{"id":2492,"date":"2024-12-04T08:18:30","date_gmt":"2024-12-04T13:18:30","guid":{"rendered":"https:\/\/auclairmeloche.com\/book-an-appointment\/"},"modified":"2025-12-13T11:17:39","modified_gmt":"2025-12-13T16:17:39","slug":"book-an-appointment","status":"publish","type":"page","link":"https:\/\/auclairmeloche.com\/en\/book-an-appointment\/","title":{"rendered":"Book an appointment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2492\" class=\"elementor elementor-2492 elementor-78\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2106415 e-con-full e-flex e-con e-parent\" data-id=\"2106415\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b4d0e84 elementor-widget__width-initial elementor-absolute elementor-widget elementor-widget-ucaddon_image_reveal_on_scroll\" data-id=\"b4d0e84\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_position&quot;:&quot;absolute&quot;}\" data-widget_type=\"ucaddon_image_reveal_on_scroll.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n<!-- start Scroll Image Reveal -->\n\t\t<link id='uc_ac_assets_file_uc_image_reveal_css_545-css' href='https:\/\/auclairmeloche.com\/wp-content\/uploads\/ac_assets\/image_reveal_on_scroll\/uc_image_reveal.css' type='text\/css' rel='stylesheet' >\n\n<style>\/* widget: Scroll Image Reveal *\/\n\n\t\n\n    #uc_image_reveal_on_scroll_elementor_b4d0e84 .uc_overlay.uc_reveal{\n      height: 0;\n      width: 100%;\n      bottom: 0;\n\t} \n\n\t#uc_image_reveal_on_scroll_elementor_b4d0e84 .uc_overlay.uc_reveal{\n      top: unset;\n\t}\n\n\n#uc_image_reveal_on_scroll_elementor_b4d0e84 .uc_reveal{\n\ttransition: ease-in-out all 2.2s;\n    transition-delay: 1700ms;\n}\n\n#uc_image_reveal_on_scroll_elementor_b4d0e84 img\n{\n  display:block;\n}\n\n<\/style>\n\n<div class=\"uc_image_reveal\" id=\"uc_image_reveal_on_scroll_elementor_b4d0e84\">\n  <div class=\"uc_image_reveal_box\">\n              \n\t  <img fetchpriority=\"high\" decoding=\"async\" src=\"https:\/\/auclairmeloche.com\/wp-content\/uploads\/2024\/12\/texture-header.2.svg\" class=\"ue-img\" width=\"100%\"  src=\"https:\/\/auclairmeloche.com\/wp-content\/uploads\/2024\/12\/texture-header.2.svg\" alt=\"texture-header\" width=\"640\" height=\"844\">\n          \n          \n\t<div class=\"uc_overlay iv-jello\" aria-hidden=\"true\"><\/div>\n        \n  <\/div>\n<\/div>\n<!-- end Scroll Image Reveal -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-39aaf1d e-con-full e-flex e-con e-child\" data-id=\"39aaf1d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d0a340a animated-slow elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"d0a340a\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInDown&quot;,&quot;_animation_delay&quot;:3000}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Book an appointment<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f656a69 e-con-full e-flex e-con e-child\" data-id=\"f656a69\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-42964f2 elementor-widget elementor-widget-text-editor\" data-id=\"42964f2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Fill out the form below and select the type of appointment and the desired clinic. Our team will contact you as soon as possible to confirm a date and time slot with you. For all eye emergencies, please contact us by <a href=\"https:\/\/auclairmeloche.com\/en\/contact-us\/\">phone<\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1f6a0e6 e-con-full e-flex elementor-invisible e-con e-child\" data-id=\"1f6a0e6\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeIn&quot;,&quot;animation_delay&quot;:100}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ec065ef uael-gf-check-yes uael-gf-button-right uael-gf-ajax-true uael-gf-style-box uael-gf-input-size-sm uael-gf-enable-classes-no uael-gf-check-default-no uael-gf-btn-size-sm elementor-widget elementor-widget-uael-gf-styler\" data-id=\"ec065ef\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"uael-gf-styler.