"5725372\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Code<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7a19787 e-con-full e-flex e-con e-child\" data-id=\"7a19787\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9cae00d elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"9cae00d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Autism assessment<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7953d73 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"7953d73\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">96112, 96113<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-472ee19 e-con-full e-flex e-con e-child\" data-id=\"472ee19\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1175d21 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"1175d21\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Evaluation of speech sound production<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dace591 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"dace591\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">92522<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b1f117d e-con-full e-flex e-con e-child\" data-id=\"b1f117d\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d084404 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"d084404\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Evaluation of speech sound production; with evaluation of language comprehension and expression<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7e2b9c3 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"7e2b9c3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">92523<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-cb3a03b e-con-full e-flex e-con e-child\" data-id=\"cb3a03b\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-41a3e7c elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"41a3e7c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Evaluation of speech fluency<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-be27346 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"be27346\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">92523<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d88f87f e-con-full e-flex e-con e-child\" data-id=\"d88f87f\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5ea982d elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"5ea982d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Neuropsychological testing<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a648c64 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"a648c64\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">96132, 96133, 96136, 96137<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-afaee26 e-con-full e-flex e-con e-child\" data-id=\"afaee26\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-08d8450 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"08d8450\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Speech and language therapy<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cb8ab0d elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"cb8ab0d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">92507<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\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<div class=\"elementor-element elementor-element-13e5b4cd e-flex e-con-boxed e-con e-parent\" data-id=\"13e5b4cd\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-98f80f2 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"98f80f2\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Flexible Booking and <span class=\"brand-60\">Payment Options<\/span><\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-43fdb297 e-flex e-con-boxed e-con e-child\" data-id=\"43fdb297\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-677987b1 e-con-full e-flex e-con e-child\" data-id=\"677987b1\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f4c65ba elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"f4c65ba\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 325.6 383.3\"><title>Asset 4MBD-Icons<\/title><g id=\"be9812ee-b293-41dd-82f7-f4acc8963983\" data-name=\"Layer 2\"><g id=\"a95d4eb6-efd2-4022-942c-7069715eda32\" data-name=\"Layer 1\"><path 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d=\"M111.9,182.2c3.8-3.2,7.1-3.6,9.5-.9s1.9,6-2.4,10c-2.2,2.1-3.1,2.7-3.1,5.6.2,9.1.1,20.1,0,29.2s-6.1,16.4-16.5,16.4H69.1c-10.2-.1-16.2-6.2-16.2-16.4V194.7c0-9,6.1-15.4,15.1-15.5,10.8-.2,21.7-.3,32.5.1,5.4,0,8.3.1,11.4,2.9m-9.8,8.9c.1,0-.1-.3-.2-.3H67.5c-2.5,0-3.4,1.9-3.4,4.1v31.8c0,2.7,1.3,4.4,4,4.4,10.8.1,21.7.2,32.5-.1a3.6,3.6,0,0,0,3.8-3.1c.4-7,.2-14.1.2-21.7l-1.9,1.5c-4,4-8,8.2-12.2,12.1s-5.9,3.1-9.1.1l-7.1-7.1c-2.6-2.8-2.6-6-.2-8.3a5.3,5.3,0,0,1,7.1-.1l3.6,4.1Z\"><\/path><path d=\"M115.9,291.9c0,5.3.1,10.5,0,15.8-.2,9.5-6.3,15.5-15.8,15.6H68.7c-9.5,0-15.8-6.3-15.8-15.7V275.8c0-9.1,5.8-15.5,14.9-15.8q16.7-.5,33.3,0c9,.3,14.6,6.5,14.8,15.5.1,5.5,0,10.9,0,16.4m-11.3-.1c0-5.3-.1-10.5,0-15.7,0-3.1-1.3-4.6-4.4-4.6H68.8c-3.3,0-4.8,1.5-4.8,4.7.1,10.4.1,20.7,0,31,0,3.1,1.5,4.7,4.5,4.7h31.8c2.8,0,4.3-1.4,4.3-4.4-.1-5.2,0-10.5,0-15.7\"><\/path><path d=\"M176.2,135.5H142.6c-4.4,0-7-2-7-5.5s2.5-5.7,6.8-5.7h68c4.2,0,6.9,2.3,6.8,5.7s-2.6,5.5-7,5.5Z\"><\/path><path d=\"M154.3,205.1h12c4,0,6.4,2.4,6.3,5.8s-2.5,5.4-6.3,5.4H142c-3.9,0-6.3-2.1-6.4-5.4s2.5-5.7,6.4-5.8h12.3\"><\/path><\/g><\/g><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6fbd6442 elementor-widget__width-initial elementor-widget-tablet__width-initial elementor-widget elementor-widget-heading\" data-id=\"6fbd6442\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Booking Assessments & Evaluations<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5511a4b8 elementor-widget-tablet__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"5511a4b8\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>A deposit is processed to reserve an assessment appointment. The balance remaining is due on the final day of testing.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-4cc144bb e-con-full e-flex e-con e-child\" data-id=\"4cc144bb\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-390ff47 elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"390ff47\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 381.7 357.6\"><title>Our team<\/title><g id=\"fd18ac06-e293-4f5b-b01e-d49abd0526c0\" data-name=\"Layer 2\"><g id=\"aa926668-5a24-4832-8cff-05d67842c006\" data-name=\"Layer 1\"><path 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class=\"elementor-element elementor-element-263c9cc4 elementor-widget__width-initial elementor-widget-tablet__width-initial text-balance-class elementor-widget elementor-widget-heading\" data-id=\"263c9cc4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Cost-Effective Support Packages<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c9185bf elementor-widget-tablet__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"c9185bf\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>For ongoing support, we offer packages for services like Executive Function Coaching and Academic Boost Tutoring at reduced prices. <\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-608bc788 e-con-full e-flex e-con e-child\" data-id=\"608bc788\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4aa2954 elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"4aa2954\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 383.1 383.4\"><title>Asset 16MBD-Icons<\/title><g id=\"a880983b-b2ba-436f-bc47-e58cfd438900\" data-name=\"Layer 2\"><g id=\"ea4bc76a-ff72-49da-ae3d-43a44616ef9c\" data-name=\"Layer 1\"><path 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d=\"M191.5,40.7a34,34,0,1,0,34.1,34,34,34,0,0,0-34.1-34m-.2,56.7a22.6,22.6,0,1,1,.5,0Z\"><\/path><path d=\"M89.7,185a25.3,25.3,0,1,0-25.4-25.3A25.1,25.1,0,0,0,89.2,185h.5m-.2-39.1a13.7,13.7,0,0,1,13.9,13.5v.5a13.9,13.9,0,0,1-27.8-.2,13.8,13.8,0,0,1,13.9-13.8\"><\/path><path d=\"M294,185a25.3,25.3,0,1,0-25.6-25,25,25,0,0,0,25,25h.6m-.2-39.1a13.8,13.8,0,0,1,13.8,13.7,13.9,13.9,0,0,1-27.8.9v-.8a13.7,13.7,0,0,1,13.5-13.8Z\"><\/path><\/g><\/g><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7ce04ac7 elementor-widget__width-initial elementor-widget-tablet__width-initial text-balance-class elementor-widget elementor-widget-heading\" data-id=\"7ce04ac7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Flexible Payment <br>Options<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d12ac81 elementor-widget-tablet__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"d12ac81\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"thread-list-item-message-column\"><div><div class=\"message ql-snow \"><div class=\"ql-editor\"><p>We strive to make your payment process as convenient as possible. We accept all major credit and debit cards, as well as FSA and HSA cards.