/* growform client2 bundle.url: https://assets.growform.co/75ce62c9-mnos4903/form.bundle.js resolve.source: kv resolve.at: 2026-04-15T10:39:48.760Z form.source: api cache.age_ms: 0 kv.value_present: true fallback_used: false */ ;(function () { var EMBED_TYPE = "iFrame"; var FORM_ID = "69bb1da2e1e4367271b15592"; var FORM_BUNDLE_URL = "https://assets.growform.co/75ce62c9-mnos4903/form.bundle.js"; // injected by worker (KV/memory/fallback) var FORM_DATA = {"data":{"form":{"_id":"69bb1da2e1e4367271b15592","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":"color","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":"No","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":"minimal"},"localization":{"dateFormat":"MM/DD/YYYY"},"exportTransparentBackground":false,"customScript":"","logo":null,"footer":null,"captureSystemDetails":false,"actionOnSubmit":"fireJavaScript","analyticsSettings":{"custom_gtm":{"parentContainerId":"UA-148810779-3"},"trustedForm":{"enabled":true}},"sendCustomRedirectQueryParams":false},"fields":{"Decorative Header_52363373085874":{"type":"Decorative Header","value":"
Thank you — your check is complete.
","width":12,"step":"complete","sortOrder":1,"fieldStyle":{"fontSize":{"value":19,"unit":"px"},"fontWeight":null},"margins":{"marginTop":20},"stepId":"complete","v":2},"buttons_198925635310047":{"type":"Buttons","validationRules":{"required":true},"label":"Current_Benefits","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes","id":"7467d8894d028b9f80815227"},{"text":"No","id":"bbd108ee596ea8d3a129618e"}],"stepId":"acd45227cac332d443c4e1db","sortOrder":2,"hideLabel":true},"buttons_171161144773257":{"type":"Buttons","validationRules":{"required":true},"label":"Previously_Applied","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes, claim pending","id":"7467d8894d028b9f80815227"},{"text":"Yes, claim denied","id":"bbd108ee596ea8d3a129618e"},{"text":"No","id":"74a755790b0810d9f78fc48c"}],"stepId":"ff4727c9498ef9c0a6c989d9","sortOrder":2,"hideLabel":true},"buttons_773833508728816":{"type":"Buttons","validationRules":{"required":true},"label":"Condition_Start","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Less than 1 year","id":"7467d8894d028b9f80815227"},{"text":"1 to 3 years ago","id":"bbd108ee596ea8d3a129618e"},{"text":"3 to 5 years ago","id":"74a755790b0810d9f78fc48c"},{"text":"Over 5 years ago","id":"33621164d73c220fe539a3a2"}],"stepId":"36e2653a4166bb19999f70c4","sortOrder":2,"hideLabel":true},"decorative_header_852009340781120":{"type":"Decorative Header","value":"Did you lose work?
","width":12,"v":2,"sortOrder":1,"stepId":"26bd795ccc845c710ed5ad4f"},"buttons_4786449251019":{"type":"Buttons","validationRules":{"required":true},"label":"Work_Reduction","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes","id":"7467d8894d028b9f80815227"},{"text":"No","id":"bbd108ee596ea8d3a129618e"}],"stepId":"26bd795ccc845c710ed5ad4f","sortOrder":2,"hideLabel":true},"decorative_text_146998306554572":{"type":"Decorative Text","value":"When did this injury occur?
","fieldStyle":{"fontSize":{"value":19,"unit":"px"}},"width":12,"v":2,"stepId":"36e2653a4166bb19999f70c4","sortOrder":1},"decorative_text_374503454265685":{"type":"Decorative Text","value":"Have you applied for benefits?
","fieldStyle":{"fontSize":{"value":19,"unit":"px"}},"width":12,"v":2,"stepId":"ff4727c9498ef9c0a6c989d9","sortOrder":1},"decorative_text_837310951084091":{"type":"Decorative Text","value":"Are you currently receiving benefits?
","fieldStyle":{"fontSize":{"value":19,"unit":"px"}},"width":12,"v":2,"stepId":"acd45227cac332d443c4e1db","sortOrder":1},"decorative_header_245715906457863":{"type":"Decorative Header","value":"Have you worked 5 out of the last 10 years?
","width":12,"v":2,"sortOrder":1,"stepId":"c5380b4a8eb1bf607667808b"},"buttons_872393850438952":{"type":"Buttons","validationRules":{"required":true},"label":"Worked_5_Of_Last_10_Years","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes","id":"7467d8894d028b9f80815227"},{"text":"No","id":"bbd108ee596ea8d3a129618e"}],"stepId":"c5380b4a8eb1bf607667808b","sortOrder":2,"hideLabel":true},"decorative_header_822938361128611":{"type":"Decorative Header","value":"Have you been treated by a doctor?
","width":12,"v":2,"sortOrder":1,"stepId":"57c292f17de0d89c47db56c2"},"buttons_858778705259659":{"type":"Buttons","validationRules":{"required":true},"label":"Doctor_Treatment","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes","id":"7467d8894d028b9f80815227"},{"text":"No","id":"bbd108ee596ea8d3a129618e"}],"stepId":"57c292f17de0d89c47db56c2","sortOrder":2,"hideLabel":true},"decorative_header_442419504589264":{"type":"Decorative Header","value":"Have you hired an attorney?
