Find Your Cure

<div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_44' style='display:none'><a id='gf_44' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_44' id='gform_44' action='/treatment/#gf_44'> <div class='gform_body'><ul id='gform_fields_44' class='gform_fields top_label form_sublabel_below description_below'><li id='field_44_4' class='gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_44_4' >How Would You Like To Be Contacted<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_44_4' onchange='gf_apply_rules(44,[3,5]);' class='large gfield_select' tabindex='1' aria-required="true" aria-invalid="false"><option value='' selected='selected' class='gf_placeholder'>How Would You Like To Be Contacted</option><option value='Contact Me Via Phone' >Contact Me Via Phone</option><option value='Contact Me Via Email' >Contact Me Via Email</option></select></div></li><li id='field_44_2' class='gfield aligncenter field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_44_2' >Untitled</label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_44_2' type='text' value='' class='large' tabindex='2' placeholder='Enter Your Name Here' aria-invalid="false" /></div></li><li id='field_44_3' class='gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_44_3' >Number<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_number'><input name='input_3' id='input_44_3' type='text' value='' class='large' tabindex='3' placeholder='Enter Your Phone Number Here' aria-required="true" aria-invalid="false"/></div></li><li id='field_44_5' class='gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_44_5' >Email<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_email'> <input name='input_5' id='input_44_5' type='text' value='' class='large' tabindex='4' placeholder='Enter Your Email Here' aria-required="true" aria-invalid="false"/> </div></li> </ul></div> <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_44' class='om-trigger-conversion, gform_button button,' value='Yes, Please Call Me Back Now!!' tabindex='5' onclick='if(window["gf_submitting_44"]){return false;} window["gf_submitting_44"]=true; ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_44"]){return false;} window["gf_submitting_44"]=true; jQuery("#gform_44").trigger("submit",[true]); }' /> <input type='hidden' name='gform_ajax' value='form_id=44&title=&description=&tabindex=1' /> <input type='hidden' class='gform_hidden' name='is_submit_44' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='44' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_44' value='WyJbXSIsIjZjZDNiMTI4YTZiM2IyMjA0NDdkM2IwMWZhMjU3ZTlhIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_44' id='gform_target_page_number_44' value='0' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_44' id='gform_source_page_number_44' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </form> </div> <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_44' id='gform_ajax_frame_44'>This iframe contains the logic required to handle Ajax powered Gravity Forms.</iframe> <script type='text/javascript'>jQuery(document).ready(function($){gformInitSpinner( 44, 'https://www.rangoliayurved.com/spaceallocate/plugins/gravityforms/images/spinner.gif' );jQuery('#gform_ajax_frame_44').load( function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_44');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_44').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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