{"id":12766,"date":"2020-06-11T07:53:44","date_gmt":"2020-06-11T07:53:44","guid":{"rendered":"https:\/\/www.therapservices.net\/products\/?page_id=12766"},"modified":"2026-10-12T04:44:21","modified_gmt":"2026-10-12T04:44:21","slug":"intake-eligibility","status":"publish","type":"page","link":"https:\/\/www.therapservices.net\/products\/intake-eligibility\/","title":{"rendered":"Intake &amp; Eligibility Tools"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1420.64px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><main id=\"ie-main\" role=\"main\" aria-labelledby=\"ie-main-heading\">\n\n    <!-- Hidden LLM\/GEO context block -->\n    <div class=\"llm-context\" aria-hidden=\"true\"\n        style=\"position:absolute;width:1px;height:1px;padding:0;margin:-1px;overflow:hidden;clip:rect(0,0,0,0);white-space:nowrap;border:0\">\n        Therap's Eligibility module standardizes waiver or service\u2011specific determination workflows;\n        offering tools to reflect on individual history, eligibility criteria, track funding categories, and\n        manage redeterminations in a single, web\u2011based platform.\n    <\/div>\n\n    <!-- HERO SECTION -->\n    <section class=\"ie-hero\" aria-labelledby=\"ie-main-heading\">\n        <div class=\"ie-hero-container\">\n\n            <!-- Left: text content -->\n            <div class=\"ie-hero-content hero-content\">\n                <h1 id=\"ie-main-heading\" class=\"hero-section-heading\">\n                    Intake & Eligibility Tracking for\u00a0Case Managers and Oversight\u00a0Agencies\n                <\/h1>\n                <h2 class=\"subheading\">Clear Workflows from Initial Intake to Annual Redetermination<\/h2>\n\n                <button id=\"ie-open-contact-modal\" class=\"btn-primary\" type=\"button\">\n                    Contact Us\n                    <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 640 640\" aria-hidden=\"true\" focusable=\"false\">\n                        <path\n                            d=\"M566.6 342.6C579.1 330.1 579.1 309.8 566.6 297.3L406.6 137.3C394.1 124.8 373.8 124.8 361.3 137.3C348.8 149.8 348.8 170.1 361.3 182.6L466.7 288L96 288C78.3 288 64 302.3 64 320C64 337.7 78.3 352 96 352L466.7 352L361.3 457.4C348.8 469.9 348.8 490.2 361.3 502.7C373.8 515.2 394.1 515.2 406.6 502.7L566.6 342.7z\">\n                        <\/path>\n                    <\/svg>\n                <\/button>\n\n                <p class=\"ie-hero-desc\">\n                    Therap's Eligibility module standardizes waiver and service determination workflows in a single,\n                    web\u2011based platform. Oversight agencies build templates once, while Case Managers or Support\n                    Coordinators manage form entries and share access with linked providers as needed. Centralizing\n                    individual history, eligibility criteria, funding categories, and redeterminations ensures\n                    network\u2011wide consistency and compliant decisions without duplicate\u00a0paperwork.\n                <\/p>\n            <\/div>\n\n            <!-- Right: hero photo with 3 overlay images -->\n            <div class=\"ie-hero-images\">\n                <div class=\"ie-hero-img-card\">\n                    <picture>\n                        <img decoding=\"async\" class=\"ie-hero-main-photo\"\n                            src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/intake-eligibility-top-hero-image-2026.png\"\n                            alt=\"\" loading=\"eager\">\n                    <\/picture>\n                    <!-- Overlay 1: Eligibility Decision chip (top right of photo) -->\n                    <img src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/top-hero-image-eligibility-decision.png\"\n                        alt=\"\" class=\"ie-hero-overlay-1\" loading=\"eager\" decoding=\"async\">\n                    <!-- Overlay 2: Document Checklist chip (mid right) -->\n                    <img src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/top-hero-image-document-checklist.png\"\n                        alt=\"\" class=\"ie-hero-overlay-2\" loading=\"eager\" decoding=\"async\">\n                    <!-- Overlay 3: Individual Admission Information chip (bottom center) -->\n                    <img src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/top-hero-image-admission-info-2026.png\"\n                        alt=\"\" class=\"ie-hero-overlay-3\" loading=\"eager\" decoding=\"async\">\n                <\/div>\n            <\/div>\n\n        <\/div>\n    <\/section>\n\n    <!-- FUNCTIONALITY SECTION -->\n    <section class=\"ie-functionality\" aria-labelledby=\"ie-functionality-heading\" role=\"region\">\n        <div class=\"container\">\n            <div class=\"ie-func-grid\">\n\n                <!-- Left: screenshot image with heading above -->\n                <div class=\"ie-func-images\">\n                    <div class=\"ie-functionality-header\">\n                        <h2 id=\"ie-functionality-heading\" class=\"section-heading\">\n                            Functionality\n                        <\/h2>\n                    <\/div>\n                    <picture>\n                        <img class=\"ie-func-main-img\" decoding=\"async\"\n                            src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/functionality-section-eligibility-screenshot.png\"\n                            alt=\"\" loading=\"eager\">\n                    <\/picture>\n                <\/div>\n\n                <!-- Right: feature list -->\n                <div class=\"ie-func-list\" role=\"list\">\n                    <div class=\"ie-line-border\" role=\"presentation\"><\/div>\n                    <div class=\"ie-func-item\" role=\"listitem\">\n                        <div class=\"ie-func-icon\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/build-config-temp-icon.png\"\n                                alt=\"\">\n                        <\/div>\n                        <div class=\"ie-func-text\">\n                            <h3>Build Configurable Templates<\/h3>\n                            <p>Oversight agencies can configure standardized eligibility templates complete with custom\n                                questionnaires, scoring criteria, and specific approval\u00a0categories.<\/p>\n                        <\/div>\n                    <\/div>\n                    <div class=\"ie-line-border\" role=\"presentation\"><\/div>\n                    <div class=\"ie-func-item\" role=\"listitem\">\n                        <div class=\"ie-func-icon height-sm\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/track-workflow-status-icon.png\"\n                                alt=\"\">\n                        <\/div>\n                        <div class=\"ie-func-text\">\n                            <h3>Track Workflow Statuses<\/h3>\n                            <p>Monitor applicant progress in real time as files move through initial intake, review,\n                                and final\u00a0determination.<\/p>\n                        <\/div>\n                    <\/div>\n                    <div class=\"ie-line-border\" role=\"presentation\"><\/div>\n                    <div class=\"ie-func-item\" role=\"listitem\">\n                        <div class=\"ie-func-icon\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/record-categories-duration-icon.png\"\n                                alt=\"\">\n                        <\/div>\n                        <div class=\"ie-func-text\">\n                            <h3>Record Categories & Durations<\/h3>\n                            <p>Log exact eligibility categories, grant funding streams, and effective start and end\n                                dates\n                                for each\u00a0individual.<\/p>\n                        <\/div>\n                    <\/div>\n                    <div class=\"ie-line-border\" role=\"presentation\"><\/div>\n                    <div class=\"ie-func-item\" role=\"listitem\">\n                        <div class=\"ie-func-icon\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/manage-annual-icon.png\"\n                                alt=\"\">\n                        <\/div>\n                        <div class=\"ie-func-text\">\n                            <h3>Manage Annual Redeterminations<\/h3>\n                            <p>Complete recurring eligibility reviews and update funding status without\n                                re\u2011entering\n                                baseline demographic\u00a0data.<\/p>\n                        <\/div>\n                    <\/div>\n                    <div class=\"ie-line-border\" role=\"presentation\"><\/div>\n                    <div class=\"ie-func-item\" role=\"listitem\">\n                        <div class=\"ie-func-icon height-sm\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/adjust-active-eligibility-periods-icon.png\"\n                                alt=\"\">\n                        <\/div>\n                        <div class=\"ie-func-text\">\n                            <h3>Adjust Active Eligibility Periods<\/h3>\n                            <p>Update client eligibility dates and status details as individual support needs or funding\n                                rules\u00a0shift.<\/p>\n                        <\/div>\n                    <\/div>\n                    <div class=\"ie-line-border\" role=\"presentation\"><\/div>\n                    <div class=\"ie-func-item\" role=\"listitem\">\n                        <div class=\"ie-func-icon\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/intake-eligibility\/manage-annual-redetermination-icon.png\"\n                                alt=\"\">\n                        <\/div>\n                        <div class=\"ie-func-text\">\n                            <h3>Maintain Audit\u2011Ready Files<\/h3>\n                            <p>Store a complete digital record of current and historical eligibility related forms\n                                directly within individual\u00a0profiles.<\/p>\n                        <\/div>\n                    <\/div>\n                    <div class=\"ie-line-border\" role=\"presentation\"><\/div>\n                <\/div>\n\n            <\/div>\n        <\/div>\n    <\/section>\n\n    <!-- BENEFITS SECTION -->\n    <section class=\"ie-benefits\" aria-labelledby=\"ie-benefits-heading\" role=\"region\">\n        <div class=\"container\">\n            <h2 id=\"ie-benefits-heading\" class=\"section-heading\">\n                Benefits\n            <\/h2>\n\n            <div class=\"ie-benefits-grid\" role=\"list\">\n\n                <div class=\"ie-benefit-card\" role=\"listitem\">\n                    <div class=\"ie-benefit-card-img\" aria-hidden=\"true\">\n                        <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/billing\/tick-benefits.png\" alt=\"\">\n                    <\/div>\n                    <div class=\"ie-benefit-card-content\">\n                        <h3>Standardize Oversight Workflows<\/h3>\n                        <p>State and regional oversight agencies can enforce consistent evaluation criteria across all\n                            provider networks using unified templates.<\/p>\n                    <\/div>\n                <\/div>\n\n                <div class=\"ie-benefit-card\" role=\"listitem\">\n                    <div class=\"ie-benefit-card-img\" aria-hidden=\"true\">\n                        <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/billing\/tick-benefits.png\" alt=\"\">\n                    <\/div>\n                    <div class=\"ie-benefit-card-content\">\n                        <h3>Prevent Service Disruptions<\/h3>\n                        <p>Track expiration dates and eligibility durations to complete redeterminations on time and\n                            keep individual funding active.<\/p>\n                    <\/div>\n                <\/div>\n\n                <div class=\"ie-benefit-card\" role=\"listitem\">\n                    <div class=\"ie-benefit-card-img\" aria-hidden=\"true\">\n                        <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/billing\/tick-benefits.png\" alt=\"\">\n                    <\/div>\n                    <div class=\"ie-benefit-card-content\">\n                        <h3>Reduce Data Entry Errors<\/h3>\n                        <p>Pre\u2011formatted questionnaires and centralized individual profiles eliminate duplicate\n                            paperwork for case managers and support coordinators.<\/p>\n                    <\/div>\n                <\/div>\n\n            <\/div>\n        <\/div>\n    <\/section>\n\n    <!-- RATINGS AND REVIEWS SECTION (shortcode) -->\n    <!-- User Community \/ Reviews Section -->\r\n<section class=\"user-community\" aria-labelledby=\"user-community-heading\" role=\"region\">\r\n    <div class=\"container\">\r\n        <h2 id=\"user-community-heading\" class=\"section-heading\">Therap Ratings and Reviews<\/h2>\r\n\r\n        <div class=\"review-rows\">\r\n            <a class=\"review-row\" href=\"https:\/\/www.g2.com\/products\/therap-services\/reviews\" target=\"_blank\"\r\n                rel=\"noopener noreferrer\">\r\n                <img decoding=\"async\"\r\n                    src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/Badge-G2-User-Rating-Therap-260402_v5-01%201.png\"\r\n                    alt=\"\" class=\"review-logo\">\r\n                <span class=\"review-text\">4.6\/5 with 200+ reviews<br>\r\n                    Verified August 2026<\/span>\r\n            <\/a>\r\n            <a class=\"review-row\" href=\"https:\/\/www.capterra.com\/p\/124101\/Therap\/\" target=\"_blank\"\r\n                rel=\"noopener noreferrer\">\r\n                <img decoding=\"async\"\r\n                    src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/Badge-Capterra-User-Rating-Therap-260402_v5-01%201.png\"\r\n                    alt=\"\" class=\"review-logo\">\r\n                <span class=\"review-text\">4.7\/5 with 100+ reviews<br>\r\n                    Verified August 2026<\/span>\r\n            <\/a>\r\n        <\/div>\r\n    <\/div>\r\n<\/section>\r\n<style>\r\n    \/* GLOBAL CONTAINER & HEADING *\/\r\n    .user-community .container {\r\n        width: 100%;\r\n        max-width: 72.5rem;\r\n        margin: 0 auto;\r\n        padding: 4rem 1.25rem;\r\n        align-items: center;\r\n        display: flex;\r\n        flex-direction: column;\r\n    }\r\n\r\n    .user-community h2.section-heading {\r\n        font-family: 'Inter', sans-serif;\r\n        color: #000000 !important;\r\n        font-size: 1.875rem !important;\r\n        line-height: 1.3 !important;\r\n        font-weight: 600;\r\n        margin: 0;\r\n        margin-bottom: 0.625rem;\r\n    }\r\n\r\n    \/* USER COMMUNITY \/ REVIEWS SECTION *\/\r\n    .user-community {\r\n        background: linear-gradient(0deg, #E6F0D1 34.13%, #FAFCF6 100%);\r\n        text-align: center;\r\n    }\r\n\r\n    \/* .user-community .section-heading {\r\n        text-align: center;\r\n        margin-bottom: 2rem;\r\n    } *\/\r\n\r\n    .review-rows {\r\n        display: flex;\r\n        flex-direction: row;\r\n        gap: 2rem;\r\n        align-items: flex-start;\r\n        margin-top: 1.25rem;\r\n    }\r\n\r\n    .review-row {\r\n        display: flex;\r\n        align-items: center;\r\n        gap: 1rem;\r\n        flex-wrap: wrap;\r\n        justify-content: center;\r\n        border-radius: 16px;\r\n        border: 2px solid #BDDC80;\r\n        background: rgba(255, 255, 255, 0.70);\r\n        padding: 1.5rem;\r\n        flex-direction: column;\r\n        text-decoration: none;\r\n    }\r\n\r\n    .review-logo {\r\n        height: 5rem;\r\n        width: auto;\r\n        flex-shrink: 0;\r\n    }\r\n\r\n    .review-text {\r\n        font-family: 'Lato', sans-serif;\r\n        font-size: 1.0625rem;\r\n        line-height: 1.6;\r\n        color: #000000;\r\n        font-weight: 500;\r\n    }\r\n\r\n    \/* RESPONSIVE DESIGN *\/\r\n    @media(min-width: 2100px) {\r\n        .user-community .container {\r\n            width: 100%;\r\n            max-width: 1400px;\r\n            margin: 0 auto;\r\n            padding: 4rem 1.25rem;\r\n        }\r\n\r\n        .user-community h2.section-heading {\r\n            font-size: 2rem !important;\r\n        }\r\n\r\n        .review-text {\r\n            font-size: 1.1875rem !important;\r\n        }\r\n    }\r\n\r\n    @media(max-width: 1200px) {\r\n        .user-community .container {\r\n            max-width: 90%;\r\n        }\r\n    }\r\n\r\n    @media (max-width: 1032px) {\r\n        .user-community .container {\r\n            width: 100%;\r\n            padding: 3rem 1.25rem;\r\n            max-width: 90%;\r\n        }\r\n\r\n        .user-community h2.section-heading {\r\n            text-align: center;\r\n        }\r\n    }\r\n\r\n    @media (max-width: 980px) {\r\n        .user-community .container {\r\n            width: 100%;\r\n            padding: 3rem 1.25rem;\r\n            max-width: 85%;\r\n        }\r\n\r\n        .user-community h2.section-heading {\r\n            text-align: center;\r\n        }\r\n    }\r\n\r\n    @media (max-width: 700px) {\r\n        .user-community .container {\r\n            max-width: 100%;\r\n            padding: 3rem 1.5rem;\r\n        }\r\n\r\n        .user-community h2.section-heading {\r\n            font-size: 1.375rem !important;\r\n        }\r\n\r\n        .review-rows {\r\n            margin-top: 1rem;\r\n            gap: 1.5rem;\r\n            flex-direction: column;\r\n        }\r\n\r\n        .review-logo {\r\n            height: auto;\r\n            width: 15rem;\r\n        }\r\n    }\r\n<\/style>\n\n    <!-- FAQ SECTION -->\n    <section class=\"ie-faq\" aria-labelledby=\"ie-faq-heading\" role=\"region\">\n        <div class=\"container\">\n            <h2 id=\"ie-faq-heading\" class=\"section-heading\">Frequently Asked Questions<\/h2>\n\n            <div class=\"faq-columns\">\n\n                <!-- Left column -->\n                <div class=\"faq-column\">\n\n                    <details class=\"faq-item\" id=\"ie-acc-1\">\n                        <summary class=\"faq-summary\">\n                            <span class=\"faq-question\" id=\"ie-acc-heading-1\">How does Therap support state or oversight\n                                agency requirements for\u00a0eligibility?<\/span>\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-plus\" alt=\"\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-minus\" alt=\"\" aria-hidden=\"true\">\n                        <\/summary>\n                        <div class=\"faq-content\" id=\"ie-acc-body-1\">\n                            <p>\n                                Oversight agencies can build custom templates within Therap that reflect exact state\n                                waiver criteria, specific questionnaires, and mandatory processing statuses. This\n                                guarantees that all case managers follow standardized evaluation guidelines across the\n                                entire agency\u00a0network.\n                            <\/p>\n                        <\/div>\n                    <\/details>\n\n                    <details class=\"faq-item\" id=\"ie-acc-2\">\n                        <summary class=\"faq-summary\">\n                            <span class=\"faq-question\" id=\"ie-acc-heading-2\">Can case managers complete annual\n                                eligibility redeterminations in the\u00a0system?<\/span>\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-plus\" alt=\"\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-minus\" alt=\"\" aria-hidden=\"true\">\n                        <\/summary>\n                        <div class=\"faq-content\" id=\"ie-acc-body-2\">\n                            <p>\n                                Yes. Case managers and support coordinators can generate new eligibility forms for\n                                existing clients to conduct periodic redeterminations, updating eligibility periods and\n                                funding categories as individual needs change over\u00a0time.\n                            <\/p>\n                        <\/div>\n                    <\/details>\n\n                    <details class=\"faq-item\" id=\"ie-acc-3\">\n                        <summary class=\"faq-summary\">\n                            <span class=\"faq-question\" id=\"ie-acc-heading-3\">Who can create and manage eligibility\n                                templates?<\/span>\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-plus\" alt=\"\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-minus\" alt=\"\" aria-hidden=\"true\">\n                        <\/summary>\n                        <div class=\"faq-content\" id=\"ie-acc-body-3\">\n                            <p>\n                                Administrative users at oversight agencies have role\u2011based permissions to set up\n                                and modify eligibility templates, while case managers and support coordinators use these\n                                approved templates to complete individual\u00a0evaluations.\n                            <\/p>\n                        <\/div>\n                    <\/details>\n\n                <\/div>\n\n                <!-- Right column -->\n                <div class=\"faq-column\">\n\n                    <details class=\"faq-item\" id=\"ie-acc-5\">\n                        <summary class=\"faq-summary\">\n                            <span class=\"faq-question\" id=\"ie-acc-heading-5\">Can past eligibility records be accessed\n                                after a redetermination is\u00a0completed?