{"id":51237,"date":"2022-10-26T13:31:02","date_gmt":"2022-10-26T11:31:02","guid":{"rendered":"https:\/\/www.camed-medical.de\/leadformular\/"},"modified":"2023-03-14T15:47:31","modified_gmt":"2023-03-14T14:47:31","slug":"offer-request","status":"publish","type":"page","link":"https:\/\/www.camed-medical.de\/en\/offer-request\/","title":{"rendered":"Offer Request"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|tablet&#8221; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; background_image=&#8221;https:\/\/www.camed-medical.de\/wp-content\/uploads\/2022\/09\/hero-bg.jpg&#8221; custom_padding=&#8221;100px||100px||true|false&#8221; custom_padding_tablet=&#8221;80px||80px||true|false&#8221; custom_padding_phone=&#8221;50px||50px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; 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sticky_enabled=&#8221;0&#8243;]<\/p>\n<p>Receive now free of charge and without obligation for you selected offers.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|tablet&#8221; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;120px||120px||true|false&#8221; custom_padding_tablet=&#8221;80px||80px||true|false&#8221; custom_padding_phone=&#8221;50px||50px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; max_width=&#8221;780px&#8221; module_alignment=&#8221;center&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.18.0&#8243; 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for='choice_5_16_2' id='label_5_16_2' class='gform-field-label gform-field-label--type-inline'>Stand system<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_18' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_18' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_3' class='gform_page' data-js='page-field-id-18' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_52\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What type of probe do you need?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_52'><div class='gchoice gchoice_5_52_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.1' type='checkbox'  value='Convex'  id='choice_5_52_1'   aria-describedby=\"gfield_description_5_52\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_1' id='label_5_52_1' class='gform-field-label gform-field-label--type-inline'>Convex<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.2' type='checkbox'  value='Linear'  id='choice_5_52_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_2' id='label_5_52_2' class='gform-field-label gform-field-label--type-inline'>Linear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.3' type='checkbox'  value='Micro-Convex Probe'  id='choice_5_52_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_3' id='label_5_52_3' class='gform-field-label gform-field-label--type-inline'>Micro-Convex Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.4' type='checkbox'  value='CWD-Pin Probe'  id='choice_5_52_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_4' id='label_5_52_4' class='gform-field-label gform-field-label--type-inline'>CWD-Pin Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.5' type='checkbox'  value='Phased-Array Probe'  id='choice_5_52_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_5' id='label_5_52_5' class='gform-field-label gform-field-label--type-inline'>Phased-Array Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.6' type='checkbox'  value='Endo-Probe'  id='choice_5_52_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_6' id='label_5_52_6' class='gform-field-label gform-field-label--type-inline'>Endo-Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.7' type='checkbox'  value='TEE-Probe'  id='choice_5_52_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_7' id='label_5_52_7' class='gform-field-label gform-field-label--type-inline'>TEE-Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.8' type='checkbox'  value='Other probe type'  id='choice_5_52_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_8' id='label_5_52_8' class='gform-field-label gform-field-label--type-inline'>Other probe type<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.9' type='checkbox'  value='I need a consultation'  id='choice_5_52_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_9' id='label_5_52_9' class='gform-field-label gform-field-label--type-inline'>I need a consultation<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_52'>Multiple selection is possible!<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_19' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_4' class='gform_page' data-js='page-field-id-19' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What device condition do you need?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_20'>\n\t\t\t<div class='gchoice gchoice_5_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='New device'  id='choice_5_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_20_0' id='label_5_20_0' class='gform-field-label gform-field-label--type-inline'>New device<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Demonstration system'  id='choice_5_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_20_1' id='label_5_20_1' class='gform-field-label gform-field-label--type-inline'>Demonstration system<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Used device'  id='choice_5_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_20_2' id='label_5_20_2' class='gform-field-label gform-field-label--type-inline'>Used device<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_21' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_5' class='gform_page' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_53\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Which financing solution is suitable for you?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_53'><div class='gchoice gchoice_5_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='Purchase'  id='choice_5_53_1'   aria-describedby=\"gfield_description_5_53\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_1' id='label_5_53_1' class='gform-field-label gform-field-label--type-inline'>Purchase<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_53_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.2' type='checkbox'  value='Financing'  id='choice_5_53_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_2' id='label_5_53_2' class='gform-field-label gform-field-label--type-inline'>Financing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_53_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.3' type='checkbox'  value='Leasing'  id='choice_5_53_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_3' id='label_5_53_3' class='gform-field-label gform-field-label--type-inline'>Leasing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_53_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.4' type='checkbox'  value='Rent'  id='choice_5_53_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_4' id='label_5_53_4' class='gform-field-label gform-field-label--type-inline'>Rent<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_53'>Multiple selection is possible!<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_23' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_23' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_6' class='gform_page' data-js='page-field-id-23' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What do you want to invest?