{"id":15882,"date":"2024-01-02T10:51:57","date_gmt":"2024-01-02T10:51:57","guid":{"rendered":"https:\/\/sagaclinic.com\/?page_id=15882"},"modified":"2024-01-02T11:39:32","modified_gmt":"2024-01-02T11:39:32","slug":"donor-matching-system","status":"publish","type":"page","link":"https:\/\/sagaclinic.com\/sq\/donor-matching-system\/","title":{"rendered":"Donor Matching System"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"15882\" class=\"elementor elementor-15882\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3c548bca elementor-reverse-tablet elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wd-section-disabled\" data-id=\"3c548bca\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7a9daa7\" data-id=\"7a9daa7\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cf34ae6 elementor-widget elementor-widget-wd_text_block\" data-id=\"cf34ae6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wd_text_block.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<link rel=\"stylesheet\" id=\"wd-text-block-css\" href=\"https:\/\/sagaclinic.com\/wp-content\/themes\/woodmart\/css\/parts\/el-text-block.min.css?ver=7.3.2\" type=\"text\/css\" media=\"all\" \/> \t\t\t\t\t<div class=\"wd-text-block reset-last-child text-left\">\n\t\t\t\n\t\t\t<div data-uniq='69dbed6033e29' class='uniq-69dbed6033e29 formcraft-css form-live align-left'><script> window.formcraftLogic = window.formcraftLogic || {}; 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.fc-form.fc-form-2 .form-element .fileupload-cover .button-file,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover .button,\n\t\t\t.formcraft-datepicker .ui-datepicker-header,\n\t\t\t.formcraft-datepicker .ui-datepicker-title\n\t\t\t{\n\t\t\t\tbackground: #173057;\n\t\t\t\tcolor: #ffffff;\n\t\t\t}\n\t\t\t.formcraft-datepicker td .ui-state-active,\n\t\t\t.formcraft-datepicker td .ui-state-hover,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .slider-cover .ui-slider-range\n\t\t\t{\n\t\t\t\tbackground: #173057;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-header,\n\t\t\t.formcraft-css .fc-form .field-cover>div.full hr\n\t\t\t{\n\t\t\t\tborder-color: #142a4c;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-prev:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-next:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker 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ul\n\t\t\t{\n\t\t\t\tcolor: #777;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"text\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"password\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"email\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"radio\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"checkbox\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"tel\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover select,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover textarea\n\t\t\t{\n\t\t\t\tbackground-color: #fafafa;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"radio\"]:checked,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"checkbox\"]:checked {\n\t\t\t\tborder-color: #142a4c;\n\t\t\t\tbackground: #173057;\t\t\t\t\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .star-cover label .star\n\t\t\t{\n\t\t\t\ttext-shadow: 0px 1px 0px #142a4c;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .slider-cover .ui-slider-range\n\t\t\t{\n\t\t\t\tbox-shadow: 0px 1px 1px #142a4c inset;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .fileupload-cover .button-file\n\t\t\t{\n\t\t\t\tborder-color: #142a4c;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"password\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"email\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"tel\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"text\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html textarea:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html select:focus\n\t\t\t{\n\t\t\t\tborder-color: #173057;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html .field-cover .is-read-only:focus {\n\t\t\t\tborder-color: #ccc;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2\t\t\t{\n\t\t\t\tfont-family: Courgette;\n\t\t\t}\n\t\t\t@media (max-width : 480px) {\n\t\t\t\thtml .dedicated-page,\n\t\t\t\thtml .dedicated-page .formcraft-css .fc-pagination > div.active\n\t\t\t\t{\n\t\t\t\t\tbackground: url(https:\/\/mshcreativebeta.com\/stemgene\/wp-content\/plugins\/formcraft3\/views\/..\/assets\/images\/backgrounds\/fibre.png);\n\t\t\t\t}\n\t\t\t}\n\t\t<\/style>\n\t\t<div class=\"form-cover\">\n\t\t\t<form data-auto-scroll=\"\" data-no-message-redirect=\"\" data-thousand=\",\" data-decimal=\".\" data-delay=\"\" data-id=\"2\" class=\"fc-form fc-form-2 align- fc-temp-class save-form- dont-submit-hidden- disable-enter- label-placeholder field-border-visible frame-visible remove-asterisk-false icons-hide-false field-alignment-left\" style=\"width: 1250px; color: #777777; font-size: 125%; background: url(https:\/\/mshcreativebeta.com\/stemgene\/wp-content\/plugins\/formcraft3\/views\/..\/assets\/images\/backgrounds\/fibre.png)\" action=\"\">\n\t\t\t\t<!-- ngRepeat: page in Builder.FormElements track by $index --><div class=\"form-page form-page-0\" data-index=\"0\">\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"form-page-content      ng-not-empty\">\n\t\t\t\t\t\t<div data-identifier=\"field5\" data-index=\"0\" style=\"width: 100%\" class=\"form-element form-element-field5 options-false form-element-0 default-false form-element-type-customText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"absolute-false customText-cover field-cover\" style=\"left: ; top: ;right: ;bottom: ;color:  !important; background-color:\"><div class=\"full\" style=\"text-align: left\"><h1 style=\"text-align: center\" >Patient personal contact data<\/h1><hr ><\/div><input type=\"hidden\" name=\"field5\" data-field-id=\"field5\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field18\" data-index=\"1\" style=\"width: 50%\" class=\"even form-element form-element-field18 options-false form-element-1 default-false form-element-type-oneLineText is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Name<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Name\" make-read-only=\"false\" data-field-id=\"field18\" name=\"field18[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field22\" data-index=\"2\" style=\"width: 50%\" class=\"form-element form-element-field22 options-false form-element-2 default-false form-element-type-oneLineText