{"id":791,"date":"2019-01-07T10:44:47","date_gmt":"2019-01-07T10:44:47","guid":{"rendered":"https:\/\/c1mdevsite.com\/evexipel.com\/?page_id=791"},"modified":"2019-03-26T05:10:28","modified_gmt":"2019-03-26T10:10:28","slug":"bhrt-checklist-for-woman","status":"publish","type":"page","link":"https:\/\/c1mdevsite.com\/evexipel.com\/bhrt-checklist-for-woman\/","title":{"rendered":"BHRT Checklist for Woman"},"content":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; equal_height=&#8221;yes&#8221; content_placement=&#8221;middle&#8221; css=&#8221;.vc_custom_1546846507724{padding-top: 100px !important;padding-bottom: 135px !important;background-image: url(https:\/\/c1mdevsite.com\/evexipel.com\/wp-content\/uploads\/2019\/01\/slider-2-1.jpg?id=790) !important;}&#8221;][vc_column][vc_custom_heading text=&#8221;BHRT Checklist for Women&#8221; font_container=&#8221;tag:h2|font_size:50px|text_align:center|color:%23ffffff|line_height:60px&#8221; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1548312295395{margin-top: 0px !important;margin-bottom: 0px !important;}&#8221;][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1549030613243{padding-bottom: 100px !important;}&#8221;][vc_column][vc_column_text css=&#8221;.vc_custom_1549027867775{margin-top: 15px !important;margin-bottom: 15px !important;}&#8221;]<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/c1mdevsite.com\/evexipel.com\/privacy-policy\/\" target=\"_blank\" rel=\"noopener noreferrer\">Privacy Policy<\/a><\/p>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<div class=\"checklist-form-wrap\">\n<div class=\"checklist-step checklist-step-active\">\n<div class=\"progress\">\n<div class=\"progress-bar progress-bar-striped\" style=\"width: 50%;\" role=\"progressbar\" aria-valuenow=\"50\" aria-valuemin=\"0\" aria-valuemax=\"100\"><span class=\"sr-only\">50% Complete (success)<\/span><\/div>\n<\/div>\n<form id=\"inf_form_2b227ec9495e8e85eb1eaded14b79d5b\" class=\"infusion-form\" accept-charset=\"UTF-8\" action=\"\" method=\"POST\"><input name=\"inf_form_xid\" type=\"hidden\" value=\"2b227ec9495e8e85eb1eaded14b79d5b\" \/> <input name=\"inf_form_name\" type=\"hidden\" value=\"BHRT Checklist for Women\" \/> <input name=\"infusionsoft_version\" type=\"hidden\" value=\"1.70.0.77019\" \/><\/p>\n<div class=\"row\">\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\"><label for=\"inf_field_FirstName\">First Name *<\/label> <input id=\"inf_field_FirstName\" class=\"infusion-field-input required\" name=\"inf_field_FirstName\" type=\"text\" placeholder=\"First Name *\" \/><\/div>\n<\/div>\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\"><label for=\"inf_field_LastName\">Last Name *<\/label> <input id=\"inf_field_LastName\" class=\"infusion-field-input required\" name=\"inf_field_LastName\" type=\"text\" placeholder=\"Last Name *\" \/><\/div>\n<\/div>\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\"><label for=\"inf_field_Email\">Email *<\/label> <input id=\"inf_field_Email\" class=\"infusion-field-input required\" name=\"inf_field_Email\" type=\"text\" placeholder=\"Email *\" \/><\/div>\n<\/div>\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\"><label for=\"inf_field_Phone1\">Phone *<\/label> <input id=\"inf_field_Phone1\" class=\"infusion-field-input required\" name=\"inf_field_Phone1\" type=\"text\" placeholder=\"Phone\" \/><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Whatisthebestwaytocontactyou\">What is the best way to contact you?<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Whatisthebestwaytocontactyou_Email\" name=\"inf_custom_Whatisthebestwaytocontactyou\" type=\"radio\" value=\"Email\" \/> <label for=\"inf_custom_Whatisthebestwaytocontactyou_Email\">Email<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Whatisthebestwaytocontactyou_Phone\" name=\"inf_custom_Whatisthebestwaytocontactyou\" type=\"radio\" value=\"Phone\" \/> <label for=\"inf_custom_Whatisthebestwaytocontactyou_Phone\">Phone<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Whatisthebestwaytocontactyou_Text\" name=\"inf_custom_Whatisthebestwaytocontactyou\" type=\"radio\" value=\"Text\" \/> <label for=\"inf_custom_Whatisthebestwaytocontactyou_Text\">Text<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"row\">\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\"><label for=\"inf_custom_Besttimetoreachcontact\">What is the best time to reach you?<\/label> <input id=\"inf_custom_Besttimetoreachcontact\" class=\"infusion-field-input\" name=\"inf_custom_Besttimetoreachcontact\" type=\"text\" placeholder=\"What is the best time to reach you?