psteiner29

Thank you for your help. seems to be working again now when emailed. TY

Hello

This is what I have and on the front end, the groups are working as intended:

<label>Please Select: (required)</label>
[radio radio-432 “I am a physician who wants to dispense NeuRemedy” “I am a patient who wants to get started with NeuRemedy” ]<br/>

[group group-patient-phone]
<div id=”clearfix”>
<div id=”left”>
<label> Your Name (req.)
[text* your-name] </label>
<label> Email Address (req.)
[email* your-email] </label>
</div>
<div id=”right”>
<label> Zip Code (req.)
[text* ZipCode] </label>
<label>Phone Number
[tel* Phone placeholder “Please provide your phone number”]</label>

</div>
[/group]
</div>

[group group-doctor]
<div id=”clearfix”>
<div id=”left”>
<label> First Name (req.)
[text* your-name-doctor] </label>
<label>Last Name (req.)
[text* your-lastname-doctor] </label>
<label>Degree (req.)
[text* Degree]</label>
<label>Email Address (req.)
[email* your-email-doctor] </label>
</div>

<div id=”right”>
<label> Office Name
[text Office]</label>
<label> Office Phone (req.)
[tel* tel-793]</label>
<label> Office Street Address (req.)
[text* address]</label>
<label>Office City (req.)
[text* City]</label>
<label>Office Zip Code (req.)
[text* ZipCode2] </label>
<label>Office State (req.)
[select* your-state include_blank data:us_subdivisions.states data:us_subdivisions.districts data:us_subdivisions.territories]</label>
</div>
</div>
[/group]

<label>Message
[textarea your-message x2 placeholder “Message”]</label>

[group group-patient-phone]
<label>How did you hear about NeuRemedy?
[select PatientSurveyQ “Please select” “Recommended by Physician” “Recommended by Friend/Family” “Internet Research” “Google Search” “Advertisement” “Email”]</label>
[/group]

[group group-doctor]
<label>How did you hear about NeuRemedy?
[select DoctorSurveyQ “Please select” “Saw at conference” “Attended a lecture” “Recommend by fellow physician” “Recommended by patient ” “Advertisement” “Email” “Google search”]</label>
[/group]

<label>Please send me news & information about NeuRemedy.</label>
[checkbox NeuRemedyBrochure default:1 “YES”]

[submit “Send”]