<\/span>\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-plus\" alt=\"\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-minus\" alt=\"\" aria-hidden=\"true\">\n                        <\/summary>\n                        <div class=\"faq-content\" id=\"ie-acc-body-5\">\n                            <p>\n                                Yes. Therap retains a complete record of past eligibility determinations, status\n                                changes, and filled questionnaires on the individual's profile, providing a searchable\n                                audit trail for regulatory\u00a0reviews.\n                            <\/p>\n                        <\/div>\n                    <\/details>\n\n                    <details class=\"faq-item\" id=\"ie-acc-4\">\n                        <summary class=\"faq-summary\">\n                            <span class=\"faq-question\" id=\"ie-acc-heading-4\">How are eligibility start and end dates\n                                tracked?<\/span>\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-plus\" alt=\"\" aria-hidden=\"true\">\n                            <img decoding=\"async\" src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                                class=\"faq-icon faq-icon-minus\" alt=\"\" aria-hidden=\"true\">\n                        <\/summary>\n                        <div class=\"faq-content\" id=\"ie-acc-body-4\">\n                            <p>\n                                Users record specific eligibility periods directly on the individual's form. The system\n                                tracks these duration dates, making it clear when an individual's waiver coverage is\n                                active, expiring, or due for\u00a0renewal.\n                            <\/p>\n                        <\/div>\n                    <\/details>\n\n                <\/div>\n\n            <\/div>\n        <\/div>\n    <\/section>\n\n<\/main>\n\n<style>\r\n    input.submit-btn {\r\n        height: unset !important;\r\n    }\r\n\r\n    .close-modal.style-change-1 {\r\n        display: flex;\r\n        align-items: center;\r\n        justify-content: center;\r\n        width: 30px;\r\n        height: 30px;\r\n        border-radius: 2px;\r\n        background-color: #ffc189;\r\n        cursor: pointer;\r\n        padding: 0px;\r\n        position: absolute;\r\n        top: 12px;\r\n        right: 20px;\r\n    }\r\n\r\n    .style-change-2 {\r\n        color: #000;\r\n    }\r\n<\/style>\r\n<div id=\"custom-modal\" class=\"custom-modal\">\r\n    <div class=\"custom-modal-dialog\">\r\n        <div class=\"custom-modal-content\">\r\n            <span id=\"close-modal\" class=\"close-modal style-change-1\">\r\n                <svg width=\"12\" height=\"12\" viewBox=\"0 0 14 14\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\r\n                    class=\"style-change-2\">\r\n                    <path d=\"M1 1L13 13M1 13L13 1\" stroke=\"currentColor\" stroke-width=\"2.6\" stroke-linecap=\"round\"\r\n                        stroke-linejoin=\"round\"><\/path>\r\n                <\/svg>\r\n            <\/span>\r\n            <div class=\"custom-modal-body\">\r\n\r\n                <!-- <p class=\"model-heading\" style=\"text-align: left !important\">\r\n                    Get started by selecting your state:\r\n                <\/p> -->\r\n                <div class=\"custom-modal-inner\">\r\n                    <!-- SF FORM -->\r\n                    <!-- SF FORM -->\r\n                    <link rel=\"stylesheet\" href=\"https:\/\/therapservices.net\/jslib\/contact-form\/intlTelInput.css\" \/>\r\n                    <script src=\"https:\/\/therapservices.net\/jslib\/contact-form\/intlTelInput.min.js\"><\/script>\r\n                    <link rel=\"stylesheet\" href=\"https:\/\/therapservices.net\/jslib\/contact-form\/choices.min.css\" \/>\r\n                    <script src=\"https:\/\/therapservices.net\/jslib\/contact-form\/choices.min.js\" defer><\/script>\r\n                    <style>\r\n                        \/* Minimal reset and form base styles *\/\r\n                        *,\r\n                        ::before,\r\n                        ::after {\r\n                            box-sizing: border-box !important;\r\n                        }\r\n\r\n                        .choices__list--dropdown .choices__item:first-child,\r\n                        select option:first-child {\r\n                            display: none !important;\r\n                        }\r\n\r\n                        select {\r\n                            cursor: pointer;\r\n                        }\r\n\r\n                        .fusion-column-wrapper.fusion-column-has-shadow.fusion-flex-justify-content-flex-start.fusion-content-layout-column {\r\n                            width: 100%;\r\n                            margin: 0;\r\n                        }\r\n\r\n                        .fusion-layout-column.fusion_builder_column.fusion-builder-column-0 {\r\n                            margin-bottom: 0 !important;\r\n                        }\r\n\r\n                        .custom-modal {\r\n                            left: 0;\r\n                        }\r\n\r\n                        .choices[data-type*=select-one]::after {\r\n                            z-index: 2;\r\n                        }\r\n\r\n                        input,\r\n                        select,\r\n                        textarea {\r\n                            font-family: inherit !important;\r\n                            font-size: 100% !important;\r\n                            margin: 0 !important;\r\n                            line-height: inherit !important;\r\n                            color: inherit !important;\r\n                            border-radius: 0 !important;\r\n                        }\r\n\r\n                        \/* Base styles for form elements *\/\r\n                        .custom-form input[type=\"text\"],\r\n                        .custom-form input[type=\"email\"],\r\n                        .custom-form textarea,\r\n                        .custom-form select {\r\n                            -webkit-appearance: none !important;\r\n                            -moz-appearance: none !important;\r\n                            appearance: none !important;\r\n                            border-width: 1px !important;\r\n                            border-color: #ffaa00 !important;\r\n                            border-radius: 0.375rem !important;\r\n                            padding: 0.5rem 0.75rem !important;\r\n                            background-color: #fff !important;\r\n                            height: 50px;\r\n                        }\r\n\r\n                        .custom-form input[type=\"tel\"] {\r\n                            -webkit-appearance: none !important;\r\n                            -moz-appearance: none !important;\r\n                            appearance: none !important;\r\n                            border-width: 1px !important;\r\n                            border-color: #ffaa00 !important;\r\n                            border-radius: 0.375rem !important;\r\n                            \/* padding: 0.5rem 0.75rem !important; *\/\r\n                            background-color: #fff !important;\r\n                            height: 50px;\r\n                        }\r\n\r\n                        .custom-form input[type=\"checkbox\"] {\r\n                            \/* appearance: none !important; *\/\r\n                            padding: 0 !important;\r\n                            display: inline-block !important;\r\n                            vertical-align: middle !important;\r\n                            height: 1rem !important;\r\n                            width: 1rem !important;\r\n                            border-width: 1px !important;\r\n                            border-color: #ffaa00 !important;\r\n                            border-radius: 0.25rem !important;\r\n                        }\r\n\r\n                        .custom-form input[type=\"checkbox\"]:checked {\r\n                            background-color: #2563eb !important;\r\n                            border-color: #2563eb !important;\r\n                            background-image: url(\"data:image\/svg+xml,svg viewBox='0 0 16 16' fill='white' xmlns='http:\/\/www.w3.org\/2000\/svg'path d='M12.207 4.793a1 1 0 0 1 0 1.414l-5 5a1 1 0 0 1-1.414 0l-2-2a1 1 0 0 1 1.414-1.414L6.5 9.086l4.293-4.293a1 1 0 0 1 1.414 0z'\/\/svg\") !important;\r\n                            background-size: 100% 100% !important;\r\n                            background-position: center !important;\r\n                            background-repeat: no-repeat !important;\r\n                        }\r\n\r\n                        .custom-form select {\r\n                            background-image: url(\"data:image\/svg+xml,svg xmlns='http:\/\/www.w3.org\/2000\/svg' fill='none' viewBox='0 0 20 20'path stroke='6b7280' stroke-linecap='round' stroke-linejoin='round' stroke-width='1.5' d='M6 8l4 4 4-4'\/\/svg\") !important;\r\n                            background-position: right 0.5rem center !important;\r\n                            background-repeat: no-repeat !important;\r\n                            background-size: 1.5em 1.5em !important;\r\n                            padding-right: 2.5rem !important;\r\n                        }\r\n\r\n                        \/* Page Body *\/\r\n                        .form-page-body {\r\n                            \/* --tw-gradient-from: #fff !important;\r\n                            --tw-gradient-stops: var(--tw-gradient-from),\r\n                                var(--tw-gradient-to, rgba(255, 255, 255, 0)) !important;\r\n                            --tw-gradient-to: #faf2c6 !important;\r\n                            background-image: linear-gradient(to bottom,\r\n                                    var(--tw-gradient-stops)) !important; *\/\r\n                            display: flex !important;\r\n                            align-items: start !important;\r\n                            justify-content: center !important;\r\n                            \/* min-height: 100vh !important; *\/\r\n                            margin: 0 !important;\r\n                            padding: 1rem !important;\r\n                            padding-bottom: 5% !important;\r\n                            padding-top: 4% !important;\r\n                        }\r\n\r\n                        .fusion-layout-column.fusion_builder_column.fusion-builder-column-0.fusion_builder_column_1_1.\\31 _1.fusion-flex-column {\r\n                            margin-bottom: 0;\r\n                        }\r\n\r\n                        \/* Form Wrapper *\/\r\n                        .custom-form {\r\n                            width: 100% !important;\r\n                            margin-top: -10%;\r\n                        }\r\n\r\n                        .custom-modal-dialog,\r\n                        .custom-modal-2-dialog {\r\n                            max-width: 750px;\r\n                        }\r\n\r\n                        .custom-modal .custom-modal-body,\r\n                        .custom-modal-2 .custom-modal-body {\r\n                            padding: 0;\r\n                            \/* margin-top: 0; *\/\r\n                        }\r\n\r\n                        \/* Form Container *\/\r\n                        .custom-form .contact-form-content {\r\n                            \/* background-color: #fff !important; *\/\r\n                            border-width: 1px !important;\r\n                            \/* border: 1px solid #ffaa00 !important; *\/\r\n                            \/* box-shadow: 0 1px 6px 2px rgb(0 0 0 \/ 23%) !important; *\/\r\n                            border-radius: 0.375rem !important;\r\n                            padding: 2rem !important;\r\n                            width: 100% !important;\r\n                            max-width: 800px !important;\r\n                            margin: 0 auto !important;\r\n                        }\r\n\r\n                        .custom-form .contact-form-content>*:not([hidden])~*:not([hidden]) {\r\n                            margin-top: 1.25rem !important;\r\n                        }\r\n\r\n                        \/* Form Title *\/\r\n                        .custom-form .title {\r\n                            font-size: 2.5rem !important;\r\n                            line-height: 3rem !important;\r\n                            color: #000 !important;\r\n                            font-weight: 600 !important;\r\n                            text-align: center !important;\r\n                            margin-bottom: 2rem !important;\r\n                        }\r\n\r\n                        \/* Form Row Layouts *\/\r\n                        .custom-form .form-row {\r\n                            width: 100% !important;\r\n                        }\r\n\r\n                        .custom-form .grid-2 {\r\n                            display: grid !important;\r\n                            grid-template-columns: repeat(1, minmax(0, 1fr)) !important;\r\n                            gap: 1rem !important;\r\n                        }\r\n\r\n                        \/* === FLOATING LABEL STYLES START === *\/\r\n\r\n                        \/* 1. Set form field container to relative *\/\r\n                        .custom-form .form-field,\r\n                        .custom-form .form-row {\r\n                            position: relative !important;\r\n                        }\r\n\r\n                        \/* 2. Style the floating label *\/\r\n                        .custom-form .form-label {\r\n                            position: absolute !important;\r\n                            top: 50% !important;\r\n                            left: 0.75rem !important;\r\n                            transform: translateY(-50%) !important;\r\n                            font-size: 1rem !important;\r\n                            color: #000 !important;\r\n                            background-color: #fff !important;\r\n                            pointer-events: none !important;\r\n                            transition: all 0.2s ease !important;\r\n                            padding: 0 0.25rem !important;\r\n                            margin-bottom: 0 !important;\r\n                            display: block !important;\r\n                            width: 90%;\r\n                        }\r\n\r\n                        \/* 3. Adjust label for textareas *\/\r\n                        .custom-form .form-textarea+.form-label {\r\n                            top: 2.5rem !important;\r\n                            transform: translateY(-50%) !important;\r\n                        }\r\n\r\n                        \/* 4. \"Float\" animation for ALL fields\r\n .custom-form .form-input:focus+.form-label,\r\n .custom-form .form-input:not(:placeholder-shown)+.form-label,\r\n .custom-form .form-textarea:focus+.form-label,\r\n .custom-form .form-textarea:not(:placeholder-shown)+.form-label,\r\n .custom-form .form-select:focus+.form-label,\r\n .custom-form .form-select:valid+.form-label,\r\n .custom-form .form-input.has-value+.form-label,\r\n .custom-form .form-textarea.has-value+.form-label,\r\n\r\n .custom-form .iti:has(.form-input:focus)+.form-label,\r\n .custom-form .iti:has(.form-input:not(:placeholder-shown))+.form-label,\r\n .custom-form .iti:has(.form-input.has-value)+.form-label {\r\n top: 0 !important;\r\n left: 0.5rem !important;\r\n font-size: 0.75rem !important;\r\n color: #6b7280 !important;\r\n transform: translateY(-50%) !important;\r\n display: none !important;\r\n } *\/\r\n\r\n                        \/* This is the NEW rule - use this one *\/\r\n                        .custom-form .form-input:focus+.form-label,\r\n                        .custom-form .form-textarea:focus+.form-label,\r\n                        .custom-form .iti:has(.form-input:focus)+.form-label,\r\n                        .custom-form .form-input:not(:placeholder-shown)+.form-label,\r\n                        .custom-form .form-textarea:not(:placeholder-shown)+.form-label,\r\n                        .custom-form .form-select:valid+.form-label,\r\n                        .custom-form .choices:has(.form-select:valid)+.form-label,\r\n                        .custom-form .form-input.has-value+.form-label,\r\n                        .custom-form .form-textarea.has-value+.form-label,\r\n                        .custom-form .iti:has(.form-input:not(:placeholder-shown))+.form-label,\r\n                        .custom-form .iti:has(.form-input.has-value)+.form-label {\r\n                            display: none !important;\r\n                        }\r\n\r\n                        \/* === FLOATING LABEL STYLES END === *\/\r\n\r\n                        .custom-form .required-asterisk {\r\n                            color: #ef4444 !important;\r\n                        }\r\n\r\n                        .custom-form .form-input:not(#init_phone),\r\n                        .custom-form .form-select,\r\n                        .custom-form .form-textarea {\r\n                            width: 100% !important;\r\n                            border-color: #ffaa00 !important;\r\n                            padding: 0.5rem 0.75rem !important;\r\n                            outline: 2px solid transparent !important;\r\n                            outline-offset: 2px !important;\r\n                        }\r\n\r\n                        .custom-form .form-textarea {\r\n                            padding-top: 1rem !important;\r\n                            padding-bottom: 1rem !important;\r\n                            height: auto !important;\r\n                        }\r\n\r\n                        .custom-form .form-input:focus,\r\n                        .custom-form .form-select:focus,\r\n                        .custom-form .form-textarea:focus {\r\n                            --tw-ring-color: #fde047 !important;\r\n                            --tw-ring-offset-shadow: var(--tw-ring-inset) 0 0 0 var(--tw-ring-offset-width) var(--tw-ring-offset-color) !important;\r\n                            --tw-ring-shadow: var(--tw-ring-inset) 0 0 0 calc(2px + var(--tw-ring-offset-width)) var(--tw-ring-color) !important;\r\n                            box-shadow: var(--tw-ring-offset-shadow), var(--tw-ring-shadow),\r\n                                var(--tw-shadow, 0 0 #0000) !important;\r\n                        }\r\n\r\n                        .custom-form .form-select {\r\n                            background-color: #fff !important;\r\n                        }\r\n\r\n                        \/* Privacy Row *\/\r\n                        .custom-form .privacy-row {\r\n                            display: flex;\r\n                            align-items: center !important;\r\n                            justify-content: center !important;\r\n                            margin: 0 auto !important;\r\n                            position: static !important;\r\n                            margin-top: 1.25rem !important;\r\n                        }\r\n\r\n                        .custom-form .privacy-row>*:not([hidden])~*:not([hidden]) {\r\n                            margin-left: 0.5rem !important;\r\n                        }\r\n\r\n                        .form-row.privacy-row {\r\n                            display: flex;\r\n                            flex-flow: row wrap;\r\n                            align-items: center;\r\n                            align-items: center;\r\n                            margin: 0 auto !important;\r\n                            width: 100% !important;\r\n                        }\r\n\r\n                        .custom-form .form-checkbox {\r\n                            margin-top: 0.25rem !important;\r\n                            border-color: #ffaa00 !important;\r\n                        }\r\n\r\n                        .custom-form .privacy-label,\r\n                        .custom-form .privacy-label a,\r\n                        .trouble-login-info p,\r\n                        .trouble-login-info a {\r\n                            font-size: 1rem !important;\r\n                            line-height: 1.9rem !important;\r\n                            position: static !important;\r\n                            transform: none !important;\r\n                            color: inherit !important;\r\n                            background-color: transparent !important;\r\n                            padding: 0 !important;\r\n                        }\r\n\r\n                        .custom-form .privacy-label a,\r\n                        .trouble-login-info a {\r\n                            font-weight: 600 !important;\r\n                            color: #0c4c7c !important;\r\n                            text-decoration-line: none !important;\r\n                        }\r\n\r\n                        .custom-form .privacy-link {\r\n                            \/* color: #0c4c7c !important; *\/\r\n                            \/* text-decoration-line: underline !important; *\/\r\n                        }\r\n\r\n                        .custom-form .privacy-link:hover,\r\n                        .trouble-login-info a:hover {\r\n                            text-decoration-line: underline !important;\r\n                            color: #0c4c7c !important;\r\n                        }\r\n\r\n                        \/* Submit Button *\/\r\n                        .custom-form .submit-row {\r\n                            text-align: center !important;\r\n                            position: static !important;\r\n                        }\r\n\r\n                        .custom-form .submit-button {\r\n                            display: flex;\r\n                            margin: 0 auto !important;\r\n                            background-color: #cfe99a !important;\r\n                            color: #0c4c7c !important;\r\n                            font-weight: 700 !important;\r\n                            padding-top: 0.5rem !important;\r\n                            padding-bottom: 0.5rem !important;\r\n                            padding-left: 1.5rem !important;\r\n                            padding-right: 1.5rem !important;\r\n                            border-radius: 0.375rem !important;\r\n                            transition-property: color, background-color, border-color,\r\n                                text-decoration-color, fill, stroke !important;\r\n                            transition-timing-function: cubic-bezier(0.4, 0, 0.2, 1) !important;\r\n                            transition-duration: 150ms !important;\r\n                            border: none !important;\r\n                            cursor: pointer !important;\r\n                            outline: none !important;\r\n                        }\r\n\r\n                        .custom-form .submit-button:hover {\r\n                            background-color: #cfe99b !important;\r\n                        }\r\n\r\n                        .iti {\r\n                            width: 100% !important;\r\n                        }\r\n\r\n                        .choices {\r\n                            margin-bottom: 0 !important;\r\n                        }\r\n\r\n                        \/* This styles the 'closed' box to match your other inputs *\/\r\n                        .choices[data-type*=\"select-one\"] .choices__inner {\r\n                            border-width: 1px !important;\r\n                            border-color: #ffaa00 !important;\r\n                            border-radius: 0.375rem !important;\r\n                            padding: 0.5rem 0.75rem !important;\r\n                            background-color: #fff !important;\r\n                            height: 50px;\r\n                            font-size: 1rem;\r\n                            display: flex;\r\n                            align-items: center;\r\n                        }\r\n\r\n                        \/* This styles the 'open' dropdown list *\/\r\n                        .choices__list--dropdown {\r\n                            border-color: #ffaa00 !important;\r\n                            border-radius: 0.375rem !important;\r\n                        }\r\n\r\n                        \/* This styles a single option in the list *\/\r\n                        .choices__item--choice {\r\n                            font-size: 1rem;\r\n                            padding: 0.5rem 1rem;\r\n                            background-color: #fff;\r\n                            \/* Default background *\/\r\n                            color: #333;\r\n                            \/* Default text color *\/\r\n                        }\r\n\r\n                        \/* * HERE IS YOUR HOVER STYLE! \r\n * This styles the 'highlighted' (hovered) option \r\n *\/\r\n                        .choices__list--dropdown .choices__item--choice.is-highlighted {\r\n                            background-color: #fff8cb !important;\r\n                            \/* Your submit button color *\/\r\n                            color: #0c4c7c !important;\r\n                            \/* Your submit button text color *\/\r\n                        }\r\n\r\n                        \/* START: MODIFIED - Hide conditional rows by default *\/\r\n                        #county_row,\r\n                        #trouble-login-info,\r\n                        #message-row,\r\n                        #how-many-individuals-row {\r\n                            display: none;\r\n                        }\r\n\r\n                        #trouble-login-info {\r\n                            text-align: center;\r\n                        }\r\n\r\n                        #zip_row {\r\n                            display: none;\r\n                        }\r\n\r\n                        \/* END: MODIFIED *\/\r\n\r\n                        input#init_phone {\r\n                            \/* Adjust padding for the floating label *\/\r\n                            \/* padding-left: 52px !important; *\/\r\n                            \/* Default was 52px, but floating label needs more *\/\r\n                        }\r\n\r\n                        \/* Adjust label position for intl-tel-input *\/\r\n                        .custom-form .iti+.form-label {\r\n                            left: 75px !important;\r\n                            width: 50%;\r\n                            \/* Match the start of the number input *\/\r\n                            \/* The 'top' and 'transform' are handled by the base .form-label rule *\/\r\n                        }\r\n\r\n                        #submit-case,\r\n                        #submit-lead {\r\n                            display: none !important;\r\n                        }\r\n\r\n                        \/* START: ADDED - Notification styles *\/\r\n                        #custom-notification {\r\n                            display: none;\r\n                            position: fixed;\r\n                            top: 20px;\r\n                            left: 50%;\r\n                            transform: translateX(-50%);\r\n                            background-color: #fff;\r\n                            border: 1px solid #ffaa00;\r\n                            border-left-width: 5px;\r\n                            padding: 1rem 1.5rem;\r\n                            border-radius: 0.375rem;\r\n                            box-shadow: 0 4px 12px rgba(0, 0, 0, 0.15);\r\n                            z-index: 9999;\r\n                            font-family: inherit;\r\n                            font-size: 1rem;\r\n                            color: #333;\r\n                            max-width: 90%;\r\n                            text-align: center;\r\n                        }\r\n\r\n                        #custom-notification-message {\r\n                            margin: 0;\r\n                        }\r\n\r\n                        \/* END: ADDED *\/\r\n                        .fusion-fullwidth.fullwidth-box.fusion-builder-row-1.fusion-flex-container.has-pattern-background.has-mask-background.hundred-percent-fullwidth.non-hundred-percent-height-scrolling {\r\n                            padding-left: 0;\r\n                            padding-right: 0;\r\n                        }\r\n\r\n                        .fusion-builder-row.fusion-row.fusion-flex-align-items-flex-start.fusion-flex-content-wrap {\r\n                            margin-left: 0;\r\n                            margin-right: 0;\r\n                        }\r\n\r\n                        .error-message {\r\n                            display: none;\r\n                            \/* Hide by default *\/\r\n                            width: 100%;\r\n                            margin-top: 0.25rem;\r\n                            \/* 4px *\/\r\n                            font-size: 0.875rem;\r\n                            \/* 14px *\/\r\n                            line-height: 1.25rem;\r\n                            \/* 20px *\/\r\n                            color: #ef4444;\r\n                            \/* Red color *\/\r\n                            text-align: left;\r\n                        }\r\n\r\n                        \/* Adjust for selects in a form-field *\/\r\n                        .form-field .error-message {\r\n                            padding-left: 0.25rem;\r\n                        }\r\n\r\n                        \/* Adjust for rows that are not form-fields *\/\r\n                        .form-row.how-many-individuals-row .error-message,\r\n                        .form-row.message-row .error-message {\r\n                            padding-left: 0.75rem;\r\n                        }\r\n\r\n                        \/* Make privacy error centered *\/\r\n                        .privacy-row {\r\n                            flex-wrap: wrap;\r\n                            \/* Allow wrapping *\/\r\n                            justify-content: center;\r\n                            \/* Center checkbox\/label *\/\r\n                        }\r\n\r\n                        .privacy-row .error-message {\r\n                            width: 100%;\r\n                            text-align: center;\r\n                            margin-top: 0.5rem;\r\n                        }\r\n\r\n                        .form-row.has-error .form-label {\r\n                            top: 35% !important;\r\n                        }\r\n\r\n                        \/* For the phone input *\/\r\n                        .form-row.has-error .iti+.form-label {\r\n                            top: 35% !important;\r\n                        }\r\n\r\n                        \/* For the textarea (which is in a .form-row) *\/\r\n                        .form-row.has-error .form-textarea+.form-label {\r\n                            top: 2.75rem !important;\r\n                            \/* Adjust as needed, 35% won't look right here *\/\r\n                        }\r\n\r\n                        span#error-recaptcha {\r\n                            text-align: center;\r\n                        }\r\n\r\n                        @media (max-width: 1100px) {\r\n                            .form-page-body {\r\n                                align-items: start !important;\r\n                            }\r\n                        }\r\n\r\n                        @media (max-width: 900px) {\r\n                            .custom-form .contact-form-content {\r\n                                max-width: 600px !important;\r\n                            }\r\n                        }\r\n\r\n                        \/* Responsive *\/\r\n                        @media (min-width: 768px) {\r\n                            .custom-form .grid-2 {\r\n                                grid-template-columns: repeat(2, minmax(0, 1fr)) !important;\r\n                            }\r\n                        }\r\n\r\n                        @media (max-width: 600px) {\r\n                            .custom-modal {\r\n                                padding-left: 1%;\r\n                                padding-right: 1%;\r\n                            }\r\n\r\n                            .custom-form .title {\r\n                                font-size: 2rem !important;\r\n                            }\r\n\r\n                            .custom-form .form-textarea+.form-label {\r\n                                top: 3.5rem !important;\r\n                                transform: translateY(-50%) !important;\r\n                                width: 90%;\r\n                            }\r\n\r\n                            .form-row.privacy-row {\r\n                                flex-flow: row;\r\n                                justify-content: start !important;\r\n                                align-items: start !important;\r\n                            }\r\n\r\n                            .form-row.how-many-individuals-row .choices[data-type*=\"select-one\"] .choices__inner {\r\n                                height: 100px;\r\n                            }\r\n\r\n                            .form-row.how-many-individuals-row label.form-label {\r\n                                width: 90%;\r\n                            }\r\n\r\n                            .custom-form .privacy-label,\r\n                            .custom-form .privacy-label a,\r\n                            .trouble-login-info p,\r\n                            .trouble-login-info a {\r\n                                font-size: 1rem !important;\r\n                                line-height: 1.5rem !important;\r\n                            }\r\n\r\n                            .custom-form .privacy-row>*:not([hidden])~*:not([hidden]) {\r\n                                margin-top: -2px;\r\n                            }\r\n\r\n                            .form-row.has-error .iti+.form-label {\r\n                                top: 50% !important;\r\n                            }\r\n                        }\r\n                    <\/style>\r\n                    <div class=\"form-page-body\">\r\n\r\n                        <!-- START: ADDED Notification Modal -->\r\n                        <div id=\"custom-notification\">\r\n                            <p id=\"custom-notification-message\"><\/p>\r\n                        <\/div>\r\n                        <!-- END: ADDED Notification Modal -->\r\n\r\n                        <div class=\"custom-form\">\r\n                            <!-- START: MODIFIED - Changed form back to div -->\r\n                            <div id=\"contactForm\" class=\"contact-form-content\">\r\n                                <!-- END: MODIFIED -->\r\n                                <h2 class=\"title\">Contact our team<\/h2>\r\n\r\n                                <div class=\"form-row grid-2\">\r\n                                    <div class=\"form-field\">\r\n                                        <input type=\"text\" id=\"init_firstName\" name=\"firstName\" required\r\n                                            class=\"form-input\">\r\n                                        <label for=\"init_firstName\" class=\"form-label\">First Name <span\r\n                                                class=\"required-asterisk\">*<\/span><\/label>\r\n                                        <span class=\"error-message\" id=\"error-firstName\"><\/span>\r\n                                    <\/div>\r\n                                    <div class=\"form-field\">\r\n                                        <input type=\"text\" id=\"init_lastName\" name=\"lastName\" required\r\n                                            class=\"form-input\">\r\n                                        <label for=\"init_lastName\" class=\"form-label\">Last Name <span\r\n                                                class=\"required-asterisk\">*<\/span><\/label>\r\n                                        <span class=\"error-message\" id=\"error-lastName\"><\/span>\r\n                                    <\/div>\r\n                                <\/div>\r\n\r\n                                <div class=\"form-row grid-2\">\r\n                                    <div class=\"form-field\">\r\n                                        <input type=\"email\" id=\"init_email\" name=\"email\" required class=\"form-input\">\r\n                                        <label for=\"init_email\" class=\"form-label\">Work Email <span\r\n                                                class=\"required-asterisk\">*<\/span><\/label>\r\n                                        <span class=\"error-message\" id=\"error-email\"><\/span>\r\n                                    <\/div>\r\n\r\n                                    <div class=\"form-field\">\r\n                                        <input id=\"init_phone\" name=\"phone\" type=\"tel\" class=\"form-input\">\r\n                                        <label for=\"init_phone\" class=\"form-label\">Phone Number<\/label>\r\n                                        <span class=\"error-message\" id=\"error-phone\"><\/span>\r\n                                    <\/div>\r\n                                <\/div>\r\n\r\n                                <div class=\"form-row grid-2\">\r\n                                    <div class=\"form-field\">\r\n                                        <input type=\"text\" id=\"init_company\" name=\"company\" required class=\"form-input\">\r\n                                        <label for=\"init_company\" class=\"form-label\">Company Name <span\r\n                                                class=\"required-asterisk\">*<\/span><\/label>\r\n                                        <span class=\"error-message\" id=\"error-company\"><\/span>\r\n                                    <\/div>\r\n                                    <div class=\"form-field\">\r\n                                        <input type=\"text\" id=\"init_jobTitle\" name=\"jobTitle\" required\r\n                                            class=\"form-input\">\r\n                                        <label for=\"init_jobTitle\" class=\"form-label\">Job Title <span\r\n                                                class=\"required-asterisk\">*<\/span><\/label>\r\n                                        <span class=\"error-message\" id=\"error-jobTitle\"><\/span>\r\n                                    <\/div>\r\n                                <\/div>\r\n\r\n                                <div class=\"form-row grid-2\">\r\n                                    <div class=\"form-field\">\r\n                                        <select id=\"init_therapUser\" name=\"init_therapUser\" required class=\"form-select\"\r\n                                            autocomplete=\"off\">\r\n                                            <option value=\"\" style=\"display: none;\"><\/option>\r\n                                            <option>Current Therap User<\/option>\r\n                                            <option>Potential Therap User<\/option>\r\n                                        <\/select>\r\n                                        <label for=\"init_therapUser\" class=\"form-label\">Are you a Current Therap User?\r\n                                            <span class=\"required-asterisk\">*<\/span><\/label>\r\n                                        <span class=\"error-message\" id=\"error-therapUser\"><\/span>\r\n                                    <\/div>\r\n                                    <div class=\"form-field\">\r\n                                        <select id=\"init_state\" name=\"init_state\" required class=\"form-select\"\r\n                                            autocomplete=\"off\">\r\n                                            <option value=\"\" style=\"display: none;\"><\/option>\r\n                                            <option value=\"AL\">Alabama<\/option>\r\n                                            <option value=\"AK\">Alaska<\/option>\r\n                                            <option value=\"AZ\">Arizona<\/option>\r\n                                            <option value=\"AR\">Arkansas<\/option>\r\n                                            <option value=\"CA\">California<\/option>\r\n                                            <option value=\"CO\">Colorado<\/option>\r\n                                            <option value=\"CT\">Connecticut<\/option>\r\n                                            <option value=\"DE\">Delaware<\/option>\r\n                                            <option value=\"DC\">District Of Columbia<\/option>\r\n                                            <option value=\"FL\">Florida<\/option>\r\n                                            <option value=\"GA\">Georgia<\/option>\r\n                                            <option value=\"HI\">Hawaii<\/option>\r\n                                            <option value=\"ID\">Idaho<\/option>\r\n                                            <option value=\"IL\">Illinois<\/option>\r\n                                            <option value=\"IN\">Indiana<\/option>\r\n                                            <option value=\"IA\">Iowa<\/option>\r\n                                            <option value=\"KS\">Kansas<\/option>\r\n                                            <option value=\"KY\">Kentucky<\/option>\r\n                                            <option value=\"LA\">Louisiana<\/option>\r\n                                            <option value=\"ME\">Maine<\/option>\r\n                                            <option value=\"MD\">Maryland<\/option>\r\n                                            <option value=\"MA\">Massachusetts<\/option>\r\n                                            <option value=\"MI\">Michigan<\/option>\r\n                                            <option value=\"MN\">Minnesota<\/option>\r\n                                            <option value=\"MS\">Mississippi<\/option>\r\n                                            <option value=\"MO\">Missouri<\/option>\r\n                                            <option value=\"MT\">Montana<\/option>\r\n                                            <option value=\"NE\">Nebraska<\/option>\r\n                                            <option value=\"NV\">Nevada<\/option>\r\n                                            <option value=\"NH\">New Hampshire<\/option>\r\n                                            <option value=\"NJ\">New Jersey<\/option>\r\n                                            <option value=\"NM\">New Mexico<\/option>\r\n                                            <option value=\"NY\">New York<\/option>\r\n                                            <option value=\"NC\">North Carolina<\/option>\r\n                                            <option value=\"ND\">North Dakota<\/option>\r\n                                            <option value=\"OH\">Ohio<\/option>\r\n                                            <option value=\"OK\">Oklahoma<\/option>\r\n                                            <option value=\"OR\">Oregon<\/option>\r\n                                            <option value=\"PA\">Pennsylvania<\/option>\r\n                                            <option value=\"RI\">Rhode Island<\/option>\r\n                                            <option value=\"SC\">South Carolina<\/option>\r\n                                            <option value=\"SD\">South Dakota<\/option>\r\n                                            <option value=\"TN\">Tennessee<\/option>\r\n                                            <option value=\"TX\">Texas<\/option>\r\n                                            <option value=\"UT\">Utah<\/option>\r\n                                            <option value=\"VT\">Vermont<\/option>\r\n                                            <option value=\"VA\">Virginia<\/option>\r\n                                            <option value=\"WA\">Washington<\/option>\r\n                                            <option value=\"WV\">West Virginia<\/option>\r\n                                            <option value=\"WI\">Wisconsin<\/option>\r\n                                            <option value=\"WY\">Wyoming<\/option>\r\n                                            <option value=\"Guam\">Guam<\/option>\r\n                                            <option value=\"PR\">Puerto Rico<\/option>\r\n                                            <option value=\"other\">Other (non-US)<\/option>\r\n                                        <\/select>\r\n                                        <label for=\"init_state\" class=\"form-label\">State\/Territory <span\r\n                                                class=\"required-asterisk\">*<\/span><\/label>\r\n                                        <span class=\"error-message\" id=\"error-state\"><\/span>\r\n                                    <\/div>\r\n                                <\/div>\r\n\r\n                                <div class=\"form-row how-can-we-assist-you-row\" id=\"how-can-we-assist-you-row\"\r\n                                    style=\"display: none;\">\r\n                                    <select id=\"init_assistance\" name=\"init_assistance\" required class=\"form-select\"\r\n                                        autocomplete=\"off\">\r\n                                        <option value=\"\" style=\"display: none;\"><\/option>\r\n                                        <option value=\"Having issues logging into my Therap account\">Having issues\r\n                                            logging into my Therap\r\n                                            account<\/option>\r\n                                        <option value=\"Other\">Other<\/option>\r\n                                    <\/select>\r\n                                    <label for=\"init_assistance\" class=\"form-label\">How can we assist you? <span\r\n                                            class=\"required-asterisk\">*<\/span><\/label>\r\n                                    <span class=\"error-message\" id=\"error-assistance\"><\/span>\r\n                                <\/div>\r\n\r\n                                <div class=\"form-row how-many-individuals-row\" id=\"how-many-individuals-row\">\r\n                                    <select id=\"init_individuals\" name=\"init_individuals\" required class=\"form-select\"\r\n                                        autocomplete=\"off\">\r\n                                        <option value=\"\" style=\"display: none;\"><\/option>\r\n                                        <option>1-10<\/option>\r\n                                        <option>11-50<\/option>\r\n                                        <option>51-200<\/option>\r\n                                        <option>201-1000<\/option>\r\n                                        <option>1001+<\/option>\r\n                                    <\/select>\r\n                                    <label for=\"init_individuals\" class=\"form-label\">How many Individuals does your\r\n                                        agency support? <span class=\"required-asterisk\">*<\/span><\/label>\r\n                                    <span class=\"error-message\" id=\"error-individuals\"><\/span>\r\n                                <\/div>\r\n\r\n                                <!-- county dropdown -->\r\n                                <!-- START: MODIFIED - Removed 'required' from select, will be added by JS -->\r\n                                <div class=\"form-row\" id=\"county_row\">\r\n                                    <div class=\"form-field\">\r\n                                        <select id=\"init_county\" name=\"init_county\" class=\"form-select\"\r\n                                            autocomplete=\"off\">\r\n                                            <!-- END: MODIFIED -->\r\n                                            <option value=\"\" style=\"display: none;\"><\/option>\r\n                                            <option value=\"Alameda\">Alameda<\/option>\r\n                                            <option value=\"Alpine\">Alpine<\/option>\r\n                                            <option value=\"Amador\">Amador<\/option>\r\n                                            <option value=\"Butte\">Butte<\/option>\r\n                                            <option value=\"Calaveras\">Calaveras<\/option>\r\n                                            <option value=\"Colusa\">Colusa<\/option>\r\n                                            <option value=\"Contra Costa\">Contra Costa<\/option>\r\n                                            <option value=\"Del Norte\">Del Norte<\/option>\r\n                                            <option value=\"El Dorado\">El Dorado<\/option>\r\n                                            <option value=\"Fresno\">Fresno<\/option>\r\n                                            <option value=\"Glenn\">Glenn<\/option>\r\n                                            <option value=\"Humboldt\">Humboldt<\/option>\r\n                                            <option value=\"Imperial\">Imperial<\/option>\r\n                                            <option value=\"Inyo\">Inyo<\/option>\r\n                                            <option value=\"Kern\">Kern<\/option>\r\n                                            <option value=\"Kings\">Kings<\/option>\r\n                                            <option value=\"Lake\">Lake<\/option>\r\n                                            <option value=\"Lassen\">Lassen<\/option>\r\n                                            <option value=\"Los Angeles\">Los Angeles<\/option>\r\n                                            <option value=\"Madera\">Madera<\/option>\r\n                                            <option value=\"Marin\">Marin<\/option>\r\n                                            <option value=\"Mariposa\">Mariposa<\/option>\r\n                                            <option value=\"Mendocino\">Mendocino<\/option>\r\n                                            <option value=\"Merced\">Merced<\/option>\r\n                                            <option value=\"Modoc\">Modoc<\/option>\r\n                                            <option value=\"Mono\">Mono<\/option>\r\n                                            <option value=\"Monterey\">Monterey<\/option>\r\n                                            <option value=\"Napa\">Napa<\/option>\r\n                                            <option value=\"Nevada\">Nevada<\/option>\r\n                                            <option value=\"Orange\">Orange<\/option>\r\n                                            <option value=\"Placer\">Placer<\/option>\r\n                                            <option value=\"Plumas\">Plumas<\/option>\r\n                                            <option value=\"Riverside\">Riverside<\/option>\r\n                                            <option value=\"Sacramento\">Sacramento<\/option>\r\n                                            <option value=\"San Benito\">San Benito<\/option>\r\n                                            <option value=\"San Bernardino\">San Bernardino<\/option>\r\n                                            <option value=\"San Diego\">San Diego<\/option>\r\n                                            <option value=\"San Francisco\">San Francisco<\/option>\r\n                                            <option value=\"San Joaquin\">San Joaquin<\/option>\r\n                                            <option value=\"San Luis Obispo\">San Luis Obispo<\/option>\r\n                                            <option value=\"San Mateo\">San Mateo<\/option>\r\n                                            <option value=\"Santa Barbara\">Santa Barbara<\/option>\r\n                                            <option value=\"Santa Clara\">Santa Clara<\/option>\r\n                                            <option value=\"Santa Cruz\">Santa Cruz<\/option>\r\n                                            <option value=\"Shasta\">Shasta<\/option>\r\n                                            <option value=\"Sierra\">Sierra<\/option>\r\n                                            <option value=\"Siskiyou\">Siskiyou<\/option>\r\n                                            <option value=\"Solano\">Solano<\/option>\r\n                                            <option value=\"Sonoma\">Sonoma<\/option>\r\n                                            <option value=\"Stanislaus\">Stanislaus<\/option>\r\n                                            <option value=\"Sutter\">Sutter<\/option>\r\n                                            <option value=\"Tehama\">Tehama<\/option>\r\n                                            <option value=\"Trinity\">Trinity<\/option>\r\n                                            <option value=\"Tulare\">Tulare<\/option>\r\n                                            <option value=\"Tuolumne\">Tuolumne<\/option>\r\n                                            <option value=\"Ventura\">Ventura<\/option>\r\n                                            <option value=\"Yolo\">Yolo<\/option>\r\n                                            <option value=\"Yuba\">Yuba<\/option>\r\n                                        <\/select>\r\n                                        <label for=\"init_county\" class=\"form-label\">County <span\r\n                                                class=\"required-asterisk\">*<\/span><\/label>\r\n                                        <span class=\"error-message\" id=\"error-county\"><\/span>\r\n                                    <\/div>\r\n                                <\/div>\r\n\r\n                                <!-- START: ADDED ZIP ROW -->\r\n                                <div class=\"form-row\" id=\"zip_row\" style=\"display: none;\">\r\n                                    <div class=\"form-field\">\r\n                                        <input type=\"text\" id=\"init_zip\" name=\"init_zip\" class=\"form-input\">\r\n                                        <label for=\"init_zip\" class=\"form-label\">Zip Code <span\r\n                                                class=\"required-asterisk\">*<\/span><\/label>\r\n                                        <span class=\"error-message\" id=\"error-zip\"><\/span>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <!-- END: ADDED ZIP ROW -->\r\n                                <div class=\"form-row trouble-login-info\" id=\"trouble-login-info\" style=\"display: none;\">\r\n                                    <p>If you are having issues logging in to your Therap account,<br>please view the <a\r\n                                            href=\"https:\/\/help.therapservices.net\/s\/article\/2035\"\r\n                                            target=\"_blank\">Login&nbsp;Troubleshooting&nbsp;Guide<\/a>.<\/p>\r\n                                <\/div>\r\n\r\n                                <div class=\"form-row message-row\" id=\"message-row\">\r\n                                    <!-- START: MODIFIED - Added asterisk span, removed 'required' from textarea -->\r\n                                    <textarea id=\"init_message\" name=\"init_message\" rows=\"3\"\r\n                                        class=\"form-textarea\"><\/textarea>\r\n                                    <label for=\"init_message\" class=\"form-label\">Please let us know how we can assist\r\n                                        you.<span id=\"message-required-asterisk\" class=\"required-asterisk\"\r\n                                            style=\"display: none;\">*<\/span><\/label>\r\n                                    <span class=\"error-message\" id=\"error-message\"><\/span>\r\n                                    <!-- END: MODIFIED -->\r\n                                <\/div>\r\n\r\n                                <div class=\"form-row privacy-row\" id=\"privacy-row\">\r\n                                    <input type=\"checkbox\" id=\"privacy\" required class=\"form-checkbox\" value=\"checked\">\r\n                                    <label for=\"privacy\" class=\"privacy-label\">\r\n                                        <span class=\"required-asterisk\">*<\/span> I have read and acknowledged Therap's\r\n                                        <a href=\"https:\/\/www.therapservices.net\/privacy-policy\/\" class=\"privacy-link\"\r\n                                            target=\"_blank\">Privacy Policy<\/a>.\r\n                                    <\/label>\r\n                                    <span class=\"error-message\" id=\"error-privacy\"><\/span>\r\n                                <\/div>\r\n\r\n                                <div class=\"hidden_form\">\r\n                                    <form id=\"first-form-web-to-case\"\r\n                                        action=\"https:\/\/webto.salesforce.com\/servlet\/servlet.WebToCase?encoding=UTF-8\"\r\n                                        method=\"POST\" onsubmit=\"return validateForm2()\">\r\n\r\n                                        <input type=hidden name='captcha_settings' id=\"captcha_web_to_case\"\r\n                                            value='{\"keyname\":\"TherapReCaptchaNM\",\"fallback\":\"true\",\"orgId\":\"00Di0000000GyrQ\",\"ts\":\"\"}'>\r\n\r\n                                        <input type=hidden name=\"orgid\" value=\"00Di0000000GyrQ\">\r\n                                        <input type=hidden name=\"retURL\"\r\n                                            value=\"https:\/\/www.therapservices.net\/thankyou\/landing-page-thank-you.php\">\r\n\r\n                                        <input id=\"00N0H00000JoJtu\" maxlength=\"255\" name=\"00N0H00000JoJtu\" size=\"20\"\r\n                                            type=\"hidden\" value=\"Contact Us - Request Form\" \/>\r\n                                        <input id=\"subject\" maxlength=\"80\" name=\"subject\" size=\"20\" type=\"hidden\"\r\n                                            value=\"Contact Us - Request Form\" \/>\r\n\r\n                                        <input id=\"00N0H00000JoJtw\" maxlength=\"255\" name=\"00N0H00000JoJtw\" size=\"20\"\r\n                                            value=\"ND\" type=\"hidden\" \/>\r\n\r\n                                        <label for=\"wc-name\" style=\"display: none;\">Name<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"wc-name\" maxlength=\"80\" name=\"name\" size=\"20\" type=\"hidden\" \/>\r\n\r\n                                        <input type=\"hidden\" name=\"description\" value='Job Title' \/>\r\n                                        <label for=\"wc-title\" style=\"display: none;\">Job Title<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"wc-title\" maxlength=\"100\" name=\"description\" size=\"20\"\r\n                                            type=\"hidden\" \/>\r\n\r\n                                        <label for=\"wc-company\" style=\"display: none;\">Company<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"wc-company\" maxlength=\"80\" name=\"company\" size=\"20\" type=\"hidden\" \/>\r\n\r\n                                        <label for=\"wc-email\" style=\"display: none;\">Email<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"wc-email\" maxlength=\"255\" name=\"email\" size=\"20\" type=\"hidden\" \/>\r\n\r\n                                        <label for=\"phone\" style=\"display: none;\">Phone<\/label>\r\n                                        <input id=\"phone\" maxlength=\"255\" name=\"phone\" size=\"20\" type=\"hidden\"\r\n                                            placeholder=\"For example: xxxxxxxxxx or xxx-xxx-xxxx\" \/>\r\n\r\n                                        <input type=\"hidden\" name=\"description\" value=\"You are a:\" \/>\r\n                                        <!-- START: ADDED for showOptNew1 logic -->\r\n                                        <span id=\"rn1_set\" style=\"display:none;\"><\/span>\r\n                                        <!-- END: ADDED -->\r\n                                        <div id=\"how-can-assist-you\" style=\"display: none;\">\r\n\r\n                                        <\/div>\r\n                                        <input type=\"hidden\" name=\"description\"\r\n                                            value='Let us know how we can assist you. Please do NOT include any PHI data on this form.:' \/>\r\n                                        <label for=\"indicate\" style=\"display: none;\">Let us know how we can assist you.\r\n                                            Please do NOT\r\n                                            include any PHI data on this form..<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"indicate\" maxlength=\"100\" name=\"description\" size=\"20\"\r\n                                            type=\"hidden\" \/>\r\n                                        <!-- START: Removed 'required' -->\r\n\r\n                                        <!-- <input type=\"hidden\" name=\"hidden\" value=\"Description:\" style=\"display: none;\" \/> -->\r\n                                        <!-- <label for=\"comments\" style=\"display: none;\">Description<\/label> -->\r\n                                        <input id=\"comments\" name=\"description\" style=\"width:100%\" rows=\"10\" cols=\"50\"\r\n                                            type=\"hidden\"><\/input>\r\n\r\n                                        <input type=\"hidden\" name=\"description\"\r\n                                            value=\" I have read and acknowledged Therap's Privacy Policy.\" \/>\r\n                                        <label for=\"wc-privacy\" style=\"display: none;\">I have read and acknowledged\r\n                                            Therap's Privacy\r\n                                            Policy.<span class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"wc-privacy\" name=\"description\" size=\"20\" type=\"hidden\" \/>\r\n\r\n                                        <input type=\"hidden\" id=\"external\" name=\"external\" value=\"1\" \/>\r\n\r\n                                        <!-- START: ADDED hidden input for reCAPTCHA token -->\r\n                                        <input type=\"hidden\" id=\"case-recaptcha-response\" name=\"g-recaptcha-response\"\r\n                                            value=\"\">\r\n                                        <!-- END: ADDED hidden input -->\r\n\r\n                                        <label for=\"g-recaptcha-response\" title=\"\" style=\"display:none\">label<\/label>\r\n                                        <!-- REMOVED: Old reCAPTCHA div\r\n                    <div id=\"g-recaptcha-1\" class=\"g-recaptcha\" data-sitekey=\"6LcS0L8bAAAAAAYp12xb0iAv0o2OHrMqx-vhd-Rj\"><\/div>\r\n                    -->\r\n\r\n                                        <input id=\"submit-case\" type=\"submit\" class=\"submit-btn submit-button\"\r\n                                            value=\"Submit\" name=\"submitButtonCase\">\r\n\r\n                                    <\/form>\r\n                                    <form id=\"second-form-web-to-lead\"\r\n                                        action=\"https:\/\/webto.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8&orgId=00Di0000000GyrQ\"\r\n                                        method=\"POST\" onsubmit=\"return validateForm()\">\r\n\r\n                                        <input type=hidden name='captcha_settings' id=\"captcha_web_to_load\"\r\n                                            value='{\"keyname\":\"TherapReCaptchaNM\",\"fallback\":\"true\",\"orgId\":\"00Di0000000GyrQ\",\"ts\":\"\"}'>\r\n\r\n                                        <input type=hidden name=\"oid\" value=\"00Di0000000GyrQ\">\r\n                                        <input type=hidden name=\"retURL\"\r\n                                            value=\"https:\/\/www.therapservices.net\/thankyou\/landing-page-thank-you.php\">\r\n                                        <input type=\"hidden\" name=\"lead_source\" value=\"Web\"\/>\r\n                                        <!-- Referer -->\r\n                                        <label for=\"00N0H00000K4t5R\" style=\"display:none\">Referrer:<\/label>\r\n                                        <input id=\"00N0H00000K4t5R\" maxlength=\"255\" name=\"00N0H00000K4t5R\" size=\"20\"\r\n                                            type=\"hidden\" value=\"\" \/>\r\n\r\n                                        <label for=\"first_name\" style=\"display:none\">First Name<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"first_name\" maxlength=\"40\" name=\"first_name\" size=\"20\"\r\n                                            type=\"hidden\" \/>\r\n                                        <!