{"id":30,"date":"2020-06-16T23:35:58","date_gmt":"2020-06-16T15:35:58","guid":{"rendered":"http:\/\/spot.com.hk\/?page_id=30"},"modified":"2025-04-16T17:51:35","modified_gmt":"2025-04-16T09:51:35","slug":"contact-us","status":"publish","type":"page","link":"https:\/\/spot.com.hk\/zh\/contact-us\/","title":{"rendered":"\u806f\u7d61\u6211\u5011"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; min_height=&#8221;99px&#8221; custom_padding=&#8221;3px|||||&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;||17px|||&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; custom_margin=&#8221;||26px|||&#8221; custom_padding=&#8221;0px|||||&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;]Thank you for your enquiry.\u00a0 Please <strong><a href=\"#contactform\" title=\"make appointment\">fill in the form<\/a> <\/strong>to send us a message, or contact the clinic directly using the details below.[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;3px|||||&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;4.16&#8243; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_text admin_label=&#8221;Text&#8221; _builder_version=&#8221;4.19.0&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;]<\/p>\n<h2>Central<\/h2>\n<p>17\/F Wing&#8217;s Building<br \/>110-116 Queens Road<br \/><span style=\"font-size: 15px;\">Central,\u00a0<\/span><span style=\"font-size: 15px;\">Hong Kong<\/span><\/p>\n<p><a href=\"tel:+85228073223\"><span style=\"font-size: 15px;\">(852) 2807 3223<\/span><\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.19.0&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;]<\/p>\n<h2>Kowloon Bay<\/h2>\n<p>Unit 1501A, 15\/F Eastmark<br \/>21 Sheung Yuet Road<br \/>Kowloon\u00a0Bay<br \/>Kowloon<\/p>\n<p><a href=\"tel:+85228070800\">(852) 2807 0800<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;]<\/p>\n<h2>Wong Chuk Hang<\/h2>\n<p>10\/F, 1021-1025 One Island South<br \/>2 Heung Yip Road<br \/>Wong Chuk Hang, Hong Kong<\/p>\n<p><a href=\"tel:+85228072992\">(852) 2807 2992<\/a><\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;]<\/p>\n<h2 class=\"title\">Discovery Bay<\/h2>\n<p>6\/F, Flat 604<br \/>South DB Plaza (Block A)<br \/>Discovery Bay<br \/>Lantau Island<\/p>\n<p><a href=\"tel:+85228072992\">(852) 2807 2992<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_map address=&#8221;2\/F, Wings Building, 110-116 Queen&#8217;s Road Central, Central, Hong Kong&#8221; zoom_level=&#8221;11&#8243; address_lat=&#8221;22.299862133222&#8243; address_lng=&#8221;114.1337008255&#8243; _builder_version=&#8221;4.16&#8243; sticky_position=&#8221;top&#8221; sticky_offset_top=&#8221;180px&#8221; sticky_limit_bottom=&#8221;row&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_map_pin title=&#8221;SPOT Central&#8221; pin_address=&#8221;2\/F, Wings Building, 110-116 Queen&#8217;s Road Central, Central, Hong Kong&#8221; pin_address_lat=&#8221;22.2836414&#8243; pin_address_lng=&#8221;114.1546757&#8243; _builder_version=&#8221;4.10.8&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;]<\/p>\n<p>17\/F, Wings Building, 110-116 Queen&#8217;s Road Central, Central, Hong Kong<\/p>\n<p><a href=\"https:\/\/www.google.com\/maps\/dir\/\/2%2FF,+Impakt+Hong+Kong,+Wings+Building,+110-116+Queen&#039;s+Road+Central,+Central,+Hong+Kong\/@22.2836414,114.1524817,17z\/data=!4m8!4m7!1m0!1m5!1m1!1s0x3404007ca12fb491:0x34160959c0ad2ab9!2m2!1d114.1546757!2d22.2836414\" target=\"_blank\" rel=\"noopener\">Get Directions<\/a><\/p>\n<p>[\/et_pb_map_pin][et_pb_map_pin title=&#8221;SPOT Kowloon Bay&#8221; pin_address=&#8221;21 Sheung Yuet Rd, Kowloon Bay, Hong Kong&#8221; pin_address_lat=&#8221;22.3222915&#8243; pin_address_lng=&#8221;114.2112344&#8243; _builder_version=&#8221;4.10.8&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;]<\/p>\n<p>Unit 1501A, 15\/F Eastmark, 21 Sheung Yuet Road, Kowloon Bay,\u00a0Kowloon<\/p>\n<p><a href=\"https:\/\/www.google.com\/maps\/dir\/\/22.3225198,114.2111808\/@22.3222915,114.2090404,17z\" target=\"_blank\" rel=\"noopener\">Get Directions<\/a><\/p>\n<p>[\/et_pb_map_pin][et_pb_map_pin title=&#8221;SPOT Wong Chuk Hang&#8221; pin_address=&#8221;2 Heung Yip Rd, Aberdeen, Hong Kong&#8221; pin_address_lat=&#8221;22.2486161&#8243; pin_address_lng=&#8221;114.1691604&#8243; _builder_version=&#8221;4.10.8&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;]<\/p>\n<p>1021-1025 One Island South, 2 Heung Yip Road, Wong Chuk Hang, Hong Kong<\/p>\n<p><a href=\"https:\/\/www.google.com\/maps\/dir\/\/One+Island+South,+2+Heung+Yip+Rd,+Hong+Kong\/@22.2485971,114.1668688,17z\/data=!4m8!4m7!1m0!1m5!1m1!1s0x340400221427932f:0xdac696b4661b3f5a!2m2!1d114.1690628!2d22.2485971\" target=\"_blank\" rel=\"noopener\">Get