{"id":456,"date":"2025-02-06T23:05:08","date_gmt":"2025-02-06T23:05:08","guid":{"rendered":"https:\/\/classenviewvet.com\/?page_id=456"},"modified":"2025-02-06T23:10:14","modified_gmt":"2025-02-06T23:10:14","slug":"medical-history-form","status":"publish","type":"page","link":"https:\/\/classenviewvet.com\/index.php\/medical-history-form\/","title":{"rendered":"Medical History Form"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-e23fbb94-294c-4c69-8583-72adb5d6d7f2 wpforms-render-modern\" id=\"wpforms-458\"><form id=\"wpforms-form-458\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"458\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/456\" data-token=\"1891b320e91adc1d3346d86e1e96243e\" data-token-time=\"1777044594\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-458-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_1\">Pet&#039;s Name? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-458-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-458-field_1-error\" aria-describedby=\"wpforms-458-field_1-description\" required><div id=\"wpforms-458-field_1-description\" class=\"wpforms-field-description\">Please Enter Your Pet&#8217;s Name Here<\/div><\/div><div id=\"wpforms-458-field_2-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_2\">Species? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-458-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required=\"required\"><option value=\"Please Select\"  selected='selected' class=\"choice-4 depth-1\"  >Please Select<\/option><option value=\"Canine\"  class=\"choice-1 depth-1\"  >Canine<\/option><option value=\"Feline\"  class=\"choice-2 depth-1\"  >Feline<\/option><option value=\"Avian\"  class=\"choice-3 depth-1\"  >Avian<\/option><option value=\"Other\"  class=\"choice-6 depth-1\"  >Other<\/option><\/select><div id=\"wpforms-458-field_2-description\" class=\"wpforms-field-description\">Please Tell Us What Species Your Pet Is. <\/div><\/div><div id=\"wpforms-458-field_3-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_3\">Sex? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-458-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required=\"required\"><option value=\"Please Choose\"  class=\"choice-4 depth-1\"  >Please Choose<\/option><option value=\"Male\"  class=\"choice-1 depth-1\"  >Male<\/option><option value=\"Female\"  class=\"choice-2 depth-1\"  >Female<\/option><option value=\"Unknown\"  class=\"choice-3 depth-1\"  >Unknown<\/option><\/select><\/div><div id=\"wpforms-458-field_19-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Has Your Pet Been Spayed or Neutered? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-458-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_19_1\" name=\"wpforms[fields][19]\" value=\"Yes\" aria-errormessage=\"wpforms-458-field_19_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_19_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_19_2\" name=\"wpforms[fields][19]\" value=\"No\" aria-errormessage=\"wpforms-458-field_19_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_19_2\">No<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-458-field_4-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"4\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-458-field_4\" >Pet Microchip? Name?<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-458-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-458-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_5\">Breed? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-458-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-458-field_5-error\" required><\/div><div id=\"wpforms-458-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_6\">Color? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-458-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-458-field_6-error\" required><\/div><div id=\"wpforms-458-field_18-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">Does Your Pet Have A Microchip? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-458-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_18_1\" name=\"wpforms[fields][18]\" value=\"Yes\" aria-errormessage=\"wpforms-458-field_18_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_18_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_18_2\" name=\"wpforms[fields][18]\" value=\"No\" aria-errormessage=\"wpforms-458-field_18_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_18_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-458-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_8\">What Brand Of Food Do You Feed? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-458-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-458-field_8-error\" required><\/div><div id=\"wpforms-458-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_9\">Pet&#039;s Birth Date? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-458-field_9\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-alias=\"datetime\" data-inputmask-inputformat=\"mm\/yy\" data-inputmask-inputmode=\"numeric\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-458-field_9-error\" required><\/div><div id=\"wpforms-458-field_10-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Does Your Pet Have Any Known Allergies?