is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Surname<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Surname\" make-read-only=\"false\" data-field-id=\"field22\" name=\"field22[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field19\" data-index=\"3\" style=\"width: 50%\" class=\"even form-element form-element-field19 options-false form-element-3 default-false form-element-type-oneLineText is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >E Mail<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"E Mail\" make-read-only=\"false\" data-field-id=\"field19\" name=\"field19[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field21\" data-index=\"4\" style=\"width: 50%\" class=\"form-element form-element-field21 options-false form-element-4 default-false form-element-type-oneLineText is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Phone<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Phone\" make-read-only=\"false\" data-field-id=\"field21\" name=\"field21[]\" data-min-char=\"\" data-max-char=\"11\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field12\" data-index=\"5\" style=\"width: 50%\" class=\"even form-element form-element-field12 options-false form-element-5 default-false form-element-type-dropdown is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Select your country of residence<\/span><\/span><span class=\"sub-label\"><span >Select your country of residence<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field12\" name=\"field12\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Country of residence<\/option><option value=\"AF\" class=\"\">Afghanistan<\/option><option value=\"AL\" class=\"\">Albania<\/option><option value=\"DZ\" class=\"\">Algeria<\/option><option value=\"AS\" class=\"\">American Samoa<\/option><option value=\"AD\" class=\"\">Andorra<\/option><option value=\"AO\" class=\"\">Angola<\/option><option value=\"AI\" class=\"\">Anguilla<\/option><option value=\"AQ\" class=\"\">Antarctica<\/option><option value=\"AG\" class=\"\">Antigua And Barbuda<\/option><option value=\"AR\" class=\"\">Argentina<\/option><option value=\"AM\" class=\"\">Armenia<\/option><option value=\"AW\" class=\"\">Aruba<\/option><option value=\"AU\" class=\"\">Australia<\/option><option value=\"AT\" class=\"\">Austria<\/option><option value=\"AZ\" class=\"\">Azerbaijan<\/option><option value=\"BS\" class=\"\">Bahamas<\/option><option value=\"BH\" class=\"\">Bahrain<\/option><option value=\"BD\" class=\"\">Bangladesh<\/option><option value=\"BB\" class=\"\">Barbados<\/option><option value=\"BY\" class=\"\">Belarus<\/option><option value=\"BE\" class=\"\">Belgium<\/option><option value=\"BZ\" class=\"\">Belize<\/option><option value=\"BJ\" class=\"\">Benin<\/option><option value=\"BM\" class=\"\">Bermuda<\/option><option value=\"BT\" class=\"\">Bhutan<\/option><option value=\"BO\" class=\"\">Bolivia<\/option><option value=\"BA\" class=\"\">Bosnia And Herzegovina<\/option><option value=\"BW\" class=\"\">Botswana<\/option><option value=\"BV\" class=\"\">Bouvet Island<\/option><option value=\"BR\" class=\"\">Brazil<\/option><option value=\"IO\" class=\"\">British Indian Ocean Territory<\/option><option value=\"BN\" class=\"\">Brunei Darussalam<\/option><option value=\"BG\" class=\"\">Bulgaria<\/option><option value=\"BF\" class=\"\">Burkina Faso<\/option><option value=\"BI\" class=\"\">Burundi<\/option><option value=\"KH\" class=\"\">Cambodia<\/option><option value=\"CM\" class=\"\">Cameroon<\/option><option value=\"CA\" class=\"\">Canada<\/option><option value=\"CV\" class=\"\">Cape Verde<\/option><option value=\"KY\" class=\"\">Cayman Islands<\/option><option value=\"CF\" class=\"\">Central African Republic<\/option><option value=\"TD\" class=\"\">Chad<\/option><option value=\"CL\" class=\"\">Chile<\/option><option value=\"CN\" class=\"\">China<\/option><option value=\"CX\" class=\"\">Christmas Island<\/option><option value=\"CC\" class=\"\">Cocos (keeling) Islands<\/option><option value=\"CO\" class=\"\">Colombia<\/option><option value=\"KM\" class=\"\">Comoros<\/option><option value=\"CG\" class=\"\">Congo<\/option><option value=\"CD\" class=\"\">Congo, The Democratic Republic Of The<\/option><option value=\"CK\" class=\"\">Cook Islands<\/option><option value=\"CR\" class=\"\">Costa Rica<\/option><option value=\"CI\" class=\"\">Cote D'ivoire<\/option><option value=\"HR\" class=\"\">Croatia<\/option><option value=\"CU\" class=\"\">Cuba<\/option><option value=\"CY\" class=\"\">Cyprus<\/option><option value=\"CZ\" class=\"\">Czech Republic<\/option><option value=\"DK\" class=\"\">Denmark<\/option><option value=\"DJ\" class=\"\">Djibouti<\/option><option value=\"DM\" class=\"\">Dominica<\/option><option value=\"DO\" class=\"\">Dominican Republic<\/option><option value=\"TP\" class=\"\">East Timor<\/option><option value=\"EC\" class=\"\">Ecuador<\/option><option value=\"EG\" class=\"\">Egypt<\/option><option value=\"SV\" class=\"\">El Salvador<\/option><option value=\"GQ\" class=\"\">Equatorial Guinea<\/option><option value=\"ER\" class=\"\">Eritrea<\/option><option value=\"EE\" class=\"\">Estonia<\/option><option value=\"ET\" class=\"\">Ethiopia<\/option><option value=\"FK\" class=\"\">Falkland Islands (malvinas)<\/option><option value=\"FO\" class=\"\">Faroe Islands<\/option><option value=\"FJ\" class=\"\">Fiji<\/option><option value=\"FI\" class=\"\">Finland<\/option><option value=\"FR\" class=\"\">France<\/option><option value=\"GF\" class=\"\">French Guiana<\/option><option value=\"PF\" class=\"\">French Polynesia<\/option><option value=\"TF\" class=\"\">French Southern Territories<\/option><option value=\"GA\" class=\"\">Gabon<\/option><option value=\"GM\" class=\"\">Gambia<\/option><option value=\"GE\" class=\"\">Georgia<\/option><option value=\"DE\" class=\"\">Germany<\/option><option value=\"GH\" class=\"\">Ghana<\/option><option value=\"GI\" class=\"\">Gibraltar<\/option><option value=\"GR\" class=\"\">Greece<\/option><option value=\"GL\" class=\"\">Greenland<\/option><option value=\"GD\" class=\"\">Grenada<\/option><option value=\"GP\" class=\"\">Guadeloupe<\/option><option value=\"GU\" class=\"\">Guam<\/option><option value=\"GT\" class=\"\">Guatemala<\/option><option value=\"GN\" class=\"\">Guinea<\/option><option value=\"GW\" class=\"\">Guinea-bissau<\/option><option value=\"GY\" class=\"\">Guyana<\/option><option value=\"HT\" class=\"\">Haiti<\/option><option value=\"HM\" class=\"\">Heard Island And Mcdonald Islands<\/option><option value=\"VA\" class=\"\">Holy See (vatican City State)<\/option><option value=\"HN\" class=\"\">Honduras<\/option><option value=\"HK\" class=\"\">Hong Kong<\/option><option value=\"HU\" class=\"\">Hungary<\/option><option value=\"IS\" class=\"\">Iceland<\/option><option value=\"IN\" class=\"\">India<\/option><option value=\"ID\" class=\"\">Indonesia<\/option><option value=\"IR\" class=\"\">Iran, Islamic Republic Of<\/option><option value=\"IQ\" class=\"\">Iraq<\/option><option value=\"IE\" class=\"\">Ireland<\/option><option value=\"IL\" class=\"\">Israel<\/option><option value=\"IT\" class=\"\">Italy<\/option><option value=\"JM\" class=\"\">Jamaica<\/option><option value=\"JP\" class=\"\">Japan<\/option><option value=\"JO\" class=\"\">Jordan<\/option><option value=\"KZ\" class=\"\">Kazakstan<\/option><option value=\"KE\" class=\"\">Kenya<\/option><option value=\"KI\" class=\"\">Kiribati<\/option><option value=\"KP\" class=\"\">Korea, Democratic People's Republic Of<\/option><option value=\"KR\" class=\"\">Korea, Republic Of<\/option><option value=\"KV\" class=\"\">Kosovo<\/option><option value=\"KW\" class=\"\">Kuwait<\/option><option value=\"KG\" class=\"\">Kyrgyzstan<\/option><option value=\"LA\" class=\"\">Lao People's Democratic Republic<\/option><option value=\"LV\" class=\"\">Latvia<\/option><option value=\"LB\" class=\"\">Lebanon<\/option><option value=\"LS\" class=\"\">Lesotho<\/option><option value=\"LR\" class=\"\">Liberia<\/option><option value=\"LY\" class=\"\">Libyan Arab Jamahiriya<\/option><option value=\"LI\" class=\"\">Liechtenstein<\/option><option value=\"LT\" class=\"\">Lithuania<\/option><option value=\"LU\" class=\"\">Luxembourg<\/option><option value=\"MO\" class=\"\">Macau<\/option><option value=\"MK\" class=\"\">Macedonia, The Former Yugoslav Republic Of<\/option><option value=\"MG\" class=\"\">Madagascar<\/option><option value=\"MW\" class=\"\">Malawi<\/option><option value=\"MY\" class=\"\">Malaysia<\/option><option value=\"MV\" class=\"\">Maldives<\/option><option value=\"ML\" class=\"\">Mali<\/option><option value=\"MT\" class=\"\">Malta<\/option><option value=\"MH\" class=\"\">Marshall Islands<\/option><option value=\"MQ\" class=\"\">Martinique<\/option><option value=\"MR\" class=\"\">Mauritania<\/option><option value=\"MU\" class=\"\">Mauritius<\/option><option value=\"YT\" class=\"\">Mayotte<\/option><option value=\"MX\" class=\"\">Mexico<\/option><option value=\"FM\" class=\"\">Micronesia, Federated States Of<\/option><option value=\"MD\" class=\"\">Moldova, Republic Of<\/option><option value=\"MC\" class=\"\">Monaco<\/option><option value=\"MN\" class=\"\">Mongolia<\/option><option value=\"MS\" class=\"\">Montserrat<\/option><option value=\"ME\" class=\"\">Montenegro<\/option><option value=\"MA\" class=\"\">Morocco<\/option><option value=\"MZ\" class=\"\">Mozambique<\/option><option value=\"MM\" class=\"\">Myanmar<\/option><option value=\"NA\" class=\"\">Namibia<\/option><option value=\"NR\" class=\"\">Nauru<\/option><option value=\"NP\" class=\"\">Nepal<\/option><option value=\"NL\" class=\"\">Netherlands<\/option><option value=\"AN\" class=\"\">Netherlands Antilles<\/option><option value=\"NC\" class=\"\">New Caledonia<\/option><option value=\"NZ\" class=\"\">New Zealand<\/option><option value=\"NI\" class=\"\">Nicaragua<\/option><option value=\"NE\" class=\"\">Niger<\/option><option value=\"NG\" class=\"\">Nigeria<\/option><option value=\"NU\" class=\"\">Niue<\/option><option value=\"NF\" class=\"\">Norfolk Island<\/option><option value=\"MP\" class=\"\">Northern Mariana Islands<\/option><option value=\"NO\" class=\"\">Norway<\/option><option value=\"OM\" class=\"\">Oman<\/option><option value=\"PK\" class=\"\">Pakistan<\/option><option value=\"PW\" class=\"\">Palau<\/option><option value=\"PS\" class=\"\">Palestinian Territory, Occupied<\/option><option value=\"PA\" class=\"\">Panama<\/option><option value=\"PG\" class=\"\">Papua New Guinea<\/option><option value=\"PY\" class=\"\">Paraguay<\/option><option value=\"PE\" class=\"\">Peru<\/option><option value=\"PH\" class=\"\">Philippines<\/option><option value=\"PN\" class=\"\">Pitcairn<\/option><option value=\"PL\" class=\"\">Poland<\/option><option value=\"PT\" class=\"\">Portugal<\/option><option value=\"PR\" class=\"\">Puerto Rico<\/option><option value=\"QA\" class=\"\">Qatar<\/option><option value=\"RE\" class=\"\">Reunion<\/option><option value=\"RO\" class=\"\">Romania<\/option><option value=\"RU\" class=\"\">Russian Federation<\/option><option value=\"RW\" class=\"\">Rwanda<\/option><option value=\"SH\" class=\"\">Saint Helena<\/option><option value=\"KN\" class=\"\">Saint Kitts And Nevis<\/option><option value=\"LC\" class=\"\">Saint Lucia<\/option><option value=\"PM\" class=\"\">Saint Pierre And Miquelon<\/option><option value=\"VC\" class=\"\">Saint Vincent And The Grenadines<\/option><option value=\"WS\" class=\"\">Samoa<\/option><option value=\"SM\" class=\"\">San Marino<\/option><option value=\"ST\" class=\"\">Sao Tome And Principe<\/option><option value=\"SA\" class=\"\">Saudi Arabia<\/option><option value=\"SN\" class=\"\">Senegal<\/option><option value=\"RS\" class=\"\">Serbia<\/option><option value=\"SC\" class=\"\">Seychelles<\/option><option value=\"SL\" class=\"\">Sierra Leone<\/option><option value=\"SG\" class=\"\">Singapore<\/option><option value=\"SK\" class=\"\">Slovakia<\/option><option value=\"SI\" class=\"\">Slovenia<\/option><option value=\"SB\" class=\"\">Solomon Islands<\/option><option value=\"SO\" class=\"\">Somalia<\/option><option value=\"ZA\" class=\"\">South Africa<\/option><option value=\"GS\" class=\"\">South Georgia And The South Sandwich Islands<\/option><option value=\"ES\" class=\"\">Spain<\/option><option value=\"LK\" class=\"\">Sri Lanka<\/option><option value=\"SD\" class=\"\">Sudan<\/option><option value=\"SR\" class=\"\">Suriname<\/option><option value=\"SJ\" class=\"\">Svalbard And Jan Mayen<\/option><option value=\"SZ\" class=\"\">Swaziland<\/option><option value=\"SE\" class=\"\">Sweden<\/option><option value=\"CH\" class=\"\">Switzerland<\/option><option value=\"SY\" class=\"\">Syrian Arab Republic<\/option><option value=\"TW\" class=\"\">Taiwan, Province Of China<\/option><option value=\"TJ\" class=\"\">Tajikistan<\/option><option value=\"TZ\" class=\"\">Tanzania, United Republic Of<\/option><option value=\"TH\" class=\"\">Thailand<\/option><option value=\"TG\" class=\"\">Togo<\/option><option value=\"TK\" class=\"\">Tokelau<\/option><option value=\"TO\" class=\"\">Tonga<\/option><option value=\"TT\" class=\"\">Trinidad