<\/p><\/div><\/div><\/div><\/div>\t\t\t\t\t\t<\/div>\n\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\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-64e82b3 e-flex e-con-boxed e-con e-parent\" data-id=\"64e82b3\" data-element_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\t\t<div class=\"elementor-element elementor-element-28df5ba elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"28df5ba\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">We Proudly Accept CareCredit<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5026ab4 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"5026ab4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Would You Like to Pay For Your Assessment Over Time?<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1e95a0f e-con-full e-flex e-con e-child\" data-id=\"1e95a0f\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e2a34f6 elementor-widget elementor-widget-text-editor\" data-id=\"e2a34f6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tUse the CareCredit credit card to help finance your healthcare needs!\n\nNow you can pay online with CareCredit at the time of care, when you get a post-care bill, or up to 30 days before your appointment, quickly and securely. Special financing options are available.*\n\nVisit <span style=\"color: #f1efe6;\"><a style=\"color: #f1efe6;\" href=\"https:\/\/www.carecredit.com\/go\/226KFT\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\"><span style=\"text-decoration: underline;\">www.carecredit.com<\/span><\/a><\/span> or contact our office to learn more.\n\nReady to apply? <a href=\"https:\/\/www.carecredit.com\/go\/226KFT\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\"><span style=\"text-decoration: underline;\"><span style=\"color: #f1efe6; text-decoration: underline;\">Apply Online<\/span><\/span><\/a> for your CareCredit card today.\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8164cb3 e-con-full e-flex e-con e-child\" data-id=\"8164cb3\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7ed90d7 elementor-widget elementor-widget-image\" data-id=\"7ed90d7\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/www.carecredit.com\/go\/226KFT\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"800\" height=\"167\" src=\"https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/11\/carecredit_synchonysolution_teal.png\" class=\"attachment-large size-large wp-image-6314\" alt=\"\" srcset=\"https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/11\/carecredit_synchonysolution_teal.png 800w, https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/11\/carecredit_synchonysolution_teal-300x63.png 300w, https:\/\/www.themindbydesign.com\/wp-content\/uploads\/2023\/11\/carecredit_synchonysolution_teal-768x160.png 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6096275 elementor-widget elementor-widget-heading\" data-id=\"6096275\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">*Subject to credit approval. Minimum monthly payments required. Ask us for details.<\/p>\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<div class=\"elementor-element elementor-element-6055629c e-con-full elementor-hidden-tablet elementor-hidden-mobile e-flex e-con e-parent\" data-id=\"6055629c\" data-element_type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-3d3f4913 e-flex e-con-boxed e-con e-child\" data-id=\"3d3f4913\" data-element_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-49979f61 e-flex e-con-boxed e-con e-child\" data-id=\"49979f61\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-527b5f94 elementor-widget elementor-widget-text-editor\" data-id=\"527b5f94\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><span style=\"font-weight: 400;\">Paying For The Care Your Child Needs Doesn\u2019t Have To Be A Headache<\/span><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-768f7ac9 text-balance-class elementor-hidden-mobile elementor-widget elementor-widget-heading\" data-id=\"768f7ac9\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Reach Out to Our Team Anytime<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7e9345b5 text-balance-class elementor-hidden-desktop elementor-hidden-tablet elementor-widget elementor-widget-heading\" data-id=\"7e9345b5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Reach Out To Our Team Anytime. We\u2019re Here To Help!<\/h2>\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\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<section class=\"elementor-element elementor-element-2a4a861a e-flex e-con-boxed e-con e-parent\" data-id=\"2a4a861a\" data-element_type=\"container\" id=\"getintouch\" 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-2ea645ab e-con-full e-flex e-con e-child\" data-id=\"2ea645ab\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2a5b0a26 elementor-widget elementor-widget-heading\" data-id=\"2a5b0a26\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Get in <span class=\"brand-80\">Touch  <\/span><\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7a3d26f elementor-widget elementor-widget-text-editor\" data-id=\"7a3d26f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\tLet us know how we can help. You&#8217;re welcome to fill out a form or give us a call or text at <a href; =\"tel:669-282-2510\"><span style=\"color: #a9502a; text-decoration: underline;\">669-282-2510<\/a><\/span>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-88e0991 elementor-widget elementor-widget-spacer\" data-id=\"88e0991\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-column .elementor-spacer-inner{height:var(--spacer-size)}.e-con{--container-widget-width:100%}.e-con-inner>.elementor-widget-spacer,.e-con>.elementor-widget-spacer{width:var(--container-widget-width,var(--spacer-size));--align-self:var(--container-widget-align-self,initial);--flex-shrink:0}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container,.e-con>.elementor-widget-spacer>.elementor-widget-container{height:100%;width:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer{height:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner{height:var(--container-widget-height,var(--spacer-size))}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty,.e-con>.elementor-widget-spacer.elementor-widget-empty{position:relative;min-height:22px;min-width:22px}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon,.e-con>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon{position:absolute;top:0;bottom:0;left:0;right:0;margin:auto;padding:0;width:22px;height:22px}<\/style>\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-74e1a45e e-con-full e-flex e-con e-child\" data-id=\"74e1a45e\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-18e876f5 elementor-widget__width-inherit jotform-main elementor-widget elementor-widget-global elementor-global-6545 elementor-widget-html\" data-id=\"18e876f5\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<script src=\"https:\/\/cdn03.jotfor.ms\/static\/prototype.forms.js?v=3.3.53700\" type=\"text\/javascript\"><\/script>\r\n<script src=\"https:\/\/cdn01.jotfor.ms\/static\/jotform.forms.js?v=3.3.53700\" type=\"text\/javascript\"><\/script>\r\n<script src=\"https:\/\/cdn02.jotfor.ms\/js\/punycode-1.4.1.min.js?v=3.3.53700\" type=\"text\/javascript\" defer><\/script>\r\n<script src=\"https:\/\/cdn03.jotfor.ms\/js\/vendor\/maskedinput_5.0.9.min.js?v=3.3.53700\" type=\"text\/javascript\"><\/script>\r\n<script src=\"https:\/\/cdn01.jotfor.ms\/s\/umd\/387f62f0899\/for-widgets-server.js?v=3.3.53700\" type=\"text\/javascript\"><\/script>\r\n<script type=\"text\/javascript\">\tJotForm.newDefaultTheme = false;\r\n\tJotForm.extendsNewTheme = true;\r\n\tJotForm.singleProduct = false;\r\n\tJotForm.newPaymentUIForNewCreatedForms = true;\r\n\tJotForm.texts = {\"confirmEmail\":\"E-mail does not match\",\"pleaseWait\":\"Please wait...\",\"validateEmail\":\"You need to validate this e-mail\",\"confirmClearForm\":\"Are you sure you want to clear the form\",\"lessThan\":\"Your score should be less than or equal to\",\"incompleteFields\":\"There are incomplete required fields. 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Please complete them.\",\"inputCarretErrorA\":\"Input should not be less than the minimum value:\",\"inputCarretErrorB\":\"Input should not be greater than the maximum value:\",\"justSoldOut\":\"Just Sold Out\",\"lessThan\":\"Your score should be less than or equal to\",\"maxCharactersError\":\"The number of characters should not be more than the maximum value:\",\"maxDigitsError\":\"The maximum digits allowed is\",\"maxFileSize_infoMessage\":\"Max. file size\",\"maxSelectionsError\":\"The maximum number of selections allowed is \",\"minCharactersError\":\"The number of characters should not be less than the minimum value:\",\"minSelectionsError\":\"The minimum required number of selections is \",\"multipleError\":\"\",\"multipleFileUploads_emptyError\":\"{file} is empty, please select files again without it.