{"id":970,"date":"2023-10-26T11:07:50","date_gmt":"2023-10-26T10:07:50","guid":{"rendered":"https:\/\/medrbs.com\/?page_id=970"},"modified":"2024-03-22T08:50:17","modified_gmt":"2024-03-22T12:50:17","slug":"contact","status":"publish","type":"page","link":"https:\/\/medrbs.com\/contact\/","title":{"rendered":"Contact"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"970\" class=\"elementor elementor-970\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-226b9e0 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"226b9e0\" 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-1ff2b23\" data-id=\"1ff2b23\" 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-8d7dcd6 elementor-widget elementor-widget-heading\" data-id=\"8d7dcd6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 15-04-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">Get In Touch<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e3d11ee elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"e3d11ee\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 15-04-2024 *\/\n.elementor-widget-divider{--divider-border-style:none;--divider-border-width:1px;--divider-color:#0c0d0e;--divider-icon-size:20px;--divider-element-spacing:10px;--divider-pattern-height:24px;--divider-pattern-size:20px;--divider-pattern-url:none;--divider-pattern-repeat:repeat-x}.elementor-widget-divider .elementor-divider{display:flex}.elementor-widget-divider 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.elementor-divider__text{direction:rtl}.e-con-inner>.elementor-widget-divider,.e-con>.elementor-widget-divider{width:var(--container-widget-width,100%);--flex-grow:var(--container-widget-flex-grow)}<\/style>\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\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-ee26eb0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ee26eb0\" 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-33 elementor-inner-column elementor-element elementor-element-ce8e418\" data-id=\"ce8e418\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-ef1e779 elementor-view-stacked elementor-shape-circle elementor-position-top elementor-mobile-position-top elementor-widget elementor-widget-icon-box\" data-id=\"ef1e779\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<link rel=\"stylesheet\" href=\"https:\/\/medrbs.com\/wp-content\/plugins\/elementor\/assets\/css\/widget-icon-box.min.css\">\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<span  class=\"elementor-icon elementor-animation-\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-map-marker-alt\"><\/i>\t\t\t\t<\/span>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<span  >\n\t\t\t\t\t\t\tAddress\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tColden Street 43-23 Flushing NY 11355\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\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<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-892ead5\" data-id=\"892ead5\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-aeeac79 elementor-view-stacked elementor-shape-circle elementor-position-top elementor-mobile-position-top elementor-widget elementor-widget-icon-box\" data-id=\"aeeac79\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"tel:+17187018746\" class=\"elementor-icon elementor-animation-\" tabindex=\"-1\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-phone-alt\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<a href=\"tel:+17187018746\" >\n\t\t\t\t\t\t\tPhone\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\t\n(718) 701-8746 <br>\n\n(516) 707-8748\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\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<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-1cc1067\" data-id=\"1cc1067\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-8ad6547 elementor-view-stacked elementor-shape-circle elementor-position-top elementor-mobile-position-top elementor-widget elementor-widget-icon-box\" data-id=\"8ad6547\" data-element_type=\"widget\" data-widget_type=\"icon-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-icon-box-wrapper\">\n\n\t\t\t\t\t\t<div class=\"elementor-icon-box-icon\">\n\t\t\t\t<a href=\"mailto:info@medrbs.com\" class=\"elementor-icon elementor-animation-\" tabindex=\"-1\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-envelope\"><\/i>\t\t\t\t<\/a>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t\t\t\t<div class=\"elementor-icon-box-content\">\n\n\t\t\t\t\t\t\t\t\t<h3 class=\"elementor-icon-box-title\">\n\t\t\t\t\t\t<a href=\"mailto:info@medrbs.com\" >\n\t\t\t\t\t\t\tEmail\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/h3>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<p class=\"elementor-icon-box-description\">\n\t\t\t\t\t\tinfo@medrbs.com <br>\nMedrbsny@gmail.com\t\t\t\t\t<\/p>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t\n\t\t<\/div>\n\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\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-48e5164 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"48e5164\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-47af995\" data-id=\"47af995\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-4883588 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4883588\" 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-50 elementor-inner-column elementor-element elementor-element-f8e2e3e\" data-id=\"f8e2e3e\" 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-2f4f113 elementor-widget elementor-widget-heading\" data-id=\"2f4f113\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Connect With <span style=\"color: #E10F28; \"> Medrbs !<\/span><\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2e0eeff elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"2e0eeff\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 15-04-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>At Medrbs , we value open communication and are eager to connect with you. Whether you have inquiries about our billing and coding services, want to discuss customized solutions for your practice, or have general questions, our team is here to assist you. Feel free to reach out through the contact form, and let&#8217;s embark on a journey of optimizing your practice&#8217;s financial health together.<\/p><p>We appreciate your interest in Medrbs and look forward to the opportunity to provide you with exceptional support and solutions. Your success is our priority, and we are committed to fostering a strong and collaborative partnership with your healthcare practice.