{"id":2169,"date":"2019-07-08T09:42:15","date_gmt":"2019-07-08T09:42:15","guid":{"rendered":"https:\/\/nembutalsolution.org\/appointment\/"},"modified":"2026-06-16T03:08:02","modified_gmt":"2026-06-16T03:08:02","slug":"%e0%a4%a8%e0%a5%87%e0%a4%ae%e0%a5%8d%e0%a4%ac%e0%a5%81%e0%a4%9f%e0%a4%b2-%e0%a4%91%e0%a4%a8%e0%a4%b2%e0%a4%be%e0%a4%87%e0%a4%a8-%e0%a4%91%e0%a4%b0%e0%a5%8d%e0%a4%a1%e0%a4%b0-%e0%a4%95%e0%a4%b0","status":"publish","type":"page","link":"https:\/\/nembutalsolution.org\/hi\/order-nembutal-online\/","title":{"rendered":"\u0928\u0947\u092e\u094d\u092c\u0941\u091f\u0932 \u0911\u0930\u094d\u0921\u0930 \u0915\u0930\u0947\u0902"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><div id=\"tm-row-6a32d3701f3b7\" class=\"vc_row vc_row-outer vc_row-fluid\"><div id=\"tm-column-6a32d3701fa09\" class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner \"><div class=\"wpb_wrapper\"><style id=\"wpforms-css-vars-5448\">\n\t\t\t\t#wpforms-5448 {\n\t\t\t\t--wpforms-field-border-radius: 6px;\n--wpforms-field-background-color: rgba(255, 255, 255, 0.8);\n--wpforms-field-border-color: #a3a9c2;\n--wpforms-field-border-color-spare: #a3a9c2;\n--wpforms-field-text-color: #6a6a6a;\n--wpforms-label-color: #000000;\n--wpforms-label-sublabel-color: #6a6a6a;\n--wpforms-label-error-color: #d80f0f;\n--wpforms-button-border-radius: 5px;\n--wpforms-button-background-color: #2f590f;\n--wpforms-button-border-color: #2f590f;\n--wpforms-container-padding: 60px;\n--wpforms-container-border-radius: 10px;\n--wpforms-background-color: #e5e6ea;\n--wpforms-background-image: stock;\n--wpforms-background-position: top right;\n--wpforms-field-menu-color: #e5e6ea;\n--wpforms-page-break-color: #2f590f;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: 0px 30px 50px -10px rgba(0, 0, 0, 0.15);\n\n\t\t\t}\n\t\t\t<\/style><style id=\"wpforms-css-vars-5448-custom-css\">\n\t\t\t\t#wpforms-5448 {\n\t\t\t\t\t\/* ====================== PROFESSIONAL WPFORMS STYLING - Form 2076 ====================== *\/\r\n\r\n#wpforms-2076 {\r\n    background-color: #ffffff;\r\n    padding: 40px 35px;\r\n    border-radius: 12px;\r\n    box-shadow: 0 10px 30px rgba(0, 0, 0, 0.08);\r\n    max-width: 680px;\r\n    margin: 0 auto;\r\n}\r\n\r\n\/* Labels *\/\r\n#wpforms-2076 .wpforms-field-label {\r\n    font-weight: 600;\r\n    color: #1e2937;\r\n    margin-bottom: 8px;\r\n    font-size: 15px;\r\n}\r\n\r\n\/* Fix Radio Buttons Overlap - Main Fix *\/\r\n#wpforms-2076 .wpforms-field-radio li {\r\n    margin-bottom: 20px !important;\r\n    padding: 4px 0;\r\n}\r\n\r\n#wpforms-2076 .wpforms-field-radio label {\r\n    display: flex !important;\r\n    align-items: center !important;\r\n    gap: 14px !important;\r\n    font-size: 16px;\r\n    line-height: 1.5;\r\n    cursor: pointer;\r\n}\r\n\r\n#wpforms-2076 .wpforms-field-radio input[type=&quot;radio&quot;] {\r\n    margin-right: 12px !important;\r\n    width: 20px;\r\n    height: 20px;\r\n    transform: scale(1.12);\r\n    flex-shrink: 0;\r\n}\r\n\r\n\/* Input Fields *\/\r\n#wpforms-2076 input[type=&quot;text&quot;],\r\n#wpforms-2076 input[type=&quot;email&quot;],\r\n#wpforms-2076 input[type=&quot;tel&quot;],\r\n#wpforms-2076 input[type=&quot;number&quot;],\r\n#wpforms-2076 textarea,\r\n#wpforms-2076 select {\r\n    border: 2px solid #e2e8f0;\r\n    border-radius: 8px;\r\n    padding: 14px 16px;\r\n    font-size: 16px;\r\n    color: #1e2937;\r\n    transition: all 0.3s ease;\r\n    width: 100%;\r\n    box-sizing: border-box;\r\n}\r\n\r\n#wpforms-2076 input:focus,\r\n#wpforms-2076 textarea:focus,\r\n#wpforms-2076 select:focus {\r\n    border-color: #066aab;\r\n    box-shadow: 0 0 0 3px rgba(6, 106, 171, 0.15);\r\n    outline: none;\r\n}\r\n\r\n\/* Submit Button *\/\r\n#wpforms-2076 .wpforms-submit-container button[type=&quot;submit&quot;] {\r\n    background-color: #066aab;\r\n    color: #ffffff;\r\n    font-weight: 600;\r\n    font-size: 17px;\r\n    padding: 16px 32px;\r\n    border-radius: 8px;\r\n    border: none;\r\n    transition: all 0.3s ease;\r\n    width: 100%;\r\n}\r\n\r\n#wpforms-2076 .wpforms-submit-container button[type=&quot;submit&quot;]:hover {\r\n    background-color: #05568f;\r\n    transform: translateY(-2px);\r\n    box-shadow: 0 8px 20px rgba(6, 106, 171, 0.25);\r\n}\r\n\r\n\/* Field Spacing *\/\r\n#wpforms-2076 .wpforms-field {\r\n    margin-bottom: 24px;\r\n}\r\n\r\n\/* Responsive *\/\r\n@media (max-width: 640px) {\r\n    #wpforms-2076 {\r\n        padding: 25px 20px;\r\n    }\r\n}\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-5448\"><form id=\"wpforms-form-5448\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"5448\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/hi\/wp-json\/wp\/v2\/pages\/2169\" data-token=\"6fcdd6029739c53fffe7c1fcadee8d63\" data-token-time=\"1781715824\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Order Form<\/div><div class=\"wpforms-description\">Please fill out the form below to place your order. Provide accurate contact details so we can process your request quickly and securely. Your privacy is our priority.