https://store-lumivera.vercel.app/_nuxt/BdjERKlH.js

1import{products as Jt}from"./B_dd1JcY.js";import{y as ke,v as Pe,e as Zt,m as Ke,n as ei,z as he,I as Oe,K as ti,N as ut}from"./CoDuZEfM.js";import{u as ii}from"./BUxte-09.js";const ri=/^[a-zA-Z0-9._%+-]+@[a-zA-Z0-9.-]+\.[a-zA-Z]{2,}$/;function Yi(e){if(!e)return null;const t=String(e).replace(/\D/g,"");return t.length!==10?null:`+1${t}`}function oi(e,t,T){const a=e==null||e==="";return t.type==="required"?a?{isValid:!1,message:t.message}:{isValid:!0}:a?{isValid:!0}:t.type==="email"?ri.test(String(e))?{isValid:!0}:{isValid:!1,message:t.message}:t.type==="phone"?String(e).replace(/\D/g,"").length!==10?{isValid:!1,message:t.message}:{isValid:!0}:t.type==="minLength"&&t.value!==void 0?String(e).length<t.value?{isValid:!1,message:t.message}:{isValid:!0}:t.type==="maxLength"&&t.value!==void 0?String(e).length>t.value?{isValid:!1,message:t.message}:{isValid:!0}:t.type==="pattern"&&t.value?new RegExp(t.value).test(String(e))?{isValid:!0}:{isValid:!1,message:t.message}:t.type==="custom"&&t.validator?(T?t.validator(e,T):t.validator(e))?{isValid:!0}:{isValid:!1,message:t.message}:{isValid:!0}}function si(e,t,T){for(const a of t){const i=oi(e,a,T);if(!i.isValid)return i}return{isValid:!0}}function ni(e,t){return t.forEach((function(T){T&&typeof T!="string"&&!Array.isArray(T)&&Object.keys(T).forEach((function(a){if(a!=="default"&&!(a in e)){var i=Object.getOwnPropertyDescriptor(T,a);Object.defineProperty(e,a,i.get?i:{enumerable:!0,get:function(){return T[a]}})}}))})),Object.freeze(e)}function ft(e,t){return new Promise((function(T,a){let i;return ai(e).then((function(r){try{return i=r,T(new Blob([t.slice(0,2),i,t.slice(2)],{type:"image/jpeg"}))}catch(h){return a(h)}}),a)}))}const ai=e=>new Promise(((t,T)=>{const a=new FileReader;a.addEventListener("load",(({target:{result:i}})=>{const r=new DataView(i);let h=0;if(r.getUint16(h)!==65496)return T("not a valid JPEG");for(h+=2;;){const c=r.getUint16(h);if(c===65498)break;const S=r.getUint16(h+2);if(c===65505&&r.getUint32(h+4)===1165519206){const b=h+10;let s;switch(r.getUint16(b)){case 18761:s=!0;break;case 19789:s=!1;break;default:return T("TIFF header contains invalid endian")}if(r.getUint16(b+2,s)!==42)return T("TIFF header contains invalid version");const n=r.getUint32(b+4,s),o=b+n+2+12*r.getUint16(b+n,s);for(let y=b+n+2;y<o;y+=12)if(r.getUint16(y,s)==274){if(r.getUint16(y+2,s)!==3)return T("Orientation data type is invalid");if(r.getUint32(y+4,s)!==1)return T("Orientation data count is invalid");r.setUint16(y+8,1,s);break}

1return t(i.slice(h,h+2+S))}h+=2+S}return t(new Blob)})),a.readAsArrayBuffer(e)}));var We={},di={get exports(){return We},set exports(e){We=e}};(function(e){var t,T,a={};di.exports=a,a.parse=function(i,r){for(var h=a.bin.readUshort,c=a.bin.readUint,S=0,b={},s=new Uint8Array(i),n=s.length-4;c(s,n)!=101010256;)n--;S=n,S+=4;var o=h(s,S+=4);h(s,S+=2);var y=c(s,S+=2),g=c(s,S+=4);S+=4,S=g;for(var P=0;P<o;P++){c(s,S),S+=4,S+=4,S+=4,c(s,S+=4),y=c(s,S+=4);var k=c(s,S+=4),L=h(s,S+=4),U=h(s,S+2),O=h(s,S+4);S+=6;var M=c(s,S+=8);S+=4,S+=L+U+O,a._readLocal(s,M,b,y,k,r)}return b},a._readLocal=function(i,r,h,c,S,b){var s=a.bin.readUshort,n=a.bin.readUint;n(i,r),s(i,r+=4),s(i,r+=2);var o=s(i,r+=2);n(i,r+=2),n(i,r+=4),r+=4;var y=s(i,r+=8),g=s(i,r+=2);r+=2;var P=a.bin.readUTF8(i,r,y);if(r+=y,r+=g,b)h[P]={size:S,csize:c};else{var k=new Uint8Array(i.buffer,r);if(o==0)h[P]=new Uint8Array(k.buffer.slice(r,r+c));else{if(o!=8)throw"unknown compression method: "+o;var L=new Uint8Array(S);a.inflateRaw(k,L),h[P]=L}}},a.inflateRaw=function(i,r){return a.F.inflate(i,r)},a.inflate=function(i,r){return i[0],i[1],a.inflateRaw(new Uint8Array(i.buffer,i.byteOffset+2,i.length-6),r)},a.deflate=function(i,r){r==null&&(r={level:6});var h=0,c=new Uint8Array(50+Math.floor(1.1*i.length));c[h]=120,c[h+1]=156,h+=2,h=a.F.deflateRaw(i,c,h,r.level);var S=a.adler(i,0,i.length);return c[h+0]=S>>>24&255,c[h+1]=S>>>16&255,c[h+2]=S>>>8&255,c[h+3]=S>>>0&255,new Uint8Array(c.buffer,0,h+4)},a.deflateRaw=function(i,r){r==null&&(r={level:6});var h=new Uint8Array(50+Math.floor(1.1*i.length)),c=a.F.deflateRaw(i,h,c,r.level);return new Uint8Array(h.buffer,0,c)},a.encode=function(i,r){r==null&&(r=!1);var h=0,c=a.bin.writeUint,S=a.bin.writeUshort,b={};for(var s in i){var n=!a._noNeed(s)&&!r,o=i[s],y=a.crc.crc(o,0,o.length);b[s]={cpr:n,usize:o.length,crc:y,file:n?a.deflateRaw(o):o}}for(var s in b)h+=b[s].file.length+30+46+2*a.bin.sizeUTF8(s);h+=22;var g=new Uint8Array(h),P=0,k=[];for(var s in b){var L=b[s];k.push(P),P=a._writeHeader(g,P,s,L,0)}var U=0,O=P;for(var s in b)L=b[s],k.push(P),P=a._writeHeader(g,P,s,L,1,k[U++]);var M=P-O;return c(g,P,101010256),P+=4,S(g,P+=4,U),S(g,P+=2,U),c(g,P+=2,M),c(g,P+=4,O),P+=4,P+=2,g.buffer},a._noNeed=function(i){var r=i.split(".").pop().toLowerCase();return"png,jpg,jpeg,zip".indexOf(r)!=-1},a._writeHeader=function(i,r,h,c,S,b){var s=a.bin.writeUint,n=a.bin.writeUshort,o=c.file;return s(i,r,S==0?67324752:33639248),r+=4,S==1&&(r+=2),n(i,r,20),n(i,r+=2,0),n(i,r+=2,c.cpr?8:0),s(i,r+=2,0),s(i,r+=4,c.crc),s(i,r+=4,o.length),s(i,r+=4,c.usize),n(i,r+=4,a.bin.sizeUTF8(h)),n(i,r+=2,0),r+=2,S==1&&(r+=2,r+=2,s(i,r+=6,b),r+=4),r+=a.bin.writeUTF8(i,r,h),S==0&&(i.set(o,r),r+=o.length),r},a.crc={table:(function(){for(var i=new Uint32Array(256),r=0;r<256;r++){for(var h=r,c=0;c<8;c++)1&h?h=3988292384^h>>>1:h>>>=1;i[r]=h}return i})(),update:function(i,r,h,c){for(var S=0;S<c;S++)i=a.crc.table[255&(i^r[h+S])]^i>>>8;return i},crc:function(i,r,h){return 4294967295^a.crc.update(4294967295,i,r,h)}},a.adler=function(i,r,h){for(var c=1,S=0,b=r,s=r+h;b<s;){for(var n=Math.min(b+5552,s);b<n;)S+=c+=i[b++];c%=65521,S%=65521}return S<<16|c},a.bin={readUshort:function(i,r){return i[r]|i[r+1]<<8},writeUshort:function(i,r,h){i[r]=255&h,i[r+1]=h>>8&255},readUint:function(i,r){return 16777216*i[r+3]+(i[r+2]<<16|i[r+1]<<8|i[r])},writeUint:function(i,r,h){i[r]=255&h,i[r+1]=h>>8&255,i[r+2]=h>>16&255,i[r+3]=h>>24&255},readASCII:function(i,r,h){for(var c="",S=0;S<h;S++)c+=String.fromCharCode(i[r+S]);return c},writeASCII:function(i,r,h){for(var c=0;c<h.length;c++)i[r+c]=h.charCodeAt(c)},pad:function(i){return i.length<2?"0"+i:i},readUTF8:function(i,r,h){for(var c,S="",b=0;b<h;b++)S+="%"+a.bin.pad(i[r+b].toString(16));try{c=decodeURIComponent(S)}catch{return a.bin.readASCII(i,r,h)}return c},writeUTF8:function(i,r,h){for(var c=h.length,S=0,b=0;b<c;b++){var s=h.charCodeAt(b);if((4294967168&s)==0)i[r+S]=s,S++;else if((4294965248&s)==0)i[r+S]=192|s>>6,i[r+S+1]=128|s>>0&63,S+=2;else if((4294901760&s)==0)i[r+S]=224|s>>12,i[r+S+1]=128|s>>6&63,i[r+S+2]=128|s>>0&63,S+=3;else{if((4292870144&s)!=0)throw"e";i[r+S]=240|s>>18,i[r+S+1]=128|s>>12&63,i[r+S+2]=128|s>>6&63,i[r+S+3]=128|s>>0&63,S+=4}}return S},sizeUTF8:function(i){for(var r=i.length,h=0,c=0;c<r;c++){var S=i.charCodeAt(c);if((4294967168&S)==0)h++;else if((4294965248&S)==0)h+=2;else if((4294901760&S)==0)h+=3;else{if((4292870144&S)!=0)throw"e";h+=4}}return h}},a.F={},a.F.deflateRaw=function(i,r,h,c){var S=[[0,0,0,0,0],[4,4,8,4,0],[4,5,16,8,0],[4,6,16,16,0],[4,10,16,32,0],[8,16,32,32,0],[8,16,128,128,0],[8,32,128,256,0],[32,128,258,1024,1],[32,258,258,4096,1]][c],b=a.F.U,s=a.F._goodIndex;a.F._hash;var n=a.F._putsE,o=0,y=h<<3,g=0,P=i.length;if(c==0){for(;o<P;)n(r,y,o+(v=Math.min(65535,P-o))==P?1:0),y=a.F._copyExact(i,o,v,r,y+8),o+=v;return y>>>3}var k=b.lits,L=b.strt,U=b.prev,O=0,M=0,Q=0,m=0,A=0,u=0;for(P>2&&(L[u=a.F._hash(i,0)]=0),o=0;o<P;o++){if(A=u,o+1<P-2){u=a.F._hash(i,o+1);var p=o+1&32767;U[p]=L[u],L[u]=p}if(g<=o){(O>14e3||M>26697)&&P-o>100&&(g<o&&(k[O]=o-g,O+=2,g=o),y=a.F._writeBlock(o==P-1||g==P?1:0,k,O,m,i,Q,o-Q,r,y),O=M=m=0,Q=o);var I=0;o<P-2&&(I=a.F._bestMatch(i,o,U,A,Math.min(S[2],P-o),S[3]));var v=I>>>16,C=65535&I;if(I!=0){C=65535&I;var x=s(v=I>>>16,b.of0);b.lhst[257+x]++;var E=s(C,b.df0);b.dhst[E]++,m+=b.exb[x]+b.dxb[E],k[O]=v<<23|o-g,k[O+1]=C<<16|x<<8|E,O+=2,g=o+v}else b.lhst[i[o]]++;M++}}for(Q==o&&i.length!=0||(g<o&&(k[O]=o-g,O+=2,g=o),y=a.F._writeBlock(1,k,O,m,i,Q,o-Q,r,y),O=0,M=0,O=M=m=0,Q=o);(7&y)!=0;)y++;return y>>>3},a.F._bestMatch=function(i,r,h,c,S,b){var s=32767&r,n=h[s],o=s-n+32768&32767;if(n==s||c!=a.F._hash(i,r-o))return 0;for(var y=0,g=0,P=Math.min(32767,r);o<=P&&--b!=0&&n!=s;){if(y==0||i[r+y]==i[r+y-o]){var k=a.F._howLong(i,r,o);if(k>y){if(g=o,(y=k)>=S)break;o+2<k&&(k=o+2);for(var L=0,U=0;U<k-2;U++){var O=r-o+U+32768&32767,M=O-h[O]+32768&32767;M>L&&(L=M,n=O)}}}o+=(s=n)-(n=h[s])+32768&32767}return y<<16|g},a.F._howLong=function(i,r,h){if(i[r]!=i[r-h]||i[r+1]!=i[r+1-h]||i[r+2]!=i[r+2-h])return 0;var c=r,S=Math.min(i.length,r+258);for(r+=3;r<S&&i[r]==i[r-h];)r++;return r-c},a.F._hash=function(i,r){return(i[r]<<8|i[r+1])+(i[r+2]<<4)&65535},a.saved=0,a.F._writeBlock=function(i,r,h,c,S,b,s,n,o){var y,g,P,k,L,U,O,M,Q,m=a.F.U,A=a.F._putsF,u=a.F._putsE;m.lhst[256]++,g=(y=a.F.getTrees())[0],P=y[1],k=y[2],L=y[3],U=y[4],O=y[5],M=y[6],Q=y[7];var p=32+((o+3&7)==0?0:8-(o+3&7))+(s<<3),I=c+a.F.contSize(m.fltree,m.lhst)+a.F.contSize(m.fdtree,m.dhst),v=c+a.F.contSize(m.ltree,m.lhst)+a.F.contSize(m.dtree,m.dhst);v+=14+3*O+a.F.contSize(m.itree,m.ihst)+(2*m.ihst[16]+3*m.ihst[17]+7*m.ihst[18]);for(var C=0;C<286;C++)m.lhst[C]=0;for(C=0;C<30;C++)m.dhst[C]=0;for(C=0;C<19;C++)m.ihst[C]=0;var x=p<I&&p<v?0:I<v?1:2;if(A(n,o,i),A(n,o+1,x),o+=3,x==0){for(;(7&o)!=0;)o++;o=a.F._copyExact(S,b,s,n,o)}else{var E,f;if(x==1&&(E=m.fltree,f=m.fdtree),x==2){a.F.makeCodes(m.ltree,g),a.F.revCodes(m.ltree,g),a.F.makeCodes(m.dtree,P),a.F.revCodes(m.dtree,P),a.F.makeCodes(m.itree,k),a.F.revCodes(m.itree,k),E=m.ltree,f=m.dtree,u(n,o,L-257),u(n,o+=5,U-1),u(n,o+=5,O-4),o+=4;for(var l=0;l<O;l++)u(n,o+3*l,m.itree[1+(m.ordr[l]<<1)]);o+=3*O,o=a.F._codeTiny(M,m.itree,n,o),o=a.F._codeTiny(Q,m.itree,n,o)}for(var d=b,w=0;w<h;w+=2){for(var q=r[w],D=q>>>23,G=d+(8388607&q);d<G;)o=a.F._writeLit(S[d++],E,n,o);if(D!=0){var H=r[w+1],R=H>>16,W=H>>8&255,N=255&H;u(n,o=a.F._writeLit(257+W,E,n,o),D-m.of0[W]),o+=m.exb[W],A(n,o=a.F._writeLit(N,f,n,o),R-m.df0[N]),o+=m.dxb[N],d+=D}}o=a.F._writeLit(256,E,n,o)}return o},a.F._copyExact=function(i,r,h,c,S){var b=S>>>3;return c[b]=h,c[b+1]=h>>>8,c[b+2]=255-c[b],c[b+3]=255-c[b+1],b+=4,c.set(new Uint8Array(i.buffer,r,h),b),S+(h+4<<3)},a.F.getTrees=function(){for(var i=a.F.U,r=a.F._hufTree(i.lhst,i.ltree,15),h=a.F._hufTree(i.dhst,i.dtree,15),c=[],S=a.F._lenCodes(i.ltree,c),b=[],s=a.F._lenCodes(i.dtree,b),n=0;n<c.length;n+=2)i.ihst[c[n]]++;for(n=0;n<b.length;n+=2)i.ihst[b[n]]++;for(var o=a.F._hufTree(i.ihst,i.itree,7),y=19;y>4&&i.itree[1+(i.ordr[y-1]<<1)]==0;)y--;return[r,h,o,S,s,y,c,b]},a.F.getSecond=function(i){for(var r=[],h=0;h<i.length;h+=2)r.push(i[h+1]);return r},a.F.nonZero=function(i){for(var r="",h=0;h<i.length;h+=2)i[h+1]!=0&&(r+=(h>>1)+",");return r},a.F.contSize=function(i,r){for(var h=0,c=0;c<r.length;c++)h+=r[c]*i[1+(c<<1)];return h},a.F._codeTiny=function(i,r,h,c){for(var S=0;S<i.length;S+=2){var b=i[S],s=i[S+1];c=a.F._writeLit(b,r,h,c);var n=b==16?2:b==17?3:7;b>