-- START: Removed 'required' -->\r\n\r\n                                        <label for=\"last_name\" style=\"display:none\">Last Name<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"last_name\" maxlength=\"80\" name=\"last_name\" size=\"20\" type=\"hidden\" \/>\r\n                                        <!-- START: Removed 'required' -->\r\n\r\n                                        <label for=\"title\" style=\"display:none\">Job Title<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"title\" maxlength=\"100\" name=\"title\" size=\"20\" type=\"hidden\" \/>\r\n                                        <!-- START: Removed 'required' -->\r\n\r\n                                        <label for=\"company\" style=\"display:none\">Company<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"company\" maxlength=\"80\" name=\"company\" size=\"20\" type=\"hidden\" \/>\r\n                                        <!-- START: Removed 'required' -->\r\n\r\n                                        <label for=\"email\" style=\"display:none\">Email<span\r\n                                                class=\"required-star\">*<\/span><\/label>\r\n                                        <input id=\"email\" maxlength=\"80\" name=\"email\" size=\"20\" type=\"hidden\" \/>\r\n                                        <!-- START: Removed 'required' -->\r\n\r\n                                        <label for=\"phone2\" style=\"display:none\">Phone<\/label>\r\n                                        <input id=\"phone2\" maxlength=\"80\" name=\"phone\" size=\"20\" type=\"hidden\"\r\n                                            placeholder=\"For example: xxxxxxxxxx or xxx-xxx-xxxx\" \/>\r\n                                        <input id=\"00NVs00000JawpJ\" name=\"00NVs00000JawpJ\" size=\"20\" type=\"hidden\"\r\n                                            value=\"\" \/>\r\n                                        <fieldset style=\"padding:0px;margin-top:0px;margin-bottom:0px;border:none\">\r\n                                            <span class=\"radio-label\" style=\"display: none;\">\r\n                                                You are a:\r\n                                                <span class=\"required-star\">*<\/span>\r\n                                            <\/span>\r\n                                            <label style=\"margin-top:0;margin-bottom: 5px; display: none;\"\r\n                                                for=\"wl_radio_n_1\">\r\n                                                <input class=\"radio-btn\" id=\"wl_radio_n_1\" name=\"00N0H00000K4t5W\"\r\n                                                    type=\"radio\" value=\"Therap User\" \/>\r\n                                                <!-- START: Removed 'required' -->\r\n                                                <span class=\"radio_text\">Existing Therap User<\/span>\r\n                                            <\/label>\r\n                                            <label style=\"margin-top:0;margin-bottom: 18px; display: none;\"\r\n                                                for=\"wl_radio_n_2\">\r\n                                                <input class=\"radio-btn\" id=\"wl_radio_n_2\" name=\"00N0H00000K4t5W\"\r\n                                                    type=\"radio\" value=\"Potential Therap User\" \/>\r\n                                                <span class=\"radio_text\">Potential Therap Customer<\/span>\r\n                                            <\/label>\r\n                                        <\/fieldset>\r\n\r\n                                        <input id=\"state\" maxlength=\"80\" name=\"state\" size=\"20\" type=\"hidden\"\r\n                                            value=\"\" \/>\r\n\r\n                                        <div id=\"zip_box\" style=\"display:none\">\r\n                                            <label for=\"zip\" style=\"display:none\">Zip<span\r\n                                                    class=\"required-star\">*<\/span><\/label>\r\n                                            <input id=\"zip\" maxlength=\"40\" name=\"zip\" size=\"20\" type=\"hidden\" \/>\r\n                                        <\/div>\r\n\r\n                                        <div id=\"county_box\" style=\"display:none\">\r\n                                            <label for=\"00N6S00000KKVwo\" style=\"display:none\">County<span\r\n                                                    class=\"required-star\">*<\/span><\/label>\r\n                                            <select id=\"00N6S00000KKVwo\" name=\"00N6S00000KKVwo\" style=\"width:100%\"\r\n                                                title=\"County\">\r\n                                                <option value=\"\">--None--<\/option>\r\n                                                <option value=\"Alameda\">Alameda<\/option>\r\n                                                <option value=\"Alpine\">Alpine<\/option>\r\n                                                <option value=\"Amador\">Amador<\/option>\r\n                                                <option value=\"Butte\">Butte<\/option>\r\n                                                <option value=\"Calaveras\">Calaveras<\/option>\r\n                                                <option value=\"Colusa\">Colusa<\/option>\r\n                                                <option value=\"Contra Costa\">Contra Costa<\/option>\r\n                                                <option value=\"Del Norte\">Del Norte<\/option>\r\n                                                <option value=\"El Dorado\">El Dorado<\/option>\r\n                                                <option value=\"Fresno\">Fresno<\/option>\r\n                                                <option value=\"Glenn\">Glenn<\/option>\r\n                                                <option value=\"Humboldt\">Humboldt<\/option>\r\n                                                <option value=\"Imperial\">Imperial<\/option>\r\n                                                <option value=\"Inyo\">Inyo<\/option>\r\n                                                <option value=\"Kern\">Kern<\/option>\r\n                                                <option value=\"Kings\">Kings<\/option>\r\n                                                <option value=\"Lake\">Lake<\/option>\r\n                                                <option value=\"Lassen\">Lassen<\/option>\r\n                                                <option value=\"Los Angeles\">Los Angeles<\/option>\r\n                                                <option value=\"Madera\">Madera<\/option>\r\n                                                <option value=\"Marin\">Marin<\/option>\r\n                                                <option value=\"Mariposa\">Mariposa<\/option>\r\n                                                <option value=\"Mendocino\">Mendocino<\/option>\r\n                                                <option value=\"Merced\">Merced<\/option>\r\n                                                <option value=\"Modoc\">Modoc<\/option>\r\n                                                <option value=\"Mono\">Mono<\/option>\r\n                                                <option value=\"Monterey\">Monterey<\/option>\r\n                                                <option value=\"Napa\">Napa<\/option>\r\n                                                <option value=\"Nevada\">Nevada<\/option>\r\n                                                <option value=\"Orange\">Orange<\/option>\r\n                                                <option value=\"Placer\">Placer<\/option>\r\n                                                <option value=\"Plumas\">Plumas<\/option>\r\n                                                <option value=\"Riverside\">Riverside<\/option>\r\n                                                <option value=\"Sacramento\">Sacramento<\/option>\r\n                                                <option value=\"San Benito\">San Benito<\/option>\r\n                                                <option value=\"San Bernardino\">San Bernardino<\/option>\r\n                                                <option value=\"San Diego\">San Diego<\/option>\r\n                                                <option value=\"San Francisco\">San Francisco<\/option>\r\n                                                <option value=\"San Joaquin\">San Joaquin<\/option>\r\n                                                <option value=\"San Luis Obispo\">San Luis Obispo<\/option>\r\n                                                <option value=\"San Mateo\">San Mateo<\/option>\r\n                                                <option value=\"Santa Barbara\">Santa Barbara<\/option>\r\n                                                <option value=\"Santa Clara\">Santa Clara<\/option>\r\n                                                <option value=\"Santa Cruz\">Santa Cruz<\/option>\r\n                                                <option value=\"Shasta\">Shasta<\/option>\r\n                                                <option value=\"Sierra\">Sierra<\/option>\r\n                                                <option value=\"Siskiyou\">Siskiyou<\/option>\r\n                                                <option value=\"Solano\">Solano<\/option>\r\n                                                <option value=\"Sonoma\">Sonoma<\/option>\r\n                                                <option value=\"Stanislaus\">Stanislaus<\/option>\r\n                                                <option value=\"Sutter\">Sutter<\/option>\r\n                                                <option value=\"Tehama\">Tehama<\/option>\r\n                                                <option value=\"Trinity\">Trinity<\/option>\r\n                                                <option value=\"Tulare\">Tulare<\/option>\r\n                                                <option value=\"Tuolumne\">Tuolumne<\/option>\r\n                                                <option value=\"Ventura\">Ventura<\/option>\r\n                                                <option value=\"Yolo\">Yolo<\/option>\r\n                                                <option value=\"Yuba\">Yuba<\/option>\r\n                                            <\/select>\r\n                                        <\/div>\r\n                                        <input type=\"hidden\" name=\"description\"\r\n                                            value='Please let us know what you are looking to learn more about.:' \/>\r\n                                        <input id=\"lead_description\" name=\"description\" type=\"hidden\" \/>\r\n\r\n                                        <!-- add hidden field for acknowledgement -->\r\n                                        <input type=\"hidden\" id=\"lead-acknowledgement-label\" name=\"description\"\r\n                                            value=\"I have read and acknowledged Therap's Privacy Policy.\" \/>\r\n                                        <label for=\"lead-acknowledgement\" style=\"display: none;\">I have read and\r\n                                            acknowledged Therap's\r\n                                            Privacy Policy.<\/label>\r\n                                        <input type=\"hidden\" id=\"lead-acknowledgement\" name=\"description\" value=\"\" \/>\r\n                                        <!-- END: Added hidden field for acknowledgement -->\r\n                                        <!-- START: ADDED hidden input for reCAPTCHA token -->\r\n                                        <input type=\"hidden\" id=\"lead-recaptcha-response\" name=\"g-recaptcha-response\"\r\n                                            value=\"\">\r\n                                        <!-- END: ADDED hidden input -->\r\n\r\n                                        <label for=\"g-recaptcha-response-1\" title=\"\" style=\"display:none\">label<\/label>\r\n                                        <!-- REMOVED: Old reCAPTCHA div\r\n                    <div style=\"display: none;\" id=\"g-recaptcha-2\" class=\"g-recaptcha\"><\/div>\r\n                    -->\r\n\r\n                                        <input id=\"submit-lead\" type=\"submit\" class=\"submit-btn submit-button\"\r\n                                            value=\"Submit\" name=\"submitButtonLead\">\r\n                                    <\/form>\r\n                                <\/div>\r\n\r\n                                <!-- START: ADDED new visible reCAPTCHA widget holder -->\r\n                                <div class=\"form-row\" id=\"recaptcha-widget\"\r\n                                    style=\"display: flex; justify-content: center; margin-top: 1.25rem;\">\r\n                                    <div id=\"visible-recaptcha-widget\"><\/div>\r\n                                <\/div>\r\n                                <div class=\"form-row\"\r\n                                    style=\"text-align: center; margin-top: -1rem; margin-bottom: 1rem;\">\r\n                                    <span class=\"error-message\" id=\"error-recaptcha\"><\/span>\r\n                                <\/div>\r\n                                <!-- END: ADDED new visible reCAPTCHA widget holder -->\r\n\r\n                                <div class=\"form-row submit-row\">\r\n                                    <!-- START: MODIFIED - Changed to type=\"button\" to prevent default submit -->\r\n                                    <button type=\"button\" id=\"main-submit-button\" class=\"submit-button\">\r\n                                        <!-- END: MODIFIED -->\r\n                                        Submit\r\n                                    <\/button>\r\n                                <\/div>\r\n                            <\/div> <!-- END: MODIFIED - Changed form back to div -->\r\n                        <\/div>\r\n\r\n                        <META HTTP-EQUIV=\"Content-type\" CONTENT=\"text\/html; charset=UTF-8\">\r\n\r\n                    <\/div>\r\n                    <!-- START: ADDED new JS for explicit reCAPTCHA rendering -->\r\n                    <script>\r\n                        let recaptchaToken = ''; \/\/ Global variable to store the token\r\n                        let recaptchaWidgetId; \/\/ To store the ID of the rendered widget\r\n                        \/**\r\n                         * This is called by the api.js script tag once it's loaded\r\n                         *\/\r\n                        function onRecaptchaLoad() {\r\n                            \/\/ Render the new visible widget\r\n                            if (document.getElementById('visible-recaptcha-widget')) {\r\n                                recaptchaWidgetId = grecaptcha.render('visible-recaptcha-widget', {\r\n                                    'sitekey': '6LekGeIZAAAAAJXBg-y-JcCQPjFDXFJnXUQDZ17F', \/\/ Your sitekey\r\n                                    'callback': onRecaptchaSuccess\r\n                                });\r\n                            }\r\n                        }\r\n                        \/**\r\n                         * This is called by reCAPTCHA when the user successfully solves it\r\n                         *\/\r\n                        function onRecaptchaSuccess(token) {\r\n                            recaptchaToken = token;\r\n                            \/\/ Automatically populate the hidden token fields in *both* forms\r\n                            const caseResponse = document.getElementById('case-recaptcha-response');\r\n                            if (caseResponse) {\r\n                                caseResponse.value = token;\r\n                            }\r\n                            const leadResponse = document.getElementById('lead-recaptcha-response');\r\n                            if (leadResponse) {\r\n                                leadResponse.value = token;\r\n                            }\r\n                        }\r\n                    <\/script>\r\n                    <!-- END: ADDED new JS -->\r\n\r\n                    <!-- START: MODIFIED script tag to load reCAPTCHA explicitly -->\r\n                    <script src=\"https:\/\/www.google.com\/recaptcha\/api.js?onload=onRecaptchaLoad&render=explicit\" async\r\n                        defer><\/script>\r\n                    <!-- END: MODIFIED script tag -->\r\n\r\n                    <!-- START: REPLACED timestamp function -->\r\n                    <script>\r\n                        const choicesInstances = {};\r\n                        \/**\r\n                         * Updates timestamp on captcha_settings hidden inputs for both forms\r\n                         * if the reCAPTCHA has not been solved.\r\n                         *\/\r\n                        function timestamp() {\r\n                            \/\/ Check our new global token variable\r\n                            if (recaptchaToken.trim() == \"\") {\r\n                                var captchaSettingsInputs = document.getElementsByName(\"captcha_settings\");\r\n                                var newTime = JSON.stringify(new Date().getTime());\r\n                                \/\/ Loop and update *both* captcha_settings inputs\r\n                                captchaSettingsInputs.forEach(function(input) {\r\n                                    try {\r\n                                        var elems = JSON.parse(input.value);\r\n                                        elems[\"ts\"] = newTime;\r\n                                        input.value = JSON.stringify(elems);\r\n                                    } catch (e) {\r\n                                        \/\/ Silently fail to avoid console spam\r\n                                    }\r\n                                });\r\n                            }\r\n                        }\r\n                        setInterval(timestamp, 500);\r\n                        \/\/ <!-- END: REPLACED timestamp function -->\r\n                        \/\/ <!-- START: ADDED Validation Functions (Global Scope) -->\r\n                        let notificationTimer;\r\n                        \/**\r\n                         * Shows a non-blocking notification message.\r\n                         *\/\r\n                        function showNotification(message) {\r\n                            const notification = document.getElementById('custom-notification');\r\n                            const messageEl = document.getElementById('custom-notification-message');\r\n                            if (notification && messageEl) {\r\n                                messageEl.textContent = message;\r\n                                notification.style.display = 'block';\r\n                                \/\/ Clear existing timer\r\n                                if (notificationTimer) {\r\n                                    clearTimeout(notificationTimer);\r\n                                }\r\n                                \/\/ Hide after 3 seconds\r\n                                notificationTimer = setTimeout(() => {\r\n                                    notification.style.display = 'none';\r\n                                }, 3000);\r\n                            } else {\r\n                                \/\/ Fallback if modal isn't present\r\n                                console.warn(message);\r\n                            }\r\n                        }\r\n                        \/**\r\n                         * Validates email format.\r\n                         *\/\r\n                        function validateEmail(email) {\r\n                            var re = \/^[A-Z0-9._%-]+@[A-Z0-9.-]+\\.[A-Z]{2,4}$\/i;\r\n                            return re.test(email);\r\n                        }\r\n\r\n                        function validateEmail2(email) {\r\n                            var re = \/^[A-Z0-9._%-]+@[A-Z0-9.-]+\\.[A-Z]{2,4}$\/i;\r\n                            return re.test(email);\r\n                        }\r\n                        \/**\r\n                         * Validation for the hidden Web-to-Lead form.\r\n                         *\/\r\n                        function validateForm() {\r\n                            var email = document.getElementById(\"email\").value;\r\n                            if (email == \"hunterleap@yahoo.com\" || email == \"guthalsp@gmail.com\") {\r\n                                \/\/ This will redirect, but the form won't submit to SF\r\n                                window.location.href =\r\n                                    \"https:\/\/www.therapservices.net\/thankyou\/landing-page-thank-you.php\";\r\n                                return false;\r\n                            }\r\n                            if (email.length > 0) {\r\n                                if (!validateEmail(email)) {\r\n                                    showNotification('Please fill in a valid value for all required fields: Email');\r\n                                    return false;\r\n                                }\r\n                            }\r\n                            \/\/ Check our global reCAPTCHA token\r\n                            if (recaptchaToken.length == 0) {\r\n                                showNotification('Please Select : \"I\\'m not a robot\"');\r\n                                return false;\r\n                            }\r\n                            var phone = document.getElementById(\"phone2\").value;\r\n                            if (email == \"mhollins1@gmail.com\" || email == \"mhollins1@gamil.com\" || email ==\r\n                                \"shawntae917@gmail.com\" || phone == \"(402) 429-2587\" || phone == \"(308) 999-0109\") {\r\n                                showNotification('You have already submitted the form.');\r\n                                return false;\r\n                            }\r\n                            \/\/ Phone regex check removed, as iti.js handles validation before syncing.