Resources

<div id="form"> <div class="form-content" id="step1"> <p class="up text-center"><strong style="font-size:18px;">Please select your age group*</strong></p> <p class="input-bigg text-center"> <select name="age" class="select"> <option value="no">Age</option> <option value="20-42">20-42</option> <option value="43-64">43-64</option> <option value="65-80">65-80</option> </select> </p> <div class="error" id="button_step2_error"></div> <p class="text-center"><button type="submit" id="button_step2">Next</button></p> <p class="bottom text-center"><em style="font-size:13px;color:#888;">We guarantee 100% privacy. Your information will not be shared.</em></p> </div> <div class="form-content clearfix" id="step2"> <div class="row"> <div class="col-sm-6"> <p> <strong>Q1. Have you had a hysterectomy?*</strong><br> <input type="radio" id="f-option" name="questions2" value="yes" /><label for="f-option">Yes</label><input type="radio" id="f-option1" name="questions2" value="no" /><label for="f-option1">No</label> </p> <p> <strong>Q2. Have you had a period in the last year?*</strong><br> <input type="radio" id="f-option4" name="questions4" value="yes" /><label for="f-option4">Yes</label><input type="radio" id="f-option5" name="questions4" value="no" /><label for="f-option5">No</label> </p> <p> <strong>Q3. Are you experiencing hot flushes?*</strong><br> <input type="radio" id="f-option2" name="questions3" value="yes" /><label for="f-option2">Yes</label><input type="radio" id="f-option3" name="questions3" value="no" /><label for="f-option3">No</label> </p> <p> <strong>Q4. Is low libido a concern for you?*</strong><br> <input type="radio" id="f-option10" name="questions7" value="yes" /><label for="f-option10">Yes</label><input type="radio" id="f-option11" name="questions7" value="no" /><label for="f-option11">No</label> </p> </div> <div class="col-sm-6"> <p> <strong>Q5. Are you having trouble with sleep?*</strong><br> <input type="radio" id="f-option6" name="questions5" value="yes" /><label for="f-option6">Yes</label><input type="radio" id="f-option7" name="questions5" value="no" /><label for="f-option7">No</label> </p> <p> <strong>Q6. Is low energy a concern for you?*</strong><br> <input type="radio" id="f-option8" name="questions6" value="yes" /><label for="f-option8">Yes</label><input type="radio" id="f-option9" name="questions6" value="no" /><label for="f-option9">No</label> </p> <p> <strong>Q7. Do you experience weight fluctuations?*</strong><br> <input type="radio" id="f-option12" name="questions8" value="yes" /><label for="f-option12">Yes</label><input type="radio" id="f-option13" name="questions8" value="no" /><label for="f-option13">No</label> </p> </div> </div> <div class="clear"></div> <div class="error" id="button_step3_error"></div> <p class="text-center"> <button type="submit" id="button_step3">Next</button></p> <p class="bottom text-center"><em style="font-size:13px;color:#888;">We guarantee 100% privacy. Your information will not be shared.</em></p> </div> <div class="form-content" id="menopausal"> <form method="post" id="contact" action="https://www.menopausecentre.com.au/wp-content/themes/amc/action.php"> <div id="messages"> <p class="text-center" style="font-size:18px;"><strong><span id="messages_results"></span></strong></p> <p class="text-center"><span id="messages_text"></span></p> <input type="hidden" name="check_menopausal" /> <input type="hidden" name="menopausal" /> <input type="hidden" name="email_check" /> <input type="hidden" name="form_age" /> <input type="hidden" name="form_questions2" /> <input type="hidden" name="form_questions3" /> <input type="hidden" name="form_questions4" /> <input type="hidden" name="form_questions5" /> <input type="hidden" name="form_questions6" /> <input type="hidden" name="form_questions7" /> <input type="hidden" name="form_questions8" /> <input type="hidden" name="form_name" /> <input type="hidden" name="form_email" /> <input type="hidden" name="form_phone" /> <input type="hidden" name="email_check" id="email_check"/> <div class="row"> <div class="col-sm-4"><p><input type="text" name="name" class="required" placeholder="Name"/></p></div> <div