115&&(a.F._putsE(h,c,s,n),c+=n)}return c},a.F._lenCodes=function(i,r){for(var h=i.length;h!=2&&i[h-1]==0;)h-=2;for(var c=0;c<h;c+=2){var S=i[c+1],b=c+3<h?i[c+3]:-1,s=c+5<h?i[c+5]:-1,n=c==0?-1:i[c-1];if(S==0&&b==S&&s==S){for(var o=c+5;o+2<h&&i[o+2]==S;)o+=2;(y=Math.min(o+1-c>>>1,138))<11?r.push(17,y-3):r.push(18,y-11),c+=2*y-2}else if(S==n&&b==S&&s==S){for(o=c+5;o+2<h&&i[o+2]==S;)o+=2;var y=Math.min(o+1-c>>>1,6);r.push(16,y-3),c+=2*y-2}else r.push(S,0)}return h>>>1},a.F._hufTree=function(i,r,h){var c=[],S=i.length,b=r.length,s=0;for(s=0;s<b;s+=2)r[s]=0,r[s+1]=0;for(s=0;s<S;s++)i[s]!=0&&c.push({lit:s,f:i[s]});var n=c.length,o=c.slice(0);if(n==0)return 0;if(n==1){var y=c[0].lit;return o=y==0?1:0,r[1+(y<<1)]=1,r[1+(o<<1)]=1,1}c.sort((function(M,Q){return M.f-Q.f}));var g=c[0],P=c[1],k=0,L=1,U=2;for(c[0]={lit:-1,f:g.f+P.f,l:g,r:P,d:0};L!=n-1;)g=k!=L&&(U==n||c[k].f<c[U].f)?c[k++]:c[U++],P=k!=L&&(U==n||c[k].f<c[U].f)?c[k++]:c[U++],c[L++]={lit:-1,f:g.f+P.f,l:g,r:P};var O=a.F.setDepth(c[L-1],0);for(O>h&&(a.F.restrictDepth(o,h,O),O=h),s=0;s<n;s++)r[1+(o[s].lit<<1)]=o[s].d;return O},a.F.setDepth=function(i,r){return i.lit!=-1?(i.d=r,r):Math.max(a.F.setDepth(i.l,r+1),a.F.setDepth(i.r,r+1))},a.F.restrictDepth=function(i,r,h){var c=0,S=1<<h-r,b=0;for(i.sort((function(n,o){return o.d==n.d?n.f-o.f:o.d-n.d})),c=0;c<i.length&&i[c].d>r;c++){var s=i[c].d;i[c].d=r,b+=S-(1<<h-s)}for(b>>>=h-r;b>0;)(s=i[c].d)<r?(i[c].d++,b-=1<<r-s-1):c++;for(;c>=0;c--)i[c].d==r&&b<0&&(i[c].d--,b++);b!=0&&console.log("debt left")},a.F._goodIndex=function(i,r){var h=0;return r[16|h]<=i&&(h|=16),r[8|h]<=i&&(h|=8),r[4|h]<=i&&(h|=4),r[2|h]<=i&&(h|=2),r[1|h]<=i&&(h|=1),h},a.F._writeLit=function(i,r,h,c){return a.F._putsF(h,c,r[i<<1]),c+r[1+(i<<1)]},a.F.inflate=function(i,r){var h=Uint8Array;

1if(i[0]==3&&i[1]==0)return r||new h(0);var c=a.F,S=c._bitsF,b=c._bitsE,s=c._decodeTiny,n=c.makeCodes,o=c.codes2map,y=c._get17,g=c.U,P=r==null;P&&(r=new h(i.length>>>2<<3));for(var k,L,U=0,O=0,M=0,Q=0,m=0,A=0,u=0,p=0,I=0;U==0;)if(U=S(i,I,1),O=S(i,I+1,2),I+=3,O!=0){if(P&&(r=a.F._check(r,p+(1<<17))),O==1&&(k=g.flmap,L=g.fdmap,A=511,u=31),O==2){M=b(i,I,5)+257,Q=b(i,I+5,5)+1,m=b(i,I+10,4)+4,I+=14;for(var v=0;v<38;v+=2)g.itree[v]=0,g.itree[v+1]=0;var C=1;for(v=0;v<m;v++){var x=b(i,I+3*v,3);g.itree[1+(g.ordr[v]<<1)]=x,x>C&&(C=x)}I+=3*m,n(g.itree,C),o(g.itree,C,g.imap),k=g.lmap,L=g.dmap,I=s(g.imap,(1<<C)-1,M+Q,i,I,g.ttree);var E=c._copyOut(g.ttree,0,M,g.ltree);A=(1<<E)-1;var f=c._copyOut(g.ttree,M,Q,g.dtree);u=(1<<f)-1,n(g.ltree,E),o(g.ltree,E,k),n(g.dtree,f),o(g.dtree,f,L)}for(;;){var l=k[y(i,I)&A];I+=15&l;var d=l>>>4;if(!(d>>>8))r[p++]=d;else{if(d==256)break;var w=p+d-254;if(d>264){var q=g.ldef[d-257];w=p+(q>>>3)+b(i,I,7&q),I+=7&q}var D=L[y(i,I)&u];I+=15&D;var G=D>>>4,H=g.ddef[G],R=(H>>>4)+S(i,I,15&H);for(I+=15&H,P&&(r=a.F._check(r,p+(1<<17)));p<w;)r[p]=r[p++-R],r[p]=r[p++-R],r[p]=r[p++-R],r[p]=r[p++-R];p=w}}}else{(7&I)!=0&&(I+=8-(7&I));var W=4+(I>>>3),N=i[W-4]|i[W-3]<<8;P&&(r=a.F._check(r,p+N)),r.set(new h(i.buffer,i.byteOffset+W,N),p),I=W+N<<3,p+=N}return r.length==p?r:r.slice(0,p)},a.F._check=function(i,r){var h=i.length;if(r<=h)return i;var c=new Uint8Array(Math.max(h<<1,r));return c.set(i,0),c},a.F._decodeTiny=function(i,r,h,c,S,b){for(var s=a.F._bitsE,n=a.F._get17,o=0;o<h;){var y=i[n(c,S)&r];S+=15&y;var g=y>>>4;if(g<=15)b[o]=g,o++;else{var P=0,k=0;g==16?(k=3+s(c,S,2),S+=2,P=b[o-1]):g==17?(k=3+s(c,S,3),S+=3):g==18&&(k=11+s(c,S,7),S+=7);for(var L=o+k;o<L;)b[o]=P,o++}}return S},a.F._copyOut=function(i,r,h,c){for(var S=0,b=0,s=c.length>>>1;b<h;){var n=i[b+r];c[b<<1]=0,c[1+(b<<1)]=n,n>S&&(S=n),b++}for(;b<s;)c[b<<1]=0,c[1+(b<<1)]=0,b++;return S},a.F.makeCodes=function(i,r){for(var h,c,S,b,s=a.F.U,n=i.length,o=s.bl_count,y=0;y<=r;y++)o[y]=0;for(y=1;y<n;y+=2)o[i[y]]++;var g=s.next_code;for(h=0,o[0]=0,c=1;c<=r;c++)h=h+o[c-1]<<1,g[c]=h;for(S=0;S<n;S+=2)(b=i[S+1])!=0&&(i[S]=g[b],g[b]++)},a.F.codes2map=function(i,r,h){for(var c=i.length,S=a.F.U.rev15,b=0;b<c;b+=2)if(i[b+1]!=0)for(var s=b>>1,n=i[b+1],o=s<<4|n,y=r-n,g=i[b]<<y,P=g+(1<<y);g!=P;)h[S[g]>>>15-r]=o,g++},a.F.revCodes=function(i,r){for(var h=a.F.U.rev15,c=15-r,S=0;S<i.length;S+=2){var b=i[S]<<r-i[S+1];i[S]=h[b]>>>c}},a.F._putsE=function(i,r,h){h<<=7&r;var c=r>>>3;i[c]|=h,i[c+1]|=h>>>8},a.F._putsF=function(i,r,h){h<<=7&r;var c=r>>>3;i[c]|=h,i[c+1]|=h>>>8,i[c+2]|=h>>>16},a.F._bitsE=function(i,r,h){return(i[r>>>3]|i[1+(r>>>3)]<<8)>>>(7&r)&(1<<h)-1},a.F._bitsF=function(i,r,h){return(i[r>>>3]|i[1+(r>>>3)]<<8|i[2+(r>>>3)]<<16)>>>(7&r)&(1<<h)-1},a.F._get17=function(i,r){return(i[r>>>3]|i[1+(r>>>3)]<<8|i[2+(r>>>3)]<<16)>>>(7&r)},a.F._get25=function(i,r){return(i[r>>>3]|i[1+(r>>>3)]<<8|i[2+(r>>>3)]<<16|i[3+(r>>>3)]<<24)>>>(7&r)},a.F.U=(t=Uint16Array,T=Uint32Array,{next_code:new t(16),bl_count:new t(16),ordr:[16,17,18,0,8,7,9,6,10,5,11,4,12,3,13,2,14,1,15],of0:[3,4,5,6,7,8,9,10,11,13,15,17,19,23,27,31,35,43,51,59,67,83,99,115,131,163,195,227,258,999,999,999],exb:[0,0,0,0,0,0,0,0,1,1,1,1,2,2,2,2,3,3,3,3,4,4,4,4,5,5,5,5,0,0,0,0],ldef:new t(32),df0:[1,2,3,4,5,7,9,13,17,25,33,49,65,97,129,193,257,385,513,769,1025,1537,2049,3073,4097,6145,8193,12289,16385,24577,65535,65535],dxb:[0,0,0,0,1,1,2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,11,11,12,12,13,13,0,0],ddef:new T(32),flmap:new t(512),fltree:[],fdmap:new t(32),fdtree:[],lmap:new t(32768),ltree:[],ttree:[],dmap:new t(32768),dtree:[],imap:new t(512),itree:[],rev15:new t(32768),lhst:new T(286),dhst:new T(30),ihst:new T(19),lits:new T(15e3),strt:new t(65536),prev:new t(32768)}),(function(){for(var i=a.F.U,r=0;r<32768;r++){var h=r;h=(4278255360&(h=(4042322160&(h=(3435973836&(h=(2863311530&h)>>>1|(1431655765&h)<<1))>>>2|(858993459&h)<<2))>>>4|(252645135&h)<<4))>>>8|(16711935&h)<<8,i.rev15[r]=(h>>>16|h<<16)>>>17}function c(S,b,s){for(;b--!=0;)S.push(0,s)}for(r=0;r<32;r++)i.ldef[r]=i.of0[r]<<3|i.exb[r],i.ddef[r]=i.df0[r]<<4|i.dxb[r];c(i.fltree,144,8),c(i.fltree,112,9),c(i.fltree,24,7),c(i.fltree,8,8),a.F.makeCodes(i.fltree,9),a.F.codes2map(i.fltree,9,i.flmap),a.F.revCodes(i.fltree,9),c(i.fdtree,32,5),a.F.makeCodes(i.fdtree,5),a.F.codes2map(i.fdtree,5,i.fdmap),a.F.revCodes(i.fdtree,5),c(i.itree,19,0),c(i.ltree,286,0),c(i.dtree,30,0),c(i.ttree,320,0)})()})();var li=ni({__proto__:null,default:We},[We]);const me=(function(){var e={nextZero(s,n){for(;s[n]!=0;)n++;return n},readUshort:(s,n)=>s[n]<<8|s[n+1],writeUshort(s,n,o){s[n]=o>>8&255,s[n+1]=255&o},readUint:(s,n)=>16777216*s[n]+(s[n+1]<<16|s[n+2]<<8|s[n+3]),writeUint(s,n,o){s[n]=o>>24&255,s[n+1]=o>>16&255,s[n+2]=o>>8&255,s[n+3]=255&o},readASCII(s,n,o){let y="";for(let g=0;g<o;g++)y+=String.fromCharCode(s[n+g]);return y},writeASCII(s,n,o){for(let y=0;y<o.length;

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B=13+q.length;E(N,d,B),d+=4,l(N,d,"iCCP"),d+=4,l(N,d,"ICC profile"),d+=11,d+=2,N.set(q,d),d+=q.length,E(N,d,x(N,d-(B+4),B+4)),d+=4}if(C.pHYs!=null&&(E(N,d,9),d+=4,l(N,d,"pHYs"),d+=4,E(N,d,C.pHYs[0]),d+=4,E(N,d,C.pHYs[1]),d+=4,N[d]=C.pHYs[2],d++,E(N,d,x(N,d-13,13)),d+=4),w&&(E(N,d,8),d+=4,l(N,d,"acTL"),d+=4,E(N,d,u.frames.length),d+=4,E(N,d,C.loop!=null?C.loop:0),d+=4,E(N,d,x(N,d-12,12)),d+=4),u.ctype==3){for(E(N,d,3*(H=u.plte.length)),d+=4,l(N,d,"PLTE"),d+=4,R=0;R<H;R++){const B=3*R,Y=u.plte[R],J=255&Y,te=Y>>>

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This helps us understand your history.",question:"Past Initiatives",options:["Exercise","Dieting","Weight-loss Supplements","Intermittent Fasting","None of the Above"],required:!0,apiType:"MULTISELECT",optionImages:["/assets/images/option_icons/triedInPast_option1.svg","/assets/images/option_icons/triedInPast_option2.svg","/assets/images/option_icons/triedInPast_option3.svg","/assets/images/option_icons/triedInPast_option4.svg","/assets/images/option_icons/triedInPast_option5.svg"]}]},{id:"currentGlp1",title:"Are you currently taking any GLP-1 medications?",questions:[{id:"currentGlp1",displayQuestion:"This helps us understand your current treatment status",question:"Currently taking GLP-1 Medications",type:"SINGLESELECT",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"currentGlp1Type",title:"Which GLP-1 medication are you currently taking?",renderCondition:e=>e.currentGlp1==="Yes",questions:[{id:"currentGlp1Type",type:"DROPDOWN",question:"Current GLP-1 Medication",displayQuestion:"Please specify your current medication",options:["Compounded Semaglutide","Compounded Tirzepatide","Mounjaro","Wegovy","Zepbound","Ozempic"],required:!0,apiType:"TEXT"}]},{id:"lastDoseDate",title:"What was the approximate date of your last dose?",renderCondition:e=>e.currentGlp1==="Yes",questions:[{id:"lastDoseMonth",question:"Last Dose Month",displayQuestion:"Month",type:"DROPDOWN",required:!0,options:Array.from({length:12},(e,t)=>t+1),optionLabels:["January","February","March","April","May","June","July","August","September","October","November","December"],apiType:"DATE"},{id:"lastDoseDay",question:"Last Dose Day",displayQuestion:"Day",type:"DROPDOWN",required:!0,options:Array.from({length:31},(e,t)=>t+1),apiType:"DATE"},{id:"lastDoseYear",question:"Last Dose Year",displayQuestion:"Year",type:"DROPDOWN",required:!0,options:Array.from({length:10},(e,t)=>2024-t),apiType:"DATE"}]},{id:"lastDoseStrength",title:"What was the strength of your last dose?",renderCondition:e=>e.currentGlp1==="Yes",questions:[{id:"lastDoseStrength",type:"DROPDOWN",question:"Last Dose Strength",displayQuestion:"Please provide strength in milligrams (mg) if known",options:e=>{const t=e.currentGlp1Type;if(["Compounded Semaglutide","Wegovy","Ozempic"].includes(t)){if(t==="Compounded Semaglutide")return["0.25 mg per week","0.50 mg per week","1.00 mg per week","1.50 mg per week","2.50 mg per week"];