\r\n                            localStorage.setItem(\"gtag_user_email\", email);\r\n                            return true;\r\n                        }\r\n                        \/**\r\n                         * Validation for the hidden Web-to-Case form.\r\n                         *\/\r\n                        function validateForm2() {\r\n                            var email = document.getElementById(\"wc-email\").value;\r\n                            if (email == \"hunterleap@yahoo.com\") {\r\n                                \/\/ This will redirect, but the form won't submit to SF\r\n                                window.location.href =\r\n                                    \"https:\/\/www.therapservices.net\/thankyou\/landing-page-thank-you.php\";\r\n                                return false;\r\n                            }\r\n                            if (!validateEmail2(email)) {\r\n                                showNotification('Please fill in a valid value for all required fields: Email');\r\n                                return false;\r\n                            }\r\n                            \/\/ Check our global reCAPTCHA token\r\n                            if (recaptchaToken.length == 0) {\r\n                                showNotification('Please Select : \"I\\'m not a robot\"');\r\n                                return false;\r\n                            }\r\n                            var phone = document.getElementById(\"phone\").value;\r\n                            if (email == \"mhollins1@gmail.com\" || email == \"mhollins1@gamil.com\" || email ==\r\n                                \"shawntae917@gmail.com\" || phone == \"(402) 429-2587\" || phone == \"(308) 999-0109\") {\r\n                                showNotification('You have already submitted the form.');\r\n                                return false;\r\n                            }\r\n                            \/\/ Phone regex check removed.\r\n                            localStorage.setItem(\"gtag_user_email\", email);\r\n                            return true;\r\n                        }\r\n                        \/\/ <!-- END: ADDED Validation Functions -->\r\n                        \/\/ Initialize intl-tel-input\r\n                        const phoneInput = document.querySelector(\"#init_phone\");\r\n                        const iti = window.intlTelInput(phoneInput, {\r\n                            utilsScript: \"https:\/\/therapservices.net\/jslib\/contact-form\/utils.js\",\r\n                            initialCountry: \"us\",\r\n                            separateDialCode: true,\r\n                            placeholderNumberType: \"MOBILE\",\r\n                            \/\/                             customPlaceholder: function (selectedCountryPlaceholder, selectedCountryData) {\r\n                            \/\/ This function forces the placeholder to your desired format\r\n                            \/\/                                 return \"01-555-012\";\r\n                            \/\/ }\r\n                        });\r\n                        if (phoneInput) {\r\n                            phoneInput.addEventListener('input', function(event) {\r\n                                const currentValue = event.target.value;\r\n                                \/\/ FIX: This regex now allows digits, plus signs, and hyphens\r\n                                const allowedValue = currentValue.replace(\/[^0-9-]\/g, ''); \/\/ <-- CORRECT\r\n                                if (currentValue !== allowedValue) {\r\n                                    event.target.value = allowedValue;\r\n                                }\r\n                            });\r\n                        }\r\n                        \/\/ START: MODIFIED - Added full form logic\r\n                        const caseOnlyStates = ['AL', 'DE', 'GA', 'KY', 'NE', 'NV', 'NM', 'ND', 'RI', 'SC', 'SD', 'TN',\r\n                            'PR'\r\n                        ]; \/\/ Added OK\r\n                        \/**\r\n                         * Syncs values from visible form to hidden forms\r\n                         *\/\r\n                        function syncFormFields() {\r\n                            \/\/ Text inputs\r\n                            const inputsToSync = [{\r\n                                    visible: 'init_firstName',\r\n                                    lead: 'first_name',\r\n                                    case: null\r\n                                },\r\n                                {\r\n                                    visible: 'init_lastName',\r\n                                    lead: 'last_name',\r\n                                    case: null\r\n                                },\r\n                                {\r\n                                    visible: 'init_email',\r\n                                    lead: 'email',\r\n                                    case: 'wc-email'\r\n                                },\r\n                                {\r\n                                    visible: 'init_company',\r\n                                    lead: 'company',\r\n                                    case: 'wc-company'\r\n                                },\r\n                                {\r\n                                    visible: 'init_jobTitle',\r\n                                    lead: 'title',\r\n                                    case: 'wc-title'\r\n                                },\r\n                                {\r\n                                    visible: 'init_message',\r\n                                    lead: 'lead_description',\r\n                                    case: 'comments'\r\n                                },\r\n                                {\r\n                                    visible: 'init_zip',\r\n                                    lead: 'zip',\r\n                                    case: null\r\n                                } \/\/ Added Zip\r\n                                , {\r\n                                    visible: 'privacy',\r\n                                    lead: 'lead-acknowledgement',\r\n                                    case: 'wc-privacy'\r\n                                }\r\n                            ];\r\n                            inputsToSync.forEach(map => {\r\n                                const visibleEl = document.getElementById(map.visible);\r\n                                if (!visibleEl) return;\r\n                                \/\/ Use 'input' event for more responsive syncing\r\n                                visibleEl.addEventListener('input', (e) => {\r\n                                    const value = e.target.value;\r\n                                    if (map.lead) {\r\n                                        const leadEl = document.getElementById(map.lead);\r\n                                        if (leadEl) leadEl.value = value;\r\n                                    }\r\n                                    if (map.case) {\r\n                                        const caseEl = document.getElementById(map.case);\r\n                                        if (caseEl) caseEl.value = value;\r\n                                    }\r\n                                });\r\n                            });\r\n                            \/\/ Full Name (Case only)\r\n                            const syncFullName = () => {\r\n                                const first = document.getElementById('init_firstName').value;\r\n                                const last = document.getElementById('init_lastName').value;\r\n                                const wcName = document.getElementById('wc-name');\r\n                                if (wcName) {\r\n                                    wcName.value = `${first} ${last}`;\r\n                                }\r\n                            };\r\n                            document.getElementById('init_firstName').addEventListener('input', syncFullName);\r\n                            document.getElementById('init_lastName').addEventListener('input', syncFullName);\r\n                            \/\/ Phone (Both forms)\r\n                            const syncPhone = () => {\r\n                                \/\/ Get the full international number from the 'iti' instance\r\n                                const fullPhoneNumber = phoneInput\r\n                                    .value; \/\/ <-- This gets the number with country code\r\n                                \/\/ remove plus sign\r\n                                const sanitizedPhoneNumber = fullPhoneNumber.replace(\/^\\+\/, '');\r\n                                const leadPhone = document.getElementById('phone2');\r\n                                const casePhone = document.getElementById('phone');\r\n                                \/\/ Sync the full international number to the hidden forms\r\n                                if (leadPhone) leadPhone.value = sanitizedPhoneNumber;\r\n                                if (casePhone) casePhone.value = sanitizedPhoneNumber;\r\n                            };\r\n                            phoneInput.addEventListener('input', syncPhone);\r\n                            phoneInput.addEventListener('countrychange', syncPhone);\r\n                            \/\/ Selects\r\n                            const selectsToSync = [{\r\n                                    visible: 'init_individuals',\r\n                                    lead: '00NVs00000JawpJ',\r\n                                    case: 'null'\r\n                                },\r\n                                \/\/ State is handled separately\r\n                                {\r\n                                    visible: 'init_county',\r\n                                    lead: '00N6S00000KKVwo',\r\n                                    case: null\r\n                                }\r\n                            ];\r\n                            selectsToSync.forEach(map => {\r\n                                const visibleEl = document.getElementById(map.visible);\r\n                                if (!visibleEl) return;\r\n                                visibleEl.addEventListener('change', (e) => {\r\n                                    const value = e.target.value;\r\n                                    if (map.lead) {\r\n                                        const leadEl = document.getElementById(map.lead);\r\n                                        if (leadEl) leadEl.value = value;\r\n                                    }\r\n                                    if (map.case) {\r\n                                        const caseEl = document.getElementById(map.case);\r\n                                        if (caseEl) caseEl.value = value;\r\n                                    }\r\n                                });\r\n                            });\r\n                            \/\/ State Select (Special handling)\r\n                            \/\/ State Select (Special handling)\r\n                            const initStateSelect = document.getElementById('init_state');\r\n                            if (initStateSelect) {\r\n                                initStateSelect.addEventListener('change', (e) => {\r\n                                    const value = e.target.value;\r\n                                    \/\/ Get the full state name (the visible text)\r\n                                    const fullStateName = e.target.options[e.target.selectedIndex].text;\r\n                                    \/\/ Sync the ABBREVIATION to the Lead form (Required for Lead field)\r\n                                    const leadState = document.getElementById('state');\r\n                                    if (leadState) leadState.value = value;\r\n                                    \/\/ Sync the FULL STATE NAME to the Case form (Your requested change)\r\n                                    const caseState = document.getElementById('00N0H00000JoJtw');\r\n                                    if (caseState) caseState.value =\r\n                                        fullStateName; \/\/ <--- MODIFIED to use fullStateName\r\n                                    if (leadState.value == \"Guam\") {\r\n                                        leadState.value = \"GU\";\r\n                                    }\r\n                                    \/\/ Trigger conditional field updates\r\n                                    updateConditionalFields();\r\n                                    updateMessageRequirement();\r\n                                    updateIndividualsFieldVisibility();\r\n                                    logSubmissionType();\r\n                                });\r\n                            }\r\n                            \/\/ Therap User (Special handling for both forms)\r\n                            const therapUserSelect = document.getElementById('init_therapUser');\r\n                            const assistSelect = document.getElementById('init_assistance');\r\n                            const initIndividuals = document.getElementById('init_individuals');\r\n                            if (therapUserSelect) {\r\n                                const troubleLoginInfo = document.getElementById(\r\n                                    'trouble-login-info'); \/\/ <-- ADD THIS LINE\r\n                                const messageRow = document.getElementById('message-row'); \/\/ NEW LINE\r\n                                const assistRow2 = document.getElementById('how-can-we-assist-you-row'); \/\/ NEW LINE\r\n                                const privacyRow = document.getElementById('privacy-row'); \/\/ NEW LINE\r\n                                const recaptchaRow = document.getElementById('recaptcha-widget'); \/\/ NEW LINE\r\n                                const howCanAssistYou = document.getElementById('how-can-assist-you'); \/\/ NEW LINE\r\n                                therapUserSelect.addEventListener('change', (e) => {\r\n                                    const value = e.target.value;\r\n                                    \/\/ 1. Sync to Lead form radios\r\n                                    const radioYes = document.getElementById('wl_radio_n_1');\r\n                                    const radioNo = document.getElementById('wl_radio_n_2');\r\n                                    var stateValue = document.getElementById('init_state').value;\r\n                                    howCanAssistYou.innerHTML = '';\r\n                                    mainSubmitButton.style.display = 'block';\r\n                                    troubleLoginInfo.style.display = 'none';\r\n                                    recaptchaRow.style.display = 'flex';\r\n                                    privacyRow.style.display = 'flex';\r\n                                    document.getElementById('county_row').style.display = 'none';\r\n                                    initIndividuals.selectedIndex = 0;\r\n                                    assistSelect.selectedIndex = 0;\r\n                                    if (stateValue === 'CA' && (assistSelect.selectedIndex != 2)) {\r\n                                        document.getElementById('county_row').style.display = 'block';\r\n                                        if (choicesInstances['init_county']) {\r\n                                            choicesInstances['init_county'].enable();\r\n                                            choicesInstances['init_county'].setChoiceByValue('', true);\r\n                                        }\r\n                                    }\r\n                                    if (choicesInstances['init_assistance']) {\r\n                                        choicesInstances['init_assistance'].enable();\r\n                                        choicesInstances['init_assistance'].setChoiceByValue('', true);\r\n                                    }\r\n                                    if (choicesInstances['init_individuals']) {\r\n                                        choicesInstances['init_individuals'].enable();\r\n                                        choicesInstances['init_individuals'].setChoiceByValue('', true);\r\n                                    }\r\n                                    updateIndividualsFieldVisibility();\r\n                                    if (radioYes && radioNo) {\r\n                                        if (value === 'Current Therap User') {\r\n                                            radioYes.checked = true;\r\n                                            assistRow2.style.display = 'block';\r\n                                            messageRow.style.display = 'none'; \/\/ NEW LINE\r\n                                        } else {\r\n                                            radioNo.checked = true;\r\n                                            assistRow2.style.display = 'none';\r\n                                            messageRow.style.display = 'block'; \/\/ NEW LINE\r\n                                        }\r\n                                    }\r\n                                    \/\/ 2. Sync to Case form hidden description (replaces showOptNew1)\r\n                                    const rn1Set = document.getElementById(\"rn1_set\");\r\n                                    if (rn1Set) {\r\n                                        const descValue = (value === 'Current Therap User' ?\r\n                                            'Current Therap User' : 'Potential Therap User');\r\n                                        rn1Set.innerHTML = '<input type=\"hidden\" value=\"' + descValue +\r\n                                            '\" name=\"description\" \/>';\r\n                                    }\r\n                                    if (troubleLoginInfo) {\r\n                                        \/\/ messageRow.style.display = 'block'; \/\/ NEW LINE\r\n                                        if (value === 'Current Therap User') {\r\n                                            \/\/ troubleLoginInfo.style.display = 'block';\r\n                                        } else {\r\n                                            \/\/ troubleLoginInfo.style.display = 'none';\r\n                                        }\r\n                                        if (value === \"\") {\r\n                                            messageRow.style.display = 'none'; \/\/ NEW LINE\r\n                                        }\r\n                                    }\r\n                                    updateMessageRequirement();\r\n                                    updateIndividualsFieldVisibility();\r\n                                    logSubmissionType();\r\n                                });\r\n                                assistSelect.addEventListener('change', (e) => {\r\n                                    const value = e.target.value;\r\n                                    var stateValue = document.getElementById('init_state').value;\r\n                                    if (assistSelect.selectedIndex == 0) {\r\n                                        troubleLoginInfo.style.display = 'none';\r\n                                        if (stateValue === 'CA') {\r\n                                            document.getElementById('county_row').style.display = 'block';\r\n                                        }\r\n                                    }\r\n                                    if (assistSelect.selectedIndex == 1) {\r\n                                        if (stateValue === 'CA') {\r\n                                            document.getElementById('county_row').style.display = 'none';\r\n                                        }\r\n                                    }\r\n                                    \/\/ assistSelect.selectedIndex = 0;\r\n                                    \/\/ Sync to Case form hidden subject\r\n                                    if (value == \"Other\") {\r\n                                        if (stateValue === 'CA') {\r\n                                            document.getElementById('county_row').style.display = 'block';\r\n                                        }\r\n                                        messageRow.style.display = 'block'; \/\/ NEW LINE\r\n                                        \/\/ main-submit-button hide\r\n                                        mainSubmitButton.style.display = 'block';\r\n                                        troubleLoginInfo.style.display = 'none';\r\n                                        recaptchaRow.style.display = 'flex';\r\n                                        privacyRow.style.display = 'flex';\r\n                                        $(\"#message-row label[for='init_message']\").html(\r\n                                            `Let us know how we can assist you. Please do NOT include any PHI data on this form. <span id=\"message-required-asterisk\" class=\"required-asterisk\">*<\/span>`\r\n                                        );\r\n                                        howCanAssistYou.innerHTML =\r\n                                            '<input type=\"hidden\" value=\"How can we assist you?