{"id":12279,"date":"2021-11-11T21:31:38","date_gmt":"2021-11-12T02:31:38","guid":{"rendered":"https:\/\/staging.somnomed.com\/ca\/?page_id=12279"},"modified":"2021-11-11T21:32:18","modified_gmt":"2021-11-12T02:32:18","slug":"somtabs-order-form-canada","status":"publish","type":"page","link":"https:\/\/staging.somnomed.com\/ca\/somtabs-order-form-canada\/","title":{"rendered":"SomTabs Order Form Canada"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"12279\" class=\"elementor elementor-12279\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-22db6ef elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"22db6ef\" data-element_type=\"section\" data-e-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-top-column elementor-element elementor-element-124b0b8\" data-id=\"124b0b8\" data-element_type=\"column\" data-e-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-f1fc378 elementor-widget elementor-widget-template\" data-id=\"f1fc378\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"template.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-template\">\n\t\t\t\t\t<div data-elementor-type=\"page\" data-elementor-id=\"12271\" class=\"elementor elementor-12271\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-5db4bcee elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5db4bcee\" data-element_type=\"section\" data-e-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-top-column elementor-element elementor-element-75041a6a\" data-id=\"75041a6a\" data-element_type=\"column\" data-e-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-4e150445 elementor-widget elementor-widget-spacer\" data-id=\"4e150445\" data-element_type=\"widget\" data-e-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\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-44652c45 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"44652c45\" data-element_type=\"section\" data-e-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-top-column elementor-element elementor-element-7acf776f\" data-id=\"7acf776f\" data-element_type=\"column\" data-e-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-33a38944 elementor-widget elementor-widget-heading\" data-id=\"33a38944\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">SomTabs<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5db506b8 elementor-widget elementor-widget-text-editor\" data-id=\"5db506b8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5>Gentle and thorough cleaning tablets for your oral appliances<\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-36d2f926 elementor-widget elementor-widget-text-editor\" data-id=\"36d2f926\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Exclusively from SomnoMed<sup>\u00ae<\/sup><strong>, <\/strong>SomTabs oral device cleaning tablets help keep SomnoDent<sup>\u00ae<\/sup> devices in pristine condition. It kills 99% of germs and odor-causing bacteria. Each box contains 96 tablets.<\/p><p>To order SomTabs fill in the form below.<\/p>\t\t\t\t\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-top-column elementor-element elementor-element-656e2cee\" data-id=\"656e2cee\" data-element_type=\"column\" data-e-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-7fad883 elementor-widget elementor-widget-image\" data-id=\"7fad883\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/staging.somnomed.com\/ca\/wp-content\/uploads\/sites\/10\/2021\/11\/Image-for-website-1024x683.png\" class=\"attachment-large size-large wp-image-12297\" alt=\"\" srcset=\"https:\/\/staging.somnomed.com\/ca\/wp-content\/uploads\/sites\/10\/2021\/11\/Image-for-website-1024x683.png 1024w, https:\/\/staging.somnomed.com\/ca\/wp-content\/uploads\/sites\/10\/2021\/11\/Image-for-website-300x200.png 300w, https:\/\/staging.somnomed.com\/ca\/wp-content\/uploads\/sites\/10\/2021\/11\/Image-for-website-768x512.png 768w, https:\/\/staging.somnomed.com\/ca\/wp-content\/uploads\/sites\/10\/2021\/11\/Image-for-website.png 1200w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\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<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-1dcae27 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1dcae27\" data-element_type=\"section\" data-e-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-top-column elementor-element elementor-element-746e28a\" data-id=\"746e28a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\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 data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-2d2ab2af elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2d2ab2af\" data-element_type=\"section\" data-e-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-top-column elementor-element elementor-element-71af29cc\" data-id=\"71af29cc\" data-element_type=\"column\" data-e-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-5e822828 elementor-widget elementor-widget-spacer\" data-id=\"5e822828\" data-element_type=\"widget\" data-e-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<div class=\"elementor-element elementor-element-175c2825 elementor-widget elementor-widget-eael-adv-tabs\" data-id=\"175c2825\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-adv-tabs.