{"id":658,"date":"2019-04-03T10:59:43","date_gmt":"2019-04-03T15:59:43","guid":{"rendered":"https:\/\/whyweight.com\/?page_id=658"},"modified":"2024-02-19T09:35:30","modified_gmt":"2024-02-19T15:35:30","slug":"contact","status":"publish","type":"page","link":"https:\/\/whyweight.com\/contact\/","title":{"rendered":"Contact"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework gf_stylespro_wrapper sp_goose_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Why Weight Contact<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2' class=' gf_stylespro sp_goose' action='\/wp-json\/wp\/v2\/pages\/658' data-formid='2' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Le2IzQnAAAAANDWY6wY-nhS4LPNFS7PqNf27GZS' data-tabindex='0'><input id=\"input_c599f72f82d4a850e820b72105c86b2f\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_c599f72f82d4a850e820b72105c86b2f\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_15\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_15\" ><h2 class=\"gsection_title\">1. Tell us how to get in touch with you<\/h2><\/li><li id=\"field_2_2\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_2\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_2'>\n                            \n                            <span id='input_2_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_2_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_2_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_3\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_3\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Zip Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_zip ginput_container_address gform-grid-row' id='input_2_3' >\n                        <input type='hidden' class='gform_hidden' name='input_3.4' id='input_2_3_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_2_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_2_3_5' value=''    aria-required='true'    \/>\n                                    <label for='input_2_3_5' id='input_2_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_2_3_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_2_4\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_left o_medium\"  data-field-class=\"gf_half gf_left o_medium\" data-js-reload=\"field_2_4\" ><label class='gfield_label gform-field-label' for='input_2_4'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_2_4' type='tel' value='' class='large full'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_5\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_right o_medium\"  data-field-class=\"gf_half gf_right o_medium\" data-js-reload=\"field_2_5\" ><label class='gfield_label gform-field-label' for='input_2_5'>Email<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_5' id='input_2_5' type='email' value='' class='large full'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_2_13\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_left o_medium\"  data-field-class=\"gf_half gf_left o_medium\" data-js-reload=\"field_2_13\" ><label class='gfield_label gform-field-label' for='input_2_13'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_13' id='input_2_13' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_13_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_13_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_13' class='gform_hidden' value='https:\/\/whyweight.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_2_26\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_right o_medium\"  data-field-class=\"gf_half gf_right o_medium\" data-js-reload=\"field_2_26\" ><label class='gfield_label gform-field-label' for='input_2_26'>How did you hear about us?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_2_26' class='large full gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Select one ...<\/option><option value='Internet Web Search' >Internet Web Search<\/option><option value='Referral - Personal' >Referral - Personal<\/option><option value='Referral - Insurance' >Referral - Insurance<\/option><option value='Referral - Physician' >Referral - Physician<\/option><option value='Social Media' >Social Media<\/option><option value='Employer' >Employer<\/option><option value='Health Fair Events' >Health Fair Events<\/option><option value='Magazine' >Magazine<\/option><option value='Radio' >Radio<\/option><option value='TV' >TV<\/option><option value='eMail Blast' >eMail Advertising<\/option><\/select><\/div><\/li><li id=\"field_2_17\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_17\" ><h2 class=\"gsection_title\">2. Insurance Information<\/h2><div class='gsection_description' id='gfield_description_2_17'>The following information is options, but will speed up the process.<\/div><\/li><li id=\"field_2_6\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_left o_medium\"  data-field-class=\"gf_half gf_left o_medium\" data-js-reload=\"field_2_6\" ><label class='gfield_label gform-field-label' for='input_2_6'>Insurance Company<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_2_6' type='text' value='' class='large full' maxlength='200'     aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_7\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_right o_medium\"  data-field-class=\"gf_half gf_right o_medium\" data-js-reload=\"field_2_7\" ><label class='gfield_label gform-field-label' for='input_2_7'>Insured Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_2_7' type='text' value='' class='large full' maxlength='100'     aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_8\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_left o_medium\"  data-field-class=\"gf_half gf_left o_medium\" data-js-reload=\"field_2_8\" ><label class='gfield_label gform-field-label' for='input_2_8'>Member Policy Number<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_2_8' type='text' value='' class='large full' maxlength='20'     aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_9\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_half gf_right o_medium\"  data-field-class=\"gf_half gf_right o_medium\" data-js-reload=\"field_2_9\" ><label class='gfield_label gform-field-label' for='input_2_9'>Group Number<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_2_9' type='text' value='' class='large full' maxlength='20'     aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_12\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_12\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Insured&#039;s Full Name<\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_12'>\n                            \n                            <span id='input_2_12_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.3' id='input_2_12_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_2_12_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_12_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.6' id='input_2_12_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_2_12_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_22\" class=\"gfield gfield--type-phone field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible o_medium\"  data-field-class=\"o_medium\" data-js-reload=\"field_2_22\" ><label class='gfield_label gform-field-label' for='input_2_22'>Customer Service Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_22' id='input_2_22' type='tel' value='' class='large full'    aria-invalid=\"false\" aria-describedby=\"gfield_description_2_22\"  \/><\/div><div class='gfield_description' id='gfield_description_2_22'>(Usually located on the back of your insurance card)<\/div><\/li><li id=\"field_2_16\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_16\" ><h2 class=\"gsection_title\">3. Help us determine your weight loss needs<\/h2><div class='gsection_description' id='gfield_description_2_16'>Body Mass Index (BMI) is the measurement that will help determine if you are a candidate for this surgery.<\/div><\/li><li id=\"field_2_18\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_list_5col o_medium\"  data-field-class=\"gf_list_5col o_medium\" data-js-reload=\"field_2_18\" ><label class='gfield_label gform-field-label' >Gender<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_18'>\n\t\t\t<li class='gchoice gchoice_2_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='Male'  id='choice_2_18_0'    \/>\n\t\t\t\t<label for='choice_2_18_0' id='label_2_18_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='Female'  id='choice_2_18_1'    \/>\n\t\t\t\t<label for='choice_2_18_1' id='label_2_18_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_24\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_left o_medium\"  data-field-class=\"gf_third gf_left o_medium\" data-js-reload=\"field_2_24\" ><label class='gfield_label gform-field-label' for='input_2_24'>Weight<\/label><div class='ginput_container ginput_container_number'><input name='input_24' id='input_2_24' type='number' step='any'   value='' class='large full'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_2_23\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\" data-js-reload=\"field_2_23\" ><label class='gfield_label gform-field-label' for='input_2_23'>Height - Feet<\/label><div class='ginput_container ginput_container_number'><input name='input_23' id='input_2_23' type='number' step='any'   value='' class='large full'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_2_25\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gf_third gf_right o_medium\"  data-field-class=\"gf_third gf_right o_medium\" data-js-reload=\"field_2_25\" ><label class='gfield_label gform-field-label' for='input_2_25'>Height - Inches<\/label><div class='ginput_container ginput_container_number'><input name='input_25' id='input_2_25' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_2_27\" class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_27\" ><div class='ginput_container ginput_container_text'><input name='input_27' id='input_2_27' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/li><li id=\"field_2_28\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_28\" ><label class='gfield_label gform-field-label' for='input_2_28'>Email<\/label><div class='ginput_container'><input name='input_28' id='input_2_28' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_28'>This field is for validation purposes and should be left unchanged.<\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' value='SUBMIT'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( 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