<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-5448-field_26-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"26\"><div id=\"wpforms-5448-field_26\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-5448-field_26-error\"><h4>Fill the form below to place an order<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5448-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-5448-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-5448-field_1-error\" required><label for=\"wpforms-5448-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5448-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-5448-field_1-last-error\" required><label for=\"wpforms-5448-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-5448-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_2\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-5448-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-5448-field_2-error\" required><\/div>\t\t<div id=\"wpforms-5448-field_8-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"8\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-5448-field_8\" >Order want to<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-5448-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-5448-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_3\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-5448-field_3\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-5448-field_3-error\" required><\/div><div id=\"wpforms-5448-field_16-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"16\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-5448-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_14\">Body Weight (Lbs) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5448-field_14\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-5448-field_14-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-5448-field_15-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_15\">Age <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-5448-field_15\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][15]\" min=\"21\" max=\"150\" step=\"any\" aria-errormessage=\"wpforms-5448-field_15-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><\/div><\/div><div id=\"wpforms-5448-field_18-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_18\">Select Nembutal Form <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-5448-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>--- Select formulation ---<\/option><option value=\"Nembutal Powder\" >Nembutal Powder<\/option><option value=\"Nembutal Oral Solution\" >Nembutal Oral Solution<\/option><option value=\"Injectable Nembutal Solution\" >Injectable Nembutal Solution<\/option><option value=\"Nembutal Pills\/tablets\" >Nembutal Pills\/tablets<\/option><\/select><\/div><div id=\"wpforms-5448-field_5-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"5\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage (g) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-5448-field_5_1\" class=\"wpforms-payment-price\" data-amount=\"380\" name=\"wpforms[fields][5]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_5_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_5_1\">9g Nembutal Powder(Body weight less than 100lb) - <span class=\"wpforms-currency-symbol\">&#8364;380<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-5448-field_5_2\" class=\"wpforms-payment-price\" data-amount=\"420\" name=\"wpforms[fields][5]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_5_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_5_2\">12g Nembutal Powder(Body weight ranges between 100lb - 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;420<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-5448-field_5_3\" class=\"wpforms-payment-price\" data-amount=\"530\" name=\"wpforms[fields][5]\" value=\"3\" aria-errormessage=\"wpforms-5448-field_5_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_5_3\">15g Nembutal Powder(Body weight above 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;530<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_19-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"19\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage (ml) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-5448-field_19_1\" class=\"wpforms-payment-price\" data-amount=\"385\" name=\"wpforms[fields][19]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_19_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_19_1\">200ml Nembutal Oral Liquid(Body weight less than 100lb) - <span class=\"wpforms-currency-symbol\">&#8364;385<\/span><\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-5448-field_19_4\" class=\"wpforms-payment-price\" data-amount=\"506\" name=\"wpforms[fields][19]\" value=\"4\" aria-errormessage=\"wpforms-5448-field_19_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_19_4\">250ml Nembutal Oral Liquid(Body weight ranges between 100lb - 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;506<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-5448-field_19_2\" class=\"wpforms-payment-price\" data-amount=\"600\" name=\"wpforms[fields][19]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_19_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_19_2\">300ml Nembutal Oral Liquid(Body weight above 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;600<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_20-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"20\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-5448-field_20_1\" class=\"wpforms-payment-price\" data-amount=\"300\" name=\"wpforms[fields][20]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_20_1\">25ml Injectable Nembutal Solution(Body Weight less than 100lb) - <span class=\"wpforms-currency-symbol\">&#8364;300<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-5448-field_20_2\" class=\"wpforms-payment-price\" data-amount=\"410\" name=\"wpforms[fields][20]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_20_2\">50ml Injectable Nembutal Solution(Body weight ranges between 100l - 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;410<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-5448-field_20_3\" class=\"wpforms-payment-price\" data-amount=\"600\" name=\"wpforms[fields][20]\" value=\"3\" aria-errormessage=\"wpforms-5448-field_20_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_20_3\">100ml Injectable Nembutal Solution(Body weight above 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;600<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_21-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"21\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage (1000mg\/tabs) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-5448-field_21_1\" class=\"wpforms-payment-price\" data-amount=\"360\" name=\"wpforms[fields][21]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_21_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_21_1\">18 Nembutal pills(Body weight less than 100lb) - <span class=\"wpforms-currency-symbol\">&#8364;360<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-5448-field_21_2\" class=\"wpforms-payment-price\" data-amount=\"415\" name=\"wpforms[fields][21]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_21_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_21_2\">24 Nembutal pills(Body weight between 100lb - 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;415<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-5448-field_21_3\" class=\"wpforms-payment-price\" data-amount=\"510\" name=\"wpforms[fields][21]\" value=\"3\" aria-errormessage=\"wpforms-5448-field_21_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_21_3\">30 Nembutal pills(Body weight above 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;510<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_22-container\" class=\"wpforms-field wpforms-field-payment-checkbox wpforms-list-inline\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Additional Options<\/legend><ul id=\"wpforms-5448-field_22\" class=\"wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_22_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M112 96c-26.5 0-48 21.5-48 48V256h96V144c0-26.5-21.5-48-48-48zM0 144C0 82.1 50.1 32 112 32s112 50.1 112 112V368c0 61.9-50.1 112-112 112S0 429.9 0 368V144zM554.9 399.4c-7.1 12.3-23.7 13.1-33.8 3.1L333.5 214.9c-10-10-9.3-26.7 3.1-33.8C360 167.7 387.1 160 416 160c88.4 0 160 71.6 160 160c0 28.9-7.7 56-21.1 79.4zm-59.5 59.5C472 472.3 444.9 480 416 480c-88.4 0-160-71.6-160-160c0-28.9 7.7-56 21.1-79.4c7.1-12.3 23.7-13.1 33.8-3.1L498.5 425.1c10 10 9.3 26.7-3.1 33.8z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_22_1\" class=\"wpforms-payment-price wpforms-screen-reader-element\" data-amount=\"15\" name=\"wpforms[fields][22][]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_22_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Zofran (antiemetic pills) - <span class=\"wpforms-currency-symbol\">&#8364;15<\/span><\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_22_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 640 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M112 0C85.5 0 64 21.5 64 48V96H16c-8.8 0-16 7.2-16 16s7.2 16 16 16H64 272c8.8 0 16 7.2 16 16s-7.2 16-16 16H64 48c-8.8 0-16 7.2-16 16s7.2 16 16 16H64 240c8.8 0 16 7.2 16 16s-7.2 16-16 16H64 16c-8.8 0-16 7.2-16 16s7.2 16 16 16H64 208c8.8 0 16 7.2 16 16s-7.2 16-16 16H64V416c0 53 43 96 96 96s96-43 96-96H384c0 53 43 96 96 96s96-43 96-96h32c17.7 0 32-14.3 32-32s-14.3-32-32-32V288 256 237.3c0-17-6.7-33.3-18.7-45.3L512 114.7c-12-12-28.3-18.7-45.3-18.7H416V48c0-26.5-21.5-48-48-48H112zM544 237.3V256H416V160h50.7L544 237.3zM160 368a48 48 0 1 1 0 96 48 48 0 1 1 0-96zm272 48a48 48 0 1 1 96 0 48 48 0 1 1 -96 0z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_22_2\" class=\"wpforms-payment-price wpforms-screen-reader-element\" data-amount=\"50\" name=\"wpforms[fields][22][]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_22_2-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Express Shipping - <span class=\"wpforms-currency-symbol\">&#8364;50<\/span><\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_22_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 640 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M480 416h96c35.3 0 64-28.7 64-64V160c0-35.3-28.7-64-64-64H480V416zM448 96H192V416H448V96zM64 96C28.7 96 0 124.7 0 160V352c0 35.3 28.7 64 64 64h96V96H64zM248 208a24 24 0 1 1 48 0 24 24 0 1 1 -48 0zm120-24a24 24 0 1 1 0 48 24 24 0 1 1 0-48zM248 304a24 24 0 1 1 48 0 24 24 0 1 1 -48 0zm120-24a24 24 0 1 1 0 48 24 24 0 1 1 0-48z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_22_3\" class=\"wpforms-payment-price wpforms-screen-reader-element\" data-amount=\"35\" name=\"wpforms[fields][22][]\" value=\"3\" aria-errormessage=\"wpforms-5448-field_22_3-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Barbiturate test kit - <span class=\"wpforms-currency-symbol\">&#8364;35<\/span><\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_4-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5448-field_4\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][4][address1]\" aria-errormessage=\"wpforms-5448-field_4-error\" required><label for=\"wpforms-5448-field_4\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5448-field_4-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][4][address2]\" aria-errormessage=\"wpforms-5448-field_4-address2-error\" ><label for=\"wpforms-5448-field_4-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5448-field_4-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][4][city]\" aria-errormessage=\"wpforms-5448-field_4-city-error\" required><label for=\"wpforms-5448-field_4-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5448-field_4-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][4][state]\" aria-errormessage=\"wpforms-5448-field_4-state-error\" required><label for=\"wpforms-5448-field_4-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5448-field_4-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][4][postal]\" aria-errormessage=\"wpforms-5448-field_4-postal-error\" required><label for=\"wpforms-5448-field_4-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-5448-field_4-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][4][country]\" aria-errormessage=\"wpforms-5448-field_4-country-error\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-5448-field_4-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-5448-field_24-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">How do you want us to Contact you?