{"id":7733,"date":"2024-07-04T11:31:45","date_gmt":"2024-07-04T11:31:45","guid":{"rendered":"https:\/\/wesmiledental.my\/?page_id=7733"},"modified":"2024-07-04T11:44:55","modified_gmt":"2024-07-04T11:44:55","slug":"assessment","status":"publish","type":"page","link":"https:\/\/wesmiledental.my\/sc\/we-smile-clear-aligners\/assessment\/","title":{"rendered":"Assessment"},"content":{"rendered":"<div class=\"vc_row wpb_row vc_row-fluid\"><div class=\"wpb_column vc_column_container vc_col-sm-12 wd-alignment-left\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_text_column wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<div class=\"vc_row wpb_row vc_row-fluid strip-background strip_bottom vc_row-has-fill wd-rs-641e714c1e989\" data-vc-full-width=\"true\" data-vc-full-width-init=\"false\">\n<div class=\"wpb_column vc_column_container vc_col-sm-12 wd-alignment-left\">\n<div class=\"vc_column-inner\">\n<div class=\"wpb_wrapper\">\n<div id=\"wd-641e756b4a4c3\" class=\"title-wrapper wd-wpb set-mb-s reset-last-child wd-rs-641e756b4a4c3 wd-title-color-white wd-title-style-default wd-width-100 text-center noMargin vc_custom_1679717744523 wd-underline-colored\">\n<div class=\"liner-continer\">\n<h4 class=\"woodmart-title-container title wd-font-weight- wd-fontsize-xxl\"><span style=\"color: #ffffff;\">Assessment<\/span><\/h4>\n<\/div>\n<div class=\"breadcrums\">\n<p><span style=\"color: #ffffff;\"><a style=\"color: #ffffff;\" href=\"https:\/\/wesmiledental.my\/\">Home<\/a> | Assessment<\/span><\/p>\n<\/div>\n<p><!--div class=\"title-after_title set-cont-mb-s reset-last-child wd-fontsize-s\">Cosmetic Dentistry<\/div -->\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"vc_row-full-width vc_clearfix\"><\/div>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div><div class=\"vc_row wpb_row vc_row-fluid vc_custom_1672380272454 vc_row-o-content-top vc_row-flex row-reverse-mobile row-reverse-tablet 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<div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span> - Step 1\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_custom' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_custom percentbar_50' style='width:50%; color:#fff; background-color:#00fd00;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_2\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_2\" ><h4 class=\"textCenter\">Let\u2019s get to know you first!<\/h4><\/div><div id=\"field_1_3\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_3\" ><label class='gfield_label gform-field-label' for='input_1_3'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_1_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_24\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_24\" ><label class='gfield_label gform-field-label' for='input_1_24'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_1_24' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_5\" ><label class='gfield_label gform-field-label' for='input_1_5'>What\u2019s your email?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_1_5' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_23\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_23\" ><label class='gfield_label gform-field-label' for='input_1_23'>What\u2019s your contact number?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_1_23' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_8\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfsp_dot o_medium\"  data-field-class=\"gfsp_dot o_medium\" data-js-reload=\"field_1_8\" ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_8'><div class='gchoice gchoice_1_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='&lt;small&gt;My WhatsApp number is different from my local mobile number&lt;\/small&gt;'  id='choice_1_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_8_1' id='label_1_8_1' class='gform-field-label gform-field-label--type-inline'><small>My WhatsApp number is different from my local mobile number<\/small><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_25\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_25\" ><label class='gfield_label gform-field-label' for='input_1_25'>How can we contact you to follow up on treatment?<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_1_25' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_10\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_10\" ><label class='gfield_label gform-field-label' for='input_1_10'>Choose location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_1_10' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Select<\/option><option value='Taman Desa' >Taman Desa<\/option><option value='Rawang' >Rawang<\/option><option value='Jaya One' >Jaya One<\/option><option value='Oasis Ara Damansara' >Oasis Ara Damansara<\/option><option value='LaLaport BBCC' >LaLaport BBCC<\/option><\/select><\/div><\/div><fieldset id=\"field_1_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfsp_dot o_medium\"  data-field-class=\"gfsp_dot o_medium\" data-js-reload=\"field_1_11\" ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_11'><div class='gchoice gchoice_1_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='&lt;small&gt;I agree to be contacted by We Smile via WhatsApp and other channels&lt;\/small&gt;'  id='choice_1_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1' class='gform-field-label gform-field-label--type-inline'><small>I agree to be contacted by We Smile via WhatsApp and other channels<\/small><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_4' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-4' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_12\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_12\" ><h4 class=\"textCenter\">Tell us more about your smile<\/h4><\/div><div id=\"field_1_13\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_13\" ><label class='gfield_label gform-field-label' for='input_1_13'>Why are you thinking about straightening your teeth?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_1_13' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='I&#039;d like generally straighter teeth' >I&#039;d like generally straighter teeth<\/option><option value='I want to feel more confident' >I want to feel more confident<\/option><option value='I&#039;m getting married' >I&#039;m getting married<\/option><option value='I am looking for or starting a new job' >I am looking for or starting a new job<\/option><option value='Other: Please specify' >Other: Please specify<\/option><\/select><\/div><\/div><div id=\"field_1_14\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_14\" ><label class='gfield_label gform-field-label' for='input_1_14'>Other<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_1_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_list_4col gfsp_dot o_medium\"  data-field-class=\"gf_list_4col gfsp_dot o_medium\" data-js-reload=\"field_1_15\" ><legend class='gfield_label gform-field-label' >Have you worn braces or invisible aligners in the past?