<\/legend><ul id=\"wpforms-458-field_10\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_10_1\" name=\"wpforms[fields][10][]\" value=\"Skin\" aria-errormessage=\"wpforms-458-field_10_1-error\" aria-describedby=\"wpforms-458-field_10-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_10_1\">Skin<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_10_2\" name=\"wpforms[fields][10][]\" value=\"Food\" aria-errormessage=\"wpforms-458-field_10_2-error\" aria-describedby=\"wpforms-458-field_10-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_10_2\">Food<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_10_3\" name=\"wpforms[fields][10][]\" value=\"Medication(s)\" aria-errormessage=\"wpforms-458-field_10_3-error\" aria-describedby=\"wpforms-458-field_10-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_10_3\">Medication(s)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_10_4\" name=\"wpforms[fields][10][]\" value=\"Seasonal\" aria-errormessage=\"wpforms-458-field_10_4-error\" aria-describedby=\"wpforms-458-field_10-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_10_4\">Seasonal<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_10_5\" name=\"wpforms[fields][10][]\" value=\"Environmental\" aria-errormessage=\"wpforms-458-field_10_5-error\" aria-describedby=\"wpforms-458-field_10-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_10_5\">Environmental<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_10_6\" name=\"wpforms[fields][10][]\" value=\"Other\" aria-errormessage=\"wpforms-458-field_10_6-error\" aria-describedby=\"wpforms-458-field_10-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_10_6\">Other<\/label><\/li><\/ul><div id=\"wpforms-458-field_10-description\" class=\"wpforms-field-description\">Please Check All That Apply<\/div><\/fieldset><\/div><div id=\"wpforms-458-field_11-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Has Your Pet Had Any Of The Following Symptoms Or Diagnoses?<\/legend><ul id=\"wpforms-458-field_11\"><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_4\" name=\"wpforms[fields][11][]\" value=\"Allergies\" aria-errormessage=\"wpforms-458-field_11_4-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_4\">Allergies<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_5\" name=\"wpforms[fields][11][]\" value=\"Anxiety\" aria-errormessage=\"wpforms-458-field_11_5-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_5\">Anxiety<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_6\" name=\"wpforms[fields][11][]\" value=\"Arthritis\" aria-errormessage=\"wpforms-458-field_11_6-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_6\">Arthritis<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_7\" name=\"wpforms[fields][11][]\" value=\"Cancer\" aria-errormessage=\"wpforms-458-field_11_7-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_7\">Cancer<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_8\" name=\"wpforms[fields][11][]\" value=\"Dental Extractions\" aria-errormessage=\"wpforms-458-field_11_8-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_8\">Dental Extractions<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_9\" name=\"wpforms[fields][11][]\" value=\"Ear Infection\" aria-errormessage=\"wpforms-458-field_11_9-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_9\">Ear Infection<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_10\" name=\"wpforms[fields][11][]\" value=\"Eye Infection\" aria-errormessage=\"wpforms-458-field_11_10-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_10\">Eye Infection<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_11\" name=\"wpforms[fields][11][]\" value=\"Gastroenteritis\" aria-errormessage=\"wpforms-458-field_11_11-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_11\">Gastroenteritis<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_12\" name=\"wpforms[fields][11][]\" value=\"Heart Disease\" aria-errormessage=\"wpforms-458-field_11_12-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_12\">Heart Disease<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_13\" name=\"wpforms[fields][11][]\" value=\"Heartworms\" aria-errormessage=\"wpforms-458-field_11_13-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_13\">Heartworms<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_14\" name=\"wpforms[fields][11][]\" value=\"Hip Dysplasia\" aria-errormessage=\"wpforms-458-field_11_14-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_14\">Hip Dysplasia<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_15\" name=\"wpforms[fields][11][]\" value=\"Idiopathic Vestibular Diseases\" aria-errormessage=\"wpforms-458-field_11_15-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_15\">Idiopathic Vestibular Diseases<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_16\" name=\"wpforms[fields][11][]\" value=\"Intestinal Parasites\" aria-errormessage=\"wpforms-458-field_11_16-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_16\">Intestinal Parasites<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_17\" name=\"wpforms[fields][11][]\" value=\"Kidney Disease\" aria-errormessage=\"wpforms-458-field_11_17-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_17\">Kidney Disease<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_18\" name=\"wpforms[fields][11][]\" value=\"Liver