\",\"multipleFileUploads_fileLimitError\":\"Only {fileLimit} file uploads allowed.\",\"multipleFileUploads_minSizeError\":\"{file} is too small, minimum file size is {minSizeLimit}.\",\"multipleFileUploads_onLeave\":\"The files are being uploaded, if you leave now the upload will be cancelled.\",\"multipleFileUploads_sizeError\":\"{file} is too large, maximum file size is {sizeLimit}.\",\"multipleFileUploads_typeError\":\"{file} has invalid extension. 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Please select another slot.\",\"soldOut\":\"Sold Out\",\"startButtonText\":\"START\",\"submissionLimit\":\"Sorry! Only one entry is allowed. Multiple submissions are disabled for this form.\",\"submitButtonText\":\"Submit\",\"subProductItemsLeft\":\"({count} items left)\",\"uploadExtensions\":\"You can only upload following files:\",\"uploadFilesize\":\"File size cannot be bigger than:\",\"uploadFilesizemin\":\"File size cannot be smaller than:\",\"url\":\"This field can only contain a valid URL\",\"validateEmail\":\"You need to validate this e-mail\",\"wordLimitError\":\"Too many words. The limit is\",\"wordMinLimitError\":\"Too few words.  The minimum is\"});\r\n\t\/*INIT-END*\/\r\n\t});\r\n\r\n   setTimeout(function() {\r\nJotForm.paymentExtrasOnTheFly([null,null,{\"name\":\"submit2\",\"qid\":\"2\",\"text\":\"Submit\",\"type\":\"control_button\"},{\"description\":\"\",\"name\":\"name\",\"qid\":\"3\",\"text\":\"Name\",\"type\":\"control_fullname\"},{\"description\":\"\",\"name\":\"email\",\"qid\":\"4\",\"subLabel\":\"\",\"text\":\"Email\",\"type\":\"control_email\"},{\"description\":\"\",\"name\":\"phoneNumber\",\"qid\":\"5\",\"text\":\"Phone Number\",\"type\":\"control_phone\"},null,{\"description\":\"\",\"name\":\"childsAge\",\"qid\":\"7\",\"subLabel\":\"\",\"text\":\"Child's Age\",\"type\":\"control_number\"},{\"description\":\"\",\"name\":\"childsSchool\",\"qid\":\"8\",\"subLabel\":\"\",\"text\":\"Child's School\",\"type\":\"control_textbox\"},{\"name\":\"pageBreak\",\"qid\":\"9\",\"text\":\"Page Break\",\"type\":\"control_pagebreak\"},{\"description\":\"\",\"name\":\"wouldYou\",\"qid\":\"10\",\"text\":\"Would you prefer email or phone for initial correspondence?\",\"type\":\"control_radio\"},{\"description\":\"\",\"name\":\"howCan\",\"qid\":\"11\",\"text\":\"How can we help?\",\"type\":\"control_radio\"},{\"description\":\"\",\"name\":\"whichAssessment\",\"qid\":\"12\",\"subLabel\":\"\",\"text\":\"Which assessment are you interested in?\",\"type\":\"control_dropdown\"},{\"description\":\"\",\"name\":\"whichService\",\"qid\":\"13\",\"subLabel\":\"\",\"text\":\"Which service are you interested in?\",\"type\":\"control_dropdown\"},null,{\"description\":\"\",\"mde\":\"No\",\"name\":\"whatAre\",\"qid\":\"15\",\"subLabel\":\"\",\"text\":\"What are your presenting concerns? What should we know?\",\"type\":\"control_textarea\",\"wysiwyg\":\"Disable\"},{\"description\":\"\",\"name\":\"pleaseVerify\",\"qid\":\"16\",\"text\":\"Please verify that you are human\",\"type\":\"control_captcha\"},null,null,{\"description\":\"\",\"name\":\"typeA\",\"qid\":\"19\",\"text\":\"\",\"type\":\"control_checkbox\"},{\"description\":\"\",\"name\":\"typeA20\",\"qid\":\"20\",\"subLabel\":\"\",\"text\":\"How did you hear about us?\",\"type\":\"control_dropdown\"},{\"description\":\"\",\"name\":\"whoReferred\",\"qid\":\"21\",\"subLabel\":\"\",\"text\":\"Please Specify\",\"type\":\"control_textbox\"},null,null,null,null,null,null,{\"name\":\"typeA28\",\"qid\":\"28\",\"text\":\"Get Page URL\",\"type\":\"control_widget\"}]);}, 20); \r\n<\/script>\r\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn01.jotfor.ms\/stylebuilder\/static\/form-common.css?v=6ce5ebf\r\n\"\/>\r\n<style type=\"text\/css\">@media print{*{-webkit-print-color-adjust: exact !important;color-adjust: exact !important;}.form-section{display:inline!important}.form-pagebreak{display:none!important}.form-section-closed{height:auto!important}.page-section{position:initial!important}}<\/style>\r\n<link id=\"custom-font\" type=\"text\/css\" rel=\"stylesheet\" href=\"\/\/cdn.jotfor.ms\/fonts\/?family=Inter\" \/>\r\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn02.jotfor.ms\/themes\/CSS\/defaultV2.css?v=6ce5ebf\r\n\"\/>\r\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn03.jotfor.ms\/themes\/CSS\/548b1325700cc48d318b4567.css?v=3.3.53700&themeRevisionID=64ff099762313412041c01ae\"\/>\r\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn01.jotfor.ms\/css\/styles\/payment\/payment_styles.css?3.3.53700\" \/>\r\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn02.jotfor.ms\/css\/styles\/payment\/payment_feature.css?3.3.53700\" \/>\r\n<style type=\"text\/css\" id=\"form-designer-style\">\r\n    \/* Injected CSS Code *\/\r\n\/*PREFERENCES STYLE*\/\r\n  \/* NEW THEME STYLE *\/\r\n\r\n  \/* colors *\/\r\n\r\n  .form-textbox, .form-textarea {\r\n    color: undefined;\r\n  }\r\n  .FITB-inptCont .form-textbox, .FITB-inptCont .form-dropdown,\r\n  span.FITB-inptCont[data-type=selectbox] select,\r\n  span.FITB-inptCont[data-type=timebox] select {\r\n    color: #000000;\r\n  }\r\n  .rating-item input:hover+label {\r\n    color: #2e69ff;\r\n  }\r\n\r\n  .calendar-new-header-withSVG .calendar-new-header .nextYear svg,\r\n  .calendar-new-header-withSVG .calendar-new-header .nextMonth svg,\r\n  .calendar-new-header-withSVG .calendar-new-header .previousYear svg,\r\n  .calendar-new-header-withSVG .calendar-new-header .previousMonth svg {\r\n    color: #000000;\r\n  }\r\n\r\n  li[data-type=control_fileupload] .qq-upload-button,\r\n  .until-text,\r\n  .form-submit-reset {\r\n    color: #2c3345;\r\n  }\r\n\r\n  .stageEmpty,\r\n  .btn-barebone,\r\n  .formPage-stuff,\r\n  .scrollToTop .scrollToTop-text {\r\n    color: #6F76A7;\r\n  }\r\n  .scrollToTop svg {\r\n    fill: #6F76A7;\r\n  }\r\n  .rating-item label {\r\n    color: rgba(195, 202, 216, 0.75);\r\n  }\r\n  .currentDate,\r\n  .pickerItem select,\r\n  .appointmentCalendar .calendarDay,\r\n  .calendar.popup th,\r\n  .calendar.popup table tbody td,\r\n  .calendar-new-header>*,\r\n  .form-collapse-table {\r\n    color: #000000;\r\n  }\r\n  .appointmentCalendar {\r\n    background-color: transparent;\r\n  }\r\n  .appointmentCalendar .dayOfWeek {\r\n    color: #2e69ff;\r\n  }\r\n  .appointmentSlotsContainer > * {\r\n    color: #2e69ff;\r\n  }\r\n  li[data-type=control_fileupload] .jfUpload-heading,\r\n  ::placeholder,\r\n  .form-dropdown.is-active,\r\n  .form-dropdown:first-child,\r\n  .form-spinner-input {\r\n    color: #57647e;\r\n  }\r\n  .appointmentCalendar .calendarWeek .calendarDay.isUnavailable,\r\n  .calendar tr.days td.otherDay,\r\n  .calendar tr.days td:hover:not(.unselectable) {\r\n    color: #CAD0CF;\r\n  }\r\n  span.form-sub-label, label.form-sub-label, div.form-header-group .form-subHeader,\r\n  .rating-item-title.for-to > label:first-child,\r\n  .rating-item-title.for-from > label:first-child,\r\n  .rating-item-title .editor-container * {\r\n    color: #57647e;\r\n  }\r\n  .form-pagebreak-next {\r\n    color: #2c3345;\r\n  }\r\n  .form-pagebreak-back {\r\n    color: #2c3345;\r\n  }\r\n  .rating-item input:checked+label,\r\n  .rating-item input:focus+label {\r\n    color: #FFFFFF;\r\n  }\r\n  .clear-pad-btn {\r\n    color: #57647e;\r\n  }\r\n  .form-textbox::placeholder,\r\n  .form-dropdown:not(.time-dropdown):not(:required),\r\n  .form-dropdown:not(:required),\r\n  .form-dropdown:required:invalid {\r\n    color: #57647e;\r\n  }\r\n  \/* border-colors *\/\r\n  .form-dropdown,\r\n  .form-textarea,\r\n  .form-textbox,\r\n  li[data-type=control_fileupload] .qq-upload-button,\r\n  .rating-item label,\r\n  .rating-item input:focus+label,\r\n  .rating-item input:checked+label,\r\n  .jf-form-buttons,\r\n  .form-checkbox+label:before, .form-checkbox+span:before, .form-radio+label:before, .form-radio+span:before,\r\n  .signature-pad-passive,\r\n  .signature-wrapper,\r\n  .appointmentCalendarContainer,\r\n  .appointmentField .timezonePickerName,\r\n  .appointmentDayPickerButton,\r\n  .appointmentCalendarContainer .monthYearPicker .pickerItem+.pickerItem,\r\n  .appointmentCalendarContainer .monthYearPicker,\r\n  .appointmentCalendar .calendarDay.isActive .calendarDayEach, .appointmentCalendar .calendarDay.isToday .calendarDayEach, .appointmentCalendar .calendarDay:not(.empty):hover .calendarDayEach,\r\n  .calendar.popup:before,\r\n  .calendar-new-month,\r\n  .form-matrix-column-headers, .form-matrix-table td, .form-matrix-table td:last-child,\r\n  .form-matrix-table th, .form-matrix-table