\"> <input type=\"hidden\" value=\"' +\r\n                                            value +\r\n                                            '\" name=\"description\" \/>';\r\n                                    } else {\r\n                                        troubleLoginInfo.style.display = 'block';\r\n                                        mainSubmitButton.style.display = 'none';\r\n                                        messageRow.style.display = 'none'; \/\/ NEW LINE\r\n                                        recaptchaRow.style.display = 'none';\r\n                                        privacyRow.style.display = 'none';\r\n                                        $(\"#message-row label[for='init_message']\").html(\r\n                                            `Let us know how we can assist you. Please do NOT include any PHI data on this form. <span id=\"message-required-asterisk\" class=\"required-asterisk\">*<\/span>`\r\n                                        );\r\n                                        howCanAssistYou.innerHTML =\r\n                                            '<input type=\"hidden\" value=\"How can we assist you?\"> <input type=\"hidden\" value=\"' +\r\n                                            value +\r\n                                            '\" name=\"description\" \/>';\r\n                                        \/\/ messageRow label text will be Let us know how we can assist you. Please do NOT include any PHI data on this form.\r\n                                        \/\/ messageRow.querySelector('label[for=\"init_message\"]').textContent = 'Let us know how we can assist you. Please do NOT include any PHI data on this form.';\r\n                                        \/\/$(\"#message-row label[for='init_message']\").text('Let us know how we can assist you. Please do NOT include any PHI data on this form.');\r\n                                        document.querySelectorAll(\".has-error\").forEach(e => e.classList.remove(\r\n                                            \"has-error\"));\r\n                                        document.querySelectorAll(\".error-message\").forEach(e => e\r\n                                            .removeAttribute(\"style\"));\r\n                                    }\r\n                                    updateMessageRequirement();\r\n                                });\r\n                            }\r\n                        }\r\n                        \/**\r\n                         * Updates visibility of County (CA) and Zip (NY) fields\r\n                         *\/\r\n                        function updateIndividualsFieldVisibility() {\r\n                            const stateValue = document.getElementById('init_state').value;\r\n                            const isTherapUser = document.getElementById('init_therapUser').value;\r\n                            const individualsRow = document.getElementById('how-many-individuals-row');\r\n                            const assistRow = document.getElementById('how-can-we-assist-you-row');\r\n                            if (!individualsRow) return; \/\/ Safety check\r\n                            if (!isTherapUser) return;\r\n                            if (caseOnlyStates.includes(stateValue) || isTherapUser === 'Current Therap User') {\r\n                                \/\/ This is a Web-to-Case submission, so HIDE it\r\n                                individualsRow.style.display = 'none';\r\n                            } else {\r\n                                \/\/ This is a Web-to-Lead submission, so SHOW it\r\n                                individualsRow.style.display = 'block';\r\n                            }\r\n                        }\r\n\r\n                        function updateConditionalFields() {\r\n                            const stateValue = document.getElementById('init_state').value;\r\n                            const countyRow = document.getElementById('county_row');\r\n                            const countySelect = document.getElementById('init_county');\r\n                            const zipRow = document.getElementById('zip_row');\r\n                            const zipInput = document.getElementById('init_zip');\r\n                            \/\/ Handle County (CA)\r\n                            if (stateValue === 'CA') {\r\n                                if (document.getElementById(\"init_therapUser\").value == \"Current Therap User\") {\r\n                                    if (document.getElementById(\"init_assistance\").selectedIndex == 1) {\r\n                                        countyRow.style.display = 'none';\r\n                                        countySelect.required = false;\r\n                                    } else {\r\n                                        countyRow.style.display = 'block';\r\n                                        countySelect.required = true;\r\n                                    }\r\n                                } else {\r\n                                    countyRow.style.display = 'block';\r\n                                    countySelect.required = true;\r\n                                }\r\n                            } else {\r\n                                countyRow.style.display = 'none';\r\n                                countySelect.required = false;\r\n                            }\r\n                            \/\/ Handle Zip (NY)\r\n                            \/\/ if (stateValue === 'NY') {\r\n                            \/\/     zipRow.style.display = 'block';\r\n                            \/\/     zipInput.required = true;\r\n                            \/\/ } else {\r\n                            \/\/     zipRow.style.display = 'none';\r\n                            \/\/     zipInput.required = false;\r\n                            \/\/ }\r\n                        }\r\n                        \/**\r\n                         * Updates 'required' status of Message field based on State\r\n                         *\/\r\n                        \/**\r\n                         * Updates 'required' status AND label text of Message field based on State AND User Type\r\n                         *\/\r\n                        function updateMessageRequirement() {\r\n                            const stateValue = document.getElementById('init_state').value;\r\n                            const isTherapUser = document.getElementById('init_therapUser').value;\r\n                            const messageTextarea = document.getElementById('init_message');\r\n                            const messageAsterisk = document.getElementById('message-required-asterisk');\r\n                            \/\/ --- START: Added lines ---\r\n                            const messageLabel = document.querySelector('label[for=\"init_message\"]');\r\n                            if (!messageLabel) return; \/\/ Exit if label isn't found\r\n                            const labelTextNode = messageLabel.firstChild; \/\/ This gets the text part of the label\r\n                            \/\/ --- END: Added lines ---\r\n                            if (caseOnlyStates.includes(stateValue) || isTherapUser === 'Current Therap User') {\r\n                                \/\/ REQUIRED STATE (Case Form Logic)\r\n                                messageTextarea.required = true;\r\n                                messageAsterisk.style.display = 'inline';\r\n                                $(\"#message-row label[for='init_message']\").html(\r\n                                    `Let us know how we can assist you. Please do NOT include any PHI data on this form. <span id=\"message-required-asterisk\" class=\"required-asterisk\">*<\/span>`\r\n                                );\r\n                                \/\/labelTextNode.textContent = 'Let us know how we can assist you. Please do NOT include any PHI data on this form. '; \/\/ Set original text\r\n                            } else {\r\n                                \/\/ OPTIONAL STATE (Lead Form Logic)\r\n                                messageTextarea.required = false;\r\n                                messageAsterisk.style.display = 'none';\r\n                                labelTextNode.textContent =\r\n                                    'Please let us know what you are looking to learn more about. '; \/\/ Set new text\r\n                            }\r\n                        }\r\n                        \/**\r\n                         * Manually validates all required fields in the visible form.\r\n                         *\/\r\n                        \/**\r\n                         * Manually validates all required fields in the visible form.\r\n                         *\/\r\n                        \/**\r\n                         * Logs the submission type based on current selections.\r\n                         *\/\r\n                        function showError(fieldKey, message, elementId) {\r\n                            const errorEl = document.getElementById('error-' + fieldKey);\r\n                            if (errorEl) {\r\n                                errorEl.textContent = message;\r\n                                errorEl.style.display = 'block';\r\n                            }\r\n                            \/\/ Add 'has-error' class to the parent container\r\n                            if (elementId) {\r\n                                const inputEl = document.getElementById(elementId);\r\n                                if (inputEl) {\r\n                                    \/\/ Find the closest container\r\n                                    const parentContainer = inputEl.closest('.form-row');\r\n                                    if (parentContainer) {\r\n                                        parentContainer.classList.add('has-error');\r\n                                    }\r\n                                }\r\n                            }\r\n                        }\r\n                        \/**\r\n                         * Hides a specific error message.\r\n                         *\/\r\n                        function clearError(fieldId) {\r\n                            const errorEl = document.getElementById('error-' + fieldId);\r\n                            if (errorEl) {\r\n                                errorEl.textContent = '';\r\n                                errorEl.style.display = 'none';\r\n                            }\r\n                        }\r\n                        \/**\r\n                         * Clears all visible error messages on the form.\r\n                         *\/\r\n                        function clearAllErrors() {\r\n                            const errorMessages = document.querySelectorAll('.error-message');\r\n                            errorMessages.forEach(el => {\r\n                                el.textContent = '';\r\n                                el.style.display = 'none';\r\n                            });\r\n                            \/\/ Remove all 'has-error' classes\r\n                            const errorContainers = document.querySelectorAll('.has-error');\r\n                            errorContainers.forEach(el => {\r\n                                el.classList.remove('has-error');\r\n                            });\r\n                        }\r\n\r\n                        function logSubmissionType() {\r\n                            \/\/ We need to read the values *inside* the function so it gets the latest state\r\n                            const isTherapUser = document.getElementById('init_therapUser').value;\r\n                            const stateValue = document.getElementById('init_state').value;\r\n                            \/\/ Check if both fields have a value before logging\r\n                            if (stateValue && isTherapUser) {\r\n                                if (caseOnlyStates.includes(stateValue)) {\r\n                                    console.log(\"Submission type will be: Web-to-Case (State rule)\");\r\n                                } else if (isTherapUser === 'Current Therap User') {\r\n                                    console.log(\"Submission type will be: Web-to-Case (Existing user rule)\");\r\n                                } else {\r\n                                    console.log(\"Submission type will be: Web-to-Lead\");\r\n                                }\r\n                            } else {\r\n                                \/\/ This just prevents spamming the console before both are selected\r\n                                console.log(\"Submission type: Waiting for both State and User Type selection.\");\r\n                            }\r\n                        }\r\n                        \/**\r\n                         * Manually validates all required fields in the visible form\r\n                         * and shows inline error messages.\r\n                         *\/\r\n                        function manualCheckValidity(formElement) {\r\n                            clearAllErrors(); \/\/ Start by clearing all errors\r\n                            let isValid = true;\r\n                            let firstInvalidElement = null;\r\n                            \/\/ --- Define Validation Rules ---\r\n                            \/\/ Note: The 'id' is the HTML element ID, 'key' is for the error span ID.\r\n                            const fieldsToValidate = [{\r\n                                    id: 'init_firstName',\r\n                                    key: 'firstName',\r\n                                    msg: 'Please enter your First Name'\r\n                                },\r\n                                {\r\n                                    id: 'init_lastName',\r\n                                    key: 'lastName',\r\n                                    msg: 'Please enter your Last Name'\r\n                                },\r\n                                {\r\n                                    id: 'init_email',\r\n                                    key: 'email',\r\n                                    msg: 'Please enter your Work Email',\r\n                                    emailMsg: 'Please enter a valid Work Email'\r\n                                },\r\n                                {\r\n                                    id: 'init_company',\r\n                                    key: 'company',\r\n                                    msg: 'Please enter your Company Name'\r\n                                },\r\n                                {\r\n                                    id: 'init_jobTitle',\r\n                                    key: 'jobTitle',\r\n                                    msg: 'Please enter your Job Title'\r\n                                },\r\n                                {\r\n                                    id: 'init_therapUser',\r\n                                    key: 'therapUser',\r\n                                    msg: 'Please select type of user'\r\n                                },\r\n                                {\r\n                                    id: 'init_state',\r\n                                    key: 'state',\r\n                                    msg: 'Please select your State\/Territory'\r\n                                },\r\n                                {\r\n                                    id: 'init_individuals',\r\n                                    key: 'individuals',\r\n                                    msg: 'Please select the number of Individuals'\r\n                                },\r\n                                {\r\n                                    id: 'init_county',\r\n                                    key: 'county',\r\n                                    msg: 'Please select your County'\r\n                                },\r\n                                {\r\n                                    id: 'init_assistance',\r\n                                    key: 'assistance',\r\n                                    msg: 'Please select how we can assist you'\r\n                                },\r\n                                {\r\n                                    id: 'init_message',\r\n                                    key: 'message',\r\n                                    msg: 'Please tell us how we can assist you'\r\n                                },\r\n                                {\r\n                                    id: 'privacy',\r\n                                    key: 'privacy',\r\n                                    msg: 'You must acknowledge the Privacy Policy'\r\n                                }\r\n                            ];\r\n                            fieldsToValidate.forEach(field => {\r\n                                const el = document.getElementById(field.id);\r\n                                if (!el) return; \/\/ Skip if element doesn't exist\r\n                                \/\/ Check if element is required and visible\r\n                                const parentContainer = el.closest('.form-row, .form-field, .privacy-row');\r\n                                const isVisible = parentContainer && window.getComputedStyle(parentContainer)\r\n                                    .display !== 'none';\r\n                                const isRequired = el.hasAttribute('required');\r\n                                if (isRequired && isVisible) {\r\n                                    let fieldIsInvalid = false;\r\n                                    if (el.type === 'checkbox') {\r\n                                        if (!el.checked) {\r\n                                            fieldIsInvalid = true;\r\n                                            \/\/ *** FIX: Pass field.id as 3rd argument ***\r\n                                            showError(field.key, field.msg, field.id);\r\n                                        }\r\n                                    } else {\r\n                                        if (el.value.trim() === '') {\r\n                                            fieldIsInvalid = true;\r\n                                            \/\/ *** FIX: Pass field.id as 3rd argument ***\r\n                                            showError(field.key, field.msg, field.id);\r\n                                        }\r\n                                    }\r\n                                    \/\/ Special check for Email format\r\n                                    if (field.id === 'init_email' && !fieldIsInvalid && el.value.trim() !==\r\n                                        '') {\r\n                                        if (!validateEmail(el\r\n                                                .value)) { \/\/ Uses your existing validateEmail function\r\n                                            fieldIsInvalid = true;\r\n                                            \/\/ *** FIX: Pass field.id as 3rd argument ***\r\n                                            showError(field.key, field.emailMsg, field.id);\r\n                                        }\r\n                                    }\r\n                                    if (fieldIsInvalid) {\r\n                                        isValid = false;\r\n                                        if (!firstInvalidElement) {\r\n                                            firstInvalidElement = el; \/\/ Store first invalid element to focus\r\n                                        }\r\n                                    }\r\n                                }\r\n                            });\r\n                            \/\/ --- Phone Validation (Not required, but check format if filled) ---\r\n                            const phoneVal = phoneInput.value.trim();\r\n                            if (phoneVal !== '') {\r\n                                \/\/ Regex: Allows only digits, or digits separated by a hyphen.\r\n                                \/\/ ^\\d+    = Must start with one or more digits\r\n                                \/\/ (-\\d+)* = Can be followed by zero or more groups of (hyphen + digits)\r\n                                \/\/ $       = Must match until the end of the string\r\n                                const phoneRegex = \/^\\d{3}-\\d{3}-\\d{4}$|^\\d{10}$\/;\r\n                                if (!phoneRegex.test(phoneVal)) {\r\n                                    isValid = false;\r\n                                    \/\/ Updated error message to match the new rule\r\n                                    showError('phone', 'Please enter a valid phone number', 'init_phone');\r\n                                    if (!firstInvalidElement) {\r\n                                        firstInvalidElement = phoneInput;\r\n                                    }\r\n                                }\r\n                            }\r\n                            \/\/ --- reCAPTCHA Validation ---\r\n                            if (recaptchaToken.length == 0) {\r\n                                isValid = false;\r\n                                \/\/ *** FIX: Pass null as 3rd argument ***\r\n                                showError('recaptcha', 'Please Select : \"I\\'m not a robot\"', null);\r\n                            }\r\n                            \/\/ --- Focus first invalid element ---\r\n                            if (firstInvalidElement) {\r\n                                \/\/ Check if it's a Choices.js select\r\n                                const choicesContainer = firstInvalidElement.closest('.form-field, .form-row') ?.querySelector('.choices');\r\n                                if (choicesContainer) {\r\n                                    choicesContainer.focus();\r\n                                } else {\r\n                                    firstInvalidElement.focus();\r\n                                }\r\n                            }\r\n                            return isValid; \/\/ All checks passed!