<h2>{global:formtitle}</h2>
{error}
<!-- Do not remove this ID, it is used to identify the page so that the pagination script can work correctly -->
<fieldset class="formContainer formHidden" id="rsform_{global:formid}_page_0">
	<div class="row">
		<div class="col-md-12">
			<div class="row mb-3 rsform-block rsform-block-first-name rsform-type-textbox{First Name:errorClass}">
				<label class="col-sm-3 col-form-label formControlLabel" data-bs-toggle="tooltip" title="{First Name:descriptionhtml}" for="First Name">{First Name:caption}<strong class="formRequired">(*)</strong></label>
				<div class="formControls col-sm-9">
					{First Name:body}
					<div><span class="formValidation">{First Name:validation}</span></div>
				</div>
			</div>
			<div class="row mb-3 rsform-block rsform-block-last-name rsform-type-textbox{Last_Name:errorClass}">
				<label class="col-sm-3 col-form-label formControlLabel" data-bs-toggle="tooltip" title="{Last_Name:descriptionhtml}" for="Last_Name">{Last_Name:caption}<strong class="formRequired">(*)</strong></label>
				<div class="formControls col-sm-9">
					{Last_Name:body}
					<div><span class="formValidation">{Last_Name:validation}</span></div>
				</div>
			</div>
			<div class="row mb-3 rsform-block rsform-block-mobile-phone rsform-type-textarea{Mobile_Phone:errorClass}">
				<label class="col-sm-3 col-form-label formControlLabel" data-bs-toggle="tooltip" title="{Mobile_Phone:descriptionhtml}" for="Mobile_Phone">{Mobile_Phone:caption}<strong class="formRequired">(*)</strong></label>
				<div class="formControls col-sm-9">
					{Mobile_Phone:body}
					<div><span class="formValidation">{Mobile_Phone:validation}</span></div>
				</div>
			</div>
			<div class="row mb-3 rsform-block rsform-block-email rsform-type-textbox{Email:errorClass}">
				<label class="col-sm-3 col-form-label formControlLabel" data-bs-toggle="tooltip" title="{Email:descriptionhtml}" for="Email">{Email:caption}<strong class="formRequired">(*)</strong></label>
				<div class="formControls col-sm-9">
					{Email:body}
					<div><span class="formValidation">{Email:validation}</span></div>
				</div>
			</div>
			<div class="row mb-3 rsform-block rsform-block-application-type rsform-type-checkboxgroup{Application_Type:errorClass}">
				<label class="col-sm-3 col-form-label pt-0 formControlLabel" data-bs-toggle="tooltip" title="{Application_Type:descriptionhtml}" id="Application_Type-grouplbl">{Application_Type:caption}<strong class="formRequired">(*)</strong></label>
				<div class="formControls col-sm-9" role="group" aria-labelledby="Application_Type-grouplbl">
					{Application_Type:body}
					<div><span class="formValidation">{Application_Type:validation}</span></div>
				</div>
			</div>
			<div class="row mb-3 rsform-block rsform-block-insurance-status rsform-type-checkboxgroup{Insurance_Status:errorClass}">
				<label class="col-sm-3 col-form-label pt-0 formControlLabel" data-bs-toggle="tooltip" title="{Insurance_Status:descriptionhtml}" id="Insurance_Status-grouplbl">{Insurance_Status:caption}</label>
				<div class="formControls col-sm-9" role="group" aria-labelledby="Insurance_Status-grouplbl">
					{Insurance_Status:body}
					<div><span class="formValidation">{Insurance_Status:validation}</span></div>
				</div>
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-md-12">
			<div class="row mb-3 rsform-block rsform-block-quick-contact rsform-type-pagebreak{Quick_Contact:errorClass}">
				<div class="col-sm-3 col-form-label formControlLabel"></div>
				<div class="formControls col-sm-9 btn-group">
					{Quick_Contact:body}
				</div>
			</div>
		</div>
	</div>
</fieldset>
<!-- Do not remove this ID, it is used to identify the page so that the pagination script can work correctly -->
<fieldset class="formContainer formHidden" id="rsform_{global:formid}_page_1">
	<div class="row">
		<div class="col-md-12">
		</div>
	</div>
	<div class="row">
		<div class="col-md-12">
		</div>
	</div>
</fieldset>