{"id":7090,"date":"2024-12-04T08:09:27","date_gmt":"2024-12-04T14:09:27","guid":{"rendered":"https:\/\/guardianpharmacy.com\/denver\/?page_id=7090"},"modified":"2024-12-04T08:09:27","modified_gmt":"2024-12-04T14:09:27","slug":"denver-equipment-request-form","status":"publish","type":"page","link":"https:\/\/guardianpharmacy.com\/denver\/denver-equipment-request-form\/","title":{"rendered":"Denver Equipment Request Form"},"content":{"rendered":"            <script type=\"text\/javascript\">\r\n                jQuery(document).ready(function(){\r\n                    jQuery('#input_13_8').change(function(){\r\n                        var state_id = jQuery(this).val();\r\n                        jQuery(\"#input_13_1\").empty();\r\n                        jQuery.ajax({\r\n                            url: \"https:\/\/guardianpharmacy.com\/denver\/wp-admin\/admin-ajax.php\",\r\n                            type: 'POST',\r\n                            data: 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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 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class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_13'  action='\/denver\/wp-json\/wp\/v2\/pages\/7090' data-formid='13' > \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><div id='gform_fields_13' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_13_1\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_1\"><label class='gfield_label gform-field-label' for='input_13_1' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_13_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_3\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_3\"><label class='gfield_label gform-field-label' for='input_13_3' >Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_13_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_4\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_4\"><label class='gfield_label gform-field-label' for='input_13_4' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_13_4' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_5\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_5\"><label class='gfield_label gform-field-label' for='input_13_5' >Community Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_13_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_6\"  class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_6\"><label class='gfield_label gform-field-label' for='input_13_6' >Community Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_13_6' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_7\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_7\"><label class='gfield_label gform-field-label' for='input_13_7' >Scanner Issue<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_13_7' type='text' value='' class='large'   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id='label_13_10_2' class='gform-field-label gform-field-label--type-inline'>Sharps<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Main Cart'  id='choice_13_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_10_3' id='label_13_10_3' class='gform-field-label gform-field-label--type-inline'>Main Cart<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_13_11\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_11\"><label class='gfield_label gform-field-label' for='input_13_11' >Rails<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_13_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_12\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_12\"><label class='gfield_label gform-field-label' for='input_13_12' >Additional Equipment Requests<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_13_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_13\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_13\"><label class='gfield_label gform-field-label' for='input_13_13' >More Information<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_13_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_13_14\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_14\"><legend class='gfield_label gform-field-label'  >Do you need Med Destruction Liners<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_13_14'>\n\t\t\t<div class='gchoice gchoice_13_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_13_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_13_14_0' id='label_13_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_13_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_13_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_13_14_1' id='label_13_14_1' class='gform-field-label 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