th:last-child, .form-matrix-table tr:last-child td, .form-matrix-table tr:last-child th, .form-matrix-table tr:not([role=group])+tr[role=group] th,\r\n  .form-matrix-headers.form-matrix-column-headers,\r\n  .isSelected .form-matrix-column-headers:nth-last-of-type(2),\r\n  li[data-type=control_inline] input[type=email], li[data-type=control_inline] input[type=number],\r\n  li[data-type=control_inline] input[type=tel], li[data-type=control_inline] input[type=text] {\r\n    border-color: rgba(195, 202, 216, 0.75);\r\n  }\r\n  .stageEmpty,\r\n  .form-page-break:before,\r\n  .welcome-page-break:before,\r\n  .thankyou-page-break:before,\r\n  .form-cover-break:before,\r\n  .form-page-break:after,\r\n  .welcome-page-break:after,\r\n  .thankyou-page-break:after,\r\n  .form-cover-break:after {\r\n    border-color: #C8CEED;\r\n  }\r\n\r\n  .rating-item input:hover+label {\r\n    border-color: #2e69ff;\r\n  }\r\n  .appointmentSlot,\r\n  .form-checkbox:checked+label:before, .form-checkbox:checked+span:before, .form-checkbox:checked+span label:before,\r\n  .form-radio:checked+label:before, .form-radio:checked+span:before,\r\n  .form-dropdown:focus, .form-textarea:focus, .form-textbox:focus, .signature-wrapper:focus,\r\n  .form-line[data-payment=\"true\"] .form-product-item .p_checkbox .checked,\r\n  .form-dropdown:hover, .form-textarea:hover, .form-textbox:hover, .signature-wrapper:hover {\r\n    border-color: #2e69ff;\r\n  }\r\n\r\n  .calendar tr.days td:hover:not(.unselectable):after {\r\n    border-color: #e5eaf4;\r\n  }\r\n  .form-header-group,\r\n  .form-buttons-wrapper, .form-pagebreak, .form-submit-clear-wrapper,\r\n  .form-pagebreak-next,\r\n  .form-pagebreak-back,\r\n  .form-checkbox:hover+label:before, .form-checkbox:hover+span:before, .form-radio:hover+label:before, .form-radio:hover+span:before,\r\n  .divider {\r\n    border-color: #FFFFFF;\r\n  }\r\n  .form-pagebreak-back:focus, .form-pagebreak-next:focus, .form-submit-button:focus {\r\n    border-color: rgba(46, 105, 255, 1);\r\n  }\r\n  \/* background-colors *\/\r\n  .form-line-active {\r\n    background-color: #F1F5FF;\r\n  }\r\n  .stageEmpty {\r\n    background-color:  #FFFFFF;\r\n  }\r\n  .form-line-error {\r\n    background-color: #FFD6D6;\r\n  }\r\n  .form-matrix-column-headers, .form-matrix-row-headers,\r\n  .form-spinner-button-container>*,\r\n  .form-collapse-table,\r\n  .form-collapse-table:hover,\r\n  .appointmentDayPickerButton {\r\n    background-color: #e5eaf4;\r\n  }\r\n  .calendar.popup, .calendar.popup table,\r\n  .calendar.popup table tbody td:after{\r\n    background-color: #FFFFFF;\r\n  }\r\n\r\n  .appointmentCalendar .calendarDay.isActive .calendarDayEach,\r\n  .appointmentFieldRow.forSelectedDate,\r\n  .calendar.popup tr.days td.selected:after,\r\n  .calendar.popup:after,\r\n  .submit-button,\r\n  .form-checkbox:checked+label:before, .form-checkbox:checked+span:before, .form-checkbox:checked+span label:before,\r\n  .form-radio+label:after, .form-radio+span:after,\r\n  .rating-item input:checked+label,\r\n  .appointmentCalendar .calendarDay:after,\r\n  .form-line[data-payment=\"true\"] .form-product-item .p_checkbox .checked,\r\n  .rating-item input:focus+label,\r\n  .formPage-removePage:hover,\r\n  .btn-barebone:hover, .btn-barebone:active {\r\n    background-color: #2e69ff;\r\n  }\r\n  .appointmentSlot.active {\r\n    background-color: #2e69ff !important;\r\n  }\r\n  .clear-pad-btn,\r\n  .appointmentCalendar .dayOfWeek,\r\n  .calendar.popup th {\r\n    background-color: #eef3ff !important;\r\n  }\r\n  .appointmentField .timezonePicker:hover+.timezonePickerName,\r\n  .form-spinner-button-container>*:hover {\r\n    background-color: #eef3ff;\r\n  }\r\n  .form-matrix-values,\r\n  .form-matrix-values,\r\n  .signature-wrapper,\r\n  .signature-pad-passive,\r\n  .rating-item label,\r\n  .form-checkbox+label:before, .form-checkbox+span:before,\r\n  .form-radio+label:before, .form-radio+span:before {\r\n    background-color: #FFFFFF;\r\n  }\r\n  li[data-type=control_fileupload] .qq-upload-button {\r\n    background-color: #fbfcff;\r\n  }\r\n  .JotFormBuilder .appContainer #app li.form-line[data-type=control_matrix].isSelected\r\n  .questionLine-editButton.forRemove:after,\r\n  .JotFormBuilder .appContainer #app li.form-line[data-type=control_matrix].isSelected .questionLine-editButton.forRemove:before {\r\n    background-color: #FFFFFF;\r\n  }\r\n  .appointmentCalendarContainer, .appointmentSlot,\r\n  .rating-item-title.for-to > label:first-child,\r\n  .rating-item-title.for-from > label:first-child,\r\n  .rating-item-title .editor-container *,\r\n  .calendar-opened {\r\n    background-color: transparent;\r\n  }\r\n  .page-section li.form-line-active[data-type=\"control_button\"] {\r\n    background-color: #F1F5FF;\r\n  }\r\n  .appointmentCalendar .calendarDay.isSelected:after {\r\n    color: #FFFFFF;\r\n  }\r\n  \/* shadow *\/\r\n  .form-dropdown:hover, .form-textarea:hover, .form-textbox:hover, .signature-wrapper:hover,\r\n  .calendar.popup:before,\r\n  .jSignature:hover,\r\n  li[data-type=control_fileupload] .qq-upload-button-hover,\r\n  .form-line[data-payment=\"true\"] .form-product-item .p_checkbox .checked,\r\n  .form-line[data-payment=\"true\"] .form-product-item .p_checkbox:hover .select_border,\r\n  .form-checkbox:hover+label:before, .form-checkbox:hover+span:before, .form-radio:hover+label:before, .form-radio:hover+span:before,\r\n  .calendar.popup:before {\r\n    border-color: rgba(169, 191, 249, 0.5);\r\n    box-shadow: 0 0 0 1px rgba(201, 216, 254, 0.25);\r\n  }\r\n  .form-dropdown:focus, .form-textarea:focus, .form-textbox:focus, .signature-wrapper:focus,\r\n  li[data-type=control_fileupload] .qq-upload-button-focus,\r\n  .form-checkbox:focus+label:before, .form-checkbox:focus+span:before, .form-radio:focus+label:before, .form-radio:focus+span:before,\r\n  .calendar.popup:before {\r\n    border-color: rgba(46, 105, 255, 1);\r\n    box-shadow: 0 0 0 1px rgba(201, 216, 254, 0.25);\r\n  }\r\n  .calendar.popup table tbody td{\r\n    box-shadow: none;\r\n  }\r\n\r\n  \/* button colors *\/\r\n  .submit-button {\r\n    background-color: #18BD5B;\r\n    border-color: #18BD5B;\r\n  }\r\n  .submit-button:hover {\r\n    background-color: #16AA52;\r\n    border-color: #16AA52;\r\n  }\r\n  .form-pagebreak-next {\r\n    background-color: #2e69ff;\r\n  }\r\n  .form-pagebreak-back {\r\n    background-color: #2e69ff;\r\n  }\r\n  .form-pagebreak-back:hover {\r\n    background-color: #CED0DA;\r\n    border-color: #CED0DA;\r\n    \r\n  }\r\n  .form-pagebreak-next:hover {\r\n    background-color: #2554CC;\r\n    border-color: #2554CC;\r\n    \r\n  }\r\n  .form-sacl-button, .form-submit-print {\r\n    background-color: transparent;\r\n    color: #2c3345;\r\n    border-color: rgba(195, 202, 216, 0.75);\r\n  }\r\n  .form-sacl-button:hover, .form-submit-print:hover,\r\n  .appointmentSlot:not(.disabled):not(.active):hover,\r\n  .appointmentDayPickerButton:hover,\r\n  .rating-item input:hover+label {\r\n    background-color: #96B4FF;\r\n  }\r\n\r\n  \/* payment styles *\/\r\n\r\n  .form-line[data-payment=true] .form-textbox,\r\n  .form-line[data-payment=true] .select-area,\r\n  .form-line[data-payment=true] #coupon-input,\r\n  .form-line[data-payment=true] #coupon-container input,\r\n  .form-line[data-payment=true] input#productSearch-input,\r\n  .form-line[data-payment=true] .form-product-category-item:after,\r\n  .form-line[data-payment=true] .filter-container .dropdown-container .select-content,\r\n  .form-line[data-payment=true] .form-textbox.form-product-custom_quantity,\r\n  .form-line[data-payment=\"true\"] .form-product-item .p_checkbox .select_border,\r\n  .form-line[data-payment=\"true\"] .form-product-item .form-product-container .form-sub-label-container span.select_cont,\r\n  .form-line[data-payment=true] select.form-dropdown,\r\n  .form-line[data-payment=true] #payment-category-dropdown .select-area,\r\n  .form-line[data-payment=true] #payment-sorting-products-dropdown .select-area,\r\n  .form-line[data-payment=true] .dropdown-container .select-content {\r\n    border-color: rgba(195, 202, 216, 0.75);\r\n    border-color: undefined;\r\n  }\r\n  .form-line[data-payment=\"true\"] hr,\r\n  .form-line[data-payment=true] .p_item_separator,\r\n  .form-line[data-payment=\"true\"] .payment_footer.new_ui,\r\n  .form-line.card-3col .form-product-item.new_ui,\r\n  .form-line.card-2col .form-product-item.new_ui {\r\n    border-color: rgba(195, 202, 216, 0.75);\r\n    border-color: undefined;\r\n  }\r\n  .form-line[data-payment=true] .form-product-category-item {\r\n    border-color: rgba(195, 202, 216, 0.75);\r\n    border-color: undefined;\r\n  }\r\n  .form-line[data-payment=true] #coupon-input,\r\n  .form-line[data-payment=true] .form-textbox.form-product-custom_quantity,\r\n  .form-line[data-payment=true] input#productSearch-input,\r\n  .form-line[data-payment=true] .select-area,\r\n  .form-line[data-payment=true] .custom_quantity,\r\n  .form-line[data-payment=true] .filter-container .select-content,\r\n  .form-line[data-payment=true] .p_checkbox .select_border,\r\n  .form-line[data-payment=true] #payment-category-dropdown .select-area,\r\n  .form-line[data-payment=true] #payment-sorting-products-dropdown .select-area,\r\n  .form-line[data-payment=true] .dropdown-container .select-content {\r\n    background-color: #FFFFFF;\r\n  }\r\n  .form-line[data-payment=true] .form-product-category-item.title_collapsed.has_selected_product .selected-items-icon {\r\n   background-color: undefined;\r\n   border-color: undefined;\r\n  }\r\n  .form-line[data-payment=true].form-line.card-3col .form-product-item,\r\n  .form-line[data-payment=true].form-line.card-2col .form-product-item {\r\n   background-color: undefined;\r\n  }\r\n  .form-line[data-payment=true] .payment-form-table input.form-textbox,\r\n  .form-line[data-payment=true] .payment-form-table input.form-dropdown,\r\n  .form-line[data-payment=true] .payment-form-table .form-sub-label-container > div,\r\n  .form-line[data-payment=true] .payment-form-table span.form-sub-label-container iframe,\r\n  .form-line[data-type=control_square] .payment-form-table span.form-sub-label-container iframe {\r\n    border-color: rgba(195, 202, 216, 0.75);\r\n  }\r\n\r\n  \/* icons *\/\r\n  .appointmentField .timezonePickerName:before {\r\n    background-image: url(data:image\/svg+xml;base64,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);\r\n  }\r\n  .appointmentCalendarContainer .monthYearPicker .pickerArrow.prev:after {\r\n    background-image: url(data:image\/svg+xml;base64,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);\r\n  }\r\n  .appointmentCalendarContainer .monthYearPicker .pickerArrow.next:after {\r\n    background-image: url(data:image\/svg+xml;base64,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);\r\n  }\r\n  .appointmentField .timezonePickerName:after {\r\n    background-image: url(data:image\/svg+xml;base64,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);\r\n    width: 11px;\r\n  }\r\n  li[data-type=control_datetime] [data-wrapper-react=true].extended>div+.form-sub-label-container .form-textbox:placeholder-shown,\r\n  li[data-type=control_datetime] [data-wrapper-react=true]:not(.extended) .form-textbox:not(.time-dropdown):placeholder-shown,\r\n  .appointmentCalendarContainer .currentDate {\r\n    background-image: url(data:image\/svg+xml;base64,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);\r\n  }\r\n  .form-star-rating-star.Stars {\r\n    background-image: 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 }\r\n  li[data-type=control_fileupload] .qq-upload-button:before {\r\n    background-image: url(data:image\/svg+xml;base64,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);\r\n  }\r\n  .appointmentDayPickerButton {\r\n    background-image: url(data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iOCIgaGVpZ2h0PSIxNCIgdmlld0JveD0iMCAwIDggMTQiIGZpbGw9Im5vbmUiIHhtbG5zPSJodHRwOi8vd3d3LnczLm9yZy8yMDAwL3N2ZyI+CjxwYXRoIGQ9Ik0xIDEzTDcgN0wxIDAuOTk5OTk5IiBzdHJva2U9IiM4Nzk1QUMiIHN0cm9rZS13aWR0aD0iMiIgc3Ryb2tlLWxpbmVjYXA9InJvdW5kIiBzdHJva2UtbGluZWpvaW49InJvdW5kIi8+Cjwvc3ZnPgo=);\r\n  }\r\n  .FITB:not(.formRender) .qb-datebox input:not([data-labelid]), .FITB:not(.formRender) .qb-selectbox input:not([data-labelid]),\r\n  .FITB:not(.formRender) .qb-signaturebox input:not([data-labelid]), .FITB:not(.formRender) .qb-textbox input:not([data-labelid]),\r\n  .FITB:not(.formRender) .qb-timebox input:not([data-labelid]), span.FITB-inptCont[data-type=datebox] label,\r\n  span.FITB-inptCont[data-type=signaturebox] label, span.FITB-inptCont[data-type=textbox] label, span.FITB-inptCont[data-type=timebox] label,\r\n  span.FITB-inptCont[data-type=datebox] input:focus~label, span.FITB-inptCont[data-type=datebox] input:valid~label,\r\n  span.FITB-inptCont[data-type=signaturebox] input:focus~label, span.FITB-inptCont[data-type=signaturebox] input:valid~label,\r\n  span.FITB-inptCont[data-type=textbox] input:focus~label, span.FITB-inptCont[data-type=textbox] input:valid~label,\r\n  span.FITB-inptCont[data-type=timebox] input:focus~label, span.FITB-inptCont[data-type=timebox] input:valid~label {\r\n    color: #57647e;\r\n  }\r\n\r\n  input::placeholder {\r\n    \r\n  }\r\n\r\n  \/* NEW THEME STYLE *\/\r\n  \/*PREFERENCES STYLE*\/\r\n\/* Begining of advanced designer *\/\r\n\/*PREFERENCES STYLE*\/\r\n\/*  1 - Preferences style *\/\r\n\/*  1 - FONT FAMILY *\/\r\n.form-all {\r\n  font-family: \"Inter\", sans-serif;\r\n}\r\n\/* 2 - FORM WIDTH *\/\r\n.form-all {\r\n  max-width: 1500px;\r\n}\r\n\/* 5 - FONT SIZE *\/\r\n.form-all {\r\n  font-size: 18px;\r\n}\r\n\/* 5 - input bg color *\/\r\n.form-textbox,\r\n.form-textarea,\r\n.form-radio-other-input,\r\n.form-checkbox-other-input,\r\n.form-captcha input,\r\n.form-spinner input {\r\n  background-color: #ffffff;\r\n}\r\n\/* 10 - LINE SPACING *\/\r\n.form-line {\r\n  margin-top: 12px;\r\n  margin-bottom: 12px;\r\n}\r\n.supernova .form-all,\r\n.form-all {\r\n  background-color: rgba(255, 255, 255, 0);\r\n}\r\n.supernova {\r\n  background-color: rgba(76, 90, 101, 0);\r\n}\r\n.supernova body {\r\n  background-color: transparent;\r\n}\r\n.form-all,\r\n.form-label-top,\r\n.form-label-left,\r\n.form-label-right,\r\n.form-html,\r\n.form-checkbox-item label,\r\n.form-radio-item label,\r\nspan.FITB .qb-checkbox-label,\r\nspan.FITB .qb-radiobox-label,\r\nspan.FITB .form-radio label,\r\nspan.FITB .form-checkbox label,\r\n[data-blotid][data-type=checkbox] [data-labelid],\r\n[data-blotid][data-type=radiobox] [data-labelid],\r\nspan.FITB-inptCont[data-type=checkbox] label,\r\nspan.FITB-inptCont[data-type=radiobox] label,\r\n.form-sub-label {\r\n  color: #ffffff;\r\n}\r\n\/*PREFERENCES STYLE*\/\r\n\/* 17 - INPUT WIDTHS *\/\r\n\/*  20 - FORM PADDING *\/\r\nul.form-section {\r\n  padding: 0px 38px;\r\n}\r\n.form-textbox:not(#productSearch-input),\r\n.form-textarea,\r\nli[data-type=control_fileupload] .qq-upload-button,\r\n.signature-wrapper {\r\n  border-color: rgba(195, 202, 216, 0.75);\r\n}\r\n.form-textarea:hover,\r\n.form-textbox:hover,\r\nli[data-type=control_fileupload] .qq-upload-button:hover,\r\n.signature-wrapper:hover {\r\n  border-color: rgba(195, 202, 216, 0.5);\r\n  box-shadow: 0 0 0 2px rgba(195, 202, 216, 0.25);\r\n}\r\n.form-textarea:focus,\r\n.form-textbox:focus,\r\nli[data-type=control_fileupload] .qq-upload-button:focus,\r\n.signature-wrapper:focus {\r\n  border-color: #c3cad8;\r\n  box-shadow: 0 0 0 3px rgba(195, 202, 216, 0.25);\r\n}\r\n\/* Heights *\/\r\n\/* 11 - LINE PADDING *\/\r\n\/* LABEL STYLE *\/\r\n.form-dropdown:first-child {\r\n  border-color: rgba(195, 202, 216, 0.75);\r\n  background-color: #ffffff;\r\n}\r\n\/* 12 - ROUNDED INPUTS *\/\r\n.supernova .form-all,\r\n.form-all {\r\n  border-radius: 3px;\r\n}\r\n.form-section:first-child {\r\n  border-radius: 3px 3px 0 0;\r\n}\r\n.form-section:last-child {\r\n  border-radius: 0 0 3px 3px;\r\n}\r\n.form-radio-item,\r\n.form-checkbox-item {\r\n  padding-bottom: 0px;\r\n}\r\n.form-radio-item:last-child,\r\n.form-checkbox-item:last-child {\r\n  padding-bottom: 0;\r\n}\r\n.form-single-column .form-checkbox-item,\r\n.form-single-column .form-radio-item {\r\n  width: 100%;\r\n}\r\n.form-checkbox-item .editor-container div,\r\n.form-radio-item .editor-container div {\r\n  position: relative;\r\n}\r\n.form-checkbox-item .editor-container div:before,\r\n.form-radio-item .editor-container div:before {\r\n  display: inline-block;\r\n  vertical-align: middle;\r\n  left: 0;\r\n  width: 20px;\r\n  height: 20px;\r\n}\r\n.submit-button {\r\n  font-size: 18px;\r\n  font-weight: bold;\r\n  font-family: inherit;\r\n  border: none;\r\n  border-width: 0px;\r\n  border-style: solid;\r\n  border-color: rgba(195, 202, 216, 0.75);\r\n}\r\n.submit-button {\r\n  min-width: 200px;\r\n}\r\nli[data-type=\"control_button\"] .form-submit-button {\r\n  color: #f1efe6;\r\n  background-color: #d07445;\r\n  background-image: none;\r\n  box-shadow: none;\r\n  text-shadow: none;\r\n}\r\nli[data-type=\"control_button\"] .form-submit-button:hover {\r\n  background-color: #8c4723;\r\n}\r\nli[data-type=\"control_button\"] button.jf-form-buttons.form-sacl-button,\r\nli[data-type=\"control_button\"] button.jf-form-buttons.form-submit-print {\r\n  color: #d07445;\r\n  border-color: #d07445;\r\n  background-image: none;\r\n  background-color: #fff;\r\n}\r\nli[data-type=\"control_button\"] button.jf-form-buttons.form-sacl-button:hover,\r\nli[data-type=\"control_button\"] button.jf-form-buttons.form-submit-print:hover {\r\n  background-color: #8c4723;\r\n  color: #fff;\r\n}\r\nli[data-type=\"control_button\"] button.jf-form-buttons.form-pagebreak-back {\r\n  background-image: none;\r\n  background-color: #8c4723;\r\n  box-shadow: none;\r\n  text-shadow: none;\r\n}\r\nli[data-type=\"control_button\"] button.jf-form-buttons.form-pagebreak-back:hover {\r\n  background-color: #633219;\r\n  color: #fff;\r\n}\r\n.form-buttons-wrapper,\r\n.form-submit-clear-wrapper {\r\n  justify-content: center;\r\n}\r\n.form-pagebreak-back,\r\n.form-pagebreak-next {\r\n  border-radius: 6px;\r\n}\r\n.form-all .form-pagebreak-back,\r\n.form-all .form-pagebreak-next {\r\n  font-family: \"Inter\", sans-serif;\r\n  font-size: 18px;\r\n  font-weight: bold;\r\n  border: none;\r\n  border-width: 0px;\r\n  border-style: solid;\r\n  border-color: false;\r\n}\r\n.form-all .form-pagebreak-back,\r\n.form-all .form-pagebreak-next {\r\n  min-width: 156px;\r\n}\r\n.form-all li[data-type=\"control_pagebreak\"] .form-pagebreak-next {\r\n  background-color: #d07445;\r\n  background-image: none;\r\n  box-shadow: none;\r\n  text-shadow: none;\r\n  color: #f1efe6;\r\n}\r\n.form-all li[data-type=\"control_pagebreak\"] .form-pagebreak-next:hover {\r\n  background-color: #8c4723;\r\n}\r\n.form-all li[data-type=\"control_pagebreak\"] button.jf-form-buttons.form-sacl-button {\r\n  color: #d07445;\r\n  border-color: #d07445;\r\n  background-image: none;\r\n  background-color: #fff;\r\n  color: #f1efe6;\r\n}\r\n.form-all li[data-type=\"control_pagebreak\"] button.jf-form-buttons.form-sacl-button:hover {\r\n  background-color: #8c4723;\r\n  color: #fff;\r\n}\r\n.form-all li[data-type=\"control_pagebreak\"] button.jf-form-buttons.form-pagebreak-back {\r\n  background-image: none;\r\n  background-color: #8c4723;\r\n  box-shadow: none;\r\n  text-shadow: none;\r\n  color: #f1efe6;\r\n}\r\n.form-all li[data-type=\"control_pagebreak\"] button.jf-form-buttons.form-pagebreak-back:hover {\r\n  background-color: #633219;\r\n  color: #fff;\r\n}\r\nli[data-type=\"control_image\"] div {\r\n  text-align: left;\r\n}\r\nli[data-type=\"control_image\"] img {\r\n  border: none;\r\n  border-width: 0px !important;\r\n  border-style: solid !important;\r\n  border-color: false !important;\r\n}\r\n.supernova {\r\n  background-repeat: no-repeat;\r\n  background-attachment: scroll;\r\n  background-position: center top;\r\n}\r\n.supernova {\r\n  background-image: none;\r\n}\r\n#stage {\r\n  background-image: none;\r\n}\r\n\/* | *\/\r\n.form-all {\r\n  background-repeat: no-repeat;\r\n  background-attachment: scroll;\r\n  background-position: center top;\r\n}\r\n.form-header-group {\r\n  background-repeat: no-repeat;\r\n  background-attachment: scroll;\r\n  background-position: center top;\r\n}\r\n.header-large h1.form-header {\r\n  font-size: 2em;\r\n}\r\n.header-large h2.form-header {\r\n  font-size: 1.5em;\r\n}\r\n.header-large h3.form-header {\r\n  font-size: 1.17em;\r\n}\r\n.header-large h1 + .form-subHeader {\r\n  font-size: 1em;\r\n}\r\n.header-large h2 + .form-subHeader {\r\n  font-size: .875em;\r\n}\r\n.header-large h3 + .form-subHeader {\r\n  font-size: .75em;\r\n}\r\n.header-default h1.form-header {\r\n  font-size: 2em;\r\n}\r\n.header-default h2.form-header {\r\n  font-size: 1.5em;\r\n}\r\n.header-default h3.form-header {\r\n  font-size: 1.17em;\r\n}\r\n.header-default h1 + .form-subHeader {\r\n  font-size: 1em;\r\n}\r\n.header-default h2 + .form-subHeader {\r\n  font-size: .875em;\r\n}\r\n.header-default h3 + .form-subHeader {\r\n  font-size: .75em;\r\n}\r\n.header-small h1.form-header {\r\n  font-size: 2em;\r\n}\r\n.header-small h2.form-header {\r\n  font-size: 1.5em;\r\n}\r\n.header-small h3.form-header {\r\n  font-size: 1.17em;\r\n}\r\n.header-small h1 + .form-subHeader {\r\n  font-size: 1em;\r\n}\r\n.header-small h2 + .form-subHeader {\r\n  font-size: .875em;\r\n}\r\n.header-small h3 + .form-subHeader {\r\n  font-size: .75em;\r\n}\r\n.form-header-group {\r\n  text-align: left;\r\n}\r\ndiv.form-header-group.header-large,\r\ndiv.form-header-group.hasImage {\r\n  margin: 0px -38px;\r\n}\r\ndiv.form-header-group.header-large,\r\ndiv.form-header-group.hasImage {\r\n  padding: 40px 52px;\r\n}\r\n.form-header-group .form-header,\r\n.form-header-group .form-subHeader {\r\n  color: #000000;\r\n}\r\n.form-line-error {\r\n  -webkit-transition-property: none;\r\n  -moz-transition-property: none;\r\n  -ms-transition-property: none;\r\n  -o-transition-property: none;\r\n  transition-property: none;\r\n  -webkit-transition-duration: 0.3s;\r\n  -moz-transition-duration: 0.3s;\r\n  -ms-transition-duration: 0.3s;\r\n  -o-transition-duration: 0.3s;\r\n  transition-duration: 0.3s;\r\n  -webkit-transition-timing-function: ease;\r\n  -moz-transition-timing-function: ease;\r\n  -ms-transition-timing-function: ease;\r\n  -o-transition-timing-function: ease;\r\n  transition-timing-function: ease;\r\n  background-color: #ffd6d6;\r\n}\r\n.form-line-error .form-error-message {\r\n  background-color: #f23a3c;\r\n  clear: both;\r\n  float: none;\r\n}\r\n.form-line-error .form-error-message .form-error-arrow {\r\n  border-bottom-color: #f23a3c;\r\n}\r\n.form-line-error input:not(#coupon-input),\r\n.form-line-error textarea,\r\n.form-line-error .form-validation-error {\r\n  border: 1px solid #f23a3c;\r\n  box-shadow: 0 0 3px #f23a3c;\r\n}\r\n.form-line-error {\r\n  -webkit-transition-property: none;\r\n  -moz-transition-property: none;\r\n  -ms-transition-property: none;\r\n  -o-transition-property: none;\r\n  transition-property: none;\r\n  -webkit-transition-duration: 0.3s;\r\n  -moz-transition-duration: 0.3s;\r\n  -ms-transition-duration: 0.3s;\r\n  -o-transition-duration: 0.3s;\r\n  transition-duration: 0.3s;\r\n  -webkit-transition-timing-function: ease;\r\n  -moz-transition-timing-function: ease;\r\n  -ms-transition-timing-function: ease;\r\n  -o-transition-timing-function: ease;\r\n  transition-timing-function: ease;\r\n  background-color: #ffd6d6;\r\n}\r\n.form-header-group .form-header,\r\n.form-header-group .form-subHeader {\r\n  color: #000000;\r\n}\r\n.form-line-active {\r\n  background-color: rgba(217, 142, 104, 0);\r\n}\r\n\/* 29 - FORM COLUMNS *\/\r\n.form-line-column {\r\n  width: calc(100\/2 * 1% - 8px);\r\n}\r\n\r\n\/*__INSPECT_SEPERATOR__*\/\r\n.form-label.form-label-top {\r\n    font-family : 'Roboto Flex',Sans-Serif;\r\n}\r\n\r\n.form-pagebreak-next {\r\n    font-family : 'Roboto Flex',Sans-Serif;\r\n}\r\n\r\n.form-submit-button {\r\n    font-family : 'Roboto Flex',Sans-Serif;\r\n}\r\n\r\n.form-submit-button-reports-400.form-pagebreak-back.jf-form-buttons {\r\n    font-family : 'Roboto Flex',Sans-Serif;\r\n}\r\n\r\n.form-section.page-section {\r\n    box-shadow : none;\r\n    border-radius : 10px;\r\n    background-color : transparent;\r\n}\r\n\r\n#form-pagebreak-back_2 {\r\n    background-color : #33333370;\r\n}\r\n\r\n#form-pagebreak-back_2:hover {\r\n    background-color : #33333390;\r\n}\r\n\r\n.form-all {\r\n    border : none;\r\n}\r\n\r\n.form-sub-label {\r\n    color : white;\r\n}\r\n\r\n.form-label.form-label-auto {\r\n    display : block;\r\n    float : none;\r\n    text-align : left;\r\n    width : 100%;\r\n}\r\n\r\n.badge-wrapper {\r\n    background : white;\r\n    margin-top : -10px;\r\n}\r\n\r\n.form-pagebreak-back.jf-form-buttons {\r\n    background-color : #909090 !important;\r\n    color : white;\r\n}\r\n\r\n.form-pagebreak-back.jf-form-buttons:hover {\r\n    background-color : #696969 !important;\r\n}\r\n\r\n@media only screen and (max-width: 650px){\r\n    ul.form-section {\r\n        padding : 0px !important;\r\n    }\r\n\r\n}\r\n\r\n\r\n    \/* Injected CSS Code *\/\r\n<\/style>\r\n\r\n<form class=\"jotform-form\" onsubmit=\"return typeof testSubmitFunction !