
{"id":5403,"date":"2018-12-16T00:23:42","date_gmt":"2018-12-16T08:23:42","guid":{"rendered":"https:\/\/driphydration.com\/?page_id=5403"},"modified":"2025-10-23T03:53:02","modified_gmt":"2025-10-23T10:53:02","slug":"stomach-flu-iv-treatment","status":"publish","type":"page","link":"https:\/\/driphydration.com\/stomach-flu-iv-treatment\/","title":{"rendered":"Stomach Flu Treatment"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221;][vc_column]                    <article class=\"product-intro\">\n                <div class=\"product-intro__slider\">\n                                                                                                                        \t\t\t\t\t                                        \n                    <div class=\"product-intro__wrapper\">\n                                                    <img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Stomach-Flu_DRIP.png\" alt=\"Stomach Flu IV Treatment\" class=\"product-intro__img\"\/>\n                                                                            <picture>\n                                                                    <source srcset=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Stomach-Flu_Hero_Mob.jpg\" media=\"(min-width: 200px) and (max-width: 600px)\">\n                                                                <img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Stomach-Flu_Hero_Desk.jpg\" alt=\"Stomach Flu IV Treatment\" class=\"product-intro__bg\"\/>\n                            <\/picture>\n                                                <div class=\"ecommerce_container\">\n                            <div class=\"product-intro___content\">\n                                <div class=\"container_top\">\n                                                                                                                <h1 class=\"title\" data-title=\"\">Stomach Flu IV Treatment<\/h1>\n                                                                                                                <div class=\"price\" data-prod-title=\"\">\n                                            <span class=\"currency\">$<\/span><span data-class=\"title\">299<\/span>\n                                        <\/div>\n                                                                    <\/div>\n                                <div class=\"container_description\">\n                                                                                            <div class=\"text\"><strong>Soothe &amp; Heal<\/strong><\/p>\n<p>Includes a blend of fluids, electrolytes, vitamins, and medications to help you quickly recover from the symptoms of stomach flu.<\/p>\n<p><strong>Ingredients:<\/strong> B-Complex Vitamins, Vitamin B12, Vitamin C, Pepcid, Zofran<\/div>\n                                                                                        <div class=\"product-intro___rating\">\n                                                                                            <\/div>\n                                <\/div>\n\n                                                                    <!-- Two buttons -->\n                                    <div class=\"row-buttom-im\">\n                                                                                    <a href=\"#Book-IV-Therapy\" class=\"btn-new white\"\n                                                                                                >\n                                                BOOK NOW                                            <\/a>\n                                          \n                                                                                    <a href=\"https:\/\/driphydration.com\/vitamin-drip-membership\/\" class=\"btn-new outline-white\"\n                                                                                                >\n                                                VIEW PLANS                                            <\/a>\n                                                                            <\/div>\n                                \n\n                                <div class=\"row-icon\">\n                                                                            <img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/icons.svg\" alt=\"icon\"\/>\n                                                                    <\/div>\n\t\t\t\t\t\t\t\t<div class=\"content-raiting\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n                            <\/div>\n                        <\/div>\n                    <\/div>\n                <\/div>\n            <\/article>\n          \n                        <article\n            class=\"right-for-you\"\n            >\n            <div class=\"ecommerce_container\">\n                                                                    <h2 class=\"right-for-you__title-mobile\">Fast and effective stomach flu relief, delivered directly to you<\/h2>\n                                                    <img decoding=\"async\" class=\"\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Stomach-Flu_Square_4.jpg\"                             alt=\"Fast and effective stomach flu relief, delivered directly to you\"  \/>\n                                                <div class=\"right-for-you__content\">\n                                            <h2 class=\"right-title\">Fast and effective stomach flu relief, delivered directly to you<\/h2>\n                                                                <div class=\"text\"><p>The stomach flu can leave you feeling in pain and miserable for several days, taking time away from the things in your life that really matter. This condition can also leave you extremely dehydrated, which can prolong your recovery as well as worsen the severity of your symptoms.<\/p>\n<p>Drip Hydration can help. Our Stomach Flu IV treatment can help combat the symptoms of a stomach flu. Nausea can make it all but impossible to ingest fluids or medications. Our Stomach Flu IV is administered directly into your bloodstream, circumventing nausea by bypassing your digestive system altogether.<\/p>\n<\/div>\n                                        \n                    <div class=\"container__buttons\">\n                                                    <a href=\"#Book-IV-Therapy\"\n                            class=\"btn-new white\"\n                                                        >\n                                BOOK NOW                            <\/a>\n                                                                                                     \n                    <\/div>\n                                    <\/div>\n            <\/div>\n        <\/article>\n                <article\n            class=\"right-for-you text_on_left without_background\"\n            >\n            <div class=\"ecommerce_container\">\n                                                                                    <img decoding=\"async\" class=\"\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Stomach-Flu_Square_1.jpg\"  \/>\n                                                <div class=\"right-for-you__content\">\n                                                                <div class=\"text\"><p>Our treatment can provide fast relief from symptoms without the discomfort of having to ingest medications. You won\u2019t have to worry about swallowing any fluids or medications that could further upset your stomach. In addition, this treatment rehydrates your body, flushes out toxins, and restores vitamins lost due to nausea and vomiting.<\/p>\n<p>Our formula includes anti-nausea and antacid medications to help improve your symptoms quickly, all in the comfort of your home.<\/p>\n<\/div>\n                                        \n                    <div class=\"container__buttons\">\n                                                    <a href=\"#Book-IV-Therapy\"\n                            class=\"btn-new white\"\n                                                        >\n                                BOOK NOW                            <\/a>\n                                                                                                     \n                    <\/div>\n                                    <\/div>\n            <\/div>\n        <\/article>\n                <article\n            class=\"right-for-you\"\n            >\n            <div class=\"ecommerce_container\">\n                                                                    <h2 class=\"right-for-you__title-mobile\">Causes and symptoms of the stomach flu<\/h2>\n                                                    <img decoding=\"async\" class=\"\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Stomach-Flu_Square_5.jpg\"                             alt=\"Causes and symptoms of the stomach flu\"  \/>\n                                                <div class=\"right-for-you__content\">\n                                            <h2 class=\"right-title\">Causes and symptoms of the stomach flu<\/h2>\n                                                                <div class=\"text\"><p>The stomach flu wreaks havoc in your digestive system and cause nausea, vomiting, and diarrhea.<\/p>\n<p>The signs of food poisoning generally begin between 2 \u2013 12 hours after ingesting the contaminated food. While the exact symptoms of food poisoning vary slightly depending on what type of virus or bacteria is ailing you, there are several overlapping symptoms.<\/p>\n<\/div>\n                                        \n                    <div class=\"container__buttons\">\n                                                    <a href=\"#Book-IV-Therapy\"\n                            class=\"btn-new white\"\n                                                        >\n                                BOOK NOW                            <\/a>\n                                                                                                     \n                    <\/div>\n                                    <\/div>\n            <\/div>\n        <\/article>\n                <article\n            class=\"right-for-you text_on_left without_background\"\n            >\n            <div class=\"ecommerce_container\">\n                                                                    <h2 class=\"right-for-you__title-mobile\">The signs of food poisoning include:<\/h2>\n                                                    <img decoding=\"async\" class=\"\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Stomach-Flu_Square_3.jpg\"                             alt=\"The signs of food poisoning include:\"  \/>\n                                                <div class=\"right-for-you__content\">\n                                            <h2 class=\"right-title\">The signs of food poisoning include:<\/h2>\n                                                                <div class=\"text\"><ul>\n<li>Nausea<\/li>\n<li>Abdominal cramps<\/li>\n<li>Vomiting<\/li>\n<li>Diarrhea<\/li>\n<li>Fatigue<\/li>\n<li>Fever (in some cases)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>There are dozens of viruses, parasites, and harmful bacteria that can cause food poisoning. You can learn more about the types of organisms that cause food poisoning <a href=\"https:\/\/www.foodsafety.gov\/poisoning\/symptoms\/symptoms.html\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a>.<\/p>\n<\/div>\n                                        \n                    <div class=\"container__buttons\">\n                                                    <a href=\"#Book-IV-Therapy\"\n                            class=\"btn-new white\"\n                                                        >\n                                BOOK NOW                            <\/a>\n                                                                                                     \n                    <\/div>\n                                    <\/div>\n            <\/div>\n        <\/article>\n                <article class=\"icons_block\">\n            <div class=\"ecommerce_container\">\n                <div class=\"resources__head\">\n                                            <h2 class=\"title-icon\">Best uses for <strong>Stomach Flu IV<\/strong><\/h2>\n                                    <\/div>\n                                    <ul class=\"icons_list\">\n                                                                                <li>\n                                                                    <img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Upset_Stomach-1.svg\" alt=\"Soothe upset stomach\"\/>\n                                                                                                    <h5>Soothe upset stomach<\/h5>\n                                                            <\/li>\n                                                                                <li>\n                                                                    <img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Anti-Nausea.svg\" alt=\"Nausea relief\"\/>\n                                                                                                    <h5>Nausea relief<\/h5>\n                                                            <\/li>\n                                                                                <li>\n                                                                    <img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Fight_Fatigue.svg\" alt=\"Fight fatigue\"\/>\n                                                                                                    <h5>Fight fatigue<\/h5>\n                                                            <\/li>\n                                                                                <li>\n                                                                    <img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/05\/Illness_Recovery-1.svg\" alt=\"Illness recovery & support\"\/>\n                                                                                                    <h5>Illness recovery & support<\/h5>\n                                                            <\/li>\n                                            <\/ul>\n                            <\/div>\n        <\/article>\n                <article class=\"embed_social\">\n            <div class=\"ecommerce_container\">\n                                    <h2 class=\"embed-title\">Hear from <strong>our clients<\/strong><\/h2>\n                                                    <div class=\"embed\">\n                        <\/p>\n<div class=\"embedsocial-hashtag\" data-ref=\"76b0d84c8a3b24b64ff837a5ebde8bbc68f55f5a\"><\/div>\n<p><script> (function(d, s, id) { var js; if (d.getElementById(id)) {return;} js = d.createElement(s); js.id = id; js.src = \"https:\/\/embedsocial.com\/cdn\/ht.js\"; d.getElementsByTagName(\"head\")[0].appendChild(js); }(document, \"script\", \"EmbedSocialHashtagScript\")); <\/script>                    <\/div>\n  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border: 1px solid #1b262a !important;\n        background: none !important;\n        font-family: Poppins !important;\n        color: black !important;\n        border-radius: 40px !important;\n        width: 100%;\n        margin-top: 1rem !important;  \n        padding-top: 10px !important;\n       }\n       \n       .register-card-button:hover {\n            background: #37AFB1;\n            color: #fff;\n       }\n        a.register-card-button {\n    height: 50px !important;\n}\n       \n    .customer-card-button  {\n        font-size: 18px !important;\n        font-weight: 500 !important;\n        line-height: 150% !important;\n        text-align: center;\n        border: 1px solid #1b262a !important;\n        background: none !important;\n        font-family: Poppins !important;\n        color: black !important;\n        border-radius: 40px !important;\n        width: 100%;\n        margin-top: 1rem !important;\n}\n\n    .customer-card-button:hover {\n        background: #37AFB1;\n        color: #fff;\n    }\n    \n    \n     .guest-card {\n        margin-top: 40px;\n        width: 488px;\n        border-radius: 20px;\n        padding: 32px 24px;\n        border: 1px solid #D1DBE1;\n        background-color: #fff;\n    }\n    \n    .gf-status{\n    font-family: Poppins!important;\n    font-weight: 600!important;\n    font-style: SemiBold!important;\n    font-size: 20px!important;\n    leading-trim: NONE!important;\n    line-height: 26px!important;\n    letter-spacing: -1%!important;\n\n    }\n    \n    \n   button#togglePassword {\n    position: absolute;\n    border: none;\n    background: transparent;\n    cursor: pointer;\n    font-size: 16px;\n    color: gray !important;\n}\n       \n       .gf-login-form.login-127 {\n           display: block;\n           min-width: 488px !important;\n}\n       \n    button.customer-card-button {\n    height: 50px !important;\n}\n       \n\/* addd by inzy*\/\n\n.gf-login .flex-row {\n    display: flex !important;\n    flex-direction: column !important;\n    margin-top:20px !important;\n}\n       \n.password-wrapper {\n  position: relative;\n  display: flex;\n  align-items: center;\n}\n.password-wrapper input {\n  width: 100%;\n  padding-right: 40px; \/* espacio para el ojo *\/\n}\n.password-wrapper .eye-icon {\n  position: absolute;\n  right: 10px;  \/* separaci\u00f3n del borde derecho *\/\n  background: none;\n  border: none;\n  cursor: pointer;\n  color: #555; \/* ajusta el color a tu dise\u00f1o *\/\n  font-size: 16px;\n}\n       \nspan.login-sub-title {\n    color: #425962 !important;\n    font-family: Poppins!important;\n    font-weight: 500!important;\n    font-style: Medium!important;\n    font-size: 17px !important;\n    leading-trim: NONE!important;\n    line-height: 24px !important;\n    letter-spacing: 0%!important;\n    text-align: left !important;\n} \n       \n.password-label{\n   margin-bottom: 0px!important;\n}\n\n       \n\/*\n.gform-order-summary-new {\n    width: 488px;\n    margin-left: 0;\n    margin-top: 40px;\n}\n*\/\n\n\/* addd by inzy*\/\n  \n        \n@media only screen and (max-width: 480px) {\n  \n    .entire-auth-section-before-login {\n    display: flex;\n    flex-direction: column;\n  }\n    \n    .guest-card{\n        width: 100%;\n        margin-top: 40px;\n    }\n    .customer-card{\n        width: 100%;\n    }\n     .gf-login .flex-row .form-row-rememberme {\n        margin-bottom: 10px;\n        margin-left: -71px;\n    }\n    .gf-login-form.login-127 {\n        min-width: 0 !important;\n    }\n}\n<\/style>\n\n<div class=\"gf-login\">\n    \n        <div class=\"entire-auth-section-before-login\">\n\n            <div class=\"gf-login-form login-127\" style=\"display:block !important;\" >\n                <!