{"id":7142,"date":"2026-03-21T02:06:37","date_gmt":"2026-03-20T20:36:37","guid":{"rendered":"https:\/\/medcollegedarshan.com\/?post_type=formgent_form&#038;p=7142"},"modified":"2026-03-24T01:39:46","modified_gmt":"2026-03-23T20:09:46","slug":"report-quackery","status":"publish","type":"formgent_form","link":"https:\/\/medcollegedarshan.com\/index.php\/form\/report-quackery\/","title":{"rendered":"Report Quackery \/ Unethical Practices"},"content":{"rendered":"\n<style>\n    .formgent-form-7142 {\n        \/* Form variables *\/\n        --formgent-form-background-color: #ffffff;\n        --formgent-form-background-image: ;\n        --formgent-form-background-image-position:\n        center center;\n\n        --formgent-form-padding-desktop: 20px 20px 40px 20px;\n        --formgent-form-padding-tablet: 20px 20px 40px 20px;\n        --formgent-form-padding-mobile: 20px 20px 40px 20px;\n        --formgent-form-margin-desktop: 0 0 0 0;\n        --formgent-form-margin-tablet: 0 0 0 0;\n      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    class='formgent-has-input-icon formgent-suffix date'\n            style=\"width: 100%;\"\n        >\n            <input\n                autocomplete=\"off\"\n                class='formgent-field-single__input formgent-datepicker'\n                type=\"text\"\n                readonly\n                id=\"formgent-YgJjesfsHRsi\"\n                data-wp-bind--value=\"state.getDatePickerValue\"\n                placeholder=\"Select date\"\n            \/>\n        <\/div>\n            <\/div>\n<\/div>\n\n\n\n<h4 data-wp-bind--hidden=\"state.hideField\" data-wp-context=\"{ &quot;name&quot;: &quot;OqgPISCxdnDp-eQhn7cR0&quot; }\" class=\"wp-block-heading display-none\">Description of Complaint<\/h4>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"textarea-2\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-MxzpVrUox6bP\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Briefly describe what happened                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <textarea\n                class=\"formgent-field-single__input formgent-field-single__input--textarea\"\n                type=\"text\"\n                id=\"formgent-MxzpVrUox6bP\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            ><\/textarea>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"textarea-3\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-iy5d3MeOmFhD\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                What makes you believe this is <br>malpractice or illegal practice?                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <textarea\n                class=\"formgent-field-single__input formgent-field-single__input--textarea\"\n                type=\"text\"\n                id=\"formgent-iy5d3MeOmFhD\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            ><\/textarea>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{&quot;name&quot;:&quot;dropdown&quot;,&quot;field_label&quot;:&quot;Were any patients harmed?&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;thutB19Ko0FGHbAAUX6fx&quot;,&quot;label&quot;:&quot;Yes&quot;,&quot;value&quot;:&quot;yes&quot;},{&quot;label&quot;:&quot;No&quot;,&quot;id&quot;:&quot;1&quot;,&quot;collapsed&quot;:&quot;1&quot;,&quot;is_default&quot;:&quot;&quot;,&quot;value&quot;:&quot;no&quot;},{&quot;label&quot;:&quot;Not Sure&quot;,&quot;id&quot;:&quot;2&quot;,&quot;collapsed&quot;:&quot;1&quot;,&quot;is_default&quot;:&quot;&quot;,&quot;value&quot;:&quot;not-sure&quot;}]}' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-slZUuvvyXt7D\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Were any patients harmed?                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <select class=\"formgent-field-single__input formgent-field-single__input--select\"\n                id=\"formgent-slZUuvvyXt7D\"\n                data-wp-init=\"callbacks.dropdownInit\"\n                data-placeholder=\"Select an option...\"\n                autocomplete=\"off\"\n            >\n                                    <option value=\"\">Select an option...