{"id":1170,"date":"2021-01-30T20:26:18","date_gmt":"2021-01-30T20:26:18","guid":{"rendered":"https:\/\/testosteronetraumaprovidernetwork.com\/?page_id=1170"},"modified":"2021-07-29T16:00:13","modified_gmt":"2021-07-29T21:00:13","slug":"provider-sign-up","status":"publish","type":"page","link":"https:\/\/testosteronetraumaprovidernetwork.com\/provider-sign-up\/","title":{"rendered":"Provider Sign Up"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\">\t\t\t\t\t<div class=\"fusion-slider-container fusion-slider-sc-provider-signup fusion-slider-53 full-width-slider\" data-id=\"53\" data-full_height=\"\" style=\"height:400px; max-width:100%;\">\n\t\t\t\t\t\t<style type=\"text\/css\">.fusion-slider-53 .flex-direction-nav a {width:63px;height:63px;line-height:63px;font-size:25px;}<\/style>\t\t\t\t\t\t<div class=\"fusion-slider-loading\">Loading...<\/div>\n\t\t\t\t\t\t<div class=\"tfs-slider flexslider main-flex full-width-slider\" data-slider_width=\"100%\" data-slider_height=\"400px\" data-full_screen=\"0\" data-parallax=\"0\" data-nav_arrows=\"1\" data-nav_arrow_size=\"25px\" data-nav_box_width=\"63px\" data-nav_box_height=\"63px\" data-slideshow_speed=\"7000\" data-loop=\"0\" data-autoplay=\"1\" data-orderby=\"date\" data-order=\"DESC\" data-animation=\"fade\" data-animation_speed=\"600\" data-typo_sensitivity=\"1\" data-typo_factor=\"1.5\" style=\"max-width:100%;\">\n\t\t\t\t\t\t\t<ul class=\"slides\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<li data-mute=\"yes\" data-loop=\"yes\" data-autoplay=\"yes\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"slide-content-container slide-content-left\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"slide-content\" style=\"\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"caption with-bg\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"fusion-title-sc-wrapper\" style=\"background-color: rgba(0, 0, 0, 0.4);\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<style type=\"text\/css\">@media only screen and (max-width:1024px) {.fusion-title.fusion-title-1{margin-top:0px!important; margin-right:!important;margin-bottom:0px!important;margin-left:!important;}}<\/style><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"font-size:24px;margin-top:0px;margin-bottom:0px;\"><h3 class=\"title-heading-left\" style=\"margin:0;font-size:1em;line-height:38px;\">Signup To Become a Provider<\/h3><\/div>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"buttons\" >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"background background-image\" style=\"background-image: url(https:\/\/testosteronetraumaprovidernetwork.com\/wp-content\/uploads\/2021\/07\/lady-on-laptop.jpg);max-width:100%;height:400px;filter: progid:DXImageTransform.Microsoft.AlphaImageLoader(src='https:\/\/testosteronetraumaprovidernetwork.com\/wp-content\/uploads\/2021\/07\/lady-on-laptop.jpg', sizingMethod='scale');\" data-imgwidth=\"1900\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-0{width:100% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-column-0 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-0{width:100% !important;order : 0;}.fusion-builder-column-0 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-0{width:100% !important;order : 0;}.fusion-builder-column-0 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-1{ padding-top : 0px;margin-top : 0px;padding-right : 0px;padding-bottom : 0px;margin-bottom : 0px;padding-left : 0px;}<\/style><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><style type=\"text\/css\">@media only screen and (max-width:1024px) {.fusion-title.fusion-title-2{margin-top:20px!important; margin-right:!important;margin-bottom:0px!important;margin-left:!important;}}<\/style><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-two\" style=\"font-size:38px;margin-top:20px;margin-bottom:0px;\"><h2 class=\"title-heading-center\" style=\"margin:0;font-size:1em;\">How Does It Work?<\/h2><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-1{width:100% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-column-1 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-1{width:100% !important;order : 0;}.fusion-builder-column-1 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-1{width:100% !important;order : 0;}.fusion-builder-column-1 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-2{ padding-top : 40px;margin-top : 0px;padding-right : 0px;padding-bottom : 40px;margin-bottom : 0px;padding-left : 0px;}<\/style><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_3 1_3 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 10px 10px 10px 10px;\"><div class=\"fusion-content-boxes content-boxes columns row fusion-columns-1 fusion-columns-total-1 fusion-content-boxes-1 content-boxes-clean-vertical content-left content-boxes-icon-on-top\" data-animationOffset=\"top-into-view\" style=\"margin-top:0px;margin-bottom:60px;\"><style type=\"text\/css\">.fusion-content-boxes-1 .heading .content-box-heading {color:#000000;}\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-link-icon-hover .heading .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-link-icon-hover .heading .heading-link .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box-hover .heading .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box-hover .heading .heading-link .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more::after,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more::before,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .fusion-read-more:hover:after,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .fusion-read-more:hover:before,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .fusion-read-more:hover,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more::after,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more::before,\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-link-icon-hover .icon .circle-no,\n\t\t\t\t\t.fusion-content-boxes-1 .heading .heading-link:hover .content-box-heading {\n\t\t\t\t\t\tcolor: #8e8e8e;\n\t\t\t\t\t}\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box-hover .icon .circle-no {\n\t\t\t\t\t\tcolor: #8e8e8e !important;\n\t\t\t\t\t}.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box.link-area-box-hover .fusion-content-box-button {background: #d60707;color: #780404;background-image: -webkit-gradient( linear, left bottom, left top, from( #e80707 ), to( #d60707 ) );background-image: linear-gradient( to top, #e80707, #d60707 )}.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box.link-area-box-hover .fusion-content-box-button .fusion-button-text {color: #780404;}\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-link-icon-hover .heading .icon > span {\n\t\t\t\t\t\tbackground-color: #8e8e8e !important;\n\t\t\t\t\t}\n\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box-hover .heading .icon > span {\n\t\t\t\t\t\tborder-color: #8e8e8e !important;\n\t\t\t\t\t}<\/style><div style=\"border-color:rgba(255,255,255,0);\" class=\"fusion-column content-box-column content-box-column content-box-column-1 col-lg-12 col-md-12 col-sm-12 fusion-content-box-hover content-box-column-last content-box-column-last-in-row\"><div class=\"col content-box-wrapper content-wrapper link-area-link-icon icon-hover-animation-fade\" style=\"background-color:rgba(255,255,255,0);\" data-animationOffset=\"top-into-view\"><div class=\"heading heading-with-icon icon-left\"><div class=\"icon\"><i style=\"border-color:#333333;border-width:0px;background-color:#3b5998;box-sizing:content-box;height:88px;width:88px;line-height:88px;border-radius:50%;color:#ffffff;font-size:44px;\" aria-hidden=\"true\" class=\"fontawesome-icon fa-chalkboard-teacher fas circle-yes\"><\/i><\/div><h2 class=\"content-box-heading\" style=\"font-size:26px;line-height:31px;\">Sign Up<\/h2><\/div><div class=\"fusion-clearfix\"><\/div><div class=\"content-container\" style=\"color:#747474;\">\n<p data-pm-slice=\"1 1 &#091;&#093;\">Signing up is quick and easy. In just a few easy steps, the #1 resource for those who are looking for providers to help them with Testosterone Trauma, Health and Personal Growth.<\/p>\n<\/div><\/div><\/div><style type=\"text\/css\">\n\t\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .heading-link:hover .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box:hover .heading-link .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-link-icon-hover .heading .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-1 .fusion-content-box-hover .link-area-box-hover .heading .icon i.circle-yes {\n\t\t\t\t\t\t\tbackground-color: #8e8e8e !important;\n\t\t\t\t\t\t\tborder-color: #8e8e8e !important;\n\t\t\t\t\t\t}<\/style><div class=\"fusion-clearfix\"><\/div><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-2{width:33.333333333333% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-column-2 > .fusion-column-wrapper {padding-top : 10 !important;padding-right : 10 !important;margin-right : 5.76%;padding-bottom : 10 !important;padding-left : 10 !important;margin-left : 5.76%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-2{width:33.333333333333% !important;order : 0;}.fusion-builder-column-2 > .fusion-column-wrapper {margin-right : 5.76%;margin-left : 5.76%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-2{width:100% !important;order : 0;}.fusion-builder-column-2 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_3 1_3 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 10px 10px 10px 10px;\"><div class=\"fusion-content-boxes content-boxes columns row fusion-columns-1 fusion-columns-total-1 fusion-content-boxes-2 content-boxes-clean-vertical content-left content-boxes-icon-on-top\" data-animationOffset=\"top-into-view\" style=\"margin-top:0px;margin-bottom:60px;\"><style type=\"text\/css\">.fusion-content-boxes-2 .heading .content-box-heading {color:#74748a;}\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-link-icon-hover .heading .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-link-icon-hover .heading .heading-link .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box-hover .heading .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box-hover .heading .heading-link .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more::after,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more::before,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .fusion-read-more:hover:after,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .fusion-read-more:hover:before,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .fusion-read-more:hover,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more::after,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more::before,\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-link-icon-hover .icon .circle-no,\n\t\t\t\t\t.fusion-content-boxes-2 .heading .heading-link:hover .content-box-heading {\n\t\t\t\t\t\tcolor: #878787;\n\t\t\t\t\t}\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box-hover .icon .circle-no {\n\t\t\t\t\t\tcolor: #878787 !important;\n\t\t\t\t\t}.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box.link-area-box-hover .fusion-content-box-button {background: #d60707;color: #780404;background-image: -webkit-gradient( linear, left bottom, left top, from( #e80707 ), to( #d60707 ) );background-image: linear-gradient( to top, #e80707, #d60707 )}.