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5637fea elementor-widget elementor-widget-heading\" data-id=\"5637fea\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Social:<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b531f19 elementor-shape-circle e-grid-align-left elementor-grid-0 elementor-widget elementor-widget-social-icons\" data-id=\"b531f19\" data-element_type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 15-04-2024 *\/\n.elementor-widget-social-icons.elementor-grid-0 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.elementor-icon.elementor-social-icon{border-radius:10%}.elementor-shape-circle .elementor-icon.elementor-social-icon{border-radius:50%}<\/style>\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-facebook elementor-animation-grow elementor-repeater-item-735d007\" href=\"https:\/\/www.facebook.com\/Medrbsny\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Facebook<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-facebook\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-twitter elementor-animation-grow elementor-repeater-item-6d032b4\" href=\"https:\/\/twitter.com\/Medrbsny\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Twitter<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-twitter\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-linkedin elementor-animation-grow elementor-repeater-item-fc948f4\" href=\"https:\/\/www.linkedin.com\/company\/medrbs-medical-billing-company\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Linkedin<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-linkedin\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-instagram elementor-animation-grow elementor-repeater-item-58dba24\" href=\"https:\/\/www.instagram.com\/med_rbs\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Instagram<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-instagram\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\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<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-e524fa0\" data-id=\"e524fa0\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-e66cc85 elementor-button-align-center elementor-widget elementor-widget-global elementor-global-1762 elementor-widget-form\" data-id=\"e66cc85\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor-pro - v3.7.7 - 20-09-2022 *\/\n.elementor-button.elementor-hidden,.elementor-hidden{display:none}.e-form__step{width:100%}.e-form__step:not(.elementor-hidden){display:-webkit-box;display:-ms-flexbox;display:flex;-ms-flex-wrap:wrap;flex-wrap:wrap}.e-form__buttons{-ms-flex-wrap:wrap;flex-wrap:wrap}.e-form__buttons,.e-form__buttons__wrapper{display:-webkit-box;display:-ms-flexbox;display:flex}.e-form__indicators{-webkit-box-pack:justify;-ms-flex-pack:justify;justify-content:space-between;-ms-flex-wrap:nowrap;flex-wrap:nowrap;font-size:13px;margin-bottom:var(--e-form-steps-indicators-spacing)}.e-form__indicators,.e-form__indicators__indicator{display:-webkit-box;display:-ms-flexbox;display:flex;-webkit-box-align:center;-ms-flex-align:center;align-items:center}.e-form__indicators__indicator{-webkit-box-orient:vertical;-webkit-box-direction:normal;-ms-flex-direction:column;flex-direction:column;-webkit-box-pack:center;-ms-flex-pack:center;justify-content:center;-ms-flex-preferred-size:0;flex-basis:0;padding:0 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linear}.e-form__indicators__indicator:first-child{padding-left:0}.e-form__indicators__indicator:last-child{padding-right:0}.e-form__indicators__indicator--state-inactive{color:var(--e-form-steps-indicator-inactive-primary-color,#c2cbd2)}.e-form__indicators__indicator--state-inactive [class*=indicator--shape-]:not(.e-form__indicators__indicator--shape-none){background-color:var(--e-form-steps-indicator-inactive-secondary-color,#fff)}.e-form__indicators__indicator--state-inactive object,.e-form__indicators__indicator--state-inactive svg{fill:var(--e-form-steps-indicator-inactive-primary-color,#c2cbd2)}.e-form__indicators__indicator--state-active{color:var(--e-form-steps-indicator-active-primary-color,#39b54a);border-color:var(--e-form-steps-indicator-active-secondary-color,#fff)}.e-form__indicators__indicator--state-active 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.elementor-button>span{display:-webkit-box;display:-ms-flexbox;display:flex;-webkit-box-pack:center;-ms-flex-pack:center;justify-content:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center}.elementor-form .elementor-button .elementor-button-text{white-space:normal;-webkit-box-flex:0;-ms-flex-positive:0;flex-grow:0}.elementor-form .elementor-button svg{height:auto}.elementor-form .elementor-button .e-font-icon-svg{height:1em}.elementor-select-wrapper .select-caret-down-wrapper{position:absolute;top:50%;-webkit-transform:translateY(-50%);-ms-transform:translateY(-50%);transform:translateY(-50%);inset-inline-end:10px;pointer-events:none;font-size:11px}.elementor-select-wrapper .select-caret-down-wrapper svg{display:unset;width:1em;aspect-ratio:unset;fill:currentColor}.elementor-select-wrapper .select-caret-down-wrapper i{font-size:19px;line-height:2}.elementor-select-wrapper.remove-before:before{content:\"\"!important}<\/style>\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"970\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"e66cc85\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Medrbs\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_5628f1a elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5628f1a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tContact Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_5628f1a]\" id=\"form-field-field_5628f1a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4b97748 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4b97748\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tState\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4b97748]\" id=\"form-field-field_4b97748\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_77e94e0 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_77e94e0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPractice Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_77e94e0]\" id=\"form-field-field_77e94e0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5b5c9ef elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5b5c9ef\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMonthly Collection\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_5b5c9ef]\" id=\"form-field-field_5b5c9ef\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Average Monthly Collection\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_6d56d82 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6d56d82\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdditional Information\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_6d56d82]\" id=\"form-field-field_6d56d82\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_c3bfe5e elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_c3bfe5e]\" id=\"form-field-field_c3bfe5e\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-field_c3bfe5e\">By entering your phone number, you agree  to receive text messages according to our terms of use and <a  href=\"https:\/\/medrbs.com\/privacy-policy\/\"> privacy policy <\/a><\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_7ac2243]\" id=\"form-field-field_7ac2243\" class=\"elementor-field elementor-size-sm \" style=\"display:none !important;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-sm\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" 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