<\/legend><ul id=\"wpforms-5448-field_24\" class=\"wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #227021;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_24_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M64 112c-8.8 0-16 7.2-16 16v22.1L220.5 291.7c20.7 17 50.4 17 71.1 0L464 150.1V128c0-8.8-7.2-16-16-16H64zM48 212.2V384c0 8.8 7.2 16 16 16H448c8.8 0 16-7.2 16-16V212.2L322 328.8c-38.4 31.5-93.7 31.5-132 0L48 212.2zM0 128C0 92.7 28.7 64 64 64H448c35.3 0 64 28.7 64 64V384c0 35.3-28.7 64-64 64H64c-35.3 0-64-28.7-64-64V128z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_24_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][24][]\" value=\"E-mail\" aria-errormessage=\"wpforms-5448-field_24_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">E-mail<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 depth-1 wpforms-icon-choices-item wpforms-selected\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_24_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M347.1 24.6c7.7-18.6 28-28.5 47.4-23.2l88 24C499.9 30.2 512 46 512 64c0 247.4-200.6 448-448 448c-18 0-33.8-12.1-38.6-29.5l-24-88c-5.3-19.4 4.6-39.7 23.2-47.4l96-40c16.3-6.8 35.2-2.1 46.3 11.6L207.3 368c70.4-33.3 127.4-90.3 160.7-160.7L318.7 167c-13.7-11.2-18.4-30-11.6-46.3l40-96z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_24_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][24][]\" value=\"PhoneCall\" aria-errormessage=\"wpforms-5448-field_24_2-error\"   checked='checked'>\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">PhoneCall<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_24_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 448 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M380.9 97.1C339 55.1 283.2 32 223.9 32c-122.4 0-222 99.6-222 222 0 39.1 10.2 77.3 29.6 111L0 480l117.7-30.9c32.4 17.7 68.9 27 106.1 27h.1c122.3 0 224.1-99.6 224.1-222 0-59.3-25.2-115-67.1-157zm-157 341.6c-33.2 0-65.7-8.9-94-25.7l-6.7-4-69.8 18.3L72 359.2l-4.4-7c-18.5-29.4-28.2-63.3-28.2-98.2 0-101.7 82.8-184.5 184.6-184.5 49.3 0 95.6 19.2 130.4 54.1 34.8 34.9 56.2 81.2 56.1 130.5 0 101.8-84.9 184.6-186.6 184.6zm101.2-138.2c-5.5-2.8-32.8-16.2-37.9-18-5.1-1.9-8.8-2.8-12.5 2.8-3.7 5.6-14.3 18-17.6 21.8-3.2 3.7-6.5 4.2-12 1.4-32.6-16.3-54-29.1-75.5-66-5.7-9.8 5.7-9.1 16.3-30.3 1.8-3.7.9-6.9-.5-9.7-1.4-2.8-12.5-30.1-17.1-41.2-4.5-10.8-9.1-9.3-12.5-9.5-3.2-.2-6.9-.2-10.6-.2-3.7 0-9.7 1.4-14.8 6.9-5.1 5.6-19.4 19-19.4 46.3 0 27.3 19.9 53.7 22.6 57.4 2.8 3.7 39.1 59.7 94.8 83.8 35.2 15.2 49 16.5 66.6 13.9 10.7-1.6 32.8-13.4 37.4-26.4 4.6-13 4.6-24.1 3.2-26.4-1.3-2.5-5-3.9-10.5-6.6z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_24_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][24][]\" value=\"Whatsapp\" aria-errormessage=\"wpforms-5448-field_24_3-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Whatsapp<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_25-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"25\"><fieldset><legend class=\"wpforms-field-label\">Multiple Choice<\/legend><ul id=\"wpforms-5448-field_25\" class=\"wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_25_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M243.4 2.6l-224 96c-14 6-21.8 21-18.7 35.8S16.8 160 32 160v8c0 13.3 10.7 24 24 24H456c13.3 0 24-10.7 24-24v-8c15.2 0 28.3-10.7 31.3-25.6s-4.8-29.9-18.7-35.8l-224-96c-8-3.4-17.2-3.4-25.2 0zM128 224H64V420.3c-.6 .3-1.2 .7-1.8 1.1l-48 32c-11.7 7.8-17 22.4-12.9 35.9S17.9 512 32 512H480c14.1 0 26.5-9.2 30.6-22.7s-1.1-28.1-12.9-35.9l-48-32c-.6-.4-1.2-.7-1.8-1.1V224H384V416H344V224H280V416H232V224H168V416H128V224zM256 64a32 32 0 1 1 0 64 32 32 0 1 1 0-64z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"radio\" id=\"wpforms-5448-field_25_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"Bank Transfer\" aria-errormessage=\"wpforms-5448-field_25_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Bank Transfer<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_25_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M504 256c0 136.967-111.033 248-248 248S8 392.967 8 256 119.033 8 256 8s248 111.033 248 248zm-141.651-35.33c4.937-32.999-20.191-50.739-54.55-62.573l11.146-44.702-27.213-6.781-10.851 43.524c-7.154-1.783-14.502-3.464-21.803-5.13l10.929-43.81-27.198-6.781-11.153 44.686c-5.922-1.349-11.735-2.682-17.377-4.084l.031-.14-37.53-9.37-7.239 29.062s20.191 4.627 19.765 4.913c11.022 2.751 13.014 10.044 12.68 15.825l-12.696 50.925c.76.194 1.744.473 2.829.907-.907-.225-1.876-.473-2.876-.713l-17.796 71.338c-1.349 3.348-4.767 8.37-12.471 6.464.271.395-19.78-4.937-19.78-4.937l-13.51 31.147 35.414 8.827c6.588 1.651 13.045 3.379 19.4 5.006l-11.262 45.213 27.182 6.781 11.153-44.733a1038.209 1038.209 0 0 0 21.687 5.627l-11.115 44.523 27.213 6.781 11.262-45.128c46.404 8.781 81.299 5.239 95.986-36.727 11.836-33.79-.589-53.281-25.004-65.991 17.78-4.098 31.174-15.792 34.747-39.949zm-62.177 87.179c-8.41 33.79-65.308 15.523-83.755 10.943l14.944-59.899c18.446 4.603 77.6 13.717 68.811 48.956zm8.417-87.667c-7.673 30.736-55.031 15.12-70.393 11.292l13.548-54.327c15.363 3.828 64.836 10.973 56.845 43.035z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"radio\" id=\"wpforms-5448-field_25_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"Crypto\" aria-errormessage=\"wpforms-5448-field_25_2-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Crypto<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_25_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M326.7 403.7c-22.1 8-45.9 12.3-70.7 12.3s-48.7-4.4-70.7-12.3c-.3-.1-.5-.2-.8-.3c-30-11-56.8-28.7-78.6-51.4C70 314.6 48 263.9 48 208C48 93.1 141.1 0 256 0S464 93.1 464 208c0 55.9-22 106.6-57.9 144c-1 1-2 2.1-3 3.1c-21.4 21.4-47.4 38.1-76.3 48.6zM256 91.9c-11.1 0-20.1 9-20.1 20.1v6c-5.6 1.2-10.9 2.9-15.9 5.1c-15 6.8-27.9 19.4-31.1 37.7c-1.8 10.2-.8 20 3.4 