Directions<\/a><\/p>\n<p>[\/et_pb_map_pin][et_pb_map_pin title=&#8221;SPOT Discovery Bay&#8221; pin_address=&#8221;Discovery Bay Rd, Discovery Bay, Hong Kong&#8221; pin_address_lat=&#8221;22.2957732&#8243; pin_address_lng=&#8221;114.0165822&#8243; _builder_version=&#8221;4.10.8&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;]<\/p>\n<p>Flat 604, South DB Plaza (Block A), Discovery Bay Rd, Discovery Bay, Hong Kong<\/p>\n<p><a href=\"https:\/\/www.google.com\/maps\/dir\/Discovery+Bay+Rd,+Discovery+Bay,+Hong+Kong\/22.2997976,114.0123703\/@22.2995886,114.0102721,17z\/data=!3m1!4b1!4m8!4m7!1m5!1m1!1s0x3403fdb0c24b7a9b:0xf3698fe6f474eac1!2m2!1d114.0125389!2d22.2993232!1m0\" target=\"_blank\" rel=\"noopener\">Get Directions<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>[\/et_pb_map_pin][\/et_pb_map][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; module_id=&#8221;contactform&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; 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screen-reader-text'>\u59d3<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_7\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_7'>Relationship<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_1_7' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Parent' >Parent<\/option><option value='Grandparent' >Grandparent<\/option><option value='Legal Guardian' >Legal Guardian<\/option><\/select><\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_9'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_1_9' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_8\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_8'>Mobile phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_1_8' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_21\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_21'>Phone number<\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_1_21' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Service(s) requested:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_11'><div class='gchoice gchoice_1_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Speech &amp; Language Therapy'  id='choice_1_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1' class='gform-field-label gform-field-label--type-inline'>Speech &amp; Language Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Occupational Therapy'  id='choice_1_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_2' id='label_1_11_2' class='gform-field-label gform-field-label--type-inline'>Occupational Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='Physiotherapy'  id='choice_1_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_3' id='label_1_11_3' class='gform-field-label gform-field-label--type-inline'>Physiotherapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.4' type='checkbox'  value='Clinical Psychology'  id='choice_1_11_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_4' id='label_1_11_4' class='gform-field-label gform-field-label--type-inline'>Clinical Psychology<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.5' type='checkbox'  value='Counselling'  id='choice_1_11_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_5' id='label_1_11_5' class='gform-field-label gform-field-label--type-inline'>Counselling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.6' type='checkbox'  value='PsychEd \/ Education Assessments'  id='choice_1_11_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_6' id='label_1_11_6' class='gform-field-label gform-field-label--type-inline'>PsychEd \/ Education Assessments<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.7' type='checkbox'  value='DIRFloortime'  id='choice_1_11_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_7' id='label_1_11_7' class='gform-field-label gform-field-label--type-inline'>DIRFloortime<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.8' type='checkbox'  value='Sensory Integration'  id='choice_1_11_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_8' id='label_1_11_8' class='gform-field-label gform-field-label--type-inline'>Sensory Integration<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.9' type='checkbox'  value='Feeding Therapy'  id='choice_1_11_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_9' id='label_1_11_9' class='gform-field-label gform-field-label--type-inline'>Feeding Therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.11' type='checkbox'  value='Shadow Teachers'  id='choice_1_11_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_11' id='label_1_11_11' class='gform-field-label gform-field-label--type-inline'>Shadow Teachers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.12' type='checkbox'  value='Unknown'  id='choice_1_11_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_12' id='label_1_11_12' class='gform-field-label gform-field-label--type-inline'>Unknown<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_12\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'>Reason for referral\/ what challenges is your child having?