","width":12,"v":2,"sortOrder":1,"stepId":"ed913efe8414cd6e2c6ca157"},"buttons_223095702228403":{"type":"Buttons","validationRules":{"required":true},"label":"Have_Attorney","width":12,"multiple":false,"buttonStyle":{"rt_buttonsPerRow":2,"rt_buttonsPerRowMobile":1,"buttonsType":"Rectangle","spacing":20,"showControls":"Yes","rt_compactLayoutOnMobile":"Yes"},"imageStyles":{},"options":[{"text":"Yes","id":"7467d8894d028b9f80815227"},{"text":"No","id":"bbd108ee596ea8d3a129618e"}],"stepId":"ed913efe8414cd6e2c6ca157","sortOrder":2,"hideLabel":true},"decorative_header_438378476530950":{"type":"Decorative Header","value":"Please describe your condition...
","width":12,"v":2,"sortOrder":1,"stepId":"8a3ace3e8618004407c58fe3"},"text_781225804559950":{"type":"Text","label":"comments","width":12,"sortOrder":2,"stepId":"8a3ace3e8618004407c58fe3","hideLabel":true,"multiline":true,"rows":2,"rowsMax":5,"validationRules":{"required":true}},"decorative_header_705198418346120":{"type":"Decorative Header","value":"Please provide your contact information
","width":12,"v":2,"sortOrder":1,"stepId":"4f579b2a881f993865e3722f"},"text_262055961954078":{"type":"Text","label":"First_Name","width":6,"sortOrder":2,"stepId":"4f579b2a881f993865e3722f","hideLabel":false,"helperText":"","validationRules":{"required":true}},"text_182802841764770":{"type":"Text","label":"Last_Name","width":6,"stepId":"4f579b2a881f993865e3722f","sortOrder":3,"hideLabel":false,"validationRules":{"required":true},"helperText":""},"address_lookup_587675423631836":{"type":"Address Lookup","label":"Address","width":12,"allowManualEntry":true,"stepId":"4f579b2a881f993865e3722f","sortOrder":4,"validationRules":{"required":true},"hideLabel":false,"helperText":""},"email_283899126618234":{"type":"Email","label":"Email","width":12,"stepId":"4f579b2a881f993865e3722f","sortOrder":5,"hideLabel":false,"helperText":""},"phone_856422254181630":{"type":"Phone","label":"Phone","width":12,"stepId":"4f579b2a881f993865e3722f","sortOrder":6,"showCountryCode":false},"zipcode_137695074367245":{"type":"Zipcode","label":"Zip","zipcodeFieldFormat":"zipcode_usa","width":6,"stepId":"4f579b2a881f993865e3722f","sortOrder":7},"number_868742782571355":{"type":"Number","label":"Applicant_Age","currencySymbol":"None","width":6,"stepId":"4f579b2a881f993865e3722f","sortOrder":8,"wholeNumbersOnly":true,"validationRules":{"required":true}},"hidden_549287042900288":{"type":"Hidden","hiddenFieldName":"leadid_tcpa_disclosure","width":12,"stepId":"4f579b2a881f993865e3722f","sortOrder":9},"toscheckbox_229291259381375":{"type":"TOSCheckbox","label":"By clicking 'SUBMIT', I agree to the terms of service.","width":12,"stepId":"4f579b2a881f993865e3722f","sortOrder":10},"decorative_text_526584173157923":{"type":"Decorative Text","value":"Please stand by while we load your results...
","fieldStyle":{"fontSize":{"value":19,"unit":"px"}},"width":12,"v":2,"stepId":"complete","sortOrder":2}},"ownedByUser":"69b9ebc6e1e4367271b0c2e3","formName":"SSDI Lawyers","personalisation":{"form_related_to":"(None - start with a blank slate)"},"created":"2026-03-18T21:48:18.552Z","steps":[{"id":"acd45227cac332d443c4e1db","name":"Getting benefits?","sortOrder":1},{"id":"ff4727c9498ef9c0a6c989d9","name":"Applied","sortOrder":2},{"id":"36e2653a4166bb19999f70c4","name":"When Injured","sortOrder":3},{"id":"26bd795ccc845c710ed5ad4f","name":"Lose work","sortOrder":4},{"id":"c5380b4a8eb1bf607667808b","name":"How long work","sortOrder":5},{"id":"57c292f17de0d89c47db56c2","name":"Treated by Doctor","sortOrder":6,"copyOf":"c5380b4a8eb1bf607667808b"},{"id":"ed913efe8414cd6e2c6ca157","name":"Hired attorney","sortOrder":7,"copyOf":"57c292f17de0d89c47db56c2"},{"id":"8a3ace3e8618004407c58fe3","name":"Condition","sortOrder":8},{"id":"4f579b2a881f993865e3722f","name":"Info","sortOrder":9}],"folderId":"69bb0b8ae1e4367271b14c47","screenshotUrl":"https://res.cloudinary.com/dqnjggegp/image/upload/v1773919786/growform-production/form-screenshots/69bb1da2e1e4367271b15592.png","isActive":true,"reportedSpam":null,"__v":0,"lastEdited":"2026-03-22T19:32:51.198Z","spamOcr":"○ Yes\nAre you currently receiving benefits?\nΟ No ○ Yes Are you currently receiving benefits ? Ο No","leadsCount":15},"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' + '