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class="cmp-navigation__item-link true"> <span class="text hyphenate">Partnering & innovation</span> </a> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0"> <a href="javascript:void(0)" :class="{dirty: navHoveredItems.includes('Careers')}" v-on:mouseover="onLinkHover('Careers')" v-on:click="openSubNav('Careers')" aria-label="Careers" class="cmp-navigation__item-link true"> <span class="text hyphenate">Careers</span> </a> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0"> <a href="javascript:void(0)" :class="{dirty: navHoveredItems.includes('About us')}" v-on:mouseover="onLinkHover('About us')" v-on:click="openSubNav('About us')" aria-label="About us" class="cmp-navigation__item-link true"> <span class="text hyphenate">About us</span> </a> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0"> <a href="/search.html" :class="{dirty: navHoveredItems.includes('Search')}" v-on:mouseover="onLinkHover('Search')" aria-label="Search" class="cmp-navigation__item-link false"> <span role="button" aria-label="Search icon navigation" class="icon icon-search"><span class="path1"></span><span class="path2"></span><span class="path3"></span><span class="path4"></span></span> </a> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0"> <a href="javascript:void(0)" :class="{dirty: navHoveredItems.includes('Patient help')}" v-on:mouseover="onLinkHover('Patient help')" v-on:click="openSubNav('Patient help')" aria-label="Patient help" class="cmp-navigation__item-link true"> <span class="text hyphenate">Patient help</span> </a> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0"> <a href="javascript:void(0)" :class="{dirty: navHoveredItems.includes('Healthcare professionals ')}" v-on:mouseover="onLinkHover('Healthcare professionals ')" v-on:click="openSubNav('Healthcare professionals ')" aria-label="Healthcare professionals " class="cmp-navigation__item-link true"> <span class="text hyphenate">Healthcare professionals</span> </a> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0"> <a href="/investors.html" :class="{dirty: navHoveredItems.includes('Investors')}" v-on:mouseover="onLinkHover('Investors')" aria-label="Investors" class="cmp-navigation__item-link false"> <span class="text hyphenate">Investors</span> </a> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0"> <a href="javascript:void(0)" :class="{dirty: navHoveredItems.includes('News \x26 media')}" v-on:mouseover="onLinkHover('News \x26 media')" v-on:click="openSubNav('News \x26 media')" aria-label="News & media" class="cmp-navigation__item-link true"> <span class="text hyphenate">News & media</span> </a> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0 cmp-navigation__item--active"> <a href="/contact-us.html" :class="{dirty: navHoveredItems.includes('Contact us')}" v-on:mouseover="onLinkHover('Contact us')" aria-label="Contact us" aria-current="page" class="cmp-navigation__item-link false"> <span class="text hyphenate">Contact us</span> </a> </li> </ul> </div> <div id="cmp-navigation__bottom-bar" class="bottom-bar" :class="{'navigation-display': isOverflowed}"> </div> <div v-if="!isTop && !tabletView" class="burger-float desktop" :class="{'top': isTop, 'not-top': !isTop}"> <button class="button burger-button" v-on:click="handleBurger" role="button" aria-label="Burger navigation button"> <span class="icon icon-burger-float-blue"><span class="path1"></span><span class="path2"></span><span class="path3"></span><span class="path4"></span><span class="path5"></span></span> <span class="icon icon-close-float-blue"><span class="path1"></span><span class="path2"></span><span class="path3"></span></span> </button> </div> <div class="burger-float mobile" v-on:click="openSubNav('')"> <button class="button burger-button" role="button" aria-label="Burger navigation button"> <span class="icon icon-burger-float-blue"><span 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src="/etc.clientlibs/nncorp/components/content/plaintext/clientlibs.min.49e418542985e1df66dcd09169fcce86.js" async></script> <div class="background gutters component-padding-topAndBottom white tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--24 tb-Grid--s--24 tb-Grid--xs--24" style="background-color: white"> <div> <div class="introplaintext-wrapper"> <div class="titlegrid tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--24 tb-Grid--s--24 tb-Grid--xs--24"> <div class="titleframe white small tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2"> <div class="tb-Grid tb-Grid--20 tb-Grid--l--20 tb-Grid--m--20 tb-Grid--s--20 tb-Grid--xs--20"> <div class="tb-GridColumn tb-GridColumn--l--6 tb-GridColumn--m--9 tb-GridColumn--s--12 tb-GridColumn--xs--20"> </div> <div class="tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--m--16 tb-GridColumn--s--18 tb-GridColumn--xs--20"> <h1 class="text plaintexttitle title color-blue smalltitle" v-html="applyContentStyle('Contact us')"> </h1> </div> </div> </div> </div> <div class="tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--24 tb-Grid--s--24 tb-Grid--xs--24"> <div class="tb-GridColumn tb-GridColumn--l--24 tb-GridColumn--m--22 tb-GridColumn--s--22 tb-GridColumn--xs--22 tb-GridColumn--offset--l--none tb-GridColumn--offset--m--1 tb-GridColumn--offset--s--1 tb-GridColumn--offset--xs--1"> <div class="frame-box tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--22 tb-Grid--s--22 tb-Grid--xs--22 no-frame-padding white small" style="background-color: white"> </div> </div> </div> </div> </div> </div> </div> </div> <div