/* growform client2
   bundle.url: https://assets.growform.co/df322d5-mhjegkpe/form.bundle.js
   resolve.source: memory
   resolve.at: 2025-11-04T11:21:29.838Z
   form.source: kv
   cache.age_ms: 7999
   fallback_used: false
*/
;(function () {
  var EMBED_TYPE = "iFrame";
  var FORM_ID = "6789fc5d693b6a000b7149e8";
  var FORM_BUNDLE_URL = "https://assets.growform.co/df322d5-mhjegkpe/form.bundle.js"; // injected by worker (KV/memory/fallback)
  var FORM_DATA = {"data":{"form":{"_id":"6789fc5d693b6a000b7149e8","steps":[{"id":"9ddf8fce80ba978e50783ff8","name":"Welcome to The Justice Collaborative","sortOrder":1},{"id":"04caa908be84bcb333fed25e","name":"What has you or a loved one experienced?","sortOrder":2,"copyOf":"ac0ce1d8634334328d03ff33"},{"id":"e37be7311845051947faaff8","name":"Serious Injury Cases: You May Qualify for These Cases(In Islamabad)","sortOrder":3,"copyOf":"04caa908be84bcb333fed25e","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"e39c0ef95ec077b61db0eee5"}]}]}},{"id":"16d01cf63c895b21a46d8b0c","name":"Depo Povera Taken","sortOrder":4,"copyOf":"04caa908be84bcb333fed25e","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"4a888fb54e5554c985610f5b"}]}]}},{"id":"c3407dcee287e0bef20876e4","name":"Have you or a loved one been diagnosed with any of these injuries?","sortOrder":5,"copyOf":"16d01cf63c895b21a46d8b0c","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"4a888fb54e5554c985610f5b"}]}]}},{"id":"cd2051e4194d730575f0bb92","name":"Are you currently represented by an attorney for this matter?","sortOrder":6,"copyOf":"4fe1f217edaba3a4a8687612","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"4a888fb54e5554c985610f5b"}]}]}},{"id":"c4427c23e75234dd9c830157","name":"Did you or a loved one received Depo-Provera medication?","sortOrder":7,"copyOf":"cd2051e4194d730575f0bb92","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"4a888fb54e5554c985610f5b"}]}]}},{"id":"64359e11bcf1a092339723b5","name":"Approximately how long did you take Depo-Provera on a regular basis?","sortOrder":8,"copyOf":"60a50b1709224af26edaaf05","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"4a888fb54e5554c985610f5b"}]}]}},{"id":"6a3ffc686eb9bc6904016747","name":"Do you already have an attorney?","sortOrder":9,"copyOf":"c723e21aee82efe69778f1d0","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"e39c0ef95ec077b61db0eee5"}]}]}},{"id":"c723e21aee82efe69778f1d0","name":"Were you exposed to firefighting foam (AFFF)?","sortOrder":10,"copyOf":"781b926a19826400b1bf9b59","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"e39c0ef95ec077b61db0eee5"}]}]}},{"id":"aa22b25f16d921324ce29645","name":"Were you or someone you know diagnosed with any of the following?","sortOrder":11,"copyOf":"c723e21aee82efe69778f1d0","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"e39c0ef95ec077b61db0eee5"}]}]}},{"id":"7a488243074f8dd413e2a3bd","name":"In what occupation were you directly exposed to firefighting foam?","sortOrder":12,"copyOf":"f49d8d267149653154f58100","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"e39c0ef95ec077b61db0eee5"}]}]}},{"id":"edd8b9ed005b8b0a0e813584","name":"Which of the following cancers do you suffer from?","sortOrder":13,"copyOf":"aa22b25f16d921324ce29645","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"6eb3411ff67f688baa451dbb","name":"Description","sortOrder":14,"copyOf":"edd8b9ed005b8b0a0e813584","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"d9a87dd71cae96c809850bd5","name":"Do you already have an attorney representing you regarding Roundup?","sortOrder":15,"copyOf":"0b9fcc8231b5f8664cc9e7e0","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"0b9fcc8231b5f8664cc9e7e0","name":"Were you exposed to Roundup Weed Killer?","sortOrder":16,"copyOf":"8347c4f7946b81302e259b16","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"a7003bbc234da6e74177406f","name":"How long have you used or been exposed to Roundup Weed Killer?","sortOrder":17,"copyOf":"0b9fcc8231b5f8664cc9e7e0","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"f49d8d267149653154f58100","name":"What year were you diagnosed?","sortOrder":18,"copyOf":"a7003bbc234da6e74177406f","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"a67e8ad40ecfed8762faf590","name":"Do you already have an attorney?","sortOrder":19,"copyOf":"a7003bbc234da6e74177406f","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"db7877f6c12b8265c5914d82"}]}]}},{"id":"b6c67d80ba30ba0f6950786a","name":"Did you or a loved one use hair relaxer/straightener products?","sortOrder":20,"copyOf":"a67e8ad40ecfed8762faf590","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"db7877f6c12b8265c5914d82"}]}]}},{"id":"55baec1b2aaeec884c350565","name":"When were you diagnosed?","sortOrder":21,"copyOf":"b6c67d80ba30ba0f6950786a","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"db7877f6c12b8265c5914d82"}]}]}},{"id":"e4235802c1eee601dc10c929","name":"Have you or a loved one been diagnosed with any of these cancers?","sortOrder":22,"copyOf":"55baec1b2aaeec884c350565","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"db7877f6c12b8265c5914d82"}]}]}},{"id":"a962cda6de62f433a5309bd8","name":"Have you or someone you love taken the brand name ozempic?","sortOrder":23,"copyOf":"c48abd022df237bfe70ab67c","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"2d3fdb731c9773bb7a59f39f"}]}]}},{"id":"220369185ffc0e1eef943b7c","name":"What were you or a loved one diagnosed with? *","sortOrder":24,"copyOf":"a962cda6de62f433a5309bd8","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"2d3fdb731c9773bb7a59f39f"}]}]}},{"id":"1a58c9b2a892bcadb23677c5","name":"Do you already have an attorney representing you regarding Ozempic?","sortOrder":25,"copyOf":"49b2c5d700cfd6ef345c8732","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"2d3fdb731c9773bb7a59f39f"}]}]}},{"id":"49b2c5d700cfd6ef345c8732","name":"Stay AT The Hospital?","sortOrder":26,"copyOf":"3ec29a1c78a664187013dc56","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"2d3fdb731c9773bb7a59f39f"}]}]}},{"id":"8ba12ea5db595ca952949cb9","name":"Talcum Length","sortOrder":27,"copyOf":"49b2c5d700cfd6ef345c8732","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"3a27192fdd4f66837f11eac2"}]}]}},{"id":"9a954122e29f93a1f88dd22f","name":"Cancer*","sortOrder":28,"copyOf":"8ba12ea5db595ca952949cb9","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"3a27192fdd4f66837f11eac2"}]}]}},{"id":"ee5c165564a2d519d9662f8c","name":"Diagnosed Year","sortOrder":29,"copyOf":"9a954122e29f93a1f88dd22f","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"3a27192fdd4f66837f11eac2"}]}]}},{"id":"c30f158e61d730377ab3a766","name":"Attorney?","sortOrder":30,"copyOf":"a67e8ad40ecfed8762faf590","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"3a27192fdd4f66837f11eac2"}]}]}},{"id":"e1319d244c233104861d71b4","name":"Diagnosed Before 70?","sortOrder":31,"copyOf":"c30f158e61d730377ab3a766","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"3a27192fdd4f66837f11eac2"}]}]}},{"id":"64212818583d874a22ffc05e","name":"Were you or a loved one exposed to Paraquat or Gramoxone?","sortOrder":32,"copyOf":"e1319d244c233104861d71b4","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"b2b8dc475b02fd3d50397b73"}]}]}},{"id":"f59bc2f2074c12c6c831d30e","name":"Do you or a loved one suffer from any symptoms of Parkinson’s Disease?","sortOrder":33,"copyOf":"c30f158e61d730377ab3a766","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"b2b8dc475b02fd3d50397b73"}]}]}},{"id":"496b695cdda980957fe365b0","name":"Do you already have an attorney?","sortOrder":34,"copyOf":"f59bc2f2074c12c6c831d30e","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"b2b8dc475b02fd3d50397b73"}]}]}},{"id":"d71df4e9be019a3c8ea1742f","name":"Diagnosed?","sortOrder":35,"copyOf":"496b695cdda980957fe365b0","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_282684349331177","operator":"selected_option","criteria":"b2b8dc475b02fd3d50397b73"}]}]}},{"id":"c26860aac3420272effa15fe","name":"Free case review","sortOrder":36,"copyOf":"d71df4e9be019a3c8ea1742f","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"8a846ca5c229c02e3b422139","name":"Were you physically Injured in a motor vehicle accident?","sortOrder":37,"copyOf":"d71df4e9be019a3c8ea1742f","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"86576a7ad798c79abcb3dfa2","name":"Did you receive medical treatment?","sortOrder":38,"copyOf":"8a846ca5c229c02e3b422139","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"d7dfb4b549bd1a4510173611","name":"Were you at fault?","sortOrder":39,"copyOf":"86576a7ad798c79abcb3dfa2","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"7e3bbb702b6ca1abf544d8a6","name":"Are you currently represented by an accident attorney? ","sortOrder":40,"copyOf":"d7dfb4b549bd1a4510173611","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"f0cd78c38f0a25411bcbf050","name":"What date did the accident occur?","sortOrder":41,"copyOf":"d7dfb4b549bd1a4510173611","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"2f9c97a106d7955ec6b398e5","name":"Do you have a police report of the incident?","sortOrder":42,"copyOf":"86576a7ad798c79abcb3dfa2","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"5b9a6002ff53c6e4ae137322","name":"How long has it been since the accident?","sortOrder":43,"copyOf":"73394e277d4746c033b1e1cf","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"c0f31fb83ac3efde6fd769f5","name":"Briefly describe what happened","sortOrder":44,"copyOf":"8a846ca5c229c02e3b422139","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"42db3c3349aafda9e6748820"}]}]}},{"id":"4ee58ed5d24ee8f90ce28172","name":"Sexual Abuse Pages","sortOrder":45,"copyOf":"c0f31fb83ac3efde6fd769f5","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"b2b8dc475b02fd3d50397b73"}]}]}},{"id":"8129112c923f69621fd67e44","name":"Please Select the Case that Applies to You:","sortOrder":46,"copyOf":"73394e277d4746c033b1e1cf","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_591331084121282","operator":"selected_option","criteria":"b2b8dc475b02fd3d50397b73"}]}]}},{"id":"4618d9d0a31f1c732f2412ba","name":"Free case review","sortOrder":47,"copyOf":"8129112c923f69621fd67e44","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_995177428099075","operator":"selected_option","criteria":"fcfa5c2a370449f531c0b857"}]}]}},{"id":"9586a526bc41b2b7c372ee14","name":"What type of abuse/assault did you suffer?","sortOrder":48,"copyOf":"c245033432b60e5d29b42b8e","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_995177428099075","operator":"selected_option","criteria":"fcfa5c2a370449f531c0b857"}]}]}},{"id":"ad58b92106753b56dba8e9d5","name":"Do you already have an attorney representing you regarding