\" \/><\/div>\n<\/div>\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\"><label for=\"inf_field_StreetAddress1\">Street Address<\/label> <input id=\"inf_field_StreetAddress1\" class=\"infusion-field-input\" name=\"inf_field_StreetAddress1\" type=\"text\" placeholder=\"Street Address\" \/><\/div>\n<\/div>\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\"><label for=\"inf_field_City\">City<\/label> <input id=\"inf_field_City\" class=\"infusion-field-input\" name=\"inf_field_City\" type=\"text\" placeholder=\"City\" \/><\/div>\n<\/div>\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\"><label for=\"inf_field_State\">State\/Province\/Region<\/label> <input id=\"inf_field_State\" class=\"infusion-field-input\" name=\"inf_field_State\" type=\"text\" placeholder=\"State\/Province\/Region\" \/><\/div>\n<\/div>\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\"><label for=\"inf_field_PostalCode\">Zip\/Postal Code *<\/label> <input id=\"inf_field_PostalCode\" class=\"infusion-field-input required\" name=\"inf_field_PostalCode\" type=\"text\" placeholder=\"Zip\/Postal Code\" \/><\/div>\n<\/div>\n<div class=\"col-sm-6\">\n<div class=\"infusion-field\">\n<p><label for=\"inf_field_Country\">Country<\/label><\/p>\n<div class=\"infusion-field-input-container\"><select id=\"inf_field_Country\" name=\"inf_field_Country\"><option value=\"\">Please select one<\/option><option value=\"Afghanistan\">Afghanistan<\/option><option value=\"\u2248land Islands\">\u2248land Islands<\/option><option value=\"Albania\">Albania<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"American Samoa\">American Samoa<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"Angola\">Angola<\/option><option value=\"Anguilla\">Anguilla<\/option><option value=\"Antarctica\">Antarctica<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"Aruba\">Aruba<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Bahamas (the)\">Bahamas (the)<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Belize\">Belize<\/option><option value=\"Benin\">Benin<\/option><option value=\"Bermuda\">Bermuda<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Bolivia (Plurinational State of)\">Bolivia (Plurinational State of)<\/option><option value=\"Bonaire, Sint Eustatius and Saba\">Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Bouvet Island\">Bouvet Island<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"British Indian Ocean Territory (the)\">British Indian Ocean Territory (the)<\/option><option value=\"Brunei Darussalam\">Brunei Darussalam<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Cabo Verde\">Cabo Verde<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Canada\">Canada<\/option><option value=\"Cayman Islands (the)\">Cayman Islands (the)<\/option><option value=\"Central African Republic (the)\">Central African Republic (the)<\/option><option value=\"Chad\">Chad<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"Christmas Island\">Christmas Island<\/option><option value=\"Cocos (Keeling) Islands (the)\">Cocos (Keeling) Islands (the)<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Comoros (the)\">Comoros (the)<\/option><option value=\"Congo (the Democratic Republic of the)\">Congo (the Democratic Republic of the)<\/option><option value=\"Congo (the)\">Congo (the)<\/option><option value=\"Cook Islands (the)\">Cook Islands (the)<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"C\u00d9te d'Ivoire\">C\u00d9te d&#8217;Ivoire<\/option><option value=\"Croatia\">Croatia<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cura\u00c1ao\">Cura\u00c1ao<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic (the)\">Czech Republic (the)<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominican Republic (the)\">Dominican Republic (the)<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Falkland Islands (the) [Malvinas]\">Falkland Islands (the) [Malvinas]<\/option><option value=\"Faroe Islands (the)\">Faroe Islands (the)<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"Finland\">Finland<\/option><option value=\"France\">France<\/option><option value=\"French Guiana\">French Guiana<\/option><option value=\"French Polynesia\">French Polynesia<\/option><option value=\"French Southern Territories (the)\">French Southern Territories (the)<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Gambia (the)\">Gambia (the)<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Germany\">Germany<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Gibraltar\">Gibraltar<\/option><option value=\"Greece\">Greece<\/option><option value=\"Greenland\">Greenland<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guadeloupe\">Guadeloupe<\/option><option value=\"Guam\">Guam<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guernsey\">Guernsey<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Heard Island and McDonald Islands\">Heard Island and McDonald