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HTML

              
                <form class="jotform-form" action="#" method="post"
		  name="form_1234" id="1234" accept-charset="utf-8"><input type="hidden" name="formID"
																					   value="1234"/>
		<div class="form-all">
			<ul class="form-section page-section">

				<li class="form-line" data-type="control_text" id="id_21">
					<div id="cid_21" class="form-input-wide">
						<div id="text_21" class="form-html"><p><span
									style="font-size:14pt;"><strong>Hi! </strong></span></p>
							<p><span style="font-size:14pt;">Before we book an appointment, please give us some information so that we can check your benefits before you arrive.</span>
							</p>
							<p style="text-align:center;"><span style="font-size:10pt;"><em>(by the way, this information is transferred securely to our servers.)</em></span>
							</p></div>
					</div>
				</li>
				<li id="cid_24" class="form-input-wide" data-type="control_pagebreak">
					<div class="form-pagebreak">
						<div class="form-pagebreak-back-container">
							<button type="button" class="form-pagebreak-back " id="form-pagebreak-back_24"> Back
							</button>
						</div>
						<div class="form-pagebreak-next-container">
							<button type="button" class="form-pagebreak-next " id="form-pagebreak-next_24"> Next
							</button>
						</div>
            </div>
				</li>
			</ul>
			<ul class="form-section page-section" style="display:none;">
				<li class="form-line" data-type="control_text" id="id_27">
					<div id="cid_27" class="form-input-wide">
						<div id="text_27" class="form-html"><p><span style="font-size:14pt;">Please fill out the following:<br/></span>
							</p></div>
					</div>
				</li>
				<li class="form-line jf-required" data-type="control_fullname" id="id_3"><label
						class="form-label form-label-left form-label-auto" id="label_3" for="input_3"> Name: <span
							class="form-required"> * </span> </label>
					<div id="cid_3" class="form-input jf-required"><span class="form-sub-label-container"
																		 style="vertical-align: top"> <input
								class="form-textbox validate[required]" type="text" size="10" name="q3_name[first]"
								id="first_3"/> <label class="form-sub-label" for="first_3" id="sublabel_first"
													  style="min-height: 13px;"> First Name </label> </span> <span
							class="form-sub-label-container" style="vertical-align: top"> <input
								class="form-textbox validate[required]" type="text" size="15" name="q3_name[last]"
								id="last_3"/> <label class="form-sub-label" for="last_3" id="sublabel_last"
													 style="min-height: 13px;"> Last Name </label> </span></div>
				</li>
				<li class="form-line jf-required" data-type="control_phone" id="id_29"><label
						class="form-label form-label-left form-label-auto" id="label_29" for="input_29"> Phone Number
						<span class="form-required"> * </span> </label>
					<div id="cid_29" class="form-input jf-required"><span class="form-sub-label-container"
																		  style="vertical-align: top"> <input
								class="form-textbox validate[required]" type="tel" name="q29_phoneNumber[area]"
								id="input_29_area" size="3"> <span class="phone-separate"> &nbsp;- </span> <label
								class="form-sub-label" for="input_29_area" id="sublabel_area" style="min-height: 13px;"> Area Code </label> </span>
						<span class="form-sub-label-container" style="vertical-align: top"> <input
								class="form-textbox validate[required]" type="tel" name="q29_phoneNumber[phone]"
								id="input_29_phone" size="8"> <label class="form-sub-label" for="input_29_phone"
																	 id="sublabel_phone" style="min-height: 13px;"> Phone Number </label> </span>
					</div>
				</li>
				<li class="form-line" data-type="control_email" id="id_4"><label
						class="form-label form-label-left form-label-auto" id="label_4" for="input_4"> E-mail: </label>
					<div id="cid_4" class="form-input jf-required"><input type="email"
																		  class=" form-textbox validate[Email]"
																		  id="input_4" name="q4_email" size="30"
																		  value=""/></div>
				</li>
				<li id="cid_26" class="form-input-wide" data-type="control_pagebreak">
					<div class="form-pagebreak">
						<div class="form-pagebreak-back-container">
							<button type="button" class="form-pagebreak-back " id="form-pagebreak-back_26"> Back
							</button>
						</div>
						<div class="form-pagebreak-next-container">
							<button type="button" class="form-pagebreak-next " id="form-pagebreak-next_26"> Next
							</button>
						</div>
					</div>
				</li>
			</ul>
			<ul class="form-section page-section" style="display:none;">
				<li class="form-line" data-type="control_text" id="id_28">
					<div id="cid_28" class="form-input-wide">
						<div id="text_28" class="form-html"><p style="text-align:left;"><span style="font-size:10pt;">If you would like us to file with your insurance provider, please fill out the following information so that we can verify your benefits before your arrival.</span>
