{"id":22392,"date":"2025-12-15T09:47:10","date_gmt":"2025-12-15T09:47:10","guid":{"rendered":"https:\/\/mainstaymedical.com\/?page_id=22392"},"modified":"2025-12-15T09:51:37","modified_gmt":"2025-12-15T09:51:37","slug":"de-zugang-zur-reactiv8-therapie-2","status":"publish","type":"page","link":"https:\/\/mainstaymedical.com\/de\/de-zugang-zur-reactiv8-therapie-2\/","title":{"rendered":"De Zugang Zur Reactiv8 Therapie 2"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"22392\" class=\"elementor elementor-22392\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b168d14 e-flex e-con-boxed e-con e-parent\" data-id=\"b168d14\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7eee096 elementor-widget elementor-widget-text-editor\" data-id=\"7eee096\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Die Ursache mechanischer CLBP behandeln, nicht nur die Symptome<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8084929 elementor-widget-tablet__width-inherit elementor-widget__width-inherit elementor-headline--style-highlight elementor-widget elementor-widget-animated-headline\" data-id=\"8084929\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;highlighted_text&quot;:&quot;chronischen Schmerzen im unteren R\\u00fccken&quot;,&quot;headline_style&quot;:&quot;highlight&quot;,&quot;marker&quot;:&quot;circle&quot;}\" data-widget_type=\"animated-headline.default\">\n\t\t\t\t\t\t\t<h1 class=\"elementor-headline\">\n\t\t\t\t\t<span class=\"elementor-headline-plain-text elementor-headline-text-wrapper\">Die einzige von der FDA zugelassene restaurative Behandlungsoption f\u00fcr Patienten mit  mechanischen <\/span>\n\t\t\t\t<span class=\"elementor-headline-dynamic-wrapper elementor-headline-text-wrapper\">\n\t\t\t\t\t<span class=\"elementor-headline-dynamic-text elementor-headline-text-active\">chronischen Schmerzen im unteren R\u00fccken<\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<\/h1>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-cf9c7a1 e-flex e-con-boxed e-con e-parent\" data-id=\"cf9c7a1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-26c6b55 e-con-full e-flex e-con e-child\" data-id=\"26c6b55\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-722d973 elementor-widget elementor-widget-heading\" data-id=\"722d973\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Erfahren Sie mehr \u00fcber die wissenschaftlichen Hintergr\u00fcnde und die Bedeutung des Multifidus-Muskels sowie der neuromuskul\u00e4ren Kontrolle bei der Behandlung chronischer Schmerzen im unteren R\u00fccken, die auf mechanische Ursachen zur\u00fcckzuf\u00fchren sind.<\/h2>\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-023d4ea e-grid e-con-full e-con e-child\" data-id=\"023d4ea\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-1d7986d e-con-full e-flex e-con e-child\" data-id=\"1d7986d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2181627 elementor-widget elementor-widget-video\" data-id=\"2181627\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;video_type&quot;:&quot;vimeo&quot;,&quot;show_image_overlay&quot;:&quot;yes&quot;,&quot;image_overlay&quot;:{&quot;url&quot;:&quot;https:\\\/\\\/mainstaymedical.com\\\/wp-content\\\/uploads\\\/2025\\\/12\\\/1631567517-a87edeced3c6d821634015fc328c4c49d2d26d10c30dc51dcfaa3223dacb038a-d_640_regionus.jpg&quot;,&quot;id&quot;:21630,&quot;size&quot;:&quot;&quot;,&quot;alt&quot;:&quot;&quot;,&quot;source&quot;:&quot;library&quot;},&quot;autoplay&quot;:&quot;yes&quot;}\" data-widget_type=\"video.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-wrapper elementor-open-inline\">\n\t\t\t<iframe class=\"elementor-video-iframe\" allowfullscreen allow=\"clipboard-write\" title=\"vimeo Video Player\" src=\"https:\/\/player.vimeo.com\/video\/807774798?color&amp;autopause=0&amp;loop=0&amp;muted=0&amp;title=1&amp;portrait=1&amp;byline=1#t=\"><\/iframe>\t\t\t\t<div class=\"elementor-custom-embed-image-overlay\" style=\"background-image: url(https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/1631567517-a87edeced3c6d821634015fc328c4c49d2d26d10c30dc51dcfaa3223dacb038a-d_640_regionus.jpg);\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-custom-embed-play\" role=\"button\" aria-label=\"Video abspielen\" tabindex=\"0\">\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" width=\"512\" height=\"512\" x=\"0\" y=\"0\" viewBox=\"0 0 512 512\" style=\"enable-background:new 0 0 512 512\" xml:space=\"preserve\" class=\"\">  <circle r=\"256\" cx=\"256\" cy=\"256\" fill=\"#ffffff\" transform=\"matrix(0.44,0,0,0.44,143.36,143.36)\"><\/circle>  <g transform=\"matrix(0.7,0,0,0.7,76.80000000000001,76.80000000000001)\">    <path d=\"M256 0C114.615 0 0 114.615 0 256s114.615 256 256 256 256-114.615 256-256S397.385 0 256 0zm-69.947 367.345v-222.69L378.908 256 186.053 367.345z\" fill=\"#091010\" opacity=\"1\" data-original=\"#000000\" class=\"\"><\/path>  <\/g><\/svg>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-694720a e-con-full e-flex e-con e-child\" data-id=\"694720a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0c8f568 elementor-widget elementor-widget-video\" data-id=\"0c8f568\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;video_type&quot;:&quot;vimeo&quot;,&quot;show_image_overlay&quot;:&quot;yes&quot;,&quot;image_overlay&quot;:{&quot;url&quot;:&quot;https:\\\/\\\/mainstaymedical.com\\\/wp-content\\\/uploads\\\/2025\\\/09\\\/image_2024-07-24_194755886.png&quot;,&quot;id&quot;:3072,&quot;size&quot;:&quot;&quot;,&quot;alt&quot;:&quot;&quot;,&quot;source&quot;:&quot;library&quot;},&quot;autoplay&quot;:&quot;yes&quot;}\" data-widget_type=\"video.