-- <h2 class=\"login-title\">Welcome to Mobile IV Therapy<\/h2> -->                \n                <span class=\"login-sub-title\">Please sign in or create an account to continue<\/span>\n                <p class=\"gf-status\" style=\"color:#1B262A;\">Sign In<\/p>\n                <p class=\"form-row need-field\">\n                    <label for=\"username\">Email<\/label>\n                    <input type=\"email\" class=\"input-text\" id=\"username\" placeholder=\"e.g. your@email.com\"\n                        autocomplete=\"username\"\n                        value=\"\" \/>\n                <\/p>\n                \n<p class=\"form-row need-field\">\n  <label for=\"password\" class=\"password-label\">Password<\/label>\n  <span class=\"password-wrapper\">\n    <input\n      type=\"password\"\n      class=\"input-text\"\n      id=\"password\"\n      placeholder=\"Your password\"\n      autocomplete=\"current-password\"\n    >\n    <button\n      type=\"button\"\n      id=\"togglePassword\"\n      aria-label=\"Show password\"\n      class=\"eye-icon\"\n    >\n      <i class=\"fa fa-eye\" id=\"toggleIcon\"><\/i>\n    <\/button>\n  <\/span>\n<\/p>   \n                \n<!--\n                <p class=\"form-row need-field\">\n                    <label for=\"password\">Password<\/label>\n                    <input type=\"password\" class=\"input-text\" id=\"password\" placeholder=\"Your password\"\n                        autocomplete=\"current-password\" \/>\n                    <button type=\"button\" id=\"togglePassword\" aria-label=\"Show password\" class=\"eye-icon\"\n                     >\n                    <i class=\"fa fa-eye\" id=\"toggleIcon\"><\/i>\n                    <\/button>\n                <\/p>\n-->\n                <div class=\"flex-row\">\n\n                    <p class=\"lost_password\">\n                        <a href=\"https:\/\/driphydration.com\/my-account\/lost-password\/\">Forgot password?<\/a>\n                    <\/p>\n\n                    <p class=\"form-row form-row-rememberme\">\n                        <label>\n                            <input type=\"checkbox\" id=\"rememberme\" value=\"forever\" \/><span>Remember me<\/span>\n                        <\/label>\n                    <\/p>\n                <\/div>\n                <p class=\"form-row\" style=\"position:relative\">\n                    <input type=\"hidden\" id=\"gfa-login-nonce\" name=\"gfa-login-nonce\" value=\"925b4ededa\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/5403\" \/>                    <input type=\"hidden\" id=\"redirect\" value=\"\/wp-json\/wp\/v2\/pages\/5403#scroll_to_form\" \/>\n                    <img decoding=\"async\" class=\"gform_ajax_spinner\" style=\"display:none;\"\n                        src=\"https:\/\/driphydration.com\/wp-content\/themes\/bridge-child\/img\/spinner.gif\"\n                        alt=\"\" \/>\n                    <a href=\"#\" id=\"submit\" class=\"gfa-button\" style=\"background:#1B262A!important;width: 488;height: 48;angle: 0 deg;opacity: 1;padding-right: 24px;padding-left: 24px;border-radius: 40px;\">Sign in<\/a>\n                <\/p>\n                <!--\n            <p class=\"back-login\">\n                <a id=\"back_login\" href=\"#\">Back<\/a>\n            <\/p>\n-->\n            <\/div>\n            <div class=\"gf-login-top\">\n                <!-- Card -->\n                <div class=\"customer-card\">\n                    <h3 class=\"customer-card-title\">New Customer<\/h3>\n                    <p class=\"customer-card-description\">Create an account to:<\/p>\n                    <ul class=\"customer-card-list\">\n                        <li>\n                            <span class=\"icon\">\n                                <svg width=\"16\" height=\"17\" viewBox=\"0 0 16 17\" fill=\"none\"\n                                    xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <circle cx=\"8\" cy=\"8.76562\" r=\"7.5\" stroke=\"#37AFB1\" \/>\n                                    <path d=\"M8 12.0977L10.6667 8.76432L8 5.43099\" stroke=\"#37AFB1\" stroke-linecap=\"round\"\n                                        stroke-linejoin=\"round\" \/>\n                                    <path d=\"M4.66797 8.76562L10.668 8.76562\" stroke=\"#37AFB1\" stroke-linecap=\"round\"\n                                        stroke-linejoin=\"round\" \/>\n                                <\/svg>\n                            <\/span>\n                            Save your information for faster booking\n                        <\/li>\n                        <li>\n                            <span class=\"icon\">\n                                <svg width=\"16\" height=\"17\" viewBox=\"0 0 16 17\" fill=\"none\"\n                                    xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <circle cx=\"8\" cy=\"8.76562\" r=\"7.5\" stroke=\"#37AFB1\" \/>\n                                    <path d=\"M8 12.0977L10.6667 8.76432L8 5.43099\" stroke=\"#37AFB1\" stroke-linecap=\"round\"\n                                        stroke-linejoin=\"round\" \/>\n                                    <path d=\"M4.66797 8.76562L10.668 8.76562\" stroke=\"#37AFB1\" stroke-linecap=\"round\"\n                                        stroke-linejoin=\"round\" \/>\n                                <\/svg>\n                            <\/span>\n                            Manage account, payments &amp; membership\n                        <\/li>\n                        <li>\n                            <span class=\"icon\">\n                                <svg width=\"16\" height=\"17\" viewBox=\"0 0 16 17\" fill=\"none\"\n                                    xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <circle cx=\"8\" cy=\"8.76562\" r=\"7.5\" stroke=\"#37AFB1\" \/>\n                                    <path d=\"M8 12.0977L10.6667 8.76432L8 5.43099\" stroke=\"#37AFB1\" stroke-linecap=\"round\"\n                                        stroke-linejoin=\"round\" \/>\n                                    <path d=\"M4.66797 8.76562L10.668 8.76562\" stroke=\"#37AFB1\" stroke-linecap=\"round\"\n                                        stroke-linejoin=\"round\" \/>\n                                <\/svg>\n                            <\/span>\n                            Stay in the loop with insider perks and offers\n                        <\/li>\n                    <\/ul>\n<!--                    -->\n                    <a href=\"https:\/\/driphydration.com\/my-account\/register\/\" class=\"register-card-button\">REGISTER NOW<\/a>\n                <\/div>\n                \n                <div class=\"guest-card\">\n                    <h3 class=\"customer-card-title\">Continue as a guest<\/h3>\n                    <p class=\"customer-card-description\">You can create an account later if you want:<\/p>  \n                    <button id=\"form_guest\" class=\"customer-card-button\" href=\"#\" style=\"color:black !important;\">Continue<\/button>\n               <\/div>\n\n            <\/div>  \n\n            <!--\n            <p>Don't have an account?\n              <button type=\"button\" id=\"register_now\">Register now<\/button>\n            <\/p>\n-->\n<!--            <p class=\"gfseparator\"><span>or<\/span><\/p>-->\n           \n    \n        <\/div>\n            <\/div>\n\n\n<script>\ndocument.addEventListener(\"DOMContentLoaded\", function(){\n  const toggle = document.getElementById(\"togglePassword\");\n  const password = document.getElementById(\"password\");\n  const icon = document.getElementById(\"toggleIcon\");\n\n  toggle.addEventListener(\"click\", function () {\n    const isPassword = password.type === \"password\";\n    password.type = isPassword ? \"text\" : \"password\";\n\n    \/\/ switch icons\n    icon.classList.toggle(\"fa-eye\");\n    icon.classList.toggle(\"fa-eye-slash\");\n\n    \/\/ accessibility label\n    toggle.setAttribute(\"aria-label\", isPassword ? \"Hide password\" : \"Show password\");\n  });\n    \n    \n\n});\n\/\/    if (jQuery('.gform-order-summary-new').length) {\n\/\/    jQuery('.gform-order-summary-new').insertAfter('.gf-login-top .guest-card');\n\/\/}\n<\/script>\n\n\n\n \n\n\n<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_127_438' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next Step'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_127_2' class='gform_page' data-js='page-field-id-438' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_127_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_127_52\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><label class=\"gfield_label step_label\">Your Appointment Address<\/label><\/div><div class=\"address-information\"><div id=\"field_127_235\" class=\"gfield gfield--type-countries gfield--input-type-countries gfield--width-full gf_left_half provider_country start_block_address gf-custom-countries gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_235'>Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_235' id='input_127_235' class='medium gfield_select'   aria-required=\"true\" aria-invalid=\"false\" form_id='127' ><option value=\"Argentina\">Argentina<\/option>\n<option value=\"Australia\">Australia<\/option>\n<option value=\"Austria\">Austria<\/option>\n<option value=\"Brazil\">Brazil<\/option>\n<option value=\"Canada\">Canada<\/option>\n<option value=\"Costa Rica\">Costa Rica<\/option>\n<option value=\"France\">France<\/option>\n<option value=\"Germany\">Germany<\/option>\n<option value=\"Greece\">Greece<\/option>\n<option value=\"Hong Kong\">Hong Kong<\/option>\n<option value=\"India\">India<\/option>\n<option value=\"Israel\">Israel<\/option>\n<option value=\"Italy\">Italy<\/option>\n<option value=\"Jamaica\">Jamaica<\/option>\n<option value=\"Mexico\">Mexico<\/option>\n<option value=\"Monaco\">Monaco<\/option>\n<option value=\"Netherlands\">Netherlands<\/option>\n<option value=\"Peru\">Peru<\/option>\n<option value=\"Philippines\">Philippines<\/option>\n<option value=\"Portugal\">Portugal<\/option>\n<option value=\"Puerto Rico\">Puerto Rico<\/option>\n<option value=\"South Africa\">South Africa<\/option>\n<option value=\"Spain\">Spain<\/option>\n<option value=\"Switzerland\">Switzerland<\/option>\n<option value=\"T\u00fcrkiye\">T\u00fcrkiye<\/option>\n<option value=\"United Arab Emirates\">United Arab Emirates<\/option>\n<option value=\"United Kingdom\">United Kingdom<\/option>\n<option value=\"United States\" selected=\"selected\">United States<\/option>\n<\/select><\/div><\/div><div id=\"field_127_365\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"font-size: 16px; color:red;\"> Having troubles with the address? <a href=\"https:\/\/driphydration.com\/contact-us\/?city=Abu%20Dhabi,%20UAE\">Contact Us<\/a> <\/p><\/div><div id=\"field_127_491\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style=\"color: red;\n    font-weight: 500;\n    font-size: 13px;\">Please include your flat number to avoid any delays upon arrival.<\/div><\/div><fieldset id=\"field_127_7\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gform_autocomplete_container gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Appointment Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip ginput_container_address gform-grid-row' id='input_127_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_127_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_127_7_1' value=''   placeholder='Street Address' aria-required='true'    \/>\n                                        <label for='input_127_7_1' id='input_127_7_1_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_127_7_2_container' >\n                                        <input type='text' name='input_7.2' id='input_127_7_2' value=''   placeholder='Address Line 2'  aria-required='false'   \/>\n                                        <label for='input_127_7_2' id='input_127_7_2_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_127_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_127_7_3' value=''   placeholder='City' aria-required='true'    \/>\n                                    <label for='input_127_7_3' id='input_127_7_3_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_7.4' id='input_127_7_4' value='California'\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_127_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_127_7_5' value=''   placeholder='ZIP' aria-required='true'    \/>\n                                    <label for='input_127_7_5' id='input_127_7_5_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_7.6' id='input_127_7_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_127_154\" class=\"gfield gfield--type-states gfield--input-type-states gfield--width-full gf_left_half gf-custom-states gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_154'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_154' id='input_127_154' class='medium gfield_select'   aria-required=\"true\" aria-invalid=\"false\" form_id='127' ><option value='' selected='selected' class='gf_placeholder'>State<\/option><option value=\"Arizona\">Arizona<\/option>\n<option value=\"California\">California<\/option>\n<option value=\"Colorado\">Colorado<\/option>\n<option value=\"Connecticut\">Connecticut<\/option>\n<option value=\"District of Columbia\">District of Columbia<\/option>\n<option value=\"Florida\">Florida<\/option>\n<option value=\"Georgia\">Georgia<\/option>\n<option value=\"Hawaii\">Hawaii<\/option>\n<option value=\"Idaho\">Idaho<\/option>\n<option value=\"Illinois\">Illinois<\/option>\n<option value=\"Kentucky\">Kentucky<\/option>\n<option value=\"Louisiana\">Louisiana<\/option>\n<option value=\"Maryland\">Maryland<\/option>\n<option value=\"Massachusetts\">Massachusetts<\/option>\n<option value=\"Michigan\">Michigan<\/option>\n<option value=\"Minnesota\">Minnesota<\/option>\n<option value=\"Missouri\">Missouri<\/option>\n<option value=\"Montana\">Montana<\/option>\n<option value=\"Nevada\">Nevada<\/option>\n<option value=\"New Jersey\">New Jersey<\/option>\n<option value=\"New Mexico\">New Mexico<\/option>\n<option value=\"New York\">New York<\/option>\n<option value=\"North Carolina\">North Carolina<\/option>\n<option value=\"North Dakota\">North Dakota<\/option>\n<option value=\"Ohio\">Ohio<\/option>\n<option value=\"Oklahoma\">Oklahoma<\/option>\n<option value=\"Oregon\">Oregon<\/option>\n<option value=\"Pennsylvania\">Pennsylvania<\/option>\n<option value=\"Rhode Island\">Rhode Island<\/option>\n<option value=\"Tennessee\">Tennessee<\/option>\n<option value=\"Texas\">Texas<\/option>\n<option value=\"Utah\">Utah<\/option>\n<option value=\"Virginia\">Virginia<\/option>\n<option value=\"Washington\">Washington<\/option>\n<option value=\"Wisconsin\">Wisconsin<\/option>\n<option value=\"Wyoming\">Wyoming<\/option>\n<\/select><\/div><\/div><div id=\"field_127_31\" class=\"gfield gfield--type-appointment_providers gfield--input-type-appointment_providers gfield--width-full provider_field end_block_address gappointments_provider gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_31'>Provider<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_31' id='input_127_31' class='medium appointment_provider_id gfield_select'   aria-required=\"true\" aria-invalid=\"false\" form_id='127' ><option value='' selected='selected' class='gf_placeholder'><\/option><option value=\"64896\">Abu Dhabi, UAE<\/option>\n<option value=\"96168\">Adelaide, Australia<\/option>\n<option value=\"34263\">Albuquerque<\/option>\n<option value=\"32496\">Amsterdam, Netherlands<\/option>\n<option value=\"34316\">Aspen<\/option>\n<option value=\"13205\">Athens, Greece<\/option>\n<option value=\"10647\">Atlanta<\/option>\n<option value=\"10391\">Austin<\/option>\n<option value=\"18099\">Bakersfield<\/option>\n<option value=\"10697\">Baltimore<\/option>\n<option value=\"54027\">Barcelona, Spain<\/option>\n<option value=\"19322\">Bellingham<\/option>\n<option value=\"18941\">Berlin, Germany<\/option>\n<option value=\"43475\">Boca Raton<\/option>\n<option value=\"147829\">Bodrum, Turkey<\/option>\n<option value=\"19324\">Boise<\/option>\n<option value=\"11259\">Boston<\/option>\n<option value=\"31851\">Brisbane, Australia<\/option>\n<option value=\"9294\">Bronx<\/option>\n<option value=\"78233\">Brooklyn<\/option>\n<option value=\"186784\">Buenos Aires, Argentina<\/option>\n<option value=\"11869\">Cabo San Lucas, Mexico<\/option>\n<option value=\"12091\">Cancun, Mexico<\/option>\n<option value=\"42886\">Cannes, France<\/option>\n<option value=\"80072\">Cape Cod<\/option>\n<option value=\"19285\">Cape Town, South Africa<\/option>\n<option value=\"65771\">Central Coast<\/option>\n<option value=\"187106\">Central Connecticut<\/option>\n<option value=\"11056\">Central New Jersey<\/option>\n<option value=\"10147\">Charlotte<\/option>\n<option value=\"13757\">Chicago<\/option>\n<option value=\"12981\">Cincinnati<\/option>\n<option value=\"12654\">Cleveland<\/option>\n<option value=\"66354\">Colorado Springs<\/option>\n<option value=\"11747\">Columbus<\/option>\n<option value=\"12763\">Connecticut<\/option>\n<option value=\"12385\">Costa Rica<\/option>\n<option value=\"12100\">Cusco, Peru<\/option>\n<option value=\"11362\">Dallas<\/option>\n<option value=\"13527\">DEFAULT PROVIDER<\/option>\n<option value=\"9328\">Denver<\/option>\n<option value=\"13735\">Detroit<\/option>\n<option value=\"186724\">Driggs<\/option>\n<option value=\"27403\">Dubai, UAE<\/option>\n<option value=\"185824\">El Paso<\/option>\n<option value=\"139205\">Eugene<\/option>\n<option value=\"133270\">Florence, Italy<\/option>\n<option value=\"43474\">Fort Lauderdale<\/option>\n<option value=\"58023\">Fort Worth<\/option>\n<option value=\"12697\">Fresno &amp; Clovis<\/option>\n<option value=\"29036\">Geneva, Switzerland<\/option>\n<option value=\"31852\">Gold Coast, Australia<\/option>\n<option value=\"188674\">Grand Rapids<\/option>\n<option value=\"28535\">Green Bay<\/option>\n<option value=\"194526\">Gstaad, Switzerland<\/option>\n<option value=\"187116\">Hampton<\/option>\n<option value=\"12667\">Hawaii - Maui<\/option>\n<option value=\"65170\">Hawaii - Oahu<\/option>\n<option value=\"184812\">Hong Kong<\/option>\n<option value=\"11361\">Houston<\/option>\n<option value=\"12266\">Ibiza, Spain<\/option>\n<option value=\"9449\">Inland Empire and Palm Springs<\/option>\n<option value=\"150940\">Istanbul, Turkey<\/option>\n<option value=\"30714\">Jackson Hole<\/option>\n<option value=\"40497\">Jacksonville<\/option>\n<option value=\"129319\">Jerusalem, Israel<\/option>\n<option