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box.link-area-box-hover .fusion-content-box-button .fusion-button-text {color: #780404;}\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-link-icon-hover .heading .icon > span {\n\t\t\t\t\t\tbackground-color: #878787 !important;\n\t\t\t\t\t}\n\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box-hover .heading .icon > span {\n\t\t\t\t\t\tborder-color: #878787 !important;\n\t\t\t\t\t}<\/style><div style=\"border-color:rgba(255,255,255,0);\" class=\"fusion-column content-box-column content-box-column content-box-column-1 col-lg-12 col-md-12 col-sm-12 fusion-content-box-hover content-box-column-last content-box-column-last-in-row\"><div class=\"col content-box-wrapper content-wrapper link-area-link-icon icon-hover-animation-fade\" style=\"background-color:rgba(255,255,255,0);\" data-animationOffset=\"top-into-view\"><div class=\"heading heading-with-icon icon-left\"><div class=\"icon\"><i style=\"border-color:#333333;border-width:0px;background-color:#3b5998;box-sizing:content-box;height:88px;width:88px;line-height:88px;border-radius:50%;color:#ffffff;font-size:44px;\" aria-hidden=\"true\" class=\"fontawesome-icon fa-pencil-ruler fas circle-yes\"><\/i><\/div><h2 class=\"content-box-heading\" style=\"font-size:26px;line-height:31px;\">Create<\/h2><\/div><div class=\"fusion-clearfix\"><\/div><div class=\"content-container\" style=\"color:#747474;\">\n<p data-pm-slice=\"1 1 &#091;&#093;\">Complete your professional profile. Prospective patients\/clients will have all the information they need to give them peace of mind when choosing you as one of their providers.<\/p>\n<\/div><\/div><\/div><style type=\"text\/css\">\n\t\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .heading-link:hover .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box:hover .heading-link .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-link-icon-hover .heading .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-2 .fusion-content-box-hover .link-area-box-hover .heading .icon i.circle-yes {\n\t\t\t\t\t\t\tbackground-color: #878787 !important;\n\t\t\t\t\t\t\tborder-color: #878787 !important;\n\t\t\t\t\t\t}<\/style><div class=\"fusion-clearfix\"><\/div><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-3{width:33.333333333333% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-column-3 > .fusion-column-wrapper {padding-top : 10 !important;padding-right : 10 !important;margin-right : 5.76%;padding-bottom : 10 !important;padding-left : 10 !important;margin-left : 5.76%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-3{width:33.333333333333% !important;order : 0;}.fusion-builder-column-3 > .fusion-column-wrapper {margin-right : 5.76%;margin-left : 5.76%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-3{width:100% !important;order : 0;}.fusion-builder-column-3 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_3 1_3 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 10px 10px 10px 10px;\"><div class=\"fusion-content-boxes content-boxes columns row fusion-columns-1 fusion-columns-total-1 fusion-content-boxes-3 content-boxes-clean-vertical content-left content-boxes-icon-on-top\" data-animationOffset=\"top-into-view\" style=\"margin-top:0px;margin-bottom:60px;\"><style type=\"text\/css\">.fusion-content-boxes-3 .heading .content-box-heading {color:#74748a;}\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-link-icon-hover .heading .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-link-icon-hover .heading .heading-link .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box-hover .heading .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box-hover .heading .heading-link .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more::after,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more::before,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .fusion-read-more:hover:after,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .fusion-read-more:hover:before,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .fusion-read-more:hover,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more::after,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more::before,\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-link-icon-hover .icon .circle-no,\n\t\t\t\t\t.fusion-content-boxes-3 .heading .heading-link:hover .content-box-heading {\n\t\t\t\t\t\tcolor: #878787;\n\t\t\t\t\t}\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box-hover .icon .circle-no {\n\t\t\t\t\t\tcolor: #878787 !important;\n\t\t\t\t\t}.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box.link-area-box-hover .fusion-content-box-button {background: #d60707;color: #780404;background-image: -webkit-gradient( linear, left bottom, left top, from( #e80707 ), to( #d60707 ) );background-image: linear-gradient( to top, #e80707, #d60707 )}.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box.link-area-box-hover .fusion-content-box-button .fusion-button-text {color: #780404;}\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-link-icon-hover .heading .icon > span {\n\t\t\t\t\t\tbackground-color: #878787 !important;\n\t\t\t\t\t}\n\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box-hover .heading .icon > span {\n\t\t\t\t\t\tborder-color: #878787 !important;\n\t\t\t\t\t}<\/style><div style=\"border-color:rgba(255,255,255,0);\" class=\"fusion-column content-box-column content-box-column content-box-column-1 col-lg-12 col-md-12 col-sm-12 fusion-content-box-hover content-box-column-last content-box-column-last-in-row\"><div class=\"col content-box-wrapper content-wrapper link-area-link-icon icon-hover-animation-fade\" style=\"background-color:rgba(255,255,255,0);\" data-animationOffset=\"top-into-view\"><div class=\"heading heading-with-icon icon-left\"><div class=\"icon\"><i style=\"border-color:#333333;border-width:0px;background-color:#3b5998;box-sizing:content-box;height:88px;width:88px;line-height:88px;border-radius:50%;color:#ffffff;font-size:44px;\" aria-hidden=\"true\" class=\"fontawesome-icon fa-pencil-ruler fas circle-yes\"><\/i><\/div><h2 class=\"content-box-heading\" style=\"font-size:26px;line-height:31px;\">Create<\/h2><\/div><div class=\"fusion-clearfix\"><\/div><div class=\"content-container\" style=\"color:#747474;\">\n<p data-pm-slice=\"1 1 &#091;&#093;\">Complete your professional profile. Prospective patients\/clients will have all the information they need to give them peace of mind when choosing you as one of their providers.<\/p>\n<\/div><\/div><\/div><style type=\"text\/css\">\n\t\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .heading-link:hover .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box:hover .heading-link .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-link-icon-hover .heading .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-3 .fusion-content-box-hover .link-area-box-hover .heading .icon i.circle-yes {\n\t\t\t\t\t\t\tbackground-color: #878787 !important;\n\t\t\t\t\t\t\tborder-color: #878787 !important;\n\t\t\t\t\t\t}<\/style><div class=\"fusion-clearfix\"><\/div><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-4{width:33.333333333333% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-column-4 > .fusion-column-wrapper {padding-top : 10 !important;padding-right : 10 !important;margin-right : 5.76%;padding-bottom : 10 !important;padding-left : 10 !important;margin-left : 5.76%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-4{width:33.333333333333% !important;order : 0;}.fusion-builder-column-4 > .fusion-column-wrapper {margin-right : 5.76%;margin-left : 5.76%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-4{width:100% !important;order : 0;}.fusion-builder-column-4 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-3{ padding-top : 0px;margin-top : 0px;padding-right : 0px;padding-bottom : 0px;margin-bottom : 0px;padding-left : 0px;}<\/style><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"max-width:1248px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><div class=\"fusion-content-boxes content-boxes columns row fusion-columns-1 fusion-columns-total-1 fusion-content-boxes-4 content-boxes-clean-vertical content-left content-boxes-icon-on-top\" data-animationOffset=\"top-into-view\" style=\"margin-top:0px;margin-bottom:60px;\"><style type=\"text\/css\">.fusion-content-boxes-4 .heading .content-box-heading {color:#000000;}\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-link-icon-hover .heading .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-link-icon-hover .heading .heading-link .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box-hover .heading .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box-hover .heading .heading-link .content-box-heading,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more::after,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-link-icon-hover.link-area-box .fusion-read-more::before,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .fusion-read-more:hover:after,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .fusion-read-more:hover:before,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .fusion-read-more:hover,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more::after,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box-hover.link-area-box .fusion-read-more::before,\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-link-icon-hover .icon .circle-no,\n\t\t\t\t\t.fusion-content-boxes-4 .heading .heading-link:hover .content-box-heading {\n\t\t\t\t\t\tcolor: #919191;\n\t\t\t\t\t}\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box-hover .icon .circle-no {\n\t\t\t\t\t\tcolor: #919191 !important;\n\t\t\t\t\t}.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box.link-area-box-hover .fusion-content-box-button {background: #d60707;color: #780404;background-image: -webkit-gradient( linear, left bottom, left top, from( #e80707 ), to( #d60707 ) );background-image: linear-gradient( to top, #e80707, #d60707 )}.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box.link-area-box-hover .fusion-content-box-button .fusion-button-text {color: #780404;}\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-link-icon-hover .heading .icon > span {\n\t\t\t\t\t\tbackground-color: #919191 !important;\n\t\t\t\t\t}\n\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box-hover .heading .icon > span {\n\t\t\t\t\t\tborder-color: #919191 !important;\n\t\t\t\t\t}<\/style><div style=\"border-color:rgba(255,255,255,0);\" class=\"fusion-column content-box-column content-box-column content-box-column-1 col-lg-12 col-md-12 col-sm-12 fusion-content-box-hover content-box-column-last content-box-column-last-in-row\"><div class=\"col content-box-wrapper content-wrapper link-area-link-icon icon-hover-animation-fade\" style=\"background-color:rgba(255,255,255,0);\" data-animationOffset=\"top-into-view\"><div class=\"heading heading-with-icon icon-left\"><div class=\"icon\"><i style=\"border-color:#333333;border-width:0px;background-color:#3b5998;box-sizing:content-box;height:88px;width:88px;line-height:88px;border-radius:50%;color:#ffffff;font-size:44px;\" aria-hidden=\"true\" class=\"fontawesome-icon fa-money-bill fas circle-yes\"><\/i><\/div><h2 class=\"content-box-heading\" style=\"font-size:26px;line-height:31px;\">Membership<\/h2><\/div><div class=\"fusion-clearfix\"><\/div><div class=\"content-container\" style=\"color:#747474;\">\n<p data-pm-slice=\"1 1 &#091;&#093;\">Monthly $8.25 = Annually $99.00<\/p>\n<p data-pm-slice=\"1 1 &#091;&#093;\">Annual Membership $60.00 that&#8217;s a savings of 40%<\/p>\n<\/div><\/div><\/div><style type=\"text\/css\">\n\t\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .heading-link:hover .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box:hover .heading-link .