{"id":3141,"date":"2022-05-26T09:47:03","date_gmt":"2022-05-26T09:47:03","guid":{"rendered":"https:\/\/thejaxcoaching.com\/?page_id=3141"},"modified":"2023-03-23T12:54:50","modified_gmt":"2023-03-23T12:54:50","slug":"fitness-coaching-form","status":"publish","type":"page","link":"https:\/\/thejaxcoaching.com\/fitness-coaching-form\/","title":{"rendered":"Fitness Coaching Form"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1331.2px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form fusion-form-builder fusion-form-form-wrapper fusion-form-3135\" style=\"--awb-tooltip-text-color:#ffffff;--awb-tooltip-background-color:#333333;\" data-form-id=\"3135\" data-config=\"{&quot;form_id&quot;:&quot;3135&quot;,&quot;form_post_id&quot;:&quot;3135&quot;,&quot;post_id&quot;:3141,&quot;form_type&quot;:&quot;ajax&quot;,&quot;confirmation_type&quot;:&quot;message&quot;,&quot;redirect_url&quot;:&quot;&quot;,&quot;field_labels&quot;:{&quot;first_name&quot;:&quot;First Name&quot;,&quot;last_name&quot;:&quot;Last Name&quot;,&quot;email&quot;:&quot;Email&quot;,&quot;phone&quot;:&quot;Phone&quot;,&quot;country&quot;:&quot;Country&quot;,&quot;date_of_birth&quot;:&quot;Date Of Birth&quot;,&quot;have_you_exercised_in_the_past_3_months&quot;:&quot;Have You Exercised In The Past 3 Months?&quot;,&quot;whats_your_fitness_level&quot;:&quot;What&#039;s your fitness Level?&quot;,&quot;are_you_following_a_diet_plan&quot;:&quot;Are you Following A Diet Plan?&quot;,&quot;briefly_describe_it&quot;:&quot;Briefly Describe It&quot;,&quot;indicate_any_diseases_or_illnesses_you_had_or_currently_have&quot;:&quot;Indicate any diseases or illnesses you had or currently have&quot;,&quot;any_other_health_problemsoperationsif_on_medications_please_mention&quot;:&quot;Any Other health problems\\\/operations\\\/if on medications please mention&quot;,&quot;what_are_your_alcohol_consumption_habits_&quot;:&quot;What Are Your Alcohol Consumption Habits? &quot;,&quot;what_are_your_caffeine_consumption_habits_&quot;:&quot;What Are Your Caffeine Consumption Habits? &quot;,&quot;what_are_your_smoking_habits_&quot;:&quot;What Are Your Smoking Habits? &quot;,&quot;what_are_your_sleeping_habits_&quot;:&quot;What Are Your Sleeping Habits? &quot;,&quot;what_equipment_do_you_have_access_to_gym_home_dumbbells&quot;:&quot;What equipment do you have access to? (gym, home, dumbbells...)&quot;,&quot;what_are_your_goals_&quot;:&quot;What Are Your Goals? &quot;,&quot;how_many_days_per_week_can_you_train&quot;:&quot;How Many Days Per Week Can You Train?&quot;,&quot;i_have_read_the_pt_agreement_terms_mentioned_in_the_page_below_and_accepted_them&quot;:&quot;I have read the PT Agreement Terms mentioned in the page below and accepted them&quot;},&quot;field_logics&quot;:{&quot;first_name&quot;:&quot;&quot;,&quot;last_name&quot;:&quot;&quot;,&quot;email&quot;:&quot;&quot;,&quot;phone&quot;:&quot;&quot;,&quot;country&quot;:&quot;&quot;,&quot;date_of_birth&quot;:&quot;&quot;,&quot;have_you_exercised_in_the_past_3_months&quot;:&quot;&quot;,&quot;whats_your_fitness_level&quot;:&quot;&quot;,&quot;are_you_following_a_diet_plan&quot;:&quot;&quot;,&quot;briefly_describe_it&quot;:&quot;&quot;,&quot;indicate_any_diseases_or_illnesses_you_had_or_currently_have&quot;:&quot;&quot;,&quot;any_other_health_problemsoperationsif_on_medications_please_mention&quot;:&quot;&quot;,&quot;what_are_your_alcohol_consumption_habits_&quot;:&quot;&quot;,&quot;what_are_your_caffeine_consumption_habits_&quot;:&quot;&quot;,&quot;what_are_your_smoking_habits_&quot;:&quot;&quot;,&quot;what_are_your_sleeping_habits_&quot;:&quot;&quot;,&quot;what_equipment_do_you_have_access_to_gym_home_dumbbells&quot;:&quot;&quot;,&quot;what_are_your_goals_&quot;:&quot;&quot;,&quot;how_many_days_per_week_can_you_train&quot;:&quot;&quot;,&quot;i_have_read_the_pt_agreement_terms_mentioned_in_the_page_below_and_accepted_them&quot;:&quot;&quot;,&quot;notice_1&quot;:&quot;&quot;},&quot;field_types&quot;:{&quot;first_name&quot;:&quot;text&quot;,&quot;last_name&quot;:&quot;text&quot;,&quot;email&quot;:&quot;email&quot;,&quot;phone&quot;:&quot;phone_number&quot;,&quot;country&quot;:&quot;text&quot;,&quot;date_of_birth&quot;:&quot;date&quot;,&quot;have_you_exercised_in_the_past_3_months&quot;:&quot;select&quot;,&quot;whats_your_fitness_level&quot;:&quot;select&quot;,&quot;are_you_following_a_diet_plan&quot;:&quot;select&quot;,&quot;briefly_describe_it&quot;:&quot;text&quot;,&quot;indicate_any_diseases_or_illnesses_you_had_or_currently_have&quot;:&quot;checkbox&quot;,&quot;any_other_health_problemsoperationsif_on_medications_please_mention&quot;:&quot;text