value=\"19814\">Johannesburg, South Africa<\/option>\n<option value=\"14576\">Knoxville<\/option>\n<option value=\"13731\">Las Vegas<\/option>\n<option value=\"12034\">Lima, Peru<\/option>\n<option value=\"171535\">Lisbon, Portugal<\/option>\n<option value=\"13730\">London, United Kingdom<\/option>\n<option value=\"187111\">Long Island<\/option>\n<option value=\"3861\">Los Angeles<\/option>\n<option value=\"22432\">Louisville<\/option>\n<option value=\"28534\">Madison<\/option>\n<option value=\"54024\">Madrid, Spain<\/option>\n<option value=\"132332\">Manchester, United Kingdom<\/option>\n<option value=\"114128\">Manhattan<\/option>\n<option value=\"158782\">Manila, Philippines<\/option>\n<option value=\"31850\">Melbourne, Australia<\/option>\n<option value=\"39314\">Memphis<\/option>\n<option value=\"12680\">Mexico City, Mexico<\/option>\n<option value=\"9559\">Miami<\/option>\n<option value=\"18412\">Milan, Italy<\/option>\n<option value=\"28533\">Milwaukee<\/option>\n<option value=\"20488\">Minneapolis<\/option>\n<option value=\"149429\">Montana<\/option>\n<option value=\"189644\">Monte Carlo, Monaco<\/option>\n<option value=\"123840\">Montego Bay, Jamaica<\/option>\n<option value=\"117130\">Monterrey, Mexico<\/option>\n<option value=\"21602\">Montreal, Canada<\/option>\n<option value=\"169302\">Mumbai, India<\/option>\n<option value=\"144375\">Munich, Germany<\/option>\n<option value=\"13183\">Mykonos, Greece<\/option>\n<option value=\"80245\">Napa<\/option>\n<option value=\"13356\">Nashville<\/option>\n<option value=\"29812\">New Orleans<\/option>\n<option value=\"56129\">North Dakota<\/option>\n<option value=\"71030\">North New Jersey<\/option>\n<option value=\"33128\">Oklahoma City<\/option>\n<option value=\"10685\">Orange County<\/option>\n<option value=\"11104\">Oregon<\/option>\n<option value=\"15278\">Orlando<\/option>\n<option value=\"10660\">Palo Alto<\/option>\n<option value=\"26769\">Paris, France<\/option>\n<option value=\"31853\">Perth, Australia<\/option>\n<option value=\"13733\">Philadelphia<\/option>\n<option value=\"9453\">Phoenix<\/option>\n<option value=\"16450\">Pittsburgh<\/option>\n<option value=\"13207\">Puerto Vallarta, Mexico<\/option>\n<option value=\"114131\">Queens &amp; Nassau County<\/option>\n<option value=\"10187\">Raleigh &amp; Durham<\/option>\n<option value=\"41765\">Reno<\/option>\n<option value=\"13263\">Rhode Island<\/option>\n<option value=\"30819\">Rockford<\/option>\n<option value=\"18417\">Rome, Italy<\/option>\n<option value=\"9292\">Sacramento<\/option>\n<option value=\"12980\">San Antonio<\/option>\n<option value=\"9611\">San Diego<\/option>\n<option value=\"9493\">San Francisco<\/option>\n<option value=\"108874\">San Juan, Puerto Rico<\/option>\n<option value=\"34779\">Santa Fe<\/option>\n<option value=\"12031\">Santa Teresa, Costa Rica<\/option>\n<option value=\"141168\">Sao Paulo, Brazil<\/option>\n<option value=\"192699\">Sardinia, Italy<\/option>\n<option value=\"9327\">Seattle<\/option>\n<option value=\"187110\">Southwestern Connecticut<\/option>\n<option value=\"19323\">Spokane<\/option>\n<option value=\"12693\">St. Barts<\/option>\n<option value=\"26493\">St. George<\/option>\n<option value=\"53582\">St. Louis<\/option>\n<option value=\"186707\">St. Tropez<\/option>\n<option value=\"78243\">Suffolk County<\/option>\n<option value=\"69418\">Sun Valley<\/option>\n<option value=\"31847\">Sydney, Australia<\/option>\n<option value=\"20460\">Tampa<\/option>\n<option value=\"31855\">Tasmania, Australia<\/option>\n<option value=\"86749\">Tel Aviv, Israel<\/option>\n<option value=\"80650\">Tenerife, Spain<\/option>\n<option value=\"183711\">Toledo<\/option>\n<option value=\"25038\">Toronto, Canada<\/option>\n<option value=\"58165\">Tucson<\/option>\n<option value=\"12199\">Tulum, Mexico<\/option>\n<option value=\"9303\">Utah<\/option>\n<option value=\"27094\">Vancouver, Canada<\/option>\n<option value=\"144423\">Vienna, Austria<\/option>\n<option value=\"12511\">Washington, DC<\/option>\n<option value=\"49391\">Washington, DC - Maryland<\/option>\n<option value=\"49388\">Washington, DC - Virginia<\/option>\n<option value=\"43476\">West Palm Beach<\/option>\n<option value=\"188094\">Westchester and Rockland County<\/option>\n<option value=\"29039\">Zurich, Switzerland<\/option>\n<\/select><\/div><\/div><\/div><fieldset id=\"field_127_152\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full wider-checkbox field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Optional Email Signup<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_152'><div class='gchoice gchoice_127_152_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.1' type='checkbox'  value='Save my Information for exclusive offers'  id='choice_127_152_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_152_1' id='label_127_152_1' class='gform-field-label gform-field-label--type-inline'>Save my Information for exclusive offers<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_127_440' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_127_440' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next Step'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_127_3' class='gform_page' data-js='page-field-id-440' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_127_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_127_443\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><label class=\"gfield_label step_label\">Service Selection<\/label><\/div><div class=\"service-information\"><div class=\"person-info person-info-1\"><div class=\"personal-information\"><div id=\"field_127_239\" class=\"gfield gfield--type-html gfield--input-type-html start_block_service start_block_personal gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Personal information (Person 1) <span style = \"font-weight: 400; font-size: 18px; color: #838383;\">(you)<\/span><\/h3><\/div><div id=\"field_127_495\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full add-person-btn gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a can_added=\"9\" href=\"\"><i class=\"fa-plus-circle fa\"><\/i> Add Person<\/a><\/div><div id=\"field_127_1\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gf-add-placeholder gf_first_name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_1'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_127_1' type='text' value='' class='medium'    placeholder='First Name' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_127_6\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gf-add-placeholder gf_last_name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_6'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_127_6' type='text' value='' class='medium'    placeholder='Last Name' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_127_2\" class=\"gfield gfield--type-email gfield--input-type-email gf_left_half gf-add-placeholder gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_2'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_127_2' type='email' value='' class='medium'   placeholder='Email' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_127_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half gf-add-placeholder gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_4'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_127_4' type='tel' value='' class='medium'  placeholder='Phone' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><input type=\"hidden\" name=\"phone_country\"><\/div><fieldset id=\"field_127_19\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield drchrono_field_dob gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_127_19' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_127_19_1_container'>\n                                            <input type='number' maxlength='2' name='input_19[]' id='input_127_19_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_127_19_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_127_19_2_container'>\n                                            <input type='number' maxlength='2' name='input_19[]' id='input_127_19_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_127_19_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_127_19_3_container'>\n                                            <input type='number' maxlength='4' name='input_19[]' id='input_127_19_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2026' step='1'\/>\n                                            <label for='input_127_19_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_127_69\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_left_half field-user-type end_block_personal gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label' >Have you used Drip Hydration before?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_127_17'>\n\t\t\t<div class='gchoice gchoice_127_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='First Time Client' checked='checked' id='choice_127_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_127_17_0' id='label_127_17_0' class='gform-field-label gform-field-label--type-inline'>First Time Client<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_127_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Return Client'  id='choice_127_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_127_17_1' id='label_127_17_1' class='gform-field-label gform-field-label--type-inline'>Return Client<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><div id=\"field_127_15\" class=\"gfield gfield--type-appointment_services gfield--input-type-appointment_services no-display field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_15'>Packages<\/label><div class='ginput_container ginput_container_select'><select name='input_15' id='input_127_15'  class='large appointment_service_id gfield_select'    aria-invalid=\"false\" form_id='127'><option value=\"2441\">Mobile IV Treatment<\/option>\n<\/select><\/div><\/div><fieldset id=\"field_127_36\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gf_list_2col add-person-1 drchrono_field_treatments is-product product-form-dropdown is-main-product field_treatments hide-services gfield_price gfield_price_127_36 gfield_product_127_36 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"gfield-product\"><legend class=\"gfield_label gform-field-label\">Select IV Treatment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"custom-product-row product-row\">\n\t\t\t<div class='gchoice product-div gchoice_127_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Dehydration|249'  id='choice_127_36_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_0\" id=\"label_127_36_0\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Dehydration-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Dehydration<\/h4><p><span class=\"ginput_price\">$249<\/span><\/p><a class=\"need\" data-title=\"Dehydration\" data-price=\"$249.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Hydrate|249'  id='choice_127_36_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_1\" id=\"label_127_36_1\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Dehydration-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Hydrate<\/h4><p><span class=\"ginput_price\">$249<\/span><\/p><a class=\"need\" data-title=\"Hydrate\" data-price=\"$249.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Energy Boost|299'  id='choice_127_36_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_2\" id=\"label_127_36_2\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2021\/06\/Energy-Boost-IV-Treatment-1Kv5.jpg\"\/><div class=\"product-info-row\"><h4>Energy Boost<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Energy Boost\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Energy|299'  id='choice_127_36_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_3\" id=\"label_127_36_3\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2021\/06\/Energy-Boost-IV-Treatment-1Kv5.jpg\"\/><div class=\"product-info-row\"><h4>Energy<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Energy\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Energy Support|299'  id='choice_127_36_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_4\" id=\"label_127_36_4\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2021\/06\/Energy-Boost-IV-Treatment-1Kv5.jpg\"\/><div class=\"product-info-row\"><h4>Energy Support<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Energy Support\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Refresh|299'  id='choice_127_36_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_5\" id=\"label_127_36_5\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2021\/06\/Energy-Boost-IV-Treatment-1Kv5.jpg\"\/><div class=\"product-info-row\"><h4>Refresh<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Refresh\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Hangover|299'  id='choice_127_36_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_6\" id=\"label_127_36_6\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Hangover-IV-Treatment-1K-144v5.jpg\"\/><div class=\"product-info-row\"><h4>Hangover<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Hangover\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Afterparty|299'  id='choice_127_36_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_7\" id=\"label_127_36_7\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Hangover-IV-Treatment-1K-144v5.jpg\"\/><div class=\"product-info-row\"><h4>Afterparty<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Afterparty\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Rehydration Support|299'  id='choice_127_36_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_8\" id=\"label_127_36_8\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Hangover-IV-Treatment-1K-144v5.jpg\"\/><div class=\"product-info-row\"><h4>Rehydration Support<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Rehydration Support\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Immune Boost|299'  id='choice_127_36_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_9\" id=\"label_127_36_9\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Immune-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Immune Boost<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Immune Boost\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Defend|299'  id='choice_127_36_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_10\" id=\"label_127_36_10\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Immune-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Defend<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Defend\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Immunity|299'  id='choice_127_36_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_11\" id=\"label_127_36_11\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Immune-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Immunity<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Immunity\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Immune Support|299'  id='choice_127_36_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_12\" id=\"label_127_36_12\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Immune-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Immune Support<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Immune Support\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Stomach Flu|299'  id='choice_127_36_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_13\" id=\"label_127_36_13\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2021\/01\/Stomach-Flu-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Stomach Flu<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Stomach Flu\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_14'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Stomach Flu Support|299'  id='choice_127_36_14' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_14\" id=\"label_127_36_14\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2021\/01\/Stomach-Flu-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Stomach Flu Support<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Stomach Flu Support\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_15'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Myers Cocktail|299'  id='choice_127_36_15' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_15\" id=\"label_127_36_15\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2021\/06\/Myers-Cocktail-IV-Treatment-1-1.jpg\"\/><div class=\"product-info-row\"><h4>Myers Cocktail<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Myers Cocktail\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_16'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Recovery|349'  id='choice_127_36_16' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_16\" id=\"label_127_36_16\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Recovery-IV-Treatment-1-2.jpg\"\/><div class=\"product-info-row\"><h4>Recovery<\/h4><p><span class=\"ginput_price\">$349<\/span><\/p><a class=\"need\" data-title=\"Recovery\" data-price=\"$349.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_17'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Recovery Support|349'  id='choice_127_36_17' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_17\" id=\"label_127_36_17\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Recovery-IV-Treatment-1-2.jpg\"\/><div class=\"product-info-row\"><h4>Recovery Support<\/h4><p><span class=\"ginput_price\">$349<\/span><\/p><a class=\"need\" data-title=\"Recovery Support\" data-price=\"$349.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_18'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Beauty|349'  id='choice_127_36_18' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_18\" id=\"label_127_36_18\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Beauty-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Beauty<\/h4><p><span class=\"ginput_price\">$349<\/span><\/p><a class=\"need\" data-title=\"Beauty\" data-price=\"$349.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_19'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Glow|349'  id='choice_127_36_19' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_19\" id=\"label_127_36_19\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Beauty-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Glow<\/h4><p><span class=\"ginput_price\">$349<\/span><\/p><a class=\"need\" data-title=\"Glow\" data-price=\"$349.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_20'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Headache Relief|349'  id='choice_127_36_20' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_20\" id=\"label_127_36_20\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2024\/06\/headache_relief-1407x2048.png\"\/><div class=\"product-info-row\"><h4>Headache Relief<\/h4><p><span class=\"ginput_price\">$349<\/span><\/p><a class=\"need\" data-title=\"Headache Relief\" data-price=\"$349.