if (window.location.protocol != "https:" && window.location.href.indexOf("formulate") == -1 && "False" === "True") {
    window.location.href = "https:" + window.location.href.substring(window.location.protocol.length);
}

var fbScriptTag = document.getElementsByClassName("1a269b8a-7857-47cd-9c58-7c09df7aecd1"),
    fbBodyTag = document.body,
    fbHeadTag = document.head,
    fbIsTestResponse = 'False',
    fbEnableInstaMedScript = 'False',
    fbRenderContainer = document.createElement("div"),
    fbRenderedCssContainer = document.createElement("div"),
    fbConfigScript = document.createElement("script"),
    fbRequireJSScript = document.createElement("script"),
    fbInstaMedJSScript = document.createElement("script"),
    fbGeoCaptchaCallback = document.createElement("script"),
    fbGeoReCaptchaCallback = document.createElement("script"),
    fbFormulateRenderer = document.createElement("script"),
    fbRenderedIntegrations = document.createElement("script"),
    fbRenderedScripts = document.createElement("script"),
    fbAutoPopulateFromQueryString = document.createElement("script"),
    fbEmbeddedCss = "",
    renderedScripts = '';

if(fbScriptTag.length === 0) {
    fbScriptTag = document.querySelector("script[src*='1a269b8a-7857-47cd-9c58-7c09df7aecd1']");
} else {
    fbScriptTag = fbScriptTag[0];
}

fbRenderContainer.id = "formRenderContainer";
fbRenderContainer.className = " fbRenderContainer fbRenderContainer_1a269b8a-7857-47cd-9c58-7c09df7aecd1";
fbRenderedCssContainer.id = "fbRenderedCssContainer";

fbConfigScript.type = "text/javascript";
fbRequireJSScript.type = "text/javascript";
fbInstaMedJSScript.type = "text/javascript";
fbGeoCaptchaCallback.type = "text/javascript";
fbGeoReCaptchaCallback.type = "text/javascript";
fbFormulateRenderer.type = "text/javascript";
fbRenderedIntegrations.type = "text/javascript";
fbRenderedScripts.type = "text/javascript";
fbAutoPopulateFromQueryString.type = "text/javascript";

fbRequireJSScript.src = "https://formulate.geonetric.com/Scripts/require.min.js";
fbInstaMedJSScript.src = "https://formulate.geonetric.com/Scripts/vendor/instamed/token.js";
fbInstaMedJSScript.id = "instamed-sdk";
fbGeoCaptchaCallback.src = "https://formulate.geonetric.com/Scripts/geo-captcha-callback.js";
fbGeoReCaptchaCallback.src = "https://www.google.com/recaptcha/api.js?onload=geoFbCaptchaCallback&render=6LdxkTEpAAAAAMKbkhz8-INpQis_mvSaIXnoyC2V";
fbFormulateRenderer.src = "https://formulate.geonetric.com/Scripts/require/formulate-renderer.js?embeddedCssType=0&isTestResponse=False&hasGoogleAnalytics=True";
fbFormulateRenderer.id = "formulateRendererScript";
fbAutoPopulateFromQueryString.src = "https://formulate.geonetric.com/Scripts/auto-populate-from-query-string.js";

if (fbEnableInstaMedScript === 'True') {
    fbInstaMedJSScript.setAttribute("data-displaymode", "embedded");
    fbInstaMedJSScript.setAttribute("data-environment", "UAT");
    fbInstaMedJSScript.setAttribute("data-mobiledisplaymode", "embedded");
}

fbGeoCaptchaCallback.onload = function() {
    if(document.querySelectorAll('.geo-fb-recaptcha').length > 0)
    {
        fbBodyTag.appendChild(fbGeoReCaptchaCallback);
    }
}

fbRequireJSScript.addEventListener("load", function() {
    fbBodyTag.appendChild(fbFormulateRenderer);
    fbBodyTag.appendChild(fbAutoPopulateFromQueryString);
});

fbFormulateRenderer.addEventListener("load", function () {
    initFormBuilderForm();
});

var embeddedCssType = 0
switch (embeddedCssType) {
    case 1:
        fbEmbeddedCss = '<link href=\"https://formulate.geonetric.com/Content/bootstrap.min.css\" rel=\"stylesheet\"><link href=\"https://formulate.geonetric.com/Content/embedded/font-awesome/css/font-awesome.min.css\" rel=\"stylesheet\"><link href=\"https://formulate.geonetric.com/Content/embedded/embedded.css\" rel=\"stylesheet\">';
        break;
    case 2:
        fbEmbeddedCss = '';
        break;
    default:
        fbEmbeddedCss = '<link href=\"https://formulate.geonetric.com/Content/embedded/font-awesome/css/font-awesome.min.css\" rel=\"stylesheet\"><link href=\"https://formulate.geonetric.com/Content/embedded/embedded.css\" rel=\"stylesheet\">';
}