Islands<\/option><option value=\"Holy See (the)\">Holy See (the)<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Hong Kong\">Hong Kong<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"India\">India<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"Iran (Islamic Republic of)\">Iran (Islamic Republic of)<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Isle of Man\">Isle of Man<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Japan\">Japan<\/option><option value=\"Jersey\">Jersey<\/option><option value=\"Johnston Island\">Johnston Island<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Korea (the Democratic People's Republic of)\">Korea (the Democratic People&#8217;s Republic of)<\/option><option value=\"Korea (the Republic of)\">Korea (the Republic of)<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic (the)\">Lao People&#8217;s Democratic Republic (the)<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libya\">Libya<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Macao\">Macao<\/option><option value=\"Macedonia (the former Yugoslav Republic of)\">Macedonia (the former Yugoslav Republic of)<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Marshall Islands (the)\">Marshall Islands (the)<\/option><option value=\"Martinique\">Martinique<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Mayotte\">Mayotte<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Micronesia (Federated States of)\">Micronesia (Federated States of)<\/option><option value=\"Midway Islands\">Midway Islands<\/option><option value=\"Moldova (the Republic of)\">Moldova (the Republic of)<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Montenegro\">Montenegro<\/option><option value=\"Montserrat\">Montserrat<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"Nepal\">Nepal<\/option><option value=\"Netherlands (the)\">Netherlands (the)<\/option><option value=\"New Caledonia\">New Caledonia<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Niger (the)\">Niger (the)<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Niue\">Niue<\/option><option value=\"Norfolk Island\">Norfolk Island<\/option><option value=\"Northern Mariana Islands (the)\">Northern Mariana Islands (the)<\/option><option value=\"Norway\">Norway<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Palau\">Palau<\/option><option value=\"Palestine, State of\">Palestine, State of<\/option><option value=\"Panama\">Panama<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines (the)\">Philippines (the)<\/option><option value=\"Pitcairn\">Pitcairn<\/option><option value=\"Poland\">Poland<\/option><option value=\"Portugal\">Portugal<\/option><option value=\"Puerto Rico\">Puerto Rico<\/option><option value=\"Qatar\">Qatar<\/option><option value=\"R\u00c8union\">R\u00c8union<\/option><option value=\"Romania\">Romania<\/option><option value=\"Russian Federation (the)\">Russian Federation (the)<\/option><option value=\"Rwanda\">Rwanda<\/option><option value=\"Saint Barth\u00c8lemy\">Saint Barth\u00c8lemy<\/option><option value=\"Saint Helena, Ascension and Tristan da Cunha\">Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Martin (French part)\">Saint Martin (French part)<\/option><option value=\"Saint Pierre and Miquelon\">Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option value=\"Saudi Arabia\">Saudi Arabia<\/option><option value=\"Senegal\">Senegal<\/option><option value=\"Serbia\">Serbia<\/option><option value=\"Seychelles\">Seychelles<\/option><option value=\"Sierra Leone\">Sierra Leone<\/option><option value=\"Singapore\">Singapore<\/option><option value=\"Sint Maarten (Dutch part)\">Sint Maarten (Dutch part)<\/option><option value=\"Slovakia\">Slovakia<\/option><option value=\"Slovenia\">Slovenia<\/option><option value=\"Solomon Islands\">Solomon Islands<\/option><option value=\"Somalia\">Somalia<\/option><option value=\"South Africa\">South Africa<\/option><option value=\"South Georgia and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/option><option value=\"South Sudan\">South Sudan<\/option><option value=\"Southern Rhodesia\">Southern Rhodesia<\/option><option value=\"Spain\">Spain<\/option><option value=\"Sri Lanka\">Sri Lanka<\/option><option value=\"Sudan (the)\">Sudan (the)<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Svalbard and Jan Mayen\">Svalbard and Jan Mayen<\/option><option value=\"Swaziland\">Swaziland<\/option><option value=\"Sweden\">Sweden<\/option><option value=\"Switzerland\">Switzerland<\/option><option value=\"Syrian Arab Republic\">Syrian Arab Republic<\/option><option value=\"Taiwan (Province of China)\">Taiwan (Province of China)<\/option><option value=\"Tajikistan\">Tajikistan<\/option><option value=\"Tanzania, United Republic of\">Tanzania, United