rideshare?","sortOrder":49,"copyOf":"e393cf36a7cbfbfb79b71c77","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_995177428099075","operator":"selected_option","criteria":"fcfa5c2a370449f531c0b857"}]}]}},{"id":"e393cf36a7cbfbfb79b71c77","name":"Were you know assaulted by your driver during or Lyft ride between?","sortOrder":50,"copyOf":"8129112c923f69621fd67e44","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_995177428099075","operator":"selected_option","criteria":"fcfa5c2a370449f531c0b857"}]}]}},{"id":"b35dc12611eaf1efe7d8be97","name":"Proof OF Receipt Ride","sortOrder":51,"copyOf":"093aa33b7cbe30a8a9b98901","conditionalLogic":{"action":"show","ruleBlocks":[{"sortOrder":0,"rules":[{"observedField":"buttons_995177428099075","operator":"selected_option","criteria":"fcfa5c2a370449f531c0b857"}]}]}},{"id":"ff4727c9498ef9c0a6c989d9","name":"Find out if you are eligible for compensation","sortOrder":52},{"id":"967e6cf161a61a71fc930ab9","name":"Great that you're taking thefirst step toward justice!","sortOrder":53,"copyOf":"ff4727c9498ef9c0a6c989d9"},{"id":"d3c30a2138469c53fc255a5c","name":"Find out if you are eligible for compensation","sortOrder":54,"copyOf":"967e6cf161a61a71fc930ab9"}],"formName":"tjc","fields":{"Decorative Header_52363373085874":{"type":"Decorative Header","value":"Thank You!","width":12,"step":"complete","sortOrder":2,"fieldStyle":{"fontSize":{"value":30,"unit":"px"},"fontWeight":"Bold"},"margins":{"marginTop":null},"stepId":"complete"},"Decorative Header_576559560634956":{"type":"Decorative Header","value":"Find out if you are eligible for compensationa","width":12,"step":5,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"ff4727c9498ef9c0a6c989d9","margins":{"marginBottom":5}},"text_373461752242760":{"type":"Text","label":"First Name","width":12,"margins":{"marginBottom":0},"step":5,"sortOrder":2,"validationRules":{"required":true},"stepId":"ff4727c9498ef9c0a6c989d9","hideLabel":false},"Decorative_Paragraph_194067845817258":{"type":"Decorative Paragraph","value":"Your submission has been received!","width":12,"step":"complete","sortOrder":3,"margins":{"marginBottom":60},"stepId":"complete","fieldStyle":{"fontSize":{"value":19,"unit":"px"}}},"decorative_header_997263865146615":{"type":"Decorative Header","value":"What has you or a loved one experienced?","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"04caa908be84bcb333fed25e","margins":{"marginBottom":5}},"buttons_591331084121282":{"type":"Buttons","validationRules":{"required":true},"label":"What has you or a loved one experienced?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Serious health issues?","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737096868/uploads/c6shpx4lkrwg5kcn0lro.webp","id":"e39c0ef95ec077b61db0eee5"},{"text":"Motor Vehicle Accident?","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737096882/uploads/xi1jif0rtkiuhqxof4my.webp","id":"42db3c3349aafda9e6748820"},{"text":"Sexual Abuse?","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737096895/uploads/z0y7xa6t9qcxgps9i8th.webp","id":"b2b8dc475b02fd3d50397b73"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"150%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Square","sq_buttonsPerRow":"3","sq_buttonsPerRowMobile":"2"},"stepId":"04caa908be84bcb333fed25e"},"decorative_header_438292964640077":{"type":"Decorative Header","value":"Depo Povera Taken Or Not?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"16d01cf63c895b21a46d8b0c","margins":{"marginBottom":5}},"buttons_28871946829103":{"type":"Buttons","validationRules":{"required":true},"label":"Depo Povera Taken Or Not?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"16d01cf63c895b21a46d8b0c"},"decorative_header_868384459113239":{"type":"Decorative Header","value":"What has you or a loved one experienced?","width":12,"sortOrder":1,"stepId":"9ddf8fce80ba978e50783ff8","fieldStyle":{"fontSize":{"value":29,"unit":"px"},"fontFamily":"Roboto"}},"decorative_paragraph_653021424394292":{"type":"Decorative Paragraph","value":"Are you or a loved one diagnosed with serious health issues such as a pysical injury or cancer? Or have you or a loved one experienced sexual abuse? You could be entitled to compensation!We are here to guide you and to find out if you are eligible for compensation. Answer the questions below and find out NOW!","width":12,"stepId":"9ddf8fce80ba978e50783ff8","sortOrder":2,"fieldStyle":{"fontSize":{"value":20,"unit":"px"},"fontFamily":"Roboto","lineHeight":"150%"}},"decorative_header_565570164801522":{"type":"Decorative Header","value":"Serious Injury Cases: You May Qualify for These Cases(In Islamabad)* ","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"e37be7311845051947faaff8","margins":{"marginBottom":5}},"buttons_282684349331177":{"type":"Buttons","validationRules":{"required":true},"label":"Serious Injury Cases: You May Qualify for These Cases(In Islamabad)","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Exposed to Fire Fighting Foam?»","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097090/uploads/rvdy9ja5hcmdqdun46bl.webp","id":"e39c0ef95ec077b61db0eee5"},{"text":"Exposed to Roundup? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097100/uploads/w0ixcrpun7xydnctihqh.webp","id":"42db3c3349aafda9e6748820"},{"text":"Exposed to Paraquat? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097107/uploads/czvjfuhdhflqgnd0cmoa.webp","id":"b2b8dc475b02fd3d50397b73"},{"text":"Used Depo-Provera? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097117/uploads/xyrauo3tfzmrxo9nzjb9.webp","id":"4a888fb54e5554c985610f5b"},{"text":"Suffering from a Personal Injury?","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097186/uploads/igkl39uf5ky6zbhfjgus.webp","id":"4d8448767447853e2044d719"},{"text":"»Used Hair Straightening products? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097216/uploads/bepzvj9rcjseqa1sx8pm.webp","id":"db7877f6c12b8265c5914d82"},{"text":"Used Baby Formula?","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097229/uploads/mxyuik3kmbsrdtt05hjd.webp","id":"aa4aba78b5ae785e35e3874b"},{"text":"»Used Talcum Powder? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097297/uploads/a6wjnhybbjcn3tufrpqs.webp","id":"3a27192fdd4f66837f11eac2"},{"text":"Defective Hernia Mesh? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097310/uploads/uz62nwlhk2dl4hohdywc.webp","id":"56fd7bc51e3f4f7eb3eb2c96"},{"text":"Used a Bard-Powerport? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097331/uploads/flixxwco2lwppwbslhfs.webp","id":"32115483d50aee942fbc5297"},{"text":"Used Ozempic? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097345/uploads/xycjoeajox5htqtozvpw.webp","id":"2d3fdb731c9773bb7a59f39f"},{"text":"Exposed to PFAS? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737097352/uploads/iwsxocjj1itid13spvgo.webp","id":"71f4008824c850f95c99aa8c"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"150%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Square","sq_buttonsPerRow":"4","sq_buttonsPerRowMobile":"2"},"stepId":"e37be7311845051947faaff8"},"decorative_header_636528295007777":{"type":"Decorative Header","value":"Are you currently represented by an attorney for this matter?","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"cd2051e4194d730575f0bb92","margins":{"marginBottom":5}},"buttons_306153825031262":{"type":"Buttons","validationRules":{"required":false},"label":"Are you (or a loved one) currently represented by an attorney for this matter?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"cd2051e4194d730575f0bb92"},"decorative_header_84901336331060":{"type":"Decorative Header","value":"Approximately how long did you or a loved one take Depo-Provera medication on a regular basis?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"64359e11bcf1a092339723b5","margins":{"marginBottom":5}},"buttons_922380152378808":{"type":"Buttons","validationRules":{"required":true},"label":"Approximately how long did you or a loved one take Depo-Provera medication on a regular basis?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"1 year","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"2 years","image":null,"id":"895ce5200c69d0a3bb93e2ae"},{"text":"3 or more years","image":null,"id":"8df77432dfab98f8a2527573"},{"text":"Yes","image":null,"id":"9f98de70b16849c7b665b14c"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"64359e11bcf1a092339723b5"},"hidden_793657067108139":{"type":"Hidden","hiddenFieldName":"depo_provera_affm_campaign_id","width":12,"stepId":"64359e11bcf1a092339723b5","sortOrder":3,"defaultValue":"czsddjmiwnxzlgp"},"hidden_569636335209093":{"type":"Hidden","hiddenFieldName":"depo_provera_affm_api_key","width":12,"stepId":"64359e11bcf1a092339723b5","sortOrder":4,"defaultValue":"ByP4LxbLyFkmXgKuL5oUOfnG5QsTIktI4DpO2mCH4WsVgnZ7KqXU96fBYKgz"},"text_294209183142193":{"type":"Text","label":"Last Name","width":12,"stepId":"ff4727c9498ef9c0a6c989d9","sortOrder":3,"validationRules":{"required":true}},"decorative_header_274818709983942":{"type":"Decorative Header","value":"Great that you're taking thefirst step toward justice!","width":12,"step":5,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"967e6cf161a61a71fc930ab9","margins":{"marginBottom":5}},"decorative_paragraph_321865357030155":{"type":"Decorative Paragraph","value":"We guide you to justice andcompensation with ease.","width":12,"stepId":"967e6cf161a61a71fc930ab9","sortOrder":2,"fieldStyle":{"fontSize":{"value":18,"unit":"px"},"fontFamily":"Roboto"}},"decorative_paragraph_360881620058433":{"type":"Decorative Paragraph","value":"1 Question","width":12,"stepId":"967e6cf161a61a71fc930ab9","sortOrder":3,"fieldStyle":{"fontSize":{"value":16,"unit":"px"},"fontFamily":"Roboto"}},"decorative_header_544596518061237":{"type":"Decorative Header","value":"Find out if you are eligible for compensation* ","width":12,"stepId":"d3c30a2138469c53fc255a5c","sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontFamily":"Roboto","fontWeight":"normal"}},"phone_81304461467723":{"type":"Phone","label":"phone no","width":12,"stepId":"d3c30a2138469c53fc255a5c","sortOrder":2,"hideLabel":true,"showCountryCode":true},"email_919230652129035":{"type":"Email","label":"Email","width":12,"stepId":"d3c30a2138469c53fc255a5c","sortOrder":3,"hideLabel":false},"decorative_header_786058993105959":{"type":"Decorative Header","value":"Were you exposed to firefighting foam (AFFF)?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"c723e21aee82efe69778f1d0","margins":{"marginBottom":5}},"buttons_106891407877647":{"type":"Buttons","validationRules":{"required":true},"label":"Were you exposed to firefighting foam (AFFF)?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"c723e21aee82efe69778f1d0"},"decorative_header_84530582073092":{"type":"Decorative Header","value":"Were you or someone you know diagnosed with any of the following?