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label,.af-element-radio input.radio{display:inline!important;float:none!important;}.af-element-radio label{display:inline;}.af-element-radio.inline{float:left;margin-left:0;margin-right:7px;}.af-element.radio{display:block!important;}.af-element{padding:5px 0;}.af-form-wrapper{text-indent:0;}.af-form{text-align:left;margin:auto;}.af-header{margin-bottom:0;margin-top:0;padding:10px;}.af-quirksMode .af-element{padding-left:0!important;padding-right:0!important;}.choiceList-radio-inline .af-element-radio{float:left;}.lastNameContainer{margin-top:10px;}.lbl-right .af-element label{text-align:right;}body {}</style><form method=\"post\" class=\"af-form-wrapper\" action=\"http://www.aweber.com/scripts/addlead.pl\"  ><div style=\"display: none;\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"1803942712\" /><input type=\"hidden\" name=\"meta_split_id\" value=\"\" /><input type=\"hidden\" name=\"listname\" value=\"drmarkgolden\" /><input type=\"hidden\" name=\"redirect\" value=\"\" id=\"redirect_7ae98cbea7ad006a2fdbeea5487afe59\" /><input type=\"hidden\" name=\"meta_adtracking\" value=\"Golden1\" /><input type=\"hidden\" name=\"meta_message\" value=\"1\" /><input type=\"hidden\" name=\"meta_required\" value=\"custom What is your age group,custom Do you suffer from,custom Do you usually wear glasses or contacts,custom Do you currently require reading glasses,custom Are you in good general health,custom Have you ever had an eye injury or eye surgery,custom Have you ever been diagnosed with diabetic retinopathy_Keratoconus_Lupus or Rheumatoid Arthritis,custom What is your main expectation from having LASIK,name (awf_first),name (awf_last),email,custom Phone number\" /><input type=\"hidden\" name=\"meta_tooltip\" value=\"\" /></div><div id=\"af-form-1803942712\" class=\"af-form\"><div id=\"af-header-1803942712\" class=\"af-header\"><div class=\"bodyText\"><p style=\"text-align: center;\"><span style=\"color: #ffffff;\">Is LASIK Right For You? <br /></span></p><p style=\"text-align: center;\"><span style=\"color: #ffffff;\"><strong>Take our FREE Evaluation to find out now: <br /></strong></span></p></div></div><div id=\"af-body-1803942712\"  class=\"af-body af-standards\"><div class=\"af-element\"><div><label class=\"previewLabel\" for=\"awf_field-302626330\">What is your age group:</label><div class=\"choiceList choiceList-radio-inline\"><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626330\" name=\"custom What is your age group\"  value=\"Under 18\" tabindex=\"500\" /> <label class=\"choice\" for=\"awf_field-302626330\">Under 18</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626331\" name=\"custom What is your age group\"  value=\"21 - 40\" tabindex=\"501\" /> <label class=\"choice\" for=\"awf_field-302626331\">21 - 40</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626332\" name=\"custom What is your age group\"  value=\"41 - 65\" tabindex=\"502\" /> <label class=\"choice\" for=\"awf_field-302626332\">41 - 65</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626333\" name=\"custom What is your age group\"  value=\"65 \" tabindex=\"503\" /> <label class=\"choice\" for=\"awf_field-302626333\">65 </label></div></div></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><div><label class=\"previewLabel\" for=\"awf_field-302626340\">Do you suffer from:</label><div class=\"choiceList choiceList-radio-inline\"><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626340\" name=\"custom Do you suffer from\"  value=\"Myopia (Nearsightedness)\" tabindex=\"504\" /> <label class=\"choice\" for=\"awf_field-302626340\">Myopia (Nearsightedness)</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626341\" name=\"custom Do you suffer from\"  value=\"Hyperopia (Farsightedness)\" tabindex=\"505\" /> <label class=\"choice\" for=\"awf_field-302626341\">Hyperopia (Farsightedness)</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626342\" name=\"custom Do you suffer from\"  value=\"Both\" tabindex=\"506\" /> <label class=\"choice\" for=\"awf_field-302626342\">Both</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626343\" name=\"custom Do you suffer from\"  value=\"Astigmatism\" tabindex=\"507\" /> <label class=\"choice\" for=\"awf_field-302626343\">Astigmatism</label></div></div></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><div><label class=\"previewLabel\" for=\"awf_field-302626350\">Do you usually wear glasses or contacts:</label><div class=\"choiceList choiceList-radio-inline\"><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626350\" name=\"custom Do you usually wear glasses or contacts\"  value=\"Glasses\" tabindex=\"508\" /> <label class=\"choice\" for=\"awf_field-302626350\">Glasses</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626351\" name=\"custom Do you usually