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div data-scroll-on-click=\"no\" data-scroll-speed=\"300\" id=\"eael-advance-tabs-175c2825\" class=\"eael-advance-tabs eael-tabs-horizontal eael-tab-auto-active \" data-tabid=\"175c2825\">\n            <div class=\"eael-tabs-nav \">\n                <ul class=\"eael-tab-inline-icon\" role=\"tablist\">\n                                            <li id=\"contents\" class=\"inactive eael-tab-item-trigger eael-tab-nav-item\" aria-selected=\"true\" data-tab=\"1\" role=\"tab\" tabindex=\"0\" aria-controls=\"contents-tab\" aria-expanded=\"false\">\n                            \n                                                        \n                                                            <span class=\"eael-tab-title title-after-icon\" >Contents<\/span>                            \n                                                    <\/li>\n                                            <li id=\"configuration\" class=\"inactive eael-tab-item-trigger eael-tab-nav-item\" aria-selected=\"false\" data-tab=\"2\" role=\"tab\" tabindex=\"-1\" aria-controls=\"configuration-tab\" aria-expanded=\"false\">\n                            \n                                                        \n                                                            <span class=\"eael-tab-title title-after-icon\" >Configuration<\/span>                            \n                                                    <\/li>\n                                            <li id=\"caution\" class=\"inactive eael-tab-item-trigger eael-tab-nav-item\" aria-selected=\"false\" data-tab=\"3\" role=\"tab\" tabindex=\"-1\" aria-controls=\"caution-tab\" aria-expanded=\"false\">\n                            \n                                                        \n                                                            <span class=\"eael-tab-title title-after-icon\" >CAUTION<\/span>                            \n                                                    <\/li>\n                                            <li id=\"device-care\" class=\"inactive eael-tab-item-trigger eael-tab-nav-item\" aria-selected=\"false\" data-tab=\"4\" role=\"tab\" tabindex=\"-1\" aria-controls=\"device-care-tab\" aria-expanded=\"false\">\n                            \n                                                        \n                                                            <span class=\"eael-tab-title title-after-icon\" >Device Care<\/span>                            \n                                                    <\/li>\n                    \n                                  <\/ul>\n            <\/div>\n            \n            <div class=\"eael-tabs-content\">\n\t\t        \n                    <div id=\"contents-tab\" class=\"clearfix eael-tab-content-item inactive\" data-title-link=\"contents-tab\">\n\t\t\t\t        <p><strong>Contents<\/strong><br \/>Sodium Bicarbonate, Potassium Caroate, Citric Acid, Sodium Citrate, Sorbitol, Sodium Lauryl Sulfate, Sodium Percarbonate, CI 73015.<\/p>                    <\/div>\n\t\t        \n                    <div id=\"configuration-tab\" class=\"clearfix eael-tab-content-item inactive\" data-title-link=\"configuration-tab\">\n\t\t\t\t        <p>1 Box of 30 Tablets<\/p>                    <\/div>\n\t\t        \n                    <div id=\"caution-tab\" class=\"clearfix eael-tab-content-item inactive\" data-title-link=\"caution-tab\">\n\t\t\t\t        <p><strong>CAUTION<\/strong><br \/>Keep tablets out of reach of children, domestic animals and those at risk of accidentally swallowing the tablet or solution. If swallowed seek immediate medical advice.<\/p><p>Not recommended for users with known hyper-sensitivity to Persulfates.<\/p>                    <\/div>\n\t\t        \n                    <div id=\"device-care-tab\" class=\"clearfix eael-tab-content-item inactive\" data-title-link=\"device-care-tab\">\n\t\t\t\t        <p>Every morning, after removing your device, rinse it under cold running water and wash with a small amount of liquid soap and a soft toothbrush. Fill your device container with fresh cold water and store the device in it throughout the day without the lid to ensure adequate air circulation.<\/p><p>When your device requires a more thorough clean, we recommend SomTabs to clean hard-to-reach areas. SomTabs are available from our online store and can be used as required.<\/p><p>Fill container with luke warm water and add a SomTab; leave to soak for 15 minutes only. After soaking, clean your device with a soft toothbrush rinse with fresh water and store immersed in water in container as usual.<\/p><p>Other helpful care tips:<\/p><ul><li>Keep your device out of direct sunlight.<\/li><li>Never use toothpaste on the device as it contains abrasives and may damage your device.<\/li><li>Never use hot or boiling water to clean your device.<\/li><li>Always brush your teeth thoroughly prior to inserting your device for the evening.<\/li><\/ul><p>Note: Cleaning tablets containing active oxygen for dentures may permanently damage the plastic of your device. The use of any cleaning agents not recommended by SomnoMed will void the device\u2019s warranty.<\/p><p>Exclusively from SomnoMed<sup>\u00ae<\/sup><strong>, <\/strong>SomTabs oral device cleaning tablets help keep SomnoDent<sup>\u00ae<\/sup> devices in pristine condition. It kills 99% of germs and odor-causing bacteria. Each box contains 96 tablets.