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_21'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Altitude Sickness|349'  id='choice_127_36_21' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_21\" id=\"label_127_36_21\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Altitude-Sickness-IV-Treatment-1-1.jpg\"\/><div class=\"product-info-row\"><h4>Altitude Sickness<\/h4><p><span class=\"ginput_price\">$349<\/span><\/p><a class=\"need\" data-title=\"Altitude Sickness\" data-price=\"$349.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_22'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Skin and Health Support|349'  id='choice_127_36_22' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_22\" id=\"label_127_36_22\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Beauty-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Skin and Health Support<\/h4><p><span class=\"ginput_price\">$349<\/span><\/p><a class=\"need\" data-title=\"Skin and Health Support\" data-price=\"$349.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_23'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Super Immune Boost|399'  id='choice_127_36_23' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_23\" id=\"label_127_36_23\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Super-Immune-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Super Immune Boost<\/h4><p><span class=\"ginput_price\">$399<\/span><\/p><a class=\"need\" data-title=\"Super Immune Boost\" data-price=\"$399.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_24'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Premium Immune Support|399'  id='choice_127_36_24' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_24\" id=\"label_127_36_24\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Super-Immune-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Premium Immune Support<\/h4><p><span class=\"ginput_price\">$399<\/span><\/p><a class=\"need\" data-title=\"Premium Immune Support\" data-price=\"$399.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_25'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Premier Immunity|399'  id='choice_127_36_25' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_25\" id=\"label_127_36_25\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Super-Immune-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Premier Immunity<\/h4><p><span class=\"ginput_price\">$399<\/span><\/p><a class=\"need\" data-title=\"Premier Immunity\" data-price=\"$399.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_26'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Super Defender|399'  id='choice_127_36_26' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_26\" id=\"label_127_36_26\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Super-Immune-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Super Defender<\/h4><p><span class=\"ginput_price\">$399<\/span><\/p><a class=\"need\" data-title=\"Super Defender\" data-price=\"$399.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_27'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='All-Inclusive|399'  id='choice_127_36_27' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_27\" id=\"label_127_36_27\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/All-Inclusive-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>All-Inclusive<\/h4><p><span class=\"ginput_price\">$399<\/span><\/p><a class=\"need\" data-title=\"All-Inclusive\" data-price=\"$399.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_28'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Premier Support|399'  id='choice_127_36_28' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_28\" id=\"label_127_36_28\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/All-Inclusive-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Premier Support<\/h4><p><span class=\"ginput_price\">$399<\/span><\/p><a class=\"need\" data-title=\"Premier Support\" data-price=\"$399.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_29'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Metabolic|369'  id='choice_127_36_29' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_29\" id=\"label_127_36_29\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/Weight-Loss-IV-Treatment.png\"\/><div class=\"product-info-row\"><h4>Metabolic<\/h4><p><span class=\"ginput_price\">$369<\/span><\/p><a class=\"need\" data-title=\"Metabolic\" data-price=\"$369.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_30'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='NAD+|799'  id='choice_127_36_30' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_30\" id=\"label_127_36_30\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2023\/03\/NAD-IV-Treatment-1-e1677752826790.png\"\/><div class=\"product-info-row\"><h4>NAD+<\/h4><p><span class=\"ginput_price\">$799<\/span><\/p><a class=\"need\" data-title=\"NAD+\" data-price=\"$799.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_31'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Premier NAD+|999'  id='choice_127_36_31' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_31\" id=\"label_127_36_31\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/NAD-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>Premier NAD+<\/h4><p><span class=\"ginput_price\">$999<\/span><\/p><a class=\"need\" data-title=\"Premier NAD+\" data-price=\"$999.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_32'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='NAD+ Boost|999'  id='choice_127_36_32' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_32\" id=\"label_127_36_32\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/NAD-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>NAD+ Boost<\/h4><p><span class=\"ginput_price\">$999<\/span><\/p><a class=\"need\" data-title=\"NAD+ Boost\" data-price=\"$999.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_33'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='NAD+ Premium|999'  id='choice_127_36_33' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_33\" id=\"label_127_36_33\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2020\/05\/NAD-Boost-IV-Treatment-.jpg\"\/><div class=\"product-info-row\"><h4>NAD+ Premium<\/h4><p><span class=\"ginput_price\">$999<\/span><\/p><a class=\"need\" data-title=\"NAD+ Premium\" data-price=\"$999.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_34'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Niagen NR|799'  id='choice_127_36_34' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_34\" id=\"label_127_36_34\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2024\/09\/NR_drip_original-optimized.jpg\"\/><div class=\"product-info-row\"><h4>Niagen IV<\/h4><p><span class=\"ginput_price\">$799<\/span><\/p><a class=\"need\" data-title=\"Niagen NR\" data-price=\"$799.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice product-div gchoice_127_36_35'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Cleanse IV|299'  id='choice_127_36_35' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for=\"choice_127_36_35\" id=\"label_127_36_35\" class=\"gform-field-label gform-field-label--type-inline product-label\"><div class=\"product-info\"><img decoding=\"async\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2025\/07\/ProductCleanse.png\"\/><div class=\"product-info-row\"><h4>Cleanse IV<\/h4><p><span class=\"ginput_price\">$299<\/span><\/p><a class=\"need\" data-title=\"Cleanse IV\" data-price=\"$299.00\">Learn More <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"14\" viewBox=\"0 0 15 14\" fill=\"none\"><g clip-path=\"url(#clip0_824_3222)\"><path d=\"M10.1592 3.83984L13.5002 7.1809L10.1592 10.522\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\"\/><path d=\"M12.9988 7.18115H1.5\" stroke=\"#00A6A7\" stroke-width=\"1.5\" stroke-miterlimit=\"10\" stroke-linecap=\"square\" stroke-linejoin=\"round\"\/><\/g><defs><clipPath id=\"clip0_824_3222\"><rect width=\"14\" height=\"14\" fill=\"white\" transform=\"translate(0.5)\"\/><\/clipPath><\/defs><\/svg><\/a><\/div><\/div><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div class=\"recommended-information\"><fieldset id=\"field_127_290\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 is-option field_boosters hide-services drchrono_boosters is-main-addons start_block_recommended gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Recommended Add-on<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_290'><div class='gchoice gchoice_127_290_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_290.1' type='checkbox'  value='Vitamin Boost|200'  id='choice_127_290_1'   aria-describedby=\"gfield_description_127_290\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_127_290_1' id='label_127_290_1' class='gform-field-label gform-field-label--type-inline'>Vitamin Boost<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_127_290'>Vitamin blend to supercharge the effectiveness of NAD+, NR treatments (B-Complex Vitamins, Vitamin B12, Vitamin C, Magnesium, Glutathione Push)<\/div><\/fieldset><div id=\"field_127_374\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_373\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 is-option field_boosters hide-services drchrono_boosters gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Add-on<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_373'><div class='gchoice gchoice_127_373_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_373.1' type='checkbox'  value='Extra 500mg of NAD+|600'  id='choice_127_373_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_373_1' id='label_127_373_1' class='gform-field-label gform-field-label--type-inline'>Extra 500mg of NAD+<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_127_341\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 is-option field_boosters intl_addon drchrono_boosters gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Add-on: Extra NAD+<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_341'><div class='gchoice gchoice_127_341_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_341.1' type='checkbox'  value='Extra 400mg of NAD+|700'  id='choice_127_341_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_341_1' id='label_127_341_1' class='gform-field-label gform-field-label--type-inline'>Extra 400mg of NAD+<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_127_311\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:15px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_310\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 is-option field_boosters drchrono_boosters gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Add-on: In-Home Lab Draw<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_310'><div class='gchoice gchoice_127_310_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_310.1' type='checkbox'  value='In-Home Lab Draw|199'  id='choice_127_310_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_310_1' id='label_127_310_1' class='gform-field-label gform-field-label--type-inline'>In-Home Lab Draw<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_127_469\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_468\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 is-option field_boosters hide-services drchrono_boosters gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Add-on<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_468'><div class='gchoice gchoice_127_468_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_468.1' type='checkbox'  value='Extra 500mg of Niagen NR|600'  id='choice_127_468_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_468_1' id='label_127_468_1' class='gform-field-label gform-field-label--type-inline'>Extra 500mg of Niagen NR<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_127_291\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_37\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gf_list_2col add-person-1 drchrono_boosters is-option booster-form-dropdown field_boosters hide-services intl_addon need-recommended gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Recommended Add-Ons<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_37'><div class='gchoice gchoice_127_37_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.1' type='checkbox'  value='Glutathione (200mg)|50'  id='choice_127_37_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_1' id='label_127_37_1' class='gform-field-label gform-field-label--type-inline'>Glutathione (200mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.2' type='checkbox'  value='Antacid|50'  id='choice_127_37_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_2' id='label_127_37_2' class='gform-field-label gform-field-label--type-inline'>Antacid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.3' type='checkbox'  value='Anti-Nausea|50'  id='choice_127_37_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_3' id='label_127_37_3' class='gform-field-label gform-field-label--type-inline'>Anti-Nausea<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.4' type='checkbox'  value='Extra Fluids (500ml)|100'  id='choice_127_37_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_4' id='label_127_37_4' class='gform-field-label gform-field-label--type-inline'>Extra Fluids (500ml)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.5' type='checkbox'  value='Extra Fluids (1000ml)|125'  id='choice_127_37_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_5' id='label_127_37_5' class='gform-field-label gform-field-label--type-inline'>Extra Fluids (1000ml)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.6' type='checkbox'  value='Vitamin C (1g)|35'  id='choice_127_37_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_6' id='label_127_37_6' class='gform-field-label gform-field-label--type-inline'>Vitamin C (1g)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.7' type='checkbox'  value='Biotin (1mg)|50'  id='choice_127_37_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_7' id='label_127_37_7' class='gform-field-label gform-field-label--type-inline'>Biotin (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.8' type='checkbox'  value='Vitamin B12 (1mg)|35'  id='choice_127_37_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_8' id='label_127_37_8' class='gform-field-label gform-field-label--type-inline'>Vitamin B12 (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.9' type='checkbox'  value='Anti-Inflammatory|50'  id='choice_127_37_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_9' id='label_127_37_9' class='gform-field-label gform-field-label--type-inline'>Anti-Inflammatory<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.11' type='checkbox'  value='B-Complex|35'  id='choice_127_37_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_11' id='label_127_37_11' class='gform-field-label gform-field-label--type-inline'>B-Complex<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.12' type='checkbox'  value='Magnesium (200mg)|35'  id='choice_127_37_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_12' id='label_127_37_12' class='gform-field-label gform-field-label--type-inline'>Magnesium (200mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.13' type='checkbox'  value='Zinc (1mg)|35'  id='choice_127_37_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_13' id='label_127_37_13' class='gform-field-label gform-field-label--type-inline'>Zinc (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.14' type='checkbox'  value='NAD (250mg)|350'  id='choice_127_37_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_14' id='label_127_37_14' class='gform-field-label gform-field-label--type-inline'>NAD (250mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.15' type='checkbox'  value='Extra 500mg of Niagen NR|600'  id='choice_127_37_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_15' id='label_127_37_15' class='gform-field-label gform-field-label--type-inline'>Extra 500mg of Niagen NR<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_37_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.16' type='checkbox'  value='Vitamin C (10g)|150'  id='choice_127_37_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_37_16' id='label_127_37_16' class='gform-field-label gform-field-label--type-inline'>Vitamin C (10g)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_127_493\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_2col add-person-1 drchrono_boosters is-option booster-form-dropdown field_boosters hide-services intl_addon need-recommended gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Recommended Add-Ons<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_493'><div class='gchoice gchoice_127_493_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.1' type='checkbox'  value='Glutathione (200mg)|50'  id='choice_127_493_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_1' id='label_127_493_1' class='gform-field-label gform-field-label--type-inline'>Glutathione (200mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.2' type='checkbox'  value='Anti-Nausea|50'  id='choice_127_493_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_2' id='label_127_493_2' class='gform-field-label gform-field-label--type-inline'>Anti-Nausea<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.3' type='checkbox'  value='Antacid|50'  id='choice_127_493_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_3' id='label_127_493_3' class='gform-field-label gform-field-label--type-inline'>Antacid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.4' type='checkbox'  value='Extra Fluids (500ml)|100'  id='choice_127_493_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_4' id='label_127_493_4' class='gform-field-label gform-field-label--type-inline'>Extra Fluids (500ml)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.5' type='checkbox'  value='Extra Fluids (1000ml)|125'  id='choice_127_493_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_5' id='label_127_493_5' class='gform-field-label gform-field-label--type-inline'>Extra Fluids (1000ml)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.6' type='checkbox'  value='Vitamin C (1g)|35'  id='choice_127_493_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_6' id='label_127_493_6' class='gform-field-label gform-field-label--type-inline'>Vitamin C (1g)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.7' type='checkbox'  value='Biotin (1mg)|50'  