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<div class='gform_heading'>
<h3 class="gform_title">2021 HealthJoy Employee Benefits Insights eBook</h3>
<span class='gform_description'>Testing form</span>
</div><form method='post' enctype='multipart/form-data' id='gform_12' action='/telemedicine/' >
<div class='gform_body gform-body'><ul id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below'><li id="field_12_8" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_12_8' >First Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_12_8' type='text' value='' class='large' placeholder='First Name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_12_9" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_12_9' >Last Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_12_9' type='text' value='' class='large' placeholder='Last Name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_12_4" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_12_4' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'>
<input name='input_4' id='input_12_4' type='text' value='' class='large' placeholder='Email' aria-required="true" aria-invalid="false" />
</div></li><li id="field_12_5" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_12_5' >company name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_12_5' type='text' value='' class='large' placeholder='Company name' aria-required="true" aria-invalid="false" /> </div></li><li id="field_12_6" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_12_6' >Company Size<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_12_6' class='large gfield_select' aria-required="true" aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>Company Size</option><option value='1-100' >1-100</option><option value='100-500' >100-500</option><option value='500-3000' >500-3000</option><option value='3000-1000' >3000-1000</option><option value='10000+' >10000+</option></select></div></li><li id="field_12_7" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible" ><label class='gfield_label' for='input_12_7' >Which Best Describes You?<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_12_7' class='large gfield_select' aria-required="true" aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>Which Best Describes You?</option><option value='Employer' >Employer</option><option value='Benefit Consultant' >Benefit Consultant</option><option value='TPA' >TPA</option><option value='PEO' >PEO</option><option value='Other' >Other</option></select></div></li></ul></div>
<div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_12' class='gform_button button' value='Get Your eBook' onclick='if(window["gf_submitting_12"]){return false;} window["gf_submitting_12"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_12"]){return false;} window["gf_submitting_12"]=true; jQuery("#gform_12").trigger("submit",[true]); }' />
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