<\/p><p><span style=\"text-decoration: underline\">Instructions on how to use SomTabs<\/span><\/p>                    <\/div>\n\t\t                    <\/div>\n        <\/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<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-7ba29cf2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7ba29cf2\" data-element_type=\"section\" data-e-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-top-column elementor-element elementor-element-2d5d4e3d\" data-id=\"2d5d4e3d\" data-element_type=\"column\" data-e-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-7ef69fd5 eael-gravity-form-button-custom elementor-widget elementor-widget-eael-gravity-form\" data-id=\"7ef69fd5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-gravity-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"eael-contact-form eael-gravity-form title-description-hide eael-custom-radio-checkbox eael-contact-form-align-default\">\n\t\t        \t\t\t\t\t<div class=\"eael-gravity-form-heading\">\n\t\t\t\t        \t\t\t\t\t\t\t<h3 class=\"eael-contact-form-title eael-gravity-form-title\">\n\t\t\t\t\t\t        SomTabs Order Form\t\t\t\t\t\t\t<\/h3>\n\t\t\t\t        \t\t\t\t        \t\t\t\t\t\t\t<div class=\"eael-contact-form-description eael-gravity-form-description\">\n\t\t\t\t\t\t        Fill in the form below to order your SomTabs today!<br>\n\n<br \/>\n <i><b>**Canadian resident orders only! Orders from outside of Canada will be refunded.<\/b><\/i>\n<br>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t        \t\t\t\t\t<\/div>\n\t\t        <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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action='\/ca\/wp-json\/wp\/v2\/pages\/12279#gf_12' data-formid='12' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_1\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_12_1 gfield_product_12_1 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Order Size<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_1'>\n\t\t\t<div class='gchoice gchoice_12_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='6 Month Supply|74'  id='choice_12_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_1_0' id='label_12_1_0' class='gform-field-label gform-field-label--type-inline'>6 Month Supply<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='12 Month Supply|148'  id='choice_12_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_1_1' id='label_12_1_1' class='gform-field-label gform-field-label--type-inline'>12 Month Supply<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_2\" class=\"gfield gfield--type-shipping gfield--input-type-singleshipping gfield--width-full gfield_price gfield_shipping gfield_shipping_12 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_2'>Standard Shipping<\/label><div class='ginput_container ginput_container_singleshipping'>\n\t\t\t\t\t<input type='text' readonly class='ginput_shipping_price gform-text-input-reset' id='input_12_2' name='input_2' value='$ 22.95 CAD' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_12_5\" class=\"gfield gfield--type-total gfield--width-full gfield_price gfield_price_12_ gfield_total gfield_total_12_ field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  aria-atomic=\"true\" aria-live=\"polite\" ><label class='gfield_label gform-field-label' for='input_12_5'>Total<\/label><div class='ginput_container ginput_container_total'>\n\t\t\t\t\t\t\t<input type='text' readonly name='input_5' id='input_12_5' value='$ 0.00 CAD' class='gform-text-input-reset ginput_total ginput_total_12' \/>\n\t\t\t\t\t\t<\/div><\/div><fieldset id=\"field_12_6\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_6'>\n                            \n                            <span id='input_12_6_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.3' id='input_12_6_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_6_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_6_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.6' id='input_12_6_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_6_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_12_7\" class=\"gfield gfield--type-email gfield--width-full 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_12_7'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_12_7' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_12_8\" class=\"gfield gfield--type-phone gfield--width-full 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_12_8'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_12_8' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_12_9\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Billing Address - Canada Residents Only<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_9' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_9_1_container' >\n                                        <input type='text' name='input_9.1' id='input_12_9_1' value=''    aria-required='true'    \/>\n                                        <label for='input_12_9_1' id='input_12_9_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_9_2_container' >\n                                        <input type='text' name='input_9.2' id='input_12_9_2' value=''     aria-required='false'   \/>\n                                        <label for='input_12_9_2' id='input_12_9_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_9_3_container' >\n                                    <input type='text' name='input_9.3' id='input_12_9_3' value=''    aria-required='true'    \/>\n                                    <label for='input_12_9_3' id='input_12_9_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_9_4_container' >\n                                        <select name='input_9.4' id='input_12_9_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_12_9_4' id='input_12_9_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_9_5_container' >\n                                    <input type='text' name='input_9.5' id='input_12_9_5' value=''    aria-required='true'    \/>\n                                    <label for='input_12_9_5' id='input_12_9_5_label' class='gform-field-label gform-field-label--type-sub '>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_9.6' id='input_12_9_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_12_9'>Shipping only available for Canada residents, unavailable for shipment to PO Boxes<\/div><\/fieldset><fieldset id=\"field_12_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Is billing address is the same as shipping address?