{"id":736,"date":"2024-05-23T04:46:13","date_gmt":"2024-05-23T04:46:13","guid":{"rendered":"https:\/\/inkvillainstattoos.com\/?page_id=736"},"modified":"2024-07-30T15:58:32","modified_gmt":"2024-07-30T15:58:32","slug":"consent-to-pierce-and-release-of-claims","status":"publish","type":"page","link":"https:\/\/www.inkvillainstattoos.com\/?page_id=736","title":{"rendered":"Consent to Pierce and Release Of Claims"},"content":{"rendered":"\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\"><style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-border-style: solid;\n--wpforms-field-border-size: 1px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-border-color-spare: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-field-menu-color: #ffffff;\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-border-style: none;\n--wpforms-button-border-size: 1px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-border-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-page-break-color: #066aab;\n--wpforms-background-image: none;\n--wpforms-background-position: center center;\n--wpforms-background-repeat: no-repeat;\n--wpforms-background-size: cover;\n--wpforms-background-width: 100px;\n--wpforms-background-height: 100px;\n--wpforms-background-color: rgba( 0, 0, 0, 0 );\n--wpforms-background-url: none;\n--wpforms-container-padding: 0px;\n--wpforms-container-border-style: none;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-color: #000000;\n--wpforms-container-border-radius: 3px;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-f23085b4-8bac-4e34-8ae0-0103d9bb8929 wpforms-render-modern\" id=\"wpforms-730\"><form id=\"wpforms-form-730\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"730\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F736&#038;wpforms_form_id=730\" data-token=\"336065c9cb1af351840d45f23e920ec3\" data-token-time=\"1778064915\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-730-field_25-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_25\">Ink Villains Location <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-730-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" required=\"required\"><option value=\"Dale Mabry\" >Dale Mabry<\/option><option value=\"Ybor City\" >Ybor City<\/option><option value=\"Kennedy\" >Kennedy<\/option><\/select><\/div><div id=\"wpforms-730-field_5-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-730-field_5\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][5][first]\" aria-errormessage=\"wpforms-730-field_5-error\" required><label for=\"wpforms-730-field_5\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-730-field_5-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][5][last]\" aria-errormessage=\"wpforms-730-field_5-last-error\" required><label for=\"wpforms-730-field_5-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-730-field_1-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"1\"><div id=\"wpforms-730-field_1\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-730-field_1-error\"><h4><\/h4>\n<p class=\"p1\"><i><br \/>\n<img loading=\"lazy\" decoding=\"async\" height=\"150\" width=\"150\" alt=\"\" src=\"http:\/\/inkvillainstattoos.com\/wp-content\/uploads\/2017\/06\/cropped-cropped-gen_logo-4-150x150.png\" class=\"alignleft wp-image-628 size-thumbnail\" srcset=\"https:\/\/www.inkvillainstattoos.com\/wp-content\/uploads\/2017\/06\/cropped-cropped-gen_logo-4-150x150.png 150w, https:\/\/www.inkvillainstattoos.com\/wp-content\/uploads\/2017\/06\/cropped-cropped-gen_logo-4-100x100.png 100w, https:\/\/www.inkvillainstattoos.com\/wp-content\/uploads\/2017\/06\/cropped-cropped-gen_logo-4.png 250w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/i><i><\/i><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><i>I acknowledge by signing this <strong>Release<\/strong> that I have been given the full opportunity to ask any and all questions which I might have about obtaining a piercing from an Ink Villains Tattoo&#8217;s Piercer\/Employee and all my questions have&nbsp;<\/i><i>been answered to my life and total satisfaction. I acknowledge I have been advised of the matters set forth <\/i><i>below and I agree as follows.<\/i><\/p>\n<p class=\"p1\"><i>1). I am not pregnant or nursing. <\/i><span class=\"s1\"><i>If <\/i><\/span><i>I have any condition that might affect the healing of a piercing, I will <\/i><i>inform my piercer.<\/i><\/p>\n<p class=\"p1\"><span class=\"s2\"><i>2). <\/i><\/span><i>I do not suffer from medical or skin conditions such as, but not limited to; keloid or hypertroic scarring, <\/i><i>psoriasis at the site of the piercing.<\/i><\/p>\n<p class=\"p1\"><i>3). I am not under the influence of drugs or alcohol. I do not have and physical, mental or medical <\/i><i>impairment or disability which might affect my well being <\/i><span class=\"s3\"><i>a,ra <\/i><\/span><i>direct or indirect result to my decision to <\/i><i>have a piercing done at this time. <\/i><span class=\"s4\"><i>_<\/i><\/span><\/p>\n<p class=\"p1\"><i>4). I acknowledge that obtaining this piercing is my choice alone and will result to a permanent change to <\/i><i>my appearance, and that no representation has been made to me as to the ability to restore the skin <\/i><i>involved in this piercing to its pre-piercing condition.<\/i><\/p>\n<p class=\"p1\"><i>5). I acknowledge infection is always possible as a result of obtaining a piercing. I have received aftercare <\/i><i>instructions and I agree to FOLLOW them all while my piercing is healing.<\/i><\/p>\n<p class=\"p1\"><i>6). I understand that I will be pierced by using appropriate instruments and sterilization.