<\/option>\n                                            <option value=\"yes\">\n                            Yes                        <\/option>\n                                            <option value=\"no\">\n                            No                        <\/option>\n                                            <option value=\"not-sure\">\n                            Not Sure                        <\/option>\n                                                <\/select>\n\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{&quot;name&quot;:&quot;dropdown-2&quot;,&quot;field_label&quot;:&quot;Is the person practicing without &lt;br&gt;proper qualification or license?&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;thutB19Ko0FGHbAAUX6fx&quot;,&quot;label&quot;:&quot;Yes&quot;,&quot;value&quot;:&quot;yes&quot;},{&quot;label&quot;:&quot;No&quot;,&quot;id&quot;:&quot;1&quot;,&quot;collapsed&quot;:&quot;1&quot;,&quot;is_default&quot;:&quot;&quot;,&quot;value&quot;:&quot;no&quot;},{&quot;label&quot;:&quot;Not Sure&quot;,&quot;id&quot;:&quot;2&quot;,&quot;collapsed&quot;:&quot;1&quot;,&quot;is_default&quot;:&quot;&quot;,&quot;value&quot;:&quot;not-sure&quot;}]}' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-okuq7iQ2JV4m\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Is the person practicing without <br>proper qualification or license?                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <select class=\"formgent-field-single__input formgent-field-single__input--select\"\n                id=\"formgent-okuq7iQ2JV4m\"\n                data-wp-init=\"callbacks.dropdownInit\"\n                data-placeholder=\"Select an option...\"\n                autocomplete=\"off\"\n            >\n                                    <option value=\"\">Select an option...<\/option>\n                                            <option value=\"yes\">\n                            Yes                        <\/option>\n                                            <option value=\"no\">\n                            No                        <\/option>\n                                            <option value=\"not-sure\">\n                            Not Sure                        <\/option>\n                                                <\/select>\n\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"text\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-IAdY3Te3QF3k\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Any witnesses or additional details:                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-IAdY3Te3QF3k\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                    <\/div>\n    <\/div>\n<\/div>\n\n<style>\n        .formgent-upload-container {\n            min-height: 150px;\n            display: flex;\n            align-items: center;\n            justify-content: center;\n            flex-direction: column;\n            cursor: pointer;\n            border-radius: 8px;\n            border: 1px dashed var(--formgent-color-gray-300);\n            background: var(--formgent-field-background-color);\n            width: 100%;\n            padding: 20px;\n            text-align: center;\n        }\n        .formgent-upload-container .formgent-upload-area {\n            border: 0 none;\n        }\n        .formgent-upload-container p {\n            color: var(--formgent-field-placeholder-color);\n            text-align: center;\n            font-size: 14px;\n            font-weight: 400;\n            line-height: 1.6;\n            margin: 8px 0 0 0;\n        }\n        .formgent-upload-button {\n            display: inline-flex;\n            padding: 8px 12px;\n            justify-content: center;\n            align-items: center;\n            gap: 6px;\n            border-radius: 8px;\n            background: var(--formgent-color-gray-500, #747c89);\n            cursor: pointer;\n            color: #fff;\n            text-align: center;\n            font-size: 13px;\n            font-weight: 500;\n            transition: 0.3s ease;\n            border: 0 none;\n            box-shadow: none;\n        }\n    <\/style>\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{\"name\":\"file-upload\",\"highlightFileUpload\":false,\"uploadedFiles\":[],\"maxSizeError\":false,\"maxFileError\":false,\"maxAllowed\":5,\"notAllowed\":false,\"maxAllowedReached\":false}' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-single--file-upload formgent-field-align-top\">\n                    <span\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Upload Supporting Evidence                            <\/span>\n                <div\n            class=\"formgent-upload-container\"\n        >\n            <label aria-disabled=\"false\"\n                for=\"formgent-SF9u7TdFDTQL\"\n                class=\"formgent-upload-area\"\n                tabindex=\"0\"\n                role=\"button\"\n                aria-label=\"Upload\"\n                data-wp-class--formgent-file-upload-highlight=\"context.highlightFileUpload\"\n                data-wp-class--formgent-file-upload-disabled=\"context.maxAllowedReached\"\n                data-wp-bind--aria-disabled=\"context.maxAllowedReached\"\n                data-wp-on--dragenter=\"actions.fileDragEnter\"\n                data-wp-on--dragover=\"actions.fileDragEnter\"\n                data-wp-on--dragleave=\"actions.fileDragLeave\"\n                data-wp-on--drop=\"actions.fileDrop\"\n                data-wp-on--keydown=\"actions.handleUploadAreaKeydown\"\n            >\n                <span class=\"formgent-upload-button\">\n                    <svg width=\"14\" height=\"14\" viewBox=\"0 0 14 14\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0.333252 1.00016C0.333252 0.631973 0.631729 0.333496 0.999919 0.333496H12.9999C13.3681 0.333496 13.6666 0.631973 13.6666 1.00016C13.6666 1.36835 13.3681 1.66683 12.9999 1.66683H0.999919C0.631729 1.66683 0.333252 1.36835 0.333252 1.00016ZM6.99992 3.00016C7.17673 3.00016 7.3463 3.0704 7.47132 3.19542L11.4713 7.19543C11.7317 7.45577 11.7317 7.87788 11.4713 8.13823C11.211 8.39858 10.7889 8.39858 10.5285 8.13823L7.66659 5.27631V13.0002C7.66659 13.3684 7.36811 13.6668 6.99992 13.6668C6.63173 13.6668 6.33325 13.3684 6.33325 13.0002V5.27631L3.47132 8.13823C3.21097 8.39858 2.78886 8.39858 2.52851 8.13823C2.26816 7.87788 2.26816 7.45577 2.52851 7.19543L6.52851 3.19542C6.65354 3.0704 6.82311 3.00016 6.99992 3.00016Z\" fill=\"currentColor\"\/>\n<\/svg>\n                    Upload                <\/span>\n                <input\n                    multiple\n                    type=\"file\"\n                    class=\"formgent-file-input\"\n                    style=\"display: none;\"\n                    id=\"formgent-SF9u7TdFDTQL\"\n                    data-wp-on--change=\"actions.onChangeFile\"\n                    data-wp-bind--disabled=\"context.maxAllowedReached\"\n                \/>\n\n                <!-- Hidden validation input for required field validation -->\n                <input\n                    type=\"hidden\"\n                    class=\"formgent-validate-field-input\"\n                    name=\"file-upload\"\n                    value=\"\"\n                \/>\n\n                <p>Drop file here or click to upload<\/p>\n\n                                    <p>Maximum file size allowed: 10000KB<\/p>\n                \n                                    <p>Maximum number of files allowed: 5<\/p>\n                            <\/label>\n\n            <span hidden class=\"formgent-warning-message\" data-wp-bind--hidden=\"!context.maxSizeError\">\n                Maximum file size allowed: 10000KB            <\/span>\n            <span hidden class=\"formgent-warning-message\" data-wp-bind--hidden=\"!context.maxFileError\">\n                Maximum number of files allowed: 5            <\/span>\n            <span hidden class=\"formgent-warning-message\" data-wp-bind--hidden=\"!context.notAllowed\">\n                File type not allowed. Allowed file types: image\/jpeg, image\/png, image\/gif, application\/pdf            <\/span>\n\n\n            <div hidden class=\"formgent-file-preview\" data-wp-bind--hidden=\"!state.hasFiles\">\n                <ul class=\"formgent-preview-items\">\n                    <template data-wp-each=\"context.uploadedFiles\">\n                        <li