{"html":"\u003carticle class=\"sc-container sc-container-spacious\" id=\"SC-page-ndis-quote\"\u003e\n  \u003cdiv class=\"SC-Grid\"\u003e\n    \u003csection class=\"SC-Grid_main sc-rich-text\"\u003e\u003cheader class=\"SC-PageHeader \" \u003e\n    \u003ch1 class=\"SC-PageHeader_heading\"\u003e\n      Request an NDIS Quote\n    \u003c/h1\u003e\n\u003c/header\u003e\n      \u003csection class=\"SC-ContentBlockContainer\" id=\"SC-ContentBlockContainer-ndis-container\" data-cb=\"ndis-container\"\u003e\n\n  \u003cdiv class=\"SC-ContentBlockContainer_body sc-even-distribution\"\u003e\n      \u003c!-- CB 'ndis-quote-form' --\u003e\n\u003c!-- ---------------------------------------------------------------------- --\u003e\n\u003c!-- NOTE: Please add the following \u003cMETA\u003e element to your page \u003cHEAD\u003e. --\u003e\n\u003c!-- If necessary, please modify the charset parameter to specify the --\u003e\n\u003c!-- character set of your HTML page. --\u003e\n\u003c!-- ---------------------------------------------------------------------- --\u003e\n\n\u003cmeta http-equiv=\"Content-type\" content=\"text/html; charset=UTF-8\" /\u003e\n\n\u003c!-- ---------------------------------------------------------------------- --\u003e\n\u003c!-- NOTE: Please add the following \u003cFORM\u003e element to your page. --\u003e\n\u003c!-- ---------------------------------------------------------------------- --\u003e\n\n\u003cscript\u003e\nfunction doSubmit() {\nalert(\"Thanks for your enquiry, we will be in touch soon.\");\nreturn true;\n}\nconst picklistDependency = {\n        'Rental': ['Home Assist - SEVEN (Rental)', 'Home Assist - NOVO (Rental)','Falls Assist - SEVEN (Rental)','Home \u0026 Go Anywhere (Rental)','GPS Rental Bundle'],\n        'Purchase': ['Home Assist - SEVEN (Purchase)', 'Home Assist - NOVO (Purchase)','Falls Assist - SEVEN (Purchase)','Home \u0026 Go Anywhere (Purchase)','GPS LocateMe Watch Self-Monitored Bundle','GPS LocateMe Watch Purchase Bundle','GPS LocateMe Self-Monitored Bundle','GPS LocateMe Purchase Bundle','GO Purchase Bundle']\n    };\n\n    function updateDependentPicklist() {\n        const controllingField = document.getElementById(\"00NOY000001Pb2D\").value;\n        const dependentField = document.getElementById(\"00NOY000001Pb5R\");\n\n        // Clear existing options\n        dependentField.innerHTML = '\u003coption value=\"\"\u003e--Select--\u003c/option\u003e';\n\n        // Populate the dependent field based on selected controlling field\n        if (picklistDependency[controllingField]) {\n            picklistDependency[controllingField].forEach(value =\u003e {\n                const option = document.createElement(\"option\");\n                option.value = value;\n                option.text = value;\n                dependentField.appendChild(option);\n            });\n        }\n    }\n\u003c/script\u003e\n\n\u003cform onsubmit=\"return doSubmit();\" action=\"https://webto.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8\" method=\"POST\"\u003e\n\u003cinput type=\"hidden\" name=\"oid\" value=\"00D2w00000MGGeX\" /\u003e\n\u003cinput type=\"hidden\" name=\"retURL\" value=\"https://blueassist.com.au\" /\u003e\n\u003cinput type=\"hidden\" id=\"lead_source\" name=\"lead_source\" value=\"Store\" /\u003e\n\u003cinput type=\"hidden\" id=\"country\" name=\"country\" value=\"Australia\" /\u003e\n\u003cinput type=\"hidden\" id=\"00N2w00000bgu18\" name=\"00N2w00000bgu18\" value=\"NDIS\" /\u003e\n\n\u003c!-- ---------------------------------------------------------------------- --\u003e\n\u003c!-- NOTE: These fields are optional debugging elements. Please uncomment --\u003e\n\u003c!-- these lines if you wish to test in debug mode. --\u003e\n\u003c!-- \u003cinput type=\"hidden\" name=\"debug\" value=1\u003e --\u003e\n\u003c!-- \u003cinput type=\"hidden\" name=\"debugEmail\" value=\"support@carnacgroup.com\"\u003e --\u003e\n\n\u003c!