&quot;,&quot;what_are_your_alcohol_consumption_habits_&quot;:&quot;text&quot;,&quot;what_are_your_caffeine_consumption_habits_&quot;:&quot;text&quot;,&quot;what_are_your_smoking_habits_&quot;:&quot;text&quot;,&quot;what_are_your_sleeping_habits_&quot;:&quot;text&quot;,&quot;what_equipment_do_you_have_access_to_gym_home_dumbbells&quot;:&quot;textarea&quot;,&quot;what_are_your_goals_&quot;:&quot;text&quot;,&quot;how_many_days_per_week_can_you_train&quot;:&quot;number&quot;,&quot;i_have_read_the_pt_agreement_terms_mentioned_in_the_page_below_and_accepted_them&quot;:&quot;checkbox&quot;,&quot;recaptcha_1&quot;:&quot;recaptcha&quot;,&quot;submit_1&quot;:&quot;submit&quot;,&quot;notice_1&quot;:&quot;notice&quot;},&quot;nonce_method&quot;:&quot;ajax&quot;}\"><form action=\"https:\/\/thejaxcoaching.com\/fitness-coaching-form\/\" method=\"post\" class=\"fusion-form fusion-form-3135\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;text-transform:none;--fontSize:27;line-height:1.3;\">Personal Info<\/h3><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:20px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"first_name\">First Name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" name=\"first_name\" id=\"first_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:20px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"last_name\">Last Name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" name=\"last_name\" id=\"last_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:20px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"email\">Email <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"email\" name=\"email\" id=\"email\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:20px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"phone\">Phone<\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" name=\"phone\" id=\"phone\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:20px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"country\">Country <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" name=\"country\" id=\"country\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-7 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:20px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><label for=\"date_of_birth\">Date Of Birth <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><input autocomplete=\"no\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"date_of_birth\" name=\"date_of_birth\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\"autocomplete=\"no\"\/><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-8 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-three\"><h3 class=\"fusion-title-heading title-heading-center fusion-responsive-typography-calculated\" style=\"margin:0;text-transform:none;--fontSize:27;line-height:1.3;\">Health Info<\/h3><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-9 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:20px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><label for=\"have_you_exercised_in_the_past_3_months\">Have You Exercised In The Past 3 Months? <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-select-wrapper\"><select tabindex=\"\" id=\"have_you_exercised_in_the_past_3_months\" name=\"have_you_exercised_in_the_past_3_months\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-10 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:20px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><label for=\"whats_your_fitness_level\">What&#039;s your fitness Level? <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-select-wrapper\"><select tabindex=\"\" id=\"whats_your_fitness_level\" name=\"whats_your_fitness_level\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><option value=\"Beginner\" >Beginner<\/option><option value=\"Intermediate\" >Intermediate<\/option><option value=\"Advanced\" >Advanced<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-11 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><label for=\"are_you_following_a_diet_plan\">Are you Following A Diet Plan? <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-select-wrapper\"><select tabindex=\"\" id=\"are_you_following_a_diet_plan\" name=\"are_you_following_a_diet_plan\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"briefly_describe_it\">Briefly Describe It<\/label><\/div><input type=\"text\" name=\"briefly_describe_it\" id=\"briefly_describe_it\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-12 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><span class=\"label\">Indicate any diseases or illnesses you had or