<iframe name="hidden_iframe" id="hidden_iframe" style="display:none;" onload="if(submitted) {window.location='/thank-you/';}"></iframe><!-- [et_pb_line_break_holder] --><div class="modal" id="id01"><!-- [et_pb_line_break_holder] --> <form action="https://docs.google.com/forms/d/e/1FAIpQLScBWIg6V17kTCw1SuYGy7uPmfE4oUrxaw1-mjyg0_KnwIcOhA/formResponse" method="post" target="hidden_iframe" onsubmit="submitted=true;" class="custom-google-form modal-content"><!-- [et_pb_line_break_holder] --> <a href="javascript:void(0)" class="closeNavbtn" onclick="document.getElementById('id01').style.display = 'none'" title="Close">×</a><!-- [et_pb_line_break_holder] --> <div class="form-tab"><!-- [et_pb_line_break_holder] --> <div class="form-top"><!-- [et_pb_line_break_holder] --> <h2>Referral <strong>Guidelines</strong></h2><!-- [et_pb_line_break_holder] --> <p>Before submitting, the contact must be aware that they are being referred.</p><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="form-bottom"><!-- [et_pb_line_break_holder] --> <input type="button" class="nextBtn" onclick="nextPrev(1)" value="Continue"> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="form-tab"><!-- [et_pb_line_break_holder] --> <div class="form-top"><!-- [et_pb_line_break_holder] --> <h2>Your <strong>Information</strong></h2><!-- [et_pb_line_break_holder] --> <p>Fields marked with (*) are required.</p><!-- [et_pb_line_break_holder] --> <input placeholder="First name *" name="entry.898665832" type="text" required="required"><!-- [et_pb_line_break_holder] --> <input placeholder="Last name *" name="entry.1292887185" type="text" required="required"><!-- [et_pb_line_break_holder] --> <input placeholder="Phone *" name="entry.1140780163" type="tel" required="required"> <!-- [et_pb_line_break_holder] --> <input placeholder="E-mail *" name="entry.230246881" type="email" required="required"><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="form-bottom"><!-- [et_pb_line_break_holder] --> <input type="button" class="nextBtn" onclick="nextPrev(1)" value="Continue"> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="form-tab"><!-- [et_pb_line_break_holder] --> <div class="form-top"><!-- [et_pb_line_break_holder] --> <h2>Person Being <strong>Referred</strong></h2><!-- [et_pb_line_break_holder] --> <p>Fields marked with (*) are required.</p><!-- [et_pb_line_break_holder] --> <input placeholder="First name *" name="entry.1854559638" type="text" required="required"><!-- [et_pb_line_break_holder] --> <input placeholder="Last name *" name="entry.2094610314" type="text" required="required"><!-- [et_pb_line_break_holder] --> <input placeholder="Phone *" name="entry.2099408034" type="tel" required="required"> <!-- [et_pb_line_break_holder] --> <input placeholder="E-mail *" name="entry.1419467868" type="email" required="required"><!-- [et_pb_line_break_holder] --> <input type="hidden" value="Pending" name="entry.51645090"><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="form-bottom"><!-- [et_pb_line_break_holder] --> <input type="button" class="prevBtn" onclick="nextPrev(-1)" value="Previous"> <!-- [et_pb_line_break_holder] --> <input type="submit" class="nextBtn" value="Submit"> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <!-- Circles which indicates the steps of the form: --><!-- [et_pb_line_break_holder] --> <div class="form-steps"><!-- [et_pb_line_break_holder] --> <span class="form-step"></span><!-- [et_pb_line_break_holder] --> <span class="form-step"></span> <!-- [et_pb_line_break_holder] --> <span class="form-step"></span> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </form><!-- [et_pb_line_break_holder] --></div><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><script src="https://ajax.googleapis.com/ajax/libs/jquery/3.3.1/jquery.min.js"></script><!-- [et_pb_line_break_holder] --><script><!-- [et_pb_line_break_holder] -->var submitted = false;<!-- [et_pb_line_break_holder] -->var currentTab = 0; 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