== 'undefined' && testSubmitFunction();\" action=\"https:\/\/hipaa-submit.jotform.com\/submit\/233234415311039\" method=\"post\" name=\"form_233234415311039\" id=\"233234415311039\" accept-charset=\"utf-8\" autocomplete=\"off\"><input type=\"hidden\" name=\"formID\" value=\"233234415311039\" \/><input type=\"hidden\" id=\"JWTContainer\" value=\"\" \/><input type=\"hidden\" id=\"cardinalOrderNumber\" value=\"\" \/><input type=\"hidden\" id=\"jsExecutionTracker\" name=\"jsExecutionTracker\" value=\"build-date-1715134354142\" \/><input type=\"hidden\" id=\"submitSource\" name=\"submitSource\" value=\"unknown\" \/><input type=\"hidden\" id=\"buildDate\" name=\"buildDate\" value=\"1715134354142\" \/>\r\n  <div role=\"main\" class=\"form-all\">\r\n    <ul class=\"form-section page-section\">\r\n      <li class=\"form-line jf-required\" data-type=\"control_fullname\" id=\"id_3\" data-compound-hint=\"First Name,Last Name\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_3\" for=\"first_3\" aria-hidden=\"false\"> Name<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_3\" class=\"form-input-wide jf-required\" data-layout=\"full\">\r\n          <div data-wrapper-react=\"true\"><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"first\"><input type=\"text\" id=\"first_3\" name=\"q3_name[first]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"nope\" size=\"10\" placeholder=\"First Name\" data-component=\"first\" aria-labelledby=\"label_3\" required=\"\" value=\"\" \/><\/span><span class=\"form-sub-label-container\" style=\"vertical-align:top\" data-input-type=\"last\"><input type=\"text\" id=\"last_3\" name=\"q3_name[last]\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"nope\" size=\"15\" placeholder=\"Last Name\" data-component=\"last\" aria-labelledby=\"label_3\" required=\"\" value=\"\" \/><\/span><\/div>\r\n        <\/div>\r\n      <\/li>\r\n      <li class=\"form-line form-line-column form-col-1 jf-required\" data-type=\"control_email\" id=\"id_4\"><label class=\"form-label form-label-top\" id=\"label_4\" for=\"input_4\" aria-hidden=\"false\"> Email<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_4\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <input type=\"email\" id=\"input_4\" name=\"q4_email\" class=\"form-textbox validate[required, Email]\" data-defaultvalue=\"\" autoComplete=\"nope\" style=\"width:310px\" size=\"310\" placeholder=\"example@example.com\" data-component=\"email\" aria-labelledby=\"label_4\" required=\"\" value=\"\" \/> <\/div>\r\n      <\/li>\r\n      <li class=\"form-line form-line-column form-col-2 jf-required\" data-type=\"control_phone\" id=\"id_5\" data-compound-hint=\"(669) 282-2510\"><label class=\"form-label form-label-top\" id=\"label_5\" for=\"input_5_full\"> Phone Number<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_5\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <span class=\"form-sub-label-container\" style=\"vertical-align:top\"><input type=\"tel\" id=\"input_5_full\" name=\"q5_phoneNumber[full]\" data-type=\"mask-number\" class=\"mask-phone-number form-textbox validate[required, Fill Mask]\" data-defaultvalue=\"\" autoComplete=\"nope\" style=\"width:310px\" data-masked=\"true\" placeholder=\"(669) 282-2510\" data-component=\"phone\" aria-labelledby=\"label_5\" required=\"\" value=\"\" \/><\/span> <\/div>\r\n      <\/li>\r\n      <li class=\"form-line form-line-column form-col-3 jf-required\" data-type=\"control_number\" id=\"id_7\"><label class=\"form-label form-label-top\" id=\"label_7\" for=\"input_7\" aria-hidden=\"false\"> Child's Age<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_7\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <input type=\"number\" id=\"input_7\" name=\"q7_childsAge\" data-type=\"input-number\" class=\" form-number-input form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"nope\" style=\"width:310px\" size=\"310\" placeholder=\"e.g., 6\" data-component=\"number\" aria-labelledby=\"label_7\" required=\"\" step=\"any\" value=\"\" \/> <\/div>\r\n      <\/li>\r\n      <li class=\"form-line form-line-column form-col-4\" data-type=\"control_textbox\" id=\"id_8\"><label class=\"form-label form-label-top\" id=\"label_8\" for=\"input_8\" aria-hidden=\"false\"> Child's School <\/label>\r\n        <div id=\"cid_8\" class=\"form-input-wide\" data-layout=\"half\"> <input type=\"text\" id=\"input_8\" name=\"q8_childsSchool\" data-type=\"input-textbox\" class=\"form-textbox\" data-defaultvalue=\"\" autoComplete=\"nope\" style=\"width:310px\" size=\"310\" data-component=\"textbox\" aria-labelledby=\"label_8\" value=\"\" \/> <\/div>\r\n      <\/li>\r\n      <li class=\"form-line jf-required\" data-type=\"control_textarea\" id=\"id_15\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_15\" for=\"input_15\" aria-hidden=\"false\"> What are your presenting concerns? What should we know?<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_15\" class=\"form-input-wide jf-required\" data-layout=\"full\">\r\n          <div class=\"form-textarea-limit\"><span><textarea id=\"input_15\" class=\"form-textarea validate[required]\" name=\"q15_whatAre\" style=\"width:648px;height:163px\" data-component=\"textarea\" required=\"\" aria-labelledby=\"label_15\"><\/textarea>\r\n              <div class=\"form-textarea-limit-indicator\"><span data-limit=\"2000\" type=\"Letters\" data-minimum=\"-1\" data-typeminimum=\"Letters\" id=\"input_15-limit\">0\/2000<\/span><\/div>\r\n            <\/span><\/div>\r\n        <\/div>\r\n      <\/li>\r\n      <li class=\"form-line always-hidden\" data-type=\"control_widget\" id=\"id_28\">\r\n        <div id=\"cid_28\" class=\"form-input-wide always-hidden\" data-layout=\"full\">\r\n          <div style=\"width:100%;text-align:Left\" data-component=\"widget-directEmbed\">\r\n            <div class=\"direct-embed-widgets get-form-page-url-widget \" data-type=\"direct-embed\" style=\"width:1px;min-height:50px\"><input type='hidden' id='input_28' name='q28_typeA28' class='form-hidden getParentURL'>\r\n              <script type='text\/javascript' src='\/\/widgets.jotform.io\/getParentUrl\/min\/scripts.min.js'><\/script>\r\n            <\/div>\r\n          <\/div>\r\n        <\/div>\r\n      <\/li>\r\n      <li id=\"cid_9\" class=\"form-input-wide\" data-type=\"control_pagebreak\">\r\n        <div class=\"form-pagebreak\" data-component=\"pagebreak\">\r\n          <div class=\"form-pagebreak-back-container\"><button id=\"form-pagebreak-back_9\" type=\"button\" class=\"form-pagebreak-back  jf-form-buttons\" data-component=\"pagebreak-back\">Back<\/button><\/div>\r\n          <div class=\"form-pagebreak-next-container\"><button id=\"form-pagebreak-next_9\" type=\"button\" class=\"form-pagebreak-next  jf-form-buttons\" data-component=\"pagebreak-next\">Next<\/button><\/div>\r\n          <div style=\"clear:both\" class=\"pageInfo form-sub-label\" id=\"pageInfo_9\"><\/div>\r\n        <\/div>\r\n      <\/li>\r\n    <\/ul>\r\n    <ul class=\"form-section page-section\" style=\"display:none;\">\r\n      <li class=\"form-line jf-required\" data-type=\"control_radio\" id=\"id_11\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_11\" aria-hidden=\"false\"> How can we help?<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_11\" class=\"form-input-wide jf-required\" data-layout=\"full\">\r\n          <div class=\"form-single-column\" role=\"group\" aria-labelledby=\"label_11\" data-component=\"radio\"><span class=\"form-radio-item\" style=\"clear:left\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_11\" class=\"form-radio validate[required]\" id=\"input_11_0\" name=\"q11_howCan\" value=\"Evaluation &amp; Assessments\" required=\"\" \/><label id=\"label_input_11_0\" for=\"input_11_0\">Evaluation &amp; Assessments<\/label><\/span><span class=\"form-radio-item\" style=\"clear:left\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_11\" class=\"form-radio validate[required]\" id=\"input_11_1\" name=\"q11_howCan\" value=\"Support Services\" required=\"\" \/><label id=\"label_input_11_1\" for=\"input_11_1\">Support Services<\/label><\/span><span class=\"form-radio-item\" style=\"clear:left\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_11\" class=\"form-radio validate[required]\" id=\"input_11_2\" name=\"q11_howCan\" value=\"I&#x27;m not sure\" required=\"\" \/><label id=\"label_input_11_2\" for=\"input_11_2\">I'm not sure<\/label><\/span><\/div>\r\n        <\/div>\r\n      <\/li>\r\n      <li class=\"form-line always-hidden jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_12\"><label class=\"form-label form-label-top\" id=\"label_12\" for=\"input_12\" aria-hidden=\"false\"> Which assessment are you interested in?<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_12\" class=\"form-input-wide always-hidden jf-required\" data-layout=\"half\"> <select class=\"form-dropdown validate[required]\" id=\"input_12\" name=\"q12_whichAssessment\" style=\"width:310px\" data-component=\"dropdown\" required=\"\" aria-label=\"Which assessment are you interested in?\">\r\n            <option value=\"\">Please Select<\/option>\r\n            <option value=\"Autism Testing\">Autism Testing<\/option>\r\n            <option value=\"IQ Testing\">IQ Testing<\/option>\r\n            <option value=\"Psycho-Educational Evaluation\">Psycho-Educational Evaluation<\/option>\r\n            <option value=\"School Neuropsychological Evaluation\">School Neuropsychological Evaluation<\/option>\r\n            <option value=\"Speech and Language Evaluation\">Speech and Language Evaluation<\/option>\r\n            <option value=\"I&#x27;m Not Sure\">I&#x27;m Not Sure<\/option>\r\n          <\/select> <\/div>\r\n      <\/li>\r\n      <li class=\"form-line always-hidden jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_dropdown\" id=\"id_13\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_13\" for=\"input_13\" aria-hidden=\"false\"> Which service are you interested in?