And Tobago<\/option><option value=\"TN\" class=\"\">Tunisia<\/option><option value=\"TR\" class=\"\">Turkey<\/option><option value=\"TM\" class=\"\">Turkmenistan<\/option><option value=\"TC\" class=\"\">Turks And Caicos Islands<\/option><option value=\"TV\" class=\"\">Tuvalu<\/option><option value=\"UG\" class=\"\">Uganda<\/option><option value=\"UA\" class=\"\">Ukraine<\/option><option value=\"AE\" class=\"\">United Arab Emirates<\/option><option value=\"GB\" class=\"\">United Kingdom<\/option><option value=\"US\" class=\"\">United States<\/option><option value=\"UM\" class=\"\">United States Minor Outlying Islands<\/option><option value=\"UY\" class=\"\">Uruguay<\/option><option value=\"UZ\" class=\"\">Uzbekistan<\/option><option value=\"VU\" class=\"\">Vanuatu<\/option><option value=\"VE\" class=\"\">Venezuela<\/option><option value=\"VN\" class=\"\">Viet Nam<\/option><option value=\"VG\" class=\"\">Virgin Islands, British<\/option><option value=\"VI\" class=\"\">Virgin Islands, U.s.<\/option><option value=\"WF\" class=\"\">Wallis And Futuna<\/option><option value=\"EH\" class=\"\">Western Sahara<\/option><option value=\"YE\" class=\"\">Yemen<\/option><option value=\"ZM\" class=\"\">Zambia<\/option><option value=\"ZW\" class=\"\">Zimbabwe<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field24\" data-index=\"6\" style=\"width: 50%\" class=\"form-element form-element-field24 options-false form-element-6 default-false form-element-type-dropdown is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Language<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field24\" name=\"field24\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Country of treatment<\/option><option value=\"AF\" class=\"\">Afghanistan<\/option><option value=\"AL\" class=\"\">Albania<\/option><option value=\"DZ\" class=\"\">Algeria<\/option><option value=\"AS\" class=\"\">American Samoa<\/option><option value=\"AD\" class=\"\">Andorra<\/option><option value=\"AO\" class=\"\">Angola<\/option><option value=\"AI\" class=\"\">Anguilla<\/option><option value=\"AQ\" class=\"\">Antarctica<\/option><option value=\"AG\" class=\"\">Antigua And Barbuda<\/option><option value=\"AR\" class=\"\">Argentina<\/option><option value=\"AM\" class=\"\">Armenia<\/option><option value=\"AW\" class=\"\">Aruba<\/option><option value=\"AU\" class=\"\">Australia<\/option><option value=\"AT\" class=\"\">Austria<\/option><option value=\"AZ\" class=\"\">Azerbaijan<\/option><option value=\"BS\" class=\"\">Bahamas<\/option><option value=\"BH\" class=\"\">Bahrain<\/option><option value=\"BD\" class=\"\">Bangladesh<\/option><option value=\"BB\" class=\"\">Barbados<\/option><option value=\"BY\" class=\"\">Belarus<\/option><option value=\"BE\" class=\"\">Belgium<\/option><option value=\"BZ\" class=\"\">Belize<\/option><option value=\"BJ\" class=\"\">Benin<\/option><option value=\"BM\" class=\"\">Bermuda<\/option><option value=\"BT\" class=\"\">Bhutan<\/option><option value=\"BO\" class=\"\">Bolivia<\/option><option value=\"BA\" class=\"\">Bosnia And Herzegovina<\/option><option value=\"BW\" class=\"\">Botswana<\/option><option value=\"BV\" class=\"\">Bouvet Island<\/option><option value=\"BR\" class=\"\">Brazil<\/option><option value=\"IO\" class=\"\">British Indian Ocean Territory<\/option><option value=\"BN\" class=\"\">Brunei Darussalam<\/option><option value=\"BG\" class=\"\">Bulgaria<\/option><option value=\"BF\" class=\"\">Burkina Faso<\/option><option value=\"BI\" class=\"\">Burundi<\/option><option value=\"KH\" class=\"\">Cambodia<\/option><option value=\"CM\" class=\"\">Cameroon<\/option><option value=\"CA\" class=\"\">Canada<\/option><option value=\"CV\" class=\"\">Cape Verde<\/option><option value=\"KY\" class=\"\">Cayman Islands<\/option><option value=\"CF\" class=\"\">Central African Republic<\/option><option value=\"TD\" class=\"\">Chad<\/option><option value=\"CL\" class=\"\">Chile<\/option><option value=\"CN\" class=\"\">China<\/option><option value=\"CX\" class=\"\">Christmas Island<\/option><option value=\"CC\" class=\"\">Cocos (keeling) Islands<\/option><option value=\"CO\" class=\"\">Colombia<\/option><option value=\"KM\" class=\"\">Comoros<\/option><option value=\"CG\" class=\"\">Congo<\/option><option value=\"CD\" class=\"\">Congo, The Democratic Republic Of The<\/option><option value=\"CK\" class=\"\">Cook Islands<\/option><option value=\"CR\" class=\"\">Costa Rica<\/option><option value=\"CI\" class=\"\">Cote D'ivoire<\/option><option value=\"HR\" class=\"\">Croatia<\/option><option value=\"CU\" class=\"\">Cuba<\/option><option value=\"CY\" class=\"\">Cyprus<\/option><option value=\"CZ\" class=\"\">Czech Republic<\/option><option value=\"DK\" class=\"\">Denmark<\/option><option value=\"DJ\" class=\"\">Djibouti<\/option><option value=\"DM\" class=\"\">Dominica<\/option><option value=\"DO\" class=\"\">Dominican Republic<\/option><option value=\"TP\" class=\"\">East Timor<\/option><option value=\"EC\" class=\"\">Ecuador<\/option><option value=\"EG\" class=\"\">Egypt<\/option><option value=\"SV\" class=\"\">El Salvador<\/option><option value=\"GQ\" class=\"\">Equatorial Guinea<\/option><option value=\"ER\" class=\"\">Eritrea<\/option><option value=\"EE\" class=\"\">Estonia<\/option><option value=\"ET\" class=\"\">Ethiopia<\/option><option value=\"FK\" class=\"\">Falkland Islands (malvinas)<\/option><option value=\"FO\" class=\"\">Faroe Islands<\/option><option value=\"FJ\" class=\"\">Fiji<\/option><option value=\"FI\" class=\"\">Finland<\/option><option value=\"FR\" class=\"\">France<\/option><option value=\"GF\" class=\"\">French Guiana<\/option><option value=\"PF\" class=\"\">French Polynesia<\/option><option value=\"TF\" class=\"\">French Southern Territories<\/option><option value=\"GA\" class=\"\">Gabon<\/option><option value=\"GM\" class=\"\">Gambia<\/option><option value=\"GE\" class=\"\">Georgia<\/option><option value=\"DE\" class=\"\">Germany<\/option><option value=\"GH\" class=\"\">Ghana<\/option><option value=\"GI\" class=\"\">Gibraltar<\/option><option value=\"GR\" class=\"\">Greece<\/option><option value=\"GL\" class=\"\">Greenland<\/option><option value=\"GD\" class=\"\">Grenada<\/option><option value=\"GP\" class=\"\">Guadeloupe<\/option><option value=\"GU\" class=\"\">Guam<\/option><option value=\"GT\" class=\"\">Guatemala<\/option><option value=\"GN\" class=\"\">Guinea<\/option><option value=\"GW\" class=\"\">Guinea-bissau<\/option><option value=\"GY\" class=\"\">Guyana<\/option><option value=\"HT\" class=\"\">Haiti<\/option><option