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-wrapper elementor-open-inline\">\n\t\t\t<iframe class=\"elementor-video-iframe\" allowfullscreen allow=\"clipboard-write\" title=\"vimeo Video Player\" src=\"https:\/\/player.vimeo.com\/video\/823440568?color&amp;autopause=0&amp;loop=0&amp;muted=0&amp;title=1&amp;portrait=1&amp;byline=1#t=\"><\/iframe>\t\t\t\t<div class=\"elementor-custom-embed-image-overlay\" style=\"background-image: url(https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/image_2024-07-24_194755886.png);\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-custom-embed-play\" role=\"button\" aria-label=\"Video abspielen\" tabindex=\"0\">\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" width=\"512\" height=\"512\" x=\"0\" y=\"0\" viewBox=\"0 0 512 512\" style=\"enable-background:new 0 0 512 512\" xml:space=\"preserve\" class=\"\">  <circle r=\"256\" cx=\"256\" cy=\"256\" fill=\"#ffffff\" transform=\"matrix(0.44,0,0,0.44,143.36,143.36)\"><\/circle>  <g transform=\"matrix(0.7,0,0,0.7,76.80000000000001,76.80000000000001)\">    <path d=\"M256 0C114.615 0 0 114.615 0 256s114.615 256 256 256 256-114.615 256-256S397.385 0 256 0zm-69.947 367.345v-222.69L378.908 256 186.053 367.345z\" fill=\"#091010\" opacity=\"1\" data-original=\"#000000\" class=\"\"><\/path>  <\/g><\/svg>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-dd24b57 e-con-full e-flex e-con e-child\" data-id=\"dd24b57\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-baa91ad elementor-widget elementor-widget-heading\" data-id=\"baa91ad\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u00dcberzeugende klinische Daten Zusammenstellung klinischer Nachweise und wissenschaftlicher Literatur zur Unterst\u00fctzung von ReActiv8 Restorative Neurostimulation<\/h2>\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-265e4c8 e-grid e-con-full e-con e-child\" data-id=\"265e4c8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-30df195 e-con-full e-flex e-con e-child\" data-id=\"30df195\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fcad09d elementor-widget elementor-widget-image\" data-id=\"fcad09d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/Three-Year-Durability.pdf\" target=\"_blank\">\n\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"602\" src=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/three-year-thumbail-800x602-1.png\" class=\"attachment-full size-full wp-image-21960\" alt=\"\" srcset=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/three-year-thumbail-800x602-1.png 800w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/three-year-thumbail-800x602-1-300x226.png 300w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/three-year-thumbail-800x602-1-768x578.png 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-4941a30 e-con-full e-flex e-con e-child\" data-id=\"4941a30\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-bb0b481 elementor-widget elementor-widget-image\" data-id=\"bb0b481\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/Two-Year-Durability.pdf\" target=\"_blank\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"800\" height=\"602\" src=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/image-24.jpg\" class=\"attachment-full size-full wp-image-21961\" alt=\"\" srcset=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/image-24.jpg 800w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/image-24-300x226.jpg 300w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/image-24-768x578.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2a3491b e-con-full e-flex e-con e-child\" data-id=\"2a3491b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-dd51769 elementor-widget elementor-widget-heading\" data-id=\"dd51769\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Nachweise aus der Praxis<\/h2>\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7977fd1 e-grid e-con-full e-con e-child\" data-id=\"7977fd1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-809c424 e-con-full e-flex e-con e-child\" data-id=\"809c424\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3742919 elementor-widget elementor-widget-image\" data-id=\"3742919\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"800\" height=\"350\" src=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/screenshot-2.jpg\" class=\"attachment-full size-full wp-image-21964\" alt=\"\" srcset=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/screenshot-2.jpg 800w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/screenshot-2-300x131.jpg 300w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/screenshot-2-768x336.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8d8bde7 e-con-full e-flex e-con e-child\" data-id=\"8d8bde7\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e71146b elementor-widget elementor-widget-image\" data-id=\"e71146b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36184040\/\" target=\"_blank\" rel=\"noopener\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"350\" src=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/capture-1.jpg\" class=\"attachment-full size-full wp-image-21965\" alt=\"\" srcset=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/capture-1.jpg 800w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/capture-1-300x131.jpg 300w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/09\/capture-1-768x336.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8629a9d e-con-full e-flex e-con e-child\" data-id=\"8629a9d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4e21e31 elementor-widget elementor-widget-heading\" data-id=\"4e21e31\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Unterst\u00fctzung der Gesellschaft f\u00fcr ReActiv8 Restorative Neurostimulation<\/h2>\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-beb1db7 e-grid e-con-full e-con e-child\" data-id=\"beb1db7\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-7d6c151 e-con-full e-flex e-con e-child\" data-id=\"7d6c151\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-283099d elementor-widget elementor-widget-image\" data-id=\"283099d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"602\" src=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/National-Institute-for-Health-and-Care-Excellence.jpg\" class=\"attachment-full size-full wp-image-21617\" alt=\"\" srcset=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/National-Institute-for-Health-and-Care-Excellence.jpg 800w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/National-Institute-for-Health-and-Care-Excellence-300x226.jpg 300w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/National-Institute-for-Health-and-Care-Excellence-768x578.