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"aa22b25f16d921324ce29645","margins":{"marginBottom":5}},"single_select_810802725005308":{"type":"Single Select","width":12,"label":"Were you or someone you know diagnosed with any of the following?","options":[{"text":"Kidney cancer","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"Thyroid cancer","id":"93f4898ef62e56a6ef1ea611"},{"text":"Testicular cancer","id":"7885860335d8a39e60883e9e"},{"text":"Prostate cancer","image":null,"id":"789f6e8933fd0d4bf39266b0"},{"text":"Thyroid disease","image":null,"id":"025f00075bc71b4569ccc823"},{"text":"Liver cancer","image":null,"id":"9cc77f8cd87500830948af0b"},{"text":"Ulcerative Colitis","image":null,"id":"8f140f71fd1729ffad15ec3c"},{"text":"Other types of Cancer","image":null,"id":"f8f8741e66a0fdbec062fa23"},{"text":"Other types of Illness","image":null,"id":"bf34bf31d619c7bf5b0cbb8a"}],"helperText":null,"stepId":"aa22b25f16d921324ce29645","sortOrder":2,"hideLabel":false,"validationRules":{"required":true}},"decorative_header_280946659049282":{"type":"Decorative Header","value":"Which of the following cancers do you suffer from?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"edd8b9ed005b8b0a0e813584","margins":{"marginBottom":5}},"single_select_598835521013948":{"type":"Single Select","width":12,"label":"Which of the following cancers do you suffer from?","options":[{"text":"Non-Hodgkin's Lymphoma (NHL)","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"Chronic Lymphocytic Leukemia (CLL)","id":"93f4898ef62e56a6ef1ea611"},{"text":"Diffuse Large B-Cell Lymphoma (B-DLCL)","id":"7885860335d8a39e60883e9e"},{"text":"Small Lymphocytic Lymphoma (B-SLL)","image":null,"id":"789f6e8933fd0d4bf39266b0"},{"text":"Hairy Cell Leukemia (HCL)","image":null,"id":"025f00075bc71b4569ccc823"},{"text":"Mantle Cell Lymphoma (MCL)","image":null,"id":"9cc77f8cd87500830948af0b"},{"text":"B-Cell Lymphoma","image":null,"id":"8f140f71fd1729ffad15ec3c"},{"text":"Mycosis Fungoides (T-MF)","image":null,"id":"f8f8741e66a0fdbec062fa23"},{"text":"T-Cell Lymphoma","image":null,"id":"bf34bf31d619c7bf5b0cbb8a"},{"text":"Follicular Lymphoma (B-FL)","image":null,"id":"5d0dfc11c8b568717cca716d"},{"text":"Primary Central Nervous System (CNS) Lymphoma","image":null,"id":"7feaa3eb199086a34ba96b52"},{"text":"Small Lymphocytic Lymphoma (SLL)","image":null,"id":"e8640e35aeb5cb2dc35ab3b4"},{"text":"Anaplastic Large T/Null-Cell Lymphoma (T/N-ALCL)","image":null,"id":"56d1fcffa940a05d26ce1140"}],"helperText":null,"stepId":"edd8b9ed005b8b0a0e813584","sortOrder":2,"hideLabel":false,"validationRules":{"required":true}},"decorative_header_862071039153290":{"type":"Decorative Header","value":"Description","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"6eb3411ff67f688baa451dbb","margins":{"marginBottom":5}},"text_473255551236618":{"type":"Text","label":"Description ","width":12,"stepId":"6eb3411ff67f688baa451dbb","sortOrder":2,"multiline":true,"rows":5,"hideLabel":true,"validationRules":{"required":true}},"decorative_header_594381316266451":{"type":"Decorative Header","value":"Were you exposed to Roundup Weed Killer?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"0b9fcc8231b5f8664cc9e7e0","margins":{"marginBottom":5}},"buttons_131584155092375":{"type":"Buttons","validationRules":{"required":true},"label":"Were you exposed to Roundup Weed Killer?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes, directly exposed","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"Yes, indirectly exposed","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"0b9fcc8231b5f8664cc9e7e0"},"decorative_header_195735821749997":{"type":"Decorative Header","value":"How long have you used or been exposed to Roundup Weed Killer?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"a7003bbc234da6e74177406f","margins":{"marginBottom":5}},"buttons_625380290338325":{"type":"Buttons","validationRules":{"required":true},"label":"How long have you used or been exposed to Roundup Weed Killer?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"2 or more years","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"1 year","image":null,"id":"895ce5200c69d0a3bb93e2ae"},{"text":"Less than 1 year","image":null,"id":"72e803af226c895f0a7b7897"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"a7003bbc234da6e74177406f"},"decorative_header_713702674987931":{"type":"Decorative Header","value":"What year were you diagnosed? *","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"f49d8d267149653154f58100","margins":{"marginBottom":5}},"single_select_922071776544977":{"type":"Single Select","width":12,"label":"What year were you diagnosed? ","options":[{"text":"2001","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"2002","id":"93f4898ef62e56a6ef1ea611"},{"text":"2003","id":"7885860335d8a39e60883e9e"},{"text":"2004","image":null,"id":"486d42a5e5b24feb59a970c5"},{"text":"2005","image":null,"id":"bf315310af1af940c3318163"},{"text":"2006","image":null,"id":"370e282447da644bea08e6b6"},{"text":"2007","image":null,"id":"47e0d276d0183f666d3c26ec"},{"text":"2008","image":null,"id":"4812642a3c498a05263814c6"},{"text":"2009","image":null,"id":"cee449119d8fef8cb3d7cefa"},{"text":"2010","image":null,"id":"3102e94cf5d97fb007c2cab3"},{"text":"2011","image":null,"id":"fbc8af927ca875b02db42d4e"},{"text":"2012","image":null,"id":"68c9f6bf7e8e1ca98ed12fc8"},{"text":"2013","image":null,"id":"36e0e619ebd459adfd23837c"},{"text":"2014","image":null,"id":"08676aabed2297d6a03e0ab9"},{"text":"2015","image":null,"id":"f3e9d95484fdb103bd5e3cae"},{"text":"2016","image":null,"id":"d06835eff3c976906e525459"},{"text":"2017","image":null,"id":"3bdfae9423e194a34ced2bbf"},{"text":"2018","image":null,"id":"d1e955d8f33dc450e40c92d7"},{"text":"2019","image":null,"id":"cfe499da2da1907c621f52e5"},{"text":"2020","image":null,"id":"d33c58085875ec408494d447"},{"text":"2021","image":null,"id":"cb5e779a50988647dba759f7"},{"text":"2022","image":null,"id":"1f6b5482b38d91b223033c18"},{"text":"2023","image":null,"id":"d80a9b05c05e39fcb8363387"},{"text":"2024","image":null,"id":"12f983062841029d7f245716"},{"text":"2025","image":null,"id":"9a6a8dee7039626bc476f018"}],"helperText":null,"stepId":"f49d8d267149653154f58100","sortOrder":2,"hideLabel":false,"validationRules":{"required":true}},"hidden_221680553467901":{"type":"Hidden","hiddenFieldName":"roundup_affm_campaign_id","width":12,"stepId":"f49d8d267149653154f58100","sortOrder":3,"defaultValue":"flgu9g9lpsd6cmx","location":null},"hidden_207658571040363":{"type":"Hidden","hiddenFieldName":"roundup_affm_api_key","width":12,"stepId":"f49d8d267149653154f58100","sortOrder":4,"defaultValue":"FZB0pnKar0mtLcOOkYZsoWsyRnHf2BZkcRdoeBfVOW85mSEV5uV4KuRcQCIi","location":null},"decorative_header_749419340274810":{"type":"Decorative Header","value":"In what occupation were you directly exposed to firefighting foam (AFFF)?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"7a488243074f8dd413e2a3bd","margins":{"marginBottom":5}},"single_select_196037143039741":{"type":"Single Select","width":12,"label":"In what occupation were you directly exposed to firefighting foam (AFFF)?","options":[{"text":"Firefighter (civilian or military)","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"First Responder (civilian or military)","id":"93f4898ef62e56a6ef1ea611"},{"text":"Other military personnel","id":"7885860335d8a39e60883e9e"},{"text":"Airport personnel","image":null,"id":"486d42a5e5b24feb59a970c5"},{"text":"Aviation engineer working around planes","image":null,"id":"bf315310af1af940c3318163"},{"text":"Navy service member","image":null,"id":"370e282447da644bea08e6b6"},{"text":"Military service personnel who trained with AFFF","image":null,"id":"47e0d276d0183f666d3c26ec"},{"text":"Other occupation","image":null,"id":"4812642a3c498a05263814c6"}],"helperText":null,"stepId":"7a488243074f8dd413e2a3bd","sortOrder":2,"hideLabel":false,"validationRules":{"required":true}},"decorative_header_145743905861526":{"type":"Decorative Header","value":"Do you already have an attorney?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"a67e8ad40ecfed8762faf590","margins":{"marginBottom":5}},"buttons_507089421507408":{"type":"Buttons","validationRules":{"required":true},"label":"Do you already have an attorney?(Hair Straightener))","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"a67e8ad40ecfed8762faf590"},"decorative_header_572607551740037":{"type":"Decorative Header","value":"Did you or a loved one use hair relaxer/straightener products?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"b6c67d80ba30ba0f6950786a","margins":{"marginBottom":5}},"buttons_463327016037566":{"type":"Buttons","validationRules":{"required":true},"label":"Did you or a loved one use hair relaxer/straightener products?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"b6c67d80ba30ba0f6950786a"},"decorative_header_597081353186164":{"type":"Decorative Header","value":"When were you diagnosed?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"55baec1b2aaeec884c350565","margins":{"marginBottom":5}},"single_select_303911230237727":{"type":"Single Select","width":12,"label":"When were you diagnosed?","options":[{"text":"2011","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"2012","id":"93f4898ef62e56a6ef1ea611"},{"text":"2013","id":"7885860335d8a39e60883e9e"},{"text":"2014","image":null,"id":"87745a63cca34ade5ec64bd3"},{"text":"2015","image":null,"id":"36e4a7d4e437f9939dcaabc1"},{"text":"2016","image":null,"id":"77e129e6b55d468e50421564"},{"text":"2017","image":null,"id":"9a01be3587f29aef86264766"},{"text":"2018","image":null,"id":"652b20177c14c9856e2d21b7"},{"text":"2019","image":null,"id":"d4badc1070f79265778dcc86"},{"text":"2020","image":null,"id":"2d3587820f7b830ed4fedd23"},{"text":"2021","image":null,"id":"580e68598818ea03617783e2"},{"text":"2022","image":null,"id":"6cc6a8ce3b8255e88d48f004"},{"text":"2023","image":null,"id":"f27772df0bab14897103e3a9"},{"text":"2024","image":null,"id":"6f23df45b5cb29b1bdb58cc5"},{"text":"2025","image":null,"id":"5fd099a41a7ca3b9740f138c"}],"helperText":null,"stepId":"55baec1b2aaeec884c350565","sortOrder":2,"validationRules":{"required":true}},"decorative_header_212786207005587":{"type":"Decorative Header","value":"Have you or someone you love taken the brand name ozempic, wegovy, mounjaro, or rybelsus for weight loss?