{"id":1686,"date":"2023-09-15T15:52:04","date_gmt":"2023-09-15T15:52:04","guid":{"rendered":"https:\/\/dev.thronebio.com\/tb\/?page_id=1686"},"modified":"2023-11-22T19:18:55","modified_gmt":"2023-11-22T19:18:55","slug":"apply-for-stem-cell-treatment-of-alopecia-areata-child","status":"publish","type":"page","link":"https:\/\/dev.thronebio.com\/tb\/apply-for-stem-cell-educator-treatment\/apply-for-stem-cell-treatment-of-alopecia-areata-child\/","title":{"rendered":"Apply For Stem Cell Treatment Of Alopecia Areata-Child"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1686\" class=\"elementor elementor-1686\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6cd041e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6cd041e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-58ac207\" data-id=\"58ac207\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4a37a7b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4a37a7b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e37b519\" data-id=\"e37b519\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ea4b211 elementor-widget elementor-widget-heading\" data-id=\"ea4b211\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Application For Stem Cell Treatment Of Alopecia Areata-Child<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e708e1a elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"e708e1a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">To initiate the application process for Throne's cord blood stem cell treatment targeting Alopecia Areata for a child, kindly complete the following application.<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-12a6591 elementor-widget elementor-widget-wpforms\" data-id=\"12a6591\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><style id=\"wpforms-css-vars-elementor-widget-12a6591\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-12a6591 {\n\t\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-852\"><form id=\"wpforms-form-852\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"852\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/tb\/wp-json\/wp\/v2\/pages\/1686?wpforms_form_id=852\" data-token=\"5372f739caf825a16ce2c6dae641d716\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-852-field_59-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"59\"><fieldset><legend class=\"wpforms-field-label\">Child&#039;s Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-852-field_59\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][59][first]\" aria-errormessage=\"wpforms-852-field_59-error\" required><label for=\"wpforms-852-field_59\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-852-field_59-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][59][last]\" aria-errormessage=\"wpforms-852-field_59-last-error\" required><label for=\"wpforms-852-field_59-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-852-field_60-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"60\"><fieldset><legend class=\"wpforms-field-label\">Child&#039;s Address<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-852-field_60\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][60][address1]\" aria-errormessage=\"wpforms-852-field_60-error\" ><label for=\"wpforms-852-field_60\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-852-field_60-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][60][address2]\" aria-errormessage=\"wpforms-852-field_60-address2-error\" ><label for=\"wpforms-852-field_60-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-852-field_60-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][60][city]\" aria-errormessage=\"wpforms-852-field_60-city-error\" ><label for=\"wpforms-852-field_60-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-852-field_60-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][60][state]\" placeholder=\"--- Select state ---\" aria-errormessage=\"wpforms-852-field_60-state-error\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-852-field_60-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-852-field_60-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][60][postal]\" aria-errormessage=\"wpforms-852-field_60-postal-error\" ><label for=\"wpforms-852-field_60-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-852-field_62-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"62\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-852-field_62\" aria-hidden=\"false\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-852-field_61-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_61\">Child&#039;s Date of Birth<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-852-field_61\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][61][date]\" aria-errormessage=\"wpforms-852-field_61-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-852-field_63-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_63\">Today&#039;s Date<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-852-field_63\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][63][date]\" aria-errormessage=\"wpforms-852-field_63-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-852-field_66-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_66\">Child&#039;s Age<\/label><select id=\"wpforms-852-field_66\" class=\"wpforms-field-medium\" name=\"wpforms[fields][66]\"><option value=\"Enter Child&#039;s Age Here\" >Enter Child&#039;s Age Here<\/option><option value=\"Less Than One Year\" >Less Than One Year<\/option><option value=\"One To Two Years\" >One To Two Years<\/option><option value=\"Two To Three Years\" >Two To Three Years<\/option><option value=\"Three To Four Years\" >Three To Four Years<\/option><option value=\"Four To Five Years\" >Four To Five Years<\/option><option value=\"Five To Six Years\" >Five To Six Years<\/option><option value=\"Six To Seven Years\" >Six To Seven Years<\/option><option value=\"Seven To Eight