20if(t==="Wegovy")return["0.25 mg","0.5 mg","1.0 mg","1.7 mg","2.4 mg"];if(t==="Ozempic")return["0.25 mg","0.5 mg","1.0 mg","2.0 mg"]}return["Compounded Tirzepatide","Mounjaro","Zepbound"].includes(t)?["2.5 mg","5.0 mg","7.5 mg","10.0 mg","12.5 mg","15.0 mg"]:[]},required:!0,apiType:"TEXT"}]},{id:"prescriptionUpload",title:"Please upload a copy of your current prescription",renderCondition:e=>e.currentGlp1==="Yes",questions:[{id:"prescriptionUpload",question:"Prescription Upload",displayQuestion:"This helps us verify your current medication",type:"FILE_INPUT",required:!0,apiType:"FILE"}]},{id:"pregnancyStatus",title:"Are you currently pregnant, breastfeeding, or planning to become pregnant within the next 2 months?",questions:[{id:"pregnancyStatus",displayQuestion:"This information is crucial for your safety",question:"Pregnancy Status",type:"SINGLESELECT",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"criticalConditions",title:"These conditions may prevent GLP-1 medication prescription",questions:[{id:"criticalConditions",type:"MULTISELECT",displayQuestion:"Please select all that apply",question:"Critical Medical Conditions",options:["Gastroparesis","Pancreatic Cancer","Pancreatitis","Type 1 Diabetes or Diabetes Requiring Insulin","Hypoglycemia","Medullary Thyroid Cancer (MTC) or family history of MTC","Bipolar Disorder","Schizophrenia","Multiple Endocrine Neoplasia syndrome type 2 (MEN-2) or family history of MEN-2","Anorexia or Bulimia","Current Symptomatic Gallstones or Active Gallbladder Disease","Active Substance Abuse Disorder","None of the above"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"medicalConditions1",title:"Please check all current or past medical conditions",questions:[{id:"medicalConditions1",type:"MULTISELECT",displayQuestion:"This helps us understand your health profile",question:"Medical Conditions 1",options:["Hypertension (high blood pressure)","High cholesterol","Type 2 diabetes","Obstructive sleep apnea","Gout","Metabolic 

20syndrome","Heart disease, stroke, or peripheral vascular disease","Heart Failure","Atrial fibrillation or flutter","Tachycardia or fast heart rate","Any ECG abnormality or heart rhythm abnormality","None of the above"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"medicalConditions2",title:"Please check all current or past medical conditions",questions:[{id:"medicalConditions2",type:"MULTISELECT",displayQuestion:"Please select all that apply",question:"Medical Conditions 2",options:["Gallbladder removed","Fatty Liver (MASLD or MASH)","Cirrhosis or end-stage liver disease","Chronic Kidney Disease Stage 3 or greater","Hypothyroidism","Hyperthyroidism, or Thyroid Issues","None of the above"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"currentMedications",title:"Are you currently taking any medications?",questions:[{id:"currentMedications",displayQuestion:"Including Prescription, Over-The-Counter (OTC), or Supplements",question:"Currently Taking Medications",type:"SINGLESELECT",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"medicationList",title:"Please list all medications you are currently taking",renderCondition:e=>e.currentMedications==="Yes",questions:[{id:"medicationList",displayQuestion:"Including Prescription, Over-The-Counter (OTC), or Supplements",question:"Medication List",type:"textarea",required:!0,placeholder:"List all medications, dosages, and frequency",apiType:"TEXT"}]},{id:"surgicalHistory",title:"List any surgeries you have had in the past",questions:[{id:"surgicalHistory",displayQuestion:"If you haven't had any surgeries, type N/A ",question:"Surgical History",type:"textarea",required:!0,placeholder:"List surgeries and dates, or type N/A",apiType:"TEXT"}]},{id:"allergies",title:"Please list all of your known allergies",questions:[{id:"allergies",displayQuestion:"Please type N/A if none. This helps us avoid potential reactions",type:"textarea",required:!0,placeholder:"List all known allergies, or type N/A",apiType:"TEXT"}]},{id:"consultationType",title:"Choose your preferred consultation method. Email/Text is fastest, Phone/Video has a consultation fee.",questions:[{id:"consultationType",question:"$49 consultation fee will apply only if your prescription is approved and you choose not to proceed with treatment. The consultation is free if you move forward with purchasing your prescription. If you prefer to speak with your provider prior to approval, please select Phone or Video Consultation.",type:"SINGLESELECT",options:["Email and Text Message (Fastest Option)","Video Call Consultation ($49 fee applies if you don't proceed with treatment)","Phone Call Consultation ($49 fee applies if you don't proceed with treatment)"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]}],kt=["Alabama","Alaska","Arizona","Arkansas","California","Colorado","Connecticut","Delaware","Florida","Georgia","Hawaii","Idaho","Illinois","Indiana","Iowa","Kansas","Kentucky","Louisiana","Maine","Maryland","Massachusetts","Michigan","Minnesota","Mississippi","Missouri","Montana","Nebraska","Nevada","New Hampshire","New Jersey","New Mexico","New York","North Carolina","North Dakota","Ohio","Oklahoma","Oregon","Pennsylvania","Rhode Island","South Carolina","South Dakota","Tennessee","Texas","Utah","Vermont","Virginia","Washington","West Virginia","Wisconsin","Wyoming"],it=[{id:"heightWeight",title:"What is your height and weight?",displayValue:{condition:e=>e.feet&&e.inches!=null&&e.weight,calculate:e=>{const T=(e.feet*12+e.inches)*.0254;return(e.weight*.453592/(T*T)).toFixed(2)},template:"BMI: {{value}}"},questions:[{id:"feet",question:"Feet",type:"DROPDOWN",required:!0,options:[4,5,6,7],apiType:"TEXT"},{id:"inches",question:"Inches",type:"DROPDOWN",required:!0,options:[0,1,2,3,4,5,6,7,8,9,10,11],apiType:"TEXT"},{id:"weight",question:"Weight (in lbs)",type:"number",required:!0,placeholder:"Enter your weight",apiType:"TEXT"}]},{id:"genderIdentity",title:"What is your gender identity?",questionSubtext:"Not required. This helps us personalize your care experience.",questions:[{id:"genderIdentity",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Woman","Man","Non-binary","Prefer to self-describe","Prefer not to say"],required:!1,apiType:"SINGLESELECT"}]},{id:"hormoneJourney",title:"Which of the following best describes where you are in y

20our hormone journey?",questionSubtext:'<p>Hormone changes can begin years before your last period.</p><br/><ul class="list-disc pl-5 my-2 space-y-1"><li><strong>Perimenopause:</strong> the transition phase when your hormones begin to shift; periods may become irregular and symptoms like hot flashes or mood changes can start.</li><li><strong>Menopause:</strong> defined as 12 consecutive months without a period; most symptoms peak around this time.</li><li><strong>Post-menopause:</strong> the years after menopause; systemic symptoms often ease, but some — like vaginal dryness — can persist or worsen without treatment.</li><li><strong>Surgical menopause:</strong> menopause caused by surgical removal of the ovaries; symptoms often come on more suddenly.</li></ul><br/><p>Not sure which applies? Choose the option that feels closest — your provider will review your full history.</p>',questions:[{id:"hormoneJourney",type:"SINGLESELECT",question:"",displayQuestion:"",options:["I still have regular periods, but I'm having symptoms I think might be hormone-related","My periods have become irregular or unpredictable (this could be perimenopause)","I haven't had a period in less than 12 months (this could be perimenopause or early menopause)","I haven't had a period in 12 or more months (in menopause or may be in menopause)","I had surgery to remove my ovaries, which brought on menopause symptoms","I had a hysterectomy (uterus removed), but still have my ovaries","I had a full hysterectomy — both my uterus and ovaries were removed"],required:!0,apiType:"SINGLESELECT"}]},{id:"uterusIntact",title:"Do you have a uterus?",renderCondition:e=>!V(e)&&!Je.includes(e.hormoneJourney),questions:[{id:"uterusIntact",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Yes","No","I'm not sure"],required:!0,apiType:"SINGLESELECT"}]},{id:"progesteroneInfo",title:"Why progesterone matters — if you have a uterus",questionSubtext:"If you have a uterus and you're prescribed systemic estrogen, your provider will ensure progesterone is in your treatment plan as well. Because of how estrogen and progesterone work together, this is standard practice for patients who haven't had a hysterectomy to protect the uterine lining.",renderCondition:e=>!V(e)&&!Je.includes(e.hormoneJourney)&&e.uterusIntact!=="No",questions:[]},{id:"menopauseSymptomChecklist",title:"Which of the following symptoms are you experiencing? (check all that apply)",renderCondition:e=>!V(e),questions:[{id:"menopauseSymptomChecklist",type:"MULTISELECT",question:"Symptoms",displayQuestion:"Check all that apply.",options:["Acne or hair changes","Vaginal dryness, itching, or pain (general or during sex)","Urinary incontinence or frequent UTIs","Irregular bleeding or spotting","Trouble sleeping","Irritability, anxiety, depression, or mood swings","Brain fog / memory issues","Fatigue / low energy","Hot flashes / night sweats","Weight gain","Loss of muscle mass or strength","Decreased libido","Breast tenderness","Joint or muscle pain","Migraines or headaches"],required:!0,apiType:"MULTISELECT"}]},{id:"symptomTreatmentInfo",title:"What symptoms mean for treatment",questionSubtext:`<ul class="list-disc pl-5 my-3 space-y-2">
21  <li><strong>Hot flashes, night sweats, sleep, mood, acne, or brain fog:</strong> Systemic hormone therapy (estrogen, with or without progesterone) addresses these whole-body symptoms.</li>
22  <li><strong>Vaginal dryness, pain during sex, or recurrent UTIs:</strong> Local vaginal estrogen treats vaginal and urinary symptoms with minimal systemic effect.</li>
23</ul>
24<p class="mt-4">Together, a bundled plan covering both systemic and local treatment may be the right fit.</p>`,renderCondition:e=>!V(e)&&Array.isArray(e.menopauseSymptomChecklist)&&e.menopauseSymptomChecklist.some(t=>$e.includes(t))||!e.menopauseSymptomChecklist.some(t=>xt.includes(t)),questions:[]},{id:"personalInfo",title:"What is your full name? This is the name your provider will use to address you.",questions:[{id:"firstName",question:"First Name",type:"text",required:!0,placeholder:"Enter your first name",apiType:"TEXT",validation:[{type:"required",message:"First name is required"}],halfWidth:!0},{id:"lastName",question:"Last Name",type:"text",required:!0,placeholder:"Enter your last name",apiType:"TEXT",validation:[{type:"required",message:"Last name is required"}],halfWidth:!0},{id:"shippingState",type:"DROPDOWN",question:"State",displayQuestion:"What state do you live in?",options:kt,required:!0,apiType:"TEXT"},{id:"email",question:"Email Address",type:"email",required:!0,placeholder:"[email protected]",apiType:"TEXT",validation:[{type:"required",message:"Email address is required"},{type:"email",message:"Please enter a valid email address"}]},{id:"phone",question:"Phone Number",type:"tel",required:!0,placeholder:"123-456-7890",apiType:"TEXT",validation:[{type:"required",message:"Phone number is required"},{type:"phone",message:"Please enter a valid US phone number (e.g., 123-456-7890 or (123) 456-7890)"}]}]},{id:"dheaAddOnInterest",title:"Would you like your provider to consider adding DHEA to your treatment plan?",questionSubtext:"DHEA is a hormone precursor that may help supp

24ort energy, mood, and libido during menopause. Your provider will confirm whether it's a safe and appropriate addition based on your full history.",renderCondition:e=>!V(e)&&Array.isArray(e.menopauseSymptomChecklist)&&e.menopauseSymptomChecklist.includes(Pt),questions:[{id:"dheaAddOnInterest",type:"SINGLESELECT",question:"",displayQuestion:"",options:[Mt,Si],required:!0,apiType:"SINGLESELECT"}]},{id:"systemicRouteChoice",title:"Do you have a preference on how you take medications?",questionSubtext:"If not, treatment will be recommended based on your symptoms.",renderCondition:e=>!V(e)&&Array.isArray(e.menopauseSymptomChecklist)&&e.menopauseSymptomChecklist.some(t=>$e.includes(t)),questions:[{id:"systemicRouteChoice",type:"SINGLESELECT",question:"",displayQuestion:"",options:[{name:Ze,value:Ze},{name:ht,value:ht},{name:"Patch",value:wt},"I'm not sure","I don't have a preference"],required:!0,apiType:"SINGLESELECT"}]},{id:"priorHormoneProducts",title:"Have you ever taken any of the below products?",renderCondition:e=>!V(e),questions:[{id:"priorHormoneProducts",type:"MULTISELECT",question:"Prior Hormone Products",displayQuestion:"Select all that apply.",options:["Estrogen patches","Estrogen cream","Vaginal estrogen cream","Injectable estrogen","Injectable testosterone","Androgel","Testosterone compounded cream","Progesterone (oral, vaginal, or cream)","None of the above"],required:!0,apiType:"MULTISELECT",exclusiveOption:"None of the above"}]},{id:"priorHormoneProductsDetails",title:"Please tell us more about the dose, delivery method, and any side effects from prior hormone products.",renderCondition:e=>!V(e)&&Array.isArray(e.priorHormoneProducts)&&e.priorHormoneProducts.some(t=>t!=="None of the above"),questions:[{id:"priorHormoneProductsDetails",type:"textarea",question:"Prior Hormone Product Details",displayQuestion:"Please tell us more about the dose, delivery method, and any side effects from prior hormone products.",required:!0,apiType:"TEXT"}]},{id:"fertilityPlans",title:"Are you currently trying to have children, breastfeeding, or planning to preserve fertility?",renderCondition:e=>!V(e),questions:[{id:"fertilityPlans",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"fertilityPlansDetails",title:"Please share more about your fertility plans or timeline.",renderCondition:e=>!V(e)&&e.fertilityPlans==="Yes",questions:[{id:"fertilityPlansDetails",type:"textarea",question:"",displayQuestion:"",required:!0,apiType:"TEXT"}]},{id:"birthControlMethods",title:"Are you currently using any of these forms of birth control?",renderCondition:e=>!V(e),questions:[{id:"birthControlMethods",type:"MULTISELECT",question:"Birth Control Methods",displayQuestion:"Select all that apply.",options:["Birth control pill (progestin-only)","Birth control pill (other)","Birth control patch","Vaginal ring (NuvaRing or Annovera)","Birth control shot (Depo-Provera)","Nexplanon arm implant","Hormonal IUD (Mirena, Liletta, Kyleena, Skyla)","Copper IUD (Paragard)","Sterilization (tubal ligation or tubes removed)","My partner has had a vasectomy","Condoms","Phexxi","Other"],required:!0,apiType:"MULTISELECT"}]},{id:"medicalConditions",title:"Please check all current or past medical conditions. (select all that apply)",questionSubtext:"These questions help your provider determine which treatments are safest for you. Some conditions require extra care or a different approach — this is not a judgment, it is how we make sure your plan is right for you. Please answer as completely as you can.",renderCondition:e=>!V(e),questions:[{id:"medicalConditions",type:"MULTISELECT",question:"Medical Conditions",displayQuestion:"Select all that apply.",options:["Asthma","Autoimmune disease (e.g., lupus, rheumatoid arthritis)","Active blood vessel disease or clotting disorder (e.g., DVT/PE)","Breast, uterine, or ovarian cancer","Heart disease, stroke, or peripheral vascular disease","Dementia","Edema (fluid retention)","Endometriosis","Epilepsy (seizures)","High blood lipids or cholesterol","Hypertension","Diabetes","Heart failure or stroke","Active liver disease","Kidney disease","Migraine headache","High calcium in the blood (hypercalcemia)","Uncontrolled thyroid disorder","Recent miscarriage","Vaginal bleeding","None of the above"],required:!0,apiType:"MULTISELECT",exclusiveOption:"None of the above"}]},{id:"otherMedicalConditions",title:"Do you have any other current medical conditions?",renderCondition:e=>!V(e),questions:[{id:"otherMedicalConditions",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"otherMedicalConditionsDetails",title:"Please list all current medical conditions.",renderCondition:e=>!V(e)&&e.otherMedicalConditions==="Yes",questions:[{id:"otherMedicalConditionsDetails",type:"textarea",question:"",displayQuestion:"",required:!0,apiType:"TEXT"}]},{id:"currentMedications",title:"Are you currently taking any medications, including supplements?",renderCondition:e=>!V(e),questions:[{id:"currentMedications",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"currentMedicationsDetails",title:"Please list all current medications including Rx, OTC, and supplements with dosages.",renderCondition:e=>!V(e)&&e.currentMedications==="Yes",questions:[{id:"currentMedicationsDetails",type:"textarea",question:"",displayQuestion:"",required:!0,apiType:"TEXT"}]},{id:"knownAllergies",title:"Do you have any known allergies?",renderCondition:e=>!V(e),questions:[{id:"knownAllergies",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"knownAllergiesDetails",title:"Please list all known allergies.",renderCondition:e=>!V(e)&&e.knownAllergies==="Yes",questions:[{id:"knownAllergiesDetails",type:"textarea",question:"",displayQuestion:"",required:!0,apiType:"TEXT"}]},{id:"tobaccoUse",title:"Do you currently smoke or use tobacco products?",renderCondition:e=>!V(e),questions:[{id:"tobaccoUse",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"recentHormoneLabs",title:"Do you have any recent lab work related to hormone therapy completed within the past 60 days?",renderCondition:e=>!V(e),questions:[{id:"recentHormoneLabs",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"recentHormoneLabsTiming",title:"When was your most recent lab test related to hormone therapy?",renderCondition:e=>!V(e)&&e.recentHormoneLabs==="Yes",questions:[{id:"recentHormoneLabsTiming",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Within the last 30 days","Within the last 45 days","Within the last 60 days","I have not had any recent lab tests"],required:!0,apiType:"SINGLESELECT"}]}

