/* growform client2 bundle.url: https://assets.growform.co/06f828b-mhc46129/form.bundle.js resolve.source: kv resolve.at: 2025-11-03T14:31:44.789Z form.source: kv cache.age_ms: 0 kv.value_present: true fallback_used: false */ ;(function () { var EMBED_TYPE = "iFrame"; var FORM_ID = "68654cb0cd5e7c000b6b3d07"; var FORM_BUNDLE_URL = "https://assets.growform.co/06f828b-mhc46129/form.bundle.js"; // injected by worker (KV/memory/fallback) var FORM_DATA = {"data":{"form":{"_id":"68654cb0cd5e7c000b6b3d07","steps":[{"id":"acd45227cac332d443c4e1db","name":"Quote Form","sortOrder":1}],"isActive":true,"formName":"Lead Form with Jornaya","fields":{"Decorative Header_52363373085874":{"type":"Decorative Header","value":"Thank You!","width":12,"step":"complete","sortOrder":1,"fieldStyle":{"fontSize":{"value":19,"unit":"px"},"fontWeight":"Bold"},"margins":{"marginTop":20},"stepId":"complete"},"Decorative_Paragraph_194067845817258":{"type":"Decorative Paragraph","value":"Thanks for getting in touch. We'll be in contact soon.","width":12,"step":"complete","sortOrder":2,"margins":{"marginBottom":60},"stepId":"complete"},"name_122840883998954":{"type":"Name","label":"What is your name?","width":12,"hideLabel":false,"options":{"Firstname":{"value":null,"errorText":null,"validationRules":{"required":true}},"Lastname":{"value":null,"errorText":null,"validationRules":{"required":true}},"Prefix":{"value":null,"errorText":null}},"stepId":"acd45227cac332d443c4e1db","sortOrder":1,"hidePrefix":true},"phone_909480530422051":{"type":"Phone","label":"What is your phone number?","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":2,"showCountryCode":false},"email_284785320924340":{"type":"Email","label":"What is your email address?","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":3},"time_972514712361382":{"type":"Time","label":"Preferred Contact Time","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":4},"dob_988337440449926":{"type":"DOB","label":"What is your date of birth?","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":5},"single_select_958094143290924":{"type":"Single Select","width":12,"label":"Gender","options":[{"text":"Male","id":"62262bc86026d909ef2c6cb9"},{"text":"Female","id":"27b7b490c91eec6787f5f3b8"}],"helperText":null,"stepId":"acd45227cac332d443c4e1db","sortOrder":6,"validationRules":{"required":true}},"zipcode_463634374971898":{"type":"Zipcode","label":"What is your zip code?","zipcodeFieldFormat":"zipcode_usa","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":7},"single_select_674049607263413":{"type":"Single Select","width":12,"label":"Citizenship Status","options":[{"text":"Yes (U.S Citizen or Legal Resident)","id":"62262bc86026d909ef2c6cb9"},{"text":"NO","id":"27b7b490c91eec6787f5f3b8"}],"helperText":null,"stepId":"acd45227cac332d443c4e1db","sortOrder":8},"single_select_549298254142246":{"type":"Single Select","width":12,"label":"Do you currently have Medicare A and Medicare B","options":[{"text":"Yes","id":"62262bc86026d909ef2c6cb9"},{"text":"No","id":"27b7b490c91eec6787f5f3b8"}],"helperText":null,"stepId":"acd45227cac332d443c4e1db","sortOrder":9},"number_257618340631978":{"type":"Number","label":"Number of People in Household","currencySymbol":"None","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":10,"wholeNumbersOnly":true},"number_530279665396110":{"type":"Number","label":"Estimated Household Income (Annual)","currencySymbol":"$","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":11,"wholeNumbersOnly":true},"single_select_339744544181434":{"type":"Single Select","width":12,"label":"Do you take any prescription medications?","options":[{"text":"Yes","id":"62262bc86026d909ef2c6cb9"},{"text":"No","id":"27b7b490c91eec6787f5f3b8"}],"helperText":null,"stepId":"acd45227cac332d443c4e1db","sortOrder":12},"text_857857014964697":{"type":"Text","label":"List any medications (If applicable)","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":13,"multiline":true,"rows":5},"text_778059411962258":{"type":"Text","label":"Preferred Doctors or Facilities","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":14,"multiline":true,"rows":5},"multi_select_739838845932338":{"type":"Multi Select","width":12,"label":"Additional Coverage Interested In.","options":[{"text":"Dental","id":"9240a13b72e2165a9128f564"},{"text":"Vision","id":"806f4bb425f189bd2d5f13c1"},{"text":"Hearing","id":"f1f0ae443c7cea6293dcd603"},{"text":"Not Sure","image":null,"id":"5545a1e32f62977624b25adb"}],"helperText":null,"stepId":"acd45227cac332d443c4e1db","sortOrder":15},"multi_select_101403422890311":{"type":"Multi