							</p></div>
					</div>
				</li>
        <li class="form-line" data-type="control_textbox" id="id_16"><label
						class="form-label form-label-left form-label-auto" id="label_16" for="input_16"> Insurance
						Provider: </label>
					<div id="cid_16" class="form-input jf-required"><input type="text" class=" form-textbox"
																		   data-type="input-textbox" id="input_16"
																		   name="q16_insuranceProvider16" size="40"
																		   value=""/></div>
				</li>
				<li class="form-line" data-type="control_textbox" id="id_17"><label
						class="form-label form-label-left form-label-auto" id="label_17" for="input_17"> Member
						ID#: </label>
					<div id="cid_17" class="form-input jf-required"><input type="text" class=" form-textbox"
																		   data-type="input-textbox" id="input_17"
																		   name="q17_memberId17" size="40" value=""/>
					</div>
				</li>
				<li class="form-line" data-type="control_textbox" id="id_18"><label
						class="form-label form-label-left form-label-auto" id="label_18" for="input_18"> Insurance Phone
						(if not Medicare): </label>
					<div id="cid_18" class="form-input jf-required"><input type="text" class=" form-textbox"
																		   data-type="input-textbox" id="input_18"
																		   name="q18_insurancePhone" size="40"
																		   value=""/></div>
				</li>
				<li class="form-line" data-type="control_textbox" id="id_30"><label
						class="form-label form-label-left form-label-auto" id="label_30" for="input_30"> Referring
						Doctor: </label>
					<div id="cid_30" class="form-input jf-required"><input type="text" class=" form-textbox"
																		   data-type="input-textbox" id="input_30"
																		   name="q30_referringDoctor30" size="20"
																		   value=""/></div>
				</li>
				<li class="form-line" data-type="control_textbox" id="id_31"><label
						class="form-label form-label-left form-label-auto" id="label_31" for="input_31"> Referring
						Doctor Phone: </label>
					<div id="cid_31" class="form-input jf-required"><input type="text" class=" form-textbox"
																		   data-type="input-textbox" id="input_31"
																		   name="q31_referringDoctor31" size="20"
																		   value=""/></div>
				</li>
				<li id="cid_32" class="form-input-wide" data-type="control_pagebreak">
					<div class="form-pagebreak">
						<div class="form-pagebreak-back-container">
							<button type="button" class="form-pagebreak-back " id="form-pagebreak-back_32"> Back
							</button>
						</div>
						<div class="form-pagebreak-next-container">
							<button type="button" class="form-pagebreak-next " id="form-pagebreak-next_32"> Next
							</button>
						</div>
					</div>
				</li>
			</ul>
			<ul class="form-section page-section" style="display:none;">
				<li class="form-line" data-type="control_text" id="id_33">
					<div id="cid_33" class="form-input-wide">
						<div id="text_33" class="form-html"><p>Lastly, let us know what products you are interested in
								and any additional information you would like to give us.</p></div>
					</div>
				</li>
				<li class="form-line" data-type="control_checkbox" id="id_19"><label
						class="form-label form-label-left form-label-auto" id="label_19" for="input_19"> Choose
						Any: </label>
					<div id="cid_19" class="form-input jf-required">
						<div class="form-single-column"><span class="form-checkbox-item" style="clear:left;"> <span
									class="dragger-item"> </span> <input type="checkbox" class="form-checkbox"
																		 id="input_19_0" name="q19_chooseAny19[]"
																		 value="Breast Care Products"/> <label
									id="label_input_19_0" for="input_19_0"> Breast Care Products </label> </span> <span
								class="form-checkbox-item" style="clear:left;"> <span
									class="dragger-item"> </span> <input type="checkbox" class="form-checkbox"
																		 id="input_19_1" name="q19_chooseAny19[]"
																		 value="Compression Products"/> <label
									id="label_input_19_1" for="input_19_1"> Compression Products </label> </span> <span
								class="form-checkbox-item" style="clear:left;"> <span
									class="dragger-item"> </span> <input type="checkbox" class="form-checkbox"
																		 id="input_19_2" name="q19_chooseAny19[]"
																		 value="Wigs"/> <label id="label_input_19_2"
																							   for="input_19_2"> Wigs </label> </span>
						</div>
					</div>
				</li>
				<li class="form-line" data-type="control_textarea" id="id_20"><label
						class="form-label form-label-left form-label-auto" id="label_20" for="input_20">
						Comment </label>
					<div id="cid_20" class="form-input jf-required"><textarea id="input_20" class="form-textarea"
																			  name="q20_comment" cols="40"
																			  rows="6"></textarea></div>
				</li>
			