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"a962cda6de62f433a5309bd8","margins":{"marginBottom":5}},"single_select_752759346763609":{"type":"Single Select","width":12,"label":"Have you or someone you love taken the brand name ozempic, wegovy, mounjaro, or rybelsus for weight loss?","options":[{"text":"Ozempic","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"Wegovy","id":"93f4898ef62e56a6ef1ea611"},{"text":"Mounjaro","id":"7885860335d8a39e60883e9e"},{"text":"Rybelsus","image":null,"id":"87745a63cca34ade5ec64bd3"}],"helperText":null,"stepId":"a962cda6de62f433a5309bd8","sortOrder":2,"validationRules":{"required":true}},"decorative_header_266794677399105":{"type":"Decorative Header","value":"What were you or a loved one diagnosed with? *","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"220369185ffc0e1eef943b7c","margins":{"marginBottom":5}},"single_select_180726611817508":{"type":"Single Select","width":12,"label":"What were you or a loved one diagnosed with? ","options":[{"text":"Gastroparesis","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"Pulmonary aspiration","id":"93f4898ef62e56a6ef1ea611"},{"text":"Gastric Injury","id":"7885860335d8a39e60883e9e"},{"text":"Persistent vomiting","image":null,"id":"87745a63cca34ade5ec64bd3"},{"text":"Bowel obstruction","image":null,"id":"b4ae365bdfe0f4fd52a6ebdc"},{"text":"Stomach paralysis","image":null,"id":"5891a348887e451c6310c968"},{"text":"Deep vein thrombosis (DVT)","image":null,"id":"cdf5977bef1eed7c488251e3"},{"text":"Ileus","image":null,"id":"1c795d99add33d50f910f50c"}],"helperText":null,"stepId":"220369185ffc0e1eef943b7c","sortOrder":2,"validationRules":{"required":true}},"decorative_header_993841766270454":{"type":"Decorative Header","value":"Stay AT The Hospital?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"49b2c5d700cfd6ef345c8732","margins":{"marginBottom":5}},"buttons_994136809671246":{"type":"Buttons","validationRules":{"required":true},"label":"Stay AT The Hospital","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"49b2c5d700cfd6ef345c8732"},"decorative_header_989570579419969":{"type":"Decorative Header","value":"Talcum Length*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"8ba12ea5db595ca952949cb9","margins":{"marginBottom":5}},"single_select_567281436275085":{"type":"Single Select","width":12,"label":"Talcum Length","options":[{"text":"1-2 years","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"2-4 years","id":"93f4898ef62e56a6ef1ea611"},{"text":"Less than 1 year","id":"7885860335d8a39e60883e9e"},{"text":"4-5 years","image":null,"id":"f82ef62e132e9e27e295a1be"},{"text":"5-9 years","image":null,"id":"fe798dd642e5b153911b7cf6"}],"helperText":null,"stepId":"8ba12ea5db595ca952949cb9","sortOrder":2,"validationRules":{"required":true}},"decorative_header_235160645558221":{"type":"Decorative Header","value":"Cancer*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"9a954122e29f93a1f88dd22f","margins":{"marginBottom":5}},"single_select_229043077936546":{"type":"Single Select","width":12,"label":"Cancer","options":[{"text":"Fallopian Tube cancer","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"Serous Epithelial Ovarian cancer","id":"93f4898ef62e56a6ef1ea611"},{"text":"Ovarian cancer","id":"7885860335d8a39e60883e9e"},{"text":"Mesothelioma","image":null,"id":"f82ef62e132e9e27e295a1be"},{"text":"Peritoneal Cancer","image":null,"id":"fe798dd642e5b153911b7cf6"},{"text":"Endometrioid Ovarian cancer","image":null,"id":"2ca128db3cd373a926987018"}],"helperText":null,"stepId":"9a954122e29f93a1f88dd22f","sortOrder":2,"validationRules":{"required":true}},"decorative_header_65876924152777":{"type":"Decorative Header","value":"Diagnosed Year*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"ee5c165564a2d519d9662f8c","margins":{"marginBottom":5}},"single_select_925436135605522":{"type":"Single Select","width":12,"label":"Diagnosed Year","options":[{"text":"2011","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"2012","id":"93f4898ef62e56a6ef1ea611"},{"text":"2013","id":"7885860335d8a39e60883e9e"},{"text":"2014","image":null,"id":"f82ef62e132e9e27e295a1be"},{"text":"2015","image":null,"id":"fe798dd642e5b153911b7cf6"},{"text":"2016","image":null,"id":"2ca128db3cd373a926987018"},{"text":"2017","image":null,"id":"7ac14ff6343903dc56e89bb1"},{"text":"2018","image":null,"id":"b6320e6013df5e872242e756"},{"text":"2019","image":null,"id":"532ab5919e4a07e85cd3d919"},{"text":"2020","image":null,"id":"a4463e0944c90e02ac1fd1fe"},{"text":"2021","image":null,"id":"97d0cf17c844e3d101ff3f30"},{"text":"2022","image":null,"id":"3aed21e4f95ed4a84ef3e27f"},{"text":"2023","image":null,"id":"3ac63438aeaac18e36129df9"},{"text":"2024","image":null,"id":"115bea4887270df0e837661f"},{"text":"2025","image":null,"id":"94c999976d62dbb9b928ff12"}],"helperText":null,"stepId":"ee5c165564a2d519d9662f8c","sortOrder":2,"validationRules":{"required":true}},"decorative_header_328420374001232":{"type":"Decorative Header","value":"Attorney?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"c30f158e61d730377ab3a766","margins":{"marginBottom":5}},"buttons_221320924069350":{"type":"Buttons","validationRules":{"required":true},"label":"Attorney?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"c30f158e61d730377ab3a766"},"decorative_header_732176235289008":{"type":"Decorative Header","value":"Diagnosed Before 70?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"e1319d244c233104861d71b4","margins":{"marginBottom":5}},"buttons_364091682746937":{"type":"Buttons","validationRules":{"required":true},"label":"Diagnosed Before 70?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"e1319d244c233104861d71b4"},"decorative_header_213356647646884":{"type":"Decorative Header","value":"Were you or a loved one exposed to Paraquat or Gramoxone?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"64212818583d874a22ffc05e","margins":{"marginBottom":5}},"single_select_68752992582196":{"type":"Single Select","width":12,"label":"Were you or a loved one exposed to Paraquat or Gramoxone?","options":[{"text":"Yes, directly exposed - I worked with the product","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"Yes, indirectly exposed - I live near farm land","id":"93f4898ef62e56a6ef1ea611"},{"text":"Responding for a loved one","id":"7885860335d8a39e60883e9e"},{"text":"No","image":null,"id":"469e5b31ab1f91feb66cfc90"}],"helperText":null,"stepId":"64212818583d874a22ffc05e","sortOrder":2,"validationRules":{"required":true}},"decorative_header_224550661720477":{"type":"Decorative Header","value":"Do you or a loved one suffer from any symptoms of Parkinson’s Disease such as tremors?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"f59bc2f2074c12c6c831d30e","margins":{"marginBottom":5}},"buttons_688840713192642":{"type":"Buttons","validationRules":{"required":true},"label":"Do you or a loved one suffer from any symptoms of Parkinson’s Disease such as tremors?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Symptoms only","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"f59bc2f2074c12c6c831d30e"},"decorative_header_834797448391472":{"type":"Decorative Header","value":"Do you already have an attorney? *","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"496b695cdda980957fe365b0","margins":{"marginBottom":5}},"buttons_528788148458301":{"type":"Buttons","validationRules":{"required":true},"label":"Do you already have an attorney?(Paraquat)","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"496b695cdda980957fe365b0"},"decorative_header_529738127286280":{"type":"Decorative Header","value":"Diagnosed?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"d71df4e9be019a3c8ea1742f","margins":{"marginBottom":5}},"buttons_618718915873426":{"type":"Buttons","validationRules":{"required":true},"label":"Diagnosed?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"d71df4e9be019a3c8ea1742f"},"decorative_header_211347366108213":{"type":"Decorative Header","value":"Free case review","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"c26860aac3420272effa15fe","margins":{"marginBottom":5}},"decorative_paragraph_317447349672562":{"type":"Decorative Paragraph","value":"8 Questions","width":12,"stepId":"c26860aac3420272effa15fe","sortOrder":2},"decorative_header_698008707462547":{"type":"Decorative Header","value":"Were you physically Injured in a motor vehicle accident?* ","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"8a846ca5c229c02e3b422139","margins":{"marginBottom":5}},"buttons_359446480791954":{"type":"Buttons","validationRules":{"required":false},"label":"Were you physically Injured in a motor vehicle accident?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"8a846ca5c229c02e3b422139"},"decorative_header_200800101976996":{"type":"Decorative Header","value":"Did you receive medical treatment?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"86576a7ad798c79abcb3dfa2","margins":{"marginBottom":5}},"buttons_724025535017644":{"type":"Buttons","validationRules":{"required":false},"label":"Did you receive medical treatment?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"86576a7ad798c79abcb3dfa2"},"decorative_header_658618660550256":{"type":"Decorative Header","value":"Were you at fault?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"d7dfb4b549bd1a4510173611","margins":{"marginBottom":5}},"buttons_522550657029567":{"type":"Buttons","validationRules":{"required":false},"label":"Were you at fault?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"d7dfb4b549bd1a4510173611"},"decorative_header_480588158599657":{"type":"Decorative Header","value":"What date did the accident occur?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"f0cd78c38f0a25411bcbf050","margins":{"marginBottom":5}},"decorative_header_726980594834101":{"type":"Decorative Header","value":"Do you have a police report of the incident?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"2f9c97a106d7955ec6b398e5","margins":{"marginBottom":5}},"buttons_825881554838513":{"type":"Buttons","validationRules":{"required":false},"label":"Do you have a police report of the incident?*","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"2f9c97a106d7955ec6b398e5"},"decorative_header_989032399944823":{"type":"Decorative Header","value":"Briefly describe what happened","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"c0f31fb83ac3efde6fd769f5","margins":{"marginBottom":5}},"text_119401502953527":{"type":"Text","label":"Briefly describe what happened","width":12,"stepId":"c0f31fb83ac3efde6fd769f5","sortOrder":2,"multiline":true,"rows":5,"hideLabel":true},"decorative_header_416880737862270":{"type":"Decorative Header","value":"Sexual Abuse Pages:","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"4ee58ed5d24ee8f90ce28172","margins":{"marginBottom":5}},"decorative_paragraph_890287864986385":{"type":"Decorative Paragraph","value":"1 Question","width":12,"stepId":"4ee58ed5d24ee8f90ce28172","sortOrder":2,"fieldStyle":{"fontSize":{"value":16,"unit":"px"},"fontFamily":"Roboto"}},"decorative_header_687120407488370":{"type":"Decorative Header","value":"You May Qualify for These Cases: Please Select the Case that Applies to You:* ","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"8129112c923f69621fd67e44","margins":{"marginBottom":5}},"buttons_995177428099075":{"type":"Buttons","validationRules":{"required":false},"label":"You May Qualify for These Cases: Please Select the Case that Applies to You:*","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Assaulted during a Uber/Lyft ride? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737111131/uploads/aejb7gsde959iz2gb8jv.webp","id":"fcfa5c2a370449f531c0b857"},{"text":"Experience Abuse at a Mormon Church? »","image":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737111139/uploads/vtksvbndj7yvb1k6mmqt.webp","id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"150%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Square","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"8129112c923f69621fd67e44"},"decorative_header_842521575230428":{"type":"Decorative Header","value":"Free case review","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"4618d9d0a31f1c732f2412ba","margins":{"marginBottom":5}},"decorative_paragraph_54831532795299":{"type":"Decorative Paragraph","value":"4 Question","width":12,"stepId":"4618d9d0a31f1c732f2412ba","sortOrder":2,"fieldStyle":{"fontSize":{"value":16,"unit":"px"},"fontFamily":"Roboto"}},"decorative_header_56781575557188":{"type":"Decorative Header","value":"Were you or someone you know assaulted by your driver during an Uber or Lyft ride between 2012-Pacresent?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"e393cf36a7cbfbfb79b71c77","margins":{"marginBottom":5}},"buttons_494584084177107":{"type":"Buttons","validationRules":{"required":true},"label":"Were you or someone you know assaulted by your driver during an Uber or Lyft ride between 2012-Pacresent?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes, in a Lyft","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"Yes, in an Uber","image":null,"id":"895ce5200c69d0a3bb93e2ae"},{"text":"No","image":null,"id":"f7efafc92abfc632ea7adc47"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"150%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"e393cf36a7cbfbfb79b71c77"},"decorative_header_596588351340540":{"type":"Decorative Header","value":"What type of abuse/assault did you suffer?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"9586a526bc41b2b7c372ee14","margins":{"marginBottom":5}},"single_select_349676504112338":{"type":"Single Select","width":12,"label":"What type of abuse/assault did you suffer?","options":[{"text":"Physical abuse/assault","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"Verbal abuse/assault","id":"93f4898ef62e56a6ef1ea611"}],"helperText":null,"stepId":"9586a526bc41b2b7c372ee14","sortOrder":2,"validationRules":{"required":true}},"hidden_868644080873264":{"type":"Hidden","hiddenFieldName":"ozempic_affm_campaign_id","width":12,"stepId":"49b2c5d700cfd6ef345c8732","sortOrder":3,"defaultValue":"8jdki8sl5f1qr06d"},"hidden_32015789639822":{"type":"Hidden","hiddenFieldName":"ozempic_affm_api_key","width":12,"stepId":"49b2c5d700cfd6ef345c8732","sortOrder":4,"defaultValue":"0ZzHK0QMxJNZ041YLUusiAjRHKsYr3UHWugQ8S3j5uo9wDtJAPkQDC1bqO62"},"hidden_294683640210413":{"type":"Hidden","hiddenFieldName":"talcum_powder_affm_campaign_id","width":12,"stepId":"e1319d244c233104861d71b4","sortOrder":3,"defaultValue":"ugmfxdlg9sl9c9p"},"hidden_206803274802402":{"type":"Hidden","hiddenFieldName":"talcum_powder_affm_api_key","width":12,"stepId":"e1319d244c233104861d71b4","sortOrder":4,"defaultValue":"mPJW83eyqf1SMlQx3V5tJXbuDt6L5kO61IjDbRou8kED6VKf03Xxlwf00n7Q"},"hidden_151581538192165":{"type":"Hidden","hiddenFieldName":"paraquat_affm_campaign_id","width":12,"stepId":"d71df4e9be019a3c8ea1742f","sortOrder":3,"defaultValue":"hl1pxicomtdpffd"},"hidden_312171868533714":{"type":"Hidden","hiddenFieldName":"paraquat_affm_api_key","width":12,"stepId":"d71df4e9be019a3c8ea1742f","sortOrder":4,"defaultValue":"Dtv5Twk0BrEePpGJdcEmZk5JbLsCRK8LgUhOULEizJ2i0aIytstRL0WVP9OG"},"decorative_header_636822477801765":{"type":"Decorative Header","value":"Did you or a loved one received Depo-Provera medication on a regular basis?","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"c4427c23e75234dd9c830157","margins":{"marginBottom":5}},"buttons_523335207531019":{"type":"Buttons","validationRules":{"required":false},"label":"Did you or a loved one received Depo-Provera medication on a regular basis?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"c4427c23e75234dd9c830157"},"hidden_121821900332484":{"type":"Hidden","hiddenFieldName":"fire_affm_campaign_id","width":12,"stepId":"7a488243074f8dd413e2a3bd","sortOrder":3,"defaultValue":"bbiojhuynfupcld "},"hidden_610570336696095":{"type":"Hidden","hiddenFieldName":"fire_affm_api_key","width":12,"stepId":"7a488243074f8dd413e2a3bd","sortOrder":4,"defaultValue":"gRKamfxQJw9dLy7bMvuYFYKj8ahhLnevT3nlf5yGIxZITOFzu6vMsRRsVqsc"},"decorative_header_77159825258955":{"type":"Decorative Header","value":"Do you already have an attorney?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"6a3ffc686eb9bc6904016747","margins":{"marginBottom":5}},"buttons_62151267671541":{"type":"Buttons","validationRules":{"required":true},"label":"Do you already have an attorney?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"6a3ffc686eb9bc6904016747"},"hidden_762581647303626":{"type":"Hidden","hiddenFieldName":"jornaya_leadid","width":12,"stepId":"7a488243074f8dd413e2a3bd","sortOrder":5,"defaultValue":"5C151FA1-4792-0888-010E-F357EEBCA27C"},"decorative_header_252560924851218":{"type":"Decorative Header","value":"Have you or a loved one been diagnosed with any of these cancers?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"e4235802c1eee601dc10c929","margins":{"marginBottom":5}},"single_select_533136187651560":{"type":"Single Select","width":12,"label":"Have you or a loved one been diagnosed with any of these cancers?","options":[{"text":"Ovarian cancer","id":"77a3d5399c1e7d40e9dc31b0"},{"text":"Uterine cancer","id":"93f4898ef62e56a6ef1ea611"},{"text":"Endometrial cancer","id":"7885860335d8a39e60883e9e"},{"text":"Serous Ovarian Cancer","image":null,"id":"87745a63cca34ade5ec64bd3"},{"text":"Endometrioid Ovarian Cancer","image":null,"id":"36e4a7d4e437f9939dcaabc1"},{"text":"Mucinous Ovarian","image":null,"id":"77e129e6b55d468e50421564"},{"text":"Clear Cell Ovarian Cancer","image":null,"id":"9a01be3587f29aef86264766"},{"text":"Undifferentiated Ovarian","image":null,"id":"5fd099a41a7ca3b9740f138c"}],"helperText":null,"stepId":"e4235802c1eee601dc10c929","sortOrder":2,"validationRules":{"required":true}},"hidden_878297498402924":{"type":"Hidden","hiddenFieldName":"hair_affm_campaign_id","width":12,"stepId":"e4235802c1eee601dc10c929","sortOrder":3,"defaultValue":"agxw6ooikqwyzon"},"hidden_611496195475201":{"type":"Hidden","hiddenFieldName":"hair_affm_api_key","width":12,"stepId":"e4235802c1eee601dc10c929","sortOrder":4,"defaultValue":"HdDXritylD72ZdWOCGVUPFWEwd1RDbSHH0pmThG6IiWlEemaEJ5kc1MNUKc0"},"decorative_header_904455338480946":{"type":"Decorative Header","value":"Do you already have an attorney representing you regarding Ozempic compensation? *","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"1a58c9b2a892bcadb23677c5","margins":{"marginBottom":5}},"buttons_547808877180010":{"type":"Buttons","validationRules":{"required":true},"label":"Do you already have an attorney representing you regarding Ozempic compensation?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"1a58c9b2a892bcadb23677c5"},"hidden_833148519190698":{"type":"Hidden","hiddenFieldName":"paraquat_jornaya_leadid","width":12,"stepId":"d71df4e9be019a3c8ea1742f","sortOrder":5,"defaultValue":"9ADF9E34-32BD-955E-B691-835A2236CE589ADF9E34-32BD-955E-B691-835A2236CE58"},"decorative_image_848237765284126":{"type":"Decorative Image","value":"https://res.cloudinary.com/dqnjggegp/image/upload/v1737368278/uploads/prtcppktijn53ch1npzs.png","width":12,"imageWidth":128,"imageHeight":128,"imageInitialHeight":128,"imageInitialWidth":128,"stepId":"complete","sortOrder":1,"margins":{"marginTop":50}},"decorative_header_367030597496752":{"type":"Decorative Header","value":"Do you already have an attorney representing you regarding Roundup?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"d9a87dd71cae96c809850bd5","margins":{"marginBottom":5}},"buttons_514152867704493":{"type":"Buttons","validationRules":{"required":true},"label":"Do you already have an attorney representing you regarding Roundup?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"d9a87dd71cae96c809850bd5"},"decorative_header_254154549599495":{"type":"Decorative Header","value":"Have you or a loved one been diagnosed with any of these injuries? *","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"c3407dcee287e0bef20876e4","margins":{"marginBottom":5}},"buttons_999178231267362":{"type":"Buttons","validationRules":{"required":true},"label":"Have you or a loved one been diagnosed with any of these injuries?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Meningioma","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"Spinal Meningioma","image":null,"id":"895ce5200c69d0a3bb93e2ae"},{"text":"Brain Meningioma","image":null,"id":"7ae408e95ce39dbfb7eebb91"},{"text":"Brain Tumor","image":null,"id":"290f8fd734477c60ad99fe4e"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"c3407dcee287e0bef20876e4"},"decorative_header_146656652045253":{"type":"Decorative Header","value":"Are you currently represented by an accident attorney? *","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"7e3bbb702b6ca1abf544d8a6","margins":{"marginBottom":5}},"buttons_340003192662991":{"type":"Buttons","validationRules":{"required":false},"label":"Are you currently represented by an accident attorney? ","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"50%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"7e3bbb702b6ca1abf544d8a6"},"hidden_199564113232417":{"type":"Hidden","hiddenFieldName":"MVA_affm_campaign_id","width":12,"stepId":"c0f31fb83ac3efde6fd769f5","sortOrder":3,"defaultValue":"cx9dcxe3gsgzxf"},"hidden_367120422530248":{"type":"Hidden","hiddenFieldName":"MVA_affm_api_key","width":12,"stepId":"c0f31fb83ac3efde6fd769f5","sortOrder":4,"defaultValue":"cpLxcwNmyKKUpkmTlqxns6LrVVzQLaUx2lnLtrPTRtqSB9a4Qe4WTOCIPPc4"},"hidden_505243521635602":{"type":"Hidden","hiddenFieldName":"MVA_jornaya_leadid","width":12,"stepId":"c0f31fb83ac3efde6fd769f5","sortOrder":5,"defaultValue":"9ADF9E34-32BD-955E-B691-835A2236CE58"},"decorative_header_620125250986272":{"type":"Decorative Header","value":"How long has it been since the accident?