if (fbIsTestResponse === 'True') {
    fbRenderContainer.setAttribute('data-test-mode', 'true');
} else {
    fbRenderContainer.setAttribute('data-test-mode', 'false');
}

fbRenderContainer.innerHTML = "<div id=\'formContainer_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'fbFormContainer fbFormContainer_1a269b8a-7857-47cd-9c58-7c09df7aecd1 BlockLabels hidden\'>\
<p>Required fields are marked with <span class=\'fb-required\'>*</span></p>\
<input type=\'hidden\' name=\'formId\' id=\'formId\' value=\'1a269b8a-7857-47cd-9c58-7c09df7aecd1\' />\
<input type=\'hidden\' name=\'formName\' id=\'formName\' value=\'Western OBGYN Meet and Greet\' />\
<input type=\'hidden\' name=\'formVersion\' value=\'11\' id=\'formVersion\' />\
<input type=\'hidden\' name=\'organizationId\' id=\'organizationId\' value=\'10a9327c-4ecd-4401-b8e2-789dddc6f2b2\' />\
<input type=\'hidden\' name=\'responseId\' id=\'responseId\' value=\'b678c56c-793b-427e-8bd3-e3d3a7971b4b\' />\
<input type=\'hidden\' name=\'formBaseUrl\' id=\'formBaseUrl\' value=\'https://formulate.geonetric.com\' />\
\
\
\
                        <fieldset class=\'fb-fieldset \'>\
                            <legend class=\'fb-legend \'>Name</legend>\
                            \
                            <div class=\'row\'>\
                                <div class=\'col-sm-6\'>\
                                    \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label  \' for=\'FormField1_1a269b8a-7857-47cd-9c58-7c09df7aecd1First\'>First name<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <input class=\'fb-name-field form-control input-medium\' id=\'FormField1_1a269b8a-7857-47cd-9c58-7c09df7aecd1First\' name=\'FormField1_1a269b8a-7857-47cd-9c58-7c09df7aecd1First\' type=\'text\' data-export-label=\'Name_First_Name\'  integration-export-label=\'\' placeholder=\'\' required data-msg-required=\'First name is required.\' />\
                        \
                    </div>\
                </div>\
                                </div>\
                                <div class=\'col-sm-6\'>\
                                    \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label  \' for=\'FormField1_1a269b8a-7857-47cd-9c58-7c09df7aecd1Last\'>Last name<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <input class=\'fb-name-field form-control input-medium\' id=\'FormField1_1a269b8a-7857-47cd-9c58-7c09df7aecd1Last\' name=\'FormField1_1a269b8a-7857-47cd-9c58-7c09df7aecd1Last\' type=\'text\' data-export-label=\'Name_Last_Name\'  integration-export-label=\'\' placeholder=\'\' required data-msg-required=\'Last name is required.\' />\
                        \
                    </div>\
                </div>\
                                </div>\
                            </div>\
                        </fieldset><div class=\'form-group\'><label for=\'FormField2_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'control-label  \'>Email address<span class=\'fb-required\'>*</span></label><div><input type=\'email\' name=\'FormField2_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' id=\'FormField2_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'form-control input-medium \' value=\'\' required data-msg-required=\'Email address is required.\' data-export-label=\'Email_address\'  data-msg-email=\'Please specify a valid email.\' />\
</div></div><div class=\'form-group\'><label for=\'FormField3_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'control-label  \'>Phone number<span class=\'fb-required\'>*</span></label><div><input type=\'text\' name=\'FormField3_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' id=\'FormField3_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'form-control input-medium \' value=\'\' required data-msg-required=\'Phone number is required.\' data-export-label=\'Phone_number\'  data-rule-phoneUS=\'true\' data-msg-phoneUS=\'Please specify a valid phone number.\' />\
</div></div><div class=\'form-group\'><label for=\'FormField9_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'control-label  \'>Postal code<span class=\'fb-required\'>*</span></label><div>\
<input type=\'text\' name=\'FormField9_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' id=\'FormField9_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'form-control input-medium \' value=\'\'  required data-msg-required=\'Postal code is required.\' data-export-label=\'Postal_code\'  placeholder=\'\'  />\
</div></div><div class=\'form-group\'><label for=\'FormField5_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'control-label  \'>Age<span class=\'fb-required\'>*</span></label><div><select  name=\'FormField5_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' id=\'FormField5_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'form-control \' style=\'width: auto\' required data-msg-required=\'Age is required.\' data-export-label=\'Age\' ><option value=\'\' selected>( Please Select )</option><option value=\'Under 20\'>Under 20</option><option value=\'20-35\'>20-35</option><option value=\'36-50\'>36-50</option><option value=\'51-65\'>51-65</option><option value=\'66-80\'>66-80</option><option value=\'Over 80\'>Over 80</option><option value=\'Prefer not to answer\'>Prefer not to answer</option></select></div></div><div class=\'form-group\'><label  class=\'control-label  \'>Western OB/GYN clinic preference<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'Arlington\' required data-msg-required=\'Western OB/GYN clinic preference is required.\' name=\'checkbox4\' id=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_1\' class=\'right\' data-export-label=\'Clinic_location\' ><label for=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_1\'>Arlington</label></div><div class=\'flow\'><input type=\'radio\' value=\'Belle Plaine\' required data-msg-required=\'Western OB/GYN clinic preference is required.\' name=\'checkbox4\' id=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_2\' class=\'right\' data-export-label=\'Clinic_location\' ><label for=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_2\'>Belle Plaine</label></div><div class=\'flow\'><input type=\'radio\' value=\'Chanhassen\' required data-msg-required=\'Western OB/GYN clinic preference is required.\' name=\'checkbox4\' id=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_3\' class=\'right\' data-export-label=\'Clinic_location\' ><label for=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_3\'>Chanhassen</label></div><div class=\'flow\'><input type=\'radio\' value=\'Chaska\' required data-msg-required=\'Western OB/GYN clinic preference is required.\' name=\'checkbox4\' id=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_4\' class=\'right\' data-export-label=\'Clinic_location\' ><label for=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_4\'>Chaska</label></div><div class=\'flow\'><input type=\'radio\' value=\'Delano\' required data-msg-required=\'Western OB/GYN clinic preference is required.