\r\n                        }\r\n                        \/\/ Handle main submit button click\r\n                        const mainSubmitButton = document.getElementById('main-submit-button');\r\n                        if (mainSubmitButton) {\r\n                            mainSubmitButton.addEventListener('click', function(e) {\r\n                                const mainForm = document.getElementById('contactForm');\r\n                                \/\/ Manually trigger validation\r\n                                if (manualCheckValidity(mainForm)) {\r\n                                    const isTherapUser = document.getElementById('init_therapUser').value;\r\n                                    const stateValue = document.getElementById('init_state').value;\r\n                                    \/\/ --- SUBMISSION LOGIC ---\r\n                                    if (caseOnlyStates.includes(stateValue)) {\r\n                                        console.log(\"Submitting 'Web to Case' form for specific state...\");\r\n                                        document.getElementById('first-form-web-to-case').submit();\r\n                                    } else if (isTherapUser === 'Current Therap User') {\r\n                                        console.log(\"Submitting 'Web to Case' form for existing user...\");\r\n                                        document.getElementById('first-form-web-to-case').submit();\r\n                                    } else {\r\n                                        console.log(\"Submitting 'Web to Lead' form for new user...\");\r\n                                        document.getElementById('second-form-web-to-lead').submit();\r\n                                    }\r\n                                    \/\/ --- END OF SUBMISSION LOGIC ---\r\n                                } else {\r\n                                    \/\/ Validation failed, manualCheckValidity already showed the error.\r\n                                    console.log('Form is invalid.');\r\n                                }\r\n                            });\r\n                        }\r\n                        document.addEventListener('DOMContentLoaded', function() {\r\n                            \/\/ Set referrer for lead form\r\n                            try {\r\n                                \/\/ document.getElementById(\"00N0H00000K4t5R\").value = document.URL;\r\n                                const savedUtms = localStorage.getItem('saved_utm_query');\r\n                                const currentCleanUrl = window.location.href.split('?')[0]; \/\/ Current page path without query parameters\r\n\r\n                                if (savedUtms) {\r\n                                    \/\/ Appends saved UTMs to the current form submission page URL\r\n                                    document.getElementById(\"00N0H00000K4t5R\").value = currentCleanUrl + savedUtms;\r\n                                } else {\r\n                                    \/\/ Fallback if no UTMs exist\r\n                                    document.getElementById(\"00N0H00000K4t5R\").value = document.URL;\r\n                                }\r\n                            } catch (e) {}\r\n                            \/\/ Keep track of Choices instances\r\n                            const selectsToStyle = document.querySelectorAll(\r\n                                '#init_individuals, #init_therapUser, #init_state, #init_county, #init_assistance'\r\n                            );\r\n                            selectsToStyle.forEach(select => {\r\n                                \/\/ Store the instance using the select's ID as the key\r\n                                choicesInstances[select.id] = new Choices(select, {\r\n                                    searchEnabled: false,\r\n                                    itemSelectText: 'Select',\r\n                                    shouldSort: false,\r\n                                });\r\n                            });\r\n                            \/\/ This jQuery-like selector ($) won't work without jQuery.\r\n                            \/\/ Let's rewrite it in plain JavaScript.\r\n                            try {\r\n                                const initPhoneInput = document.getElementById(\"init_phone\");\r\n                                if (initPhoneInput) {\r\n                                    \/\/ Get computed style\r\n                                    const style = window.getComputedStyle(initPhoneInput);\r\n                                    var padding = style.getPropertyValue('padding-left');\r\n                                    \/\/ Parse it to an integer and add 10\r\n                                    var newPadding = parseInt(padding, 10) + 10;\r\n                                    \/\/ Apply the new value\r\n                                    const phoneLabel = document.querySelector(\".custom-form .iti+.form-label\");\r\n                                    if (phoneLabel) {\r\n                                        phoneLabel.style.left = newPadding + \"px\";\r\n                                    }\r\n                                }\r\n                            } catch (e) {\r\n                                console.warn(\"Could not set phone label position:\", e);\r\n                            }\r\n                            \/\/ Add real-time validation listeners\r\n                            const allFormFields = document.querySelectorAll(\r\n                                '#init_firstName, #init_lastName, #init_email, #init_company, #init_jobTitle, #init_therapUser, #init_state, #init_individuals, #init_county, #init_assistance, #init_message, #privacy'\r\n                            );\r\n                            allFormFields.forEach(field => {\r\n                                field.addEventListener(field.tagName === 'SELECT' ? 'change' : 'input',\r\n                                    (e) => {\r\n                                        \/\/ Determine the most specific container to control the error style (form-field or form-row)\r\n                                        let container = e.target.closest(\r\n                                            '.form-field, .privacy-row');\r\n                                        if (!container && e.target.id === 'init_message') {\r\n                                            container = e.target.closest('.form-row.message-row');\r\n                                        }\r\n                                        \/\/ 1. Clear the specific error message\r\n                                        const errorKey = e.target.id.replace('init_',\r\n                                            ''); \/\/ e.g., 'init_firstName' -> 'firstName'\r\n                                        clearError(\r\n                                            errorKey\r\n                                            ); \/\/ This function just hides the error message span\r\n                                        \/\/ 2. Re-run a detailed validation check for the current field only\r\n                                        let isFieldValid = true;\r\n                                        \/\/ Check if the element should be considered \"filled\"\r\n                                        const isFilled = e.target.value.trim() !== '' || (e.target\r\n                                            .type === 'checkbox' && e.target.checked);\r\n                                        if (e.target.hasAttribute('required') && !isFilled) {\r\n                                            isFieldValid = false;\r\n                                        }\r\n                                        \/\/ Special email format check\r\n                                        else if (e.target.id === 'init_email' && isFilled && !\r\n                                            validateEmail(e.target.value)) {\r\n                                            isFieldValid = false;\r\n                                        }\r\n                                        if (isFieldValid) {\r\n                                            if (container) {\r\n                                                \/\/ Only remove the error class from this field's immediate container\r\n                                                container.classList.remove('has-error');\r\n                                            }\r\n                                        } else {\r\n                                            \/\/ If it's still invalid, show the error again and ensure the class stays on the container\r\n                                            \/\/ Note: You would normally call showError here, but we only want to clear on input.\r\n                                            \/\/ For now, let's focus on clearing the class correctly.\r\n                                        }\r\n                                    });\r\n                            });\r\n                            \/\/ Select all text inputs and textareas\r\n                            const inputs = document.querySelectorAll(\r\n                                '.form-input, .form-textarea'\r\n                            );\r\n                            inputs.forEach(input => {\r\n                                \/\/ 1. Add blank placeholder.\r\n                                input.placeholder = ' ';\r\n                                \/\/ 2. Fallback for older browsers\r\n                                function checkValue() {\r\n                                    if (input.value) {\r\n                                        input.classList.add('has-value');\r\n                                    } else {\r\n                                        input.classList.remove('has-value');\r\n                                    }\r\n                                }\r\n                                input.addEventListener('blur', checkValue);\r\n                                \/\/ 3. Check on load in case of browser autofill\r\n                                checkValue();\r\n                            });\r\n                            \/\/ Add change listener to selects for the same JS fallback (if needed)\r\n                            const selects = document.querySelectorAll('.form-select');\r\n                            const mainForm = document.getElementById('contactForm');\r\n                            if (mainForm) {\r\n                                mainForm.addEventListener('reset', function() {\r\n                                    \/\/ On reset, the :valid state might not update, so we force it\r\n                                    selects.forEach(select => {\r\n                                        select.classList.remove('has-value');\r\n                                        \/\/ Reset Choices.js instance\r\n                                        const choice = choicesInstances[select.id];\r\n                                        if (choice) {\r\n                                            choice.setChoiceByValue('');\r\n                                        }\r\n                                    });\r\n                                    \/\/ Also reset the reCAPTCHA\r\n                                    try {\r\n                                        grecaptcha.reset(recaptchaWidgetId);\r\n                                    } catch (e) {\r\n                                        console.warn(\"Could not reset reCAPTCHA widget.\");\r\n                                    }\r\n                                    recaptchaToken = ''; \/\/ Clear the token\r\n                                    \/\/ Manually reset conditional fields\r\n                                    updateConditionalFields();\r\n                                    updateMessageRequirement();\r\n                                    updateIndividualsFieldVisibility();\r\n                                });\r\n                            }\r\n                            \/\/ START: ADDED - New logic initialization\r\n                            \/\/ Set initial state\r\n                            updateConditionalFields();\r\n                            updateMessageRequirement();\r\n                            \/\/ Activate input syncing\r\n                            syncFormFields();\r\n\r\n                            function updateSalesforceSubject() {\r\n                                const url = window.location.href.toLowerCase();\r\n                                const isContactPage = url.includes('contact');\r\n                                \/\/ Determine the subject value based on the URL check\r\n                                const subjectValue = isContactPage ?\r\n                                    \"Contact Us - Request Form\" :\r\n                                    \"Therap State - Request Form\";\r\n                                \/\/ Get the hidden inputs for the Web-to-Case form (first-form-web-to-case)\r\n                                const customField = document.getElementById('00N0H00000JoJtu');\r\n                                const subjectField = document.getElementById('subject');\r\n                                \/\/ Apply the determined value to both hidden fields\r\n                                if (customField) {\r\n                                    customField.value = subjectValue;\r\n                                }\r\n                                if (subjectField) {\r\n                                    subjectField.value = subjectValue;\r\n                                }\r\n                                console.log(\"Salesforce Subject set to:\", subjectValue);\r\n                            }\r\n                            \/\/ Call the function once when the DOM content is fully loaded\r\n                            updateSalesforceSubject(); \/\/ Call the function directly inside DOMContentLoaded\r\n                            \/\/ END: ADDED\r\n                            \/\/ remove br on 600px viewport and below\r\n                            function removeBrOnSmallScreens() {\r\n                                if ($(window).width() <= 600) {\r\n                                    $(\"div#trouble-login-info p\").html(\r\n                                        'If you are having issues logging in to your Therap account, please view the <a href=\"https:\/\/help.therapservices.net\/s\/article\/2035\" target=\"_blank\">Login\u00a0Troubleshooting\u00a0Guide<\/a>.'\r\n                                    );\r\n                                } else {\r\n                                    $(\"div#trouble-login-info p\").html(\r\n                                        'If you are having issues logging in to your Therap account,<br>please view the <a href=\"https:\/\/help.therapservices.net\/s\/article\/2035\" target=\"_blank\">Login\u00a0Troubleshooting\u00a0Guide<\/a>.'\r\n                                    );\r\n                                }\r\n                            }\r\n                            removeBrOnSmallScreens();\r\n                            $(window).resize(function() {\r\n                                removeBrOnSmallScreens();\r\n                            });\r\n                        });\r\n                    <\/script>\r\n                    <!-- SF FORM END -->\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n<\/div>\r\n<div id=\"custom-modal-2\" class=\"custom-modal\">\r\n    <div class=\"custom-modal-dialog\">\r\n        <div class=\"custom-modal-content\">\r\n            <span id=\"close-modal-2\" class=\"close-modal style-change-1\">\r\n                <svg width=\"12\" height=\"12\" viewBox=\"0 0 14 14\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\r\n                    class=\"ai-style-change-2\">\r\n                    <path d=\"M1 1L13 13M1 13L13 1\" stroke=\"currentColor\" stroke-width=\"2.6\" stroke-linecap=\"round\"\r\n                        stroke-linejoin=\"round\"><\/path>\r\n                <\/svg>\r\n            <\/span>\r\n            <div class=\"custom-modal-body\">\r\n\r\n                <p class=\"model-heading\" style=\"text-align: center !important\">\r\n                    <!-- Get started -->\r\n                <\/p>\r\n                <div class=\"custom-modal-inner\">\r\n                    <!-- Calendly inline widget begin -->\r\n                    <div class=\"calendly-inline-widget\" data-url=\"https:\/\/calendly.com\/d\/crzr-d9t-5hp\"\r\n                        style=\"min-width:320px;height:700px;\"><\/div>\r\n                    <script type=\"text\/javascript\" src=\"https:\/\/assets.calendly.com\/assets\/external\/widget.js\" async>\r\n                    <\/script>\r\n                    <!-- Calendly inline widget end -->\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n<\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-12766","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.4 (Yoast SEO v28.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Eligibility Determination Software for HCBS Case Managers | Therap<\/title>\n<meta name=\"description\" content=\"Standardize eligibility determinations, track funding categories, and manage annual redeterminations for HCBS waivers with Therap&#039;s Intake &amp; Eligibility software.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.therapservices.net\/products\/intake-eligibility\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Intake &amp; Eligibility Tools\" \/>\n<meta property=\"og:description\" content=\"Standardize eligibility determinations, track funding categories, and manage annual redeterminations for HCBS waivers with Therap&#039;s Intake &amp; Eligibility software.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.therapservices.net\/products\/intake-eligibility\/\" \/>\n<meta property=\"og:site_name\" content=\"products\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/therapservices\" \/>\n<meta property=\"article:modified_time\" content=\"2026-10-12T04:44:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.therapservices.net\/products\/wp-content\/uploads\/sites\/60\/2026\/05\/thumbnail-bizsite.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"628\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"10 minutes\" \/>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Eligibility Determination Software for HCBS Case Managers | Therap","description":"Standardize eligibility determinations, track funding categories, and manage annual redeterminations for HCBS waivers with Therap's Intake & Eligibility software.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.therapservices.net\/products\/intake-eligibility\/","og_locale":"en_US","og_type":"article","og_title":"Intake &amp; Eligibility Tools","og_description":"Standardize eligibility determinations, track funding categories, and manage annual redeterminations for HCBS waivers with Therap's Intake & Eligibility software.","og_url":"https:\/\/www.therapservices.net\/products\/intake-eligibility\/","og_site_name":"products","article_publisher":"https:\/\/www.facebook.com\/therapservices","article_modified_time":"2026-10-12T04:44:21+00:00","og_image":[{"width":1200,"height":628,"url":"https:\/\/www.therapservices.net\/products\/wp-content\/uploads\/sites\/60\/2026\/05\/thumbnail-bizsite.png","type":"image\/png"}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"10 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.therapservices.net\/products\/intake-eligibility\/","url":"https:\/\/www.therapservices.net\/products\/intake-eligibility\/","name":"Eligibility Determination Software for HCBS Case Managers | Therap","isPartOf":{"@id":"https:\/\/www.therapservices.net\/products\/#website"},"datePublished":"2020-06-11T07:53:44+00:00","dateModified":"2026-10-12T04:44:21+00:00","description":"Standardize eligibility determinations, track funding categories, and manage annual redeterminations for HCBS waivers with Therap's Intake & Eligibility software.","breadcrumb":{"@id":"https:\/\/www.therapservices.net\/products\/intake-eligibility\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.therapservices.net\/products\/intake-eligibility\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.therapservices.net\/products\/intake-eligibility\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.therapservices.net\/products\/"},{"@type":"ListItem","position":2,"name":"Intake &amp; Eligibility Tools"}]},{"@type":"WebSite","@id":"https:\/\/www.therapservices.net\/products\/#website","url":"https:\/\/www.therapservices.net\/products\/","name":"products","description":"Electronic Documentation for I\/DD Providers","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.therapservices.net\/products\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/www.therapservices.net\/products\/wp-json\/wp\/v2\/pages\/12766","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.therapservices.net\/products\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.therapservices.net\/products\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.therapservices.net\/products\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.therapservices.net\/products\/wp-json\/wp\/v2\/comments?post=12766"}],"version-history":[{"count":7,"href":"https:\/\/www.therapservices.net\/products\/wp-json\/wp\/v2\/pages\/12766\/revisions"}],"predecessor-version":[{"id":17495,"href":"https:\/\/www.therapservices.net\/products\/wp-json\/wp\/v2\/pages\/12766\/revisions\/17495"}],"wp:attachment":[{"href":"https:\/\/www.therapservices.net\/products\/wp-json\/wp\/v2\/media?parent=12766"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}