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_24'>\n\t\t\t<div class='gchoice gchoice_5_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='over 30,000'  id='choice_5_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_24_0' id='label_5_24_0' class='gform-field-label gform-field-label--type-inline'>over 30,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='20.000 - 30.000 Euro'  id='choice_5_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_24_1' id='label_5_24_1' class='gform-field-label gform-field-label--type-inline'>20.000 - 30.000 Euro<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='10.000 - 20.000 Euro'  id='choice_5_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_24_2' id='label_5_24_2' class='gform-field-label gform-field-label--type-inline'>10.000 - 20.000 Euro<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='5000 -10.000 Euro'  id='choice_5_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_24_3' id='label_5_24_3' class='gform-field-label gform-field-label--type-inline'>5000 -10.000 Euro<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_25\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_25'>Budget<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_5_25' class='textarea small'    placeholder='Budget'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_26' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_26' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_7' class='gform_page' data-js='page-field-id-26' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >When do you plan to make the purchase?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_27'>\n\t\t\t<div class='gchoice gchoice_5_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='immediately'  id='choice_5_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_27_0' id='label_5_27_0' class='gform-field-label gform-field-label--type-inline'>immediately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='1-3 months'  id='choice_5_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_27_1' id='label_5_27_1' class='gform-field-label gform-field-label--type-inline'>1-3 months<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='4-6 months'  id='choice_5_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_27_2' id='label_5_27_2' class='gform-field-label gform-field-label--type-inline'>4-6 months<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='6-12 months'  id='choice_5_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_27_3' id='label_5_27_3' class='gform-field-label gform-field-label--type-inline'>6-12 months<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_28' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_28' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_8' class='gform_page' data-js='page-field-id-28' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_30\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Which device have they worked with so far?<\/h4><\/div><div id=\"field_5_29\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_29'>Please specify manufacturer + model!<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_5_29' class='textarea small'    placeholder='Please specify manufacturer + model!'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_31\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_31'>Are you happy with the device?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_5_31' class='textarea small'    placeholder='Are you happy with the device?'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_33\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>If you do not have a device, click \"Next\"!<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_34' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_34' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_9' class='gform_page' data-js='page-field-id-34' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you need any other software?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_35'>\n\t\t\t<div class='gchoice gchoice_5_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Yes'  id='choice_5_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_35_0' id='label_5_35_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='No'  id='choice_5_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_35_1' id='label_5_35_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_36' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_36' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_10' class='gform_page' data-js='page-field-id-36' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_37\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Which software do you need?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_37'>\n\t\t\t<div class='gchoice gchoice_5_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='SonoGDT'  id='choice_5_37_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_37_0' id='label_5_37_0' class='gform-field-label gform-field-label--type-inline'>SonoGDT<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Archiving software'  id='choice_5_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_37_1' id='label_5_37_1' class='gform-field-label gform-field-label--type-inline'>Archiving software<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_37_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Other'  id='choice_5_37_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_37_2' id='label_5_37_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_38\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_38'>Other<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_5_38' type='text' value='' class='large'    placeholder='Other'  aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_39' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_39' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_11' class='gform_page' data-js='page-field-id-39' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_40\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Where may we send the offers?<\/h4><\/div><div id=\"field_5_41\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_41'>Last name *<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_5_41' type='text' value='' class='large'    placeholder='Last name *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_42\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_42'>First name *<\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_5_42' type='text' value='' class='large'    placeholder='First name *'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_43\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_43'>City<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_5_43' type='text' value='' class='large'    placeholder='City'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_44\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_44'>ZIP CODE<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_5_44' type='text' value='' class='large'    placeholder='ZIP CODE' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_45\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_45'>Street<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_5_45' type='text' value='' class='large'    placeholder='Street'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_46\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_46'>House number<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_5_46' type='text' value='' class='large'    