Years\" >Seven To Eight Years<\/option><option value=\"Eight To Nine Years\" >Eight To Nine Years<\/option><option value=\"Nine To Ten Years\" >Nine To Ten Years<\/option><option value=\"Ten To Eleven Years\" >Ten To Eleven Years<\/option><option value=\"Eleven To Twelve Years\" >Eleven To Twelve Years<\/option><option value=\"Twelve To Thirteen Years\" >Twelve To Thirteen Years<\/option><option value=\"Thirteen To Fourteen Years\" >Thirteen To Fourteen Years<\/option><option value=\"Fourteen To Fifteen Years\" >Fourteen To Fifteen Years<\/option><option value=\"Fifteen To Sixteen Years\" >Fifteen To Sixteen Years<\/option><option value=\"Sixteen To Seventeen Years\" >Sixteen To Seventeen Years<\/option><option value=\"Seventeen To Eighteen Years\" >Seventeen To Eighteen Years<\/option><\/select><\/div><\/div><\/div><\/div><div id=\"wpforms-852-field_5-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">Your Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-852-field_5\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][5][first]\" aria-errormessage=\"wpforms-852-field_5-error\" required><label for=\"wpforms-852-field_5\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-852-field_5-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][5][last]\" aria-errormessage=\"wpforms-852-field_5-last-error\" required><label for=\"wpforms-852-field_5-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-852-field_6-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Your Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-852-field_6\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][6][address1]\" aria-errormessage=\"wpforms-852-field_6-error\" required><label for=\"wpforms-852-field_6\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-852-field_6-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][6][address2]\" aria-errormessage=\"wpforms-852-field_6-address2-error\" ><label for=\"wpforms-852-field_6-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-852-field_6-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][6][city]\" aria-errormessage=\"wpforms-852-field_6-city-error\" required><label for=\"wpforms-852-field_6-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-852-field_6-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][6][state]\" placeholder=\"--- Select state ---\" aria-errormessage=\"wpforms-852-field_6-state-error\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-852-field_6-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-852-field_6-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][6][postal]\" aria-errormessage=\"wpforms-852-field_6-postal-error\" required><label for=\"wpforms-852-field_6-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-852-field_7-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_7\">Your Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-852-field_7\" class=\"wpforms-field-small wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-852-field_7-error\" required><\/div><div id=\"wpforms-852-field_8-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_8\">Your Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-852-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" spellcheck=\"false\" aria-errormessage=\"wpforms-852-field_8-error\" required><\/div><div id=\"wpforms-852-field_11-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Has The Child Been Diagnosed With Alopecia Areata? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-852-field_11\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_11_1\" name=\"wpforms[fields][11]\" value=\"Yes, Within The Last Six Months\" aria-errormessage=\"wpforms-852-field_11_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_11_1\">Yes, Within The Last Six Months<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_11_2\" name=\"wpforms[fields][11]\" value=\"Yes, Within The Last Twelve Months\" aria-errormessage=\"wpforms-852-field_11_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_11_2\">Yes, Within The Last Twelve Months<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_11_4\" name=\"wpforms[fields][11]\" value=\"Yes, More Than Two Years Ago\" aria-errormessage=\"wpforms-852-field_11_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_11_4\">Yes, More Than Two Years Ago<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_11_6\" name=\"wpforms[fields][11]\" value=\"No\" aria-errormessage=\"wpforms-852-field_11_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_11_6\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-852-field_12-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_12\">If The Child Has Been Diagnosed With Alopecia Areata, What Was The Date Of That Diagnosis?<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-852-field_12\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][12][date]\" aria-errormessage=\"wpforms-852-field_12-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-852-field_57-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"57\"><fieldset><legend class=\"wpforms-field-label\">Is There A Family History Of Alopecia Areata?