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_15'>\n\t\t\t<div class='gchoice gchoice_1_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='YES'  id='choice_1_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_15_0' id='label_1_15_0' class='gform-field-label gform-field-label--type-inline'>YES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='NO' checked='checked' id='choice_1_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_15_1' id='label_1_15_1' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_16\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_16\" ><label class='gfield_label gform-field-label' for='input_1_16'>Choose the option that best describes your biggest concern with your smile<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_1_16' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Fix a spacing issue' >Fix a spacing issue<\/option><option value='Fix a crowding issue' >Fix a crowding issue<\/option><option value='Fix a bite problem (overbite, underbite or cross-bite)' >Fix a bite problem (overbite, underbite or cross-bite)<\/option><option value='Generally straighter teeth' >Generally straighter teeth<\/option><\/select><\/div><\/div><fieldset id=\"field_1_18\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf_list_2col gfsp_o_frame o-custom-bg o_medium\"  data-field-class=\"gf_list_2col gfsp_o_frame o-custom-bg o_medium\" data-js-reload=\"field_1_18\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >How would you describe your teeth?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_18'><div class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_1_18_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.1' type='checkbox'  value='Crowding teeth'  id='choice_1_18_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/brudee.com\/wp-content\/uploads\/2022\/03\/crowding.png' \/><\/div><div class='o_text'>Crowding teeth<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_1_18_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.2' type='checkbox'  value='Protruding teeth'  id='choice_1_18_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_18_2' id='label_1_18_2' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/brudee.com\/wp-content\/uploads\/2022\/03\/protruding.png' \/><\/div><div class='o_text'>Protruding teeth<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_1_18_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.3' type='checkbox'  value='Gaps in teeth'  id='choice_1_18_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_18_3' id='label_1_18_3' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/brudee.com\/wp-content\/uploads\/2022\/03\/gaps.png' \/><\/div><div class='o_text'>Gaps in teeth<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gfsp_choice_ornament gfsp_choice_img gchoice gchoice_1_18_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.4' type='checkbox'  value='Crooked teeth'  id='choice_1_18_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_18_4' id='label_1_18_4' class='gform-field-label gform-field-label--type-inline'><div class='o_label'><div class='o_img_wr'><img class='gfsp_label_img' src='https:\/\/brudee.com\/wp-content\/uploads\/2022\/03\/crooked.png' \/><\/div><div class='o_text'>Crooked teeth<\/div><\/div><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_18_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.5' type='checkbox'  value='I&#039;m not sure'  id='choice_1_18_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_18_5' id='label_1_18_5' class='gform-field-label gform-field-label--type-inline'>I'm not sure<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_19\" class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_19\" ><label class='gfield_label gform-field-label' for='input_1_19'>Bite down naturally on your back teeth and smile wide! Use the white lines as a guide.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_19'><img decoding=\"async\" src=\"https:\/\/brudee.com\/wp-content\/uploads\/2022\/05\/p1.jpg\">\n<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='209715200' \/><input name='input_19' id='input_1_19' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_19 gfield_description_1_19\" onchange='javascript:gformValidateFileSize( this, 209715200 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_19'>Max. file size: 200 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_19'><\/div><\/div><\/div><div id=\"field_1_20\" class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_20\" ><label class='gfield_label gform-field-label' for='input_1_20'>Bring your phone up, open wide, and show your bottom-front teeth by keeping lips away. Use the white lines as a guide.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_20'><img decoding=\"async\" src=\"https:\/\/brudee.com\/wp-content\/uploads\/2022\/05\/p2.jpg\">\n<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='209715200' \/><input name='input_20' id='input_1_20' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_20 gfield_description_1_20\" onchange='javascript:gformValidateFileSize( this, 209715200 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_20'>Max. file size: 200 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_20'><\/div><\/div><\/div><div id=\"field_1_21\" class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_21\" ><label class='gfield_label gform-field-label' for='input_1_21'>Tilt your phone down, open wide and show your upper-front teeth by keeping lips away. Use the white lines as a guide.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_21'><img decoding=\"async\" src=\"https:\/\/brudee.com\/wp-content\/uploads\/2022\/05\/p3.jpg\">\n<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='209715200' \/><input name='input_21' id='input_1_21' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_21 gfield_description_1_21\" onchange='javascript:gformValidateFileSize( this, 209715200 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_21'>Max. file size: 200 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_21'><\/div><\/div><\/div><div id=\"field_1_22\" class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_1_22\" ><label class='gfield_label gform-field-label' for='input_1_22'>Turn your head to the side and clench evenly on your back teeth. Smile big! Use the white lines as a guide.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_22'><img decoding=\"async\" src=\"https:\/\/brudee.com\/wp-content\/uploads\/2022\/05\/p4.jpg\">\n<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='209715200' \/><input name='input_22' id='input_1_22' type='file' class='large' aria-describedby=\"gfield_upload_rules_1_22 gfield_description_1_22\" onchange='javascript:gformValidateFileSize( this, 209715200 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_22'>Max. file size: 200 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_1_22'><\/div><\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  jQuery(\"#gform_1\").trigger(\"submit\",[true]); 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