placeholder='House number'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_47\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_47'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_47' id='input_5_47' type='email' value='' class='large'   placeholder='E-mail *' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_48\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_48'>Phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_48' id='input_5_48' type='tel' value='' class='large'  placeholder='Phone number *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_50\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_50'>Specialization<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_5_50' type='text' value='' class='large'    placeholder='Specialization'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_49\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_49'>Name of the practice<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_5_49' type='text' value='' class='large'    placeholder='Name of the practice'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_51\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Please fill in the fields so that we can send you your manufacturer comparison offer without obligation. Your data is secure and will only be used for this request. <\/p><\/div><fieldset id=\"field_5_12\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Data protection<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_12.1' id='input_5_12_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_5_12_1' >I agree that my details from the contact form will be collected and processed to answer my request. The data will be deleted after your request has been processed. Detailed information on handling user data can be found in our <a href=\"https:\/\/camed.getnetfame.de\/en\/privacy-policy\/\" target=\"_blank\">Privacy Policy.<\/a><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/label><input type='hidden' name='input_12.2' value='I agree that my details from the contact form will be collected and processed to answer my request. The data will be deleted after your request has been processed. Detailed information on handling user data can be found in our &lt;a href=&quot;https:\/\/camed.getnetfame.de\/en\/privacy-policy\/&quot; target=&quot;_blank&quot;&gt;Privacy Policy.&lt;\/a&gt;' class='gform_hidden' \/><input type='hidden' name='input_12.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_5' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='submit' id='gform_submit_button_5' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=5&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;styles=[]&amp;hash=f4565548ec4b69cd317a0c6b4c92e791' \/>\n      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class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_5' id='gform_5'  action='\/en\/wp-json\/wp\/v2\/pages\/51237#gf_5' data-formid='5' novalidate>\n        <div id='gf_progressbar_wrapper_5' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>11<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_9' style='width:9%;'><span>9%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_5_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Choose your specialization<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_13'>\n\t\t\t<div class='gchoice gchoice_5_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='General Medicine'  id='choice_5_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_0' id='label_5_13_0' class='gform-field-label gform-field-label--type-inline'>General Medicine<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Gynecology'  id='choice_5_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_1' id='label_5_13_1' class='gform-field-label gform-field-label--type-inline'>Gynecology<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Urology'  id='choice_5_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_2' id='label_5_13_2' class='gform-field-label gform-field-label--type-inline'>Urology<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Internal medicine'  id='choice_5_13_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_3' id='label_5_13_3' class='gform-field-label gform-field-label--type-inline'>Internal medicine<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Cardiology'  id='choice_5_13_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_4' id='label_5_13_4' class='gform-field-label gform-field-label--type-inline'>Cardiology<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Orthopedics'  id='choice_5_13_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_5' id='label_5_13_5' class='gform-field-label gform-field-label--type-inline'>Orthopedics<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='ENT'  id='choice_5_13_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_6' id='label_5_13_6' class='gform-field-label gform-field-label--type-inline'>ENT<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Pediatrics'  id='choice_5_13_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_7' id='label_5_13_7' class='gform-field-label gform-field-label--type-inline'>Pediatrics<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Neurology'  id='choice_5_13_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_8' id='label_5_13_8' class='gform-field-label gform-field-label--type-inline'>Neurology<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Radiology'  id='choice_5_13_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_9' id='label_5_13_9' class='gform-field-label gform-field-label--type-inline'>Radiology<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Anesthesia'  id='choice_5_13_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_10' id='label_5_13_10' class='gform-field-label gform-field-label--type-inline'>Anesthesia<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Veterinary'  id='choice_5_13_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_11' id='label_5_13_11' class='gform-field-label gform-field-label--type-inline'>Veterinary<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Rheumatology'  id='choice_5_13_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_12' id='label_5_13_12' class='gform-field-label gform-field-label--type-inline'>Rheumatology<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_13_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Phlebology'  id='choice_5_13_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_13_13' id='label_5_13_13' class='gform-field-label gform-field-label--type-inline'>Phlebology<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_5_15' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_2' class='gform_page' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What type of device do you need?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_16'>\n\t\t\t<div class='gchoice gchoice_5_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Handheld'  id='choice_5_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_16_0' id='label_5_16_0' class='gform-field-label gform-field-label--type-inline'>Handheld<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Portable'  id='choice_5_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_16_1' id='label_5_16_1' class='gform-field-label gform-field-label--type-inline'>Portable<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Stand system'  id='choice_5_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_16_2' id='label_5_16_2' class='gform-field-label gform-field-label--type-inline'>Stand system<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_18' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_18' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_3' class='gform_page' data-js='page-field-id-18' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_52\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What type of probe do you need?