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"uael-gf-style uael-gf-check-style elementor-clickable\">\n\t<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' style='display:none'>\n                        <div 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'  id='gform_3'  action='\/en\/wp-json\/wp\/v2\/pages\/2492' data-formid='3' novalidate><div class='gf_invisible ginput_recaptchav3'  data-tabindex='1'><input id=\"input_bfdac43ce5b88fb280a46e2b292cbf67\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_bfdac43ce5b88fb280a46e2b292cbf67\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_3_8\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_8'>Select the type of appointment you want*<\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_3_8' class='large gfield_select' tabindex='2'    aria-invalid=\"false\" ><option value='Eye exam' >Eye exam<\/option><option value='Eye exam and frame selection' >Eye exam and frame selection<\/option><option value='Frame selection' >Frame selection<\/option><option value='Adjustments and repairs' >Adjustments and repairs<\/option><option value='Picking up your order' >Picking up your order<\/option><option value='Contact lens' >Contact lens<\/option><\/select><\/div><\/div><fieldset id=\"field_3_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Select a clinic for your appointment*<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_3_10'>\n\t\t\t<div class='gchoice gchoice_3_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Coteau-du-Lac Clinic'  id='choice_3_10_0' onchange='gformToggleRadioOther( this )'  tabindex='3'  \/>\n\t\t\t\t\t<label for='choice_3_10_0' id='label_3_10_0' class='gform-field-label gform-field-label--type-inline'>Coteau-du-Lac Clinic<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Valleyfield Clinic'  id='choice_3_10_1' onchange='gformToggleRadioOther( this )'  tabindex='4'  \/>\n\t\t\t\t\t<label for='choice_3_10_1' id='label_3_10_1' class='gform-field-label gform-field-label--type-inline'>Valleyfield Clinic<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='No preference'  id='choice_3_10_2' onchange='gformToggleRadioOther( this )'  tabindex='5'  \/>\n\t\t\t\t\t<label for='choice_3_10_2' id='label_3_10_2' class='gform-field-label gform-field-label--type-inline'>No preference<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Select your optometrist - Valleyfield Clinic:<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_3_11'>\n\t\t\t<div class='gchoice gchoice_3_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Dr. Annie Auclair, Optometrist'  id='choice_3_11_0' onchange='gformToggleRadioOther( this )'  tabindex='6'  \/>\n\t\t\t\t\t<label for='choice_3_11_0' id='label_3_11_0' class='gform-field-label gform-field-label--type-inline'>Dr. Annie Auclair, Optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Dr. Mila Leboeuf, optometrist'  id='choice_3_11_1' onchange='gformToggleRadioOther( this )'  tabindex='7'  \/>\n\t\t\t\t\t<label for='choice_3_11_1' id='label_3_11_1' class='gform-field-label gform-field-label--type-inline'>Dr. Mila Leboeuf, optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Dr. Kellie Beaulieu, Optometrist'  id='choice_3_11_2' onchange='gformToggleRadioOther( this )'  tabindex='8'  \/>\n\t\t\t\t\t<label for='choice_3_11_2' id='label_3_11_2' class='gform-field-label gform-field-label--type-inline'>Dr. Kellie Beaulieu, Optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='First available'  id='choice_3_11_3' onchange='gformToggleRadioOther( this )'  tabindex='9'  \/>\n\t\t\t\t\t<label for='choice_3_11_3' id='label_3_11_3' class='gform-field-label gform-field-label--type-inline'>First available<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Select your optometrist - Coteau-du-Lac Clinic:<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_3_12'>\n\t\t\t<div class='gchoice gchoice_3_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Dr. Catherine Brault, Optometrist'  id='choice_3_12_0' onchange='gformToggleRadioOther( this )'  tabindex='10'  \/>\n\t\t\t\t\t<label for='choice_3_12_0' id='label_3_12_0' class='gform-field-label gform-field-label--type-inline'>Dr. Catherine Brault, Optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Dr. Annie Auclair, Optometrist'  id='choice_3_12_1' onchange='gformToggleRadioOther( this )'  tabindex='11'  \/>\n\t\t\t\t\t<label