<\/legend><ul id=\"wpforms-852-field_57\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_57_1\" name=\"wpforms[fields][57][]\" value=\"One or more siblings\" aria-errormessage=\"wpforms-852-field_57_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_57_1\">One or more siblings<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_57_2\" name=\"wpforms[fields][57][]\" value=\"One or more parents\" aria-errormessage=\"wpforms-852-field_57_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_57_2\">One or more parents<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_57_3\" name=\"wpforms[fields][57][]\" value=\"One or more grandparents\" aria-errormessage=\"wpforms-852-field_57_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_57_3\">One or more grandparents<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_57_4\" name=\"wpforms[fields][57][]\" value=\"One or more first cousins\" aria-errormessage=\"wpforms-852-field_57_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_57_4\">One or more first cousins<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_57_5\" name=\"wpforms[fields][57][]\" value=\"None of the above\" aria-errormessage=\"wpforms-852-field_57_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_57_5\">None of the above<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-852-field_58-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"58\"><fieldset><legend class=\"wpforms-field-label\">If The Child&#039;s Alopecia Areata Has Been Diagnosed Using The Severity Of Alopecia Tool (&quot;SALT&quot;), Enter Your Most Recent Classification Under That Tool<\/legend><ul id=\"wpforms-852-field_58\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_58_1\" name=\"wpforms[fields][58]\" value=\"S0\u2009=\u2009no hair loss\" aria-errormessage=\"wpforms-852-field_58_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_58_1\">S0\u2009=\u2009no hair loss<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_58_2\" name=\"wpforms[fields][58]\" value=\"S1\u2009=\u20091\u201324% hair loss\" aria-errormessage=\"wpforms-852-field_58_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_58_2\">S1\u2009=\u20091\u201324% hair loss<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_58_3\" name=\"wpforms[fields][58]\" value=\"S2\u2009=\u200925\u201349% hair loss\" aria-errormessage=\"wpforms-852-field_58_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_58_3\">S2\u2009=\u200925\u201349% hair loss<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_58_5\" name=\"wpforms[fields][58]\" value=\"S3\u2009=\u200950\u201374% hair loss\" aria-errormessage=\"wpforms-852-field_58_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_58_5\">S3\u2009=\u200950\u201374% hair loss<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_58_4\" name=\"wpforms[fields][58]\" value=\"S4a\u2009=\u200975\u201395% hair loss\" aria-errormessage=\"wpforms-852-field_58_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_58_4\">S4a\u2009=\u200975\u201395% hair loss<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_58_7\" name=\"wpforms[fields][58]\" value=\"S4b\u2009=\u200996\u201399% hair loss\" aria-errormessage=\"wpforms-852-field_58_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_58_7\">S4b\u2009=\u200996\u201399% hair loss<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_58_6\" name=\"wpforms[fields][58]\" value=\"S5\u2009=\u2009100% hair loss\" aria-errormessage=\"wpforms-852-field_58_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_58_6\">S5\u2009=\u2009100% hair loss<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_58_8\" name=\"wpforms[fields][58]\" value=\"No SALT Evaluation Has Been Done\" aria-errormessage=\"wpforms-852-field_58_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_58_8\">No SALT Evaluation Has Been Done<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-852-field_72-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"72\"><div id=\"wpforms-852-field_72\" aria-errormessage=\"wpforms-852-field_72-error\">Do You Want To See How To Calculate The Child's SALT Score? <a href=\"https:\/\/www.jaad.org\/article\/S0190-9622(19)30127-6\/pdf\">CLICK HERE<\/a>\r\n<\/div><\/div><div id=\"wpforms-852-field_14-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_14\">Child&#039;s Weight (in pounds) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-852-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-852-field_14-error\" required><\/div><div id=\"wpforms-852-field_18-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"18\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-852-field_18\" aria-hidden=\"false\">Layout<\/label><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-852-field_19-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_19\">Child&#039;s Height In Feet<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-852-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-852-field_19-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-852-field_20-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_20\">And Inches<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-852-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-852-field_20-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-852-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_22\">List All Of The Child&#039;s Prescription Medications (enter &quot;None&quot; if none)<\/label><input type=\"text\" id=\"wpforms-852-field_22\" class=\"wpforms-field-large\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-852-field_22-error\" ><\/div><div id=\"wpforms-852-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_23\">List All Of The Child&#039;s Allergies (enter &quot;None&quot; if none) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-852-field_23\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-852-field_23-error\" required><\/div><div id=\"wpforms-852-field_24-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_24\">List All Of The Child&#039;s Vaccinations For Which You Have Records And Age When Vaccinated <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-852-field_24\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][24]\" aria-errormessage=\"wpforms-852-field_24-error\" required><\/textarea><\/div><div id=\"wpforms-852-field_70-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"70\"><fieldset><legend class=\"wpforms-field-label\">Does The Child Have Any Of These Other Autoimmune Disorders? Check All That Apply. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-852-field_70\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_1\" name=\"wpforms[fields][70][]\" value=\"Gluten-Sensitive Enteropathy \/ Celiac Disease\" aria-errormessage=\"wpforms-852-field_70_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_1\">Gluten-Sensitive Enteropathy \/ Celiac Disease<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_2\" name=\"wpforms[fields][70][]\" value=\"Crohn&#039;s Disease\" aria-errormessage=\"wpforms-852-field_70_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_2\">Crohn's Disease<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_5\" name=\"wpforms[fields][70][]\" value=\"Ulcerative Colitis\" aria-errormessage=\"wpforms-852-field_70_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_5\">Ulcerative Colitis<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_11\" name=\"wpforms[fields][70][]\" value=\"Autoimmune Hepatitis\" aria-errormessage=\"wpforms-852-field_70_11-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_11\">Autoimmune Hepatitis<\/label><\/li><li class=\"choice-20 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_20\" name=\"wpforms[fields][70][]\" value=\"Type 1 Diabetes \/ Juvenile Onset Diabetes\" aria-errormessage=\"wpforms-852-field_70_20-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_20\">Type 1 Diabetes \/ Juvenile Onset Diabetes<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_10\" name=\"wpforms[fields][70][]\" value=\"Hyperthyroidism \/ Hashimoto&#039;s Disease\" aria-errormessage=\"wpforms-852-field_70_10-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_10\">Hyperthyroidism \/ Hashimoto's Disease<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_9\" name=\"wpforms[fields][70][]\" value=\"Hypothyroidism \/ Grave&#039;s Disease\" aria-errormessage=\"wpforms-852-field_70_9-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_9\">Hypothyroidism \/ Grave's Disease<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_8\" name=\"wpforms[fields][70][]\" value=\"Adrenal Insufficiency \/ Addison&#039;s Disease\" aria-errormessage=\"wpforms-852-field_70_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_8\">Adrenal Insufficiency \/ Addison's Disease<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_7\" name=\"wpforms[fields][70][]\" value=\"Juvenile Rheumatoid Arthritis \/ Juvenile Idiopathic Arthritis\" aria-errormessage=\"wpforms-852-field_70_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_7\">Juvenile Rheumatoid Arthritis \/ Juvenile Idiopathic Arthritis<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_6\" name=\"wpforms[fields][70][]\" value=\"Psoriasis \/ Psoriatic Arthritis\" aria-errormessage=\"wpforms-852-field_70_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_6\">Psoriasis \/ Psoriatic Arthritis<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_15\" name=\"wpforms[fields][70][]\" value=\"Juvenile Dermatoid Arthritis\" aria-errormessage=\"wpforms-852-field_70_15-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_15\">Juvenile Dermatoid Arthritis<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_14\" name=\"wpforms[fields][70][]\" value=\"Lupus\" aria-errormessage=\"wpforms-852-field_70_14-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_14\">Lupus<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_13\" name=\"wpforms[fields][70][]\" value=\"Scleroderma\" aria-errormessage=\"wpforms-852-field_70_13-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_13\">Scleroderma<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_12\" name=\"wpforms[fields][70][]\" value=\"Multiple Sclerosis\" aria-errormessage=\"wpforms-852-field_70_12-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_12\">Multiple Sclerosis<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_17\" name=\"wpforms[fields][70][]\" value=\"Childhood Autism\" aria-errormessage=\"wpforms-852-field_70_17-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_17\">Childhood Autism<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_16\" name=\"wpforms[fields][70][]\" value=\"Other (list below)\" aria-errormessage=\"wpforms-852-field_70_16-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_16\">Other (list below)<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_19\" name=\"wpforms[fields][70][]\" value=\"Possibly (list below)\" aria-errormessage=\"wpforms-852-field_70_19-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_19\">Possibly (list below)<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-852-field_70_18\" name=\"wpforms[fields][70][]\" value=\"None Of The Above\" aria-errormessage=\"wpforms-852-field_70_18-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_70_18\">None Of The Above<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-852-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_25\">List All Of The Child&#039;s Other Chronic Illnesses Or Disorders, Especially If Autoimmune, (enter &quot;None&quot; If none) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-852-field_25\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][25]\" aria-errormessage=\"wpforms-852-field_25-error\" required><\/div><div id=\"wpforms-852-field_53-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_53\">Enter The Name, Address, Phone Number, And Email Address Of The Doctor And\/Or Clinic That Provides The Child&#039;s Alopecia Areata Care<\/label><textarea id=\"wpforms-852-field_53\" class=\"wpforms-field-medium\" name=\"wpforms[fields][53]\" aria-errormessage=\"wpforms-852-field_53-error\" ><\/textarea><\/div><div id=\"wpforms-852-field_54-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"54\"><fieldset><legend class=\"wpforms-field-label\">Email Communication Authorization: I give permission for Throne Biotechnology And Its Doctors To Communicate With Me Regarding My Care By Telephone, Text Message, or Email. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-852-field_54\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_54_1\" name=\"wpforms[fields][54]\" value=\"Yes\" aria-errormessage=\"wpforms-852-field_54_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_54_1\">Yes<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-852-field_55-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"55\"><fieldset><legend class=\"wpforms-field-label\">Required HIPPA Privacy Practices Notice (To See A Copy Of Our HIPPA Privacy Practices, See The Next Paragraph) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-852-field_55\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-852-field_55_1\" name=\"wpforms[fields][55]\" value=\"Yes, I have been shown a copy of this office&#039;s HIPPA Privacy Practices Notice.\" aria-errormessage=\"wpforms-852-field_55_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-852-field_55_1\">Yes, I have been shown a copy of this office's HIPPA Privacy Practices Notice.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-852-field_69-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"69\"><div id=\"wpforms-852-field_69\" aria-errormessage=\"wpforms-852-field_69-error\">Click <a href=\"https:\/\/dev.thronebio.com\/tb\/wp-content\/uploads\/2023\/09\/HIPPA-Notice-Throne-9-18-2023.pdf\">here<\/a> to review our HIPPA Privacy Policy.<\/div><\/div><div id=\"wpforms-852-field_67-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_67\">The Throne Stem Cell Treatment Is A Two Day Procedure. Please Enter Your Preferred Date To Begin The Procedure.<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-852-field_67\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][67][date]\" aria-errormessage=\"wpforms-852-field_67-error\" ><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-852-field_71-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-852-field_71\">Please Upload Photos \/ Images \/ Videos Of The Child&#039;s Hair Loss And Any Other Relevant Documents Here (Maximum of 5 files totaling no more than 25 megabytes)<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"71\"\n\t\tdata-form-id=\"852\"\n\t\tdata-input-name=\"wpforms_852_71\"\n\t\tdata-extensions=\"jpg,png,gif,pdf,doc,mpg\"\n\t\tdata-max-size=\"5242880\"\n\t\tdata-max-file-number=\"5\"\n\t\tdata-post-max-size=\"31457280\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 5 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-852-field_71\"\n\t\tname=\"wpforms_852_71\" \t\tvalue=\"\">\n<\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"852\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-852\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/dev.thronebio.com\/tb\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c991361 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c991361\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-58c0c67\" data-id=\"58c0c67\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c5f6049 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c5f6049\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d5a939e\" data-id=\"d5a939e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cd09647 elementor-widget elementor-widget-text-editor\" data-id=\"cd09647\" data-element_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<h6 id=\"wpforms-599-field_60\" aria-errormessage=\"wpforms-599-field_60-error\">Thank you for your interest in the Throne Stem Cell Treatment. We will respond to your application within the next two business days.<\/h6>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-944e9b4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"944e9b4\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4d329a8\" data-id=\"4d329a8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8fa0329 elementor-widget elementor-widget-spacer\" data-id=\"8fa0329\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e1210ac elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e1210ac\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2f6c334\" data-id=\"2f6c334\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-846a6c3 elementor-widget elementor-widget-text-editor\" data-id=\"846a6c3\" data-element_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>Throne Biotechnologies, 10 Forest Avenue, Suite 110, Paramus, NJ 07652<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Application For Stem Cell Treatment Of Alopecia Areata-Child To initiate the application process for Throne&#8217;s cord blood stem cell treatment targeting Alopecia Areata for a child, kindly complete the following application. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Child&#039;s Name * FirstLast Child&#039;s&hellip;&nbsp;<a href=\"https:\/\/dev.thronebio.com\/tb\/apply-for-stem-cell-educator-treatment\/apply-for-stem-cell-treatment-of-alopecia-areata-child\/\" rel=\"bookmark\">Read More &raquo;<span class=\"screen-reader-text\">Apply For Stem Cell Treatment Of Alopecia Areata-Child<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2115,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/template-pagebuilder-full-width.php","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"class_list":["post-1686","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/dev.thronebio.com\/tb\/wp-json\/wp\/v2\/pages\/1686","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dev.thronebio.com\/tb\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dev.thronebio.com\/tb\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dev.thronebio.com\/tb\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dev.thronebio.com\/tb\/wp-json\/wp\/v2\/comments?post=1686"}],"version-history":[{"count":8,"href":"https:\/\/dev.thronebio.com\/tb\/wp-json\/wp\/v2\/pages\/1686\/revisions"}],"predecessor-version":[{"id":2491,"href":"https:\/\/dev.thronebio.com\/tb\/wp-json\/wp\/v2\/pages\/1686\/revisions\/2491"}],"up":[{"embeddable":true,"href":"https:\/\/dev.thronebio.com\/tb\/wp-json\/wp\/v2\/pages\/2115"}],"wp:attachment":[{"href":"https:\/\/dev.thronebio.com\/tb\/wp-json\/wp\/v2\/media?parent=1686"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}