29c4.2 8.8 10.7 15 17.3 19.5c11.6 7.9 26.9 12.5 38.6 16l2.2 .7c13.9 4.2 23.4 7.4 29.3 11.7c2.5 1.8 3.4 3.2 3.7 4c.3 .8 .9 2.6 .2 6.7c-.6 3.5-2.5 6.4-8 8.8c-6.1 2.6-16 3.9-28.8 1.9c-6-1-16.7-4.6-26.2-7.9l0 0 0 0 0 0c-2.2-.7-4.3-1.5-6.4-2.1c-10.5-3.5-21.8 2.2-25.3 12.7s2.2 21.8 12.7 25.3c1.2 .4 2.7 .9 4.4 1.5c7.9 2.7 20.3 6.9 29.8 9.1V304c0 11.1 9 20.1 20.1 20.1s20.1-9 20.1-20.1v-5.5c5.3-1 10.5-2.5 15.4-4.6c15.7-6.7 28.4-19.7 31.6-38.7c1.8-10.4 1-20.3-3-29.4c-3.9-9-10.2-15.6-16.9-20.5c-12.2-8.8-28.3-13.7-40.4-17.4l-.8-.2c-14.2-4.3-23.8-7.3-29.9-11.4c-2.6-1.8-3.4-3-3.6-3.5c-.2-.3-.7-1.6-.1-5c.3-1.9 1.9-5.2 8.2-8.1c6.4-2.9 16.4-4.5 28.6-2.6c4.3 .7 17.9 3.3 21.7 4.3c10.7 2.8 21.6-3.5 24.5-14.2s-3.5-21.6-14.2-24.5c-4.4-1.2-14.4-3.2-21-4.4V112c0-11.1-9-20.1-20.1-20.1zM48 352H64c19.5 25.9 44 47.7 72.2 64H64v32H256 448V416H375.8c28.2-16.3 52.8-38.1 72.2-64h16c26.5 0 48 21.5 48 48v64c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V400c0-26.5 21.5-48 48-48z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"radio\" id=\"wpforms-5448-field_25_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"Other\" aria-errormessage=\"wpforms-5448-field_25_3-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Other<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_7-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_7\">Special instructions (optional)<\/label><textarea id=\"wpforms-5448-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-5448-field_7-error\" ><\/textarea><\/div><div id=\"wpforms-5448-field_6-container\" class=\"wpforms-field wpforms-field-payment-total wpforms-conditional-field wpforms-conditional-show wpforms-field-medium wpforms-summary-enabled\" data-field-id=\"6\" style=\"display:none;\" aria-live=\"polite\" aria-atomic=\"true\"><label class=\"wpforms-field-label\">Order Summary<\/label><div class=\"wpforms-order-summary-container\">\n\t<table class=\"wpforms-order-summary-preview\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\" role=\"presentation\">\n\t\t<caption style=\"display: none;\">Order Summary<\/caption>\n\t\t<thead>\n\t\t\t<tr>\n\t\t\t\t<th class=\"wpforms-order-summary-item-label\" valign=\"top\">Item<\/th>\n\t\t\t\t<th class=\"wpforms-order-summary-item-quantity\" valign=\"top\">\n\t\t\t\t\t<span class=\"wpforms-order-summary-item-quantity-label-full\">Quantity<\/span>\n\t\t\t\t\t<span class=\"wpforms-order-summary-item-quantity-label-short\">Qty<\/span>\n\t\t\t\t<\/th>\n\t\t\t\t<th class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">Total<\/th>\n\t\t\t<\/tr>\n\t\t<\/thead>\n\t\t<tbody>\n\t\t\t<tr class=\"wpforms-order-summary-placeholder\" style=\"display: table-row;\">\n\t\t\t\t<td colspan=\"3\" valign=\"top\">There are no products selected.<\/td>\n\t\t\t<\/tr>\n\t\t\t<tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - 9g Nembutal Powder(Body weight less than 100lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;380<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - 12g Nembutal Powder(Body weight ranges between 100lb - 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;420<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - 15g Nembutal Powder(Body weight above 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;530<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - 200ml Nembutal Oral Liquid(Body weight less than 100lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;385<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"4\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - 250ml Nembutal Oral Liquid(Body weight ranges between 100lb - 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;506<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - 300ml Nembutal Oral Liquid(Body weight above 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;600<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - 25ml Injectable Nembutal Solution(Body Weight less than 100lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;300<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - 50ml Injectable Nembutal Solution(Body weight ranges between 100l - 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;410<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - 100ml Injectable Nembutal Solution(Body weight above 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;600<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - 18 Nembutal pills(Body weight less than 100lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;360<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - 24 Nembutal pills(Body weight between 100lb - 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;415<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - 30 Nembutal pills(Body weight above 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;510<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"22\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Additional Options - Zofran (antiemetic pills)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;15<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"22\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Additional Options - Express Shipping<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;50<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"22\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Additional Options - Barbiturate test kit<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;35<\/td><\/tr><tr class=\"wpforms-order-summary-preview-total\" ><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Total<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\"><\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;0<\/td><\/tr>\t\t<\/tbody>\n\t<\/table>\n<\/div>\n<div class=\"wpforms-payment-total\" style=\"display:none\">&#8364;0<\/div><input type=\"hidden\" id=\"wpforms-5448-field_6\" class=\"wpforms-field-medium