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-5f27cc1 e-con-full e-flex e-con e-child\" data-id=\"5f27cc1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-69cadc3 elementor-widget elementor-widget-image\" data-id=\"69cadc3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"602\" src=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/MCD.jpg\" class=\"attachment-full size-full wp-image-21618\" alt=\"\" srcset=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/MCD.jpg 800w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/MCD-300x226.jpg 300w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/MCD-768x578.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ef8e59b e-con-full e-flex e-con e-child\" data-id=\"ef8e59b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c37f088 elementor-widget elementor-widget-heading\" data-id=\"c37f088\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Kommerzielle Zulassung von ReActiv8 Restorative Neurostimulation durch Versicherungen<\/h2>\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7063a6b e-grid e-con-full e-con e-child\" data-id=\"7063a6b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-c48bc4e e-con-full e-flex e-con e-child\" data-id=\"c48bc4e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d6d016c elementor-widget elementor-widget-image\" data-id=\"d6d016c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/policies.credenceblue.com\/portal\/web\/medical-policies\/-\/mp-623\" target=\"_blank\" rel=\"noopener\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"602\" src=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/BCBS-ReActiv8.jpg\" class=\"attachment-full size-full wp-image-21619\" alt=\"\" srcset=\"https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/BCBS-ReActiv8.jpg 800w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/BCBS-ReActiv8-300x226.jpg 300w, https:\/\/mainstaymedical.com\/wp-content\/uploads\/2025\/12\/BCBS-ReActiv8-768x578.jpg 768w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-4bc6c8b e-con-full e-flex e-con e-child\" data-id=\"4bc6c8b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-14974f1 elementor-widget elementor-widget-heading\" data-id=\"14974f1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Machen Sie den ersten Schritt in Richtung ReActiv8 Restorative Neurostimulation f\u00fcr eine restaurative Neurostimulation mit dem ReActiv8-System<\/h2>\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2f6acee e-con-full e-flex e-con e-child\" data-id=\"2f6acee\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-92d53d5 elementor-widget elementor-widget-shortcode\" data-id=\"92d53d5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar 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id='gform_4'  action='\/de\/wp-json\/wp\/v2\/pages\/22392#gf_4' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_1\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_1'>Physician First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_4_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_3\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_3'>Physician Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_4_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_87\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_87'>Specialty<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_87' id='input_4_87' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Specialty' selected='selected'>Specialty<\/option><option value='Interventional Pain\/Anesthesia' >Interventional Pain\/Anesthesia<\/option><option value='Interventional Pain\/PM&amp;R' >Interventional Pain\/PM&amp;R<\/option><option value='Interventional Pain\/Radiology' >Interventional Pain\/Radiology<\/option><option value='Neurosurgeon' >Neurosurgeon<\/option><option value='Orthopedic surgeon' >Orthopedic surgeon<\/option><option value='Other, please specify' >Other, please specify<\/option><\/select><\/div><\/div><div id=\"field_4_4\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>Practice Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_4_4' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_88\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_88'>Specialty - Please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_4_88' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_6\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_6'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_4_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_7\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_7'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_4_7' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_60\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_60'>Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_60' id='input_4_60' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' selected='selected'>United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select><\/div><\/div><div id=\"field_4_59\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_59'>City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_4_59' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_61\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_61'>State<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_4_61' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_62\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_62'>ZIP<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_4_62' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_10\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_10'>NPI<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_4_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_11\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_11'>Website<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_4_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_13\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_13'>Office\/Practice Contact Name<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_4_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_14\" class=\"gfield gfield--type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_14'>Office\/Practice Contact Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_14' id='input_4_14' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_15\" class=\"gfield gfield--type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_15'>Office\/Practice Contact Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_15' id='input_4_15' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_4_77\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have access to an Ambulatory Surgery Center (ASC) or Hospital Outpatient Department (HOPD)?