id='choice_127_493_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_7' id='label_127_493_7' class='gform-field-label gform-field-label--type-inline'>Biotin (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.8' type='checkbox'  value='Vitamin B12 (1mg)|35'  id='choice_127_493_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_8' id='label_127_493_8' class='gform-field-label gform-field-label--type-inline'>Vitamin B12 (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.9' type='checkbox'  value='Anti-Inflammatory|50'  id='choice_127_493_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_9' id='label_127_493_9' class='gform-field-label gform-field-label--type-inline'>Anti-Inflammatory<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.11' type='checkbox'  value='B-Complex|35'  id='choice_127_493_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_11' id='label_127_493_11' class='gform-field-label gform-field-label--type-inline'>B-Complex<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.12' type='checkbox'  value='Magnesium (200mg)|35'  id='choice_127_493_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_12' id='label_127_493_12' class='gform-field-label gform-field-label--type-inline'>Magnesium (200mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.13' type='checkbox'  value='NAD (250mg)|350'  id='choice_127_493_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_13' id='label_127_493_13' class='gform-field-label gform-field-label--type-inline'>NAD (250mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.14' type='checkbox'  value='Extra 500mg of Niagen NR|600'  id='choice_127_493_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_14' id='label_127_493_14' class='gform-field-label gform-field-label--type-inline'>Extra 500mg of Niagen NR<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_493_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_493.15' type='checkbox'  value='Vitamin C (10g)|150'  id='choice_127_493_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_493_15' id='label_127_493_15' class='gform-field-label gform-field-label--type-inline'>Vitamin C (10g)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_127_490\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_2col add-person-1 drchrono_boosters is-option booster-form-dropdown field_boosters hide-services intl_addon need-recommended gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Recommended Add-Ons<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_490'><div class='gchoice gchoice_127_490_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.1' type='checkbox'  value='Glutathione (200mg)|50'  id='choice_127_490_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_1' id='label_127_490_1' class='gform-field-label gform-field-label--type-inline'>Glutathione (200mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.2' type='checkbox'  value='Anti-Nausea|50'  id='choice_127_490_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_2' id='label_127_490_2' class='gform-field-label gform-field-label--type-inline'>Anti-Nausea<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.3' type='checkbox'  value='Antacid|50'  id='choice_127_490_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_3' id='label_127_490_3' class='gform-field-label gform-field-label--type-inline'>Antacid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.4' type='checkbox'  value='Extra Fluids (1000ml)|125'  id='choice_127_490_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_4' id='label_127_490_4' class='gform-field-label gform-field-label--type-inline'>Extra Fluids (1000ml)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.5' type='checkbox'  value='Extra Fluids (500ml)|125'  id='choice_127_490_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_5' id='label_127_490_5' class='gform-field-label gform-field-label--type-inline'>Extra Fluids (500ml)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.6' type='checkbox'  value='Vitamin C (1g)|35'  id='choice_127_490_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_6' id='label_127_490_6' class='gform-field-label gform-field-label--type-inline'>Vitamin C (1g)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.7' type='checkbox'  value='Biotin (1mg)|50'  id='choice_127_490_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_7' id='label_127_490_7' class='gform-field-label gform-field-label--type-inline'>Biotin (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.8' type='checkbox'  value='Vitamin B12 (1mg)|35'  id='choice_127_490_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_8' id='label_127_490_8' class='gform-field-label gform-field-label--type-inline'>Vitamin B12 (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.9' type='checkbox'  value='Anti-Inflammatory|50'  id='choice_127_490_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_9' id='label_127_490_9' class='gform-field-label gform-field-label--type-inline'>Anti-Inflammatory<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.11' type='checkbox'  value='B-Complex|35'  id='choice_127_490_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_11' id='label_127_490_11' class='gform-field-label gform-field-label--type-inline'>B-Complex<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.12' type='checkbox'  value='Magnesium (200mg)|35'  id='choice_127_490_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_12' id='label_127_490_12' class='gform-field-label gform-field-label--type-inline'>Magnesium (200mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.13' type='checkbox'  value='Zinc (1mg)|35'  id='choice_127_490_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_13' id='label_127_490_13' class='gform-field-label gform-field-label--type-inline'>Zinc (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.14' type='checkbox'  value='NAD (250mg)|350'  id='choice_127_490_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_14' id='label_127_490_14' class='gform-field-label gform-field-label--type-inline'>NAD (250mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.15' type='checkbox'  value='Oxygen|50'  id='choice_127_490_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_15' id='label_127_490_15' class='gform-field-label gform-field-label--type-inline'>Oxygen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_490_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_490.16' type='checkbox'  value='Vitamin C (10g)|150'  id='choice_127_490_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_490_16' id='label_127_490_16' class='gform-field-label gform-field-label--type-inline'>Vitamin C (10g)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_127_407\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_2col add-person-1 drchrono_boosters is-option booster-form-dropdown field_boosters hide-services intl_addon gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Recommended  Add-Ons<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_407'><div class='gchoice gchoice_127_407_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.1' type='checkbox'  value='Glutathione (200mg)|50'  id='choice_127_407_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_1' id='label_127_407_1' class='gform-field-label gform-field-label--type-inline'>Glutathione (200mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.2' type='checkbox'  value='Anti-Nausea|50'  id='choice_127_407_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_2' id='label_127_407_2' class='gform-field-label gform-field-label--type-inline'>Anti-Nausea<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.3' type='checkbox'  value='Antacid|50'  id='choice_127_407_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_3' id='label_127_407_3' class='gform-field-label gform-field-label--type-inline'>Antacid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.4' type='checkbox'  value='Extra Fluids (500ml)|100'  id='choice_127_407_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_4' id='label_127_407_4' class='gform-field-label gform-field-label--type-inline'>Extra Fluids (500ml)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.5' type='checkbox'  value='Vitamin C (1g)|35'  id='choice_127_407_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_5' id='label_127_407_5' class='gform-field-label gform-field-label--type-inline'>Vitamin C (1g)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.6' type='checkbox'  value='Biotin (1mg)|50'  id='choice_127_407_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_6' id='label_127_407_6' class='gform-field-label gform-field-label--type-inline'>Biotin (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.7' type='checkbox'  value='Vitamin B12 (1mg)|35'  id='choice_127_407_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_7' id='label_127_407_7' class='gform-field-label gform-field-label--type-inline'>Vitamin B12 (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.8' type='checkbox'  value='Super antioxidant|69'  id='choice_127_407_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_8' id='label_127_407_8' class='gform-field-label gform-field-label--type-inline'>Super antioxidant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.9' type='checkbox'  value='Taurine|39'  id='choice_127_407_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_9' id='label_127_407_9' class='gform-field-label gform-field-label--type-inline'>Taurine<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.11' type='checkbox'  value='B12|25'  id='choice_127_407_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_11' id='label_127_407_11' class='gform-field-label gform-field-label--type-inline'>B12<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.12' type='checkbox'  value='B-Complex|49'  id='choice_127_407_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_12' id='label_127_407_12' class='gform-field-label gform-field-label--type-inline'>B-Complex<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.13' type='checkbox'  value='Selenium|39'  id='choice_127_407_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_13' id='label_127_407_13' class='gform-field-label gform-field-label--type-inline'>Selenium<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.14' type='checkbox'  value='Magnesium (200mg)|35'  id='choice_127_407_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_14' id='label_127_407_14' class='gform-field-label gform-field-label--type-inline'>Magnesium (200mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.15' type='checkbox'  value='Zinc (5mg)|30'  id='choice_127_407_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_15' id='label_127_407_15' class='gform-field-label gform-field-label--type-inline'>Zinc (5mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.16' type='checkbox'  value='Zinc (1mg)|35'  id='choice_127_407_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_16' id='label_127_407_16' class='gform-field-label gform-field-label--type-inline'>Zinc (1mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.17' type='checkbox'  value='NAD (50mg)|100'  id='choice_127_407_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_17' id='label_127_407_17' class='gform-field-label gform-field-label--type-inline'>NAD (50mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.18' type='checkbox'  value='NAD (100mg)|200'  id='choice_127_407_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_18' id='label_127_407_18' class='gform-field-label gform-field-label--type-inline'>NAD (100mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.19' type='checkbox'  value='NAD (250mg)|450'  id='choice_127_407_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_19' id='label_127_407_19' class='gform-field-label gform-field-label--type-inline'>NAD (250mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.21' type='checkbox'  value='MIC|39'  id='choice_127_407_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_21' id='label_127_407_21' class='gform-field-label gform-field-label--type-inline'>MIC<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.22' type='checkbox'  value='ALA|39'  id='choice_127_407_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_22' id='label_127_407_22' class='gform-field-label gform-field-label--type-inline'>ALA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.23' type='checkbox'  value='Additional Hydration Fluids|100'  id='choice_127_407_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_23' id='label_127_407_23' class='gform-field-label gform-field-label--type-inline'>Additional Hydration Fluids<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.24' type='checkbox'  value='Vitamin C (7.5g)|150'  id='choice_127_407_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_24' id='label_127_407_24' class='gform-field-label gform-field-label--type-inline'>Vitamin C (7.5g)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.25' type='checkbox'  value='Vitamin C (7.5g)|150'  id='choice_127_407_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_25' id='label_127_407_25' class='gform-field-label gform-field-label--type-inline'>Vitamin C (7.5g)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_407_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_407.26' type='checkbox'  value='Vitamin C (10g)|150'  id='choice_127_407_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_407_26' id='label_127_407_26' class='gform-field-label gform-field-label--type-inline'>Vitamin C (10g)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_127_147\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:15px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_269\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 drchrono_2nd_boosters is-option field_services hide-services fixed-prices gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Tests (can select multiple)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_269'><div class='gchoice gchoice_127_269_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_269.1' type='checkbox'  value='Standard Nasal Swab PCR Test|149'  id='choice_127_269_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_269_1' id='label_127_269_1' class='gform-field-label gform-field-label--type-inline'>Standard Nasal Swab PCR Test<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_127_331\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 drchrono_2nd_boosters is-option field_services hide-services fixed-prices gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Tests (can select multiple)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_331'><div class='gchoice gchoice_127_331_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_331.1' type='checkbox'  value='Same Day PCR|449'  id='choice_127_331_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_331_1' id='label_127_331_1' class='gform-field-label gform-field-label--type-inline'>Same Day PCR<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_331_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_331.2' type='checkbox'  value='Next Day PCR|399'  id='choice_127_331_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_331_2' id='label_127_331_2' class='gform-field-label gform-field-label--type-inline'>Next Day PCR<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_127_244\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 exclude_coupon lab_fee gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Lab Fee<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_244'><div class='gchoice gchoice_127_244_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_244.1' type='checkbox'  value='Nasal Swab PCR Test - Lab Fee|100'  id='choice_127_244_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_244_1' id='label_127_244_1' class='gform-field-label gform-field-label--type-inline'>Nasal Swab PCR Test - Lab Fee<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_127_270\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:15px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_73\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox add-person-1 drchrono_2nd_boosters is-option field_services hide-services gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Booster Shots (can select multiple)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_73'><div class='gchoice gchoice_127_73_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_73.1' type='checkbox'  value='Mental Clarity (NAD)|149'  id='choice_127_73_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_73_1' id='label_127_73_1' class='gform-field-label gform-field-label--type-inline'>Mental Clarity (NAD)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_73_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_73.2' type='checkbox'  value='Glow (Vitamin D)|75'  id='choice_127_73_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_73_2' id='label_127_73_2' class='gform-field-label gform-field-label--type-inline'>Glow (Vitamin D)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_73_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_73.3' type='checkbox'  value='Fat Burner (Lipostat)|75'  id='choice_127_73_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_73_3' id='label_127_73_3' class='gform-field-label gform-field-label--type-inline'>Fat Burner (Lipostat)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_127_408\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 is-option field_services drc_person_2nd_boosters hide services intl_addon gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Booster Shots (can select multiple)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_408'><div class='gchoice gchoice_127_408_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.1' type='checkbox'  value='Mental Clarity (100mg)|275'  id='choice_127_408_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_1' id='label_127_408_1' class='gform-field-label gform-field-label--type-inline'>Mental Clarity (100mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_408_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.2' type='checkbox'  value='Mental Clarity (50mg)|200'  id='choice_127_408_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_2' id='label_127_408_2' class='gform-field-label gform-field-label--type-inline'>Mental Clarity (50mg)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_408_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.3' type='checkbox'  value='Mental Clarity (NAD+)|150'  id='choice_127_408_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_3' id='label_127_408_3' class='gform-field-label gform-field-label--type-inline'>Mental Clarity (NAD+)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_408_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.4' type='checkbox'  value='Mental Clarity (NAD)|100'  