Republic of<\/option><option value=\"Thailand\">Thailand<\/option><option value=\"Timor-Leste\">Timor-Leste<\/option><option value=\"Togo\">Togo<\/option><option value=\"Tokelau\">Tokelau<\/option><option value=\"Tonga\">Tonga<\/option><option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Turks and Caicos Islands (the)\">Turks and Caicos Islands (the)<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"United Arab Emirates (the)\">United Arab Emirates (the)<\/option><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"United States\">United States<\/option><option value=\"United States Minor Outlying Islands (the)\">United States Minor Outlying Islands (the)<\/option><option value=\"Upper Volta\">Upper Volta<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Venezuela (Bolivarian Republic of)\">Venezuela (Bolivarian Republic of)<\/option><option value=\"Viet Nam\">Viet Nam<\/option><option value=\"Virgin Islands (British)\">Virgin Islands (British)<\/option><option value=\"Virgin Islands (U.S.)\">Virgin Islands (U.S.)<\/option><option value=\"Wallis and Futuna\">Wallis and Futuna<\/option><option value=\"Western Sahara\">Western Sahara<\/option><option value=\"Yemen\">Yemen<\/option><option value=\"Zambia\">Zambia<\/option><option value=\"Zimbabwe\">Zimbabwe<\/option><\/select><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\"><label for=\"inf_custom_Comments\">Additional Info<\/label><textarea id=\"inf_custom_Comments\" cols=\"24\" name=\"inf_custom_Comments\" rows=\"5\" placeholder=\"Additional Info\"><\/textarea><\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Howdidyouhearaboutus\">How did you hear about us?<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_Search Engine\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"Search Engine\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_Search Engine\">Search Engine<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_Radio\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"Radio\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_Radio\">Radio<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_Yellow Pages\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"Yellow Pages\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_Yellow Pages\">Yellow Pages<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_Twitter\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"Twitter\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_Twitter\">Twitter<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_Facebook\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"Facebook\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_Facebook\">Facebook<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_Instagram\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"Instagram\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_Instagram\">Instagram<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_TV\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"TV\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_TV\">TV<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_Physician\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"Physician\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_Physician\">Physician<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_Friend \/ Family Member\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"Friend \/ Family Member\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_Friend \/ Family Member\">Friend \/ Family Member<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Howdidyouhearaboutus_Other\" name=\"inf_custom_Howdidyouhearaboutus\" type=\"radio\" value=\"Other\" \/> <label for=\"inf_custom_Howdidyouhearaboutus_Other\">Other<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\"><label for=\"inf_custom_Other\">Other<\/label> <input id=\"inf_custom_Other\" class=\"infusion-field-input\" name=\"inf_custom_Other\" type=\"text\" placeholder=\"Other\" \/><\/div>\n<div class=\"checklist-form-btn-wrap\">\n<div class=\"row\">\n<div class=\"col-xs-6\"><\/div>\n<div class=\"col-xs-6 text-right\"><input id=\"\" class=\"cla_cta-btn blue-btn inf_men_form_submit\" type=\"button\" value=\"Next\" data-next=\"2\" \/><\/div>\n<\/div>\n<\/div>\n<\/form>\n<\/div>\n<div class=\"checklist-step\">\n<div class=\"progress\">\n<div class=\"progress-bar progress-bar-striped\" style=\"width: 100%;\" role=\"progressbar\" aria-valuenow=\"100\" aria-valuemin=\"0\" aria-valuemax=\"100\"><span class=\"sr-only\">100% Complete (success)<\/span><\/div>\n<\/div>\n<form id=\"inf_form_351a7609b7aac102c74b9c30ee18360d\" class=\"infusion-form\" accept-charset=\"UTF-8\" action=\"https:\/\/vi627.infusionsoft.com\/app\/form\/process\/351a7609b7aac102c74b9c30ee18360d\" method=\"POST\"><input name=\"inf_form_xid\" type=\"hidden\" value=\"351a7609b7aac102c74b9c30ee18360d\" \/> <input name=\"inf_form_name\" type=\"hidden\" value=\"BHRT Checklist for Women~br~Page 2\" \/> <input name=\"infusionsoft_version\" type=\"hidden\" value=\"1.70.0.77019\" \/> <input class=\"hidden_email_field\" name=\"inf_field_Email\" type=\"hidden\" value=\"\" \/><\/p>\n<div>\n<div>\n<div class=\"title\">\n<div class=\"title\">\n<div>\n<p class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\">Which of the following symptoms apply at this time? Please check EACH symptom. For symptoms that do not apply, please mark NONE.