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_52'><div class='gchoice gchoice_5_52_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.1' type='checkbox'  value='Convex'  id='choice_5_52_1'   aria-describedby=\"gfield_description_5_52\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_1' id='label_5_52_1' class='gform-field-label gform-field-label--type-inline'>Convex<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.2' type='checkbox'  value='Linear'  id='choice_5_52_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_2' id='label_5_52_2' class='gform-field-label gform-field-label--type-inline'>Linear<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.3' type='checkbox'  value='Micro-Convex Probe'  id='choice_5_52_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_3' id='label_5_52_3' class='gform-field-label gform-field-label--type-inline'>Micro-Convex Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.4' type='checkbox'  value='CWD-Pin Probe'  id='choice_5_52_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_4' id='label_5_52_4' class='gform-field-label gform-field-label--type-inline'>CWD-Pin Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.5' type='checkbox'  value='Phased-Array Probe'  id='choice_5_52_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_5' id='label_5_52_5' class='gform-field-label gform-field-label--type-inline'>Phased-Array Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.6' type='checkbox'  value='Endo-Probe'  id='choice_5_52_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_6' id='label_5_52_6' class='gform-field-label gform-field-label--type-inline'>Endo-Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.7' type='checkbox'  value='TEE-Probe'  id='choice_5_52_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_7' id='label_5_52_7' class='gform-field-label gform-field-label--type-inline'>TEE-Probe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.8' type='checkbox'  value='Other probe type'  id='choice_5_52_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_8' id='label_5_52_8' class='gform-field-label gform-field-label--type-inline'>Other probe type<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_52_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.9' type='checkbox'  value='I need a consultation'  id='choice_5_52_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_52_9' id='label_5_52_9' class='gform-field-label gform-field-label--type-inline'>I need a consultation<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_52'>Multiple selection is possible!<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_19' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_4' class='gform_page' data-js='page-field-id-19' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What device condition do you need?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_20'>\n\t\t\t<div class='gchoice gchoice_5_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='New device'  id='choice_5_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_20_0' id='label_5_20_0' class='gform-field-label gform-field-label--type-inline'>New device<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Demonstration system'  id='choice_5_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_20_1' id='label_5_20_1' class='gform-field-label gform-field-label--type-inline'>Demonstration system<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Used device'  id='choice_5_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_20_2' id='label_5_20_2' class='gform-field-label gform-field-label--type-inline'>Used device<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_21' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_5' class='gform_page' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_53\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Which financing solution is suitable for you?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_53'><div class='gchoice gchoice_5_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='Purchase'  id='choice_5_53_1'   aria-describedby=\"gfield_description_5_53\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_1' id='label_5_53_1' class='gform-field-label gform-field-label--type-inline'>Purchase<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_53_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.2' type='checkbox'  value='Financing'  id='choice_5_53_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_2' id='label_5_53_2' class='gform-field-label gform-field-label--type-inline'>Financing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_53_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.3' type='checkbox'  value='Leasing'  id='choice_5_53_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_3' id='label_5_53_3' class='gform-field-label gform-field-label--type-inline'>Leasing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_53_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.4' type='checkbox'  value='Rent'  id='choice_5_53_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_4' id='label_5_53_4' class='gform-field-label gform-field-label--type-inline'>Rent<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_53'>Multiple selection is possible!<\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_23' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_23' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_6' class='gform_page' data-js='page-field-id-23' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What do you want to invest?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_24'>\n\t\t\t<div class='gchoice gchoice_5_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='over 30,000'  id='choice_5_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_24_0' id='label_5_24_0' class='gform-field-label gform-field-label--type-inline'>over 30,000<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='20.000 - 30.000 Euro'  id='choice_5_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_24_1' id='label_5_24_1' class='gform-field-label gform-field-label--type-inline'>20.000 - 30.000 Euro<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='10.000 - 20.000 Euro'  id='choice_5_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_24_2' id='label_5_24_2' class='gform-field-label gform-field-label--type-inline'>10.000 - 20.000 Euro<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='5000 -10.000 Euro'  id='choice_5_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_24_3' id='label_5_24_3' class='gform-field-label gform-field-label--type-inline'>5000 -10.000 Euro<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_25\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_25'>Budget<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_5_25' class='textarea small'    placeholder='Budget'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_26' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_26' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_7' class='gform_page' data-js='page-field-id-26' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >When do you plan to make the purchase?