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_77'>\n\t\t\t<div class='gchoice gchoice_4_77_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='Yes'  id='choice_4_77_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_77_0' id='label_4_77_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_77_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='No' checked='checked' id='choice_4_77_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_77_1' id='label_4_77_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have experience with active implantable devices?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_79'>\n\t\t\t<div class='gchoice gchoice_4_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Yes'  id='choice_4_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_79_0' id='label_4_79_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='No' checked='checked' id='choice_4_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_79_1' id='label_4_79_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_78\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_78'>Please specify the name of your ASC or HOPD<\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_4_78' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_80\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_80'>Please specify experience with active implantable devices (PNS\/SCS etc, as well as indication(s))<\/label><div class='ginput_container ginput_container_text'><input name='input_80' id='input_4_80' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_89\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_89'>What % of patients presenting with mechanical CLBP is currently in your practice?<\/label><div class='ginput_container ginput_container_select'><select name='input_89' id='input_4_89' class='large gfield_select'     aria-invalid=\"false\" ><option value='-' >-<\/option><option value='&lt; 10%' >&lt; 10%<\/option><option value='10-20%' >10-20%<\/option><option value='20-30%' >20-30%<\/option><option value='40-50%' >40-50%<\/option><option value='&gt;50%' >&gt;50%<\/option><\/select><\/div><\/div><fieldset id=\"field_4_18\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Practice Structure<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_18'><div class='gchoice gchoice_4_18_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.1' type='checkbox'  value='Private Practice Integrated Spine Focus Center (Neuro, Brain\/Spine)'  id='choice_4_18_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_18_1' id='label_4_18_1' class='gform-field-label gform-field-label--type-inline'>Private Practice Integrated Spine Focus Center (Neuro, Brain\/Spine)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_18_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.2' type='checkbox'  value='Private Practice Integrated Spine Focus Center (Ortho\/PM&amp;R)'  id='choice_4_18_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_18_2' id='label_4_18_2' class='gform-field-label gform-field-label--type-inline'>Private Practice Integrated Spine Focus Center (Ortho\/PM&amp;R)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_18_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.3' type='checkbox'  value='Integrated Pain Management Practice (Interventional, Anesthesia)'  id='choice_4_18_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_18_3' id='label_4_18_3' class='gform-field-label gform-field-label--type-inline'>Integrated Pain Management Practice (Interventional, Anesthesia)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_18_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.4' type='checkbox'  value='Multi-Disciplinary (Independent)'  id='choice_4_18_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_18_4' id='label_4_18_4' class='gform-field-label gform-field-label--type-inline'>Multi-Disciplinary (Independent)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_18_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.5' type='checkbox'  value='Multi-Disciplinary (Hospital Employed)'  id='choice_4_18_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_18_5' id='label_4_18_5' class='gform-field-label gform-field-label--type-inline'>Multi-Disciplinary (Hospital Employed)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_18_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.6' type='checkbox'  value='Academic\/University Affiliated (Ortho)'  id='choice_4_18_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_18_6' id='label_4_18_6' class='gform-field-label gform-field-label--type-inline'>Academic\/University Affiliated (Ortho)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_18_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.7' type='checkbox'  value='Academic\/University Affiliated (Neuro)'  id='choice_4_18_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_18_7' id='label_4_18_7' class='gform-field-label gform-field-label--type-inline'>Academic\/University Affiliated (Neuro)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_18_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.8' type='checkbox'  value='Academic\/University Affiliated (Combined)'  id='choice_4_18_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_18_8' id='label_4_18_8' class='gform-field-label gform-field-label--type-inline'>Academic\/University Affiliated (Combined)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_18_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.9' type='checkbox'  value='None of the above (please specify)'  id='choice_4_18_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_18_9' id='label_4_18_9' class='gform-field-label gform-field-label--type-inline'>None of the above (please specify)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_19\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_19'>Practice Structure - None of the