24,{id:"recentHormoneLabsUpload",title:"Please upload a copy of your recent lab work. (ensure full name and date are visible)",questionSubtext:"This upload is optional.",renderCondition:e=>!V(e)&&e.recentHormoneLabs==="Yes"&&e.recentHormoneLabsTiming!=="I have not had any recent lab tests",questions:[{id:"recentHormoneLabsUpload",question:"Recent Lab Work",displayQuestion:"This helps your provider confirm your most recent results.",type:"FILE_INPUT",required:!1,apiType:"FILE"}]},{id:"additionalProviderInfo",title:"Is there anything else you want to tell your provider?",renderCondition:e=>!V(e),questions:[{id:"additionalProviderInfo",type:"textarea",question:"",displayQuestion:"",required:!1,apiType:"TEXT"}]},{id:"menopauseContactInfo",title:"A few last things",questions:[{id:"tosPrivacyConsent",type:"CHECKBOX",required:!0,options:['I agree to the <a href="https://lumivera.com/legal/terms-and-conditions" target="_blank" rel="noopener" class="underline">Terms of Service</a> and <a href="https://lumivera.com/legal/privacy-practices" target="_blank" rel="noopener" class="underline">Privacy Policy</a>. I agree to receive non-marketing emails or text messages related to my account (e.g., appointment reminders).'],apiType:"SINGLESELECT"},{id:"marketingConsent",type:"CHECKBOX",required:!1,options:["I consent to receive marketing emails and text messages from LumiVera at the email address and phone number provided, including promotions, discounts, and product/service updates. Msg frequency varies. Msg & data rates may apply. Reply HELP for help, STOP to opt out. Consent is not a condition of purchase."],apiType:"SINGLESELECT"}]}],nt=[{id:"menopausalSymptoms",title:"Which symptoms are you currently experiencing?",questions:[{id:"menopausalSymptoms",type:"MULTISELECT",question:"Select all that apply.",options:["Hot flashes","Night sweats","Palpitations","Joint pain","Weight gain","Fatigue","Trouble with sleep","Brain fog (e.g. poor memory, difficulty concentrating)","Mood changes (e.g. irritability, anxiety, depression)","Vaginal issues (e.g. burning, itching, vaginal dryness, decreased lubrication)","Urinary symptoms (e.g. urinary frequency, urgency, frequent UTIs, incontinence)","Painful sex","Decreased sexual arousal","Facial acne","Other facial skin concerns (e.g. collagen production, moisture, firmness, pore size, wrinkles, elasticity)","None"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"hrtTreatmentPriorities",title:"What are your top priorities with hormone replacement therapy (HRT)?",questions:[{id:"hrtTreatmentPriorities",type:"MULTISELECT",displayQuestion:"Select all that apply:",question:"Select all that apply.",options:["Reduce hot flashes and night sweats","Improve sleep quality","Address vaginal dryness or discomfort","Improve mood and emotional well-being","Increase energy and reduce fatigue","Support bone health","Improve skin health and elasticity","Address libido or sexual function concerns","Prevent long-term health risks","Other (please specify)"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"},{id:"hrtTreatmentPrioritiesOther",type:"textarea",displayQuestion:"",question:"Please specify your other priorities:",required:!0,placeholder:"Enter additional details",renderCondition:e=>{const t=e.hrtTreatmentPriorities;return Array.isArray(t)?t.includes("Other (please specify)"):t==="Other (please specify)"},apiType:"TEXT"}]},{id:"hrtProductInterest",title:"Which HRT options are you interested in?",questions:[{id:"hrtProductInterest",type:"MULTISELECT",displayQuestion:"Select all you'd like to learn more about or discuss with your provider.",question:"Which HRT options are you interested in?",options:[{name:"Estradiol Patch (applied to skin, changed 1-2x weekly)",value:"estradiol-patch"},{name:"Estradiol Vaginal Cream (applied daily to skin)",value:"estradiol-vaginal-cream"},{name:"Estradiol Tablets (taken daily by mouth)",value:"estradiol-tablets"},{name:"Progesterone Capsules (taken daily by mouth)",value:"progesterone"},{name:"Testosterone Cream",value:"testosterone-cream"},{name:"Arousal Cream",value:"arousal-cream-4"},{name:"DHEA Capsules",value:"dhea-capsules"},{name:"Bi-est Cream (50:50)",value:"bi-est-cream-50-50"},{name:"Bi-est Cream (80:20)",value:"bi-est-cream-80-20"},{name:"I’m not sure — I’d like the provider’s recommendation based on my symptoms.",value:"i-m-not-sure"}],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"menopausalSymptomsDetails",title:"Tell us more about what you’ve been experiencing.",questions:[{id:"menopausalSymptomsDetails",type:"textarea",question:"Share any additional details about your symptoms to help your provider better understand your concerns.",displayQuestion:"",required:!0,apiType:"TEXT"}]},{id:"cycleDescribed",title:"Which of the following best describes your menstrual cycle in the past 12 months?",questions:[{id:"cycleDescribed",type:"SINGLESELECT",displayQuestion:"",question:"",options:["My periods are regular","My periods are starting to become unpredictable (e.g. too close together, skipping periods or a change in duration or amount of flow)","I have not had a period in over a year","My menstrual cycle has been impacted by a medical procedure"],required:!0,apiType:"SINGLESELECT"}]}

24,{id:"unpredictablePeriods",title:"Which of the following describes how your periods are becoming more unpredictable?",renderCondition:e=>e.cycleDescribed==="My periods are starting to become unpredictable (e.g. too close together, skipping periods or a change in duration or amount of flow)",questions:[{id:"unpredictablePeriods",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"Which of the following describes how your periods are becoming more unpredictable?",options:["Bleeding is more frequent than every 21 days","Bleeding last longer than 8 days","Periods are now heavier","I bleed through a tampon or pad in 1-2 hours","Bleeding is less frequent and/or I skip more than 2 months at a time","Bleeding is much lighter","Other"],required:!0,apiType:"MULTISELECT"}]},{id:"unpredictablePeriodsDetails",title:"Please describe how your periods are becoming more unpredictable.",renderCondition:e=>{const t=e.unpredictablePeriods,T=Array.isArray(t)?t.includes("Other"):t==="Other",i=e.cycleDescribed==="My menstrual cycle has been impacted by a medical procedure";return T||i},questions:[{id:"unpredictablePeriodsDetails",type:"textarea",displayQuestion:"",question:"Please describe how your periods are becoming more unpredictable.",required:!0,apiType:"TEXT"}]},{id:"recentGynEval",title:"Have you had a recent GYN visit?",renderCondition:e=>{const t=e.unpredictablePeriods,T=Array.isArray(t)?t.includes("Other"):t==="Other",a=e.cycleDescribed;return T||a==="I have not had a period in over a year"||a==="My menstrual cycle has been impacted by a medical procedure"},questions:[{id:"recentGynEval",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"Have you had a recent GYN visit?",required:!0,options:["I have had a regular GYN evaluation in past 12 months","I have had a pelvic or transvaginal ultrasound","I have had an endometrial biopsy","I have had a D&C","I have had a hysteroscopy","I have had blood work done","Other - please explain"],apiType:"MULTISELECT"}]},{id:"recentGynEvalDetails",title:"Please tell us more.",renderCondition:e=>{const t=e.unpredictablePeriods,T=Array.isArray(t)?t.includes("Other"):t==="Other",a=e.cycleDescribed;return T||a==="I have not had a period in over a year"||a==="My menstrual cycle has been impacted by a medical procedure"},questions:[{id:"recentGynEvalDetails",type:"textarea",displayQuestion:"Please provide details, or in your own words, a summary of relevant results.",question:"Please tell us more.",required:!0,apiType:"TEXT"}]},{id:"moreThan10Years",title:"Has it been 10 years since your last period?",renderCondition:e=>{const t=e.unpredictablePeriods,T=Array.isArray(t)?t.includes("Other"):t==="Other",a=e.cycleDescribed;return T||a==="I have not had a period in over a year"||a==="My menstrual cycle has been impacted by a medical procedure"},questions:[{id:"moreThan10Years",type:"SINGLESELECT",displayQuestion:"",question:"Has it been 10 years since your last period?",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"procedureImpactedPeriods",title:"Which of the following medical procedures has impacted your menstrual cycle?",renderCondition:e=>e.cycleDescribed==="My menstrual cycle has been impacted by a medical procedure",questions:[{id:"procedureImpactedPeriods",type:"SINGLESELECT",displayQuestion:"",question:"Which of the following medical procedures has impacted your menstrual cycle?",required:!0,options:["Bilateral oophorectomy","Endometrial ablation","Uterine artery embolization (UAE)","Hormonal IUD","Hysterectomy (surgical removal of the uterus)","Other"],apiType:"SINGLESELECT"}]},{id:"bilateralOopheroctomyAge",title:"At what age did you have a bilateral oophorectomy (removal of both ovaries)?",renderCondition:e=>e.procedureImpactedPeriods==="Bilateral oophorectomy",questions:[{id:"bilateralOopheroctomyAge",type:"text",displayQuestion:"",question:"At what age did you have a bilateral oophorectomy (removal of both ovaries)?",required:!0,apiType:"TEXT"}]},{id:"bilateralOopheroctomyWhy",title:"Why did you have a bilateral oophorectomy (removal of both ovaries)?",renderCondition:e=>e.procedureImpactedPeriods==="Bilateral oophorectomy",questions:[{id:"bilateralOopheroctomyWhy",type:"textarea",displayQuestion:"",question:"Why did you have a bilateral oophorectomy (removal of both ovaries)?",required:!0,apiType:"TEXT"}]},{id:"otherProcedure",title:"What other medical procedure, if any, has impacted your menstrual cycle?",renderCondition:e=>e.procedureImpactedPeriods==="Other",questions:[{id:"otherProcedure",type:"textarea",displayQuestion:"",question:"What other medical procedure has impacted your menstrual cycle?",required:!0,apiType:"TEXT"}]},{id:"howManyPeriods",title:"How many periods have you had in the past 12 months?",renderCondition:e=>e.cycleDescribed!=="I have not had a period in over a year",questions:[{id:"howManyPeriods",type:"SINGLESELECT",displayQuestion:"",question:"Choose the option that best describes your cycle during the past year.",options:["0-2","3-5","6-12"],required:!0,apiType:"SINGLESELECT"}]},{id:"symptoms",title:"Please indicate if you have or have had any of the following conditions.",questions:[{id:"symptoms",type:"MULTISELECT",displayQuestion:"In order for your doctor to make the right treatment recommendation, we need to know a few things about your medical history.",question:"Please indicate if you have or have had any of the following conditions.",options:["None","Unexplained episodes of postmenopausal bleeding (if you've had no period in over a year)","Personal history of breast cancer","Endometrial cancer (uterine cancer)","High blood pressure","Elevated cholesterol","Heart attack","Stroke","Blood clots in legs or lungs","Genetic condition that increases your risk for clotting","Positive BRCA1 or BRCA2 genetic test","Diabetes and taking injectable insulin (not oral)","Diabetes and NOT taking injectable insulin (incl. taking oral insulin)","Migraines","Liver disease","Lupus","Lichen Sclerosis or other vulvar skin condition","Endometriosis","Other"],required:!0,apiType:"MULTISELECT"}]},{id:"symptomsPostmenopausal",title:"Have you had an evaluation for the unexplained episodes of post-menopausal bleeding?",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Unexplained episodes of postmenopausal bleeding (if you've had no period in over a year)"):t==="Unexplained episodes of postmenopausal bleeding (if you've had no period in over a year)"},questions:[{id:"symptomsPostmenopausal",type:"SINGLESELECT",displayQuestion:"",question:"Have you had an evaluation for the unexplained episodes of post-menopausal bleeding?",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"symptomsPostmenopausal2",title:"Please select the type of evaluation.",renderCondition:e=>e.symptomsPostmenopausal==="Yes",questions:[{id:"symptomsPostmenopausal2",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"Please select the type of evaluation.",options:["Pelvic exam","Pelvic or transvaginal ultrasound","Endometrial biopsy","Hysteroscopy","D&C","Other"],required:!0,apiType:"MULTISELECT"}]},{id:"symptomsPostmenopausalDetails",title:"Please provide more detail.",renderCondition:e=>e.symptomsPostmenopausal==="Yes",questions:[{id:"symptomsPostmenopausalDetails",type:"textarea",displayQuestion:"",question:"Please provide more detail.",required:!0,apiType:"TEXT"}]},{id:"symptomsBreastCancer",title:"You have options!",subtext:"While systemic hormone therapy is generally not prescribed to patients with a history of invasive breast cancer, there are other treatment options available to manage your menopause symptoms.*<br /><br />All doctors who prescribe for LumiVera are menopause-trained and follow the guidelines provided by ACOG and The Menopause Society.",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Personal history of breast cancer"):t==="Personal history of breast cancer"},questions:[{id:"symptomsBreastCancer",type:"CHECKBOX",question:"I have read and understand",displayQuestion:"Many breast cancer patients are candidates for vaginal estrogen and non-hormonal treatments. A consultation can help you explore these options and help you find an approach for your individual needs.",required:!0,options:["I have read and understand"],apiType:"SINGLESELECT"}]},{id:"symptomsBreastCancer2",title:"Please provide the year of your breast cancer diagnosis, stage of breast cancer, and estrogen receptor status.",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Personal history of breast cancer"):t==="Personal history of breast cancer"},questions:[{id:"symptomsBreastCancer2",type:"textarea",displayQuestion:"",question:"Please provide the year of your breast cancer diagnosis, stage of breast cancer, and estrogen receptor status.",required:!0,apiType:"TEXT"}]},{id:"symptomsEndometrialCancer",title:"What stage of endometrial cancer?",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Endometrial cancer (uterine cancer)"):t==="Endometrial cancer (uterine cancer)"},questions:[{id:"symptomsEndometrialCancer",type:"SINGLESELECT",displayQuestion:"",question:"What stage of endometrial cancer?",options:["Stage 1 or 2","Stage 3 or 4"],required:!0,apiType:"SINGLESELECT"}]},{id:"symptomsHighBloodPressure",title:"Is your blood pressure well-controlled? Well-controlled is defined as 130/80 or less.",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("High blood pressure"):t==="High blood pressure"},questions:[{id:"symptomsHighBloodPressure",type:"textarea",displayQuestion:"",question:"Is your blood pressure well-controlled? Well-controlled is defined as 130/80 or less.",required:!0,apiType:"TEXT"}]},{id:"symptomsBloodClot",title:"What year did the blood clot occur? What happened? Provide as much detail as possible.",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Blood clots in legs or lungs"):t==="Blood clots in legs or lungs"},questions:[{id:"symptomsBloodClot",type:"textarea",displayQuestion:"",question:"What year did the blood clot occur? What happened? Provide as much detail as possible.",required:!0,apiType:"TEXT"}]},{id:"symptomsGeneticClotting",title:"What is your genetic condition that increases your risk for clotting?",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Genetic condition that increases your risk for clotting"):t==="Genetic condition that increases your risk for clotting"},questions:[{id:"symptomsGeneticClotting",type:"SINGLESELECT",displayQuestion:"",question:"What is your genetic condition that increases your risk for clotting?",options:["Factor V Leiden","Prothrombin","Protein C or S deficiency","Other"],required:!0,apiType:"SINGLESELECT"}]},{id:"symptomsBrca",title:"Have you had an oophorectomy and/or bilateral mastectomy?",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Positive BRCA1 or BRCA2 genetic test"):t==="Positive BRCA1 or BRCA2 genetic test"},questions:[{id:"symptomsBrca",type:"SINGLESELECT",displayQuestion:"",question:"Have you had an oophorectomy and/or bilateral mastectomy?",options:["I have had an oophorectomy","I have had a bilateral mastectomy","I have had both an oophorectomy and a bilateral mastectomy","I have had neither an oophorectomy or a bilateral mastectomy"],required:!0,apiType:"SINGLESELECT"}]},{id:"symptomsBrca2",title:"At what age did you have an oophorectomy?",renderCondition:e=>{const t=e.symptomsBrca;return t==="I have had an oophorectomy"||t==="I have had both an oophorectomy and a bilateral mastectomy"},questions:[{id:"symptomsBrca2",type:"textarea",displayQuestion:"",question:"At what age did you have an oophorectomy?",required:!0,apiType:"TEXT"}]},{id:"symptomsMigraines",title:"Have you been diagnosed with migraines with aura?",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Migraines"):t==="Migraines"},questions:[{id:"symptomsMigraines",type:"SINGLESELECT",displayQuestion:"(Also called classic migraines, they are recurring headaches that strike after or at the same time as sensory disturbances like flashes of light, blind spots, and other vision changes or tingling in y