<\/i><\/p>\n<p class=\"p1\"><span class=\"s5\"><i>7). <\/i><\/span><i>I give all Rights to (Ink Villains Tattoos) take pictures and video for promotional and business related purpose.<\/i><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-730-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_2\">Therefore, I request the piercer to pierce my <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-730-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-730-field_2-error\" aria-describedby=\"wpforms-730-field_2-description\" required><div id=\"wpforms-730-field_2-description\" class=\"wpforms-field-description\">Location of Piercing<\/div><\/div><div id=\"wpforms-730-field_3-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"3\"><div id=\"wpforms-730-field_3\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-730-field_3-error\"><p class=\"p1\"><i>I understand generally all piercings <\/i><i>usually takes 2 &#8211; 8 months or longer to heal. I agree to release and forever discharge and hold <\/i><i>harmless the piercer and all employees from and claims, damages or legal action arising from or <\/i><i>connected in any way with my piercing, or the procedure and conduct used in my piercing. <\/i><span class=\"s1\"><i>\u2022<\/i><\/span><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-730-field_4-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_4\">Todays Date  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-730-field_4\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][4][date]\" aria-errormessage=\"wpforms-730-field_4-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-730-field_6-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_6\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-730-field_6\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][6]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-730-field_6-error\" required><\/div><div id=\"wpforms-730-field_7-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-730-field_7\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][7][address1]\" aria-errormessage=\"wpforms-730-field_7-error\" required><label for=\"wpforms-730-field_7\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-730-field_7-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][7][address2]\" aria-errormessage=\"wpforms-730-field_7-address2-error\" ><label for=\"wpforms-730-field_7-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-730-field_7-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][7][city]\" aria-errormessage=\"wpforms-730-field_7-city-error\" required><label for=\"wpforms-730-field_7-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-730-field_7-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][7][state]\" aria-errormessage=\"wpforms-730-field_7-state-error\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-730-field_7-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-730-field_7-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][7][postal]\" aria-errormessage=\"wpforms-730-field_7-postal-error\" required><label for=\"wpforms-730-field_7-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-730-field_29-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_29\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-730-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" spellcheck=\"false\" aria-errormessage=\"wpforms-730-field_29-error\" required><\/div><div id=\"wpforms-730-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_8\">Race <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-730-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-730-field_8-error\" required><\/div><div id=\"wpforms-730-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_9\">Sex <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-730-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-730-field_9-error\" required><\/div><div id=\"wpforms-730-field_10-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_10\">Date Of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-730-field_10\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][10][date]\" aria-errormessage=\"wpforms-730-field_10-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-730-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_11\">Age <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-730-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-730-field_11-error\" required><\/div><div id=\"wpforms-730-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_12\">License # <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-730-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-730-field_12-error\" required><\/div><div id=\"wpforms-730-field_26-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_26\">Picture of Government Issued License\/Identification (Front and Back) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"26\"\n\t\tdata-form-id=\"730\"\n\t\tdata-input-name=\"wpforms_730_26\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"52428800\"\n\t\tdata-max-file-number=\"2\"\n\t\tdata-post-max-size=\"20971520\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 2 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-730-field_26\"\n\t\tname=\"wpforms_730_26\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-730-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-730-field_13\">Physicians Information<\/label><input type=\"text\" id=\"wpforms-730-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-730-field_13-error\" aria-describedby=\"wpforms-730-field_13-description\" ><div id=\"wpforms-730-field_13-description\" class=\"wpforms-field-description\">Physician Name <\/div><\/div><div id=\"wpforms-730-field_14-container\" 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