				<li class="form-line" data-type="control_button" id="id_2">
					<div id="cid_2" class="form-input-wide">
											<div class="form-pagebreak-back-container">
							<button type="button" class="form-pagebreak-back " id="form-pagebreak-back_26"> Back
							</button>
						</div>
						<div style="margin-left:156px" class="form-buttons-wrapper">
							<button id="input_2" type="submit" class="form-submit-button"> Submit Form</button>
						</div>
					</div>
				</li>
			</ul>
		</div>

	</form>
              
            
!

CSS

              
                .jotform-form input {
  padding: 16px;
}

.jotform-form {
	background: #ffffff;
	margin: 5px;
	padding: 5px 10px 5px 10px;
}

.jotform-form li {
	margin-top: 20px;
}

.form-label {
	font-weight: 700;
}
.form-sub-label {
	font-size: 12px;
}

[data-type="control_text"] {
	line-height: 2;
}

[data-type="control_text"] strong {
	font-size: 24px;
}

.jotform-form [data-type="control_pagebreak"], .jotform-form [data-type="control_button"]{
	text-align: center;
	margin-top: 20px;
	margin-bottom: 20px;
}

[data-type^="control"] {
	display: -ms-flexbox;
	display: flex;
	-ms-flex-pack: justify;
	    justify-content: space-between;
}
[data-type^="control"] > label {
	display:inline-block;
	padding: 16px;
	font-size: 16px;
	vertical-align: top;
}

[data-type^="control"] > div {
	display:inline-block;
	-ms-flex-positive: 1;
	    flex-grow: 1;
}
[data-type="control_pagebreak"] div > div, [data-type="control_button"] div > div {
	display: inline-block;
	margin: 0 20px;
}
.form-sub-label-container {
	display: -ms-inline-flexbox;
	display: inline-flex;
	-ms-flex-direction: column;
	    flex-direction: column;
}

[data-type="control_fullname"] .form-sub-label-container {
	width: 49%;
}

[data-type="control_phone"] .form-sub-label-container:first-child {
	width: 30%;
}[data-type="control_phone"] .form-sub-label-container:first-child input {
	display: inline-block;
	width: 75%;
}
.jotform-form .showAutoCalendar, .jotform-form .date-separate, .jotform-form .phone-separate {
	display:none;
}
[data-type="control_phone"] .form-sub-label-container:last-child {
	width: 60%;
}
li.jf-required {
	position: relative;
}
.form-required {
	position: absolute;
	font-size: 12px;
	color: #ff3333;
	top: 30%;
	left: 0;
}
.form-checkbox-item {
	display: block;
}
.form-checkbox-item input{
	width: inherit;
}
label.error {
	-ms-flex-order: 99;
	    order: 99;
	display: -ms-flexbox;
	display: flex;
	color: #ff3333;
}

input.error {
	border: 1px solid #ff3333
}
              
            
!