id='choice_127_408_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_4' id='label_127_408_4' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\">Mental Clarity (NAD) <i class=\"iprice\"><\/i><\/i><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_408_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.5' type='checkbox'  value='Glow (Vitamin D)|60'  id='choice_127_408_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_5' id='label_127_408_5' class='gform-field-label gform-field-label--type-inline'>Glow (Vitamin D)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_408_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.6' type='checkbox'  value='Fat Burner|75'  id='choice_127_408_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_6' id='label_127_408_6' class='gform-field-label gform-field-label--type-inline'>Fat Burner<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_408_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.7' type='checkbox'  value='Fat Burner (Lipostat)|75'  id='choice_127_408_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_7' id='label_127_408_7' class='gform-field-label gform-field-label--type-inline'>Fat Burner (Lipostat)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_408_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.8' type='checkbox'  value='Energy (B12)|60'  id='choice_127_408_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_8' id='label_127_408_8' class='gform-field-label gform-field-label--type-inline'>Energy (B12)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_408_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.9' type='checkbox'  value='Biotin|50'  id='choice_127_408_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_9' id='label_127_408_9' class='gform-field-label gform-field-label--type-inline'>Biotin<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_408_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_408.11' type='checkbox'  value='Immune|135'  id='choice_127_408_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_408_11' id='label_127_408_11' class='gform-field-label gform-field-label--type-inline'>Immune<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_127_355\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 drchrono_2nd_boosters is-option field_services hide-services intl_addon gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Booster Shot<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_355'><div class='gchoice gchoice_127_355_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_355.1' type='checkbox'  value='Mental Clarity (NAD)|149'  id='choice_127_355_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_355_1' id='label_127_355_1' class='gform-field-label gform-field-label--type-inline'>Mental Clarity (NAD)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_127_458\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:15px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_393\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full add-person-1 drchrono_2nd_boosters is-option field_services hide-services intl_addon end_block_recommended gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Cosmetic Treatments Add-Ons<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_393'><div class='gchoice gchoice_127_393_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_393.1' type='checkbox'  value='Profhilo Skin Booster|450'  id='choice_127_393_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_393_1' id='label_127_393_1' class='gform-field-label gform-field-label--type-inline'>Profhilo Skin Booster<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_393_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_393.2' type='checkbox'  value='Express Glow Chemical Peel|199'  id='choice_127_393_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_393_2' id='label_127_393_2' class='gform-field-label gform-field-label--type-inline'>Express Glow Chemical Peel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_393_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_393.3' type='checkbox'  value='Photobiomodulation Red Light Therapy|150'  id='choice_127_393_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_393_3' id='label_127_393_3' class='gform-field-label gform-field-label--type-inline'>Photobiomodulation Red Light Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_127_393_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_393.4' type='checkbox'  value='Infrared PEMF Therapy|150'  id='choice_127_393_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_393_4' id='label_127_393_4' class='gform-field-label gform-field-label--type-inline'>Infrared PEMF Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div><div id=\"field_127_83\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full person-added no-display field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_83'>Person added<\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_127_83' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div class=\"additional-information\"><div id=\"field_127_263\" class=\"gfield gfield--type-custom_discount gfield--input-type-custom_discount gfield--width-full start_block_additional custom_discount_field field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_263'>&lt;span class=&quot;gform-field-label gfield_label_product&quot;&gt;Automatic Group Discount&lt;\/span&gt; &lt;span class=&quot;screen-reader-text&quot;&gt;Quantity&lt;\/span&gt;<\/label><div class='ginput_container'>\n\t\t\t\t<span class='ginput_custom_discount ginput_product_price ginput_custom_discount_127_263'>$0.00<\/span>\n\t\t\t\t<input type='hidden' name='input_263' id='input_127_263' class='gform_hidden ginput_custom_discount_input' data-amount='' \/>\n\t\t<\/div><\/div><div id=\"field_127_145\" class=\"gfield gfield--type-html gfield--input-type-html remove-person-btn no-display gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><a href=\"javascript:void(0);\"><i class=\"fa-minus-circle fa\"><\/i> Remove additional person<\/a><\/div><div id=\"field_127_146\" class=\"gfield gfield--type-html gfield--input-type-html add-person-btn gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><a can_added=\"9\" href=\"\"><i class=\"fa-plus-circle fa\"><\/i> Add Person<\/a><\/div><div id=\"field_127_234\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style=\"    text-align: center;\n    margin: 35px 10px;\n    \n    padding: 25px 15px;\n    border-top: 1px solid #b9d2d2;\n    border-bottom: 1px solid #b9d2d2;\"><b><u>Group Discounts<\/u><\/b> are applied to <strong>groups of 2 or more<\/strong> for all IV treatments and add-ons - <strong>5% additional discount per person<\/strong>.<\/div><\/div><div id=\"field_127_449\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_354\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full covid_attestation end_block_additional end_block_service gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_hidden\"  ><fieldset><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label' >COVID Attestation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_127_354'>Do you have COVID-19?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_127_354'>\n\t\t\t<div class='gchoice gchoice_127_354_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_354' type='radio' value='Yes'  id='choice_127_354_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_127_354\"   \/>\n\t\t\t\t\t<label for='choice_127_354_0' id='label_127_354_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_127_354_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_354' type='radio' value='No'  id='choice_127_354_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_127_354_1' id='label_127_354_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_127_441' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_127_441' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next Step'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_127_4' class='gform_page' data-js='page-field-id-441' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_127_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_127_444\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class=\"gfield_label step_label\">Schedule Your Appointment<\/label><\/div><div class=\"schedule-information\"><div id=\"field_127_254\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gf_left_half no-display start_block_schedule gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_254'>Date Preference<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_254' id='input_127_254' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='Select Date' aria-describedby=\"input_127_254_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_127_254_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_127_254' class='gform_hidden' value='https:\/\/driphydration.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_127_29\" class=\"gfield gfield--type-appointment_calendar gfield--input-type-appointment_calendar gfield--width-full field_ga_calendar gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label tabindex='0' class='gfield_label gappontments_calendar_label'><\/label><div class='ginput_container'><div id=\"gappointments_calendar\" class=\"grid-row\"><div class=\"ga_wrapper_large grid-lg-12 grid-md-12 grid-sm-12 grid-xs-12\">\n<div class=\"provider-title\">Select preferred date & time in <span class=\"provider-name\"><\/span><\/div><div id=\"ga_appointments_calendar\" form_id=\"127\"><div class=\"ga_monthly_schedule_wrapper\">\n<\/div><\/div>\n<\/div><\/div>\n<input type='hidden' name='input_29[date]' id='input_127_29' class='large ginput_appointment_calendar_input appointment_booking_date' value=''\/><input type='hidden' name='input_29[time]' id='input_127_29_time' class='large ginput_appointment_calendar_input appointment_booking_time' value=''\/><input type='hidden' name='time_book' id='time_book' value=''\/><div class='appointment_assertive' aria-live='assertive'><div>Preferred date & time:.<\/div><div class='date'>Select above<\/div><\/div><\/div>\n<\/div><div id=\"field_127_492\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"font-size: 15px;\n    color: #565656 !important;\n    padding-top: 20px;\n    line-height: inherit; font-weight: 300 !important;\">Please be aware, we will make every effort to accommodate your requested time.  <strong>Preferred times are not guaranteed and subject to change based on nurse availability. <\/strong> A member of our dispatch team will work to confirm your appointment as soon as we receive your booking.<\/p><\/div><div id=\"field_127_330\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full end_block_schedule field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_330'>Are you flexible? Please specify your window of availability.<\/label><div class='ginput_container ginput_container_text'><input name='input_330' id='input_127_330' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><\/div><div id=\"field_127_494\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><details class=\"gf-faq\" data-faq>\n  <summary class=\"gf-faq__header\">\n    <span class=\"gf-faq__title\">How does it work?<\/span>\n    <span class=\"gf-faq__icon\" aria-hidden=\"true\"><\/span>\n  <\/summary>\n\n  <div class=\"gf-faq__content\">\n    <p class=\"gf-faq__step\">\n      <span class=\"gf-faq__step-title\">Step 1 \u2014 Submit Your Preferred Time<\/span><br>\n      <span class=\"gf-faq__step-desc\">Select the date and time that works best for your schedule.<\/span>\n    <\/p>\n\n    <p class=\"gf-faq__step\">\n      <span class=\"gf-faq__step-title\">Step 2 \u2014 Confirmation & Health Screening<\/span><br>\n      <span class=\"gf-faq__step-desc\">A licensed clinician will contact you to complete a brief health questionnaire before finalizing your appointment.<\/span>\n    <\/p>\n\n    <p class=\"gf-faq__step\">\n      <span class=\"gf-faq__step-title\">Step 3 \u2014 Treatment at Your Convenience<\/span><br>\n      <span class=\"gf-faq__step-desc\">At your chosen time and location, a licensed nurse will arrive fully prepared to deliver your IV therapy with expert care and attention.<\/span>\n    <\/p>\n  <\/div>\n<\/details>\n\n<style>\n\/* Contenedor *\/\n.gf-faq {\n  border: 1px solid #e5e7eb;\n  border-radius: 8px;\n  background: #fff;\n  padding: 16px;\n  margin: 16px 0;\n  width: 100%;\n}\n\n\/* Header *\/\n.gf-faq__header {\n  display: flex;\n  align-items: center;\n  justify-content: space-between;\n  cursor: pointer;\n  margin: 0;\n}\n\n\/* T\u00edtulo principal *\/\n.gf-faq__title {\n  font-family: Poppins, sans-serif;\n  font-weight: 600;\n  font-style: normal;\n  font-size: 20px;\n  line-height: 28px;\n  letter-spacing: -0.01em; \/* -1% *\/\n  vertical-align: middle;\n  color: #1B262A;\n}\n\n\/* \u00cdcono din\u00e1mico *\/\n.gf-faq__icon::before {\n  content: \"+\";\n  font-size: 22px;\n  font-weight: 700;\n  line-height: 1;\n}\n.gf-faq[open] .gf-faq__icon::before {\n  content: \"-\";\n}\n\n\/* Contenido *\/\n.gf-faq__content {\n  margin-top: 12px;\n}\n\n\/* Step contenedor *\/\n.gf-faq__step {\n  margin: 0 0 16px;\n}\n\n\/* Step t\u00edtulo *\/\n.gf-faq__step-title {\n  display: inline-block;\n  font-family: Poppins, sans-serif;\n  font-weight: 600;\n  font-style: normal;\n  font-size: 18px;\n  line-height: 28px;\n  letter-spacing: 0;\n  color: #425962;\n}\n\n\/* Step descripci\u00f3n *\/\n.gf-faq__step-desc {\n  display: inline-block;\n  font-family: Poppins, sans-serif;\n  font-weight: 400;\n  font-style: normal;\n  font-size: 18px;\n  line-height: 28px;\n  letter-spacing: 0;\n}\n\n\/* Ocultar flecha nativa *\/\n.gf-faq__header::-webkit-details-marker {\n  display: none;\n}\n.gf-faq__header {\n  list-style: none;\n}\n<\/style>\n<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_127_442' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_127_442' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next Step'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_127_5' class='gform_page' data-js='page-field-id-442' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_127_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_127_445\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class=\"gfield_label step_label\">Overview & Payment<\/label><\/div><div class=\"overview-information\"><div id=\"field_127_446\" class=\"gfield gfield--type-custom_overview gfield--input-type-custom_overview gfield--width-full start_block_overview custom_overview field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"gfield_label gform-field-label\">Appointment Address<\/div>\n      <div class=\"gf-overview-cols\">\n        <div class=\"gf-overview-col\">\n          <strong>Booking Date & Time<\/strong>\n          <div class=\"gf-overview-date\"><\/div>\n          <div class=\"gf-overview-time\"><\/div>\n        <\/div>\n        <div class=\"gf-overview-col\">\n          <strong>Appointment Address<\/strong>\n          <div class=\"gf-overview-address\"><\/div>\n        <\/div>\n      <\/div><\/div><div id=\"field_127_268\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_405\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-radio gfield--width-full add-person-1 iv-member-signup gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class=\"gfield_label gform-field-label class-member\" data-label=\"Become a Member and Save!\">Become a Member and Save!<\/legend><div class=\"ginput_container ginput_container_radio\"><div class=\"custom-product-row member-row cnt-4 gfield_radio\" id=\"input_127_405\"><div class='gchoice gchoice_127_405_0 active' onclick='gformCustomCleanclick( 127, this )'><input class='gfield-choice-input' name='input_405' type='radio' value='' checked='checked' id='choice_127_405_0'    \/><label for='choice_127_405_0' id='label_127_405_0' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"OneTimeOrder\">Skip for Now<\/i><\/label><span class=\"custom-title\">This is a one-time order only.<\/span><span class=\"custom-save\"><\/span><\/div><div class='gchoice gchoice_127_405_1' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_405' type='radio' value='Basic (1 IV, $275\/month)|275'  id='choice_127_405_1' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_405_1' id='label_127_405_1' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipBasic\">Basic<\/i><\/label><span class=\"custom-title\">1 IV Treatment<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$275<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipBasicSave\">$100<\/i> per IV<\/span><\/div><div class='gchoice gchoice_127_405_2' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_405' type='radio' value='Premium (2 IVs, $550\/month)|550'  id='choice_127_405_2' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_405_2' id='label_127_405_2' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipPremium\">Premium<\/i><\/label><span class=\"custom-tag\">Most Popular<\/span><span class=\"custom-title\">2 IV Treatments<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$550<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipPremiumSave\">$125<\/i> per IV<\/span><\/div><div class='gchoice gchoice_127_405_3' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_405' type='radio' value='Elite (4 IVs, $1000\/month)|1000'  id='choice_127_405_3' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_405_3' id='label_127_405_3' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipElite\">Elite<\/i><\/label><span class=\"custom-title\">4 IV Treatments<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$1,000<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipEliteSave\">$150<\/i> per IV<\/span><\/div><div class='gchoice gchoice_127_405_4' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_405' type='radio' value='Platinum (8 IVs, $1800\/month)|1800'  id='choice_127_405_4' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_405_4' id='label_127_405_4' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipPlatinum\">Platinum<\/i><\/label><span class=\"custom-title\">8 IV Treatments<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$1,800<\/span>\/month<\/span><span class=\"custom-save\">Save up to \u2028<br><i class=\"iprice\" label=\"MembershipPlatinumSave\">$175<\/i> per IV<\/span><\/div><\/div><\/fieldset><fieldset id=\"field_127_406\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-radio gfield--width-full add-person-1 iv-member-signup gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class=\"gfield_label gform-field-label class-member\" data-label=\"Become a Member and Save!\">Become a Member and Save!