value=\"HM\" class=\"\">Heard Island And Mcdonald Islands<\/option><option value=\"VA\" class=\"\">Holy See (vatican City State)<\/option><option value=\"HN\" class=\"\">Honduras<\/option><option value=\"HK\" class=\"\">Hong Kong<\/option><option value=\"HU\" class=\"\">Hungary<\/option><option value=\"IS\" class=\"\">Iceland<\/option><option value=\"IN\" class=\"\">India<\/option><option value=\"ID\" class=\"\">Indonesia<\/option><option value=\"IR\" class=\"\">Iran, Islamic Republic Of<\/option><option value=\"IQ\" class=\"\">Iraq<\/option><option value=\"IE\" class=\"\">Ireland<\/option><option value=\"IL\" class=\"\">Israel<\/option><option value=\"IT\" class=\"\">Italy<\/option><option value=\"JM\" class=\"\">Jamaica<\/option><option value=\"JP\" class=\"\">Japan<\/option><option value=\"JO\" class=\"\">Jordan<\/option><option value=\"KZ\" class=\"\">Kazakstan<\/option><option value=\"KE\" class=\"\">Kenya<\/option><option value=\"KI\" class=\"\">Kiribati<\/option><option value=\"KP\" class=\"\">Korea, Democratic People's Republic Of<\/option><option value=\"KR\" class=\"\">Korea, Republic Of<\/option><option value=\"KV\" class=\"\">Kosovo<\/option><option value=\"KW\" class=\"\">Kuwait<\/option><option value=\"KG\" class=\"\">Kyrgyzstan<\/option><option value=\"LA\" class=\"\">Lao People's Democratic Republic<\/option><option value=\"LV\" class=\"\">Latvia<\/option><option value=\"LB\" class=\"\">Lebanon<\/option><option value=\"LS\" class=\"\">Lesotho<\/option><option value=\"LR\" class=\"\">Liberia<\/option><option value=\"LY\" class=\"\">Libyan Arab Jamahiriya<\/option><option value=\"LI\" class=\"\">Liechtenstein<\/option><option value=\"LT\" class=\"\">Lithuania<\/option><option value=\"LU\" class=\"\">Luxembourg<\/option><option value=\"MO\" class=\"\">Macau<\/option><option value=\"MK\" class=\"\">Macedonia, The Former Yugoslav Republic Of<\/option><option value=\"MG\" class=\"\">Madagascar<\/option><option value=\"MW\" class=\"\">Malawi<\/option><option value=\"MY\" class=\"\">Malaysia<\/option><option value=\"MV\" class=\"\">Maldives<\/option><option value=\"ML\" class=\"\">Mali<\/option><option value=\"MT\" class=\"\">Malta<\/option><option value=\"MH\" class=\"\">Marshall Islands<\/option><option value=\"MQ\" class=\"\">Martinique<\/option><option value=\"MR\" class=\"\">Mauritania<\/option><option value=\"MU\" class=\"\">Mauritius<\/option><option value=\"YT\" class=\"\">Mayotte<\/option><option value=\"MX\" class=\"\">Mexico<\/option><option value=\"FM\" class=\"\">Micronesia, Federated States Of<\/option><option value=\"MD\" class=\"\">Moldova, Republic Of<\/option><option value=\"MC\" class=\"\">Monaco<\/option><option value=\"MN\" class=\"\">Mongolia<\/option><option value=\"MS\" class=\"\">Montserrat<\/option><option value=\"ME\" class=\"\">Montenegro<\/option><option value=\"MA\" class=\"\">Morocco<\/option><option value=\"MZ\" class=\"\">Mozambique<\/option><option value=\"MM\" class=\"\">Myanmar<\/option><option value=\"NA\" class=\"\">Namibia<\/option><option value=\"NR\" class=\"\">Nauru<\/option><option value=\"NP\" class=\"\">Nepal<\/option><option value=\"NL\" class=\"\">Netherlands<\/option><option value=\"AN\" class=\"\">Netherlands Antilles<\/option><option value=\"NC\" class=\"\">New Caledonia<\/option><option value=\"NZ\" class=\"\">New Zealand<\/option><option value=\"NI\" class=\"\">Nicaragua<\/option><option value=\"NE\" class=\"\">Niger<\/option><option value=\"NG\" class=\"\">Nigeria<\/option><option value=\"NU\" class=\"\">Niue<\/option><option value=\"NF\" class=\"\">Norfolk Island<\/option><option value=\"MP\" class=\"\">Northern Mariana Islands<\/option><option value=\"NO\" class=\"\">Norway<\/option><option value=\"OM\" class=\"\">Oman<\/option><option value=\"PK\" class=\"\">Pakistan<\/option><option value=\"PW\" class=\"\">Palau<\/option><option value=\"PS\" class=\"\">Palestinian Territory, Occupied<\/option><option value=\"PA\" class=\"\">Panama<\/option><option value=\"PG\" class=\"\">Papua New Guinea<\/option><option value=\"PY\" class=\"\">Paraguay<\/option><option value=\"PE\" class=\"\">Peru<\/option><option value=\"PH\" class=\"\">Philippines<\/option><option value=\"PN\" class=\"\">Pitcairn<\/option><option value=\"PL\" class=\"\">Poland<\/option><option value=\"PT\" class=\"\">Portugal<\/option><option value=\"PR\" class=\"\">Puerto Rico<\/option><option value=\"QA\" class=\"\">Qatar<\/option><option value=\"RE\" class=\"\">Reunion<\/option><option value=\"RO\" class=\"\">Romania<\/option><option value=\"RU\" class=\"\">Russian Federation<\/option><option value=\"RW\" class=\"\">Rwanda<\/option><option value=\"SH\" class=\"\">Saint Helena<\/option><option value=\"KN\" class=\"\">Saint Kitts And Nevis<\/option><option value=\"LC\" class=\"\">Saint Lucia<\/option><option value=\"PM\" class=\"\">Saint Pierre And Miquelon<\/option><option value=\"VC\" class=\"\">Saint Vincent And The Grenadines<\/option><option value=\"WS\" class=\"\">Samoa<\/option><option value=\"SM\" class=\"\">San Marino<\/option><option value=\"ST\" class=\"\">Sao Tome And Principe<\/option><option value=\"SA\" class=\"\">Saudi Arabia<\/option><option value=\"SN\" class=\"\">Senegal<\/option><option value=\"RS\" class=\"\">Serbia<\/option><option value=\"SC\" class=\"\">Seychelles<\/option><option value=\"SL\" class=\"\">Sierra Leone<\/option><option value=\"SG\" class=\"\">Singapore<\/option><option value=\"SK\" class=\"\">Slovakia<\/option><option value=\"SI\" class=\"\">Slovenia<\/option><option value=\"SB\" class=\"\">Solomon Islands<\/option><option value=\"SO\" class=\"\">Somalia<\/option><option value=\"ZA\" class=\"\">South Africa<\/option><option value=\"GS\" class=\"\">South Georgia And The South Sandwich Islands<\/option><option value=\"ES\" class=\"\">Spain<\/option><option value=\"LK\" class=\"\">Sri Lanka<\/option><option value=\"SD\" class=\"\">Sudan<\/option><option value=\"SR\" class=\"\">Suriname<\/option><option value=\"SJ\" class=\"\">Svalbard And Jan Mayen<\/option><option value=\"SZ\" class=\"\">Swaziland<\/option><option value=\"SE\" class=\"\">Sweden<\/option><option value=\"CH\" class=\"\">Switzerland<\/option><option value=\"SY\" class=\"\">Syrian Arab Republic<\/option><option value=\"TW\" class=\"\">Taiwan, Province Of China<\/option><option value=\"TJ\" class=\"\">Tajikistan<\/option><option value=\"TZ\" class=\"\">Tanzania, United Republic Of<\/option><option value=\"TH\" class=\"\">Thailand<\/option><option value=\"TG\" class=\"\">Togo<\/option><option