for='choice_3_12_1' id='label_3_12_1' class='gform-field-label gform-field-label--type-inline'>Dr. Annie Auclair, Optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Dr. Mila Leboeuf, optometrist'  id='choice_3_12_2' onchange='gformToggleRadioOther( this )'  tabindex='12'  \/>\n\t\t\t\t\t<label for='choice_3_12_2' id='label_3_12_2' class='gform-field-label gform-field-label--type-inline'>Dr. Mila Leboeuf, optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Dr. Kellie Beaulieu, Optometrist'  id='choice_3_12_3' onchange='gformToggleRadioOther( this )'  tabindex='13'  \/>\n\t\t\t\t\t<label for='choice_3_12_3' id='label_3_12_3' class='gform-field-label gform-field-label--type-inline'>Dr. Kellie Beaulieu, Optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_12_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='First available'  id='choice_3_12_4' onchange='gformToggleRadioOther( this )'  tabindex='14'  \/>\n\t\t\t\t\t<label for='choice_3_12_4' id='label_3_12_4' class='gform-field-label gform-field-label--type-inline'>First available<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Select your optometrist - No preference:<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_3_13'>\n\t\t\t<div class='gchoice gchoice_3_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Dr. Annie Auclair, Optometrist'  id='choice_3_13_0' onchange='gformToggleRadioOther( this )'  tabindex='15'  \/>\n\t\t\t\t\t<label for='choice_3_13_0' id='label_3_13_0' class='gform-field-label gform-field-label--type-inline'>Dr. Annie Auclair, Optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Dr. Catherine Brault, Optometrist'  id='choice_3_13_1' onchange='gformToggleRadioOther( this )'  tabindex='16'  \/>\n\t\t\t\t\t<label for='choice_3_13_1' id='label_3_13_1' class='gform-field-label gform-field-label--type-inline'>Dr. Catherine Brault, Optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Dr. Mila Leboeuf, optometrist'  id='choice_3_13_2' onchange='gformToggleRadioOther( this )'  tabindex='17'  \/>\n\t\t\t\t\t<label for='choice_3_13_2' id='label_3_13_2' class='gform-field-label gform-field-label--type-inline'>Dr. Mila Leboeuf, optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Dr. Kellie Beaulieu, Optometrist'  id='choice_3_13_3' onchange='gformToggleRadioOther( this )'  tabindex='18'  \/>\n\t\t\t\t\t<label for='choice_3_13_3' id='label_3_13_3' class='gform-field-label gform-field-label--type-inline'>Dr. Kellie Beaulieu, Optometrist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_13_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='First available'  id='choice_3_13_4' onchange='gformToggleRadioOther( this )'  tabindex='19'  \/>\n\t\t\t\t\t<label for='choice_3_13_4' id='label_3_13_4' class='gform-field-label gform-field-label--type-inline'>First available<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_15\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Desired time of day<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_15'><div class='gchoice gchoice_3_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='AM'  id='choice_3_15_1' tabindex='20'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_15_1' id='label_3_15_1' class='gform-field-label gform-field-label--type-inline'>AM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='PM'  id='choice_3_15_2' tabindex='21'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_15_2' id='label_3_15_2' class='gform-field-label gform-field-label--type-inline'>PM<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_1'>First 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_1' id='input_3_1' type='text' value='' class='large'   tabindex='22' placeholder='First name*' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_3'>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_3' id='input_3_3' type='text' value='' class='large'   tabindex='23' placeholder='Last name*' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_4\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_4'>Email address<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_4' id='input_3_4' type='email' value='' 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