-- ---------------------------------------------------------------------- --\u003e\n\n\u003cdiv style=\"display: flex; justify-content:space-evenly\"\u003e\n\u003cdiv style=\"width:100%; padding: 0 20px\"\u003e\n\n\u003cheader class=\"SC-PageHeader\"\u003e\n\u003ch1 class=\"SC-PageHeader_heading\"\u003eParticipant Details\u003c/h1\u003e\n\u003c/header\u003e\n\n\u003cdiv class=\"SC-Field\"\u003e\n\u003clabel class=\"SC-Field_label\" for=\"I_am_a\" data-required=\"true\"\u003e\nI am a\u003c/label\u003e\u003cselect class=\"SC-Field_select\" id=\"00N2w00000bGSy5\" name=\"00N2w00000bGSy5\"\u003e\n\u003coption value=\"\"\u003e--None--\u003c/option\u003e\n\u003coption value=\"NDIS Participant or their family\"\u003e\nNDIS Participant or their family\n\u003c/option\u003e\n\u003coption value=\"Care or planning professional assisting NDIS Participant\"\u003e\nCare or planning professional assisting NDIS Participant\n\u003c/option\u003e\n\u003c/select\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"first_name\" class=\"SC-Field_label\"\u003e First Name \u003c/label\u003e\n\u003cinput required=\"required\" type=\"text\" class=\"SC-Field_input\" id=\"first_name\" name=\"first_name\" maxlength=\"40\" /\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"last_name\" class=\"SC-Field_label\"\u003e Last Name \u003c/label\u003e\n\u003cinput required=\"required\" type=\"text\" class=\"SC-Field_input\" id=\"last_name\" name=\"last_name\" maxlength=\"20\" /\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"email\" class=\"SC-Field_label\"\u003e Email \u003c/label\u003e\n\u003cinput required=\"required\" type=\"email\" class=\"SC-Field_input\" id=\"email\" name=\"email\" maxlength=\"80\" /\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"phone\" class=\"SC-Field_label\"\u003e Phone \u003c/label\u003e\n\u003cinput type=\"text\" class=\"SC-Field_input\" id=\"phone\" name=\"phone\" maxlength=\"20\" /\u003e\n\u003c/div\u003e\n\n\u003c/div\u003e\n\u003cdiv style=\"width:100%; padding: 0 20px\"\u003e\n\n\u003cheader class=\"SC-PageHeader\"\u003e\n\u003ch1 class=\"SC-PageHeader_heading\"\u003eAddress\u003c/h1\u003e\n\u003c/header\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"street\" class=\"SC-Field_label\"\u003e Street Address \u003c/label\u003e\n\u003ctextarea name=\"street\" class=\"SC-Field_textarea\" style=\"width: 100%\"\u003e\u003c/textarea\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"city\" class=\"SC-Field_label\"\u003e City \u003c/label\u003e\n\u003cinput type=\"text\" class=\"SC-Field_input\" name=\"city\" id=\"city\" maxlength=\"40\" /\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"state\" class=\"SC-Field_label\"\u003e State \u003c/label\u003e\n\u003cinput type=\"text\" class=\"SC-Field_input\" name=\"state\" id=\"state\" maxlength=\"20\" /\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"zip\" class=\"SC-Field_label\"\u003e Post Code \u003c/label\u003e\n\u003cinput type=\"text\" class=\"SC-Field_input\" name=\"zip\" id=\"zip\" maxlength=\"20\" /\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"participant\" class=\"SC-Field_label\"\u003e\nParticipant/Guardian Phone Number\n\u003c/label\u003e\n\u003cinput id=\"00N2w00000bGSyK\" maxlength=\"40\" name=\"00N2w00000bGSyK\" size=\"20\" type=\"text\" class=\"SC-Field_input\" /\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"dob\" class=\"SC-Field_label\"\u003e\nParticipant Date of Birth\n\u003c/label\u003e\n\u003cinput type=\"text\" class=\"SC-Field_input\" id=\"00N2w00000bGSyZ\" name=\"00N2w00000bGSyZ\" size=\"12\" placeholder=\"dd/mm/yyyy\" /\u003e\n\u003c/div\u003e\n\n\n\n\n\n\u003c/div\u003e\n\n\u003cdiv style=\"width:100%; padding: 0 20px\"\u003e\n\n\u003cheader class=\"SC-PageHeader\"\u003e\n\u003ch1 class=\"SC-PageHeader_heading\"\u003eNDIS Information\u003c/h1\u003e\n\u003c/header\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"zip\" class=\"SC-Field_label\"\u003e NDIS Number \u003c/label\u003e\n\u003cinput type=\"text\" class=\"SC-Field_input\" id=\"00N2w00000bGSyt\" maxlength=\"20\" name=\"00N2w00000bGSyt\" size=\"20\" /\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field\"\u003e\n\u003clabel class=\"SC-Field_label\" for=\"checkout_customer_information_form_shipping_country\" data-required=\"true\"\u003e\nNDIS Plan Management\u003c/label\u003e\u003cselect class=\"SC-Field_select\" id=\"00N2w00000bGSyy\" name=\"00N2w00000bGSyy\"\u003e\n\u003coption value=\"\"\u003e--None--\u003c/option\u003e\n\u003coption value=\"Self Managed\"\u003eSelf Managed\u003c/option\u003e\n\u003coption value=\"NDIA/Agency Managed\"\u003eNDIA/Agency Managed\u003c/option\u003e\n\u003coption value=\"Plan Managed\"\u003ePlan Managed\u003c/option\u003e\n\u003c/select\u003e\n\n\u003c/div\u003e\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"start\" class=\"SC-Field_label\"\u003e NDIS Plan Start Date \u003c/label\u003e\n\u003cspan class=\"dateInput dateOnlyInput\"\u003e\u003cinput class=\"SC-Field_input\" id=\"00N2w00000bGSzI\" name=\"00N2w00000bGSzI\" size=\"12\" type=\"text\" placeholder=\"dd/mm/yyyy\" /\u003e\u003c/span\u003e\n\u003c/div\u003e\n\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"end\" class=\"SC-Field_label\"\u003e NDIS Plan End Date \u003c/label\u003e\n\u003cspan class=\"dateInput dateOnlyInput\"\u003e\u003cinput class=\"SC-Field_input\" id=\"00N2w00000bGSzD\" name=\"00N2w00000bGSzD\" size=\"12\" type=\"text\" placeholder=\"dd/mm/yyyy\" /\u003e\u003c/span\u003e\n\u003c/div\u003e\n\n\n\u003c!-- Controlling Picklist Field --\u003e\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"00NOY000001Pb2D\" class=\"SC-Field_label\"\u003eBundle Type\u003c/label\u003e\n\u003cselect id=\"00NOY000001Pb2D\" name=\"00NOY000001Pb2D\" class=\"SC-Field_select\" onchange=\"updateDependentPicklist()\"\u003e\n\u003coption value=\"\"\u003e--Select--\u003c/option\u003e\n\u003coption value=\"Rental\"\u003eRental\u003c/option\u003e\n\u003coption value=\"Purchase\"\u003ePurchase\u003c/option\u003e\n\u003c/select\u003e\n\u003c/div\u003e\n\u003c!-- Dependent Picklist Field --\u003e\n\u003cdiv class=\"SC-Field SC-Field-expand\"\u003e\n\u003clabel for=\"00NOY000001Pb5R\" class=\"SC-Field_label\"\u003eBundle\u003c/label\u003e\n\u003cselect id=\"00NOY000001Pb5R\" name=\"00NOY000001Pb5R\" class=\"SC-Field_select\"\u003e\n\u003coption value=\"\"\u003e--Select--\u003c/option\u003e\n\u003c/select\u003e\n\u003c/div\u003e\n\u003cbr /\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\n\n\u003cp\u003e\nBlueassist needs the contact information you provide to us to contact you\nabout our products and services. You may unsubscribe from these\ncommunications at any time. For information on how to unsubscribe, as well\nas our privacy practices and commitment to protecting your privacy, please\nreview our\n\u003ca href=\"https://blueassist.com.au/privacy-policy\"\u003ePrivacy Policy\u003c/a\u003e.\n\u003c/p\u003e\n\n\u003cdiv style=\"display:flex; justify-content: center\"\u003e\n\n\u003cinput class=\"SC-Button SC-Button-primary SC-Button-expanded-up-to-small\" type=\"submit\" name=\"submit\" /\u003e\n\u003c/div\u003e\n\n\u003c/form\u003e\n\n  \u003c/div\u003e\n\u003c/section\u003e\n\u003c!-- Calendly badge widget begin --\u003e\n\u003clink href=\"https://assets.calendly.com/assets/external/widget.css\" rel=\"stylesheet\" /\u003e\n\n\u003cscript src=\"https://assets.calendly.com/assets/external/widget.js\" type=\"text/javascript\" async=\"\"\u003e\u003c/script\u003e\n\n\u003cscript type=\"text/javascript\"\u003ewindow.onload = function() { Calendly.initBadgeWidget({ url: 'https://calendly.com/nuttag', text: 'Schedule time with me', color: '#00ff6c', textColor: '#1a1a1a', branding: true }); }\u003c/script\u003e\n\n\u003c!-- Calendly badge widget end --\u003e\n\n    \u003c/section\u003e\n  \u003c/div\u003e\n\u003c/article\u003e","flash":null,"action":null,"notice":null}