Disease\" aria-errormessage=\"wpforms-458-field_11_18-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_18\">Liver Disease<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_19\" name=\"wpforms[fields][11][]\" value=\"Mast Cell Tumors\" aria-errormessage=\"wpforms-458-field_11_19-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_19\">Mast Cell Tumors<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_20\" name=\"wpforms[fields][11][]\" value=\"Pancreatitis\" aria-errormessage=\"wpforms-458-field_11_20-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_20\">Pancreatitis<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_21\" name=\"wpforms[fields][11][]\" value=\"Pyometra\" aria-errormessage=\"wpforms-458-field_11_21-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_21\">Pyometra<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_22\" name=\"wpforms[fields][11][]\" value=\"Thyroid Disease\" aria-errormessage=\"wpforms-458-field_11_22-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_22\">Thyroid Disease<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_23\" name=\"wpforms[fields][11][]\" value=\"Urinary Infections\" aria-errormessage=\"wpforms-458-field_11_23-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_23\">Urinary Infections<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-458-field_11_24\" name=\"wpforms[fields][11][]\" value=\"Other\" aria-errormessage=\"wpforms-458-field_11_24-error\" aria-describedby=\"wpforms-458-field_11-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_11_24\">Other<\/label><\/li><\/ul><div id=\"wpforms-458-field_11-description\" class=\"wpforms-field-description\">Please Check All That Apply<\/div><\/fieldset><\/div><div id=\"wpforms-458-field_20-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Is Your Pet Currently Taking Any Medications? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-458-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_20_1\" name=\"wpforms[fields][20]\" value=\"Yes\" aria-errormessage=\"wpforms-458-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_20_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_20_2\" name=\"wpforms[fields][20]\" value=\"No\" aria-errormessage=\"wpforms-458-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_20_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-458-field_13-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_13\">Please List Any Medications: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-458-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-458-field_13-error\" aria-describedby=\"wpforms-458-field_13-description\" required><\/textarea><div id=\"wpforms-458-field_13-description\" class=\"wpforms-field-description\">If Your Pet Is Not Taking Any Medications Please Enter &#8220;None&#8221;<\/div><\/div><div id=\"wpforms-458-field_21-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Does Your Pet Take Any OTC Supplements Or Herbal Remedies?<\/legend><ul id=\"wpforms-458-field_21\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_21_1\" name=\"wpforms[fields][21]\" value=\"Yes\" aria-errormessage=\"wpforms-458-field_21_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_21_2\" name=\"wpforms[fields][21]\" value=\"No\" aria-errormessage=\"wpforms-458-field_21_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_21_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-458-field_17-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">Does Your Pet Currently Take Any Heartworm or Flea And Tick Prevention?<\/legend><ul id=\"wpforms-458-field_17\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_17_2\" name=\"wpforms[fields][17]\" value=\"Yes\" aria-errormessage=\"wpforms-458-field_17_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_17_2\">Yes<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-458-field_17_3\" name=\"wpforms[fields][17]\" value=\"No\" aria-errormessage=\"wpforms-458-field_17_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-458-field_17_3\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-458-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_14\">Please List All Veterinary Clinics Your Pet Has Visited In The Last Five Years.<\/label><textarea id=\"wpforms-458-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-458-field_14-error\" aria-describedby=\"wpforms-458-field_14-description\" ><\/textarea><div id=\"wpforms-458-field_14-description\" class=\"wpforms-field-description\">If your pet has not been seen at a vet clinic, please enter &#8220;None&#8221;.<\/div><\/div><div id=\"wpforms-458-field_15-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-458-field_15\">Has Your Pet Ever Shown Any Signs Of Aggression Or Fear Towards People Or Pets? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-458-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" required=\"required\"><option value=\"Please Choose\"  class=\"choice-1 depth-1\"  >Please Choose<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><option value=\"No\"  class=\"choice-3 depth-1\"  >No<\/option><\/select><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-458-field_4-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-458-field_4-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-458-field_4-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- 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