currently have<\/span><\/div><fieldset><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-0\" type=\"checkbox\" value=\"Asthma\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-0\">Asthma<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-1\" type=\"checkbox\" value=\"Allergies\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-1\">Allergies<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-2\" type=\"checkbox\" value=\"Arthritis\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-2\">Arthritis<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-3\" type=\"checkbox\" value=\"Back Condition\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-3\">Back Condition<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-4\" type=\"checkbox\" value=\"High Blood Pressure\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-4\">High Blood Pressure<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-5\" type=\"checkbox\" value=\"Bursitis\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-5\">Bursitis<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-6\" type=\"checkbox\" value=\"Fatigue\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-6\">Fatigue<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-7\" type=\"checkbox\" value=\"Joint Pain\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-7\">Joint Pain<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-8\" type=\"checkbox\" value=\"Hernia\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-8\">Hernia<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-9\" type=\"checkbox\" value=\"Low Blood Pressure\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-9\">Low Blood Pressure<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-10\" type=\"checkbox\" value=\"Ulcers\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-10\">Ulcers<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-11\" type=\"checkbox\" value=\"Sinus\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-11\">Sinus<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-12\" type=\"checkbox\" value=\"Epilepsy\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-12\">Epilepsy<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-13\" type=\"checkbox\" value=\"Hemorrhoids\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-13\">Hemorrhoids<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-14\" type=\"checkbox\" value=\"Heart Condition\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-14\">Heart Condition<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-15\" type=\"checkbox\" value=\"Varicose Tension\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-15\">Varicose Tension<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-16\" type=\"checkbox\" value=\"Nervous Tension\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-16\">Nervous Tension<\/label><\/div><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-17\" type=\"checkbox\" value=\"Shortness of Breath\" name=\"indicate_any_diseases_or_illnesses_you_had_or_currently_have[]\" class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><label for=\"checkbox-indicate_any_diseases_or_illnesses_you_had_or_currently_have-1-17\">Shortness of Breath<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"any_other_health_problemsoperationsif_on_medications_please_mention\">Any Other health problems\/operations\/if on medications please mention<\/label><\/div><input type=\"text\" name=\"any_other_health_problemsoperationsif_on_medications_please_mention\" id=\"any_other_health_problemsoperationsif_on_medications_please_mention\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-13 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"what_are_your_alcohol_consumption_habits_\">What Are Your Alcohol Consumption Habits?  <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" name=\"what_are_your_alcohol_consumption_habits_\" id=\"what_are_your_alcohol_consumption_habits_\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"what_are_your_caffeine_consumption_habits_\">What Are Your Caffeine Consumption Habits?  <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" name=\"what_are_your_caffeine_consumption_habits_\" id=\"what_are_your_caffeine_consumption_habits_\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"what_are_your_smoking_habits_\">What Are Your Smoking Habits?  <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" name=\"what_are_your_smoking_habits_\" id=\"what_are_your_smoking_habits_\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"what_are_your_sleeping_habits_\">What Are Your Sleeping Habits?  <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" name=\"what_are_your_sleeping_habits_\" id=\"what_are_your_sleeping_habits_\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-14 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-textarea-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><label for=\"what_equipment_do_you_have_access_to_gym_home_dumbbells\">What equipment do you have access to? (gym, home, dumbbells...) <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><textarea cols=\"40\"  minlength=\"0\"  rows=\"4\" tabindex=\"\" id=\"what_equipment_do_you_have_access_to_gym_home_dumbbells\" name=\"what_equipment_do_you_have_access_to_gym_home_dumbbells\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><\/textarea><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"what_are_your_goals_\">What Are Your Goals?  <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" name=\"what_are_your_goals_\" id=\"what_are_your_goals_\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-number-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><label for=\"how_many_days_per_week_can_you_train\">How Many Days Per Week Can You Train? <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"number\" name=\"how_many_days_per_week_can_you_train\" id=\"how_many_days_per_week_can_you_train\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" min=\"0\" max=\"7\"\/><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-3 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-15 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-checkbox-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div class=\"fusion-form-label-wrapper\"><span class=\"label\">I have read the PT Agreement Terms mentioned in the page below and accepted them <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/span><\/div><fieldset><div class=\"fusion-form-checkbox\"><input tabindex=\"\" id=\"checkbox-i_have_read_the_pt_agreement_terms_mentioned_in_the_page_below_and_accepted_them-2-0\" type=\"checkbox\" value=\"Yes\" name=\"i_have_read_the_pt_agreement_terms_mentioned_in_the_page_below_and_accepted_them[]\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"checkbox-i_have_read_the_pt_agreement_terms_mentioned_in_the_page_below_and_accepted_them-2-0\">Yes<\/label><\/div><\/fieldset><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-16 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:20px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-1 fusion-button-default-span fusion-button-default-type\" target=\"_blank\" rel=\"noopener noreferrer\" href=\"https:\/\/thejaxcoaching.com\/pt-agreement\/\"><span class=\"fusion-button-text\">PT Agreement<\/span><\/a><\/div><div class=\"fusion-form-field fusion-form-recaptcha-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\">\t\t\t\t<div class=\"form-creator-recaptcha\" >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"fusion-form-recaptcha-wrapper\">\n\t\t\t\t\t<div\n\t\t\t\t\t\tid=\"g-recaptcha-id-form-3135\"\n\t\t\t\t\t\tclass=\"awb-recaptcha-v2 fusion-form-recaptcha-v2\"\n\t\t\t\t\t\tdata-theme=\"light\"\n\t\t\t\t\t\tdata-sitekey=\"6Lf6njEeAAAAAHlMYPonSz8o4cg09KKEuUZypHcL\"\n\t\t\t\t\t\tdata-tabindex=\"\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div><div class=\"fusion-form-field fusion-form-submit-field fusion-form-label-above\" style=\"\" data-form-id=\"3135\"><div style=\"text-align:center;\"><button type=\"submit\" class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-2 fusion-button-default-span  form-form-submit button-default\" data-form-number=\"3135\" tabindex=\"\"><span class=\"fusion-button-text\">Submit<\/span><\/button><\/div><\/div><div class=\"form-submission-notices data-notice_1\" id=\"fusion-notices-1\"><div class=\"fusion-alert alert success alert-success fusion-alert-center fusion-form-response fusion-form-response-success fusion-alert-capitalize awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"alert-icon\"><i class=\"awb-icon-check-circle\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-alert-content\">Thank you for filling the form. It has been sent.<\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div><div class=\"fusion-alert alert error alert-danger fusion-alert-center fusion-form-response fusion-form-response-error fusion-alert-capitalize awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"alert-icon\"><i class=\"awb-icon-exclamation-triangle\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-alert-content\">There was an error trying to fill the form. 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