<\/legend><div class=\"ginput_container ginput_container_radio\"><div class=\"custom-product-row member-row cnt-4 gfield_radio\" id=\"input_127_406\"><div class='gchoice gchoice_127_406_0 active' onclick='gformCustomCleanclick( 127, this )'><input class='gfield-choice-input' name='input_406' type='radio' value='' checked='checked' id='choice_127_406_0'    \/><label for='choice_127_406_0' id='label_127_406_0' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"OneTimeOrder\">Skip for Now<\/i><\/label><span class=\"custom-title\">This is a one-time order only.<\/span><span class=\"custom-save\"><\/span><\/div><div class='gchoice gchoice_127_406_1' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_406' type='radio' value='NAD Basic (1 IV, $795\/month)|795'  id='choice_127_406_1' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_406_1' id='label_127_406_1' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipNADBasic\">NAD Basic<\/i><\/label><span class=\"custom-title\">1 IV Treatment<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$795<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipNADBasicSave\">$100<\/i> per IV<\/span><\/div><div class='gchoice gchoice_127_406_2' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_406' type='radio' value='NAD Premium (2 IVs, $1500\/month)|1500'  id='choice_127_406_2' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_406_2' id='label_127_406_2' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipNADPremium\">NAD Premium<\/i><\/label><span class=\"custom-tag\">Most Popular<\/span><span class=\"custom-title\">2 IV Treatments<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$1,500<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipNADPremiumSave\">$125<\/i> per IV<\/span><\/div><div class='gchoice gchoice_127_406_3' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_406' type='radio' value='NAD Elite (4 IVs, $2900\/month)|2900'  id='choice_127_406_3' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_406_3' id='label_127_406_3' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipNADElite\">NAD Elite<\/i><\/label><span class=\"custom-title\">4 IV Treatments<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$2,900<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipNADEliteSave\">$150<\/i> per IV<\/span><\/div><div class='gchoice gchoice_127_406_4' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_406' type='radio' value='NAD Platinum (8 IVs, $5500\/month)|5500'  id='choice_127_406_4' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_406_4' id='label_127_406_4' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipNADPlatinum\">NAD Platinum<\/i><\/label><span class=\"custom-title\">8 IV Treatments<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$5,500<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipNADPlatinumSave\">$175<\/i> per IV<\/span><\/div><\/div><\/fieldset><fieldset id=\"field_127_496\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-radio gfield--width-full add-person-1 iv-member-signup gfield_price gfield_price_127_36 gfield_option_127_36 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class=\"gfield_label gform-field-label class-member\" data-label=\"Become a Member and Save!\">Become a Member and Save!<\/legend><div class=\"ginput_container ginput_container_radio\"><div class=\"custom-product-row member-row cnt-4 gfield_radio\" id=\"input_127_496\"><div class='gchoice gchoice_127_496_0 active' onclick='gformCustomCleanclick( 127, this )'><input class='gfield-choice-input' name='input_496' type='radio' value='' checked='checked' id='choice_127_496_0'    \/><label for='choice_127_496_0' id='label_127_496_0' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"OneTimeOrder\">Skip for Now<\/i><\/label><span class=\"custom-title\">This is a one-time order only.<\/span><span class=\"custom-save\"><\/span><\/div><div class='gchoice gchoice_127_496_1' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_496' type='radio' value='Niagen Basic (1 IV, $695\/month)|695'  id='choice_127_496_1' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_496_1' id='label_127_496_1' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipNADBasicNGR\">Niagen Basic<\/i><\/label><span class=\"custom-title\">1 IV Treatment<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$695<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipNADBasicSaveNGR\">$104<\/i> per IV<\/span><\/div><div class='gchoice gchoice_127_496_2' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_496' type='radio' value='Niagen Premium (2 IVs, $1300\/month)|1300'  id='choice_127_496_2' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_496_2' id='label_127_496_2' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipNADPremium\">Niagen Premium<\/i><\/label><span class=\"custom-tag\">Most Popular<\/span><span class=\"custom-title\">2 IV Treatments<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$1,300<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipNADPremiumSaveNGR\">$298<\/i> per IV<\/span><\/div><div class='gchoice gchoice_127_496_3' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_496' type='radio' value='Niagen Elite (4 IVs, $2500\/month)|2500'  id='choice_127_496_3' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_496_3' id='label_127_496_3' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipNADElite\">Niagen Elite<\/i><\/label><span class=\"custom-title\">4 IV Treatments<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$2,500<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipNADEliteSaveNGR\">$696<\/i> per IV<\/span><\/div><div class='gchoice gchoice_127_496_4' onclick='gformCustomRadioclick( this )'><input class='gfield-choice-input' name='input_496' type='radio' value='Niagen Platinum (8 IVs, $4700\/month)|4700'  id='choice_127_496_4' onchange='gformToggleRadioOther( this )'    \/><label for='choice_127_496_4' id='label_127_496_4' class='gform-field-label gform-field-label--type-inline'><i class=\"iservice\" label=\"MembershipNADPlatinum\">Niagen Platinum<\/i><\/label><span class=\"custom-title\">8 IV Treatments<\/span><span class=\"custom-price\"><span class=\"ginput_price\">$4,700<\/span>\/month<\/span><span class=\"custom-save\">Save up to<br><i class=\"iprice\" label=\"MembershipNADPlatinumSaveNGR\">$1696<\/i> per IV<\/span><\/div><\/div><\/fieldset><div id=\"field_127_352\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><fieldset id=\"field_127_62\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio custom_tips field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Tip Amount<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_127_62'>\n\t\t\t<div class='gchoice gchoice_127_62_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='5'  id='choice_127_62_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_127_62_0' id='label_127_62_0' class='gform-field-label gform-field-label--type-inline'>5%<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_127_62_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='10'  id='choice_127_62_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_127_62_1' id='label_127_62_1' class='gform-field-label gform-field-label--type-inline'>10%<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_127_62_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='15' checked='checked' id='choice_127_62_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_127_62_2' id='label_127_62_2' class='gform-field-label gform-field-label--type-inline'>15%<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_127_62_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='0'  id='choice_127_62_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_127_62_3' id='label_127_62_3' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_127_77\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half customtips_other gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_77'>Enter your tip amount:<\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_127_77' type='text' value='' class='medium'    placeholder='%'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_127_79\" class=\"gfield gfield--type-html gfield--input-type-html customtips_total gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class=\"gfield_label\">Tip Total:<\/label>\n<div class=\"ginput_container\"><span class=\"ginput_product_price\">$0.00<\/span><input name=\"custom_tips_total\" value=\"$0.00\" type=\"hidden\"><\/div><\/div><div id=\"field_127_353\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><div id=\"field_127_39\" class=\"gfield gfield--type-coupon gfield--input-type-coupon field_coupon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gf_coupon_code_127'>Promo Code<\/label><div class='ginput_container' id='gf_coupons_container_127'><input id='gf_coupon_code_127' class='gf_coupon_code' onkeyup='DisableApplyButton(127);' onchange='DisableApplyButton(127);' onpaste='setTimeout(function(){DisableApplyButton(127);}, 50);' type='text'   placeholder='Your promo code' \/><input type='button' disabled='disabled' onclick='ApplyCouponCode(127);' value='Apply' id='gf_coupon_button' class='button'  \/> <img style='display:none;' id='gf_coupon_spinner' src='https:\/\/driphydration.com\/wp-content\/themes\/bridge-child\/img\/spinner.gif' alt='please wait'\/><div id='gf_coupon_info'><\/div><label class='giftup-coupon-label'><input type='checkbox' name='giftup_code'><span>Select if you are using a Gift Card<\/span><\/label><input type='hidden' id='gf_coupon_codes_127' name='input_39' value=''  \/><input type='hidden' id='gf_total_no_discount_127'\/><input type='hidden' id='giftup_discount_127' name='giftup_discount_127'\/><input type='hidden' id='gf_coupons_127' name='gf_coupons_127' value='' \/><\/div><\/div><div id=\"field_127_450\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><div id=\"field_127_38\" class=\"gfield gfield--type-total gfield--input-type-total total_price_gf gfield_price gfield_price_127_ gfield_total gfield_total_127_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"   ><div class=\"gform-order-summary-new gform-order-summary-mobile\"><label class=\"gfield_label\">Order summary<\/label><div class=\"summary-inner\"><\/div><\/div><label class='gfield_label gform-field-label' for='input_127_38'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_38' id='input_127_38' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_127' \/>\n\t\t\t\t\t\t<\/div><input type=\"hidden\" id=\"subtotal\" value=\"\"><input type=\"hidden\" name=\"currency\" value=\"\"\/><input type=\"hidden\" name=\"currency_rate\" value=\"\"\/><input type=\"hidden\" name=\"exclude_coupon_total\" value=\"\"><input type=\"hidden\" name=\"exclude_coupon_sum\" value=\"\"><input type=\"hidden\" name=\"cplf_price\" value=\"\"><input type=\"hidden\" name=\"cplf_price_req\" value=\"\"><input type=\"hidden\" name=\"ga_provider_surcharge_price\" value=\"0|Service Fee\"><input type=\"hidden\" name=\"ga_need_provider_id\" value=\"\"\/><input type=\"hidden\" name=\"ga_provider_distance\" value=\"\"><input type=\"hidden\" name=\"manual_form_sended\" value=\"1\"><input type=\"hidden\" name=\"wordpress_user_id\" value=\"0\"><input type='hidden' name='steps_used' value=''><\/div><div id=\"field_127_467\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:30px\">&nbsp;<\/div><\/div><div id=\"field_127_149\" class=\"gfield gfield--type-stripe_creditcard gfield--input-type-stripe_creditcard field_stripe_creditcard field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gfield_label_before_complex' for='input_127_149_1'>Payment Method<\/label>        <div class=\"stripe-payment-request-button\">\n                          <label class=\"stripe-payment-klarna \">\n                <div class=\"inp\">\n                  <input type=\"radio\" name=\"pay_via_stripe_payment_request_button\"\n                         value=\"klarna\">\n                  <span><\/span>\n                <\/div>\n                <span>Klarna <i>(Buy now, pay later)<\/i><\/span>\n                <div class=\"img\"><\/div>\n              <\/label>\n              <label class=\"stripe-payment-button\">\n                <div class=\"inp\">\n                  <input type=\"radio\" name=\"pay_via_stripe_payment_request_button\"\n                         value=\"pay_button\">\n                  <span><\/span>\n                <\/div>\n                <span class=\"blabel\">Apple\/Google Pay<\/span>\n              <\/label>\n                    <\/div>\n        <input type=\"hidden\" name=\"payment_request_button_type\" value=\"\">\n                <ul class=\"gfa-saved-cards\"><li class=\"new-card\">\n        <div class=\"inp\">\n          <input id=\"payment-token-new\" type=\"radio\" name=\"gfa_payment_token\" value=\"new\" style=\"width:auto;\">\n          <span><\/span>\n        <\/div>\n        <label for=\"payment-token-new\">Use a new card<\/label>\n        <div class=\"img\"><\/div>\n        <\/li><\/ul><div class='ginput_complex ginput_container ginput_container_creditcard no-display' id='input_127_149'>\n\t\t\t\t\t\t<div class='ginput_full' id='input_127_149_1_container'>\n\t\t\t\t\t\t\t<div id='input_127_149_1'><\/div>\n\t\t\t\t\t\t\t<label for='input_127_149_1' id='input_127_149_1_label' ><\/label>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class='ginput_full ginput_cardholder' id='input_127_149_5_container'>\n\t\t\t\t\t\t\t<input class='cc-cardholder' type='text' name='input_149.5' id='input_127_149_5' value='' placeholder='Cardholder Name'>\n\t\t\t\t\t\t\t<label for='input_127_149_5' id='input_127_149_5_label' ><\/label>\n\t\t\t\t\t\t<\/div><div class=\"cc-billing-address\"><strong>Billing Address<\/strong><div class=\"inner\"><span><\/span><button type=\"button\" class=\"fa fa-pencil-alt\"><\/button><\/div><\/div><\/div><div class=\"secure-info\"><svg width=\"28\" height=\"28\" viewBox=\"0 0 28 28\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n<path d=\"M19 13.25H17.9375V9.75C17.9375 8.64531 17.0422 7.75 15.9375 7.75H12.0625C10.9578 7.75 10.0625 8.64531 10.0625 9.75V13.25H9C8.72344 13.25 8.5 13.4734 8.5 13.75V19.75C8.5 20.0266 8.72344 20.25 9 20.25H19C19.2766 20.25 19.5 20.0266 19.5 19.75V13.75C19.5 13.4734 19.2766 13.25 19 13.25ZM14.4375 16.9531V17.7812C14.4375 17.85 14.3812 17.9062 14.3125 17.9062H13.6875C13.6188 17.9062 13.5625 17.85 13.5625 17.7812V16.9531C13.4335 16.8605 13.3373 16.7294 13.2875 16.5786C13.2378 16.4278 13.2373 16.2651 13.2859 16.114C13.3345 15.9628 13.4299 15.831 13.5582 15.7375C13.6865 15.644 13.8412 15.5936 14 15.5936C14.1588 15.5936 14.3135 15.644 14.4418 15.7375C14.5701 15.831 14.6655 15.9628 14.7141 16.114C14.7627 16.2651 14.7622 16.4278 14.7125 16.5786C14.6627 16.7294 14.5665 16.8605 14.4375 16.9531ZM16.8125 13.25H11.1875V9.75C11.1875 9.26719 11.5797 8.875 12.0625 8.875H15.9375C16.4203 8.875 16.8125 9.26719 16.8125 9.75V13.25Z\" fill=\"#61C0C1\"\/>\n<circle cx=\"14\" cy=\"14\" r=\"13.5\" stroke=\"#61C0C1\"\/>\n<\/svg>We protect your payment information using encryption to provide bank-level security.<\/div><\/div><div id=\"field_127_70\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style = \"height:15px\">&nbsp;<\/div><\/div><div id=\"field_127_3\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gf-add-placeholder gf_additional_information field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_127_3'>Anything Else We Should Know? (ie., COVID-related , parking, entry instructions, time flexibility, pets)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_3' id='input_127_3' class='textarea medium'    placeholder='Your message'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_127_255\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full consent-checkbox-field wider-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Terms of Service<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_255'><div class='gchoice gchoice_127_255_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_255.1' type='checkbox'  value='I agree to the &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/driphydration.com\/terms-of-service\/&quot;&gt;Term of Service&lt;\/a&gt;, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/driphydration.com\/privacy-policy\/&quot;&gt;Privacy Policy&lt;\/a&gt;, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/driphydration.com\/consent-to-treat\/&quot;&gt;Consent To Treat&lt;\/a&gt;, and &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/driphydration.com\/cancellation-policy\/&quot;&gt;Cancellation Policy&lt;\/a&gt;'  id='choice_127_255_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_255_1' id='label_127_255_1' class='gform-field-label gform-field-label--type-inline'>I agree to the <a target=\"_blank\" href=\"https:\/\/driphydration.com\/terms-of-service\/\">Term of Service<\/a>, <a target=\"_blank\" href=\"https:\/\/driphydration.com\/privacy-policy\/\">Privacy Policy<\/a>, <a target=\"_blank\" href=\"https:\/\/driphydration.com\/consent-to-treat\/\">Consent To Treat<\/a>, and <a target=\"_blank\" href=\"https:\/\/driphydration.com\/cancellation-policy\/\">Cancellation Policy<\/a><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset>          <fieldset class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full wider-checkbox field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_visible gfa-createaccount\">\n            <legend class=\"gfield_label gform-field-label gfield_label_before_complex\">Create an account?<\/legend>\n            <div class=\"ginput_container ginput_container_checkbox\">\n              <div class=\"gfield_checkbox\">\n                <div class=\"gchoice\">\n                  <input type=\"checkbox\" name=\"gfa_createaccount\" value=\"1\" id=\"gfa_createaccount\" class=\"gfield-choice-input\" \/>\n                  <label for=\"gfa_createaccount\" class=\"gform-field-label gform-field-label--type-inline\">\n                    <b>Create an account?<\/b> (After submitting the form, an account will be created. Login details will be sent to your email address)\n                  <\/label>\n                <\/div>\n              <\/div>\n            <\/div>\n          <\/fieldset>\n          <fieldset id=\"field_127_366\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full wider-checkbox end_block_overview field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >SMS<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_127_366'><div class='gchoice gchoice_127_366_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_366.1' type='checkbox'  value='&lt;b&gt;Sign up for texts.&lt;\/b&gt; By signing up via text, you agree to receive recurring automated promotional and personalized marketing text messages (e.g. cart reminders) from Drip Hydration at the cell number used when signing up. Consent is not a condition of any purchase. Reply HELP for help and STOP to cancel. Msg frequency varies. Msg &amp; data rates may apply. View &lt;a target = &quot;_blank&quot; href=&quot;https:\/\/attnl.tv\/t\/A9M&quot;&gt;Terms&lt;\/a&gt; &amp; &lt;a target = &quot;_blank&quot; href=&quot;https:\/\/attnl.tv\/p\/A9M&quot;&gt;Privacy&lt;\/a&gt;.'  