Select","width":12,"label":"Medicare-Specific Section (If Age 65+)","options":[{"text":"I have my Medicare card","id":"9240a13b72e2165a9128f564"},{"text":"I qualify for a Special Enrollment Period (SEP)","id":"806f4bb425f189bd2d5f13c1"}],"helperText":null,"stepId":"acd45227cac332d443c4e1db","sortOrder":16},"toscheckbox_684275351059697":{"type":"TOSCheckbox","label":"Do you agree to the TCPA Disclaimer?","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":17},"hidden_823153874830541":{"type":"Hidden","hiddenFieldName":"universal_leadid","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":18,"customCssClasses":"leadid_token"},"hidden_832259378649234":{"type":"Hidden","hiddenFieldName":"LeadiD","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":19},"jornayatcpadisclosure_211929732592363":{"type":"JornayaTCPADisclosure","value":"By submitting your name and contact information you are expressly consenting via electronic signature to receive calls, text messages and/or emails to from a licensed insurance agent from Healthcare Solutions or our marketing partners listed in our Privacy Policy about Medicare Plans at the number provided (including any wireless number), and you agree such calls and/or text messages may use an auto-dialer or pre-recorded message, even if you are on do-not-call registry. Message and data rates may apply. Text STOP to opt out, or HELP for help. MSG frequency varies. You also verify that the contact information entered is correct and is your personal information and that you are over 18 years of age. This agreement is not a condition of enrollment and your consent can be revoked at any time. There is no obligation to enroll. Benefits may not be available in all plans or service areas. We do not offer every plan available in your area. Currently we represent 7 organizations which offer 59 products in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Participating sales agencies represent Medicare Advantage [HMO, PPO, PFFS, and PDP] organizations that are contracted with Medicare. You also agree to Healthcare Solutions Terms and Conditions and Privacy Policy Enrollment depends on the plan’s contract renewal. Enrollment in the described plan type may be limited to certain times of the year unless you qualify for a special enrollment period. Healthcare Solutions is not connected with or endorsed by the U.S. Government or the federal Medicare program. This is a solicitation of insurance. A licensed insurance agent/producer may contact you.","width":12,"stepId":"acd45227cac332d443c4e1db","sortOrder":20}},"options":{"numberOfSteps":5,"dateFormat":"DD/MM/YYYY","progressBar":{"enable":true},"continueButton":{"continueText":"Continue","submitText":"Submit","backText":"Back"},"customStyles":{"width":{"unit":"px","value":580},"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":"#0a83ca","bodyTextColor":"#343434","parentContainerBackgroundType":"none","innerFormBackgroundType":"none","buttonBorderColor":"#ff7500","buttonColorSelected":"#ffa659","buttonBorderColorSelected":"#ff7500","footerMarginBottom":70,"errorColor":"#ff4e4e","buttonColor":"#ff7500","buttonTextColor":"#ffffff","inputLabelColor":"#a3a3a3","inputTextColor":"#000000","defaultFont":"Open Sans","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":"Poppins","rt_buttonFontSize":15,"rt_buttonColor":"#FFFFFF","rt_buttonColorSelected":"#FFFFFF","rt_buttonTextColor":"#343434","rt_buttonBorderColor":"#DADADA","rt_buttonBorderColorSelected":"primary","inputLabelFont":"Poppins","inputFontSize":16,"continueSubmitButtonFontSize":15,"fullModeBackgroundColor":"#E7F3FA","canvasSetup":"full"},"localization":{"dateFormat":"MM/DD/YYYY"},"exportTransparentBackground":false,"customScript":"","customRedirectUrls":[{"url":""}],"logo":null,"analyticsSettings":{"jornaya":{"accountCode":"37D92862-5F85-B202-FBA2-25EE61CF8A0A","campaignKey":"0D381246-DDF0-14D8-30C7-448DD76B363F"}}},"screenshotUrl":"https://res.cloudinary.com/dqnjggegp/image/upload/v1751471412/growform-production/form-screenshots/68654cb0cd5e7c000b6b3d07.png","ownedByUser":"68654aaecd5e7c000b6b3b23","personalisation":{"form_related_to":"(None - start with a blank slate)"},"created":"2025-07-02T15:13:52.877Z","__v":0,"lastEdited":"2025-07-14T15:15:08.847Z","folderId":"68655584cd5e7c000b6b4681","leadsCount":1177},"accountIsActive":true,"accountIsFreeTrial":false}}; // ---- Utils ---- function safeJSONStringify(obj) { return JSON.stringify(obj) .replace(/<\/(script|style)/gi, '<\\/$1') .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 = '\n' + '\n' + '\n' + ' \n' + ' \n' + ' \n' + '\n' + '\n' + ' \n' + '
\n' + '