wpforms-payment-total\" name=\"wpforms[fields][6]\" value=\"0\"><\/div><div id=\"wpforms-5448-field_28-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Acknowledgement <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5448-field_28_1\" name=\"wpforms[fields][28][]\" value=\"\u00a0\u00a0&lt;strong&gt;I have read, understood, and agree to the following:&lt;\/strong&gt;&lt;br&gt;&lt;br&gt;\" aria-errormessage=\"wpforms-5448-field_28_1-error\" aria-describedby=\"wpforms-5448-field_28-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_28_1\">\u00a0\u00a0<strong>I have read, understood, and agree to the following:<\/strong><br><br><\/label><\/li><\/ul><div id=\"wpforms-5448-field_28-description\" class=\"wpforms-field-description\"><div class=\"disclaimer-text\" style=\"margin:20px 0;padding:15px;border:1px solid #e0e0e0;background-color:#f8f8f8;font-size:15px;line-height:1.6;\">\n    \n    I am a legal adult (18+ years old) and I am placing this order <strong>solely at my own risk and responsibility<\/strong>.<br \/><br \/>\n    \n    I acknowledge that <strong>Nembutal (pentobarbital)<\/strong> is a powerful controlled substance. I confirm that:\n    \n    <ul style=\"margin:12px 0 12px 25px;\">\n     \n        <li>This purchase is for <strong>personal use only<\/strong> and I will not resell or distribute it.<\/li>\n        <li>I understand this product is intended for <strong>voluntary euthanasia \/ end-of-life purposes<\/strong> and I am making this decision freely and without coercion.<\/li>\n        <li>I have consulted (or will consult) with appropriate medical and\/or legal professionals where required, and I accept full responsibility for any medical, legal, or other consequences that may arise from the use of this product.<\/li>\n        <li>The information provided on this website is for informational purposes only and <strong>does not<\/strong> constitute medical advice.<\/li>\n        <li>I release Nembutal Solution and its owners\/operators from any liability related to the misuse, improper storage, or unintended effects of this product.<\/li>\n    <\/ul>\n    \n    I confirm that all information I have provided in this order is accurate and truthful.\n    \n<\/div><\/div><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-5448-field_8-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-5448-field_8-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-5448-field_8-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"5448\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/nembutalsolution.org\/hi\/wp-json\/wp\/v2\/pages\/2169\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-5448\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" data-src=\"https:\/\/nembutalsolution.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner lazyload\" style=\"--smush-placeholder-width: 26px; --smush-placeholder-aspect-ratio: 26\/26;display: none;\" width=\"26\" height=\"26\" alt=\"Loading\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div><\/div><\/div><\/div><div id=\"tm-row-6a32d37031f16\" class=\"vc_row vc_row-outer vc_row-fluid\"><div id=\"tm-column-6a32d370322e4\" class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner \"><div class=\"wpb_wrapper\">\n<div class=\"tm-heading  left tm-animation move-up\" id=\"tm-heading-6a32d370326f2\">\n\t<h5 class=\"heading\" >Disclaimer: For legitimate research, veterinary, or peaceful exit purposes. By ordering, you confirm you are of legal age and fully compliant with your local laws. We are not responsible for any misuse. All sales final.<\/h5><\/div>\n\n<\/div><\/div><\/div><\/div><div id=\"tm-row-6a32d37032e4c\" class=\"vc_row vc_row-outer vc_row-fluid\"><div id=\"tm-column-6a32d37033260\" class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner \"><div class=\"wpb_wrapper\"><div class=\"tm-spacer\" id=\"tm-spacer-6a32d370334d8\"><\/div>\n<\/div><\/div><\/div><\/div><div id=\"tm-row-6a32d3703368d\" class=\"vc_row vc_row-outer vc_row-fluid\"><div id=\"tm-column-6a32d370339e9\" class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner \"><div class=\"wpb_wrapper\">\n\t<div class=\"wpb_raw_code wpb_raw_html wpb_content_element\" >\n\t\t<div class=\"wpb_wrapper\">\n\t\t\t<h1 style=\"text-align:center; color:#1e4d8c; margin-bottom:20px;\">Order Nembutal Online Securely \u2013 Buy Pentobarbital Sodium<\/h1>\n\n<p style=\"text-align:center; font-size:1.1em; max-width:900px; margin:0 auto 30px;\">At Nembutal Solution, we provide a safe, discreet, and reliable way to <strong>order Nembutal online<\/strong>. Pharmaceutical-grade pentobarbital for research, veterinary use, or peaceful end-of-life purposes with fast shipping across Europe and worldwide.<\/p>\n\n<h2 style=\"color:#1e4d8c; text-align:center; margin:40px 0 20px;\">Why Choose Us to Buy Nembutal Online?<\/h2>\n<ul style=\"max-width:800px; margin:0 auto 40px; padding-left:20px; font-size:1.05em;\">\n    <li><strong>Pharmaceutical Grade Quality<\/strong>: Tested for purity and potency.<\/li>\n    <li><strong>Multiple Forms Available<\/strong>: Liquid, Powder, Pills, and Injectable.<\/li>\n    <li><strong>Discreet & Secure Shipping<\/strong>: Plain packaging with tracking.<\/li>\n    <li><strong>Fast Processing<\/strong>: Orders handled within 24 hours.<\/li>\n    <li><strong>Expert Support<\/strong>: Contact us via WhatsApp or phone.<\/li>\n<\/ul>\n\n<h2 style=\"text-align:center; margin:40px 0 30px; color:#1e4d8c;\">Our Available Nembutal Products<\/h2>\n\n<div style=\"display: grid; grid-template-columns: repeat(auto-fit, minmax(280px, 1fr)); gap: 25px; margin-bottom:40px;\">\n\n    <!