id='choice_127_366_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_127_366_1' id='label_127_366_1' class='gform-field-label gform-field-label--type-inline'><b>Sign up for texts.<\/b> By signing up via text, you agree to receive recurring automated promotional and personalized marketing text messages (e.g. cart reminders) from Drip Hydration at the cell number used when signing up. Consent is not a condition of any purchase. Reply HELP for help and STOP to cancel. Msg frequency varies. Msg & data rates may apply. View <a target = \"_blank\" href=\"https:\/\/attnl.tv\/t\/A9M\">Terms<\/a> & <a target = \"_blank\" href=\"https:\/\/attnl.tv\/p\/A9M\">Privacy<\/a>.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><div id=\"field_127_367\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_367' id='input_127_367' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='[channel]' \/><\/div><\/div><div id=\"field_127_368\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_368' id='input_127_368' type='hidden' class='gform_hidden'  aria-invalid=\"false\" 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name='gform_ajax_frame_127' id='gform_ajax_frame_127' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 127, 'https:\/\/driphydration.com\/wp-content\/themes\/bridge-child\/img\/spinner.gif', true );jQuery('#gform_ajax_frame_127').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_127');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_127').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 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fa\"><\/span>\n                    <\/div>\n    <\/div>\n    <div class=\"col\">\n        <div class=\"treatment\"><div class=\"added\"><p class=\"summary-subtitle-p\"><\/p><p class=\"summary-subtitle-p\"><\/p><\/div><\/div>\n        <div class=\"ttl-add\" style=\"display:none\">Additional product<\/div>\n        <div class=\"addons\"><\/div>\n        <div class=\"labfee\"><\/div>\n    <\/div>\n<\/div>\n                    <\/div>\n                <\/div>\n                <div class=\"table summary\">\n                    <div class=\"tr sst total\" style=\"display:none\">\n                        <div class=\"col\">\n                            <p class=\"summary-subtitle-p\">Subtotal<\/p>\n                            <p class=\"summary-subtitle-p\"><span class=\"subtotal\">$0<\/span><\/p>\n                        <\/div>\n                    <\/div>\n                        <div class=\"tr sp\" style=\"display:none\">\n        <div class=\"col service\">\n            <strong>Service Fee<\/strong>\n            <span>$0<\/span>\n        <\/div>\n    <\/div>\n                    <div class=\"tr labFee\" style=\"display:none\">\n                        <div class=\"col\">\n                            <span>Lab Fee Total<\/span>\n                            <span><i class=\"fee\">$0<\/i><\/span>\n                        <\/div>\n                    <\/div>\n                        <div class=\"tr total\">\n        <div class=\"col\">\n            <strong class=\"tip-point summary-subtitle-p\">Tip not included<\/strong>\n        <\/div>\n    <\/div>        <div class=\"tr tips\" style=\"display:none\">\n            <div class=\"col\">\n                 <strong class=\"tip-name\">Tip<i><\/i><\/strong>\n                <span class=\"tip-val\">$0<\/span>\n            <\/div>\n        <\/div>    <div class=\"tr discnt\" style=\"display:none\">\n        <div class=\"col\">\n            <strong class=\"discount-title\">Automatic Group Discount<i><\/i><\/strong>\n            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<\/div><\/div><div class=\"billing-address-popup\">\n    <div class=\"inner\">\n        <div class=\"popup-close btn-cancel\">Close<\/div>\n        <h3 class=\"div-full\">Billing Address<\/h3>\n        <div>\n            <label class=\"gform-field-label\">Country<\/label>\n            <select id=\"ccbadr_country\"><option>Afghanistan<\/option><option>Albania<\/option><option>Algeria<\/option><option>American Samoa<\/option><option>Andorra<\/option><option>Angola<\/option><option>Anguilla<\/option><option>Antarctica<\/option><option>Antigua and Barbuda<\/option><option>Argentina<\/option><option>Armenia<\/option><option>Aruba<\/option><option>Australia<\/option><option>Austria<\/option><option>Azerbaijan<\/option><option>Bahamas<\/option><option>Bahrain<\/option><option>Bangladesh<\/option><option>Barbados<\/option><option>Belarus<\/option><option>Belgium<\/option><option>Belize<\/option><option>Benin<\/option><option>Bermuda<\/option><option>Bhutan<\/option><option>Bolivia<\/option><option>Bonaire, Sint Eustatius and Saba<\/option><option>Bosnia and Herzegovina<\/option><option>Botswana<\/option><option>Bouvet Island<\/option><option>Brazil<\/option><option>British Indian Ocean Territory<\/option><option>Brunei Darussalam<\/option><option>Bulgaria<\/option><option>Burkina Faso<\/option><option>Burundi<\/option><option>Cabo Verde<\/option><option>Cambodia<\/option><option>Cameroon<\/option><option>Canada<\/option><option>Cayman Islands<\/option><option>Central African Republic<\/option><option>Chad<\/option><option>Chile<\/option><option>China<\/option><option>Christmas Island<\/option><option>Cocos Islands<\/option><option>Colombia<\/option><option>Comoros<\/option><option>Congo<\/option><option>Congo, Democratic Republic of the<\/option><option>Cook Islands<\/option><option>Costa Rica<\/option><option>Croatia<\/option><option>Cuba<\/option><option>Cura\u00e7ao<\/option><option>Cyprus<\/option><option>Czechia<\/option><option>C\u00f4te d'Ivoire<\/option><option>Denmark<\/option><option>Djibouti<\/option><option>Dominica<\/option><option>Dominican Republic<\/option><option>Ecuador<\/option><option>Egypt<\/option><option>El Salvador<\/option><option>Equatorial Guinea<\/option><option>Eritrea<\/option><option>Estonia<\/option><option>Eswatini<\/option><option>Ethiopia<\/option><option>Falkland Islands<\/option><option>Faroe Islands<\/option><option>Fiji<\/option><option>Finland<\/option><option>France<\/option><option>French Guiana<\/option><option>French Polynesia<\/option><option>French Southern Territories<\/option><option>Gabon<\/option><option>Gambia<\/option><option>Georgia<\/option><option>Germany<\/option><option>Ghana<\/option><option>Gibraltar<\/option><option>Greece<\/option><option>Greenland<\/option><option>Grenada<\/option><option>Guadeloupe<\/option><option>Guam<\/option><option>Guatemala<\/option><option>Guernsey<\/option><option>Guinea<\/option><option>Guinea-Bissau<\/option><option>Guyana<\/option><option>Haiti<\/option><option>Heard Island and McDonald Islands<\/option><option>Holy See<\/option><option>Honduras<\/option><option>Hong Kong<\/option><option>Hungary<\/option><option>Iceland<\/option><option>India<\/option><option>Indonesia<\/option><option>Iran<\/option><option>Iraq<\/option><option>Ireland<\/option><option>Isle of Man<\/option><option>Israel<\/option><option>Italy<\/option><option>Jamaica<\/option><option>Japan<\/option><option>Jersey<\/option><option>Jordan<\/option><option>Kazakhstan<\/option><option>Kenya<\/option><option>Kiribati<\/option><option>Korea, Democratic People's Republic of<\/option><option>Korea, Republic of<\/option><option>Kuwait<\/option><option>Kyrgyzstan<\/option><option>Lao People's Democratic Republic<\/option><option>Latvia<\/option><option>Lebanon<\/option><option>Lesotho<\/option><option>Liberia<\/option><option>Libya<\/option><option>Liechtenstein<\/option><option>Lithuania<\/option><option>Luxembourg<\/option><option>Macao<\/option><option>Madagascar<\/option><option>Malawi<\/option><option>Malaysia<\/option><option>Maldives<\/option><option>Mali<\/option><option>Malta<\/option><option>Marshall Islands<\/option><option>Martinique<\/option><option>Mauritania<\/option><option>Mauritius<\/option><option>Mayotte<\/option><option>Mexico<\/option><option>Micronesia<\/option><option>Moldova<\/option><option>Monaco<\/option><option>Mongolia<\/option><option>Montenegro<\/option><option>Montserrat<\/option><option>Morocco<\/option><option>Mozambique<\/option><option>Myanmar<\/option><option>Namibia<\/option><option>Nauru<\/option><option>Nepal<\/option><option>Netherlands<\/option><option>New Caledonia<\/option><option>New Zealand<\/option><option>Nicaragua<\/option><option>Niger<\/option><option>Nigeria<\/option><option>Niue<\/option><option>Norfolk Island<\/option><option>North Macedonia<\/option><option>Northern Mariana Islands<\/option><option>Norway<\/option><option>Oman<\/option><option>Pakistan<\/option><option>Palau<\/option><option>Palestine, State of<\/option><option>Panama<\/option><option>Papua New Guinea<\/option><option>Paraguay<\/option><option>Peru<\/option><option>Philippines<\/option><option>Pitcairn<\/option><option>Poland<\/option><option>Portugal<\/option><option>Puerto Rico<\/option><option>Qatar<\/option><option>Romania<\/option><option>Russian Federation<\/option><option>Rwanda<\/option><option>R\u00e9union<\/option><option>Saint Barth\u00e9lemy<\/option><option>Saint Helena, Ascension and Tristan da Cunha<\/option><option>Saint Kitts and Nevis<\/option><option>Saint Lucia<\/option><option>Saint Martin<\/option><option>Saint Pierre and Miquelon<\/option><option>Saint Vincent and the Grenadines<\/option><option>Samoa<\/option><option>San Marino<\/option><option>Sao Tome and Principe<\/option><option>Saudi Arabia<\/option><option>Senegal<\/option><option>Serbia<\/option><option>Seychelles<\/option><option>Sierra Leone<\/option><option>Singapore<\/option><option>Sint Maarten<\/option><option>Slovakia<\/option><option>Slovenia<\/option><option>Solomon Islands<\/option><option>Somalia<\/option><option>South Africa<\/option><option>South Georgia and the South Sandwich Islands<\/option><option>South Sudan<\/option><option>Spain<\/option><option>Sri Lanka<\/option><option>Sudan<\/option><option>Suriname<\/option><option>Svalbard and Jan Mayen<\/option><option>Sweden<\/option><option>Switzerland<\/option><option>Syria Arab Republic<\/option><option>Taiwan<\/option><option>Tajikistan<\/option><option>Tanzania, the United Republic of<\/option><option>Thailand<\/option><option>Timor-Leste<\/option><option>Togo<\/option><option>Tokelau<\/option><option>Tonga<\/option><option>Trinidad and Tobago<\/option><option>Tunisia<\/option><option>Turkmenistan<\/option><option>Turks and Caicos Islands<\/option><option>Tuvalu<\/option><option>T\u00fcrkiye<\/option><option>US Minor Outlying Islands<\/option><option>Uganda<\/option><option>Ukraine<\/option><option>United Arab Emirates<\/option><option>United Kingdom<\/option><option>United States<\/option><option>Uruguay<\/option><option>Uzbekistan<\/option><option>Vanuatu<\/option><option>Venezuela<\/option><option>Viet Nam<\/option><option>Virgin Islands, British<\/option><option>Virgin Islands, U.S.<\/option><option>Wallis and Futuna<\/option><option>Western Sahara<\/option><option>Yemen<\/option><option>Zambia<\/option><option>Zimbabwe<\/option><option>\u00c5land Islands<\/option><\/select>\n        <\/div>\n        <div class=\"div-full\">\n            <label class=\"gform-field-label\">Street Address<\/label>\n            <input id=\"ccbadr_line1\" type=\"text\" placeholder=\"Street Address\">\n        <\/div>\n        <div class=\"div-full\">\n            <label class=\"gform-field-label\">Address Line 2<\/label>\n            <input id=\"ccbadr_line2\" type=\"text\" placeholder=\"Address Line 2\">\n        <\/div>\n        <div>\n            <label class=\"gform-field-label\">State<\/label>\n            <input id=\"ccbadr_state\" type=\"text\" 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                                                      <h3>10 Benefits Of Amino Acid IV Therapy<\/h3>\n                                        <div class=\"text\"><p>As important as amino acids are for your health, not many people know what they do. Today, we talk about their top 10 benefits.<\/p>\n<\/div>\n                                        <a href=\"https:\/\/driphydration.com\/blog\/amino-acids-benefits\/\" class=\"btn-new outline-white\" target=\"_blank\">Read more<\/a>\n                                    <\/div>\n                                <\/div>\n                            <\/div>\n                                                                                                                                        <div class=\"swiper-slide\">\n                                <div class=\"li\">\n                                                                            <img loading=\"lazy\" decoding=\"async\" width=\"1280\" height=\"768\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2023\/01\/pexels-hasib-abir-12807483-1.jpg\" class=\"attachment-full size-full wp-post-image\" alt=\"A carving of a boat with people on it\" srcset=\"https:\/\/driphydration.com\/wp-content\/uploads\/2023\/01\/pexels-hasib-abir-12807483-1.jpg 1280w, https:\/\/driphydration.com\/wp-content\/uploads\/2023\/01\/pexels-hasib-abir-12807483-1-700x420.jpg 700w, https:\/\/driphydration.com\/wp-content\/uploads\/2023\/01\/pexels-hasib-abir-12807483-1-768x461.jpg 768w\" sizes=\"auto, (max-width: 1280px) 100vw, 1280px\" \/>                                                                        <div class=\"resources__content\">\n                                                                                    <div class=\"tags\">\n                                                                                                    <span>Alternative Treatments <\/span>\n                                                                                                    <span>Athletic Performance <\/span>\n                                                                                                    <span>Beauty <\/span>\n                                                                                                    <span>Medical Weight Loss <\/span>\n                                                                                            <\/div>\n                                                                                <h3>10 Extreme Weight Loss Methods from History<\/h3>\n                                        <div class=\"text\"><p>[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221;][vc_column][vc_column_text]Fad diets and extreme weight loss methods have been trending for a long&#8230;<\/p>\n<\/div>\n                                        <a href=\"https:\/\/driphydration.com\/blog\/10-history-weight-loss-methods\/\" class=\"btn-new outline-white\" target=\"_blank\">Read more<\/a>\n                                    <\/div>\n                                <\/div>\n                            <\/div>\n                                                                                                                                        <div class=\"swiper-slide\">\n                                <div class=\"li\">\n                                                                            <img loading=\"lazy\" decoding=\"async\" width=\"640\" height=\"427\" src=\"https:\/\/driphydration.com\/wp-content\/uploads\/2022\/06\/ahtziri-lagarde-o8zGwqP8iAo-unsplash.jpg\" class=\"attachment-full size-full wp-post-image\" alt=\"hangover woman lying down\" \/>                                                                        <div class=\"resources__content\">\n                                                                                    <div class=\"tags\">\n                                                                                                    <span>Instant Delivery <\/span>\n                                                                                                    <span>IV Hydration <\/span>\n                                                                                                    <span>Vitamins <\/span>\n                                                                                            <\/div>\n                                                                                <h3>10 Reasons Why Vitamin IV Treatment is the Best Way to Get Rid of a Hangover Quickly<\/h3>\n                                        <div class=\"text\"><p>Planning a pandemic wedding in California? Here\u2019s how you can keep your wedding free from Covid-19.<\/p>\n<\/div>\n                                        <a href=\"https:\/\/driphydration.com\/blog\/10-reasons-for-vitamin-iv-treatment\/\" class=\"btn-new outline-white\" target=\"_blank\">Read more<\/a>\n                                    <\/div>\n                                <\/div>\n                            <\/div>\n                                                <\/div>\n                        <div class=\"swiper-pagination custom-slider-pagination resources-pagination\"><\/div>\n                    <\/div>\n                            <\/div>\n        <\/article>\n        [vc_raw_html css=&#8221;&#8221;]JTVCc2MlMjBuYW1lJTNEJTIyaXZfZm9ybV9wcm92aWRlcl9wYWdlX25ldyUyMiUyMHRpdGxlJTNEJTIyQm9vayUyME1vYmlsZSUyMElWJTIwU3RvbWFjaCUyMEZsdSUyMiU1RCU1QiUyRnNjJTVEJTIw[\/vc_raw_html][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221;][vc_column][\/vc_column][\/vc_row][vc_row css_animation=&#8221;&#8221; disable_element=&#8221;yes&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;full_width&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; el_id=&#8221;Book-IV-therapy&#8221; z_index=&#8221;&#8221;][vc_column][vc_row_inner row_type=&#8221;row&#8221; type=&#8221;full_width&#8221;&#8230;<\/p>\n","protected":false},"author":2,"featured_media":11434,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"full_width.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-5403","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/driphydration.com\/wp-json\/wp\/v2\/pages\/5403","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/driphydration.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/driphydration.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/driphydration.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/driphydration.com\/wp-json\/wp\/v2\/comments?post=5403"}],"version-history":[{"count":0,"href":"https:\/\/driphydration.com\/wp-json\/wp\/v2\/pages\/5403\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/driphydration.com\/wp-json\/wp\/v2\/media\/11434"}],"wp:attachment":[{"href":"https:\/\/driphydration.com\/wp-json\/wp\/v2\/media?parent=5403"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}