24our hand or face.)",question:"Have you been diagnosed with migraines with aura?",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"symptomsLiverDisease",title:"Please provide more details on your liver disease, including when you were diagnosed.",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Liver disease"):t==="Liver disease"},questions:[{id:"symptomsLiverDisease",type:"textarea",displayQuestion:"Provide as much detail as possible.",question:"Please provide more details on your liver disease, including when you were diagnosed.",required:!0,apiType:"TEXT"}]},{id:"symptomsEndometriosis",title:"Please provide the stage of your endometriosis if you know it.",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Endometriosis"):t==="Endometriosis"},questions:[{id:"symptomsEndometriosis",type:"textarea",displayQuestion:"Did you have extensive disease (e.g. endometriosis implants on the bowel, bladder, etc.)?",question:"Please provide the stage of your endometriosis if you know it.",required:!0,apiType:"TEXT"}]},{id:"symptomsOther",title:"What other conditions have you been currently or previously diagnosed with that are not listed above?",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Other"):t==="Other"},questions:[{id:"symptomsOther",type:"textarea",displayQuestion:"(e.g. another cancer). Provide as much detail as possible.",question:"What other conditions have you been currently or previously diagnosed with that are not listed above?",required:!0,apiType:"TEXT"}]},{id:"hysteroctomy",title:"Have you had a hysterectomy?",questions:[{id:"hysteroctomy",type:"SINGLESELECT",displayQuestion:"",question:"A hysterectomy is surgery to remove the uterus.",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"hysteroctomyAge",title:"At what age did you have a hysterectomy?",renderCondition:e=>e.hysteroctomy==="Yes",questions:[{id:"hysteroctomyAge",type:"textarea",displayQuestion:"",question:"At what age did you have a hysterectomy?",required:!0,apiType:"TEXT"}]},{id:"hysteroctomyWhy",title:"Why did you have a hysterectomy?",renderCondition:e=>e.hysteroctomy==="Yes",questions:[{id:"hysteroctomyWhy",type:"textarea",displayQuestion:"",question:"Why did you have a hysterectomy?",required:!0,apiType:"TEXT"}]},{id:"hysteroctomyOvaries",title:"Did you also have your ovaries removed with your uterus?",renderCondition:e=>e.hysteroctomy==="Yes",questions:[{id:"hysteroctomyOvaries",type:"SINGLESELECT",displayQuestion:"",question:"Did you also have your ovaries removed with your uterus?",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"mammogram",title:"When was your most recent mammogram?",questions:[{id:"mammogram",type:"SINGLESELECT",displayQuestion:"This information helps your provider make safe treatment recommendations.",required:!0,options:["Within the past 12 months","1-2 years ago","More than 2 years ago","I’ve never had a mammogram","I’ve had a double mastectomy"],apiType:"SINGLESELECT"}]},{id:"mammogramRequiredNotice",title:" ",renderCondition:e=>{const t=e.mammogram;return t==="1-2 years ago"||t==="More than 2 years ago"},questions:[{id:"mammogramRequiredNotice",type:"PERFECT",displayQuestion:"",question:"",required:!1,heading1:"Please note",subtext:"A mammogram within the past year is required before starting HRT."}]},{id:"mammogramResults",title:"What were the results of your most recent mammogram?",renderCondition:e=>e.mammogram==="Within the past 12 months",questions:[{id:"mammogramResults",type:"SINGLESELECT",displayQuestion:"",question:"Select the option that best describes your results.",required:!0,options:["Normal","I had another visit for additional views, but was told everything was normal","Abnormal"],apiType:"SINGLESELECT"}]},{id:"mammogramResultsDetails",title:"Please provide any details on the result.",renderCondition:e=>e.mammogramResults==="Abnormal",questions:[{id:"mammogramResultsDetails",type:"textarea",displayQuestion:"",question:"Please provide any details on the result.",required:!0,apiType:"TEXT"}]},{id:"doYouSmoke",title:"Do you currently use nicotine products, such as cigarettes or vaping devices?",questions:[{id:"doYouSmoke",type:"SINGLESELECT",displayQuestion:"",question:"Select one.",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"birthControl",title:"Are you currently using any form of birth control?",questions:[{id:"birthControl",type:"SINGLESELECT",displayQuestion:"",question:"Select one.",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"birthControlWhich",title:"Which birth control product are you currently using?",renderCondition:e=>

24e.birthControl==="Yes",questions:[{id:"birthControlWhich",type:"MULTISELECT",displayQuestion:"",question:"Which birth control product are you currently using?",required:!0,options:["Birth control pill","Birth control patch","Vaginal ring (NuvaRing or Annovera)","Birth control shot (Depo-Provera)","Nexplanon arm implant","Hormonal IUD (Mirena, Liletta, Kyleena, Skyla)","Copper IUD (Paragard)","Sterilization (tubal ligation or tubes removed)","My partner has had a vasectomy","Condoms","Phexxi","Other"],apiType:"MULTISELECT"},{id:"birthControlWhichOther",type:"text",displayQuestion:"",question:"Please specify your other birth control method:",required:!0,placeholder:"Enter details",apiType:"TEXT",renderCondition:e=>{const t=e.birthControlWhich;return Array.isArray(t)?t.includes("Other"):t==="Other"}}]},{id:"birthControlHormonalIUD",title:"Which hormonal IUD are you currently using?",renderCondition:e=>e.birthControlWhich.includes("Hormonal IUD"),questions:[{id:"birthControlHormonalIUD",type:"SINGLESELECT",displayQuestion:"",question:"Select one.",required:!0,options:["Mirena","Liletta","Kyleena","Skyla","Other"],apiType:"SINGLESELECT"},{id:"birthControlHormonalIUDOther",type:"text",displayQuestion:"",question:"Please specify which other hormonal IUD you are using:",required:!0,placeholder:"Enter details",apiType:"TEXT",renderCondition:e=>e.birthControlHormonalIUD==="Other"}]},{id:"birthControlHormonalIUDDate",title:"When was your last hormonal IUD inserted?",renderCondition:e=>e.birthControlWhich.includes("Hormonal IUD"),questions:[{id:"birthControlHormonalIUDDate",type:"text",displayQuestion:"Please provide the month and year.",question:"When was your last hormonal IUD inserted?",required:!0,apiType:"TEXT"}]},{id:"requireContraception",title:"Do you need birth control to prevent pregnancy?",questions:[{id:"requireContraception",type:"SINGLESELECT",displayQuestion:"",question:"Do you need birth control to prevent pregnancy?",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"takenHormoneTreatment",title:"Have you ever used or are you currently using hormone therapy?",questions:[{id:"takenHormoneTreatment",type:"SINGLESELECT",displayQuestion:"(e.g. birth control pills, compounded hormones or creams, sprays, gels, or hormonal pellets)",question:"Have you ever used or are you currently using hormone therapy?",required:!0,options:["Yes, I am currently using hormone therapy","I stopped using hormone therapy within the last 90 days","I used hormone therapy in the past","No, I have never used hormone therapy"],apiType:"SINGLESELECT"}]},{id:"continueHormoneTreatment",title:"Who will manage your hormone therapy prescription moving forward?",renderCondition:e=>{const t=e.takenHormoneTreatment;return t==="Yes, I am currently using hormone therapy"||t==="I stopped using hormone therapy within the last 90 days"},questions:[{id:"continueHormoneTreatment",type:"SINGLESELECT",displayQuestion:" ",question:"Are you looking for LumiVera to continue prescribing your current hormone therapy, or will your existing provider maintain that prescription?",required:!0,options:["LumiVera","My current provider"],apiType:"SINGLESELECT"}]},{id:"takenHormoneTreatmentDetails",title:"Tell us about your current or recent hormone therapy",renderCondition:e=>{const t=e.takenHormoneTreatment;return t==="Yes, I am currently using hormone therapy"||t==="I stopped using hormone therapy within the last 90 days"||t==="I used hormone therapy in the past"},questions:[{id:"takenHormoneTreatmentMedication",type:"REPEATABLE_BLOCK",blockLabel:"Medication",addButtonText:"+ Add another medication",minBlocks:1,fields:[{id:"name",type:"text",question:"Medication name",required:!0,placeholder:"e.g. Estradiol",apiType:"TEXT"},{id:"dose",type:"text",question:"Dose",required:!0,placeholder:"e.g. 0.5 mg",apiType:"TEXT"},{id:"frequency",type:"text",question:"How often do you take it?",required:!0,placeholder:"e.g. Daily",apiType:"TEXT"},{id:"month",type:"dropdown",question:"Month started",required:!0,options:["January","February","March","April","May","June","July","August","September","October","November","December"],optionValues:["01","02","03","04","05","06","07","08","09","10","11","12"],apiType:"TEXT"},{id:"year",type:"dropdown",question:"Year started",required:!0,options:Array.from({length:30},(e,t)=>String(new Date().getFullYear()-t)),apiType:"TEXT"}],required:!0,apiType:"TEXT"},{id:"takenHormoneTreatmentSatisfied",type:"SINGLESELECT",displayQuestion:"",question:"Overall, how satisfied are you with your current hormone therapy?",required:!0,options:["Satisfied","Somewhat satisfied","Not satisfied"],displayAsRow:!0,apiType:"SINGLESELECT"},{id:"takenHormoneTreatmentIssues",type:"textarea",displayQuestion:"",question:"What c

24oncerns or issues are you experiencing?",required:!0,renderCondition:e=>{const t=e.takenHormoneTreatmentSatisfied;return t==="Somewhat satisfied"||t==="Not satisfied"},apiType:"TEXT"}]},{id:"takenHormoneTreatmentStatus",title:"Which of the following best describe your experience or goals with hormone therapy?",renderCondition:e=>{const t=e.takenHormoneTreatment;return t==="Yes, I am currently using hormone therapy"||t==="I stopped using hormone therapy within the last 90 days"||t==="I used hormone therapy in the past"},questions:[{id:"takenHormoneTreatmentStatus",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"Please let us know more about your current or past hormone therapy.",required:!0,options:["I am happy with my current hormone therapy","My symptoms are not fully controlled with my current hormone therapy","I am experiencing side effects from my current hormone therapy","I would like to change my current hormone therapy","I would like LumiVera to recommend and prescribe hormone therapy","My current provider will continue prescribing my hormone therapy","I have tried hormonal birth control for perimenopause symptoms and would like other options","None of the above"],apiType:"MULTISELECT"}]},{id:"takenHormoneTreatmentMoreDetails",title:"Is there anything else you’d like your provider to know about your hormone therapy experience?",renderCondition:e=>{const t=e.takenHormoneTreatment;return t==="Yes, I am currently using hormone therapy"||t==="I stopped using hormone therapy within the last 90 days"||t==="I used hormone therapy in the past"},questions:[{id:"takenHormoneTreatmentMoreDetails",type:"textarea",displayQuestion:"",question:"Share any additional details about your symptoms, concerns, or treatment goals.",required:!0,apiType:"TEXT"}]},{id:"antidepressants",title:"Are you currently taking any antidepressant medications?",questions:[{id:"antidepressants",type:"SINGLESELECT",displayQuestion:"(e.g. Paxil, Effexor, Lexapro, Zoloft, Prozac, Wellbutrin, Desipramine)",question:"Are you currently taking any antidepressant medications?",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"antidepressantsDetails",title:"What anti-depressant are you currently taking?",renderCondition:e=>e.antidepressants==="Yes",questions:[{id:"antidepressantsDetails",type:"textarea",displayQuestion:"Please include name of medication and dosage",question:"What anti-depressant are you currently taking?",required:!0,apiType:"TEXT"}]},{id:"medications",title:"Are you currently taking any prescription medications?",questions:[{id:"medications",type:"SINGLESELECT",displayQuestion:"Select one.",question:"Are you currently taking any prescription medications?",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"medicationsDetails",title:"Please list any medications you are currently taking.",renderCondition:e=>e.medications==="Yes",questions:[{id:"medicationsDetails",type:"textarea",displayQuestion:"Include the medication name, dose, and how often you take it if known. (e.g. Levothyroxine 50mcg daily)",question:"Please list any medications you are currently taking.",required:!0,apiType:"TEXT"}]},{id:"allergies",title:"Do you have any allergies or reactions to medications or foods?",questions:[{id:"allergies",type:"SINGLESELECT",displayQuestion:"Examples include medication allergies, intolerances, or food allergies such as peanuts.",question:"Do you have any allergies or reactions to medications or foods?",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"allergiesDetails",title:"Please list all allergies or reactions to medications or adhesives.",renderCondition:e=>e.allergies==="Yes",questions:[{id:"allergiesDetails",type:"textarea",displayQuestion:"If you have no known allergies, continue to the next question.",question:"Please list all allergies or reactions to medications or adhesives.",required:!0,apiType:"TEXT"}]},{id:"familyConditions",title:"Family medical history",questions:[{id:"familyConditions",type:"MULTISELECT",displayQuestion:"",question:"Do any of your parents or siblings have a history of the following conditions?",options:["Blood clots","Heart attack","Stroke","BRCA1 or BRCA2 mutation","Breast cancer","Endometrial (uterine) cancer","Ovarian cancer","Osteoporosis","I’m not sure (e.g., adopted or no family history information available)","None of the above"],required:!0,apiType:"MULTISELECT"}]},{id:"heardAboutUs",title:"How did you hear about LumiVera?",questions:[{id:"heardAboutUs",type:"DROPDOWN",displayQuestion:"Select one.",question:"How did you hear about LumiVera?",options:["Reddit","Instagram","Facebook","Google search","Referred by a friend or family member","Referred by a healthcare provider","OrderlyMeds","Other (please specify)"],required:!0,apiType:"TEXT"}