<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_13\" class=\"form-input-wide always-hidden jf-required\" data-layout=\"half\"> <select class=\"form-dropdown validate[required]\" id=\"input_13\" name=\"q13_whichService\" style=\"width:310px\" data-component=\"dropdown\" required=\"\" aria-label=\"Which service are you interested in?\">\r\n            <option value=\"\">Please Select<\/option>\r\n            <option value=\"Academic Boost Tutoring\">Academic Boost Tutoring<\/option>\r\n            <option value=\"Educational IEP Consulting\">Educational IEP Consulting<\/option>\r\n            <option value=\"Executive Function Coaching\">Executive Function Coaching<\/option>\r\n            <option value=\"Parent Coaching\">Parent Coaching<\/option>\r\n            <option value=\"Reading Intervention\">Reading Intervention<\/option>\r\n            <option value=\"Speech and Language Therapy\">Speech and Language Therapy<\/option>\r\n            <option value=\"I&#x27;m Not Sure\">I&#x27;m Not Sure<\/option>\r\n          <\/select> <\/div>\r\n      <\/li>\r\n      <li class=\"form-line jf-required\" data-type=\"control_radio\" id=\"id_10\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_10\" aria-hidden=\"false\"> Would you prefer email or phone for initial correspondence?<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_10\" class=\"form-input-wide jf-required\" data-layout=\"full\">\r\n          <div class=\"form-multiple-column\" data-columncount=\"3\" role=\"group\" aria-labelledby=\"label_10\" data-component=\"radio\"><span class=\"form-radio-item\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_10\" class=\"form-radio validate[required]\" id=\"input_10_0\" name=\"q10_wouldYou\" value=\"Phone\" required=\"\" \/><label id=\"label_input_10_0\" for=\"input_10_0\">Phone<\/label><\/span><span class=\"form-radio-item\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_10\" class=\"form-radio validate[required]\" id=\"input_10_1\" name=\"q10_wouldYou\" value=\"Email\" required=\"\" \/><label id=\"label_input_10_1\" for=\"input_10_1\">Email<\/label><\/span><span class=\"form-radio-item\"><span class=\"dragger-item\"><\/span><input type=\"radio\" aria-describedby=\"label_10\" class=\"form-radio validate[required]\" id=\"input_10_2\" name=\"q10_wouldYou\" value=\"Text\" required=\"\" \/><label id=\"label_input_10_2\" for=\"input_10_2\">Text<\/label><\/span><\/div>\r\n        <\/div>\r\n      <\/li>\r\n      <li class=\"form-line form-line-column form-col-1 jf-required\" data-type=\"control_dropdown\" id=\"id_20\"><label class=\"form-label form-label-top\" id=\"label_20\" for=\"input_20\" aria-hidden=\"false\"> How did you hear about us?<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_20\" class=\"form-input-wide jf-required\" data-layout=\"half\"> <select class=\"form-dropdown validate[required]\" id=\"input_20\" name=\"q20_typeA20\" style=\"width:310px\" data-component=\"dropdown\" required=\"\" aria-label=\"How did you hear about us?\">\r\n            <option value=\"\">Please Select<\/option>\r\n            <option value=\"Search Engine (e.g., Google)\">Search Engine (e.g., Google)<\/option>\r\n            <option value=\"Social Media\">Social Media<\/option>\r\n            <option value=\"Psychology Today\">Psychology Today<\/option>\r\n            <option value=\"Educational Referral (e.g., Teacher)\">Educational Referral (e.g., Teacher)<\/option>\r\n            <option value=\"Professional Referral (e.g., Therapist)\">Professional Referral (e.g., Therapist)<\/option>\r\n            <option value=\"Other (Please specify)\">Other (Please specify)<\/option>\r\n          <\/select> <\/div>\r\n      <\/li>\r\n      <li class=\"form-line form-line-column form-col-2 always-hidden jf-required form-field-hidden\" style=\"display:none;\" data-type=\"control_textbox\" id=\"id_21\"><label class=\"form-label form-label-top\" id=\"label_21\" for=\"input_21\" aria-hidden=\"false\"> Please Specify<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_21\" class=\"form-input-wide always-hidden jf-required\" data-layout=\"half\"> <input type=\"text\" id=\"input_21\" name=\"q21_whoReferred\" data-type=\"input-textbox\" class=\"form-textbox validate[required]\" data-defaultvalue=\"\" autoComplete=\"nope\" style=\"width:310px\" size=\"310\" data-component=\"textbox\" aria-labelledby=\"label_21\" required=\"\" value=\"\" \/> <\/div>\r\n      <\/li>\r\n      <li class=\"form-line jf-required\" data-type=\"control_checkbox\" id=\"id_19\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_19\" for=\"input_19_0\" aria-hidden=\"true\"> <span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_19\" class=\"form-input-wide jf-required\" data-layout=\"full\">\r\n          <div class=\"form-single-column\" role=\"group\" aria-labelledby=\"label_19\" data-component=\"checkbox\"><span class=\"form-checkbox-item\" style=\"clear:left\"><span class=\"dragger-item\"><\/span><input type=\"checkbox\" aria-describedby=\"label_19\" class=\"form-checkbox validate[required]\" id=\"input_19_0\" name=\"q19_typeA[]\" value=\"I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.\" required=\"\" \/><label id=\"label_input_19_0\" for=\"input_19_0\">I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.<\/label><\/span><\/div>\r\n        <\/div>\r\n      <\/li>\r\n      <li class=\"form-line jf-required\" data-type=\"control_captcha\" id=\"id_16\"><label class=\"form-label form-label-top form-label-auto\" id=\"label_16\" for=\"input_16\" aria-hidden=\"false\"> Please verify that you are human<span class=\"form-required\">*<\/span> <\/label>\r\n        <div id=\"cid_16\" class=\"form-input-wide jf-required\" data-layout=\"full\">\r\n          <section data-wrapper-react=\"true\">\r\n            <div id=\"recaptcha_input_16\" data-component=\"recaptcha\" data-callback=\"recaptchaCallbackinput_16\" data-expired-callback=\"recaptchaExpiredCallbackinput_16\"><\/div><input type=\"hidden\" id=\"input_16\" class=\"hidden validate[required]\" name=\"recaptcha_visible\" required=\"\" \/>\r\n            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<div data-align=\"auto\" class=\"form-buttons-wrapper form-buttons-auto   jsTest-button-wrapperField\"><button id=\"input_2\" type=\"submit\" class=\"form-submit-button submit-button jf-form-buttons jsTest-submitField\" data-component=\"button\" data-content=\"\">Submit<\/button><\/div>\r\n        <\/div>\r\n      <\/li>\r\n      <li style=\"display:none\">Should be Empty: <input type=\"text\" name=\"website\" value=\"\" type=\"hidden\" \/><\/li>\r\n    <\/ul>\r\n  <\/div>\r\n  <script>\r\n    JotForm.showJotFormPowered = \"0\";\r\n  <\/script>\r\n  <script>\r\n    JotForm.poweredByText = \"Powered by Jotform\";\r\n  <\/script>\r\n  <script>\r\n    JotForm.hipaa = true;\r\n  <\/script>\r\n  <script>\r\n    JotForm.showHIPAABadge = true;\r\n  <\/script><input type=\"hidden\" class=\"simple_spc\" id=\"simple_spc\" name=\"simple_spc\" value=\"233234415311039\" \/>\r\n  <script type=\"text\/javascript\">\r\n    var all_spc = document.querySelectorAll(\"form[id='233234415311039'] .si\" + \"mple\" + \"_spc\");\r\n    for (var i = 0; i < all_spc.length; i++)\r\n    {\r\n      all_spc[i].value = \"233234415311039-233234415311039\";\r\n    }\r\n  <\/script>\r\n<\/form><script type=\"text\/javascript\">JotForm.ownerView=true;<\/script><script type=\"text\/javascript\">JotForm.forwardToHIPAA=true;<\/script><script type=\"text\/javascript\">JotForm.isNewSACL=true;<\/script>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Billing, Payments &#038; Insurance Insurance: What You Need to Know Mind by Design, like other practices that offer similar services, is considered an out-of-network provider by insurance companies. As a result, we do not accept insurance directly. However, your health insurance company may reimburse some or all of your child&#8217;s services. To determine if you [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/www.themindbydesign.com\/wp-json\/wp\/v2\/pages\/6304"}],"collection":[{"href":"https:\/\/www.themindbydesign.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.themindbydesign.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.themindbydesign.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.themindbydesign.com\/wp-json\/wp\/v2\/comments?post=6304"}],"version-history":[{"count":148,"href":"https:\/\/www.themindbydesign.com\/wp-json\/wp\/v2\/pages\/6304\/revisions"}],"predecessor-version":[{"id":11436,"href":"https:\/\/www.themindbydesign.com\/wp-json\/wp\/v2\/pages\/6304\/revisions\/11436"}],"wp:attachment":[{"href":"https:\/\/www.themindbydesign.com\/wp-json\/wp\/v2\/media?parent=6304"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}