JS

              
                ( function ($) {


    var hidePage = function($page) {
        $page.slideUp();
    };

    var showPage = function($page) {
      $page.slideDown();
    };

    var backButtonEvent = function(e) {
        var $this = $(this);
        var page = $this.parents('ul').attr('data-page');
        page = (typeof page !== 'undefined') ? parseInt(page) : -1;
        if( page > 0 ) {
            hidePage($this.parents('ul'));
            showPage($('[data-page="' + (--page) +'"]'));
            
        }
    };

    var nextButtonEvent = function(e){
        var $this = $(this);

        var page = $this.parents('ul').attr('data-page');
        page = (typeof page !== 'undefined') ? parseInt(page) : -1;
        if($this.parents('form').valid()) {
            hidePage($this.parents('ul'));
            showPage($('[data-page="' + (++page) + '"]'));
            console.log('[data-page="' + (++page) + '"]');
            
        }
    };

    var initializeFormPages = function($formPages) {
        var numPages = $formPages.length;
        $formPages.each(function(i, page) {
           $(page).attr('data-page', i)       //add page number to each
               .removeAttr('style')           //remove existing styles
               .css('display','none');        //hide each page
            if (i === 0) {
                $(page).css('display','block');  //show first page
                $(page).find('.form-pagebreak-back-container').css('display','none');  //hide back button on first page
            } else if (i === numPages-1 ) {
                $(page).find('.form-pagebreak-next-container').css('display','none');  //hide next button on last page
            }

        });


    };

    $('document').ready(function() {
        var $form, $formPages;
        $form = $('.jotform-form');

        $form.find('span').removeAttr('style');  //remove any inline styles jotform adds

        $formPages = $form.find('.page-section');

        initializeFormPages($formPages);
        $('.form-pagebreak-back').on('click', backButtonEvent);
        $('.form-pagebreak-next').on('click', nextButtonEvent);


       $('form.jotform-form').validate({
          // ignore: ':hidden',
           rules: {
               'q3_name[first]' : {
                   required: true,
                   minlength: 2
               },
               'q3_name[last]' : {
                   required: true,
                   minlength: 2
               },
               'q29_phoneNumber[area]' : {
                   required: true,
                   minlength: 3,
                   number: true
               },
               'q4_email' : {
                   email: true
               },
               'q29_phoneNumber[phone]' : {
                   required: true
               },
               'q15_dateOf15[month]' : {
                   range: [1, 12]
               },
               'q15_dateOf15[day]' : {
                   range: [1, 31]
               },
               'q15_dateOf15[year]' : {
                   range: [1900, 2030]
               },
             'q20_comment' : {
               required: true,
               minlength: 2,
             }

           },
           messages: {
               'q3_name[first]' : {
                   required: "Please input your first name",
                   minlength: "Please type in your full first name"
               },
               'q3_name[last]' : {
                   required: "Please input your last name",
                   minlength: "Please type in your full last name"
               },
               'q29_phoneNumber[area]' : {
                   required: "3 digit area code",
                   minlength: "3 digit area code",
                   number: "3 digit area code"
               },
               'q29_phoneNumber[phone]' : {
                   required: "Please enter in your 7 digit phone number"
               },
               'q15_dateOf15[month]' : {
                   range: "Please enter month: 1 - 12"
               },
               'q15_dateOf15[day]' : {
                   range: "Please enter day: 1 - 31"
               },
               'q15_dateOf15[year]' : {
                   range: "Please enter a valid 4 digit year"
               }
           }
       });
        
    });
})(jQuery);

              
            
!
999px

Console