24,{id:"heardAboutUsDetails",type:"textarea",renderCondition:e=>e.heardAboutUs==="Other (please specify)",displayQuestion:"",question:"Please specify how you heard about us.",required:!0,apiType:"TEXT"}]}],at=[{id:"skincareGoals",title:"What goals do you have for your skin?",questions:[{id:"skincareGoals",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"What goals do you have for your skin?",options:["Firmer, smoother skin","Reducing fine lines and wrinkles","Controlling acne breakouts","Moist, glowy skin","Reducing discoloration"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"skinSensitivity",title:"How sensitive is your skin?",questions:[{id:"skinSensitivity",type:"SINGLESELECT",displayQuestion:"This will let us know if your skin is easily irritated when trying new products.",question:"How sensitive is your skin?",options:["My skin is easily irritated","My skin is rarely irritated","I'm not sure"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"usingTretinoin",title:"Are you currently using tretinoin or retin-A?",questions:[{id:"usingTretinoin",type:"SINGLESELECT",displayQuestion:"",question:"Are you currently using tretinoin or retin-A?",options:["Yes","No"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"tretinoinStrength",title:"What strength tretinoin or retin-A are you using?",renderCondition:e=>e.usingTretinoin==="Yes",questions:[{id:"tretinoinStrength",type:"SINGLESELECT",displayQuestion:"",question:"What strength tretinoin or retin-A are you using?",options:["~0.025%","~0.05%","~0.08%","~0.1%","I don't know"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"skinConditions",title:"Do you have any of the following conditions?",questions:[{id:"skinConditions",type:"MULTISELECT",displayQuestion:"",question:"Do you have any of the following conditions?",options:["None","Perioral dermatitis","Eczema","Rosacea","Highly sensitive skin","Personal history of skin cancer","Personal history of breast cancer","Personal history of uterine or ovarian cancer","Other"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"skinConditionsOther",title:"Please list all other conditions.",renderCondition:e=>e.skinConditions==="Other",questions:[{id:"skinConditionsOther",type:"textarea",displayQuestion:"",question:"Please list all other conditions.",required:!0,apiType:"TEXT"}]},{id:"skincareAllergies",title:"Do you have any allergies or reactions to medications?",questions:[{id:"skincareAllergies",type:"SINGLESELECT",displayQuestion:"This includes all allergies, intolerances, and reactions to foods or previous medications (e.g. peanut allergies)",question:"Do you have any allergies or reactions to medications?",options:["Yes","No"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"skincareAllergiesWhich",title:"Please note any of the following allergies.",renderCondition:e=>e.skincareAllergies==="Yes",questions:[{id:"skincareAllergiesWhich",type:"MULTISELECT",displayQuestion:"Select all that apply:",question:"Please note any of the following allergies.",options:["Tretinoin","Niacinamide","Vitamin E","Glycerin","Peptides","Hyaluronic acid","Aloe","Azelaic Acid","Metronidazole","Metronidazole","Other"],required:!0,apiType:"MULTISELECT"}]},{id:"skincareAllergiesDetails",title:"Please list all allergies or reactions to medications or adhesives.",renderCondition:e=>{const t=e.symptoms;return Array.isArray(t)?t.includes("Other"):t==="Other"},questions:[{id:"skincareAllergiesDetails",type:"textarea",displayQuestion:"If you have no known allergies, continue to the next question.",question:"Please list all allergies or reactions to medications or adhesives.",required:!0,apiType:"TEXT"}]},{id:"pregnantBreastfeeding",title:"Are you pregnant and/or breastfeeding?",questions:[{id:"pregnantBreastfeeding",type:"SINGLESELECT",displayQuestion:"",question:"Are you pregnant and/or breastfeeding?",options:["Yes","No"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"takingMedications",title:"Are you currently taking any medications?",questions:[{id:"takingMedications",type:"SINGLESELECT",displayQuestion:"",question:"Are you currently taking any medications?",options:["Yes","No"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"takingMedicationsDetails",title:"Please list all current medications.",renderCondition:e=>e.takingMedications==="Yes",questions:[{id:"takingMedicationsDetails",type:"textarea",displayQuestion:"Please be specific. For example, instead of 'thyroid medication, please specify the brand, like 'Levothyroxine'.",question:"Please list all current medications.",required:!0,apiType:"TEXT"}]},{id:"heardAboutUs",title:"How did you hear about us?",questions:[{id:"heardAboutUs",type:"DROPDOWN",displayQuestion:"",question:"How did you hear about us?",options:["Reddit","Facebook","Google","Instagram","Word of mouth","Referral","Orderly Meds","Other (please specify)","N

24one"],required:!0,apiType:"TEXT"},{id:"heardAboutUsDetails",type:"textarea",renderCondition:e=>e.heardAboutUs==="Other (please specify)",displayQuestion:"",question:"Please specify how you heard about us.",required:!0,apiType:"TEXT"}]}],dt=[{id:"genitourinarySymptoms",title:"Let's discuss your genitourinary symptoms.",questions:[{id:"genitourinarySymptoms",type:"MULTISELECT",displayQuestion:"Select all symptoms that you are experiencing:",question:"Let's discuss your genitourinary symptoms.",options:["Bladder symptoms (frequent UTIs, urinary urgency and/or frequency)","Vaginal symptoms (dryness, burning, itching or decreased lubrication)","Vulvar or labial symptoms (dryness, burning, itching)"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"lastMenstrualPeriodSex",title:"When was your last menstrual period?",questions:[{id:"lastMenstrualPeriodSex",type:"text",displayQuestion:"Approximate month and year",question:"When was your last menstrual period?",required:!0,apiType:"TEXT"}]},{id:"cycleDescribedSex",title:"",questions:[{id:"cycleDescribedSex",type:"SINGLESELECT",displayQuestion:"",question:"Which of the following best describes your menstrual cycle in the past 12 months?",options:["My periods are regular","My periods are starting to become unpredictable (e.g. too close together, skipping periods or a change in duration or amount of flow)","I have not had a period in over a year","My menstrual cycle has been impacted by a medical procedure"],required:!0,apiType:"SINGLESELECT"}]},{id:"unpredictablePeriodsSex",title:"Which of the following describes how your periods are becoming more unpredictable?",renderCondition:e=>e.cycleDescribedSex==="My periods are starting to become unpredictable (e.g. too close together, skipping periods or a change in duration or amount of flow)",questions:[{id:"unpredictablePeriodsSex",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"Which of the following describes how your periods are becoming more unpredictable?",options:["Bleeding is more frequent than every 21 days","Bleeding last longer than 8 days","Periods are now heavier","I bleed through a tampon or pad in 1-2 hours","Bleeding is less frequent and/or I skip more than 2 months at a time","Bleeding is much lighter","Other"],required:!0,apiType:"MULTISELECT"}]},{id:"unpredictablePeriodsDetailsSex",title:"Please describe how your periods are becoming more unpredictable.",renderCondition:e=>{const t=e.unpredictablePeriodsSex,T=Array.isArray(t)?t.includes("Other"):t==="Other",a=e.cycleDescribed;return T||a==="I have not had a period in over a year"||a==="My menstrual cycle has been impacted by a medical procedure"},questions:[{id:"unpredictablePeriodsDetailsSex",type:"textarea",displayQuestion:"",question:"Please describe how your periods are becoming more unpredictable.",required:!0,apiType:"TEXT"}]},{id:"recentGynEvalSex",title:"Have you had a recent GYN evaluation?",renderCondition:e=>{const t=e.unpredictablePeriodsSex,T=Array.isArray(t)?t.includes("Other"):t==="Other",a=e.cycleDescribed;return T||a==="I have not had a period in over a year"||a==="My menstrual cycle has been impacted by a medical procedure"},questions:[{id:"recentGynEvalSex",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"Have you had a recent GYN evaluation?",required:!0,options:["I have had a regular GYN evaluation in past 12 months","I have had a pelvic or transvaginal ultrasound","I have had an endometrial biopsy","I have had a D&C","I have had a hysteroscopy","I have had blood work done","Other - please explain"],apiType:"MULTISELECT"}]},{id:"recentGynEvalDetailsSex",title:"Please tell us more.",renderCondition:e=>{const t=e.unpredictablePeriodsSex,T=Array.isArray(t)?t.includes("Other"):t==="Other",a=e.cycleDescribed;return T||a==="I have not had a period in over a year"||a==="My menstrual cycle has been impacted by a medical procedure"},questions:[{id:"recentGynEvalDetailsSex",type:"textarea",displayQuestion:"Please provide details, or in your own words, a summary of relevant results.",question:"Please tell us more.",required:!0,apiType:"TEXT"}]},{id:"moreThan10YearsSex",title:"Has it been 10 years since your last period?",renderCondition:e=>

24{const t=e.unpredictablePeriodsSex,T=Array.isArray(t)?t.includes("Other"):t==="Other",a=e.cycleDescribed;return T||a==="I have not had a period in over a year"||a==="My menstrual cycle has been impacted by a medical procedure"},questions:[{id:"moreThan10YearsSex",type:"SINGLESELECT",displayQuestion:"",question:"Has it been 10 years since your last period?",required:!0,options:["Yes","No"],apiType:"SINGLESELECT"}]},{id:"procedureImpactedPeriodsSex",title:"Which of the following medical procedures has impacted your menstrual cycle?",renderCondition:e=>e.cycleDescribedSex==="My menstrual cycle has been impacted by a medical procedure",questions:[{id:"procedureImpactedPeriodsSex",type:"SINGLESELECT",displayQuestion:"",question:"Which of the following medical procedures has impacted your menstrual cycle?",required:!0,options:["Bilateral oophorectomy","Endometrial ablation","Uterine artery embolization (UAE)","Hormonal IUD","Hysterectomy (surgical removal of the uterus)","Other"],apiType:"SINGLESELECT"}]},{id:"bilateralOopheroctomyAgeSex",title:"At what age did you have a bilateral oophorectomy (removal of both ovaries)?",renderCondition:e=>e.procedureImpactedPeriodsSex==="Bilateral oophorectomy",questions:[{id:"bilateralOopheroctomyAgeSex",type:"text",displayQuestion:"",question:"At what age did you have a bilateral oophorectomy (removal of both ovaries)?",required:!0,apiType:"TEXT"}]},{id:"bilateralOopheroctomyWhySex",title:"Why did you have a bilateral oophorectomy (removal of both ovaries)?",renderCondition:e=>e.procedureImpactedPeriodsSex==="Bilateral oophorectomy",questions:[{id:"bilateralOopheroctomyWhySex",type:"textarea",displayQuestion:"",question:"Why did you have a bilateral oophorectomy (removal of both ovaries)?",required:!0,apiType:"TEXT"}]},{id:"otherProcedureSex",title:"What other medical procedure has impacted your menstrual cycle?",renderCondition:e=>e.procedureImpactedPeriodsSex==="Other",questions:[{id:"otherProcedureSex",type:"textarea",displayQuestion:"",question:"What other medical procedure has impacted your menstrual cycle?",required:!0,apiType:"TEXT"}]},{id:"howManyPeriodsSex",title:"How many periods have you had in the past 12 months?",questions:[{id:"howManyPeriodsSex",type:"SINGLESELECT",displayQuestion:"",question:"Choose the option that best describes your cycle during the past year.",required:!0,options:["0-2","3-5","6-12"],apiType:"SINGLESELECT"}]},{id:"conditionsSex",title:"Please indicate if you have or have had any of the following conditions.",questions:[{id:"conditionsSex",type:"MULTISELECT",displayQuestion:"",question:"Please indicate if you have or have had any of the following conditions.",required:!0,options:["None","Personal history of breast cancer","Lichen Sclerosis or other vulvar skin condition","Unexplained episodes of postmenopausal bleeding (if you've had no period in over a year)","Endometrial cancer (uterine cancer)"],apiType:"MULTISELECT"}]},{id:"symptomsBreastCancerSex",title:"You have options!",renderCondition:e=>{const t=e.conditionsSex;return Array.isArray(t)?t.includes("Personal history of breast cancer"):t==="Personal history of breast cancer"},questions:[{id:"symptomsBreastCancerSex",type:"CHECKBOX",question:"I have read and understand",displayQuestion:"While systemic hormone therapy is generally not prescribed to patients with a history of invasive breast cancer, there are other treatment options available to manage your menopause symptoms.*<br /><br />All doctors who prescribe for LumiVera are menopause-trained and follow the guidelines provided by ACOG and The Menopause Society.<br /><br />Many breast cancer patients are candidates for vaginal estrogen and non-hormonal treatments. A consultation can help you explore these options and help you find an approach for your individual needs.<br /><br />",required:!0,options:["I have read and understand"],apiType:"SINGLESELECT"}]},{id:"symptomsBreastCancerSex2",title:"Please provide the year of your breast cancer diagnosis, stage of breast cancer, and estrogen receptor status.",renderCondition:e=>{const t=e.conditionsSex;return Array.isArray(t)?t.includes("Personal history of breast cancer"):t==="Personal history of breast cancer"},questions:[{id:"symptomsBreastCancerSex2",type:"textarea",displayQuestion:"",question:"Please provide the year of your breast cancer diagnosis, stage of breast cancer, and estrogen receptor status.",required:!0,apiType:"TEXT"}]},{id:"symptomsPostmenopausalSex",title:"Have you had an evaluation for the unexplained episodes of post-menopausal bleeding?",renderCondition:e=>{const t=e.conditionsSex;return Array.isArray(t)?t.includes("Unexplained episodes of postmenopausal bleeding (if you've had no period in over a year)"):t==="Unexplained episodes of postmenopausal bleeding (if you've had no period in over a year)"},questions:[{id:"symptomsPostmenopausalSex",type:"SINGLESELECT",displayQuestion:"",question:"Have you had an evaluation for the unexplained episodes of post-menopausal bleeding?",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"symptomsPostmenopausalSex2",title:"Please select the type of evaluation.",renderCondition:e=>e.conditionsSex==="Yes",questions:[{id:"symptomsPostmenopausalSex2",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"Please select the type of evaluation.",options:["Pelvic exam","Pelvic or transvaginal ultrasound","Endometrial biopsy","Hysteroscopy","D&C","Other"],required:!0,apiType:"MULTISELECT"}]},{id:"symptomsPostmenopausalSexDetails",title:"Please provide more detail.",renderCondition:e=>e.conditionsSex==="Yes",questions:[{id:"symptomsPostmenopausalSexDetails",type:"textarea",displayQuestion:"",question:"Please provide more detail.",required:!0,apiType:"TEXT"}]},{id:"usingBirthControlSex",title:"Are you currently using any form of birth control?",questions:[{id:"usingBirthControlSex",type:"SINGLESELECT",displayQuestion:"",question:"Select one.",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"birthControlWhichSex",title:"Which birth control product are you currently using?",renderCondition:e=>e.usingBirthControlSex==="Yes",questions:[{id:"birthControlWhichSex",type:"MULTISELECT",displayQuestion:"",question:"Which birth control product are you currently using?",required:!0,options:["Birth control pill","Birth control patch","Vaginal ring (NuvaRing or Annovera)","Birth control shot (Depo-Provera)","Nexplanon arm implant","Hormonal IUD (Mirena, Liletta, Kyleena, Skyla)","Copper IUD (Paragard)","Sterilization (tubal ligation or tubes removed)","My partner has had a vasectomy","Condoms","Phexxi","Other"],apiType:"MULTISELECT"},{id:"birthControlWhichSexOther",type:"text",displayQuestion:"",question:"Please specify your other birth control method:",required:!0,placeholder:"Enter details",apiType:"TEXT",renderCondition:e=>{const t=e.birthControlWhichSex;return Array.isArray(t)?t.includes("Other"):t==="Other"}}]},{id:"takenHormoneTreatmentSex",title:"Hormone therapy history",questions:[{id:"takenHormoneTreatmentSex",type:"SINGLESELECT",displayQuestion:"(e.g. birth control pills, compounded hormones or creams, sprays, gels, or hormonal pellets)",question:"Have you ever used or are you currently using hormone therapy?",options:["Yes, I am currently using hormone therapy","I stopped using hormone therapy within the last 90 days","I used hormone therapy in the past","No, I have never used hormone therapy"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"takenHormoneTreatmentDetailsSex",title:"What menopausal hormone treatment are you currently taking or have stopped taking?",renderCondition:e=>{const t=e.takenHormoneTreatmentSex;return t==="Yes, I am currently using hormone therapy"||t==="I stopped using hormone therapy within the last 90 days"||t==="I used hormone therapy in the past"},questions:[{id:"takenHormoneTreatmentDetailsSex",type:"textarea",displayQuestion:"Please include name of medication and dosage.",question:"What menopausal hormone treatment are you currently taking or have stopped taking?",required:!0,apiType:"TEXT"}]},{id:"takenHormoneTreatmentStatusSex",title:"Please let us know more about your current or past hormone therapy.",renderCondition:e=>{const t=e.takenHormoneTreatmentSex;return t==="Yes, I am currently using hormone therapy"||t==="I stopped using hormone therapy within the last 90 days"||t==="I used hormone therapy in the past"},questions:[{id:"takenHormoneTreatmentStatusSex",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"Please let us know more about your current or past hormone therapy.",required:!0,options:["I am happy with my current hormone therapy","My symptoms are not completely gone on my current hormone therapy","I am having side effects to my current hormone therapy","I do not need a RX for hormone therapy, I am getting one from my own clinician","I would like LumiVera to recommend and provide the hormone therapy","I would like a change from my current hormone therapy","I have tried birth control pills for perimenopausal symptoms and I want other options like MHT","None of the above"],apiType:"MULTISELECT"}]},{id:"takenHormoneTreatmentMoreDetailsSex",title:"Please add more details.",renderCondition:e=>{const t=e.takenHormoneTreatmentSex;return t==="Yes, I am currently using hormone therapy"||t==="I stopped using hormone therapy within the last 90 days"||t==="I used hormone therapy in the past"},questions:[{id:"takenHormoneTreatmentMoreDetailsSex",type:"textarea",displayQuestion:"",question:"Please add more details.",required:!0,apiType:"TEXT"}]},{id:"takingMedicationsSex",title:"Are you currently taking any medications?",questions:[{id:"takingMedicationsSex",type:"SINGLESELECT",displayQuestion:"",question:"Are you currently taking any medications?",options:["Yes","No"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"currentMedicationsSex",title:"Please list all current medications.",renderCondition:e=>e.takingMedicationsSex==="Yes",questions:[{id:"currentMedicationsSex",type:"textarea",displayQuestion:"Please be specific. 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24one"],required:!0,apiType:"TEXT"},{id:"heardAboutUsDetails",type:"textarea",renderCondition:e=>e.heardAboutUs==="Other (please specify)",displayQuestion:"",question:"Please specify how you heard about us.",required:!0,apiType:"TEXT"}]}],ki=[{id:"hairLossHistory",title:"Do you have a family history of hair loss?",questions:[{id:"hairLossHistory",type:"SINGLESELECT",displayQuestion:"",question:"Do you have a family history of hair loss?",options:["Yes","No"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"experiencingHairLoss",title:"Are you experiencing hair thinning or loss?",renderCondition:e=>e.hairLossHistory==="Yes",questions:[{id:"experiencingHairLoss",type:"SINGLESELECT",displayQuestion:"",question:"Are you experiencing hair thinning or loss?",options:["Hair thinning","Hair loss","Both","Neither"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"experiencingHairLossWhere",title:"Where is this happening?",renderCondition:e=>{const t=e.experiencingHairLoss;return t==="Hair thinning"||t==="Hair loss"||t==="Both"},questions:[{id:"experiencingHairLossWhere",type:"SINGLESELECT",displayQuestion:"",question:"Where is this happening?",options:["Certain spots on top of my head","Spots on sides of my head","All over my head"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"experiencingHairLossWhen",title:"When did you first start noticing changes to your hair?",renderCondition:e=>{const t=e.experiencingHairLoss;return t==="Hair thinning"||t==="Hair loss"||t==="Both"},questions:[{id:"experiencingHairLossWhen",type:"SINGLESELECT",displayQuestion:"",question:"When did you first start noticing changes to your hair?",options:["In the past month","Over the past 3 - 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24,{id:"unpredictablePeriodsHair",title:"Which of the following describes how your periods are becoming more unpredictable?",renderCondition:e=>e.personalHistoryHairLoss==="Heavy periods (e.g. bleeding is more frequent than every 21 days, bleeding lasts longer than 8 days, bleeding through a tampon or pad in 1-2 hours)",questions:[{id:"unpredictablePeriodsHair",type:"MULTISELECT",displayQuestion:"Check all that apply:",question:"Which of the following describes how your periods are becoming more unpredictable?",options:["Bleeding is more frequent than every 21 days","Bleeding last longer than 8 days","Periods are now heavier","I bleed through a tampon or pad in 1-2 hours","Bleeding is less frequent and/or I skip more than 2 months at a time","Bleeding is much lighter","Other"],required:!0,apiType:"MULTISELECT"}]},{id:"unpredictablePeriodsDetailsHair",title:"Please describe how your periods are becoming more unpredictable.",renderCondition:e=>{const 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24one"],apiType:"MULTISELECT"}]},{id:"takingMedicationsHairDetails",title:"Please specify the other hair supplements you are taking.",renderCondition:e=>e.personalHistoryHairLoss.includes("Other (specify)"),questions:[{id:"takingMedicationsHairDetails",type:"textarea",displayQuestion:"",question:"Please specify the other hair supplements you are taking.",required:!0,apiType:"TEXT"}]},{id:"symptomsBreastCancerSex",title:"You have options!",subtext:"While systemic hormone therapy is generally not prescribed to patients with a history of invasive breast cancer, there are other treatment options available to manage your menopause symptoms.*<br /><br />All doctors who prescribe for LumiVera are menopause-trained and follow the guidelines provided by ACOG and The Menopause Society.",renderCondition:e=>{const t=e.conditionsSex;return Array.isArray(t)?t.includes("Personal history of breast cancer"):t==="Personal history of breast cancer"},questions:[{id:"symptomsBreastCancerSex",type:"CHECKBOX",question:"I have read and understand",displayQuestion:"Many breast cancer patients are candidates for vaginal estrogen and non-hormonal treatments. 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24one"],required:!0,apiType:"TEXT"},{id:"heardAboutUsDetails",type:"textarea",renderCondition:e=>e.heardAboutUs==="Other (please specify)",displayQuestion:"",question:"Please specify how you heard about us.",required:!0,apiType:"TEXT"}]}],Di=[{id:"b12DeficiencyDiagnosis",title:"Have you been diagnosed with vitamin B12 deficiency by a physician or other healthcare professional?",questions:[{id:"b12DeficiencyDiagnosis",question:"B12 Deficiency Diagnosis",displayQuestion:"This helps us understand your current medical status",type:"SINGLESELECT",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"medicalConditions",title:"Do you have any of the following conditions?",questions:[{id:"medicalConditions",question:"Medical Conditions",displayQuestion:"Please check all that apply",type:"MULTISELECT",options:["Leber's optic neuropathy","Polycythemia Vera","Gout","Low potassium levels","Anemia for any reason other than low vitamin B12","Any other blood disorder","None of the above"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"heightWeight",title:"What is your height and weight? We'll use this to calculate your body mass index (BMI)",displayValue:{condition:e=>e.feet&&e.inches!=null&&e.weight,calculate:e=>{const T=(e.feet*12+e.inches)*.0254;return(e.weight*.453592/(T*T)).toFixed(2)},template:"BMI: {{value}}"},questions:[{id:"feet",question:"Feet",type:"DROPDOWN",required:!0,options:[1,2,3,4,5,6,7],apiType:"TEXT"},{id:"inches",question:"Inches",type:"DROPDOWN",required:!0,options:[0,1,2,3,4,5,6,7,8,9,10,11],apiType:"TEXT"},{id:"weight",question:"Weight (in lbs)",type:"number",required:!0,placeholder:"Enter your weight",apiType:"TEXT"}]},{id:"gender",title:"What is your gender?",questions:[{id:"gender",type:"SINGLESELECT",question:"Gender",displayQuestion:"This helps us provide personalized care",options:["Male","Female"],required:!0,apiType:"SINGLESELECT",displayAsRow:!0}]},{id:"currentMedicalConditions",title:"Please list all current medical conditions",questions:[{id:"currentMedicalConditions",question:"Current Medical Conditions",displayQuestion:"Please type N/A if none",type:"textarea",required:!0,placeholder:"List current medical conditions, or type N/A",apiType:"TEXT"}]},{id:"currentMedications",title:"Please list all your current medications, including prescription, over-the-counter, or supplements.",questions:[{id:"currentMedications",question:"Current Medications",displayQuestion:"Please include dosages. Type N/A if none.",type:"textarea",required:!0,placeholder:"List medications with dosages, or type N/A",apiType:"TEXT"}]},{id:"allergies",title:"Please list all of your known allergies",questions:[{id:"allergies",question:"Allergies",displayQuestion:"Please type N/A if none",type:"textarea",required:!0,placeholder:"List all known allergies, or type N/A if none",apiType:"TEXT"}]},{id:"additionalInfo",title:"Is there anything else you want to tell your doctor?",questions:[{id:"additionalInfo",question:"Additional Information",displayQuestion:"Please share any additional information you think is important (optional)",type:"textarea",required:!1,placeholder:"Any additional information for your doctor",apiType:"TEXT"}]},{id:"consultationType",title:"Choose your preferred consultation method. Email/Text is fastest, Phone/Video has a consultation fee.",questions:[{id:"consultationType",type:"SINGLESELECT",displayAsRow:!0,question:"$49 consultation fee will apply only if your prescription is approved and you choose not to proceed with treatment. The consultation is free if you move forward with purchasing your prescription. If you prefer to speak with your provider prior to approval, please select Phone or Video Consultation.",options:["Email and Text Message (Fastest Option)","Video","Phone Call"],required:!0,apiType:"SINGLESELECT"}]},{id:"heardAboutUs",title:"How did you hear about us?",questions:[{id:"heardAboutUs",type:"DROPDOWN",displayQuestion:"",question:"How did you hear about us?",options:["Reddit","Facebook","Google","Instagram","Word of mouth","Referral","Orderly Meds","Other (please specify)","None"],required:!0,apiType:"TEXT"}