-- Nembutal Liquid -->\n    <div style=\"border:1px solid #e0e7f0; border-radius:8px; overflow:hidden; text-align:center; background:#ffffff; box-shadow:0 4px 12px rgba(30,77,140,0.08);\">\n        <img decoding=\"async\" data-src=\"https:\/\/nembutalsolution.org\/wp-content\/uploads\/2018\/10\/o33601-1728401571-370x237.jpg\" style=\"--smush-placeholder-width: 370px; --smush-placeholder-aspect-ratio: 370\/237;width:100%; height:220px; object-fit:cover;\" alt=\"Nembutal Liquid\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\">\n        <div style=\"padding:20px;\">\n            <h3 style=\"color:#1e4d8c; margin:10px 0 12px;\">Nembutal Liquid<\/h3>\n            <p style=\"color:#555555; min-height:75px; line-height:1.5;\">Fast-acting oral solution for precise and controlled administration.<\/p>\n            <a href=\"https:\/\/nembutalsolution.org\/service\/buy-nembutal-liquid-online\/\" style=\"background:#1e88e5; color:white; padding:12px 28px; text-decoration:none; border-radius:6px; display:inline-block; font-weight:500;\">Read More<\/a>\n        <\/div>\n    <\/div>\n\n    <!-- Nembutal Powder -->\n    <div style=\"border:1px solid #e0e7f0; border-radius:8px; overflow:hidden; text-align:center; background:#ffffff; box-shadow:0 4px 12px rgba(30,77,140,0.08);\">\n        <img decoding=\"async\" data-src=\"https:\/\/nembutalsolution.org\/wp-content\/uploads\/2018\/10\/Pentobarbital-sodium-370x237.jpg\" style=\"--smush-placeholder-width: 370px; --smush-placeholder-aspect-ratio: 370\/237;width:100%; height:220px; object-fit:cover;\" alt=\"Nembutal Powder\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\">\n        <div style=\"padding:20px;\">\n            <h3 style=\"color:#1e4d8c; margin:10px 0 12px;\">Nembutal Powder<\/h3>\n            <p style=\"color:#555555; min-height:75px; line-height:1.5;\">Pure pentobarbital sodium powder \u2013 flexible and long shelf life.<\/p>\n            <a href=\"https:\/\/nembutalsolution.org\/service\/buy-nembutal-powder-online\/\" style=\"background:#1e88e5; color:white; padding:12px 28px; text-decoration:none; border-radius:6px; display:inline-block; font-weight:500;\">Read More<\/a>\n        <\/div>\n    <\/div>\n\n    <!-- Nembutal Pills -->\n    <div style=\"border:1px solid #e0e7f0; border-radius:8px; overflow:hidden; text-align:center; background:#ffffff; box-shadow:0 4px 12px rgba(30,77,140,0.08);\">\n        <img decoding=\"async\" data-src=\"https:\/\/nembutalsolution.org\/wp-content\/uploads\/2018\/10\/nembutal-pills-370x237.jpeg\" style=\"--smush-placeholder-width: 370px; --smush-placeholder-aspect-ratio: 370\/237;width:100%; height:220px; object-fit:cover;\" alt=\"Nembutal Pills\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\">\n        <div style=\"padding:20px;\">\n            <h3 style=\"color:#1e4d8c; margin:10px 0 12px;\">Nembutal Pills<\/h3>\n            <p style=\"color:#555555; min-height:75px; line-height:1.5;\">Convenient oral tablets for easy and accurate dosing.<\/p>\n            <a href=\"https:\/\/nembutalsolution.org\/service\/buy-nembutal-pills-online\/\" style=\"background:#1e88e5; color:white; padding:12px 28px; text-decoration:none; border-radius:6px; display:inline-block; font-weight:500;\">Read More<\/a>\n        <\/div>\n    <\/div>\n\n    <!-- Injectable Nembutal -->\n    <div style=\"border:1px solid #e0e7f0; border-radius:8px; overflow:hidden; text-align:center; background:#ffffff; box-shadow:0 4px 12px rgba(30,77,140,0.08);\">\n        <img decoding=\"async\" data-src=\"https:\/\/nembutalsolution.org\/wp-content\/uploads\/2018\/10\/Buy-Pentobarbital-Sodium-Liquid-Injectable-Online-20210624231650.00-370x237.jpg\" style=\"--smush-placeholder-width: 370px; --smush-placeholder-aspect-ratio: 370\/237;width:100%; height:220px; object-fit:cover;\" alt=\"Injectable Nembutal\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\">\n        <div style=\"padding:20px;\">\n            <h3 style=\"color:#1e4d8c; margin:10px 0 12px;\">Injectable Nembutal<\/h3>\n            <p style=\"color:#555555; min-height:75px; line-height:1.5;\">Sterile high-grade solution for clinical and veterinary use.<\/p>\n            <a href=\"https:\/\/nembutalsolution.org\/service\/buy-injectable-nembutal-online\/\" style=\"background:#1e88e5; color:white; padding:12px 28px; text-decoration:none; border-radius:6px; display:inline-block; font-weight:500;\">Read More<\/a>\n        <\/div>\n    <\/div>\n\n<\/div>\n\n<p style=\"text-align:center; margin:20px 0;\"><strong>Additional products:<\/strong> Barbiturate Test Kit & Zofran.<\/p>\n\n<!-- ORDER FORM ANCHOR -->\n<h2 id=\"order-form\" style=\"text-align:center; color:#1e4d8c; margin:50px 0 20px;\">Place Your Secure Order<\/h2>\n\n<p style=\"text-align:center; max-width:700px; margin:0 auto 30px;\">Fill the form above to order Nembutal online. All orders are processed with complete confidentiality.<\/p>\n\n<!-- === YOUR EXISTING ORDER FORM GOES HERE === -->\n\n<h2 style=\"color:#1e4d8c; margin-top:50px;\">Safety & Legal Information<\/h2>\n<p><strong>Important Disclaimer:<\/strong> Nembutal (pentobarbital) is a controlled substance. By ordering, you confirm you are a legal adult and using it responsibly in accordance with your local laws. This is not medical advice. All sales are final.<\/p>\n\n<p>For questions, contact us via <a href=\"https:\/\/wa.me\/31630943547\">WhatsApp<\/a>: +31 (630) 943-547.<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"Order FormPlease fill out the form below to place your order. Provide accurate contact details so we can process your request quickly and securely. Your privacy is our priority.