[wpforms id="46943"]
<div class="wpforms-container wpforms-container-full" id="wpforms-46943"><form id="wpforms-form-46943" class="wpforms-validate wpforms-form" data-formid="46943" method="post" enctype="multipart/form-data" action="/healthy/directory/" data-token="cde06b25526de1570f9583fbf4a8488a"><noscript class="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</noscript><div class="wpforms-field-container"><div id="wpforms-46943-field_0-container" class="wpforms-field wpforms-field-name" data-field-id="0"><label class="wpforms-field-label" for="wpforms-46943-field_0">Name <span class="wpforms-required-label">*</span></label><div class="wpforms-field-row wpforms-field-medium"><div class="wpforms-field-row-block wpforms-first wpforms-one-half"><input type="text" id="wpforms-46943-field_0" class="wpforms-field-name-first wpforms-field-required" name="wpforms[fields][0][first]" required><label for="wpforms-46943-field_0" class="wpforms-field-sublabel after ">First</label></div><div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-46943-field_0-last" class="wpforms-field-name-last wpforms-field-required" name="wpforms[fields][0][last]" required><label for="wpforms-46943-field_0-last" class="wpforms-field-sublabel after ">Last</label></div></div></div><div id="wpforms-46943-field_1-container" class="wpforms-field wpforms-field-email" data-field-id="1"><label class="wpforms-field-label" for="wpforms-46943-field_1">Email <span class="wpforms-required-label">*</span></label><input type="email" id="wpforms-46943-field_1" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][1]" required></div></div><div class="wpforms-field wpforms-field-hp"><label for="wpforms-46943-field-hp" class="wpforms-field-label">Website</label><input type="text" name="wpforms[hp]" id="wpforms-46943-field-hp" class="wpforms-field-medium"></div><div class="wpforms-submit-container"><input type="hidden" name="wpforms[id]" value="46943"><input type="hidden" name="wpforms[author]" value="1"><input type="hidden" name="wpforms[post_id]" value="45927"><button type="submit" name="wpforms[submit]" id="wpforms-submit-46943" class="wpforms-submit" data-alt-text="Sending..." data-submit-text="Submit" aria-live="assertive" value="wpforms-submit">Submit</button></div></form></div> <!-- .wpforms-container -->