24,{id:"heardAboutUsDetails",type:"textarea",renderCondition:e=>e.heardAboutUs==="Other (please specify)",displayQuestion:"",question:"Please specify how you heard about us.",required:!0,apiType:"TEXT"}]}],Ni=[{id:"physicalActivity",title:"How physically active are you?",questions:[{id:"physicalActivity",question:"Physical Activity Level",displayQuestion:"Understanding your activity level helps us assess your needs",type:"SINGLESELECT",displayAsRow:!0,options:["Sedentary","Somewhat Active","Active but not athletic","Athletic","Competitive/Biohacker"],required:!0,apiType:"SINGLESELECT"}]},{id:"reproductiveStatus",title:"Which of the following apply to your reproductive status?",questions:[{id:"reproductiveStatus",type:"SINGLESELECT",displayAsRow:!0,displayQuestion:"This information helps us ensure safe treatment",question:"Reproductive Status",options:["I am not currently pregnant or breastfeeding","I am currently pregnant or breastfeeding","I plan to become pregnant or breastfeed within next 6 months","I am currently going through menopause","I had a hysterectomy or am post-menopause"],required:!0,apiType:"SINGLESELECT"}]},{id:"medicalConditionsNad",title:"Do you have any one of the following Medical Conditions?",questions:[{id:"medicalConditionsNad",type:"MULTISELECT",displayQuestion:"Select all that apply",question:"Medical Conditions",options:["Diabetes","Hypertension (High Blood Pressure)","Thyroid condition","Asthma or COPD","Anxiety or depression","HIV OR AIDS","Kidney disease","Cancer","Arrhythmia or irregular heart beat","Vascular disease (stroke, blood clots etc)","Heart Failure","Gallbladder disease","Liver disease","None of the above"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"heightWeight",title:"What is your height and weight? We'll use this to calculate your body mass index (BMI)",displayValue:{condition:e=>e.feet&&e.inches!=null&&e.weight,calculate:e=>{const T=(e.feet*12+e.inches)*.0254;return(e.weight*.453592/(T*T)).toFixed(2)},template:"BMI: {{value}}"},questions:[{id:"feet",question:"Feet",type:"DROPDOWN",required:!0,options:[1,2,3,4,5,6,7],apiType:"TEXT"},{id:"inches",question:"Inches",type:"DROPDOWN",required:!0,options:[0,1,2,3,4,5,6,7,8,9,10,11],apiType:"TEXT"},{id:"weight",question:"Weight (in lbs)",type:"number",required:!0,placeholder:"Enter your weight",apiType:"TEXT"}]},{id:"gender",title:"What is your gender?",questions:[{id:"gender",type:"SINGLESELECT",displayQuestion:"This helps us provide personalized care",question:"Gender",options:["Male","Female"],required:!0,displayAsRow:!0,apiType:"SINGLESELECT"}]},{id:"liverFunction",title:"Have you ever been told your liver is not working properly?",questions:[{id:"liverFunction",question:"Liver Function",displayQuestion:"Please provide details if applicable",type:"textarea",required:!0,placeholder:"Describe any liver issues or type N/A if none",apiType:"TEXT"}]},{id:"heartFunction",title:"Have you ever been told your heart is not pumping properly?",questions:[{id:"heartFunction",question:"Heart Function",displayQuestion:"Please provide details if applicable",type:"textarea",required:!0,placeholder:"Describe any heart issues or type N/A if none",apiType:"TEXT"}]},{id:"smokingStatus",title:"Do you currently smoke?",questions:[{id:"smokingStatus",question:"Smoking Status",displayQuestion:"Please provide details if applicable",type:"text",required:!0,placeholder:"Describe your smoking status or type N/A if none",apiType:"TEXT"}]},{id:"familyHistory",title:"Do any of your immediate family members have a history of the following conditions?",questions:[{id:"familyHistory",type:"MULTISELECT",question:"Family History",displayQuestion:"Check all that apply",options:["Cancer","Heart disease","Dementia","Diabetes","High blood pressure","High Cholesterol","None of the above"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"primaryCareProvider",title:"Do you have a primary care provider?",questions:[{id:"primaryCareProvider",question:"Primary Care Provider",displayQuestion:"Please provide details if applicable",type:"textarea",required:!0,placeholder:"Describe your primary care situation or type N/A if none",apiType:"TEXT"}]},{id:"healthCheckup",title:"Have you had a general health check-up or routine physical in the past three years?",questions:[{id:"healthCheckup",question:"Health Check-up",displayQuestion:"This helps us understand your current health status",type:"SINGLESELECT",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"allergies",title:"Please list all of your known allergies",questions:[{id:"allergies",question:"Allergies",displayQuestion:"Please type N/A if none. This helps us avoid potential reactions",type:"textarea",required:!0,placeholder:"List all known allergies, or type N/A",apiType:"TEXT"}]}

24,{id:"interestInNad",title:"Understanding your goals helps us provide better care",questions:[{id:"interestInNad",question:"Interest in NAD+",displayQuestion:"Why are you interested in NAD+ Injections?",type:"textarea",required:!0,placeholder:"Please describe your interest in NAD+ therapy",apiType:"TEXT"}]},{id:"previousNadExperience",title:"Have you ever used NAD+ by patch, IV infusion, injection or nasal spray?",questions:[{id:"previousNadExperience",question:"Previous NAD+ Experience",displayQuestion:"This helps us understand your experience level",type:"SINGLESELECT",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"nadExperienceDetails",title:"Please describe and include any reactions, side effects and/or benefits you may have experienced",renderCondition:e=>e.previousNadExperience==="Yes",questions:[{id:"nadExperienceDetails",question:"NAD+ Experience Details",displayQuestion:"This helps us understand your previous experience",type:"textarea",required:!0,placeholder:"Describe your previous NAD+ experience",apiType:"TEXT"}]},{id:"selfInjectionComfort",title:"Do you feel comfortable drawing up the NAD+ solution and injecting yourself using an insulin-sized needle and syringe?",questions:[{id:"selfInjectionComfort",question:"Self Injection Comfort",displayQuestion:"This helps us determine the best administration method",type:"SINGLESELECT",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"additionalInfo",title:"Is there anything else you want to tell your doctor?",questions:[{id:"additionalInfo",question:"Additional Information",displayQuestion:"Please share any additional information you think is important (optional)",type:"textarea",required:!1,placeholder:"Any additional information for your doctor",apiType:"TEXT"}]},{id:"heardAboutUs",title:"How did you hear about us?",questions:[{id:"heardAboutUs",type:"DROPDOWN",displayQuestion:"",question:"How did you hear about us?",options:["Reddit","Facebook","Google","Instagram","Word of mouth","Referral","Orderly Meds","Other (please specify)","None"],required:!0,apiType:"TEXT"},{id:"heardAboutUsDetails",type:"textarea",renderCondition:e=>e.heardAboutUs==="Other (please specify)",displayQuestion:"",question:"Please specify how you heard about us.",required:!0,apiType:"TEXT"}]}],Hi=[{id:"heightWeight",title:"What is your height and weight?",displayValue:{condition:e=>e.feet&&e.inches!=null&&e.weight,calculate:e=>{const T=(e.feet*12+e.inches)*.0254;return(e.weight*.453592/(T*T)).toFixed(2)},template:"BMI: {{value}}"},questions:[{id:"feet",question:"Feet",type:"DROPDOWN",required:!0,options:[1,2,3,4,5,6,7],apiType:"TEXT"},{id:"inches",question:"Inches",type:"DROPDOWN",required:!0,options:[0,1,2,3,4,5,6,7,8,9,10,11],apiType:"TEXT"},{id:"weight",question:"Weight (in lbs)",type:"number",required:!0,placeholder:"Enter your weight",apiType:"TEXT"}]},{id:"reproductiveStatus",title:"Which of the following apply to your reproductive status?",questions:[{id:"reproductiveStatus",type:"SINGLESELECT",displayAsRow:!0,options:["I am not currently pregnant nor breastfeeding","I am currently pregnant or breastfeeding","I plan to become pregnant or breastfeed within the next 6 months","I am currently going through menopause","I had a hysterectomy or am post-menopausal"],required:!1,apiType:"SINGLESELECT"}]},{id:"medicalConditions",title:"Do you have any one of the following Medical Conditions? (Check all that apply)",questions:[{id:"medicalConditions",type:"MULTISELECT",displayAsRow:!0,options:["Chronic kidney disease","Asthma","Zinc deficiency","None of the above"],required:!0,apiType:"MULTISELECT"}]},{id:"glutathioneInterest",title:"Why are you interested in glutathione supplementation?",questions:[{id:"glutathioneInterest",type:"MULTISELECT",displayAsRow:!0,options:["To help with a chronic disease","For energy support","For aging support","Other"],required:!0,apiType:"MULTISELECT"}]},{id:"currentMedicalConditions",title:"Please list all current medical conditions. Please type N/A if none.",questions:[{id:"currentMedicalConditions",type:"textarea",required:!0,placeholder:"List current medical conditions, or type N/A",apiType:"TEXT"}]},{id:"currentMedications",title:"Please list all your current medications, including prescription, over-the-counter, and supplements, including dosages. Please type N/A if none.",questions:[{id:"currentMedications",type:"textarea",required:!0,placeholder:"List medications with dosages, or type N/A",apiType:"TEXT"}]},{id:"allergies",title:"Please list allergies to prescription or over-the-counter medicines, herbs, vitamins, supplements, food, dye