\' name=\'checkbox4\' id=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_5\' class=\'right\' data-export-label=\'Clinic_location\' ><label for=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_5\'>Delano</label></div><div class=\'flow\'><input type=\'radio\' value=\'Excelsior\' required data-msg-required=\'Western OB/GYN clinic preference is required.\' name=\'checkbox4\' id=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_6\' class=\'right\' data-export-label=\'Clinic_location\' ><label for=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_6\'>Excelsior</label></div><div class=\'flow\'><input type=\'radio\' value=\'Waconia\' required data-msg-required=\'Western OB/GYN clinic preference is required.\' name=\'checkbox4\' id=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_7\' class=\'right\' data-export-label=\'Clinic_location\' ><label for=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_7\'>Waconia</label></div><div class=\'flow\'><input type=\'radio\' value=\'I&#39;m not sure which location is right for me. I&#39;d like to discuss my options.\' required data-msg-required=\'Western OB/GYN clinic preference is required.\' name=\'checkbox4\' id=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_8\' class=\'right\' data-export-label=\'Clinic_location\' ><label for=\'FormField4_1a269b8a-7857-47cd-9c58-7c09df7aecd1_8\'>I&#39;m not sure which location is right for me. I&#39;d like to discuss my options.</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>Provider preference</label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'Nurse midwife\'  name=\'checkbox6\' id=\'FormField6_1a269b8a-7857-47cd-9c58-7c09df7aecd1_1\' class=\'right\' data-export-label=\'Provider_preference\' ><label for=\'FormField6_1a269b8a-7857-47cd-9c58-7c09df7aecd1_1\'>Nurse midwife</label></div><div class=\'flow\'><input type=\'radio\' value=\'Nurse practitioner\'  name=\'checkbox6\' id=\'FormField6_1a269b8a-7857-47cd-9c58-7c09df7aecd1_2\' class=\'right\' data-export-label=\'Provider_preference\' ><label for=\'FormField6_1a269b8a-7857-47cd-9c58-7c09df7aecd1_2\'>Nurse practitioner</label></div><div class=\'flow\'><input type=\'radio\' value=\'OB/GYN\'  name=\'checkbox6\' id=\'FormField6_1a269b8a-7857-47cd-9c58-7c09df7aecd1_3\' class=\'right\' data-export-label=\'Provider_preference\' ><label for=\'FormField6_1a269b8a-7857-47cd-9c58-7c09df7aecd1_3\'>OB/GYN</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>Primary health interests</label><div><div><fieldset class=\'CheckboxGroup\'><div class=\'flow Chkbx\'><input type=\'checkbox\' value=\'Gynecology \'  name=\'2083bfbd-5da1-4552-acc6-25783aa0150e_FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_checkbox_7\' id=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_1\' class=\'fo-right-margin-5\' data-export-label=\'Primary_health_interests\' ><label for=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_1\'>Gynecology </label></div><div class=\'flow Chkbx\'><input type=\'checkbox\' value=\'Menopause \'  name=\'2083bfbd-5da1-4552-acc6-25783aa0150e_FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_checkbox_7\' id=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_2\' class=\'fo-right-margin-5\' data-export-label=\'Primary_health_interests\' ><label for=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_2\'>Menopause </label></div><div class=\'flow Chkbx\'><input type=\'checkbox\' value=\'Pregnancy \'  name=\'2083bfbd-5da1-4552-acc6-25783aa0150e_FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_checkbox_7\' id=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_3\' class=\'fo-right-margin-5\' data-export-label=\'Primary_health_interests\' ><label for=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_3\'>Pregnancy </label></div><div class=\'flow Chkbx\'><input type=\'checkbox\' value=\'Prevention/screening information\'  name=\'2083bfbd-5da1-4552-acc6-25783aa0150e_FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_checkbox_7\' id=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_4\' class=\'fo-right-margin-5\' data-export-label=\'Primary_health_interests\' ><label for=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_4\'>Prevention/screening information</label></div><div class=\'flow Chkbx\'><input type=\'checkbox\' value=\'Urinary incontinence \'  name=\'2083bfbd-5da1-4552-acc6-25783aa0150e_FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_checkbox_7\' id=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_5\' class=\'fo-right-margin-5\' data-export-label=\'Primary_health_interests\' ><label for=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_5\'>Urinary incontinence </label></div><div class=\'flow Chkbx\'><input type=\'checkbox\' value=\'Well-woman care\'  name=\'2083bfbd-5da1-4552-acc6-25783aa0150e_FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_checkbox_7\' id=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_6\' class=\'fo-right-margin-5\' data-export-label=\'Primary_health_interests\' ><label for=\'FormField7_1a269b8a-7857-47cd-9c58-7c09df7aecd1_6\'>Well-woman care</label></div></fieldset></div></div></div><div class=\'form-group\'><label for=\'FormField8_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'control-label  \'>Other health interests not listed above</label><div>\
<textarea rows=\'10\' name=\'FormField8_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' id=\'FormField8_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' class=\'form-control textarea-medium\'   data-export-label=\'Other_health_interests\'  placeholder=\'\'></textarea>\
</div></div><div class=\'validationSummary\'><p><i class=\'fa fa-exclamation-triangle\'></i> The following fields are required or invalid.</p><ul></ul></div><p><em>By</em><em>&nbsp;submitting your personally identifiable information (&ldquo;PII&rdquo;), such as your name, email address or contact number, to us, you consent to our privacy policy and the use of this information for the purpose for which it is submitted. Ridgeview will treat your information as confidential and follow acceptable safeguards to protect your PII submitted to us. However, any transmission of PII over the internet may not be one hundred percent secure and submission is at your own risk.&nbsp;</em></p>\
<input type=\'hidden\' class=\'geo-fb-recaptcha\' id=\'captcha_1a269b8a-7857-47cd-9c58-7c09df7aecd1\' data-sitekey=\'6LdxkTEpAAAAAMKbkhz8-INpQis_mvSaIXnoyC2V\'>\
<div id=\'form-errors\' class=\'alert alert-danger fade in\' role=\'alert\' style=\'display:none\'></div>\
<div class=\'form-group ignore\'><div class=\'form-group ButtonHolder\'><div class=\'col-sm-4 col-sm-offset-2\'><button id=\'fb-submitButton\' type=\'button\' class=\'btn btn-primary Button\' value=\'Submit\'>Submit</button></div></div></div>\
</div>";