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_12' id='input_1_12' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_1_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Which location suits you best?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_13'>\n\t\t\t<div class='gchoice gchoice_1_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='One Island South - Wong Chuk Hang'  id='choice_1_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_0' id='label_1_13_0' class='gform-field-label gform-field-label--type-inline'>One Island South - Wong Chuk Hang<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Central'  id='choice_1_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'>Central<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Kowloon Bay'  id='choice_1_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_2' id='label_1_13_2' class='gform-field-label gform-field-label--type-inline'>Kowloon Bay<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Discovery Bay'  id='choice_1_13_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_3' id='label_1_13_3' class='gform-field-label gform-field-label--type-inline'>Discovery Bay<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_13_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='No Preference'  id='choice_1_13_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_4' id='label_1_13_4' class='gform-field-label gform-field-label--type-inline'>No Preference<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >How did you find out about SPOT?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_14'>\n\t\t\t<div class='gchoice gchoice_1_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='SPOT Website'  id='choice_1_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_0' id='label_1_14_0' class='gform-field-label gform-field-label--type-inline'>SPOT Website<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Google\/Internet search'  id='choice_1_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>Google\/Internet search<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Facebook\/Instagram'  id='choice_1_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_2' id='label_1_14_2' class='gform-field-label gform-field-label--type-inline'>Facebook\/Instagram<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Friend'  id='choice_1_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_3' id='label_1_14_3' class='gform-field-label gform-field-label--type-inline'>Friend<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Teacher'  id='choice_1_14_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_4' id='label_1_14_4' class='gform-field-label gform-field-label--type-inline'>Teacher<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Doctor\/Professional Referral'  id='choice_1_14_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_5' id='label_1_14_5' class='gform-field-label gform-field-label--type-inline'>Doctor\/Professional Referral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Virtus Referral'  id='choice_1_14_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_6' id='label_1_14_6' class='gform-field-label gform-field-label--type-inline'>Virtus Referral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='gf_other_choice'  id='choice_1_14_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_7' id='label_1_14_7' class='gform-field-label gform-field-label--type-inline'>\u5176\u4ed6<\/label><br \/><input id='input_1_14_other' class='gchoice_other_control' name='input_14_other' type='text' value='\u5176\u4ed6' aria-label='\u5176\u4ed6\uff0c\u8acb\u8a3b\u660e'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_15\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_15'>Which Doctor?<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_1_15' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_20'>Which Friend?<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_1_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset 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