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Dosage instructions Email Fill the form below to place an order Name *FirstLastEmail *Phone *Body Weight (Lbs) *Age *Select Nembutal Form *--- Select formulation ---Nembutal PowderNembutal Oral SolutionInjectable Nembutal SolutionNembutal Pills\/tabletsDosage (g) *9g Nembutal Powder(Body weight less than 100lb) - &#8364;38012g Nembutal Powder(Body weight ranges between 100lb - 135lb) - &#8364;42015g Nembutal Powder(Body weight above 135lb) - &#8364;530Dosage (ml) *200ml Nembutal Oral Liquid(Body weight less than 100lb) - &#8364;385250ml Nembutal Oral Liquid(Body weight ranges between 100lb - 135lb) - &#8364;506300ml Nembutal Oral Liquid(Body weight above 135lb) - &#8364;600Dosage *25ml Injectable Nembutal Solution(Body Weight less than 100lb) - &#8364;30050ml Injectable Nembutal Solution(Body weight ranges between 100l - 135lb) - &#8364;410100ml Injectable Nembutal Solution(Body weight above 135lb) - &#8364;600Dosage (1000mg\/tabs) *18 Nembutal pills(Body weight less than 100lb) - &#8364;36024 Nembutal pills(Body weight between 100lb - 135lb) - &#8364;41530 Nembutal pills(Body weight above 135lb) - &#8364;510Additional Options Zofran (antiemetic pills) - &#8364;15 Express Shipping - &#8364;50 Barbiturate test kit - &#8364;35 Address *Address Line 1Address Line 2CityState \/ Province \/ RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCura\u00e7aoCyprusCzech RepublicC\u00f4te d&#039;IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People&#039;s Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People&#039;s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaR\u00e9unionSaint Barth\u00e9lemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluT\u00fcrkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabwe\u00c5land IslandsCountryHow do you want us to Contact you? E-mail PhoneCall Whatsapp Multiple Choice Bank Transfer Crypto Other Special instructions (optional)Order Summary Order Summary Item Quantity Qty Total There are no products selected. Dosage (g) - 9g Nembutal Powder(Body weight less than 100lb)1&#8364;380Dosage (g) - 12g Nembutal Powder(Body weight ranges between 100lb - 135lb)1&#8364;420Dosage (g) - 15g Nembutal Powder(Body weight above 135lb)1&#8364;530Dosage (ml) - 200ml Nembutal Oral Liquid(Body weight less than 100lb)1&#8364;385Dosage (ml) - 250ml Nembutal Oral Liquid(Body weight ranges between 100lb - 135lb)1&#8364;506Dosage (ml) - 300ml Nembutal Oral Liquid(Body weight above 135lb)1&#8364;600Dosage - 25ml Injectable Nembutal Solution(Body Weight less than 100lb)1&#8364;300Dosage - 50ml Injectable Nembutal Solution(Body weight ranges between 100l - 135lb)1&#8364;410Dosage - 100ml Injectable Nembutal Solution(Body weight above 135lb)1&#8364;600Dosage (1000mg\/tabs) - 18 Nembutal pills(Body weight less than 100lb)1&#8364;360Dosage (1000mg\/tabs) - 24 Nembutal pills(Body weight between 100lb - 135lb)1&#8364;415Dosage (1000mg\/tabs) - 30 Nembutal pills(Body weight above 135lb)1&#8364;510Additional Options - Zofran (antiemetic pills)1&#8364;15Additional Options - Express Shipping1&#8364;50Additional Options - Barbiturate test kit1&#8364;35Total&#8364;0 &#8364;0Acknowledgement *\u00a0\u00a0I have read, understood, and agree to the following: I am a legal adult (18+ years old) and I am placing this order solely at my own risk and responsibility. I acknowledge that Nembutal (pentobarbital) is a powerful controlled substance. I confirm that: This purchase is for personal use only and I will not resell or distribute it. I understand this product is intended for voluntary euthanasia \/ end-of-life purposes and I am making this decision freely and without coercion. I have consulted (or will consult) with appropriate medical and\/or legal professionals where required, and I accept full responsibility for any medical, legal, or other consequences that may arise from the use of this product. The information provided on this website is for informational purposes only and does not constitute medical advice. I release Nembutal Solution and its owners\/operators from any liability related to the misuse, improper storage, or unintended effects of this product. I confirm that all information I have provided in this order is accurate and truthful. Submit Disclaimer: For legitimate research, veterinary, or peaceful exit purposes. By ordering, you confirm you are of legal age and fully compliant with your local laws. We are not responsible for any misuse. All sales final. Order Nembutal Online Securely \u2013 Buy Pentobarbital Sodium At Nembutal Solution, we provide a safe, discreet, and reliable way to order Nembutal online. Pharmaceutical-grade pentobarbital for research, veterinary use, or peaceful end-of-life purposes with fast shipping across Europe and worldwide. Why Choose Us to Buy Nembutal Online? Pharmaceutical Grade Quality: Tested for purity and potency. Multiple Forms Available: Liquid, Powder, Pills, and Injectable. Discreet & Secure Shipping: Plain packaging with tracking. Fast Processing: Orders handled within 24 hours. Expert Support: Contact us via WhatsApp or phone. Our Available Nembutal Products Nembutal Liquid Fast-acting oral solution for precise and controlled administration. Read More Nembutal Powder Pure pentobarbital sodium powder \u2013 flexible and long shelf life. Read More Nembutal Pills Convenient oral tablets for easy and accurate dosing. Read More Injectable Nembutal Sterile high-grade solution for clinical and veterinary use. Read More Additional products: Barbiturate Test Kit & Zofran. Place Your Secure Order Fill the form above to order Nembutal online. All orders are processed with complete confidentiality. Safety & Legal Information Important Disclaimer: Nembutal (pentobarbital) is a controlled substance. By ordering, you confirm you are a legal adult and using it responsibly in accordance with your local laws. This is not medical advice. All sales are final. For questions, contact us via WhatsApp: +31 (630) 943-547.","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2169","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.6 (Yoast SEO v27.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Order Nembutal Online Securely | Official Order Form<\/title>\n<meta name=\"description\" content=\"Easily and securely order Nembutal online. 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