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"5b9a6002ff53c6e4ae137322","margins":{"marginBottom":5}},"single_select_762916749247738":{"type":"Single Select","width":12,"label":"How long has it been since the accident?","options":[{"text":"Less than 1 Year","id":"046d4d9f28a0e4c91dac9677"},{"text":"Less than 2 Years","id":"b45c4b987641ffd56267a052"},{"text":"Less than 90 Days","id":"e544ba27590e1300a0e5d801"},{"text":"within_1_year","image":null,"id":"81c639cdf6c0b34abdb2ba53"},{"text":"Less than 3 Years","image":null,"id":"25578f3d4564831d8f4afc04"},{"text":"Less than 4 Years","image":null,"id":"1306b0970da4b24063eeb6f6"},{"text":"Less than 5 Years","image":null,"id":"7a2c84507e2793344ce86d47"},{"text":"5 or more Years","image":null,"id":"f26abfc5c889ffe36799f7ba"}],"helperText":null,"stepId":"5b9a6002ff53c6e4ae137322","sortOrder":2,"validationRules":{"required":true}},"decorative_header_230913392828167":{"type":"Decorative Header","value":"Proof OF Receipt Ride?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"b35dc12611eaf1efe7d8be97","margins":{"marginBottom":5}},"buttons_764260181701360":{"type":"Buttons","validationRules":{"required":false},"label":"Proof OF Receipt Ride?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"895ce5200c69d0a3bb93e2ae"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"150%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"b35dc12611eaf1efe7d8be97"},"hidden_318311414521277":{"type":"Hidden","hiddenFieldName":"rideshare_affm_campaign_id","width":12,"stepId":"e393cf36a7cbfbfb79b71c77","sortOrder":3,"defaultValue":"kdj06qs518fi8rl"},"hidden_33685850841837":{"type":"Hidden","hiddenFieldName":"rideshare_affm_api_key","width":12,"stepId":"e393cf36a7cbfbfb79b71c77","sortOrder":4,"defaultValue":"owmhcrSWXP45za3vCv7p8ejWiD2YxHQ1D7iGOHSpKGDnrB2pRe1eTS1ewiaj"},"decorative_header_864662090157510":{"type":"Decorative Header","value":"Do you already have an attorney representing you regarding rideshare?*","width":12,"step":1,"sortOrder":1,"fieldStyle":{"fontSize":{"value":25,"unit":"px"},"fontWeight":"normal","fontFamily":"Roboto"},"stepId":"ad58b92106753b56dba8e9d5","margins":{"marginBottom":5}},"buttons_122347691830303":{"type":"Buttons","validationRules":{"required":true},"label":"Do you already have an attorney representing you regarding rideshare?","width":12,"hideLabel":true,"multiple":false,"options":[{"text":"Yes","image":null,"id":"fcfa5c2a370449f531c0b857"},{"text":"No","image":null,"id":"f7efafc92abfc632ea7adc47"}],"step":1,"sortOrder":2,"helperText":"","imageStyles":{"width":"37","marginBottom":"17","sq_imageOnlyMode":"No","size":"150%"},"buttonStyle":{"minWidth":"107","height":"102","buttonsPerRow":"4","buttonsType":"Rectangle","sq_buttonsPerRow":"2","sq_buttonsPerRowMobile":"2"},"stepId":"ad58b92106753b56dba8e9d5"},"single_select_568607060834793":{"type":"Single Select","width":12,"label":"DD","options":[{"text":" 01","id":"046424c790007c118c9cec88"},{"text":"02","id":"1d2e35635618367177fb2244"},{"text":"03","id":"0c4fbdc4394445edaf88c5d6"},{"text":"04","image":null,"id":"9d6518a47843cd82e040789b"},{"text":"05","image":null,"id":"e4815d2831950a3eef3d3f59"},{"text":"06","image":null,"id":"3155b9ade1afd1ac1580a001"},{"text":"07","image":null,"id":"e9898c63db99122083a2ffc3"},{"text":"08","image":null,"id":"f32d7d68a052ee1cd2e4aed9"},{"text":"09","image":null,"id":"17237ce049f3bc62508b8264"},{"text":"10","image":null,"id":"aaa136e52278213fc9518f02"},{"text":"11","image":null,"id":"3b3aae5794ffc1418906db85"},{"text":"12","image":null,"id":"83f777e0070cc49d73e5a4c0"},{"text":"13","image":null,"id":"aad0ebcabbcf755312db0b2d"},{"text":"14","image":null,"id":"468111a24af37dcb81e96863"},{"text":"15","image":null,"id":"72ede19e8fd4ec68ad944009"},{"text":"16","image":null,"id":"4cc8cec2dcdb782250371357"},{"text":"17","image":null,"id":"a706dd7beac5a3b157fd5f3b"},{"text":"18","image":null,"id":"57b3312c1305011de76d194a"},{"text":"19","image":null,"id":"35a8e3e236b22396fdc80f64"},{"text":"20","image":null,"id":"1c8ea3e8ca90c22e6a64e372"},{"text":"21","image":null,"id":"0d0d507662b7fbd243e02287"},{"text":"22","image":null,"id":"b80a7d03d39cb3952daf4f64"},{"text":"23","image":null,"id":"1c5fcce94892b02efc017e59"},{"text":"24","image":null,"id":"20f91dac8b995a216ab1f308"},{"text":"25","image":null,"id":"16b851af4efb66d475ab083d"},{"text":"26","image":null,"id":"1b3e65a7d2453b5d38cb828e"},{"text":"27","image":null,"id":"5ba96bcaec88f5fe5016b826"},{"text":"28","image":null,"id":"787ed8d6564023538eba12a6"},{"text":"29","image":null,"id":"04849bd5b42b9705ba6c2a70"},{"text":"30","image":null,"id":"054d9d2f2adc8cbf6bd5c157"},{"text":"31","image":null,"id":"243387baf8ccc4ff27c9ed7b"}],"helperText":null,"stepId":"f0cd78c38f0a25411bcbf050","sortOrder":2,"validationRules":{"required":true}},"single_select_219384366136045":{"type":"Single Select","width":12,"label":"MM","options":[{"text":"01","id":"046424c790007c118c9cec88"},{"text":"02","id":"1d2e35635618367177fb2244"},{"text":"03","id":"0c4fbdc4394445edaf88c5d6"},{"text":"04","image":null,"id":"661d3beb0406c28d3d1c6acb"},{"text":"05","image":null,"id":"93a7840807edc755ba7e11f5"},{"text":"06","image":null,"id":"95fc651b410a33bd22f2b364"},{"text":"07","image":null,"id":"52f0e0cf9610743fc7e4639b"},{"text":"08","image":null,"id":"6121198d529d75932a496688"},{"text":"09","image":null,"id":"b2fed0dcdc8c60e14fb0ad63"},{"text":"10","image":null,"id":"d8b12c7a7c111ddddacfdd9f"},{"text":"11","image":null,"id":"2a5b2ce22c90c474aeeb1b38"},{"text":"12","image":null,"id":"f84f3b1a559a8ca396632133"}],"helperText":null,"stepId":"f0cd78c38f0a25411bcbf050","sortOrder":3,"hideLabel":false,"validationRules":{"required":true}},"single_select_137356942713128":{"type":"Single Select","width":12,"label":"YYYY","options":[{"text":"1990","id":"046424c790007c118c9cec88"},{"text":"1991","id":"1d2e35635618367177fb2244"},{"text":"1992","id":"0c4fbdc4394445edaf88c5d6"},{"text":"1993","image":null,"id":"e2837f014e5e551e5abe9ce4"},{"text":"1994","image":null,"id":"0f6b408435ded363771311cc"},{"text":"1995","image":null,"id":"f233d8803fd4b7e17f2008f0"},{"text":"1996","image":null,"id":"03a90813939aac6b8547d85e"},{"text":"1997","image":null,"id":"bb9b5230c71cbffd2d144d45"},{"text":"1998","image":null,"id":"92adb5541f2b29e438d8f7a7"},{"text":"1999","image":null,"id":"2831cc1be9679961e3f887ee"},{"text":"2000","image":null,"id":"9b1d4144467306142b6ffa46"},{"text":"2001","image":null,"id":"db9a3e20045f116f46db8dc4"},{"text":"2002","image":null,"id":"3d932e8c2d7d988c30aae8e5"},{"text":"2003","image":null,"id":"83a105c9ea728ac41928794e"},{"text":"2004","image":null,"id":"1b2689569f671cbfcbbf39a5"},{"text":"2005","image":null,"id":"df77c60025d88ecd147749f4"},{"text":"2006","image":null,"id":"196c022b14d43f7b780dde2d"},{"text":"2007","image":null,"id":"086032084956eb77fc0c53c3"},{"text":"2008","image":null,"id":"f0a76cf5f2033b4d805ab8ba"},{"text":"2009","image":null,"id":"5c6c406ac532b268f96083d8"},{"text":"2010","image":null,"id":"e48b616449bbab62e2579538"},{"text":"2011","image":null,"id":"1bc39be4a6430ec0b9e52e6b"},{"text":"2012","image":null,"id":"eab2eef10f94ad8520c281cd"},{"text":"2013","image":null,"id":"6b589895a3c59fe0bb46130e"},{"text":"2014","image":null,"id":"2e5955a8ebe29c8d7c549677"},{"text":"2015","image":null,"id":"e96c51db997f85a293fad42d"},{"text":"2016","image":null,"id":"efb042a0b7441ecd10c9f1fc"},{"text":"2017","image":null,"id":"464a008b5b9cf63f3846f54b"},{"text":"2018","image":null,"id":"ee1a0592617eb7d242121262"},{"text":"2019","image":null,"id":"a538c0645238cd6388684c3d"},{"text":"2020","image":null,"id":"4e594a86f18c7235a1841f82"},{"text":"2021","image":null,"id":"d47335719e4d1b747249865b"},{"text":"2022","image":null,"id":"fd5cf9a67fb972c677737f20"},{"text":"2023","image":null,"id":"aa82ce512be14375b901a760"},{"text":"2024","image":null,"id":"cb7cc7735e216bae5a22467c"},{"text":"2025","image":null,"id":"9b770093a8a93a959c591d71"},{"text":"2026","image":null,"id":"49331ff54bf356cc8a56b26a"},{"text":"2027","image":null,"id":"70497843ef22013b8b8c914e"},{"text":"2028","image":null,"id":"1244b3c1a165468553576ee1"},{"text":"2029","image":null,"id":"1f71ebeb6dd611ed51e9c207"},{"text":"2030","image":null,"id":"a1eb70c82352824bb722bd85"}],"helperText":null,"stepId":"f0cd78c38f0a25411bcbf050","sortOrder":4,"validationRules":{"required":true}}},"options":{"numberOfSteps":5,"dateFormat":"DD/MM/YYYY","progressBar":{"enable":true},"continueButton":{"continueText":"Next","submitText":"Submit","backText":"Back"},"customStyles":{"width":{"unit":"px","value":700},"parentContainerMinHeight":{"value":0,"unit":"px"},"parentBackgroundImage":{"imageInitialHeight":1362,"imageInitialWidth":2066,"imageHeight":1362,"imageWidth":2066,"imageUrl":"https://res.cloudinary.com/dqnjggegp/image/upload/v1597337140/uploads/qmsfk98ank3wfp1ehvyg.jpg"},"headerMarginTop":40,"parentBackgroundColor":"#ffffff","innerFormBackgroundColor":"#ffffff","innerFormBackgroundTransparency":"","primaryColor":"#01bf62","bodyTextColor":"#343434","parentContainerBackgroundType":"color","innerFormBackgroundType":"none","buttonBorderColor":"#ff7500","buttonColorSelected":"#ffa659","buttonBorderColorSelected":"#ff7500","footerMarginBottom":70,"errorColor":"#ff4e4e","buttonColor":"#ff7500","buttonTextColor":"#ffffff","inputLabelColor":"#a3a3a3","inputTextColor":"#000000","defaultFont":"Roboto","sq_buttonFont":"Poppins","sq_buttonFontSize":15,"showShadows":"Yes","sq_buttonTextColor":"#343434","sq_buttonColor":"#FFFFFF","sq_buttonColorSelected":"#FFFFFF","sq_buttonBorderColor":"#DADADA","sq_buttonBorderColorSelected":"primary","sq_buttonBannerColor":"#FFFFFF","rt_buttonFont":"Roboto","rt_buttonFontSize":14,"rt_buttonColor":"#FFFFFF","rt_buttonColorSelected":"#FFFFFF","rt_buttonTextColor":"#343434","rt_buttonBorderColor":"#DADADA","rt_buttonBorderColorSelected":"primary","inputLabelFont":"Roboto","inputFontSize":18,"continueSubmitButtonFontSize":15,"fullModeBackgroundColor":"#f3f3fe","canvasSetup":"full","progressColor":"#01bf62"},"localization":{"dateFormat":"MM/DD/YYYY"},"exportTransparentBackground":false,"customScript":"","customRedirectUrls":[{"url":""}],"logo":null,"captureSystemDetails":true,"analyticsSettings":{"trustedForm":{"enabled":true}},"customCss":".MuiGrid-root.fieldbg.fieldbg_single_select_137356942713128.MuiGrid-item.MuiGrid-grid-xs-12.MuiGrid-grid-sm-12.MuiGrid-grid-md-12.MuiGrid-grid-lg-12.MuiGrid-grid-xl-12, .MuiGrid-root.fieldbg.fieldbg_single_select_219384366136045.MuiGrid-item.MuiGrid-grid-xs-12.MuiGrid-grid-sm-12.MuiGrid-grid-md-12.MuiGrid-grid-lg-12.MuiGrid-grid-xl-12, .MuiGrid-root.fieldbg.fieldbg_single_select_568607060834793.MuiGrid-item.MuiGrid-grid-xs-12.MuiGrid-grid-sm-12.MuiGrid-grid-md-12.MuiGrid-grid-lg-12.MuiGrid-grid-xl-12 {\n  max-width: 33%;\n}"},"ownedByUser":"6786c57074275a000b6a48ca","personalisation":{"form_related_to":"Real Estate"},"created":"2025-01-17T06:44:45.181Z","__v":0,"lastEdited":"2025-02-10T18:11:41.922Z","screenshotUrl":"https://res.cloudinary.com/dqnjggegp/image/upload/v1742556281/growform-production/form-screenshots/6789fc5d693b6a000b7149e8.png","leadsCount":138,"isActive":true},"accountIsActive":true,"accountIsFreeTrial":false}};