class=\"formgent-preview-container\">\n                            <div class=\"formgent-file-preview-media\">\n                                <div>\n                                    <img\n                                        data-wp-bind--hidden=\"!context.item.isImage\"\n                                        class=\"formgent-preview-image\"\n                                        data-wp-bind--src=\"context.item.src\"\n                                    \/>\n                                    <video\n                                        data-wp-bind--hidden=\"!context.item.isVideo\"\n                                        class=\"formgent-preview-image\"\n                                        width=\"120\"\n                                        height=\"100\"\n                                    >\n                                        <source data-wp-bind--src=\"context.item.src\">\n                                    <\/video>\n                                    <span data-wp-bind--hidden=\"!context.item.isOther\">\n                                        <svg width=\"40\" height=\"40\" viewBox=\"0 0 40 40\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><g id=\"file-attachment\"><path id=\"Icon (Stroke)\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.5978 1.66675H25.4022C26.7438 1.66673 27.8511 1.66671 28.753 1.74041C29.6899 1.81695 30.551 1.98122 31.3599 2.39337C32.6143 3.03253 33.6342 4.0524 34.2734 5.30681C34.6855 6.11571 34.8498 6.97688 34.9263 7.91371C35 8.81569 35 9.92295 35 11.2645V11.6667C35 12.5872 34.2538 13.3334 33.3333 13.3334C32.4129 13.3334 31.6667 12.5872 31.6667 11.6667V11.3334C31.6667 9.90578 31.6654 8.9353 31.6041 8.18515C31.5444 7.45445 31.4362 7.08078 31.3034 6.82011C30.9838 6.19291 30.4738 5.68297 29.8466 5.36339C29.586 5.23058 29.2123 5.12237 28.4816 5.06267C27.7315 5.00138 26.761 5.00008 25.3333 5.00008H14.6667C13.239 5.00008 12.2685 5.00138 11.5184 5.06267C10.7877 5.12237 10.414 5.23058 10.1534 5.36339C9.52616 5.68297 9.01622 6.19291 8.69665 6.82012C8.56383 7.08078 8.45562 7.45445 8.39592 8.18515C8.33463 8.9353 8.33333 9.90578 8.33333 11.3334V28.6667C8.33333 30.0944 8.33463 31.0649 8.39592 31.815C8.45562 32.5457 8.56383 32.9194 8.69665 33.18C9.01622 33.8073 9.52616 34.3172 10.1534 34.6368C10.414 34.7696 10.7877 34.8778 11.5184 34.9375C12.2685 34.9988 13.239 35.0001 14.6667 35.0001H20.8333C21.7538 35.0001 22.5 35.7463 22.5 36.6667C22.5 37.5872 21.7538 38.3334 20.8333 38.3334H14.5978C13.2562 38.3334 12.1489 38.3335 11.247 38.2598C10.3101 38.1832 9.44896 38.0189 8.64006 37.6068C7.38565 36.9676 6.36578 35.9478 5.72662 34.6934C5.31447 33.8845 5.1502 33.0233 5.07366 32.0865C4.99996 31.1845 4.99998 30.0772 5 28.7356V11.2646C4.99998 9.92297 4.99996 8.8157 5.07366 7.91371C5.1502 6.97688 5.31447 6.11571 5.72662 5.30681C6.36578 4.0524 7.38565 3.03253 8.64006 2.39337C9.44896 1.98122 10.3101 1.81695 11.247 1.74041C12.149 1.66671 13.2562 1.66673 14.5978 1.66675ZM11.6667 11.6667C11.6667 10.7463 12.4129 10.0001 13.3333 10.0001H26.6667C27.5871 10.0001 28.3333 10.7463 28.3333 11.6667C28.3333 12.5872 27.5871 13.3334 26.6667 13.3334H13.3333C12.4129 13.3334 11.6667 12.5872 11.6667 11.6667ZM11.6667 18.3334C11.6667 17.4129 12.4129 16.6667 13.3333 16.6667H20.8333C21.7538 16.6667 22.5 17.4129 22.5 18.3334C22.5 19.2539 21.7538 20.0001 20.8333 20.0001H13.3333C12.4129 20.0001 11.6667 19.2539 11.6667 18.3334ZM32.5 20.0001C32.0398 20.0001 31.6667 20.3732 31.6667 20.8334V30.0001C31.6667 30.9206 30.9205 31.6667 30 31.6667C29.0795 31.6667 28.3333 30.9206 28.3333 30.0001V20.8334C28.3333 18.5322 30.1988 16.6667 32.5 16.6667C34.8012 16.6667 36.6667 18.5322 36.6667 20.8334V30.0001C36.6667 33.682 33.6819 36.6667 30 36.6667C26.3181 36.6667 23.3333 33.682 23.3333 30.0001V23.3334C23.3333 22.4129 24.0795 21.6667 25 21.6667C25.9205 21.6667 26.6667 22.4129 26.6667 23.3334V30.0001C26.6667 31.841 28.1591 33.3334 30 33.3334C31.841 33.3334 33.3333 31.841 33.3333 30.0001V20.8334C33.3333 20.3732 32.9602 20.0001 32.5 20.0001ZM11.6667 25.0001C11.6667 24.0796 12.4129 23.3334 13.3333 23.3334H19.1667C20.0871 23.3334 20.8333 24.0796 20.8333 25.0001C20.8333 25.9206 20.0871 26.6667 19.1667 26.6667H13.3333C12.4129 26.6667 11.6667 