class="col-sm-4"><p><input type="text" name="email" class="required email" placeholder="Email"/></p></div> <div class="col-sm-4"><p><input type="text" name="phone" class="required phone" placeholder="Phone"/></p></div> </div> <p class="text-center"><input type="checkbox" id="f-option15" name="questions_finishtwo" value="yes" checked><label for="f-option15" class="text"><strong>I would like to receive information on women's health</strong></label></p> <p class="text-center"><button type="submit" id="finishbuttom">Finish</button></p> <p class="bottom text-center"><em style="font-size:13px;color:#888;">We guarantee 100% privacy. Your information will not be shared.</em></p> </div> </form> </div> <div class="form-content " id="notmenopausal"> <form method="post" action="https://www.menopausecentre.com.au/wp-content/themes/amc/action.php" id="contact_finish"> <div id="messages"> <p class="text-center" style="font-size:18px;"><strong><span id="messages_results"></span></strong></p> <p class="text-center"><span id="messages_text"></span></p> <div class="hidden"><input type="text" name="form_url" value=""></div> <div class="row"> <div class="col-sm-4"><p><input type="text" placeholder="Name" name="name" class="required"></p></div> <div class="col-sm-4"><p><input type="text" placeholder="Phone Number" name="phone" class="required phone"></p></div> <div class="col-sm-4"><p><input type="email" placeholder="Email" name="email" class="required email"></p></div> </div> <div class="row"> <div class="col-sm-4"> <p><select name="state"> <option value="no_val">Your Location</option> <option value="NSW">NSW</option> <option value="VIC">VIC</option> <option value="NT">NT</option> <option value="TAS">TAS</option> <option value="QLD">QLD</option> <option value="SA">SA</option> <option value="WA">WA</option> <option value="ACT">ACT</option> </select></p> </div> <div class="col-sm-4"> <div class="row"> <div class="col-8"> <p><select name="call" class="call_select"> <option value="no_val">Best time to call</option> <option value="1">1</option> <option value="2">2</option> <option value="3">3</option> <option value="4">4</option> <option value="5">5</option> <option value="6">6</option> <option value="7">7</option> <option value="8">8</option> <option value="9">9</option> <option value="10">10</option> <option value="11">11</option> <option value="12">12</option> </select></p> </div> <div class="col-4"> <p><select name="am_pm"> <option value="AM">AM</option> <option value="PM">PM</option> </select></p> </div> </div> </div> <div class="col-sm-4"> <p><select name="hear"> <option value="no_val">Where did you hear about us</option> <option value="Google">Google</option> <option value="Facebook">Facebook</option> <option value="Friend">Friend</option> <option value="Radio">Radio</option> <option value="Referred by Friend">Referred by Friend</option> <option value="Referred by Medical Practitioner">Referred by Medical Practitioner</option> <option value="TV">TV</option> <option value="Other">Other</option> </select></p> </div> </div> <input type="hidden" name="check_menopausal" /> <input type="hidden" name="menopausal" /> <input type="hidden" name="email_check" /> <input type="hidden" name="form_age" /> <input type="hidden" name="form_questions2" /> <input type="hidden" name="form_questions3" /> <input type="hidden" name="form_questions4" /> <input type="hidden" name="form_questions5" /> <input type="hidden" name="form_questions6" /> <input type="hidden" name="form_questions7" /> <input type="hidden" name="form_questions8" /> <input type="hidden" name="form_name" /> <input type="hidden" name="form_email" /> <input type="hidden" name="form_phone" /> <p class="text-center"><button type="submit" id="finishbuttom">Finish</button></p> <p class="text-center"><input type="checkbox" id="f-option15" name="questions_finishtwo" value="yes" checked><label for="f-option15" class="text"><strong>I would like to receive information on women's health</strong></label></p> <p class="bottom text-center"><em style="font-size:13px;color:#888;">We guarantee 100% privacy. Your information will not be shared.</em></p> </div> </form> </div> </div>