wear glasses or contacts\"  value=\"Contacts\" tabindex=\"509\" /> <label class=\"choice\" for=\"awf_field-302626351\">Contacts</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626352\" name=\"custom Do you usually wear glasses or contacts\"  value=\"Both\" tabindex=\"510\" /> <label class=\"choice\" for=\"awf_field-302626352\">Both</label></div></div></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><div><label class=\"previewLabel\" for=\"awf_field-302626360\">Do you currently require reading glasses:</label><div class=\"choiceList choiceList-radio-inline\"><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626360\" name=\"custom Do you currently require reading glasses\"  value=\"Yes\" tabindex=\"511\" /> <label class=\"choice\" for=\"awf_field-302626360\">Yes</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626361\" name=\"custom Do you currently require reading glasses\"  value=\"No\" tabindex=\"512\" /> <label class=\"choice\" for=\"awf_field-302626361\">No</label></div></div></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><div><label class=\"previewLabel\" for=\"awf_field-302626370\">Are you in good general health:</label><div class=\"choiceList choiceList-radio-inline\"><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626370\" name=\"custom Are you in good general health\"  value=\"Yes\" tabindex=\"513\" /> <label class=\"choice\" for=\"awf_field-302626370\">Yes</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626371\" name=\"custom Are you in good general health\"  value=\"No\" tabindex=\"514\" /> <label class=\"choice\" for=\"awf_field-302626371\">No</label></div></div></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><div><label class=\"previewLabel\" for=\"awf_field-302626380\">Have you ever had an eye injury or eye surgery:</label><div class=\"choiceList choiceList-radio-inline\"><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626380\" name=\"custom Have you ever had an eye injury or eye surgery\"  value=\"Yes\" tabindex=\"515\" /> <label class=\"choice\" for=\"awf_field-302626380\">Yes</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626381\" name=\"custom Have you ever had an eye injury or eye surgery\"  value=\"No\" tabindex=\"516\" /> <label class=\"choice\" for=\"awf_field-302626381\">No</label></div></div></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><div><label class=\"previewLabel\" for=\"awf_field-302626390\">Have you ever been diagnosed with diabetic retinopathy Keratoconus Lupus or Rheumatoid Arthritis:</label><div class=\"choiceList choiceList-radio-inline\"><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626390\" name=\"custom Have you ever been diagnosed with diabetic retinopathy_Keratoconus_Lupus or Rheumatoid Arthritis\"  value=\"Yes\" tabindex=\"517\" /> <label class=\"choice\" for=\"awf_field-302626390\">Yes</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626391\" name=\"custom Have you ever been diagnosed with diabetic retinopathy_Keratoconus_Lupus or Rheumatoid Arthritis\"  value=\"No\" tabindex=\"518\" /> <label class=\"choice\" for=\"awf_field-302626391\">No</label></div></div></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><div><label class=\"previewLabel\" for=\"awf_field-302626400\">What is your main expectation from having LASIK:</label><div class=\"choiceList choiceList-radio-inline\"><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626400\" name=\"custom What is your main expectation from having LASIK\"  value=\"A positive impact on my lifestyle (better appearance, freedom to play sports, etc)\" tabindex=\"519\" /> <label class=\"choice\" for=\"awf_field-302626400\">A positive impact on my lifestyle (better appearance, freedom to play sports, etc)</label></div><div class=\"af-element-radio multiChoice\"><input class=\"radio\" type=\"radio\" id=\"awf_field-302626401\" name=\"custom What is your main expectation from having LASIK\"  value=\"	Better vision in general\" tabindex=\"520\" /> <label class=\"choice\" for=\"awf_field-302626401\">	Better vision in general</label></div></div></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-30262631-first\">First Name:</label><div class=\"af-textWrap\"><input id=\"awf_field-30262631-first\" type=\"text\" class=\"text\" name=\"name (awf_first)\" value=\"\"  tabindex=\"521\" /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-30262631-last\">Last Name:</label><div class=\"af-textWrap\"><input id=\"awf_field-30262631-last\" class=\"text\" type=\"text\" name=\"name (awf_last)\" value=\"\"  tabindex=\"522\" /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-30262632\">Email: </label><div class=\"af-textWrap\"><input class=\"text\" id=\"awf_field-30262632\" type=\"text\" name=\"email\" value=\"\" tabindex=\"523\"  /></div><div 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