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-link-icon-hover .heading .icon i.circle-yes,\n\t\t\t\t\t\t.fusion-content-boxes-4 .fusion-content-box-hover .link-area-box-hover .heading .icon i.circle-yes {\n\t\t\t\t\t\t\tbackground-color: #919191 !important;\n\t\t\t\t\t\t\tborder-color: #919191 !important;\n\t\t\t\t\t\t}<\/style><div class=\"fusion-clearfix\"><\/div><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-5{width:100% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-column-5 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-5{width:100% !important;order : 0;}.fusion-builder-column-5 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-5{width:100% !important;order : 0;}.fusion-builder-column-5 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-4{ padding-top : 0px;margin-top : 0px;padding-right : 0px;padding-bottom : 0px;margin-bottom : 0px;padding-left : 0px;}<\/style><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-5 fusion-flex-container hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"width:calc( 100% + 0px ) !important;max-width:calc( 100% + 0px ) !important;margin-left: calc(-0px \/ 2 );margin-right: calc(-0px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><div class=\"fusion-builder-row fusion-builder-row-inner fusion-row fusion-flex-align-items-flex-start\" style=\"width:calc( 100% + 0px ) !important;max-width:calc( 100% + 0px ) !important;margin-left: calc(-0px \/ 2 );margin-right: calc(-0px \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-0 fusion_builder_column_inner_1_4 1_4 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-nested-column-0{width:25% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-nested-column-0 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 0px;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 0px;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-nested-column-0{width:25% !important;order : 0;}.fusion-builder-nested-column-0 > .fusion-column-wrapper {margin-right : 0px;margin-left : 0px;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-nested-column-0{width:100% !important;order : 0;}.fusion-builder-nested-column-0 > .fusion-column-wrapper {margin-right : 0px;margin-left : 0px;}}<\/style><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-1 fusion_builder_column_inner_1_2 1_2 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-nested-column-1{width:50% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-nested-column-1 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 0px;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 0px;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-nested-column-1{width:50% !important;order : 0;}.fusion-builder-nested-column-1 > .fusion-column-wrapper {margin-right : 0px;margin-left : 0px;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-nested-column-1{width:100% !important;order : 0;}.fusion-builder-nested-column-1 > .fusion-column-wrapper {margin-right : 0px;margin-left : 0px;}}<\/style><\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-2 fusion_builder_column_inner_1_4 1_4 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-nested-column-2{width:25% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-nested-column-2 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 0px;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 0px;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-nested-column-2{width:25% !important;order : 0;}.fusion-builder-nested-column-2 > .fusion-column-wrapper {margin-right : 0px;margin-left : 0px;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-nested-column-2{width:100% !important;order : 0;}.fusion-builder-nested-column-2 > .fusion-column-wrapper {margin-right : 0px;margin-left : 0px;}}<\/style><\/div><\/div><div id=\"drts-platform-render-6743c2406c36d-1\" class=\"drts drts-main\"><h2>Providers: Add Listing<\/h2>\n\n<form id=\"drts-form-f7453e5a114edd354df2bdc233018cae\" method=\"post\" action=\"https:\/\/testosteronetraumaprovidernetwork.com\/add-directory-listing\/\" class=\"drts-form drts-payment-addentity-add drts-entity-form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-form-name=\"payment_addentity_add\">\n<div data-display-type=\"form\" data-display-name=\"default\" class=\"drts-display drts-display-name-form-default drts-display-default-default\"><div data-name=\"entity_form_entity_title\" class=\"drts-display-element drts-display-element-entity_form_entity_title-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-entity-title drts-entity-form-field-name-post-title drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[post_title]\">\n<label>Title<\/label>\n<div class=\"drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[post_title][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[post_title][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_string\" class=\"drts-display-element drts-display-element-entity_form_string-2 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-string drts-entity-form-field-name-field-name-and-credentials drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_name_and_credentials]\">\n<label>Name and Credentials<\/label>\n<div class=\"drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_name_and_credentials][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_name_and_credentials][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_email\" class=\"drts-display-element drts-display-element-entity_form_email-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-email drts-entity-form-field-name-field-email drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_email]\">\n<label>E-mail Address<\/label>\n<div class=\"drts-form-field drts-form-type-email\" style=\"\" data-form-field-name=\"drts[field_email][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_email][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_phone\" class=\"drts-display-element drts-display-element-entity_form_phone-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-phone drts-entity-form-field-name-field-phone drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_phone]\">\n<label>Phone Number<\/label>\n<div class=\"drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_phone][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_phone][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_phone\" class=\"drts-display-element drts-display-element-entity_form_phone-2\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-phone drts-entity-form-field-name-field-fax drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_fax]\">\n<label>Fax Number<\/label>\n<div class=\"drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_fax][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_fax][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_location_address\" class=\"drts-display-element drts-display-element-entity_form_location_address-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-location-address drts-entity-form-field-name-location-address drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[location_address]\">\n<label>Location<\/label>\n<div class=\"drts-bs-form-group drts-location-address-container drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[location_address][0]\">\n<div class=\"drts-bs-form-group drts-form-field drts-form-type-location-address\" style=\"\" data-scrollwheel=\"0\" data-center-lng=\"-73.95144\" data-center-lat=\"40.69847\" data-lng=\"\" data-lat=\"\" data-zoom=\"10\" data-map-type=\"roadmap\" data-form-field-name=\"drts[location_address][0][location][address]\">\n<div class=\"drts-bs-form-group drts-bs-form-row drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[location_address][0][location][address][street]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>Address Line 1<\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <input name=\"drts[location_address][0][location][address][street]\" type=\"text\" value=\"\" class=\"drts-bs-form-control drts-location-find-address-component drts-location-address-street\" maxlength=\"255\" \/>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<div class=\"drts-bs-form-group drts-bs-form-row drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[location_address][0][location][address][zip]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>Postal \/ Zip Code<\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <input name=\"drts[location_address][0][location][address][zip]\" type=\"text\" value=\"\" class=\"drts-bs-form-control drts-location-find-address-component drts-location-address-zip\" maxlength=\"255\" \/>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<div class=\"drts-bs-form-group drts-bs-form-row drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[location_address][0][location][address][city]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>City<\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <input name=\"drts[location_address][0][location][address][city]\" type=\"text\" value=\"\" class=\"drts-bs-form-control drts-location-find-address-component drts-location-address-city\" maxlength=\"255\" \/>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<div class=\"drts-bs-form-group drts-bs-form-row drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[location_address][0][location][address][province]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>State \/ Province \/ Region<\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <input name=\"drts[location_address][0][location][address][province]\" type=\"text\" value=\"\" class=\"drts-bs-form-control drts-location-find-address-component drts-location-address-province\" maxlength=\"255\" \/>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<div class=\"drts-bs-form-group drts-bs-form-row drts-location-address-timezone drts-form-field drts-form-type-select\" style=\"\" data-form-field-name=\"drts[location_address][0][location][address][timezone]\">\n        <div class=\"drts-bs-col-sm-3 drts-bs-col-form-label \"><label>Timezone<\/label><\/div>\n        <div class=\"drts-bs-col-sm-9 drts-form-field-main\">\n            \n            <select class=\"drts-bs-form-control \" name=\"drts[location_address][0][location][address][timezone]\" data-default-value=\"America\/Chicago\"><option value=\"\"><\/option>\n<option value=\"Africa\/Abidjan\">Africa\/Abidjan<\/option>\n<option value=\"Africa\/Accra\">Africa\/Accra<\/option>\n<option value=\"Africa\/Addis_Ababa\">Africa\/Addis_Ababa<\/option>\n<option value=\"Africa\/Algiers\">Africa\/Algiers<\/option>\n<option value=\"Africa\/Asmara\">Africa\/Asmara<\/option>\n<option value=\"Africa\/Bamako\">Africa\/Bamako<\/option>\n<option value=\"Africa\/Bangui\">Africa\/Bangui<\/option>\n<option value=\"Africa\/Banjul\">Africa\/Banjul<\/option>\n<option value=\"Africa\/Bissau\">Africa\/Bissau<\/option>\n<option value=\"Africa\/Blantyre\">Africa\/Blantyre<\/option>\n<option value=\"Africa\/Brazzaville\">Africa\/Brazzaville<\/option>\n<option value=\"Africa\/Bujumbura\">Africa\/Bujumbura<\/option>\n<option value=\"Africa\/Cairo\">Africa\/Cairo<\/option>\n<option value=\"Africa\/Casablanca\">Africa\/Casablanca<\/option>\n<option value=\"Africa\/Ceuta\">Africa\/Ceuta<\/option>\n<option value=\"Africa\/Conakry\">Africa\/Conakry<\/option>\n<option value=\"Africa\/Dakar\">Africa\/Dakar<\/option>\n<option value=\"Africa\/Dar_es_Salaam\">Africa\/Dar_es_Salaam<\/option>\n<option value=\"Africa\/Djibouti\">Africa\/Djibouti<\/option>\n<option value=\"Africa\/Douala\">Africa\/Douala<\/option>\n<option value=\"Africa\/El_Aaiun\">Africa\/El_Aaiun<\/option>\n<option value=\"Africa\/Freetown\">Africa\/Freetown<\/option>\n<option