above<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_4_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_76\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_76'>Practice Type<\/label><div class='ginput_container ginput_container_select'><select name='input_76' id='input_4_76' class='large gfield_select'     aria-invalid=\"false\" ><option value='-' selected='selected'>-<\/option><option value='Rural' >Rural<\/option><option value='Urban' >Urban<\/option><option value='Multistate' >Multistate<\/option><\/select><\/div><\/div><fieldset id=\"field_4_20\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Payer Mix for Practice (can fill in more than one)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(erforderlich)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_4_20'>Primary Payer(s) and Percentage %<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_20'><div class='gchoice gchoice_4_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Anthem'  id='choice_4_20_1'   aria-describedby=\"gfield_description_4_20\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_1' id='label_4_20_1' class='gform-field-label gform-field-label--type-inline'>Anthem<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Aetna'  id='choice_4_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_2' id='label_4_20_2' class='gform-field-label gform-field-label--type-inline'>Aetna<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.3' type='checkbox'  value='Cigna'  id='choice_4_20_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_3' id='label_4_20_3' class='gform-field-label gform-field-label--type-inline'>Cigna<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.4' type='checkbox'  value='HCSC'  id='choice_4_20_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_4' id='label_4_20_4' class='gform-field-label gform-field-label--type-inline'>HCSC<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.5' type='checkbox'  value='United Health Care'  id='choice_4_20_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_5' id='label_4_20_5' class='gform-field-label gform-field-label--type-inline'>United Health Care<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.6' type='checkbox'  value='Medicare\/Medicaid'  id='choice_4_20_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_6' id='label_4_20_6' class='gform-field-label gform-field-label--type-inline'>Medicare\/Medicaid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.7' type='checkbox'  value='Workers Compensation'  id='choice_4_20_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_7' id='label_4_20_7' class='gform-field-label gform-field-label--type-inline'>Workers Compensation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.8' type='checkbox'  value='VA\/Tri-Care'  id='choice_4_20_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_8' id='label_4_20_8' class='gform-field-label gform-field-label--type-inline'>VA\/Tri-Care<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.9' type='checkbox'  value='Self-Insured (Please Specify)'  id='choice_4_20_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_9' id='label_4_20_9' class='gform-field-label gform-field-label--type-inline'>Self-Insured (Please Specify)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.11' type='checkbox'  value='Regional Payer Mix (Please Specify)'  id='choice_4_20_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_11' id='label_4_20_11' class='gform-field-label gform-field-label--type-inline'>Regional Payer Mix (Please Specify)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_20_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.12' type='checkbox'  value='Other (Please Specify)'  id='choice_4_20_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_12' id='label_4_20_12' class='gform-field-label gform-field-label--type-inline'>Other (Please Specify)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_21\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_21'>Self-Insured (Please Specify)<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_4_21' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_22\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_22'>Regional Payer Mix (Please Specify)<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_4_22' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_23\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_23'>Other (Please Specify)<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_4_23' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_64\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Anthem Care Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_64_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_64[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_64_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_64[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_64_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_64[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_66\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Aetna Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_66_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_66[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_66_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_66[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_66_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_66[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_67\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Cigna Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_67_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_67[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_67_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_67[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_67_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_67[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_68\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >HCSC Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_68_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_68[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_68_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_68[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_68_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_68[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_69\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >United Healthcare Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_69_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_69[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_69_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_69[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_69_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_69[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_70\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Medicare\/Medicaid Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_70_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_70[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_70_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_70[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_70_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_70[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_71\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Workers Compensation Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_71_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_71[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_71_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_71[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_71_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_71[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_72\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >VA\/Tri-Care Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_72_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_72[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_72_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_72[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_72_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_72[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_73\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Self-Insured Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_73_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_73[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_73_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_73[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_73_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_73[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_74\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Regional Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_74_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_74[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_74_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_74[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_74_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_74[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_75\" class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Other Payer Mix for Practice Info<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Medical Director\/Practice Liaison Contact Info<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Percentage  % of Plans  within Practice<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_75_cell1 gform-grid-col' data-label='Medical Director\/Practice Liaison Name'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Name, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Name, Zeile {0}' type='text' name='input_75[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_75_cell2 gform-grid-col' data-label='Medical Director\/Practice Liaison Contact Info'><input aria-invalid='false'   aria-label='Medical Director\/Practice Liaison Contact Info, Zeile 1' data-aria-label-template='Medical Director\/Practice Liaison Contact Info, Zeile {0}' type='text' name='input_75[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_75_cell3 gform-grid-col' data-label='Percentage  % of Plans  within Practice'><input aria-invalid='false'   aria-label='Percentage  % of Plans  within Practice, Zeile 1' data-aria-label-template='Percentage  % of Plans  within Practice, Zeile {0}' type='text' name='input_75[]' value=''   \/><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_4_81\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_81'>How did you hear about ReActiv8 Restorative Neurostimulation?<\/label><div class='ginput_container ginput_container_select'><select name='input_81' id='input_4_81' class='large gfield_select'     aria-invalid=\"false\" ><option value='Colleague\/Friend\/Referral' >Colleague\/Friend\/Referral<\/option><option value='Social Media' >Social Media<\/option><option value='Society meeting' >Society meeting<\/option><option value='Abstract Presentation' >Abstract Presentation<\/option><option value='Online Search (please specify)' >Online Search (please specify)<\/option><option value='Journal Article (please specify)' >Journal Article (please specify)<\/option><option value='Other (please specify)' >Other (please specify)<\/option><\/select><\/div><\/div><div id=\"field_4_82\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_82'>Online search - Please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_4_82' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_83\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_83'>Journal article - Please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_4_83' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_84\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_84'>Other - Please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_4_84' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_90\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_90'>Comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_90' id='input_4_90' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_91\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"display: block\">Note:  By submitting your information above, you consent to Mainstay Medical sending you educational and clinical information regarding the ReActiv8 restorative neuromodulation system, including facilitating next steps for your ReActiv8 training and certification. 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