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Excessivesweating\">Hot flashes, sweating (episodes of sweating)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Excessivesweating_None\" name=\"inf_custom_Excessivesweating\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Excessivesweating_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Excessivesweating_Mild\" name=\"inf_custom_Excessivesweating\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Excessivesweating_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Excessivesweating_Moderate\" name=\"inf_custom_Excessivesweating\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Excessivesweating_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Excessivesweating_Severe\" name=\"inf_custom_Excessivesweating\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Excessivesweating_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Excessivesweating_Extremely Severe\" name=\"inf_custom_Excessivesweating\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Excessivesweating_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Heartdiscomfort\">Heart discomfort (unusual awareness of heart beat, heart skipping, heart racing, tightness)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Heartdiscomfort_None\" name=\"inf_custom_Heartdiscomfort\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Heartdiscomfort_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Heartdiscomfort_Mild\" name=\"inf_custom_Heartdiscomfort\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Heartdiscomfort_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Heartdiscomfort_Moderate\" name=\"inf_custom_Heartdiscomfort\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Heartdiscomfort_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Heartdiscomfort_Severe\" name=\"inf_custom_Heartdiscomfort\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Heartdiscomfort_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Heartdiscomfort_Extremely Severe\" name=\"inf_custom_Heartdiscomfort\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Heartdiscomfort_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Sleepproblems\">Sleep problems (difficulty in falling asleep difficulty in sleeping through, waking up early and feeling tired, poor sleep, sleeplessness)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Sleepproblems_None\" name=\"inf_custom_Sleepproblems\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Sleepproblems_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Sleepproblems_Mild\" name=\"inf_custom_Sleepproblems\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Sleepproblems_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Sleepproblems_Moderate\" name=\"inf_custom_Sleepproblems\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Sleepproblems_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Sleepproblems_Severe\" name=\"inf_custom_Sleepproblems\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Sleepproblems_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Sleepproblems_Extremely Severe\" name=\"inf_custom_Sleepproblems\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Sleepproblems_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Depressivemood\">Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Depressivemood_None\" name=\"inf_custom_Depressivemood\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Depressivemood_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Depressivemood_Mild\" name=\"inf_custom_Depressivemood\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Depressivemood_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Depressivemood_Moderate\" name=\"inf_custom_Depressivemood\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Depressivemood_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Depressivemood_Severe\" name=\"inf_custom_Depressivemood\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Depressivemood_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Depressivemood_Extremely