{"id":33535,"date":"2025-06-27T12:26:01","date_gmt":"2025-06-27T08:56:01","guid":{"rendered":"https:\/\/www.drsaina.com\/landings\/?page_id=33535"},"modified":"2025-08-16T10:40:54","modified_gmt":"2025-08-16T07:10:54","slug":"samane-checkup","status":"publish","type":"page","link":"https:\/\/www.drsaina.com\/landings\/samane-checkup\/","title":{"rendered":"\u0633\u0627\u0645\u0627\u0646\u0647 \u0686\u06a9\u0627\u067e"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"33535\" class=\"elementor elementor-33535\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c899191 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"c899191\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\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-805dd41\" data-id=\"805dd41\" 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-c7eb7ac elementor-widget elementor-widget-spacer\" data-id=\"c7eb7ac\" 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<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-6bfafd4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6bfafd4\" 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-inner-column elementor-element elementor-element-a6e0ba9\" data-id=\"a6e0ba9\" 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-4192467 elementor-widget elementor-widget-heading\" data-id=\"4192467\" 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<div class=\"elementor-heading-title elementor-size-default\">\u062b\u0628\u062a \u0646\u0627\u0645 \u0637\u0631\u062d \u0686\u06a9\u0627\u067e \u0633\u0644\u0627\u0645\u062a <\/div>\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 class=\"elementor-element elementor-element-54fb9a3 elementor-widget elementor-widget-shortcode\" data-id=\"54fb9a3\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\n\/\/----------------------------------------------------------\n\/\/------ JAVASCRIPT HOOK FUNCTIONS FOR GRAVITY FORMS -------\n\/\/----------------------------------------------------------\n\nif ( ! gform ) {\n\tdocument.addEventListener( 'gform_main_scripts_loaded', function() { gform.scriptsLoaded = true; } );\n\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', function() { gform.themeScriptsLoaded = true; } );\n\twindow.addEventListener( 'DOMContentLoaded', function() { gform.domLoaded = true; } );\n\n\tvar gform = {\n\t\tdomLoaded: false,\n\t\tscriptsLoaded: false,\n\t\tthemeScriptsLoaded: false,\n\t\tisFormEditor: () => typeof InitializeEditor === 'function',\n\n\t\t\/**\n\t\t * @deprecated 2.9 the use of initializeOnLoaded in the form editor context is deprecated.\n\t\t * @remove-in 4.0 this function will not check for gform.isFormEditor().\n\t\t *\/\n\t\tcallIfLoaded: function ( fn ) {\n\t\t\tif ( gform.domLoaded && gform.scriptsLoaded && ( gform.themeScriptsLoaded || gform.isFormEditor() ) ) {\n\t\t\t\tif ( gform.isFormEditor() ) {\n\t\t\t\t\tconsole.warn( 'The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.' );\n\t\t\t\t}\n\t\t\t\tfn();\n\t\t\t\treturn true;\n\t\t\t}\n\t\t\treturn false;\n\t\t},\n\n\t\t\/**\n\t\t * Call a function when all scripts are loaded\n\t\t *\n\t\t * @param function fn the callback function to call when all scripts are loaded\n\t\t *\n\t\t * @returns void\n\t\t *\/\n\t\tinitializeOnLoaded: function( fn ) {\n\t\t\tif ( ! gform.callIfLoaded( fn ) ) {\n\t\t\t\tdocument.addEventListener( 'gform_main_scripts_loaded', () => { gform.scriptsLoaded = true; gform.callIfLoaded( fn ); } );\n\t\t\t\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', () => { gform.themeScriptsLoaded = true; gform.callIfLoaded( fn ); } );\n\t\t\t\twindow.addEventListener( 'DOMContentLoaded', () => { gform.domLoaded = true; gform.callIfLoaded( fn ); } );\n\t\t\t}\n\t\t},\n\n\t\thooks: { action: {}, filter: {} },\n\t\taddAction: function( action, callable, priority, tag ) {\n\t\t\tgform.addHook( 'action', action, callable, priority, tag );\n\t\t},\n\t\taddFilter: function( action, callable, priority, tag ) {\n\t\t\tgform.addHook( 'filter', action, callable, priority, tag );\n\t\t},\n\t\tdoAction: function( action ) {\n\t\t\tgform.doHook( 'action', action, arguments );\n\t\t},\n\t\tapplyFilters: function( action ) {\n\t\t\treturn gform.doHook( 'filter', action, arguments );\n\t\t},\n\t\tremoveAction: function( action, tag ) {\n\t\t\tgform.removeHook( 'action', action, tag );\n\t\t},\n\t\tremoveFilter: function( action, priority, tag ) {\n\t\t\tgform.removeHook( 'filter', action, priority, tag );\n\t\t},\n\t\taddHook: function( hookType, action, callable, priority, tag ) {\n\t\t\tif ( undefined == gform.hooks[hookType][action] ) {\n\t\t\t\tgform.hooks[hookType][action] = [];\n\t\t\t}\n\t\t\tvar hooks = gform.hooks[hookType][action];\n\t\t\tif ( undefined == tag ) {\n\t\t\t\ttag = action + '_' + hooks.length;\n\t\t\t}\n\t\t\tif( priority == undefined ){\n\t\t\t\tpriority = 10;\n\t\t\t}\n\n\t\t\tgform.hooks[hookType][action].push( { tag:tag, callable:callable, priority:priority } );\n\t\t},\n\t\tdoHook: function( hookType, action, args ) {\n\n\t\t\t\/\/ splice args from object into array and remove first index which is the hook name\n\t\t\targs = Array.prototype.slice.call(args, 1);\n\n\t\t\tif ( undefined != gform.hooks[hookType][action] ) {\n\t\t\t\tvar hooks = gform.hooks[hookType][action], hook;\n\t\t\t\t\/\/sort by priority\n\t\t\t\thooks.sort(function(a,b){return a[\"priority\"]-b[\"priority\"]});\n\n\t\t\t\thooks.forEach( function( hookItem ) {\n\t\t\t\t\thook = hookItem.callable;\n\n\t\t\t\t\tif(typeof hook != 'function')\n\t\t\t\t\t\thook = window[hook];\n\t\t\t\t\tif ( 'action' == hookType ) {\n\t\t\t\t\t\thook.apply(null, args);\n\t\t\t\t\t} else {\n\t\t\t\t\t\targs[0] = hook.apply(null, args);\n\t\t\t\t\t}\n\t\t\t\t} );\n\t\t\t}\n\t\t\tif ( 'filter'==hookType ) {\n\t\t\t\treturn args[0];\n\t\t\t}\n\t\t},\n\t\tremoveHook: function( hookType, action, priority, tag ) {\n\t\t\tif ( undefined != gform.hooks[hookType][action] ) {\n\t\t\t\tvar hooks = gform.hooks[hookType][action];\n\t\t\t\thooks = hooks.filter( function(hook, index, arr) {\n\t\t\t\t\tvar removeHook = (undefined==tag||tag==hook.tag) && (undefined==priority||priority==hook.priority);\n\t\t\t\t\treturn !removeHook;\n\t\t\t\t} );\n\t\t\t\tgform.hooks[hookType][action] = hooks;\n\t\t\t}\n\t\t}\n\t};\n}\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_76' style='display:none'><div id='gf_76' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_76' id='gform_76'  action='\/landings\/wp-json\/wp\/v2\/pages\/33535#gf_76' data-formid='76' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_76' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_76_28\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_28'>Name<\/label><div class='ginput_container'><input name='input_28' id='input_76_28' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_76_28'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_76_25\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"title_section\">\n\t<span class=\"title\">\u0627\u0637\u0644\u0627\u0639\u0627\u062a \u0641\u0631\u062f\u06cc <\/span>\n<\/div><\/div><div id=\"field_76_1\" class=\"gfield gfield--type-text gfield--input-type-text crm_name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_1'>\u0646\u0627\u0645 \u0648 \u0646\u0627\u0645 \u062e\u0627\u0646\u0648\u0627\u062f\u06af\u06cc<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_76_1' type='text' value='' class='large'    placeholder='\u0646\u0627\u0645 \u0648 \u0646\u0627\u0645 \u062e\u0627\u0646\u0648\u0627\u062f\u06af\u06cc \u062e\u0648\u062f \u0631\u0627 \u0648\u0627\u0631\u062f \u06a9\u0646\u06cc\u062f.' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_76_3\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full landing_number_field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_3'>\u0634\u0645\u0627\u0631\u0647 \u062a\u0645\u0627\u0633<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_76_3' type='tel' value='' class='large'  placeholder='\u0634\u0645\u0627\u0631\u0647 \u062a\u0645\u0627\u0633 \u062e\u0648\u062f \u0631\u0627 \u0648\u0627\u0631\u062f \u06a9\u0646\u06cc\u062f.' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_76_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full landing-number-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_17'>\u06a9\u062f\u0645\u0644\u06cc<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_76_17' type='text' value='' class='large' maxlength='10'   placeholder='\u06a9\u062f\u0645\u0644\u06cc \u062e\u0648\u062f \u0631\u0627 \u0648\u0627\u0631\u062f \u06a9\u0646\u06cc\u062f.' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_76_26\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"title_section location\">\n\t<span class=\"title\">\u0627\u0637\u0644\u0627\u0639\u0627\u062a \u0645\u062d\u0644 \u0633\u06a9\u0648\u0646\u062a <\/span>\n<\/div><\/div><fieldset id=\"field_76_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full drsaina_homelab_base_cities gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u0634\u0647\u0631 \u0648 \u0627\u0633\u062a\u0627\u0646 \u0645\u062d\u0644 \u0633\u06a9\u0648\u0646\u062a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_76_24'>\n\t\t\t<div class='gchoice gchoice_76_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u062a\u0647\u0631\u0627\u0646\u060c \u062a\u0647\u0631\u0627\u0646'  id='choice_76_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_0' id='label_76_24_0' class='gform-field-label gform-field-label--type-inline'>\u062a\u0647\u0631\u0627\u0646\u060c \u062a\u0647\u0631\u0627\u0646<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u0645\u0634\u0647\u062f\u060c \u062e\u0631\u0627\u0633\u0627\u0646 \u0631\u0636\u0648\u06cc'  id='choice_76_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_1' id='label_76_24_1' class='gform-field-label gform-field-label--type-inline'>\u0645\u0634\u0647\u062f\u060c \u062e\u0631\u0627\u0633\u0627\u0646 \u0631\u0636\u0648\u06cc<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u06a9\u0631\u062c\u060c \u0627\u0644\u0628\u0631\u0632'  id='choice_76_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_2' id='label_76_24_2' class='gform-field-label gform-field-label--type-inline'>\u06a9\u0631\u062c\u060c \u0627\u0644\u0628\u0631\u0632<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u0627\u0635\u0641\u0647\u0627\u0646\u060c \u0627\u0635\u0641\u0647\u0627\u0646'  id='choice_76_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_3' id='label_76_24_3' class='gform-field-label gform-field-label--type-inline'>\u0627\u0635\u0641\u0647\u0627\u0646\u060c \u0627\u0635\u0641\u0647\u0627\u0646<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_24_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u0634\u06cc\u0631\u0627\u0632\u060c \u0641\u0627\u0631\u0633'  id='choice_76_24_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_4' id='label_76_24_4' class='gform-field-label gform-field-label--type-inline'>\u0634\u06cc\u0631\u0627\u0632\u060c \u0641\u0627\u0631\u0633<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_24_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u0642\u0645\u060c \u0642\u0645'  id='choice_76_24_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_5' id='label_76_24_5' class='gform-field-label gform-field-label--type-inline'>\u0642\u0645\u060c \u0642\u0645<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_24_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u0632\u0646\u062c\u0627\u0646\u060c \u0632\u0646\u062c\u0627\u0646'  id='choice_76_24_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_6' id='label_76_24_6' class='gform-field-label gform-field-label--type-inline'>\u0632\u0646\u062c\u0627\u0646\u060c \u0632\u0646\u062c\u0627\u0646<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_24_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u062a\u0628\u0631\u06cc\u0632\u060c \u0622\u0630\u0631\u0628\u0627\u06cc\u062c\u0627\u0646 \u0634\u0631\u0642\u06cc'  id='choice_76_24_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_7' id='label_76_24_7' class='gform-field-label gform-field-label--type-inline'>\u062a\u0628\u0631\u06cc\u0632\u060c \u0622\u0630\u0631\u0628\u0627\u06cc\u062c\u0627\u0646 \u0634\u0631\u0642\u06cc<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_24_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u0627\u0647\u0648\u0627\u0632\u060c \u062e\u0648\u0632\u0633\u062a\u0627\u0646'  id='choice_76_24_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_8' id='label_76_24_8' class='gform-field-label gform-field-label--type-inline'>\u0627\u0647\u0648\u0627\u0632\u060c \u062e\u0648\u0632\u0633\u062a\u0627\u0646<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_76_24_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='\u0633\u0627\u06cc\u0631 \u0634\u0647\u0631\u0647\u0627'  id='choice_76_24_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_76_24_9' id='label_76_24_9' class='gform-field-label gform-field-label--type-inline'>\u0633\u0627\u06cc\u0631 \u0634\u0647\u0631\u0647\u0627<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_76_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full drsaina_homelab_cities drs-select2 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_19'>\u062c\u0633\u062a\u062c\u0648\u06cc \u0645\u062d\u0644 \u0633\u06a9\u0648\u0646\u062a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_76_19' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>\u0627\u0646\u062a\u062e\u0627\u0628 \u0645\u062d\u0644 \u0633\u06a9\u0648\u0646\u062a<\/option><\/select><\/div><\/div><div id=\"field_76_27\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"title_section\">\n\t<span class=\"title\">\u0627\u0637\u0644\u0627\u0639\u0627\u062a \u062a\u06a9\u0645\u06cc\u0644\u06cc <\/span>\n<\/div><\/div><div id=\"field_76_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full drs-select2 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_12'>\u0628\u06cc\u0645\u0647 \u067e\u0627\u06cc\u0647<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_76_12' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>\u0627\u0646\u062a\u062e\u0627\u0628 \u0628\u06cc\u0645\u0647 \u067e\u0627\u06cc\u0647<\/option><option value='\u0628\u06cc\u0645\u0647 \u067e\u0627\u06cc\u0647 \u0646\u062f\u0627\u0631\u0645' >\u0628\u06cc\u0645\u0647 \u067e\u0627\u06cc\u0647 \u0646\u062f\u0627\u0631\u0645<\/option><option value='\u062a\u0623\u0645\u06cc\u0646 \u0627\u062c\u062a\u0645\u0627\u0639\u06cc' >\u062a\u0623\u0645\u06cc\u0646 \u0627\u062c\u062a\u0645\u0627\u0639\u06cc<\/option><option value='\u062e\u062f\u0645\u0627\u062a \u062f\u0631\u0645\u0627\u0646\u06cc (\u0633\u0644\u0627\u0645\u062a)' >\u062e\u062f\u0645\u0627\u062a \u062f\u0631\u0645\u0627\u0646\u06cc (\u0633\u0644\u0627\u0645\u062a)<\/option><option value='\u0646\u06cc\u0631\u0648\u0647\u0627\u06cc \u0645\u0633\u0644\u062d \u0648 \u062c\u0627\u0646\u0628\u0627\u0632\u0627\u0646' >\u0646\u06cc\u0631\u0648\u0647\u0627\u06cc \u0645\u0633\u0644\u062d \u0648 \u062c\u0627\u0646\u0628\u0627\u0632\u0627\u0646<\/option><option value='\u0622\u0645\u0648\u0632\u0634 \u0648 \u067e\u0631\u0648\u0631\u0634' >\u0622\u0645\u0648\u0632\u0634 \u0648 \u067e\u0631\u0648\u0631\u0634<\/option><option value='\u0628\u0627\u0646\u06a9 \u067e\u0627\u0631\u0633\u06cc\u0627\u0646' >\u0628\u0627\u0646\u06a9 \u067e\u0627\u0631\u0633\u06cc\u0627\u0646<\/option><option value='\u0628\u0627\u0646\u06a9 \u062a\u062c\u0627\u0631\u062a' >\u0628\u0627\u0646\u06a9 \u062a\u062c\u0627\u0631\u062a<\/option><option value='\u0628\u0627\u0646\u06a9 \u062a\u0648\u0633\u0639\u0647 \u0635\u0627\u062f\u0631\u0627\u062a' >\u0628\u0627\u0646\u06a9 \u062a\u0648\u0633\u0639\u0647 \u0635\u0627\u062f\u0631\u0627\u062a<\/option><option value='\u0628\u0627\u0646\u06a9 \u062f\u06cc' >\u0628\u0627\u0646\u06a9 \u062f\u06cc<\/option><option value='\u0628\u0627\u0646\u06a9 \u0631\u0641\u0627\u0647 \u06a9\u0627\u0631\u06af\u0631\u0627\u0646' >\u0628\u0627\u0646\u06a9 \u0631\u0641\u0627\u0647 \u06a9\u0627\u0631\u06af\u0631\u0627\u0646<\/option><option value='\u0628\u0627\u0646\u06a9 \u0633\u067e\u0647' >\u0628\u0627\u0646\u06a9 \u0633\u067e\u0647<\/option><option value='\u0628\u0627\u0646\u06a9 \u0635\u0627\u062f\u0631\u0627\u062a' >\u0628\u0627\u0646\u06a9 \u0635\u0627\u062f\u0631\u0627\u062a<\/option><option value='\u0628\u0627\u0646\u06a9 \u0635\u0646\u0639\u062a \u0648 \u0645\u0639\u062f\u0646' >\u0628\u0627\u0646\u06a9 \u0635\u0646\u0639\u062a \u0648 \u0645\u0639\u062f\u0646<\/option><option value='\u0628\u0627\u0646\u06a9 \u0642\u0631\u0636\u200c\u0627\u0644\u062d\u0633\u0646\u0647 \u0645\u0647\u0631 \u0627\u06cc\u0631\u0627\u0646' >\u0628\u0627\u0646\u06a9 \u0642\u0631\u0636\u200c\u0627\u0644\u062d\u0633\u0646\u0647 \u0645\u0647\u0631 \u0627\u06cc\u0631\u0627\u0646<\/option><option value='\u0628\u0627\u0646\u06a9 \u0645\u0631\u06a9\u0632\u06cc' >\u0628\u0627\u0646\u06a9 \u0645\u0631\u06a9\u0632\u06cc<\/option><option value='\u0628\u0627\u0646\u06a9 \u0645\u0633\u06a9\u0646' >\u0628\u0627\u0646\u06a9 \u0645\u0633\u06a9\u0646<\/option><option value='\u0628\u0627\u0646\u06a9 \u0645\u0644\u062a' >\u0628\u0627\u0646\u06a9 \u0645\u0644\u062a<\/option><option value='\u0628\u0627\u0646\u06a9 \u0645\u0644\u06cc' >\u0628\u0627\u0646\u06a9 \u0645\u0644\u06cc<\/option><option value='\u0628\u0627\u0646\u06a9 \u06a9\u0627\u0631\u0622\u0641\u0631\u06cc\u0646' >\u0628\u0627\u0646\u06a9 \u06a9\u0627\u0631\u0622\u0641\u0631\u06cc\u0646<\/option><option value='\u0628\u0627\u0646\u06a9 \u06a9\u0634\u0627\u0648\u0631\u0632\u06cc' >\u0628\u0627\u0646\u06a9 \u06a9\u0634\u0627\u0648\u0631\u0632\u06cc<\/option><option value='\u067e\u0698\u0648\u0647\u0634\u06af\u0627\u0647 \u0645\u062c\u0644\u0633' >\u067e\u0698\u0648\u0647\u0634\u06af\u0627\u0647 \u0645\u062c\u0644\u0633<\/option><option value='\u062a\u062c\u0627\u0631\u062a' >\u062a\u062c\u0627\u0631\u062a<\/option><option value='\u0634\u0631\u06a9\u062a \u0646\u0641\u062a' >\u0634\u0631\u06a9\u062a \u0646\u0641\u062a<\/option><option value='\u0634\u0647\u0631\u062f\u0627\u0631\u06cc' >\u0634\u0647\u0631\u062f\u0627\u0631\u06cc<\/option><option value='\u0634\u0648\u0631\u0627\u06cc \u0646\u06af\u0647\u0628\u0627\u0646' >\u0634\u0648\u0631\u0627\u06cc \u0646\u06af\u0647\u0628\u0627\u0646<\/option><option value='\u0635\u062f\u0627 \u0648 \u0633\u06cc\u0645\u0627' >\u0635\u062f\u0627 \u0648 \u0633\u06cc\u0645\u0627<\/option><option value='\u0641\u0648\u0644\u0627\u062f' >\u0641\u0648\u0644\u0627\u062f<\/option><option value='\u0645\u062c\u0644\u0633 \u0634\u0648\u0631\u0627\u06cc \u0627\u0633\u0644\u0627\u0645\u06cc' >\u0645\u062c\u0644\u0633 \u0634\u0648\u0631\u0627\u06cc \u0627\u0633\u0644\u0627\u0645\u06cc<\/option><option value='\u0647\u0644\u06cc\u06a9\u0648\u067e\u062a\u0631\u0633\u0627\u0632\u06cc' >\u0647\u0644\u06cc\u06a9\u0648\u067e\u062a\u0631\u0633\u0627\u0632\u06cc<\/option><option value='\u06a9\u0627\u0646\u0648\u0646 \u0633\u0631\u062f\u0641\u062a\u0631\u0627\u0646' >\u06a9\u0627\u0646\u0648\u0646 \u0633\u0631\u062f\u0641\u062a\u0631\u0627\u0646<\/option><\/select><\/div><\/div><div id=\"field_76_14\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full drs-select2 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_76_14'>\u0646\u0627\u0645 \u0628\u06cc\u0645\u0647 \u062a\u06a9\u0645\u06cc\u0644\u06cc<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_14' id='input_76_14' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>\u0627\u0646\u062a\u062e\u0627\u0628 \u0628\u06cc\u0645\u0647 \u062a\u06a9\u0645\u06cc\u0644\u06cc<\/option><option value='\u0628\u06cc\u0645\u0647 \u062a\u06a9\u0645\u06cc\u0644\u06cc \u0646\u062f\u0627\u0631\u0645' >\u0628\u06cc\u0645\u0647 \u062a\u06a9\u0645\u06cc\u0644\u06cc \u0646\u062f\u0627\u0631\u0645<\/option><option value='\u0646\u06cc\u0627\u0632 \u0628\u0647 \u0628\u0631\u0631\u0633\u06cc (\u0627\u0637\u0644\u0627\u0639\u06cc \u0646\u062f\u0627\u0631\u0645)' >\u0646\u06cc\u0627\u0632 \u0628\u0647 \u0628\u0631\u0631\u0633\u06cc (\u0627\u0637\u0644\u0627\u0639\u06cc \u0646\u062f\u0627\u0631\u0645)<\/option><option value='\u0622\u062a\u06cc\u0647 \u0633\u0627\u0632\u0627\u0646 \u062d\u0627\u0641\u0638' >\u0622\u062a\u06cc\u0647 \u0633\u0627\u0632\u0627\u0646 \u062d\u0627\u0641\u0638<\/option><option value='\u0622\u0631\u0645\u0627\u0646' >\u0622\u0631\u0645\u0627\u0646<\/option><option value='\u0622\u0631\u0645\u0627\u0646 \u0633\u0641\u06cc\u0631\u0627\u0646 \u0633\u0644\u0627\u0645\u062a' >\u0622\u0631\u0645\u0627\u0646 \u0633\u0641\u06cc\u0631\u0627\u0646 \u0633\u0644\u0627\u0645\u062a<\/option><option value='\u0622\u0633\u0645\u0627\u0631\u06cc SOS \u06a9\u0645\u06a9 \u0631\u0633\u0627\u0646 \u0627\u06cc\u0631\u0627\u0646' >\u0622\u0633\u0645\u0627\u0631\u06cc SOS \u06a9\u0645\u06a9 \u0631\u0633\u0627\u0646 \u0627\u06cc\u0631\u0627\u0646<\/option><option value='\u0622\u0633\u06cc\u0627' >\u0622\u0633\u06cc\u0627<\/option><option value='\u0627\u0644\u0628\u0631\u0632' >\u0627\u0644\u0628\u0631\u0632<\/option><option value='\u0627\u0645\u06cc\u062f' >\u0627\u0645\u06cc\u062f<\/option><option value='\u0627\u06cc\u0631\u0627\u0646' >\u0627\u06cc\u0631\u0627\u0646<\/option><option value='\u067e\u0627\u0631\u0633\u06cc\u0627\u0646' >\u067e\u0627\u0631\u0633\u06cc\u0627\u0646<\/option><option value='\u067e\u0627\u0633\u0627\u0631\u06af\u0627\u062f' >\u067e\u0627\u0633\u0627\u0631\u06af\u0627\u062f<\/option><option value='\u062a\u062c\u0627\u0631\u062a \u0646\u0648' >\u062a\u062c\u0627\u0631\u062a \u0646\u0648<\/option><option value='\u062a\u0639\u0627\u0648\u0646' >\u062a\u0639\u0627\u0648\u0646<\/option><option value='\u062a\u0648\u0633\u0639\u0647 \u0646\u06cc\u0634\u06a9\u0631' >\u062a\u0648\u0633\u0639\u0647 \u0646\u06cc\u0634\u06a9\u0631<\/option><option value='\u062c\u0647\u0627\u062f \u06a9\u0634\u0627\u0648\u0631\u0632\u06cc' >\u062c\u0647\u0627\u062f \u06a9\u0634\u0627\u0648\u0631\u0632\u06cc<\/option><option value='\u062d\u0627\u0641\u0638' >\u062d\u0627\u0641\u0638<\/option><option value='\u062d\u06a9\u0645\u062a' >\u062d\u06a9\u0645\u062a<\/option><option value='\u062f\u0627\u0646\u0627' >\u062f\u0627\u0646\u0627<\/option><option value='\u062f\u06cc' >\u062f\u06cc<\/option><option value='\u0631\u0627\u0632\u06cc' >\u0631\u0627\u0632\u06cc<\/option><option value='\u0633\u0627\u0645\u0627\u0646' >\u0633\u0627\u0645\u0627\u0646<\/option><option value='\u0633\u0631\u0645\u062f' >\u0633\u0631\u0645\u062f<\/option><option value='\u0633\u06cc\u0646\u0627' >\u0633\u06cc\u0646\u0627<\/option><option value='\u0641\u0648\u0644\u0627\u062f \u0645\u0628\u0627\u0631\u06a9\u0647' >\u0641\u0648\u0644\u0627\u062f \u0645\u0628\u0627\u0631\u06a9\u0647<\/option><option value='\u0645\u0627' >\u0645\u0627<\/option><option value='\u0645\u0639\u0644\u0645' >\u0645\u0639\u0644\u0645<\/option><option value='\u0645\u0644\u062a' >\u0645\u0644\u062a<\/option><option value='\u0645\u06cc\u0647\u0646' >\u0645\u06cc\u0647\u0646<\/option><option value='\u0646\u0648\u06cc\u0646' >\u0646\u0648\u06cc\u0646<\/option><option value='\u0646\u06cc\u0634\u06a9\u0631' >\u0646\u06cc\u0634\u06a9\u0631<\/option><option value='\u06a9\u0627\u0631\u0622\u0641\u0631\u06cc\u0646' >\u06a9\u0627\u0631\u0622\u0641\u0631\u06cc\u0646<\/option><option value='\u06a9\u0627\u0646\u0648\u0646 \u0633\u0631\u062f\u0641\u062a\u0631\u0627\u0646' >\u06a9\u0627\u0646\u0648\u0646 \u0633\u0631\u062f\u0641\u062a\u0631\u0627\u0646<\/option><option value='\u06a9\u0648\u062b\u0631' >\u06a9\u0648\u062b\u0631<\/option><\/select><\/div><\/div><div id=\"field_76_22\" class=\"gfield gfield--type-website gfield--input-type-website gfield--width-full source_url_2 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_76_22'>\u0633\u0648\u0631\u0633 2<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_22' id='input_76_22' type='url' value='' class='large'    placeholder='Source URL'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_76_23\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><script>\njQuery(document).ready(function(){\n    jQuery('#field_76_22').find('input').val( window.location.href );\n});\n\/\/ Re-initialize after Gravity Forms renders\njQuery(document).on('gform_post_render', function (event, form_id) {\n    drsaina_init_city_dropdown_logic();\n});\n<\/script><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_76' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='\u062b\u0628\u062a \u062f\u0631\u062e\u0648\u0627\u0633\u062a'  \/> <input type='hidden' name='gform_ajax' value='form_id=76&amp;title=&amp;description=1&amp;tabindex=0&amp;theme=gravity-theme&amp;styles=[]&amp;hash=6ea019ef134ddb364b509bc0bd3fe685' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_76' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_76' id='gform_theme_76' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_76' id='gform_style_settings_76' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_76' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='76' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='IRT' 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