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_10'><div class='gchoice gchoice_12_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Yes'  id='choice_12_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_10_1' id='label_12_10_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_12_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='No'  id='choice_12_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_10_2' id='label_12_10_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_11\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Shipping Address - Canada Residents Only<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_12_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_12_11_1' value=''    aria-required='false'    \/>\n                                        <label for='input_12_11_1' id='input_12_11_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_12_11_2_container' >\n                                        <input type='text' name='input_11.2' id='input_12_11_2' value=''     aria-required='false'   \/>\n                                        <label for='input_12_11_2' id='input_12_11_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_12_11_3' value=''    aria-required='false'    \/>\n                                    <label for='input_12_11_3' id='input_12_11_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_11_4_container' >\n                                        <select name='input_11.4' id='input_12_11_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_12_11_4' id='input_12_11_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_12_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_12_11_5' value=''    aria-required='false'    \/>\n                                    <label for='input_12_11_5' id='input_12_11_5_label' class='gform-field-label gform-field-label--type-sub '>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_11.6' id='input_12_11_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_12_11'>Shipping only available for Canada residents, unavailable for shipment to PO Boxes<\/div><\/fieldset><fieldset id=\"field_12_12\" class=\"gfield gfield--type-creditcard gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Credit Card<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_creditcard gform-grid-row' id='input_12_12'><span class='ginput_full gform-grid-col' id='input_12_12_1_container' >\n                                    <div class='gform_card_icon_container'><div class='gform_card_icon gform_card_icon_amex' >American Express<\/div><div class='gform_card_icon gform_card_icon_discover' >Discover<\/div><div class='gform_card_icon gform_card_icon_mastercard' >MasterCard<\/div><div class='gform_card_icon gform_card_icon_visa' >Visa<\/div><span class='screen-reader-text' id='field_12_12_supported_creditcards'>Supported Credit Cards: American Express, Discover, MasterCard, Visa<\/span><\/div>\n                                    <input type='text' name='input_12.1' id='input_12_12_1' value=''   onchange='gformMatchCard(\"input_12_12_1\");' onkeyup='gformMatchCard(\"input_12_12_1\");' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='true'  \/>\n                                    <label for='input_12_12_1' id='input_12_12_1_label' class='gform-field-label gform-field-label--type-sub '>Card Number<\/label>\n                                 <\/span><span class='ginput_full ginput_cardextras gform-grid-col gform-grid-row' id='input_12_12_2_container'>\n                                            <fieldset class='ginput_cardinfo_left gform-grid-col' id='input_12_12_2_cardinfo_left'>\n                                            <legend class='gform-field-label gform-field-label--type-sub '>Expiration Date<\/legend>\n                                                <span class='ginput_card_expiration_container ginput_card_field gform-grid-row'>\n                                                   <span class='ginput_card_expiration_month_container gform-grid-col'>\n                                                       <label for='input_12_12_2_month' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                                       <select name='input_12.2[]' id='input_12_12_2_month'   class='ginput_card_expiration ginput_card_expiration_month' aria-required='true'  >\n                                                           <option value=''>Month<\/option><option value='1' >01<\/option><option value='2' >02<\/option><option value='3' >03<\/option><option value='4' >04<\/option><option value='5' >05<\/option><option value='6' >06<\/option><option value='7' >07<\/option><option value='8' >08<\/option><option value='9' >09<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option>\n                                                       <\/select>\n                                                   <\/span>\n                                                   <span class='ginput_card_expiration_year_container