  // ---- Utils ----
  function safeJSONStringify(obj) {
    return JSON.stringify(obj)
      .replace(/<\/(script|style)/gi, '<\\/$1')
      .replace(/<!--/g, '<\\!--')
      .replace(/-->/g, '--\\>')
      .replace(/\u2028/g, '\\u2028')
      .replace(/\u2029/g, '\\u2029');
  }

  function preloadScript(href) {
    try {
      if (!href) return;
      if (document.querySelector('link[rel="preload"][href="' + href + '"]')) return;
      var l = document.createElement("link");
      l.rel = "preload";
      l.as = "script";
      l.href = href;
      l.crossOrigin = ""; // allow cache reuse in iframe
      document.head.appendChild(l);
    } catch (_) {}
  }

  function parseQuery() {
    var out = {};
    try {
      if (!window.location.search) return out;
      var usp = new URLSearchParams(window.location.search);
      usp.forEach(function (v, k) { out[k] = v; });
    } catch (_) {}
    return out;
  }

  function buildIframeHTML(opts) {
    var html =
'<!doctype html>\n' +
'<html lang="" style="font-size:14px; font-family:\'Muli\', sans-serif;">\n' +
'<head>\n' +
'  <meta http-equiv="Content-Type" content="text/html;charset=utf-8" />\n' +
'  <meta name="viewport" content="width=device-width, initial-scale=1">\n' +
'  <link href="https://fonts.googleapis.com/css2?family=Muli:ital,wght@0,400;0,700;1,400&display=swap" rel="stylesheet">\n' +
'</head>\n' +
'<body style="background:none; margin:0; overflow-x:clip; overflow-y:auto;">\n' +
'  <noscript>You need to enable JavaScript to run this app.</noscript>\n' +
'  <div id="growform_5ap8d5a8na90d" style="width:100%; overflow-x:hidden;"></div>\n' +
'  <script type="text/javascript" src="' + opts.bundleUrl + '"></' + 'script>\n' +
'  <script type="text/javascript">\n' +
'    (function(){\n' +
'      try {\n' +
'        if (window.Growform && typeof window.Growform.init === "function") {\n' +
'          window.Growform.init({\n' +
'            formId: ' + JSON.stringify(opts.formId) + ',\n' +
'            embedMethod: ' + JSON.stringify(opts.embedMethod) + ',\n' +
'            embedId: ' + JSON.stringify(opts.embedId) + ',\n' +
'            queryParams: ' + JSON.stringify(opts.query || {}) + ',\n' +
'            formData: ' + opts.formData + '\n' +
'          });\n' +
'        }\n' +
'      } catch(e) { /* swallow */ }\n' +
'    })();\n' +
'  </' + 'script>\n' +
'</body>\n' +
'</html>';
    return html;
  }