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_27'>\n\t\t\t<div class='gchoice gchoice_5_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='immediately'  id='choice_5_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_27_0' id='label_5_27_0' class='gform-field-label gform-field-label--type-inline'>immediately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='1-3 months'  id='choice_5_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_27_1' id='label_5_27_1' class='gform-field-label gform-field-label--type-inline'>1-3 months<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='4-6 months'  id='choice_5_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_27_2' id='label_5_27_2' class='gform-field-label gform-field-label--type-inline'>4-6 months<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='6-12 months'  id='choice_5_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_27_3' id='label_5_27_3' class='gform-field-label gform-field-label--type-inline'>6-12 months<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_28' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_28' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_8' class='gform_page' data-js='page-field-id-28' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_30\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Which device have they worked with so far?<\/h4><\/div><div id=\"field_5_29\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_29'>Please specify manufacturer + model!<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_5_29' class='textarea small'    placeholder='Please specify manufacturer + model!'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_31\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_31'>Are you happy with the device?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_5_31' class='textarea small'    placeholder='Are you happy with the device?'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_33\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>If you do not have a device, click \"Next\"!<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_34' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_34' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_9' class='gform_page' data-js='page-field-id-34' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you need any other software?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_35'>\n\t\t\t<div class='gchoice gchoice_5_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Yes'  id='choice_5_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_35_0' id='label_5_35_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='No'  id='choice_5_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_35_1' id='label_5_35_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_36' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_36' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_10' class='gform_page' data-js='page-field-id-36' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_5_37\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Which software do you need?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_37'>\n\t\t\t<div class='gchoice gchoice_5_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='SonoGDT'  id='choice_5_37_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_37_0' id='label_5_37_0' class='gform-field-label gform-field-label--type-inline'>SonoGDT<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Archiving software'  id='choice_5_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_37_1' id='label_5_37_1' class='gform-field-label gform-field-label--type-inline'>Archiving software<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_37_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Other'  id='choice_5_37_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_37_2' id='label_5_37_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_38\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_38'>Other<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_5_38' type='text' value='' class='large'    placeholder='Other'  aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_39' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_5_39' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_11' class='gform_page' data-js='page-field-id-39' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_40\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h4>Where may we send the offers?<\/h4><\/div><div id=\"field_5_41\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_41'>Last name *<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_5_41' type='text' value='' class='large'    placeholder='Last name *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_42\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_42'>First name *<\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_5_42' type='text' value='' class='large'    placeholder='First name *'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_43\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_43'>City<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_5_43' type='text' value='' class='large'    placeholder='City'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_44\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_44'>ZIP CODE<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_5_44' type='text' value='' class='large'    placeholder='ZIP CODE' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_45\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_45'>Street<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_5_45' type='text' value='' class='large'    placeholder='Street'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_46\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_46'>House number<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_5_46' type='text' value='' class='large'    placeholder='House number'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_47\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_47'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_47' id='input_5_47' type='email' value='' class='large'   placeholder='E-mail *' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_48\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_48'>Phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_48' id='input_5_48' type='tel' value='' class='large'  placeholder='Phone number *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_50\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_50'>Specialization<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_5_50' type='text' value='' class='large'    placeholder='Specialization'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_49\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_49'>Name of the practice<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_5_49' type='text' value='' class='large'    placeholder='Name of the practice'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_51\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Please fill in the fields so that we can send you your manufacturer comparison offer without obligation. 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