value=\"Africa\/Gaborone\">Africa\/Gaborone<\/option>\n<option value=\"Africa\/Harare\">Africa\/Harare<\/option>\n<option value=\"Africa\/Johannesburg\">Africa\/Johannesburg<\/option>\n<option value=\"Africa\/Juba\">Africa\/Juba<\/option>\n<option value=\"Africa\/Kampala\">Africa\/Kampala<\/option>\n<option value=\"Africa\/Khartoum\">Africa\/Khartoum<\/option>\n<option value=\"Africa\/Kigali\">Africa\/Kigali<\/option>\n<option value=\"Africa\/Kinshasa\">Africa\/Kinshasa<\/option>\n<option value=\"Africa\/Lagos\">Africa\/Lagos<\/option>\n<option value=\"Africa\/Libreville\">Africa\/Libreville<\/option>\n<option value=\"Africa\/Lome\">Africa\/Lome<\/option>\n<option value=\"Africa\/Luanda\">Africa\/Luanda<\/option>\n<option value=\"Africa\/Lubumbashi\">Africa\/Lubumbashi<\/option>\n<option value=\"Africa\/Lusaka\">Africa\/Lusaka<\/option>\n<option value=\"Africa\/Malabo\">Africa\/Malabo<\/option>\n<option value=\"Africa\/Maputo\">Africa\/Maputo<\/option>\n<option value=\"Africa\/Maseru\">Africa\/Maseru<\/option>\n<option value=\"Africa\/Mbabane\">Africa\/Mbabane<\/option>\n<option value=\"Africa\/Mogadishu\">Africa\/Mogadishu<\/option>\n<option value=\"Africa\/Monrovia\">Africa\/Monrovia<\/option>\n<option value=\"Africa\/Nairobi\">Africa\/Nairobi<\/option>\n<option value=\"Africa\/Ndjamena\">Africa\/Ndjamena<\/option>\n<option value=\"Africa\/Niamey\">Africa\/Niamey<\/option>\n<option value=\"Africa\/Nouakchott\">Africa\/Nouakchott<\/option>\n<option value=\"Africa\/Ouagadougou\">Africa\/Ouagadougou<\/option>\n<option value=\"Africa\/Porto-Novo\">Africa\/Porto-Novo<\/option>\n<option value=\"Africa\/Sao_Tome\">Africa\/Sao_Tome<\/option>\n<option value=\"Africa\/Tripoli\">Africa\/Tripoli<\/option>\n<option value=\"Africa\/Tunis\">Africa\/Tunis<\/option>\n<option value=\"Africa\/Windhoek\">Africa\/Windhoek<\/option>\n<option value=\"America\/Adak\">America\/Adak<\/option>\n<option value=\"America\/Anchorage\">America\/Anchorage<\/option>\n<option value=\"America\/Anguilla\">America\/Anguilla<\/option>\n<option value=\"America\/Antigua\">America\/Antigua<\/option>\n<option value=\"America\/Araguaina\">America\/Araguaina<\/option>\n<option value=\"America\/Argentina\/Buenos_Aires\">America\/Argentina\/Buenos_Aires<\/option>\n<option value=\"America\/Argentina\/Catamarca\">America\/Argentina\/Catamarca<\/option>\n<option value=\"America\/Argentina\/Cordoba\">America\/Argentina\/Cordoba<\/option>\n<option value=\"America\/Argentina\/Jujuy\">America\/Argentina\/Jujuy<\/option>\n<option value=\"America\/Argentina\/La_Rioja\">America\/Argentina\/La_Rioja<\/option>\n<option value=\"America\/Argentina\/Mendoza\">America\/Argentina\/Mendoza<\/option>\n<option value=\"America\/Argentina\/Rio_Gallegos\">America\/Argentina\/Rio_Gallegos<\/option>\n<option value=\"America\/Argentina\/Salta\">America\/Argentina\/Salta<\/option>\n<option value=\"America\/Argentina\/San_Juan\">America\/Argentina\/San_Juan<\/option>\n<option value=\"America\/Argentina\/San_Luis\">America\/Argentina\/San_Luis<\/option>\n<option value=\"America\/Argentina\/Tucuman\">America\/Argentina\/Tucuman<\/option>\n<option value=\"America\/Argentina\/Ushuaia\">America\/Argentina\/Ushuaia<\/option>\n<option value=\"America\/Aruba\">America\/Aruba<\/option>\n<option value=\"America\/Asuncion\">America\/Asuncion<\/option>\n<option value=\"America\/Atikokan\">America\/Atikokan<\/option>\n<option value=\"America\/Bahia\">America\/Bahia<\/option>\n<option value=\"America\/Bahia_Banderas\">America\/Bahia_Banderas<\/option>\n<option value=\"America\/Barbados\">America\/Barbados<\/option>\n<option value=\"America\/Belem\">America\/Belem<\/option>\n<option value=\"America\/Belize\">America\/Belize<\/option>\n<option value=\"America\/Blanc-Sablon\">America\/Blanc-Sablon<\/option>\n<option value=\"America\/Boa_Vista\">America\/Boa_Vista<\/option>\n<option value=\"America\/Bogota\">America\/Bogota<\/option>\n<option value=\"America\/Boise\">America\/Boise<\/option>\n<option value=\"America\/Cambridge_Bay\">America\/Cambridge_Bay<\/option>\n<option value=\"America\/Campo_Grande\">America\/Campo_Grande<\/option>\n<option value=\"America\/Cancun\">America\/Cancun<\/option>\n<option value=\"America\/Caracas\">America\/Caracas<\/option>\n<option value=\"America\/Cayenne\">America\/Cayenne<\/option>\n<option value=\"America\/Cayman\">America\/Cayman<\/option>\n<option value=\"America\/Chicago\" selected=\"selected\">America\/Chicago<\/option>\n<option value=\"America\/Chihuahua\">America\/Chihuahua<\/option>\n<option value=\"America\/Ciudad_Juarez\">America\/Ciudad_Juarez<\/option>\n<option value=\"America\/Costa_Rica\">America\/Costa_Rica<\/option>\n<option value=\"America\/Creston\">America\/Creston<\/option>\n<option value=\"America\/Cuiaba\">America\/Cuiaba<\/option>\n<option value=\"America\/Curacao\">America\/Curacao<\/option>\n<option value=\"America\/Danmarkshavn\">America\/Danmarkshavn<\/option>\n<option value=\"America\/Dawson\">America\/Dawson<\/option>\n<option value=\"America\/Dawson_Creek\">America\/Dawson_Creek<\/option>\n<option value=\"America\/Denver\">America\/Denver<\/option>\n<option value=\"America\/Detroit\">America\/Detroit<\/option>\n<option value=\"America\/Dominica\">America\/Dominica<\/option>\n<option value=\"America\/Edmonton\">America\/Edmonton<\/option>\n<option value=\"America\/Eirunepe\">America\/Eirunepe<\/option>\n<option value=\"America\/El_Salvador\">America\/El_Salvador<\/option>\n<option value=\"America\/Fort_Nelson\">America\/Fort_Nelson<\/option>\n<option value=\"America\/Fortaleza\">America\/Fortaleza<\/option>\n<option value=\"America\/Glace_Bay\">America\/Glace_Bay<\/option>\n<option value=\"America\/Goose_Bay\">America\/Goose_Bay<\/option>\n<option value=\"America\/Grand_Turk\">America\/Grand_Turk<\/option>\n<option value=\"America\/Grenada\">America\/Grenada<\/option>\n<option value=\"America\/Guadeloupe\">America\/Guadeloupe<\/option>\n<option value=\"America\/Guatemala\">America\/Guatemala<\/option>\n<option value=\"America\/Guayaquil\">America\/Guayaquil<\/option>\n<option value=\"America\/Guyana\">America\/Guyana<\/option>\n<option value=\"America\/Halifax\">America\/Halifax<\/option>\n<option value=\"America\/Havana\">America\/Havana<\/option>\n<option value=\"America\/Hermosillo\">America\/Hermosillo<\/option>\n<option value=\"America\/Indiana\/Indianapolis\">America\/Indiana\/Indianapolis<\/option>\n<option value=\"America\/Indiana\/Knox\">America\/Indiana\/Knox<\/option>\n<option value=\"America\/Indiana\/Marengo\">America\/Indiana\/Marengo<\/option>\n<option value=\"America\/Indiana\/Petersburg\">America\/Indiana\/Petersburg<\/option>\n<option value=\"America\/Indiana\/Tell_City\">America\/Indiana\/Tell_City<\/option>\n<option value=\"America\/Indiana\/Vevay\">America\/Indiana\/Vevay<\/option>\n<option value=\"America\/Indiana\/Vincennes\">America\/Indiana\/Vincennes<\/option>\n<option value=\"America\/Indiana\/Winamac\">America\/Indiana\/Winamac<\/option>\n<option value=\"America\/Inuvik\">America\/Inuvik<\/option>\n<option value=\"America\/Iqaluit\">America\/Iqaluit<\/option>\n<option value=\"America\/Jamaica\">America\/Jamaica<\/option>\n<option value=\"America\/Juneau\">America\/Juneau<\/option>\n<option value=\"America\/Kentucky\/Louisville\">America\/Kentucky\/Louisville<\/option>\n<option value=\"America\/Kentucky\/Monticello\">America\/Kentucky\/Monticello<\/option>\n<option value=\"America\/Kralendijk\">America\/Kralendijk<\/option>\n<option value=\"America\/La_Paz\">America\/La_Paz<\/option>\n<option value=\"America\/Lima\">America\/Lima<\/option>\n<option value=\"America\/Los_Angeles\">America\/Los_Angeles<\/option>\n<option value=\"America\/Lower_Princes\">America\/Lower_Princes<\/option>\n<option value=\"America\/Maceio\">America\/Maceio<\/option>\n<option value=\"America\/Managua\">America\/Managua<\/option>\n<option value=\"America\/Manaus\">America\/Manaus<\/option>\n<option value=\"America\/Marigot\">America\/Marigot<\/option>\n<option value=\"America\/Martinique\">America\/Martinique<\/option>\n<option value=\"America\/Matamoros\">America\/Matamoros<\/option>\n<option value=\"America\/Mazatlan\">America\/Mazatlan<\/option>\n<option value=\"America\/Menominee\">America\/Menominee<\/option>\n<option value=\"America\/Merida\">America\/Merida<\/option>\n<option value=\"America\/Metlakatla\">America\/Metlakatla<\/option>\n<option value=\"America\/Mexico_City\">America\/Mexico_City<\/option>\n<option value=\"America\/Miquelon\">America\/Miquelon<\/option>\n<option value=\"America\/Moncton\">America\/Moncton<\/option>\n<option value=\"America\/Monterrey\">America\/Monterrey<\/option>\n<option value=\"America\/Montevideo\">America\/Montevideo<\/option>\n<option value=\"America\/Montserrat\">America\/Montserrat<\/option>\n<option value=\"America\/Nassau\">America\/Nassau<\/option>\n<option value=\"America\/New_York\">America\/New_York<\/option>\n<option value=\"America\/Nome\">America\/Nome<\/option>\n<option value=\"America\/Noronha\">America\/Noronha<\/option>\n<option value=\"America\/North_Dakota\/Beulah\">America\/North_Dakota\/Beulah<\/option>\n<option value=\"America\/North_Dakota\/Center\">America\/North_Dakota\/Center<\/option>\n<option value=\"America\/North_Dakota\/New_Salem\">America\/North_Dakota\/New_Salem<\/option>\n<option value=\"America\/Nuuk\">America\/Nuuk<\/option>\n<option value=\"America\/Ojinaga\">America\/Ojinaga<\/option>\n<option value=\"America\/Panama\">America\/Panama<\/option>\n<option value=\"America\/Paramaribo\">America\/Paramaribo<\/option>\n<option value=\"America\/Phoenix\">America\/Phoenix<\/option>\n<option value=\"America\/Port-au-Prince\">America\/Port-au-Prince<\/option>\n<option value=\"America\/Port_of_Spain\">America\/Port_of_Spain<\/option>\n<option value=\"America\/Porto_Velho\">America\/Porto_Velho<\/option>\n<option value=\"America\/Puerto_Rico\">America\/Puerto_Rico<\/option>\n<option value=\"America\/Punta_Arenas\">America\/Punta_Arenas<\/option>\n<option value=\"America\/Rankin_Inlet\">America\/Rankin_Inlet<\/option>\n<option value=\"America\/Recife\">America\/Recife<\/option>\n<option value=\"America\/Regina\">America\/Regina<\/option>\n<option value=\"America\/Resolute\">America\/Resolute<\/option>\n<option value=\"America\/Rio_Branco\">America\/Rio_Branco<\/option>\n<option value=\"America\/Santarem\">America\/Santarem<\/option>\n<option value=\"America\/Santiago\">America\/Santiago<\/option>\n<option value=\"America\/Santo_Domingo\">America\/Santo_Domingo<\/option>\n<option value=\"America\/Sao_Paulo\">America\/Sao_Paulo<\/option>\n<option value=\"America\/Scoresbysund\">America\/Scoresbysund<\/option>\n<option value=\"America\/Sitka\">America\/Sitka<\/option>\n<option value=\"America\/St_Barthelemy\">America\/St_Barthelemy<\/option>\n<option value=\"America\/St_Johns\">America\/St_Johns<\/option>\n<option value=\"America\/St_Kitts\">America\/St_Kitts<\/option>\n<option value=\"America\/St_Lucia\">America\/St_Lucia<\/option>\n<option value=\"America\/St_Thomas\">America\/St_Thomas<\/option>\n<option value=\"America\/St_Vincent\">America\/St_Vincent<\/option>\n<option value=\"America\/Swift_Current\">America\/Swift_Current<\/option>\n<option value=\"America\/Tegucigalpa\">America\/Tegucigalpa<\/option>\n<option value=\"America\/Thule\">America\/Thule<\/option>\n<option value=\"America\/Tijuana\">America\/Tijuana<\/option>\n<option value=\"America\/Toronto\">America\/Toronto<\/option>\n<option value=\"America\/Tortola\">America\/Tortola<\/option>\n<option value=\"America\/Vancouver\">America\/Vancouver<\/option>\n<option