24s, or anything else. Please type N/A if none.",questions:[{id:"allergies",type:"textarea",required:!0,placeholder:"List all known allergies, or type N/A",apiType:"TEXT"}]},{id:"additionalInfo",title:"Is there anything else you want to tell your doctor?",questions:[{id:"additionalInfo",type:"textarea",required:!0,placeholder:"Any additional information for your doctor",apiType:"TEXT"}]},{id:"heardAboutUs",title:"How did you hear about us?",questions:[{id:"heardAboutUs",type:"DROPDOWN",displayQuestion:"",question:"How did you hear about us?",options:["Reddit","Facebook","Google","Instagram","Word of mouth","Referral","Orderly Meds","Other (please specify)","None"],required:!0,apiType:"TEXT"},{id:"heardAboutUsDetails",type:"textarea",renderCondition:e=>e.heardAboutUs==="Other (please specify)",displayQuestion:"",question:"Please specify how you heard about us.",required:!0,apiType:"TEXT"}]}],Oi=[{id:"desiredBenefits",title:"What benefits are you seeking?",questions:[{id:"desiredBenefits",type:"MULTISELECT",question:"Desired Benefits",displayQuestion:"Please check all that apply. This helps us understand your goals",options:["Muscle gain","Fat loss","Improved healing","Memory/cognitive benefits","Better sleep","General anti-aging","Other"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"medicalContraindications",title:"Do any of the following apply to you?",questions:[{id:"medicalContraindications",type:"MULTISELECT",question:"Medical Contraindications",displayQuestion:"Please select all that apply. This helps us assess safety",options:["Active cancer diagnosis","Disease of the pituitary gland","Untreated hypothyroidism","Uncontrolled diabetes","Intracranial lesion/tumor","Heart failure","None of the above"],required:!0,displayAsRow:!0,apiType:"MULTISELECT"}]},{id:"heightWeight",title:"What is your height and weight? We'll use this to calculate your body mass index (BMI)",displayValue:{condition:e=>e.feet&&e.inches!=null&&e.weight,calculate:e=>{const T=(e.feet*12+e.inches)*.0254;return(e.weight*.453592/(T*T)).toFixed(2)},template:"BMI: {{value}}"},questions:[{id:"feet",question:"Feet",type:"DROPDOWN",required:!0,options:[1,2,3,4,5,6,7],apiType:"TEXT"},{id:"inches",question:"Inches",type:"DROPDOWN",required:!0,options:[0,1,2,3,4,5,6,7,8,9,10,11],apiType:"TEXT"},{id:"weight",question:"Weight (in lbs)",type:"number",required:!0,placeholder:"Enter your weight",apiType:"TEXT"}]},{id:"gender",title:"What is your gender?",questions:[{id:"gender",type:"SINGLESELECT",question:"Gender",displayQuestion:"This helps us provide personalized care",options:["Male","Female"],required:!0,apiType:"SINGLESELECT",displayAsRow:!0}]},{id:"reproductiveStatus",renderCondition:e=>e.gender==="Female",title:"Are you pregnant, planning to become pregnant, or breastfeeding?",questions:[{id:"reproductiveStatus",question:"Reproductive Status",displayQuestion:"This information helps us ensure safe treatment",type:"SINGLESELECT",options:["Currently pregnant","Planning to become pregnant within the next 6 months","Breastfeeding","None of the above"],displayAsRow:!0,required:!0,apiType:"SINGLESELECT"}]},{id:"currentMedicalConditions",title:"Please list all current medical conditions",questions:[{id:"currentMedicalConditions",question:"Current Medical Conditions",displayQuestion:"Please type N/A if none. This helps us understand your health profile",type:"textarea",required:!0,placeholder:"List current medical conditions, or type N/A ",apiType:"TEXT"}]},{id:"currentMedications",title:"Please list all your current medications",questions:[{id:"currentMedications",type:"textarea",question:"Current Medications",displayQuestion:"Please include dosages. Type N/A if none.",required:!0,placeholder:"List medications with dosages, or type N/A",apiType:"TEXT"}]},{id:"allergies",title:"Please list all of your known allergies",questions:[{id:"allergies",question:"Allergies",displayQuestion:"Please type N/A if none. This helps us avoid potential reactions",type:"textarea",required:!0,placeholder:"List all known allergies, or type N/A if none",apiType:"TEXT"}]},{id:"additionalInfo",title:"Is there anything else you want to tell your doctor?",questions:[{id:"additionalInfo",question:"Additional Information",displayQuestion:"Please share any additional information you think is important (optional)",type:"textarea",required:!1,placeholder:"Any additional information for your doctor (optional)",apiType:"TEXT"}]}],gt=[{id:"heightWeight",title:"What is your height and weight?",displayValue:{condition:e=>e.feet&&e.inches!=null&&e.weight,calculate:e=>{const T=(e.feet*12+e.inches)*.0254;return(e.weight*.453592/(T*T)).toFixed(2)},template:"BMI: {{value}}"},questions:[{id:"feet",question:"Feet",type:"DROPDOWN",required:!0,options:[4,5,6,7],apiType:"TEXT"},{id:"inches",question:"Inches",type:"DROPDOWN",required:!0,options:[0,1,2,3,4,5,6,7,8,9,10,11],apiType:"TEXT"},{id:"weight",question:"Weight (in lbs)",type:"number",required:!0,placeholder:"Enter your weight",apiType:"TEXT"}]},{id:"longevitySymptomChecklist",title:"What are you currently experiencing?",questions:[{id:"longevitySymptomChecklist",type:"MULTISELECT",question:"Symptoms",displayQuestion:"Select all that apply.",options:["I'm tired all the time","I'm not seeing results from my workouts","I can't lose weight","I can't seem to focus","My skin is aging in a way I don't like","I get sick more often than I'd like to","I'm dealing with chronic pain","I'm having digestive or gut issues","My wounds take forever to heal","I'm not sleeping well","I'm stressed all the time","I don't feel like myself in the bedroom","I'm not sure — I just want to feel better overall"],required:!0,apiType:"MULTISELECT"}]},{id:"longevityDisqualifyingConditions",title:"Do any of these conditions apply to you?",questionSubtext:"These questions help your provider determine which treatments are safest for you. Please answer as completely as you can.",questions:[{id:"longevityDisqualifyingConditions",type:"MULTISELECT",question:"Medical Conditions",displayQuestion:"Select all that apply.",options:[...wi,et],required:!0,apiType:"MULTISELECT",exclusiveOption:et}]},{id:"currentMedications",title:"Are you currently taking any medications, including supplements?",questions:[{id:"currentMedications",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"currentMedicationsDetails",title:"Please list all current medications including Rx, OTC, and supplements with dosages.",renderCondition:e=>e.currentMedications==="Yes",questions:[{id:"currentMedicationsDetails",type:"textarea",question:"",displayQuestion:"",required:!0,apiType:"TEXT"}]},{id:"knownAllergies",title:"Do you have any known allergies?",questions:[{id:"knownAllergies",type:"SINGLESELECT",question:"",displayQuestion:"",options:["Yes","No"],required:!0,apiType:"SINGLESELECT"}]},{id:"knownAllergiesDetails",title:"Please list all known allergies.",renderCondition:e=>e.knownAllergies==="Yes",questions:[{id:"knownAllergiesDetails",type:"textarea",question:"",displayQuestion:"",required:!0,apiType:"TEXT"}]},{id:"otherOngoingHealthConditions",title:"Please describe any other ongoing health conditions.",questions:[{id:"otherOngoingHealthConditions",type:"textarea",question:"",displayQuestion:"",required:!1,apiType:"TEXT"}]},{id:"additionalProviderInfo",title:"Is there anything else you'd like your provider to know?",questions:[{id:"additionalProviderInfo",type:"textarea",question:"",displayQuestion:"",required:!1,apiType:"TEXT"}]},{id:"personalInfo",title:"What is your full name? This is the name your provider will use to address you.",renderCondition:e=>!tt(e),questions:[{id:"firstName",question:"First Name",type:"text",required:!0,placeholder:"Enter your first name",apiType:"TEXT",validation:[{type:"required",message:"First name is required"}],halfWidth:!0},{id:"lastName",question:"Last Name",type:"text",required:!0,placeholder:"Enter your last name",apiType:"TEXT",validation:[{type:"required",message:"Last name is required"}],halfWidth:!0},{id:"shippingState",type:"DROPDOWN",question:"State",displayQuestion:"What state do you live in?",options:kt,required:!0,apiType:"TEXT"},{id:"email",question:"Email Address",type:"email",required:!0,placeholder:"[email protected]",apiType:"TEXT",validation:[{type:"required",message:"Email address is required"},{type:"email",message:"Please enter a valid email address"}]},{id:"phone",question:"Phone Number",type:"tel",required:!0,placeholder:"123-456-7890",apiType:"TEXT",validation:[{type:"required",message:"Phone number is required"},{type:"phone",message:"Please enter a valid US phone number (e.g., 123-456-7890 or (123) 456-7890)"}]}]},{id:"longevityContactInfo",title:"A few last things",renderCondition:e=>!tt(e),questions:[{id:"tosPrivacyConsent",type:"CHECKBOX",required:!0,options:['I agree to the <a href="https://lumivera.com/legal/terms-and-conditions" target="_blank" rel="noopener" class="underline">Terms of Service</a> and <a href="https://lumivera.com/legal/privacy-practices" target="_blank" rel="noopener" class="underline">Privacy Policy</a>

24. I agree to receive non-marketing emails or text messages related to my account (e.g., appointment reminders).'],apiType:"SINGLESELECT"},{id:"marketingConsent",type:"CHECKBOX",required:!1,options:["I consent to receive marketing emails and text messages from LumiVera at the email address and phone number provided, including promotions, discounts, and product/service updates. Msg frequency varies. Msg & data rates may apply. Reply HELP for help, STOP to opt out. Consent is not a condition of purchase."],apiType:"SINGLESELECT"}]}],ce=[{id:"gender",title:"What sex were you assigned at birth?",questions:[{id:"gender",type:"SINGLESELECT",question:"Gender",displayQuestion:"This helps your provider recommend the safest and most appropriate care.",options:["Female","Male"],required:!0,apiType:"SINGLESELECT",optionImages:["/assets/images/option_icons/gender_option2.svg","/assets/images/option_icons/gender_option1.svg"]}]},{id:"heightWeight",title:"What is your height and weight? 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24ceive recurring marketing emails, text messages (SMS) or calls from LumiVera, including messages sent using automated technology, and auto dialer and/or prerecorded or artificial voice. I understand that consent is not a condition of purchase, that message and data rates may apply, and that I can opt out or revoke my consent at any time by replying "STOP" to any text message.'],apiType:"SINGLESELECT"}]}],Dt={id:"weight-loss",name:"Weight Loss Intake Form",description:"Comprehensive medical intake form for GLP-1 weight loss medication",version:"1.0.0",progressSteps:[{id:"start",name:"Start",description:"Weight loss goals and past initiatives",color:"#A75809"},{id:"preliminary",name:"Preliminary",description:"BMI, age, and GLP-1 medication status",color:"#A75809"},{id:"health",name:"Health",description:"Health screening and medical history",color:"#A75809"},{id:"details",name:"Details",description:"Current medications and surgical history",color:"#A75809"},{id:"eligibility",name:"Eligibility",description:"ID upload, consultation type, and consent",color:"#A75809"}],stepProgressMapping:[{stepId:"weightLossGoals",progressStepId:"start"},{stepId:"triedInPast",progressStepId:"start"},{stepId:"currentGlp1",progressStepId:"preliminary"},{stepId:"currentGlp1Type",progressStepId:"preliminary"},{stepId:"lastDoseDate",progressStepId:"preliminary"},{stepId:"lastDoseStrength",progressStepId:"preliminary"},{stepId:"prescriptionUpload",progressStepId:"preliminary"},{stepId:"pregnancyStatus",progressStepId:"health"},{stepId:"criticalConditions",progressStepId:"health"},{stepId:"medicalConditions1",progressStepId:"health"},{stepId:"medicalConditions2",progressStepId:"details"},{stepId:"currentMedications",progressStepId:"details"},{stepId:"medicationList",progressStepId:"details"},{stepId:"surgicalHistory",progressStepId:"details"},{stepId:"allergies",progressStepId:"eligibility"},{stepId:"consultationType",progressStepId:"eligibility"},{stepId:"dob",progressStepId:"eligibility"},{stepId:"personalInfo",progressStepId:"eligibility"},{stepId:"idUploadUniversal",progressStepId:"eligibility"}],steps:[...Mi,...ce],metadata:{category:"medical",estimatedTime:"15-20 minutes",targetAudience:"Adults seeking weight loss medication",compliance:["HIPAA","FDA guidelines"]}},Nt={id:"menopause",name:"Menopause Intake Form",description:"Comprehensive medical intake form for menopause treatment",version:"2.0.0",progressSteps:[{id:"basics",name:"Basics",description:"Sex, gender identity, and hormone journey",color:"#A75809"},{id:"symptoms",name:"Symptoms",description:"Current symptoms and hormone history",color:"#A75809"},{id:"history",name:"History",description:"Medical conditions and health history",color:"#A75809"},{id:"contact",name:"Contact",description:"Account, contact info, and consents",color:"#A75809"}],stepProgressMapping:[{stepId:"gender",progressStepId:"basics"},{stepId:"genderIdentity",progressStepId:"basics"},{stepId:"hormoneJourney",progressStepId:"basics"},{stepId:"uterusIntact",progressStepId:"basics"},{stepId:"progesteroneInfo",progressStepId:"basics"},{stepId:"menopauseSymptomChecklist",progressStepId:"symptoms"},{stepId:"symptomTreatmentInfo",progressStepId:"symptoms"},{stepId:"personalInfo",progressStepId:"symptoms"},{stepId:"dob",progressStepId:"symptoms"},{stepId:"heightWeight",progressStepId:"symptoms"},{stepId:"dheaAddOnInterest",progressStepId:"symptoms"},{stepId:"systemicRouteChoice",progressStepId:"symptoms"},{stepId:"priorHormoneProducts",progressStepId:"symptoms"},{stepId:"priorHormoneProductsDetails",progressStepId:"symptoms"},{stepId:"fertilityPlans",progressStepId:"symptoms"},{stepId:"fertilityPlansDetails",progressStepId:"symptoms"},{stepId:"birthControlMethods",progressStepId:"symptoms"},{stepId:"medicalConditions",progressStepId:"history"},{stepId:"otherMedicalConditions",progressStepId:"history"},{stepId:"otherMedicalConditionsDetails",progressStepId:"history"},{stepId:"currentMedications",progressStepId:"history"},{stepId:"currentMedicationsDetails",progressStepId:"history"},{stepId:"knownAllergies",progressStepId:"history"},{stepId:"knownAllergiesDetails",progressStepId:"history"},{stepId:"tobaccoUse",progressStepId:"history"},{stepId:"recentHormoneLabs",progressStepId:"history"},{stepId:"recentHormoneLabsTiming",progressStepId:"history"},{stepId:"recentHormoneLabsUpload",progressStepId:"history"},{stepId:"additionalProviderInfo",progressStepId:"history"},{stepId:"menopauseContactInfo",progressStepId:"contact"}],steps:[ce.find(e=>e.id==="gender"),...it.filter(e=>e.id!=="heightWeight").flatMap(e=>e.id==="personalInfo"?[e,ce.find(t=>

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