  function embedGrowform() {
    var growformEmbedId = "embed-" + Math.floor(Math.random() * 100000).toString();
    var iFrameHeight = (EMBED_TYPE === "modal") ? "100%" : "350px";

    preloadScript(FORM_BUNDLE_URL);

    var iframe = document.createElement("iframe");
    iframe.setAttribute("width", "100%");
    iframe.setAttribute("height", iFrameHeight);
    iframe.setAttribute("frameborder", "0");
    iframe.setAttribute("data-cookieconsent", "ignore");
    iframe.setAttribute("class", "growform_form growform_form_" + growformEmbedId);
    iframe.setAttribute("id", "growform_form");
    iframe.setAttribute("allowTransparency", "true");
    if (EMBED_TYPE !== "modal") {
      iframe.setAttribute("scrolling", "no");
    }

    var isTrustedFormEnabled = false;
    try {
      if (FORM_DATA && FORM_DATA.data && FORM_DATA.data.form && 
          FORM_DATA.data.form.options && FORM_DATA.data.form.options.analyticsSettings &&
          FORM_DATA.data.form.options.analyticsSettings.trustedForm &&
          FORM_DATA.data.form.options.analyticsSettings.trustedForm.enabled === true) {
        isTrustedFormEnabled = true;
      }
    } catch (_) {}

    if (isTrustedFormEnabled) {
      var baseUrl = "https://embed.growform.co/go/" + FORM_ID + "/embedMethod/" + EMBED_TYPE + "/";
      var iframeUrl = baseUrl + growformEmbedId;
      if (window.location.search) {
        iframeUrl = iframeUrl + window.location.search;
      }
      iframe.setAttribute("src", iframeUrl);
    } else {
      // Use srcdoc method for non-TrustedForm forms
      var html = buildIframeHTML({
        formId: FORM_ID,
        embedMethod: EMBED_TYPE,
        embedId: growformEmbedId,
        query: parseQuery(),
        bundleUrl: FORM_BUNDLE_URL,
        formData: safeJSONStringify(FORM_DATA)
      });

      try {
        if ("srcdoc" in iframe) {
          iframe.srcdoc = html;
        } else {
          var blob = new Blob([html], { type: "text/html" });
          iframe.src = URL.createObjectURL(blob);
        }
      } catch (_) {
        var blob2 = new Blob([html], { type: "text/html" });
        iframe.src = URL.createObjectURL(blob2);
      }
    }

    var currentScript = document.currentScript || (function(){
      var scripts = document.getElementsByTagName('script');
      return scripts[scripts.length - 1];
    })();
    if (currentScript && currentScript.parentNode) {
      currentScript.parentNode.insertBefore(iframe, currentScript.nextSibling);
    } else {
      // fallback if we can't find the script
      document.body.appendChild(iframe);
    }

    // ------- Public API on parent -------
    window.growform = window.growform || {};
    if (typeof window.growform.setHiddenField !== "function") {
      window.growform.setHiddenField = function(fieldName, value) {
        var iframes = document.getElementsByClassName("growform_form");
        for (var i = 0; i < iframes.length; i++) {
          if (iframes[i].contentWindow) {
            iframes[i].contentWindow.postMessage({
              action: "growform_set_hidden_field",
              fieldName: fieldName,
              value: value
            }, "*");
          }
        }
      };
    }

    // ------- Message plumbing (unchanged behaviours) -------
    function growform_receiveMessage(event) {
      var origin = event && event.origin ? event.origin : null;
      var hostOrigin = window.location.origin;

      if (
        origin !== null &&
        origin !== 'null' &&
        origin !== hostOrigin &&
        origin !== 'https://embed.growform.co'
      ) {
        console.warn('Blocked message from unexpected origin:', origin);
        return;
      }

      if (!event || !event.data || !event.data.action) return;
      if (event.data.growform_embed_id !== growformEmbedId) return;

      if (event.data.action === "growform_resize_height") {
        var h = parseInt(event.data.height, 10);
        if (!isNaN(h)) {
          var targetClass = "growform_form_" + growformEmbedId;
          h = Math.round(h) + 16;
          var el = document.getElementsByClassName(targetClass)[0];
          if (el) el.style.height = h + "px";
        }
      }

      if (event.data.action === "growform_submit_form") {
        var customScript = event.data.customScript;
        var elementId = "growform_CustomScriptPageDiv_" + growformEmbedId;
        if (!document.getElementById(elementId)) {
          var d = document.createElement("div");
          d.id = elementId;
          document.body.appendChild(d);
          d.innerHTML = customScript;
          var scripts = d.getElementsByTagName("script");
          for (var i = 0; i < scripts.length; i++) {
            try { eval(scripts[i].innerText); } catch (_) {}
          }
        }
      }

      if (event.data.action === "growform_add_parent_gtm_container") {
        var containerId = event.data.containerId;
        (function (w, d, s, l, i) {
          w[l] = w[l] || [];
          w[l].push({ "gtm.start": new Date().getTime(), event: "gtm.js" });
          var f = d.getElementsByTagName(s)[0],
              j = d.createElement(s),
              dl = l != "dataLayer" ? "&l=" + l : "";
          j.async = true;
          j.src = "https://www.googletagmanager.com/gtm.js?id=" + i + dl;
          f.parentNode.insertBefore(j, f);
        })(window, document, "script", "dataLayer", containerId);

        window.dataLayer = window.dataLayer || [];
        window.dataLayer.push({
          event: "growformAnalyticsSettings",
          growformAnalyticsSettings: event.data.analyticsSettings,
          growformEmbedId: growformEmbedId
        });
      }

      if (event.data.action === "growform_scroll_to_top") {
        var targetClass2 = "growform_form_" + growformEmbedId;
        var target = document.getElementsByClassName(targetClass2)[0];
        if (target && target.getBoundingClientRect) {
          var rect = target.getBoundingClientRect();
          var relY = rect.top;
          var absY = relY + (window.scrollY || window.pageYOffset || 0);
          var winH = window.innerHeight || document.documentElement.clientHeight;
          if (relY < 0 || relY > winH) {
            var offset = event.data.offset ? event.data.offset : 0;
            var y = absY + offset;
            setTimeout(function(){ window.scrollTo({ top: y, behavior: "smooth" }); }, 100);
          }
        }
      }

      if (event.data.action === "growform_form_loaded") {
        try {
          var ev = document.createEvent("Event");
          ev.initEvent("growform_loaded", true, true);
          window.dispatchEvent(ev);
        } catch (_) {
          try { window.dispatchEvent(new Event("growform_loaded")); } catch (_) {}
        }
      }
    }

    window.addEventListener("message", growform_receiveMessage, false);
  }

  embedGrowform();
})();