value=\"America\/Whitehorse\">America\/Whitehorse<\/option>\n<option value=\"America\/Winnipeg\">America\/Winnipeg<\/option>\n<option value=\"America\/Yakutat\">America\/Yakutat<\/option>\n<option value=\"Antarctica\/Casey\">Antarctica\/Casey<\/option>\n<option value=\"Antarctica\/Davis\">Antarctica\/Davis<\/option>\n<option value=\"Antarctica\/DumontDUrville\">Antarctica\/DumontDUrville<\/option>\n<option value=\"Antarctica\/Macquarie\">Antarctica\/Macquarie<\/option>\n<option value=\"Antarctica\/Mawson\">Antarctica\/Mawson<\/option>\n<option value=\"Antarctica\/McMurdo\">Antarctica\/McMurdo<\/option>\n<option value=\"Antarctica\/Palmer\">Antarctica\/Palmer<\/option>\n<option value=\"Antarctica\/Rothera\">Antarctica\/Rothera<\/option>\n<option value=\"Antarctica\/Syowa\">Antarctica\/Syowa<\/option>\n<option value=\"Antarctica\/Troll\">Antarctica\/Troll<\/option>\n<option value=\"Antarctica\/Vostok\">Antarctica\/Vostok<\/option>\n<option value=\"Arctic\/Longyearbyen\">Arctic\/Longyearbyen<\/option>\n<option value=\"Asia\/Aden\">Asia\/Aden<\/option>\n<option value=\"Asia\/Almaty\">Asia\/Almaty<\/option>\n<option value=\"Asia\/Amman\">Asia\/Amman<\/option>\n<option value=\"Asia\/Anadyr\">Asia\/Anadyr<\/option>\n<option value=\"Asia\/Aqtau\">Asia\/Aqtau<\/option>\n<option value=\"Asia\/Aqtobe\">Asia\/Aqtobe<\/option>\n<option value=\"Asia\/Ashgabat\">Asia\/Ashgabat<\/option>\n<option value=\"Asia\/Atyrau\">Asia\/Atyrau<\/option>\n<option value=\"Asia\/Baghdad\">Asia\/Baghdad<\/option>\n<option value=\"Asia\/Bahrain\">Asia\/Bahrain<\/option>\n<option value=\"Asia\/Baku\">Asia\/Baku<\/option>\n<option value=\"Asia\/Bangkok\">Asia\/Bangkok<\/option>\n<option value=\"Asia\/Barnaul\">Asia\/Barnaul<\/option>\n<option value=\"Asia\/Beirut\">Asia\/Beirut<\/option>\n<option value=\"Asia\/Bishkek\">Asia\/Bishkek<\/option>\n<option value=\"Asia\/Brunei\">Asia\/Brunei<\/option>\n<option value=\"Asia\/Chita\">Asia\/Chita<\/option>\n<option value=\"Asia\/Choibalsan\">Asia\/Choibalsan<\/option>\n<option value=\"Asia\/Colombo\">Asia\/Colombo<\/option>\n<option value=\"Asia\/Damascus\">Asia\/Damascus<\/option>\n<option value=\"Asia\/Dhaka\">Asia\/Dhaka<\/option>\n<option value=\"Asia\/Dili\">Asia\/Dili<\/option>\n<option value=\"Asia\/Dubai\">Asia\/Dubai<\/option>\n<option value=\"Asia\/Dushanbe\">Asia\/Dushanbe<\/option>\n<option value=\"Asia\/Famagusta\">Asia\/Famagusta<\/option>\n<option value=\"Asia\/Gaza\">Asia\/Gaza<\/option>\n<option value=\"Asia\/Hebron\">Asia\/Hebron<\/option>\n<option value=\"Asia\/Ho_Chi_Minh\">Asia\/Ho_Chi_Minh<\/option>\n<option value=\"Asia\/Hong_Kong\">Asia\/Hong_Kong<\/option>\n<option value=\"Asia\/Hovd\">Asia\/Hovd<\/option>\n<option value=\"Asia\/Irkutsk\">Asia\/Irkutsk<\/option>\n<option value=\"Asia\/Jakarta\">Asia\/Jakarta<\/option>\n<option value=\"Asia\/Jayapura\">Asia\/Jayapura<\/option>\n<option value=\"Asia\/Jerusalem\">Asia\/Jerusalem<\/option>\n<option value=\"Asia\/Kabul\">Asia\/Kabul<\/option>\n<option value=\"Asia\/Kamchatka\">Asia\/Kamchatka<\/option>\n<option value=\"Asia\/Karachi\">Asia\/Karachi<\/option>\n<option value=\"Asia\/Kathmandu\">Asia\/Kathmandu<\/option>\n<option value=\"Asia\/Khandyga\">Asia\/Khandyga<\/option>\n<option value=\"Asia\/Kolkata\">Asia\/Kolkata<\/option>\n<option value=\"Asia\/Krasnoyarsk\">Asia\/Krasnoyarsk<\/option>\n<option value=\"Asia\/Kuala_Lumpur\">Asia\/Kuala_Lumpur<\/option>\n<option value=\"Asia\/Kuching\">Asia\/Kuching<\/option>\n<option value=\"Asia\/Kuwait\">Asia\/Kuwait<\/option>\n<option value=\"Asia\/Macau\">Asia\/Macau<\/option>\n<option value=\"Asia\/Magadan\">Asia\/Magadan<\/option>\n<option value=\"Asia\/Makassar\">Asia\/Makassar<\/option>\n<option value=\"Asia\/Manila\">Asia\/Manila<\/option>\n<option value=\"Asia\/Muscat\">Asia\/Muscat<\/option>\n<option value=\"Asia\/Nicosia\">Asia\/Nicosia<\/option>\n<option value=\"Asia\/Novokuznetsk\">Asia\/Novokuznetsk<\/option>\n<option value=\"Asia\/Novosibirsk\">Asia\/Novosibirsk<\/option>\n<option value=\"Asia\/Omsk\">Asia\/Omsk<\/option>\n<option value=\"Asia\/Oral\">Asia\/Oral<\/option>\n<option value=\"Asia\/Phnom_Penh\">Asia\/Phnom_Penh<\/option>\n<option value=\"Asia\/Pontianak\">Asia\/Pontianak<\/option>\n<option value=\"Asia\/Pyongyang\">Asia\/Pyongyang<\/option>\n<option value=\"Asia\/Qatar\">Asia\/Qatar<\/option>\n<option value=\"Asia\/Qostanay\">Asia\/Qostanay<\/option>\n<option value=\"Asia\/Qyzylorda\">Asia\/Qyzylorda<\/option>\n<option value=\"Asia\/Riyadh\">Asia\/Riyadh<\/option>\n<option value=\"Asia\/Sakhalin\">Asia\/Sakhalin<\/option>\n<option value=\"Asia\/Samarkand\">Asia\/Samarkand<\/option>\n<option value=\"Asia\/Seoul\">Asia\/Seoul<\/option>\n<option value=\"Asia\/Shanghai\">Asia\/Shanghai<\/option>\n<option value=\"Asia\/Singapore\">Asia\/Singapore<\/option>\n<option value=\"Asia\/Srednekolymsk\">Asia\/Srednekolymsk<\/option>\n<option value=\"Asia\/Taipei\">Asia\/Taipei<\/option>\n<option value=\"Asia\/Tashkent\">Asia\/Tashkent<\/option>\n<option value=\"Asia\/Tbilisi\">Asia\/Tbilisi<\/option>\n<option value=\"Asia\/Tehran\">Asia\/Tehran<\/option>\n<option value=\"Asia\/Thimphu\">Asia\/Thimphu<\/option>\n<option value=\"Asia\/Tokyo\">Asia\/Tokyo<\/option>\n<option value=\"Asia\/Tomsk\">Asia\/Tomsk<\/option>\n<option value=\"Asia\/Ulaanbaatar\">Asia\/Ulaanbaatar<\/option>\n<option value=\"Asia\/Urumqi\">Asia\/Urumqi<\/option>\n<option value=\"Asia\/Ust-Nera\">Asia\/Ust-Nera<\/option>\n<option value=\"Asia\/Vientiane\">Asia\/Vientiane<\/option>\n<option value=\"Asia\/Vladivostok\">Asia\/Vladivostok<\/option>\n<option value=\"Asia\/Yakutsk\">Asia\/Yakutsk<\/option>\n<option value=\"Asia\/Yangon\">Asia\/Yangon<\/option>\n<option value=\"Asia\/Yekaterinburg\">Asia\/Yekaterinburg<\/option>\n<option value=\"Asia\/Yerevan\">Asia\/Yerevan<\/option>\n<option value=\"Atlantic\/Azores\">Atlantic\/Azores<\/option>\n<option value=\"Atlantic\/Bermuda\">Atlantic\/Bermuda<\/option>\n<option value=\"Atlantic\/Canary\">Atlantic\/Canary<\/option>\n<option value=\"Atlantic\/Cape_Verde\">Atlantic\/Cape_Verde<\/option>\n<option value=\"Atlantic\/Faroe\">Atlantic\/Faroe<\/option>\n<option value=\"Atlantic\/Madeira\">Atlantic\/Madeira<\/option>\n<option value=\"Atlantic\/Reykjavik\">Atlantic\/Reykjavik<\/option>\n<option value=\"Atlantic\/South_Georgia\">Atlantic\/South_Georgia<\/option>\n<option value=\"Atlantic\/St_Helena\">Atlantic\/St_Helena<\/option>\n<option value=\"Atlantic\/Stanley\">Atlantic\/Stanley<\/option>\n<option value=\"Australia\/Adelaide\">Australia\/Adelaide<\/option>\n<option value=\"Australia\/Brisbane\">Australia\/Brisbane<\/option>\n<option value=\"Australia\/Broken_Hill\">Australia\/Broken_Hill<\/option>\n<option value=\"Australia\/Darwin\">Australia\/Darwin<\/option>\n<option value=\"Australia\/Eucla\">Australia\/Eucla<\/option>\n<option value=\"Australia\/Hobart\">Australia\/Hobart<\/option>\n<option value=\"Australia\/Lindeman\">Australia\/Lindeman<\/option>\n<option value=\"Australia\/Lord_Howe\">Australia\/Lord_Howe<\/option>\n<option value=\"Australia\/Melbourne\">Australia\/Melbourne<\/option>\n<option value=\"Australia\/Perth\">Australia\/Perth<\/option>\n<option value=\"Australia\/Sydney\">Australia\/Sydney<\/option>\n<option value=\"Europe\/Amsterdam\">Europe\/Amsterdam<\/option>\n<option value=\"Europe\/Andorra\">Europe\/Andorra<\/option>\n<option value=\"Europe\/Astrakhan\">Europe\/Astrakhan<\/option>\n<option value=\"Europe\/Athens\">Europe\/Athens<\/option>\n<option value=\"Europe\/Belgrade\">Europe\/Belgrade<\/option>\n<option value=\"Europe\/Berlin\">Europe\/Berlin<\/option>\n<option value=\"Europe\/Bratislava\">Europe\/Bratislava<\/option>\n<option value=\"Europe\/Brussels\">Europe\/Brussels<\/option>\n<option value=\"Europe\/Bucharest\">Europe\/Bucharest<\/option>\n<option value=\"Europe\/Budapest\">Europe\/Budapest<\/option>\n<option value=\"Europe\/Busingen\">Europe\/Busingen<\/option>\n<option value=\"Europe\/Chisinau\">Europe\/Chisinau<\/option>\n<option value=\"Europe\/Copenhagen\">Europe\/Copenhagen<\/option>\n<option value=\"Europe\/Dublin\">Europe\/Dublin<\/option>\n<option value=\"Europe\/Gibraltar\">Europe\/Gibraltar<\/option>\n<option value=\"Europe\/Guernsey\">Europe\/Guernsey<\/option>\n<option value=\"Europe\/Helsinki\">Europe\/Helsinki<\/option>\n<option value=\"Europe\/Isle_of_Man\">Europe\/Isle_of_Man<\/option>\n<option value=\"Europe\/Istanbul\">Europe\/Istanbul<\/option>\n<option value=\"Europe\/Jersey\">Europe\/Jersey<\/option>\n<option value=\"Europe\/Kaliningrad\">Europe\/Kaliningrad<\/option>\n<option value=\"Europe\/Kirov\">Europe\/Kirov<\/option>\n<option value=\"Europe\/Kyiv\">Europe\/Kyiv<\/option>\n<option value=\"Europe\/Lisbon\">Europe\/Lisbon<\/option>\n<option value=\"Europe\/Ljubljana\">Europe\/Ljubljana<\/option>\n<option value=\"Europe\/London\">Europe\/London<\/option>\n<option value=\"Europe\/Luxembourg\">Europe\/Luxembourg<\/option>\n<option value=\"Europe\/Madrid\">Europe\/Madrid<\/option>\n<option value=\"Europe\/Malta\">Europe\/Malta<\/option>\n<option value=\"Europe\/Mariehamn\">Europe\/Mariehamn<\/option>\n<option value=\"Europe\/Minsk\">Europe\/Minsk<\/option>\n<option value=\"Europe\/Monaco\">Europe\/Monaco<\/option>\n<option value=\"Europe\/Moscow\">Europe\/Moscow<\/option>\n<option value=\"Europe\/Oslo\">Europe\/Oslo<\/option>\n<option value=\"Europe\/Paris\">Europe\/Paris<\/option>\n<option value=\"Europe\/Podgorica\">Europe\/Podgorica<\/option>\n<option value=\"Europe\/Prague\">Europe\/Prague<\/option>\n<option value=\"Europe\/Riga\">Europe\/Riga<\/option>\n<option value=\"Europe\/Rome\">Europe\/Rome<\/option>\n<option value=\"Europe\/Samara\">Europe\/Samara<\/option>\n<option value=\"Europe\/San_Marino\">Europe\/San_Marino<\/option>\n<option value=\"Europe\/Sarajevo\">Europe\/Sarajevo<\/option>\n<option value=\"Europe\/Saratov\">Europe\/Saratov<\/option>\n<option value=\"Europe\/Simferopol\">Europe\/Simferopol<\/option>\n<option value=\"Europe\/Skopje\">Europe\/Skopje<\/option>\n<option value=\"Europe\/Sofia\">Europe\/Sofia<\/option>\n<option value=\"Europe\/Stockholm\">Europe\/Stockholm<\/option>\n<option value=\"Europe\/Tallinn\">Europe\/Tallinn<\/option>\n<option value=\"Europe\/Tirane\">Europe\/Tirane<\/option>\n<option value=\"Europe\/Ulyanovsk\">Europe\/Ulyanovsk<\/option>\n<option value=\"Europe\/Vaduz\">Europe\/Vaduz<\/option>\n<option value=\"Europe\/Vatican\">Europe\/Vatican<\/option>\n<option value=\"Europe\/Vienna\">Europe\/Vienna<\/option>\n<option value=\"Europe\/Vilnius\">Europe\/Vilnius<\/option>\n<option value=\"Europe\/Volgograd\">Europe\/Volgograd<\/option>\n<option value=\"Europe\/Warsaw\">Europe\/Warsaw<\/option>\n<option value=\"Europe\/Zagreb\">Europe\/Zagreb<\/option>\n<option value=\"Europe\/Zurich\">Europe\/Zurich<\/option>\n<option value=\"Indian\/Antananarivo\">Indian\/Antananarivo<\/option>\n<option value=\"Indian\/Chagos\">Indian\/Chagos<\/option>\n<option value=\"Indian\/Christmas\">Indian\/Christmas<\/option>\n<option value=\"Indian\/Cocos\">Indian\/Cocos<\/option>\n<option value=\"Indian\/Comoro\">Indian\/Comoro<\/option>\n<option value=\"Indian\/Kerguelen\">Indian\/Kerguelen<\/option>\n<option value=\"Indian\/Mahe\">Indian\/Mahe<\/option>\n<option value=\"Indian\/Maldives\">Indian\/Maldives<\/option>\n<option value=\"Indian\/Mauritius\">Indian\/Mauritius<\/option>\n<option value=\"Indian\/Mayotte\">Indian\/Mayotte<\/option>\n<option value=\"Indian\/Reunion\">Indian\/Reunion<\/option>\n<option value=\"Pacific\/Apia\">Pacific\/Apia<\/option>\n<option value=\"Pacific\/Auckland\">Pacific\/Auckland<\/option>\n<option value=\"Pacific\/Bougainville\">Pacific\/Bougainville<\/option>\n<option