Severe\" name=\"inf_custom_Depressivemood\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Depressivemood_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Irritability\">Irritability (feeling nervous, inner tension, feeling aggressive)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Irritability_None\" name=\"inf_custom_Irritability\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Irritability_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Irritability_Mild\" name=\"inf_custom_Irritability\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Irritability_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Irritability_Moderate\" name=\"inf_custom_Irritability\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Irritability_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Irritability_Severe\" name=\"inf_custom_Irritability\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Irritability_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Irritability_Extremely Severe\" name=\"inf_custom_Irritability\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Irritability_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Anxiety\">Anxiety (inner restlessness, feeling panicky)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Anxiety_None\" name=\"inf_custom_Anxiety\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Anxiety_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Anxiety_Mild\" name=\"inf_custom_Anxiety\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Anxiety_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Anxiety_Moderate\" name=\"inf_custom_Anxiety\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Anxiety_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Anxiety_Severe\" name=\"inf_custom_Anxiety\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Anxiety_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Anxiety_Extremely Severe\" name=\"inf_custom_Anxiety\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Anxiety_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Physicalexhaustionlackingvitality\">Physical and mental exhaustion (general decrease in performance, impaired memory, decrease in concentration, forgetfulness)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Physicalexhaustionlackingvitality_None\" name=\"inf_custom_Physicalexhaustionlackingvitality\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Physicalexhaustionlackingvitality_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Physicalexhaustionlackingvitality_Mild\" name=\"inf_custom_Physicalexhaustionlackingvitality\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Physicalexhaustionlackingvitality_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Physicalexhaustionlackingvitality_Moderate\" name=\"inf_custom_Physicalexhaustionlackingvitality\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Physicalexhaustionlackingvitality_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Physicalexhaustionlackingvitality_Severe\" name=\"inf_custom_Physicalexhaustionlackingvitality\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Physicalexhaustionlackingvitality_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Physicalexhaustionlackingvitality_Extremely Severe\" name=\"inf_custom_Physicalexhaustionlackingvitality\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Physicalexhaustionlackingvitality_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Decreaseinsexualdesirelibido\">Sexual problems (change in sexual desire, in sexual activity and satisfaction)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Decreaseinsexualdesirelibido_None\" name=\"inf_custom_Decreaseinsexualdesirelibido\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Decreaseinsexualdesirelibido_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Decreaseinsexualdesirelibido_Mild\" name=\"inf_custom_Decreaseinsexualdesirelibido\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Decreaseinsexualdesirelibido_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Decreaseinsexualdesirelibido_Moderate\" name=\"inf_custom_Decreaseinsexualdesirelibido\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Decreaseinsexualdesirelibido_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Decreaseinsexualdesirelibido_Severe\" name=\"inf_custom_Decreaseinsexualdesirelibido\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Decreaseinsexualdesirelibido_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Decreaseinsexualdesirelibido_Extremely Severe\" name=\"inf_custom_Decreaseinsexualdesirelibido\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Decreaseinsexualdesirelibido_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Bladderproblems\">Bladder problems (difficulty in urinating, increased need