gform-grid-col'>\n                                                       <label for='input_12_12_2_year' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                                       <select name='input_12.2[]' id='input_12_12_2_year'   class='ginput_card_expiration ginput_card_expiration_year' aria-required='true'  >\n                                                           <option value=''>Year<\/option><option value='2026' >2026<\/option><option value='2027' >2027<\/option><option value='2028' >2028<\/option><option value='2029' >2029<\/option><option value='2030' >2030<\/option><option value='2031' >2031<\/option><option value='2032' >2032<\/option><option value='2033' >2033<\/option><option value='2034' >2034<\/option><option value='2035' >2035<\/option><option value='2036' >2036<\/option><option value='2037' >2037<\/option><option value='2038' >2038<\/option><option value='2039' >2039<\/option><option value='2040' >2040<\/option><option value='2041' >2041<\/option><option value='2042' >2042<\/option><option value='2043' >2043<\/option><option value='2044' >2044<\/option><option value='2045' >2045<\/option>\n                                                       <\/select>\n                                                   <\/span>\n                                                <\/span>\n                                            <\/fieldset><span class='ginput_cardinfo_right gform-grid-col' id='input_12_12_2_cardinfo_right'>\n                                                <input type='text' name='input_12.3' id='input_12_12_3'   class='ginput_card_security_code' value='' autocomplete='off' pattern='[0-9]*' title='Only digits are allowed'  aria-required='true'  \/>\n                                                <span class='ginput_card_security_code_icon'>&nbsp;<\/span>\n                                                <label for='input_12_12_3' class='gform-field-label gform-field-label--type-sub '>Security Code<\/label>\n                                             <\/span>\n                                        <\/span><span class='ginput_full gform-grid-col' id='input_12_12_5_container'>\n                                            <input type='text' name='input_12.5' id='input_12_12_5' value=''    aria-required='false'  \/>\n                                            <label for='input_12_12_5' id='input_12_12_5_label' class='gform-field-label gform-field-label--type-sub '>Cardholder Name<\/label>\n                                        <\/span> <\/div><\/fieldset><fieldset id=\"field_12_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_13'><div class='gchoice gchoice_12_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Yes, I would like to receive information and special offers from SomnoMed.'  id='choice_12_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_13_1' id='label_12_13_1' class='gform-field-label gform-field-label--type-inline'>Yes, I would like to receive information and special offers from SomnoMed.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_12' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=12&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;hash=0b47e18be49a22f6917308477f292e69' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_12' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_12' id='gform_theme_12' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_12' id='gform_style_settings_12' value='' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_12' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='12' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='T9qKziEhYjAgX6vTf0mYa5pAdlbetANGhOvINkmMnQKPS6XDkuAJvMnJnXytRcQaRLBzSOxtfZ3AJoRR4IR2nqVRA\/1QHDRvDt2twv9J13N5tSc=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_12' value='WyJ7XCIxXCI6W1wiYmZiNzNlZWM3MDllZDJkZjllYzk4Yjk4Mzk0NzkzZjFcIixcIjU5OTYwMDM0OTBiYjUyZTFkY2IyMzhlYzA4YmFkZTBlXCJdLFwiMlwiOlwiZTRmYmRmZjZkMmQyMzAxOTIzMThiNmJjYWMyNTIxNjBcIn0iLCJiMTlkOGRiODU1OGI4ODViYjc2MTkzNTlmNWU5ODM3MiJd' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_12' id='gform_target_page_number_12' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_12' id='gform_source_page_number_12' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_12' id='gform_ajax_frame_12' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 12, 'https:\/\/staging.somnomed.com\/ca\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_12').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_12');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_12').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_12').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_12').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_12').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_12').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_12').val();gformInitSpinner( 12, 'https:\/\/staging.somnomed.com\/ca\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [12, current_page]);window['gf_submitting_12'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_12').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_12').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [12]);window['gf_submitting_12'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_12').text());}else{jQuery('#gform_12').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"12\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_12\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_12\";            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