value=\"Pacific\/Chatham\">Pacific\/Chatham<\/option>\n<option value=\"Pacific\/Chuuk\">Pacific\/Chuuk<\/option>\n<option value=\"Pacific\/Easter\">Pacific\/Easter<\/option>\n<option value=\"Pacific\/Efate\">Pacific\/Efate<\/option>\n<option value=\"Pacific\/Fakaofo\">Pacific\/Fakaofo<\/option>\n<option value=\"Pacific\/Fiji\">Pacific\/Fiji<\/option>\n<option value=\"Pacific\/Funafuti\">Pacific\/Funafuti<\/option>\n<option value=\"Pacific\/Galapagos\">Pacific\/Galapagos<\/option>\n<option value=\"Pacific\/Gambier\">Pacific\/Gambier<\/option>\n<option value=\"Pacific\/Guadalcanal\">Pacific\/Guadalcanal<\/option>\n<option value=\"Pacific\/Guam\">Pacific\/Guam<\/option>\n<option value=\"Pacific\/Honolulu\">Pacific\/Honolulu<\/option>\n<option value=\"Pacific\/Kanton\">Pacific\/Kanton<\/option>\n<option value=\"Pacific\/Kiritimati\">Pacific\/Kiritimati<\/option>\n<option value=\"Pacific\/Kosrae\">Pacific\/Kosrae<\/option>\n<option value=\"Pacific\/Kwajalein\">Pacific\/Kwajalein<\/option>\n<option value=\"Pacific\/Majuro\">Pacific\/Majuro<\/option>\n<option value=\"Pacific\/Marquesas\">Pacific\/Marquesas<\/option>\n<option value=\"Pacific\/Midway\">Pacific\/Midway<\/option>\n<option value=\"Pacific\/Nauru\">Pacific\/Nauru<\/option>\n<option value=\"Pacific\/Niue\">Pacific\/Niue<\/option>\n<option value=\"Pacific\/Norfolk\">Pacific\/Norfolk<\/option>\n<option value=\"Pacific\/Noumea\">Pacific\/Noumea<\/option>\n<option value=\"Pacific\/Pago_Pago\">Pacific\/Pago_Pago<\/option>\n<option value=\"Pacific\/Palau\">Pacific\/Palau<\/option>\n<option value=\"Pacific\/Pitcairn\">Pacific\/Pitcairn<\/option>\n<option value=\"Pacific\/Pohnpei\">Pacific\/Pohnpei<\/option>\n<option value=\"Pacific\/Port_Moresby\">Pacific\/Port_Moresby<\/option>\n<option value=\"Pacific\/Rarotonga\">Pacific\/Rarotonga<\/option>\n<option value=\"Pacific\/Saipan\">Pacific\/Saipan<\/option>\n<option value=\"Pacific\/Tahiti\">Pacific\/Tahiti<\/option>\n<option value=\"Pacific\/Tarawa\">Pacific\/Tarawa<\/option>\n<option value=\"Pacific\/Tongatapu\">Pacific\/Tongatapu<\/option>\n<option value=\"Pacific\/Wake\">Pacific\/Wake<\/option>\n<option value=\"Pacific\/Wallis\">Pacific\/Wallis<\/option>\n<option value=\"UTC\">UTC<\/option><\/select>\n            <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n            \n        <\/div>\n    <\/div>\n<input type=\"hidden\" name=\"drts[location_address][0][location][address][zoom]\" value=\"10\" class=\"drts-map-field-zoom drts-form-field drts-form-type-hidden\">\n<input type=\"hidden\" name=\"drts[location_address][0][location][address][address]\" value=\"\" class=\"drts-location-address-address drts-form-field drts-form-type-hidden\">\n<input type=\"hidden\" name=\"drts[location_address][0][location][address][country]\" value=\"\" class=\"drts-location-address-country drts-form-field drts-form-type-hidden\">\n<\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_choice\" class=\"drts-display-element drts-display-element-entity_form_choice-2 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-choice drts-entity-form-field-name-field-healthcare-role-2 drts-form-field drts-form-type-checkboxes\" style=\"\" data-form-field-name=\"drts[field_healthcare_role_2]\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2\">\n    <label>Healthcare Role<\/label>\n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-form-row\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-options\">\n<div class=\"drts-bs-col-sm-4\"><div class=\"drts-form-field-radio-options drts-form-field-radio-options-column drts-bs-custom-controls-stacked\">\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"LPC - Licensed Professional Counselor\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-LPC - Licensed Professional Counselor\" name=\"drts[field_healthcare_role_2][]\" value=\"LPC - Licensed Professional Counselor\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-LPC - Licensed Professional Counselor\">LPC - Licensed Professional Counselor<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"LCSW-Licensed Clinical Social Worker\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-LCSW-Licensed Clinical Social Worker\" name=\"drts[field_healthcare_role_2][]\" value=\"LCSW-Licensed Clinical Social Worker\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-LCSW-Licensed Clinical Social Worker\">LCSW-Licensed Clinical Social Worker<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"NNC -National Certified Counselor\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-NNC -National Certified Counselor\" name=\"drts[field_healthcare_role_2][]\" value=\"NNC -National Certified Counselor\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-NNC -National Certified Counselor\">NNC -National Certified Counselor<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"CSAT - Certified Sex Addiction Therapist\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-CSAT - Certified Sex Addiction Therapist\" name=\"drts[field_healthcare_role_2][]\" value=\"CSAT - Certified Sex Addiction Therapist\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-CSAT - Certified Sex Addiction Therapist\">CSAT - Certified Sex Addiction Therapist<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"GCDF - \tGlobal Career Development Facilitator\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-GCDF - \tGlobal Career Development Facilitator\" name=\"drts[field_healthcare_role_2][]\" value=\"GCDF - \tGlobal Career Development Facilitator\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-GCDF - \tGlobal Career Development Facilitator\">GCDF - \tGlobal Career Development Facilitator<\/label><\/div>\n<\/div><\/div>\n<div class=\"drts-bs-col-sm-4\"><div class=\"drts-form-field-radio-options drts-form-field-radio-options-column drts-bs-custom-controls-stacked\">\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"EVGP - Educational Vocational Guidance Practitioner\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-EVGP - Educational Vocational Guidance Practitioner\" name=\"drts[field_healthcare_role_2][]\" value=\"EVGP - Educational Vocational Guidance Practitioner\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-EVGP - Educational Vocational Guidance Practitioner\">EVGP - Educational Vocational Guidance Practitioner<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Psychologist\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Psychologist\" name=\"drts[field_healthcare_role_2][]\" value=\"Psychologist\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Psychologist\">Psychologist<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Psychiatrist\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Psychiatrist\" name=\"drts[field_healthcare_role_2][]\" value=\"Psychiatrist\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Psychiatrist\">Psychiatrist<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Psychotherapist\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Psychotherapist\" name=\"drts[field_healthcare_role_2][]\" value=\"Psychotherapist\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Psychotherapist\">Psychotherapist <\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Gynecologist\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Gynecologist\" name=\"drts[field_healthcare_role_2][]\" value=\"Gynecologist\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Gynecologist\">Gynecologist<\/label><\/div>\n<\/div><\/div>\n<div class=\"drts-bs-col-sm-4\"><div class=\"drts-form-field-radio-options drts-form-field-radio-options-column drts-bs-custom-controls-stacked\">\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Urologist\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Urologist\" name=\"drts[field_healthcare_role_2][]\" value=\"Urologist\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Urologist\">Urologist<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"Endocrinologist\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Endocrinologist\" name=\"drts[field_healthcare_role_2][]\" value=\"Endocrinologist\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-Endocrinologist\">Endocrinologist<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"MD\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-MD\" name=\"drts[field_healthcare_role_2][]\" value=\"MD\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-MD\">MD <\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"MP\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-MP\" name=\"drts[field_healthcare_role_2][]\" value=\"MP\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-MP\">MP<\/label><\/div>\n<div class=\"drts-form-field-radio-option drts-bs-custom-control drts-bs-custom-checkbox drts-bs-my-1\" data-depth=\"0\" data-value=\"DO\" style=\"margin-left:0rem;\"><input class=\"drts-bs-custom-control-input\" type=\"checkbox\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-DO\" name=\"drts[field_healthcare_role_2][]\" value=\"DO\" \/><label class=\"drts-bs-custom-control-label\" for=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-healthcare-role-2-DO\">DO<\/label><\/div>\n<\/div><\/div>\n<\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_text\" class=\"drts-display-element drts-display-element-entity_form_text-1 \" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-text drts-entity-form-field-name-field-do-you-practice-in-other-states-please-give drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_do_you_practice_in_other_states_please_give]\">\n<label>Do you practice in other states? Please give details.<\/label>\n<div class=\"drts-form-field drts-form-type-textarea\" style=\"\" data-form-field-name=\"drts[field_do_you_practice_in_other_states_please_give][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <textarea name=\"drts[field_do_you_practice_in_other_states_please_give][0]\" class=\"drts-bs-form-control\" rows=\"10\"><\/textarea>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_range\" class=\"drts-display-element drts-display-element-entity_form_range-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-range drts-entity-form-field-name-field-price-range drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_price_range]\">\n<label>Price Range<\/label>\n<div class=\"drts-form-field drts-form-type-range\" style=\"\" data-form-field-name=\"drts[field_price_range][0]\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-price-range-0\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_price_range][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control  drts-form-slider\" maxlength=\"255\" data-type=\"double\" data-step=\"1\" data-min=\"0\" data-max=\"100\" data-min-text=\"\" data-max-text=\"\" data-grid=\"true\" data-prefix=\"$ \" data-input-values-separator=\";\" data-force-edges=\"true\" data-hide-min-max=\"true\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_url\" class=\"drts-display-element drts-display-element-entity_form_url-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-url drts-entity-form-field-name-field-website drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_website]\">\n<label>Website URL<\/label>\n<div class=\"drts-form-field drts-form-type-url\" style=\"\" data-form-field-name=\"drts[field_website][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_website][0]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"https:\/\/\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_social_accounts\" class=\"drts-display-element drts-display-element-entity_form_social_accounts-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-social-accounts drts-entity-form-field-name-field-social-accounts drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_social_accounts]\">\n<label>Social Accounts<\/label>\n<div class=\"drts-row drts-form-row drts-gutter-md\">\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][facebook]\" data-social-media-name=\"facebook\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-facebook-square\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][facebook]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Enter Facebook username or URL.