fbConfigScript.innerHTML = "window.formHost = 'https://formulate.geonetric.com'; window.submissionHost = 'https://formulate.geonetric.com/';";
fbRenderedScripts.innerHTML = renderedScripts.replace(/<script>/ig, '\n').replace(/<\/script>/ig, '').replace(/\s{4}/ig, "");
fbRenderedIntegrations.innerHTML = "";
fbRenderedCssContainer.innerHTML = '';

fbScriptTag.parentNode.insertBefore(fbRenderContainer, fbScriptTag.nextSibling);

if (!Object.prototype.hasOwnProperty.call(window, 'geoFbHasRunOnce')) {
    fbBodyTag.appendChild(fbConfigScript);
    fbBodyTag.appendChild(fbRequireJSScript);
    if (fbEnableInstaMedScript === 'True')
        fbHeadTag.appendChild(fbInstaMedJSScript);
    fbBodyTag.insertAdjacentHTML('beforeend', fbEmbeddedCss);
    fbBodyTag.appendChild(fbGeoCaptchaCallback);
    fbBodyTag.appendChild(fbRenderedIntegrations);
    fbBodyTag.appendChild(fbRenderedCssContainer);
    fbBodyTag.appendChild(fbRenderedScripts);
}

fbScriptTag.parentNode.removeChild(fbScriptTag);