value=\"TK\" class=\"\">Tokelau<\/option><option value=\"TO\" class=\"\">Tonga<\/option><option value=\"TT\" class=\"\">Trinidad And Tobago<\/option><option value=\"TN\" class=\"\">Tunisia<\/option><option value=\"TR\" class=\"\">Turkey<\/option><option value=\"TM\" class=\"\">Turkmenistan<\/option><option value=\"TC\" class=\"\">Turks And Caicos Islands<\/option><option value=\"TV\" class=\"\">Tuvalu<\/option><option value=\"UG\" class=\"\">Uganda<\/option><option value=\"UA\" class=\"\">Ukraine<\/option><option value=\"AE\" class=\"\">United Arab Emirates<\/option><option value=\"GB\" class=\"\">United Kingdom<\/option><option value=\"US\" class=\"\">United States<\/option><option value=\"UM\" class=\"\">United States Minor Outlying Islands<\/option><option value=\"UY\" class=\"\">Uruguay<\/option><option value=\"UZ\" class=\"\">Uzbekistan<\/option><option value=\"VU\" class=\"\">Vanuatu<\/option><option value=\"VE\" class=\"\">Venezuela<\/option><option value=\"VN\" class=\"\">Viet Nam<\/option><option value=\"VG\" class=\"\">Virgin Islands, British<\/option><option value=\"VI\" class=\"\">Virgin Islands, U.s.<\/option><option value=\"WF\" class=\"\">Wallis And Futuna<\/option><option value=\"EH\" class=\"\">Western Sahara<\/option><option value=\"YE\" class=\"\">Yemen<\/option><option value=\"ZM\" class=\"\">Zambia<\/option><option value=\"ZW\" class=\"\">Zimbabwe<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field26\" data-index=\"7\" style=\"width: 100%\" class=\"even form-element form-element-field26 options- form-element-7 default-false form-element-type- is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-true\"><span class=\"main-label\"><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field39\" data-index=\"8\" style=\"width: 100%\" class=\"form-element form-element-field39 options-false form-element-8 default-false form-element-type-customText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"absolute-false customText-cover field-cover\" style=\"left: ; top: ;right: ;bottom: ;color: #666666 !important; background-color:\"><div class=\"full\" style=\"text-align: left\"><h1 style=\"text-align: center\" >Egg donor physical characteristics<\/h1><hr ><\/div><input type=\"hidden\" name=\"field39\" data-field-id=\"field39\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field41\" data-index=\"9\" style=\"width: 50%\" class=\"even form-element form-element-field41 options-false form-element-9 default-false form-element-type-dropdown is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Age From<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field41\" name=\"field41\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\"> Age From<\/option><option value=\"\" class=\"\"><\/option><option value=\"18\" class=\"\">18<\/option><option value=\"19\" class=\"\">19<\/option><option value=\"20\" class=\"\">20<\/option><option value=\"21\" class=\"\">21<\/option><option value=\"22\" class=\"\">22<\/option><option value=\"23\" class=\"\">23<\/option><option value=\"24\" class=\"\">24<\/option><option value=\"25\" class=\"\">25<\/option><option value=\"26\" class=\"\">26<\/option><option value=\"27\" class=\"\">27<\/option><option value=\"28\" class=\"\">28<\/option><option value=\"29\" class=\"\">29<\/option><option value=\"30\" class=\"\">30<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field42\" data-index=\"10\" style=\"width: 50%\" class=\"form-element form-element-field42 options-false form-element-10 default-false form-element-type-dropdown is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Age From<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field42\" name=\"field42\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Age To<\/option><option value=\"18\" class=\"\">18<\/option><option value=\"19\" class=\"\">19<\/option><option value=\"20\" class=\"\">20<\/option><option value=\"21\" class=\"\">21<\/option><option value=\"22\" class=\"\">22<\/option><option value=\"23\" class=\"\">23<\/option><option value=\"24\" class=\"\">24<\/option><option value=\"25\" class=\"\">25<\/option><option value=\"26\" class=\"\">26<\/option><option value=\"27\" class=\"\">27<\/option><option value=\"28\" class=\"\">28<\/option><option value=\"29\" class=\"\">29<\/option><option value=\"30\" class=\"\">30<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field43\" data-index=\"11\" style=\"width: 50%\" class=\"even form-element form-element-field43 options-false form-element-11 default-false form-element-type-dropdown is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Race<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field43\" name=\"field43\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Select Race<\/option><option value=\"Caucasian\" class=\"\">Caucasian<\/option><option value=\"Asian\" class=\"\">Asian<\/option><option value=\"Indian\" class=\"\">Indian<\/option><option value=\"Latin\" class=\"\">Latin<\/option><option value=\"Mongoloid\" class=\"\">Mongoloid<\/option><option value=\"African\" class=\"\">African<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field44\" data-index=\"12\" style=\"width: 50%\" class=\"form-element form-element-field44 options-false form-element-12 default-false form-element-type-dropdown is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Blood group and Rh<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field44\" name=\"field44\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Blood group and Rh<\/option><option value=\"B(III) Rh+\" class=\"\">B(III) Rh+<\/option><option value=\"AB(IV) Rh+\" class=\"\">AB(IV) Rh+<\/option><option value=\"O(I) Rh+\" class=\"\">O(I) Rh+<\/option><option value=\"A(II) Rh+\" class=\"\">A(II) Rh+<\/option><option value=\"O(I) Rh-\" class=\"\">O(I) Rh-<\/option><option value=\"A(II) Rh-\" class=\"\">A(II) Rh-<\/option><option value=\"B(III) Rh-\" class=\"\">B(III) Rh-<\/option><option value=\"AB(IV) Rh-\" class=\"\">AB(IV) Rh-<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field45\" data-index=\"13\" style=\"width: 50%\" class=\"even form-element form-element-field45 options-false form-element-13 default-false form-element-type-dropdown is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Select Aye Color<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field45\" name=\"field45\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Select Aye Color<\/option><option value=\"Blue\" class=\"\">Blue<\/option><option value=\"Black\" class=\"\">Black<\/option><option value=\"Hazel\" class=\"\">Hazel<\/option><option