to urinate, bladder incontinence)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Bladderproblems_None\" name=\"inf_custom_Bladderproblems\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Bladderproblems_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Bladderproblems_Mild\" name=\"inf_custom_Bladderproblems\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Bladderproblems_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Bladderproblems_Moderate\" name=\"inf_custom_Bladderproblems\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Bladderproblems_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Bladderproblems_Severe\" name=\"inf_custom_Bladderproblems\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Bladderproblems_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Bladderproblems_Extremely Severe\" name=\"inf_custom_Bladderproblems\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Bladderproblems_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Vaginalissues\">Dryness of vagina, sensation of dryness or burning in the vagina, difficulty with sexual intercourse<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Vaginalissues_None\" name=\"inf_custom_Vaginalissues\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Vaginalissues_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Vaginalissues_Mild\" name=\"inf_custom_Vaginalissues\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Vaginalissues_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Vaginalissues_Moderate\" name=\"inf_custom_Vaginalissues\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Vaginalissues_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Vaginalissues_Severe\" name=\"inf_custom_Vaginalissues\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Vaginalissues_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Vaginalissues_Extremely Severe\" name=\"inf_custom_Vaginalissues\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Vaginalissues_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\">\n<p><label for=\"inf_custom_Joinpainandmuscularache\">Joint and muscular discomfort (pain in the joints, rheumatoid complaints)<\/label><\/p>\n<div class=\"infusion-radio\">\n<div class=\"options-container\"><span class=\"infusion-option\"> <input id=\"inf_custom_Joinpainandmuscularache_None\" name=\"inf_custom_Joinpainandmuscularache\" type=\"radio\" value=\"None\" \/> <label for=\"inf_custom_Joinpainandmuscularache_None\">None<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Joinpainandmuscularache_Mild\" name=\"inf_custom_Joinpainandmuscularache\" type=\"radio\" value=\"Mild\" \/> <label for=\"inf_custom_Joinpainandmuscularache_Mild\">Mild<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Joinpainandmuscularache_Moderate\" name=\"inf_custom_Joinpainandmuscularache\" type=\"radio\" value=\"Moderate\" \/> <label for=\"inf_custom_Joinpainandmuscularache_Moderate\">Moderate<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Joinpainandmuscularache_Severe\" name=\"inf_custom_Joinpainandmuscularache\" type=\"radio\" value=\"Severe\" \/> <label for=\"inf_custom_Joinpainandmuscularache_Severe\">Severe<\/label> <\/span> <span class=\"infusion-option\"> <input id=\"inf_custom_Joinpainandmuscularache_Extremely Severe\" name=\"inf_custom_Joinpainandmuscularache\" type=\"radio\" value=\"Extremely Severe\" \/> <label for=\"inf_custom_Joinpainandmuscularache_Extremely Severe\">Extremely Severe<\/label> <\/span><\/div>\n<\/div>\n<\/div>\n<div class=\"infusion-field\"><label for=\"inf_custom_Additionalcommentsaboutsymptoms\">Please share any additional comments about your symptoms you would like to address.<\/label><textarea id=\"inf_custom_Additionalcommentsaboutsymptoms\" cols=\"24\" name=\"inf_custom_Additionalcommentsaboutsymptoms\" rows=\"5\" placeholder=\"Please share any additional comments about your symptoms you would like to address.\"><\/textarea><\/div>\n<div>\n<div><\/div>\n<\/div>\n<div class=\"infusion-submit\">\n<div class=\"checklist-form-btn-wrap\">\n<div class=\"row\">\n<div class=\"col-xs-6\"><input id=\"\" class=\"checklist-step-btn-prev cla_cta-btn blue-btn\" type=\"button\" value=\"Previous\" data-next=\"\" data-previous=\"2\" \/><\/div>\n<div class=\"col-xs-6 text-right\"><input class=\"cla_cta-btn blue-btn\" name=\"bhrt-women-form-submit\" type=\"submit\" value=\"Submit\" \/><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/form>\n<\/div>\n<\/div>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; equal_height=&#8221;yes&#8221; content_placement=&#8221;middle&#8221; css=&#8221;.vc_custom_1546846507724{padding-top: 100px !important;padding-bottom: 135px !important;background-image: 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