\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][twitter]\" data-social-media-name=\"twitter\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-twitter-square\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][twitter]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Enter Twitter username or URL.\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][googleplus]\" data-social-media-name=\"googleplus\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-google-plus-square\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][googleplus]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Enter Google+ username or URL.\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][pinterest]\" data-social-media-name=\"pinterest\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-pinterest-square\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][pinterest]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Enter Pinterest username or URL.\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-url\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][tumblr]\" data-social-media-name=\"tumblr\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-tumblr-square\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][tumblr]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Tumblr URL\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-url\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][linkedin]\" data-social-media-name=\"linkedin\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-linkedin\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][linkedin]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"LinkedIn URL\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-url\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][flickr]\" data-social-media-name=\"flickr\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-flickr\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][flickr]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Flickr URL\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][youtube]\" data-social-media-name=\"youtube\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-youtube-square\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][youtube]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Enter YouTube username or URL.\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][instagram]\" data-social-media-name=\"instagram\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fab fa-instagram\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][instagram]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Enter Instagram username or URL. Prefix with &quot;#&quot; if hashtag.\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-md-6\">\n<div class=\"drts-social-media-field drts-bs-mb-2 drts-form-field drts-form-type-url\" style=\"\" data-form-field-name=\"drts[field_social_accounts][0][rss]\" data-social-media-name=\"rss\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-input-group\"><div class=\"drts-bs-input-group-prepend\"><span class=\"drts-bs-input-group-text\"><i class=\"fa-fw fas fa-rss-square\"><\/i><\/span><\/div>\n<input name=\"drts[field_social_accounts][0][rss]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"RSS URL\" \/><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_date\" class=\"drts-display-element drts-display-element-entity_form_date-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-date drts-entity-form-field-name-field-date-established drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_date_established]\">\n<label>Date Established<\/label>\n<div class=\"drts-form-field drts-form-type-datepicker\" style=\"\" data-form-field-name=\"drts[field_date_established][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-row\"><div class=\"drts-col-md-6 drts-view-filter-ignore\"><div class=\"drts-form-flatpickr\"><input type=\"text\" name=\"drts[field_date_established][0]\" size=\"8\" class=\"drts-bs-form-control drts-form-datepicker-date drts-form-type-textfield-with-clear\" data-date-mode=\"single\" data-date-display-format=\"F j, Y\" placeholder=\"Select date\" \/><i class=\"drts-clear fas fa-times-circle\" data-clear><\/i><\/div><\/div><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_wp_image\" class=\"drts-display-element drts-display-element-entity_form_wp_image-1\" style=\"\"><div class=\"drts-bs-form-group drts-form-upload-container drts-entity-form-field drts-entity-form-field-type-wp-image drts-entity-form-field-name-directory-photos drts-form-field drts-form-type-wp-upload\" style=\"\" data-form-field-name=\"drts[directory_photos]\">\n<label>Photos<\/label>\n<div class=\"drts-form-upload-current drts-data-table drts-form-field drts-form-type-grid\" style=\"\" data-form-field-name=\"drts[directory_photos][current]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-bs-table-responsive-md\"><table class=\"drts-bs-table drts-bs-my-0 drts-bs-table-sm\" style=\"margin-bottom:0;\">\n<thead><tr>\n<th data-column-name=\"icon\" style=\"width:20%;text-align:center;\"><\/th>\n<th data-column-name=\"name\" style=\"width:50%;\">File Name<\/th>\n<th data-column-name=\"size\" style=\"width:15%;\">File Size<\/th>\n<th data-column-name=\"check\" style=\"text-align:center;\"><\/th>\n<\/tr><\/thead>\n<tbody>\n<tr><td colspan=\"4\">No entries found<\/td><\/tr>\n<\/tbody>\n<\/table><\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<div class=\"drts-form-upload drts-form-field drts-form-type-file\" style=\"\" data-form-field-name=\"drts[directory_photos][upload]\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-directory-photos-upload\">\n    \n    <div class=\"drts-form-field-main\">\n        <div class=\"drts-bs-form-text drts-form-description drts-bs-mt-0 drts-bs-mb-3\">Max number of files 5, maximum file size 512MB. Supported file formats: gif jpeg jpg png<\/div>\n        <span class=\"drts-bs-btn drts-bs-btn-sm drts-bs-btn-outline-secondary drts-form-file-button\">\n    <i class=\"fas fa-folder-open\"><\/i> <span>Choose File<\/span>\n    <input type=\"file\" name=\"drts[directory_photos][upload][files][]\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-directory-photos-file\" multiple=\"multiple\" \/>\n<\/span>\n\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<div class=\"drts-bs-progress drts-bs-mt-1\" style=\"display:none;\"><div class=\"drts-bs-progress-bar\" role=\"progressbar\" aria-valuenow=\"0\" aria-valuemin=\"0\" aria-valuemax=\"100\"><\/div><\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_video\" class=\"drts-display-element drts-display-element-entity_form_video-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-video drts-entity-form-field-name-field-videos drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_videos]\">\n<label>Videos<\/label>\n<div class=\"drts-bs-form-group drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_videos][0]\">\n<div class=\"drts-row drts-form-row drts-gutter-sm\">\n<div class=\"drts-col-6 drts-col-md-3\">\n<div class=\"drts-form-field drts-form-type-select\" style=\"\" data-form-field-name=\"drts[field_videos][0][provider]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <select class=\"drts-bs-form-control \" name=\"drts[field_videos][0][provider]\" data-default-value=\"youtube\"><option value=\"youtube\" selected=\"selected\">YouTube<\/option>\n<option value=\"vimeo\">Vimeo<\/option><\/select>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<div class=\"drts-col-6 drts-col-md-9\">\n<div class=\"drts-form-field drts-form-type-textfield\" style=\"\" data-form-field-name=\"drts[field_videos][0][id]\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-videos-0-id\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <input name=\"drts[field_videos][0][id]\" type=\"text\" value=\"\" class=\"drts-bs-form-control \" maxlength=\"255\" placeholder=\"Enter video ID or URL\" \/>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"drts-form-field drts-form-type-addmore\" style=\"\" data-form-field-name=\"drts[field_videos][_add]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <button type=\"button\" class=\"drts-bs-btn drts-bs-btn-outline-secondary drts-bs-btn-sm drts-form-field-add\" data-field-max-num=\"0\" data-field-next-index=\"1\"><i class=\"fas fa-plus fa-fw\"><\/i> Add More<\/button>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_directory_opening_hours\" class=\"drts-display-element drts-display-element-entity_form_directory_opening_hours-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-directory-opening-hours drts-entity-form-field-name-field-opening-hours drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[field_opening_hours]\">\n<label>Opening Hours<\/label>\n<div class=\"drts-form-field drts-form-type-timepicker\" style=\"\" data-form-field-name=\"drts[field_opening_hours][0]\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-field-opening-hours-0\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div class=\"drts-row\">\n<div class=\"drts-form-timepicker-day drts-col-sm-6 drts-col-md-3\"><select class=\"drts-bs-form-control\" name=\"drts[field_opening_hours][0][day]\">\n<option value=\"\">\u2014 Select \u2014<\/option>\n<option value=\"1\">Monday<\/option>\n<option value=\"2\">Tuesday<\/option>\n<option value=\"3\">Wednesday<\/option>\n<option value=\"4\">Thursday<\/option>\n<option value=\"5\">Friday<\/option>\n<option value=\"6\">Saturday<\/option>\n<option value=\"7\">Sunday<\/option>\n<option value=\"8\">Monday - Friday<\/option>\n<option value=\"9\">Saturday - Sunday<\/option>\n<option value=\"10\">All week<\/option>\n<\/select><\/div><div class=\"drts-form-timepicker-all_day drts-col-sm-6 drts-col-md-3\"><select class=\"drts-bs-form-control\" name=\"drts[field_opening_hours][0][all_day]\">\n<option value=\"\">Enter hours<\/option>\n<option value=\"1\">All day<\/option>\n<option value=\"closed\">Closed<\/option>\n<option value=\"appointment\">Appointment only<\/option>\n<\/select><\/div><div class=\"drts-form-timepicker-start drts-col-sm-6 drts-col-md-3\"><select class=\"drts-bs-form-control\" name=\"drts[field_opening_hours][0][start]\"><option value=\"\">--<\/option><option value=\"0\">12:00 am<\/option>\n<option value=\"900\">12:15 am<\/option>\n<option value=\"1800\">12:30 am<\/option>\n<option value=\"2700\">12:45 am<\/option>\n<option value=\"3600\">1:00 am<\/option>\n<option value=\"4500\">1:15 am<\/option>\n<option value=\"5400\">1:30 am<\/option>\n<option value=\"6300\">1:45 am<\/option>\n<option value=\"7200\">2:00 am<\/option>\n<option value=\"8100\">2:15 am<\/option>\n<option value=\"9000\">2:30 am<\/option>\n<option value=\"9900\">2:45 am<\/option>\n<option value=\"10800\">3:00 am<\/option>\n<option value=\"11700\">3:15 am<\/option>\n<option value=\"12600\">3:30 am<\/option>\n<option value=\"13500\">3:45 am<\/option>\n<option value=\"14400\">4:00 am<\/option>\n<option value=\"15300\">4:15 am<\/option>\n<option value=\"16200\">4:30 am<\/option>\n<option value=\"17100\">4:45 am<\/option>\n<option