value=\"Brown\" class=\"\">Brown<\/option><option value=\"Green \" class=\"\">Green <\/option><option value=\"Gray\" class=\"\">Gray<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field46\" data-index=\"14\" style=\"width: 50%\" class=\"form-element form-element-field46 options-false form-element-14 default-false form-element-type- is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Select Hair Color<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field46\" name=\"field46\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Select Hair Color<\/option><option value=\"Brown\" class=\"\">Brown<\/option><option value=\"Blond\" class=\"\">Blond<\/option><option value=\"Black\" class=\"\">Black<\/option><option value=\"Red\" class=\"\">Red<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field47\" data-index=\"15\" style=\"width: 50%\" class=\"even form-element form-element-field47 options-false form-element-15 default-false form-element-type-dropdown is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Height (cm)<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field47\" name=\"field47\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Height (cm) From<\/option><option value=\"151\" class=\"\">151<\/option><option value=\"152\" class=\"\">152<\/option><option value=\"153\" class=\"\">153<\/option><option value=\"154\" class=\"\">154<\/option><option value=\"155\" class=\"\">155<\/option><option value=\"156\" class=\"\">156<\/option><option value=\"157\" class=\"\">157<\/option><option value=\"158\" class=\"\">158<\/option><option value=\"159\" class=\"\">159<\/option><option value=\"160\" class=\"\">160<\/option><option value=\"161\" class=\"\">161<\/option><option value=\"162\" class=\"\">162<\/option><option value=\"163\" class=\"\">163<\/option><option value=\"164\" class=\"\">164<\/option><option value=\"165\" class=\"\">165<\/option><option value=\"166\" class=\"\">166<\/option><option value=\"167\" class=\"\">167<\/option><option value=\"168\" class=\"\">168<\/option><option value=\"169\" class=\"\">169<\/option><option value=\"170\" class=\"\">170<\/option><option value=\"171\" class=\"\">171<\/option><option value=\"172\" class=\"\">172<\/option><option value=\"173\" class=\"\">173<\/option><option value=\"174\" class=\"\">174<\/option><option value=\"175\" class=\"\">175<\/option><option value=\"176\" class=\"\">176<\/option><option value=\"177\" class=\"\">177<\/option><option value=\"178\" class=\"\">178<\/option><option value=\"179\" class=\"\">179<\/option><option value=\"180\" class=\"\">180<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field48\" data-index=\"16\" style=\"width: 50%\" class=\"form-element form-element-field48 options-false form-element-16 default-false form-element-type-dropdown is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Language<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field48\" name=\"field48\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Height (cm) To<\/option><option value=\"151\" class=\"\">151<\/option><option value=\"152\" class=\"\">152<\/option><option value=\"153\" class=\"\">153<\/option><option value=\"154\" class=\"\">154<\/option><option value=\"155\" class=\"\">155<\/option><option value=\"156\" class=\"\">156<\/option><option value=\"157\" class=\"\">157<\/option><option value=\"158\" class=\"\">158<\/option><option value=\"159\" class=\"\">159<\/option><option value=\"160\" class=\"\">160<\/option><option value=\"161\" class=\"\">161<\/option><option value=\"162\" class=\"\">162<\/option><option value=\"163\" class=\"\">163<\/option><option value=\"164\" class=\"\">164<\/option><option value=\"165\" class=\"\">165<\/option><option value=\"166\" class=\"\">166<\/option><option value=\"167\" class=\"\">167<\/option><option value=\"168\" class=\"\">168<\/option><option value=\"169\" class=\"\">169<\/option><option value=\"170\" class=\"\">170<\/option><option value=\"171\" class=\"\">171<\/option><option value=\"172\" class=\"\">172<\/option><option value=\"173\" class=\"\">173<\/option><option value=\"174\" class=\"\">174<\/option><option value=\"175\" class=\"\">175<\/option><option value=\"176\" class=\"\">176<\/option><option value=\"177\" class=\"\">177<\/option><option value=\"178\" class=\"\">178<\/option><option value=\"179\" class=\"\">179<\/option><option value=\"180\" class=\"\">180<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field49\" data-index=\"17\" style=\"width: 50%\" class=\"even form-element form-element-field49 options-false form-element-17 default-false form-element-type-dropdown is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Language<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field49\" name=\"field49\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Weight (kg) From<\/option><option value=\"151\" class=\"\">151<\/option><option value=\"152\" class=\"\">152<\/option><option value=\"153\" class=\"\">153<\/option><option value=\"154\" class=\"\">154<\/option><option value=\"155\" class=\"\">155<\/option><option value=\"156\" class=\"\">156<\/option><option value=\"157\" class=\"\">157<\/option><option value=\"158\" class=\"\">158<\/option><option value=\"159\" class=\"\">159<\/option><option value=\"160\" class=\"\">160<\/option><option value=\"161\" class=\"\">161<\/option><option value=\"162\" class=\"\">162<\/option><option value=\"163\" class=\"\">163<\/option><option value=\"164\" class=\"\">164<\/option><option value=\"165\" class=\"\">165<\/option><option value=\"166\" class=\"\">166<\/option><option value=\"167\" class=\"\">167<\/option><option value=\"168\" class=\"\">168<\/option><option value=\"169\" class=\"\">169<\/option><option value=\"170\" class=\"\">170<\/option><option value=\"171\" class=\"\">171<\/option><option value=\"172\" class=\"\">172<\/option><option value=\"173\" class=\"\">173<\/option><option value=\"174\" class=\"\">174<\/option><option value=\"175\" class=\"\">175<\/option><option value=\"176\" class=\"\">176<\/option><option value=\"177\" class=\"\">177<\/option><option value=\"178\" class=\"\">178<\/option><option value=\"179\" class=\"\">179<\/option><option value=\"180\" class=\"\">180<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field50\" data-index=\"18\" style=\"width: 50%\" class=\"form-element form-element-field50 options-false form-element-18 default-false form-element-type-dropdown