25.9206 11.6667 25.0001Z\" fill=\"currentColor\"><\/path><\/g><\/svg>\n                                    <\/span>\n                                <\/div>\n                                <p class=\"formgent-file-name\">\n                                    <span data-wp-text=\"context.item.name\"><\/span><br\/>\n                                    <span data-wp-text=\"context.item.size\"><\/span>\n                                <\/p>\n                                <div\n                                    data-wp-bind--hidden=\"context.item.uploaded\"\n                                    class=\"formgent-file-preview-status\"\n                                >\n                                    <span\n                                        data-wp-style----formgent-file-upload-progress=\"context.item.progress\"\n                                        class=\"formgent-file-upload-progress\"\n                                    ><\/span>\n                                    <span\n                                        data-wp-text=\"context.item.progress\"\n                                        class=\"formgent-file-upload-progress-text\"\n                                    >\n                                        0%\n                                    <\/span>\n                                <\/div>\n                            <\/div>\n                            <div data-wp-bind--hidden=\"!context.item.uploaded\" class=\"formgent-file-preview-action\">\n                                <span\n                                    class=\"formgent-file-delete\"\n                                    tabindex=\"0\"\n                                    role=\"button\"\n                                    aria-label=\"Delete file\"\n                                    data-wp-on--click=\"actions.removeFile\"\n                                    data-wp-on--keydown=\"actions.handleRemoveFileKeydown\"\n                                >\n                                    <svg width=\"100%\" height=\"100%\" viewBox=\"0 0 24 24\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n <path d=\"M16 6V5.2C16 4.0799 16 3.51984 15.782 3.09202C15.5903 2.71569 15.2843 2.40973 14.908 2.21799C14.4802 2 13.9201 2 12.8 2H11.2C10.0799 2 9.51984 2 9.09202 2.21799C8.71569 2.40973 8.40973 2.71569 8.21799 3.09202C8 3.51984 8 4.0799 8 5.2V6M10 11.5V16.5M14 11.5V16.5M3 6H21M19 6V17.2C19 18.8802 19 19.7202 18.673 20.362C18.3854 20.9265 17.9265 21.3854 17.362 21.673C16.7202 22 15.8802 22 14.2 22H9.8C8.11984 22 7.27976 22 6.63803 21.673C6.07354 21.3854 5.6146 20.9265 5.32698 20.362C5 19.7202 5 18.8802 5 17.2V6\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/>\n <\/svg>\n                                <\/span>\n                            <\/div>\n                        <\/li>\n                    <\/template>\n                <\/ul>\n            <\/div>\n        <\/div>\n    <\/div>\n    <\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"gdpr\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single\">\n        <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--gdpr formgent-label-align-left\">\n            <input\n                class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                type=\"checkbox\"\n                id=\"formgent-tzRPzsY-NJ3R\"\n                data-wp-on--change=\"actions.updateGdpr\"\n                data-wp-bind--checked=\"state.getValue\"\n            \/>\n            <label for=\"formgent-tzRPzsY-NJ3R\" class=\"formgent-field-label\">\n                <span class=\"formgent-field-gdpr-checkbox\">\n                    <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 24 24\" fill=\"#fff\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" class=\"feather feather-check\"><polyline points=\"20 6 9 17 4 12\"><\/polyline><\/svg>\n                <\/span>\n                <span class=\"formgent-field-sub-label\">\n                    I Accept<br><strong>Declaration:<\/strong> <em>I confirm that the information provided is true to the best of my knowledge.<\/em><br><strong>Consent:<\/strong> <em>I allow 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