value=\"18000\">5:00 am<\/option>\n<option value=\"18900\">5:15 am<\/option>\n<option value=\"19800\">5:30 am<\/option>\n<option value=\"20700\">5:45 am<\/option>\n<option value=\"21600\">6:00 am<\/option>\n<option value=\"22500\">6:15 am<\/option>\n<option value=\"23400\">6:30 am<\/option>\n<option value=\"24300\">6:45 am<\/option>\n<option value=\"25200\">7:00 am<\/option>\n<option value=\"26100\">7:15 am<\/option>\n<option value=\"27000\">7:30 am<\/option>\n<option value=\"27900\">7:45 am<\/option>\n<option value=\"28800\">8:00 am<\/option>\n<option value=\"29700\">8:15 am<\/option>\n<option value=\"30600\">8:30 am<\/option>\n<option value=\"31500\">8:45 am<\/option>\n<option value=\"32400\">9:00 am<\/option>\n<option value=\"33300\">9:15 am<\/option>\n<option value=\"34200\">9:30 am<\/option>\n<option value=\"35100\">9:45 am<\/option>\n<option value=\"36000\">10:00 am<\/option>\n<option value=\"36900\">10:15 am<\/option>\n<option value=\"37800\">10:30 am<\/option>\n<option value=\"38700\">10:45 am<\/option>\n<option value=\"39600\">11:00 am<\/option>\n<option value=\"40500\">11:15 am<\/option>\n<option value=\"41400\">11:30 am<\/option>\n<option value=\"42300\">11:45 am<\/option>\n<option value=\"43200\">12:00 pm<\/option>\n<option value=\"44100\">12:15 pm<\/option>\n<option value=\"45000\">12:30 pm<\/option>\n<option value=\"45900\">12:45 pm<\/option>\n<option value=\"46800\">1:00 pm<\/option>\n<option value=\"47700\">1:15 pm<\/option>\n<option value=\"48600\">1:30 pm<\/option>\n<option value=\"49500\">1:45 pm<\/option>\n<option value=\"50400\">2:00 pm<\/option>\n<option value=\"51300\">2:15 pm<\/option>\n<option value=\"52200\">2:30 pm<\/option>\n<option value=\"53100\">2:45 pm<\/option>\n<option value=\"54000\">3:00 pm<\/option>\n<option value=\"54900\">3:15 pm<\/option>\n<option value=\"55800\">3:30 pm<\/option>\n<option value=\"56700\">3:45 pm<\/option>\n<option value=\"57600\">4:00 pm<\/option>\n<option value=\"58500\">4:15 pm<\/option>\n<option value=\"59400\">4:30 pm<\/option>\n<option value=\"60300\">4:45 pm<\/option>\n<option value=\"61200\">5:00 pm<\/option>\n<option value=\"62100\">5:15 pm<\/option>\n<option value=\"63000\">5:30 pm<\/option>\n<option value=\"63900\">5:45 pm<\/option>\n<option value=\"64800\">6:00 pm<\/option>\n<option value=\"65700\">6:15 pm<\/option>\n<option value=\"66600\">6:30 pm<\/option>\n<option value=\"67500\">6:45 pm<\/option>\n<option value=\"68400\">7:00 pm<\/option>\n<option value=\"69300\">7:15 pm<\/option>\n<option value=\"70200\">7:30 pm<\/option>\n<option value=\"71100\">7:45 pm<\/option>\n<option value=\"72000\">8:00 pm<\/option>\n<option value=\"72900\">8:15 pm<\/option>\n<option value=\"73800\">8:30 pm<\/option>\n<option value=\"74700\">8:45 pm<\/option>\n<option value=\"75600\">9:00 pm<\/option>\n<option value=\"76500\">9:15 pm<\/option>\n<option value=\"77400\">9:30 pm<\/option>\n<option value=\"78300\">9:45 pm<\/option>\n<option value=\"79200\">10:00 pm<\/option>\n<option value=\"80100\">10:15 pm<\/option>\n<option value=\"81000\">10:30 pm<\/option>\n<option value=\"81900\">10:45 pm<\/option>\n<option value=\"82800\">11:00 pm<\/option>\n<option value=\"83700\">11:15 pm<\/option>\n<option value=\"84600\">11:30 pm<\/option>\n<option value=\"85500\">11:45 pm<\/option><\/select><\/div><div class=\"drts-form-timepicker-end drts-col-sm-6 drts-col-md-3\"><select class=\"drts-bs-form-control\" name=\"drts[field_opening_hours][0][end]\"><option value=\"\">--<\/option><option value=\"0\">12:00 am<\/option>\n<option value=\"900\">12:15 am<\/option>\n<option value=\"1800\">12:30 am<\/option>\n<option value=\"2700\">12:45 am<\/option>\n<option value=\"3600\">1:00 am<\/option>\n<option value=\"4500\">1:15 am<\/option>\n<option value=\"5400\">1:30 am<\/option>\n<option value=\"6300\">1:45 am<\/option>\n<option value=\"7200\">2:00 am<\/option>\n<option value=\"8100\">2:15 am<\/option>\n<option value=\"9000\">2:30 am<\/option>\n<option value=\"9900\">2:45 am<\/option>\n<option value=\"10800\">3:00 am<\/option>\n<option value=\"11700\">3:15 am<\/option>\n<option value=\"12600\">3:30 am<\/option>\n<option value=\"13500\">3:45 am<\/option>\n<option value=\"14400\">4:00 am<\/option>\n<option value=\"15300\">4:15 am<\/option>\n<option value=\"16200\">4:30 am<\/option>\n<option value=\"17100\">4:45 am<\/option>\n<option value=\"18000\">5:00 am<\/option>\n<option value=\"18900\">5:15 am<\/option>\n<option value=\"19800\">5:30 am<\/option>\n<option value=\"20700\">5:45 am<\/option>\n<option value=\"21600\">6:00 am<\/option>\n<option value=\"22500\">6:15 am<\/option>\n<option value=\"23400\">6:30 am<\/option>\n<option value=\"24300\">6:45 am<\/option>\n<option value=\"25200\">7:00 am<\/option>\n<option value=\"26100\">7:15 am<\/option>\n<option value=\"27000\">7:30 am<\/option>\n<option value=\"27900\">7:45 am<\/option>\n<option value=\"28800\">8:00 am<\/option>\n<option value=\"29700\">8:15 am<\/option>\n<option value=\"30600\">8:30 am<\/option>\n<option value=\"31500\">8:45 am<\/option>\n<option value=\"32400\">9:00 am<\/option>\n<option value=\"33300\">9:15 am<\/option>\n<option value=\"34200\">9:30 am<\/option>\n<option value=\"35100\">9:45 am<\/option>\n<option value=\"36000\">10:00 am<\/option>\n<option value=\"36900\">10:15 am<\/option>\n<option value=\"37800\">10:30 am<\/option>\n<option value=\"38700\">10:45 am<\/option>\n<option value=\"39600\">11:00 am<\/option>\n<option value=\"40500\">11:15 am<\/option>\n<option value=\"41400\">11:30 am<\/option>\n<option value=\"42300\">11:45 am<\/option>\n<option value=\"43200\">12:00 pm<\/option>\n<option value=\"44100\">12:15 pm<\/option>\n<option value=\"45000\">12:30 pm<\/option>\n<option value=\"45900\">12:45 pm<\/option>\n<option value=\"46800\">1:00 pm<\/option>\n<option value=\"47700\">1:15 pm<\/option>\n<option value=\"48600\">1:30 pm<\/option>\n<option value=\"49500\">1:45 pm<\/option>\n<option value=\"50400\">2:00 pm<\/option>\n<option value=\"51300\">2:15 pm<\/option>\n<option value=\"52200\">2:30 pm<\/option>\n<option value=\"53100\">2:45 pm<\/option>\n<option value=\"54000\">3:00 pm<\/option>\n<option value=\"54900\">3:15 pm<\/option>\n<option value=\"55800\">3:30 pm<\/option>\n<option value=\"56700\">3:45 pm<\/option>\n<option value=\"57600\">4:00 pm<\/option>\n<option value=\"58500\">4:15 pm<\/option>\n<option value=\"59400\">4:30 pm<\/option>\n<option value=\"60300\">4:45 pm<\/option>\n<option value=\"61200\">5:00 pm<\/option>\n<option value=\"62100\">5:15 pm<\/option>\n<option value=\"63000\">5:30 pm<\/option>\n<option value=\"63900\">5:45 pm<\/option>\n<option value=\"64800\">6:00 pm<\/option>\n<option value=\"65700\">6:15 pm<\/option>\n<option value=\"66600\">6:30 pm<\/option>\n<option value=\"67500\">6:45 pm<\/option>\n<option value=\"68400\">7:00 pm<\/option>\n<option value=\"69300\">7:15 pm<\/option>\n<option value=\"70200\">7:30 pm<\/option>\n<option value=\"71100\">7:45 pm<\/option>\n<option value=\"72000\">8:00 pm<\/option>\n<option value=\"72900\">8:15 pm<\/option>\n<option value=\"73800\">8:30 pm<\/option>\n<option value=\"74700\">8:45 pm<\/option>\n<option value=\"75600\">9:00 pm<\/option>\n<option value=\"76500\">9:15 pm<\/option>\n<option value=\"77400\">9:30 pm<\/option>\n<option value=\"78300\">9:45 pm<\/option>\n<option value=\"79200\">10:00 pm<\/option>\n<option value=\"80100\">10:15 pm<\/option>\n<option value=\"81000\">10:30 pm<\/option>\n<option value=\"81900\">10:45 pm<\/option>\n<option value=\"82800\">11:00 pm<\/option>\n<option value=\"83700\">11:15 pm<\/option>\n<option value=\"84600\">11:30 pm<\/option>\n<option value=\"85500\">11:45 pm<\/option><\/select><\/div>\n<\/div>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<div class=\"drts-form-field drts-form-type-addmore\" style=\"\" data-form-field-name=\"drts[field_opening_hours][_add]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <button type=\"button\" class=\"drts-bs-btn drts-bs-btn-outline-secondary drts-bs-btn-sm drts-form-field-add\" data-field-max-num=\"0\" data-field-next-index=\"1\"><i class=\"fas fa-plus fa-fw\"><\/i> Add More<\/button>\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_wp_post_content\" class=\"drts-display-element drts-display-element-entity_form_wp_post_content-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-wp-post-content drts-entity-form-field-name-post-content drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[post_content]\">\n<label>Listing Description<\/label>\n<div class=\"drts-form-field drts-form-type-wp-editor\" style=\"\" data-form-field-name=\"drts[post_content][0]\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <div id=\"wp-drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0-editor-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><link rel='stylesheet' id='dashicons-css' href='https:\/\/testosteronetraumaprovidernetwork.com\/wp-includes\/css\/dashicons.min.css?ver=6.5.5' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='editor-buttons-css' href='https:\/\/testosteronetraumaprovidernetwork.com\/wp-includes\/css\/editor.min.css?ver=6.5.5' type='text\/css' media='all' \/>\n<div id=\"wp-drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0-editor-editor-tools\" class=\"wp-editor-tools hide-if-no-js\"><div class=\"wp-editor-tabs\"><button type=\"button\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0-editor-tmce\" class=\"wp-switch-editor switch-tmce\" data-wp-editor-id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0-editor\">Visual<\/button>\n<button type=\"button\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0-editor-html\" class=\"wp-switch-editor switch-html\" data-wp-editor-id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0-editor\">Text<\/button>\n<\/div>\n<\/div>\n<div id=\"wp-drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0-editor-editor-container\" class=\"wp-editor-container\"><div id=\"qt_drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0-editor_toolbar\" class=\"quicktags-toolbar hide-if-no-js\"><\/div><textarea class=\"wp-editor-area\" rows=\"10\" autocomplete=\"off\" cols=\"40\" name=\"drts[post_content][0]\" id=\"drts-form-f7453e5a114edd354df2bdc233018cae-drts-post-content-0-editor\"><\/textarea><\/div>\n<\/div>\n\n\n        <div class=\"drts-bs-form-text drts-form-error drts-bs-text-danger\"><\/div>\n        \n    <\/div>\n<\/div>\n<\/div><\/div>\n<div data-name=\"entity_form_entity_terms\" class=\"drts-display-element drts-display-element-entity_form_entity_terms-1\" style=\"\"><div class=\"drts-bs-form-group drts-entity-form-field drts-entity-form-field-type-entity-terms drts-entity-form-field-name-directory-category drts-form-field drts-form-type-fieldset\" style=\"\" data-form-field-name=\"drts[directory_category]\">\n<label>Categories<\/label>\n<div class=\"drts-form-field drts-form-type-select\" style=\"\" data-form-field-name=\"drts[directory_category][0]\">\n    \n    <div class=\"drts-form-field-main\">\n        \n        <select class=\"drts-bs-form-control \" name=\"drts[directory_category][0]\"><option value=\"\">\u2014 Select \u2014<\/option>\n<option value=\"34\" data-prefix=\"\" data-depth=\"0\" data-alt-value=\"doctors\">Doctors<\/option>\n<option value=\"52\" data-prefix=\"\" data-depth=\"0\" data-alt-value=\"nurse-practitioners\">Nurse Practitioners<\/option>\n<option value=\"51\" data-prefix=\"\" data-depth=\"0\" data-alt-value=\"psychiatrists\">Psychiatrists<\/option>\n<option value=\"35\" data-prefix=\"\" data-depth=\"0\" data-alt-value=\"therapists\">Therapists<\/option><\/select>\n        <div class=\"drts-bs-form-text 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