is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Weight<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"true\" class=\"validation-lenient\" data-field-id=\"field50\" name=\"field50\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Weight (kg) To<\/option><option value=\"151\" class=\"\">151<\/option><option value=\"152\" class=\"\">152<\/option><option value=\"153\" class=\"\">153<\/option><option value=\"154\" class=\"\">154<\/option><option value=\"155\" class=\"\">155<\/option><option value=\"156\" class=\"\">156<\/option><option value=\"157\" class=\"\">157<\/option><option value=\"158\" class=\"\">158<\/option><option value=\"159\" class=\"\">159<\/option><option value=\"160\" class=\"\">160<\/option><option value=\"161\" class=\"\">161<\/option><option value=\"162\" class=\"\">162<\/option><option value=\"163\" class=\"\">163<\/option><option value=\"164\" class=\"\">164<\/option><option value=\"165\" class=\"\">165<\/option><option value=\"166\" class=\"\">166<\/option><option value=\"167\" class=\"\">167<\/option><option value=\"168\" class=\"\">168<\/option><option value=\"169\" class=\"\">169<\/option><option value=\"170\" class=\"\">170<\/option><option value=\"171\" class=\"\">171<\/option><option value=\"172\" class=\"\">172<\/option><option value=\"173\" class=\"\">173<\/option><option value=\"174\" class=\"\">174<\/option><option value=\"175\" class=\"\">175<\/option><option value=\"176\" class=\"\">176<\/option><option value=\"177\" class=\"\">177<\/option><option value=\"178\" class=\"\">178<\/option><option value=\"179\" class=\"\">179<\/option><option value=\"180\" class=\"\">180<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field51\" data-index=\"19\" style=\"width: 100%\" class=\"even form-element form-element-field51 options-false form-element-19 default-false form-element-type-dropdown is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"dropdown-cover field-cover autocomplete-type-\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Number of oocytes to be ordered<\/span><\/span><span class=\"sub-label\"><span >pick one!<\/span><\/span><\/span><div><span class=\"error\"><\/span><select data-is-required=\"false\" class=\"validation-lenient\" data-field-id=\"field51\" name=\"field51\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><option value=\"\" class=\"\">Number of oocytes to be ordered<\/option><option value=\"1\" class=\"\">1<\/option><option value=\"2\" class=\"\">2<\/option><option value=\"3\" class=\"\">3<\/option><option value=\"4\" class=\"\">4<\/option><option value=\"5\" class=\"\">5<\/option><option value=\"6\" class=\"\">6<\/option><option value=\"7\" class=\"\">7<\/option><option value=\"8\" class=\"\">8<\/option><option value=\"9\" class=\"\">9<\/option><option value=\"10\" class=\"\">10<\/option><option value=\"11\" class=\"\">11<\/option><option value=\"12\" class=\"\">12<\/option><option value=\"13\" class=\"\">13<\/option><option value=\"14\" class=\"\">14<\/option><option value=\"15\" class=\"\">15<\/option><option value=\"16\" class=\"\">16<\/option><option value=\"17\" class=\"\">17<\/option><option value=\"18\" class=\"\">18<\/option><option value=\"19\" class=\"\">19<\/option><option value=\"20\" class=\"\">20<\/option><option value=\"21\" class=\"\">21<\/option><option value=\"22\" class=\"\">22<\/option><option value=\"23\" class=\"\">23<\/option><option value=\"24\" class=\"\">24<\/option><option value=\"25\" class=\"\">25<\/option><option value=\"26\" class=\"\">26<\/option><option value=\"27\" class=\"\">27<\/option><option value=\"28\" class=\"\">28<\/option><option value=\"29\" class=\"\">29<\/option><option value=\"30\" class=\"\">30<\/option><option value=\"31\" class=\"\">31<\/option><option value=\"32\" class=\"\">32<\/option><option value=\"33\" class=\"\">33<\/option><option value=\"34\" class=\"\">34<\/option><option value=\"35\" class=\"\">35<\/option><\/select><input type=\"text\"><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field53\" data-index=\"20\" style=\"width: 100%\" class=\"form-element form-element-field53 options-false form-element-20 default-false form-element-type-checkbox is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field53\" type=\"checkbox\" data-is-required=\"true\" name=\"field53[]\" value=\"I have read and accept the terms of use\" class=\"validation-lenient\"><span><span >I have read and accept the terms of use<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field53\" type=\"checkbox\" data-is-required=\"true\" name=\"field53[]\" value=\"I would like to receive company news, offers, egg donor notifications\" class=\"validation-lenient\"><span><span >I would like to receive company news, offers, egg donor notifications<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field3\" data-index=\"21\" style=\"width: 100%\" class=\"even form-element form-element-field3 options-false form-element-21 default-false form-element-type-submit is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"align-right wide-true submit-cover field-cover\"><button type=\"submit\" class=\"button submit-button\"><span class=\"text\">SEND!<\/span><span class=\"spin-cover\"><i style=\"color:\" class=\"loading-icon icon-cog animate-spin\"><\/i><\/span><\/button><\/div><div class=\"submit-response\"><\/div><label ><input type=\"text\" class=\"required_field\" name=\"website\" autocomplete=\"maple-syrup-pot\"><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div><!-- end ngRepeat: page in Builder.FormElements track by $index -->\n\t\t\t<input type=\"hidden\" name=\"trp-form-language\" value=\"sq\"\/><\/form>\n\t\t\t<div class=\"prev-next prev-next-1\" style=\"width: 1250px; color: #777777; font-size: 125%; background: url(https:\/\/mshcreativebeta.com\/stemgene\/wp-content\/plugins\/formcraft3\/views\/..\/assets\/images\/backgrounds\/fibre.png)\">\n\t\t\t\t<div>\n\t\t\t\t\t\n\t\t\t\t\t<span class=\"inactive page-prev\"><i class=\"formcraft-icon\">keyboard_arrow_left<\/i>Previous<\/span><\/div>\n\t\t\t\t<div>\n\t\t\t\t\t\n\t\t\t\t\t<span class=\"page-next\">Next<i class=\"formcraft-icon\">keyboard_arrow_right<\/i><\/span><\/div>\n\t\t\t<\/div>\n\t\t<\/div><a class=\"powered-by\" target=\"_blank\" href=\"http:\/\/formcraft-wp.com?source=pb\"\/>FormCraft - WordPress form builder<\/a><\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>1 Step 1 Patient personal contact data Nameyour full name Surnameyour full name E Mailyour full name Phoneyour full name<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-15882","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.3 - 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