class="plaintext aem-GridColumn aem-GridColumn--default--12"><div> <div class="background gutters component-padding-top frame tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--24 tb-Grid--s--24 tb-Grid--xs--24" style="background-color: white"> <div> <div class="introplaintext-wrapper"> <div class="titlegrid tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--24 tb-Grid--s--24 tb-Grid--xs--24"> <div class=" frame small tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2"> <div class="tb-Grid tb-Grid--20 tb-Grid--l--20 tb-Grid--m--20 tb-Grid--s--20 tb-Grid--xs--20"> <div class="tb-GridColumn tb-GridColumn--l--6 tb-GridColumn--m--9 tb-GridColumn--s--12 tb-GridColumn--xs--20"> </div> <div class="tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--m--16 tb-GridColumn--s--18 tb-GridColumn--xs--20"> </div> </div> </div> </div> <div class="tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--24 tb-Grid--s--24 tb-Grid--xs--24"> <div class="tb-GridColumn tb-GridColumn--l--24 tb-GridColumn--m--22 tb-GridColumn--s--22 tb-GridColumn--xs--22 tb-GridColumn--offset--l--none tb-GridColumn--offset--m--1 tb-GridColumn--offset--s--1 tb-GridColumn--offset--xs--1"> <div class=" tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--22 tb-Grid--s--22 tb-Grid--xs--22 frame-padding frame small" style="background-color:#fcf2f5;"> <div> <div> <div class="columns tb-Grid tb-Grid--l--24 tb-Grid--m--22 tb-Grid--s--22 tb-Grid--xs--22"> <div class="left-column tb-GridColumn tb-GridColumn--l--5 tb-GridColumn--m--5 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2 tb-GridColumn--offset--m--1 m-s-bottom"> <h3 class="h2 color-blue text"> <b v-html="applyContentStyle('Need help affording your medicine?')"></b> </h3> </div> <div class="right-column color-blue paragraph-l tb-GridColumn tb-GridColumn--l--13 tb-GridColumn--m--13 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2 tb-GridColumn--offset--m--2 tb-GridColumn--offset--s--1 tb-GridColumn--offset--xs--1"> <div> <div class="text section-wrapper richtext color-blue introtextsection "> <h4 class="text color-blue subsubheader h3" v-html="applyContentStyle('')"></h4> <div class="text color-blue introtext"> <p>Please visit <a href="http://www.novocare.com" target="_blank">NovoCare.com</a> or call:</p> <ul> <li> <b>Diabetes:</b> 844-Novo4Me (844-668-6463)</li> <li> <b>Obesity:</b>聽888-809-3942</li> <li> <b>Growth Hormone:</b>聽888-668-6444</li> <li> <b>Hemophilia:</b>聽844-668-6732</li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="calltoaction aem-GridColumn aem-GridColumn--default--12"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/components/content/calltoaction/clientlibs.min.ebe7c7e29fe7c41f69d1f2aa03d28ccf.css" type="text/css"> <script src="/etc.clientlibs/nncorp/components/content/calltoaction/clientlibs.min.78e2dd42584a0e624dc4d773e4de99cc.js"></script> <div class="cta-container"> <div class="gutters tb-Grid tb-Grid--24 tb-Grid--m--24 tb-Grid--xs--24 component-padding-topAndBottom frame" style="background-color: white"> <div class="background-styling-container tb-GridColumn tb-GridColumn--l--24 tb-GridColumn--m--22 tb-GridColumn--xs--24 tb-GridColumn--offset--l--none tb-GridColumn--offset--m--1 tb-GridColumn--offset--xs--0" style="background-color:#fcf2f5;"> <div class="tb-Grid tb-Grid--l--24 tb-Grid--m--22 tb-Grid--xs--24"> <div class="cta-grid tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--m--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2 tb-GridColumn--offset--m--1 tb-GridColumn--offset--xs--2"> <div class="cta-content frame-padding"> <h2 class="title cta-title xsmalltitle m-xxs-bottom color-blue" v-html="applyContentStyle('Product Supply Update')"> </h2> <p class="img-des paragraph-l color-blue cta-desc" v-html="applyContentStyle('View the latest information about the supply of our chronic weight management medicine.')"> </p> <a href="/products/product-supply-update.html" aria-label="Learn more" target="_blank"> <button class="button m-s-top button-link-animation "> <span class="text"> Learn more </span> <span class="icon icon-right-arrow"></span> </button> </a> </div> </div> </div> </div> </div> </div> </div> <div class="layoutcontainergrid responsivegrid aem-GridColumn aem-GridColumn--default--12"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/components/content/layoutcontainergrid/clientlibs.min.8e68a20a5b5ff888db6d5b26377b9644.css" type="text/css"><script type="text/javascript" src="/etc.clientlibs/nncorp/components/content/layoutcontainergrid/clientlibs.min.171a7ca77be56f15301624914902fc77.js" async></script> <div class="layout-container-grid"> <div class="gutters component-padding-bottom frame outer-container" style="background-color: white"> <div class="tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--24 tb-Grid--s--24"> <div class="frame-padding tb-GridColumn tb-GridColumn--l--24 tb-GridColumn--m--22 tb-GridColumn--s--22 tb-GridColumn--offset--l--none tb-GridColumn--offset--m--1 tb-GridColumn--offset--s--1" style="background-color:#fcf2f5;"> <div class="tb-Grid tb-Grid--24 tb-Grid--l--22 tb-Grid--m--24 tb-Grid--s--24"> <div class="tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--m--22 tb-GridColumn--s--22 tb-GridColumn--offset--l--2 tb-GridColumn--offset--m--1 tb-GridColumn--offset--s--1"> <div> <div class="rowcontainer"> <div> <div class="contentgrid_row"> <div class="columns-2 column has-content-true column-0 top_align contentgrid_column"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="image-video image aem-GridColumn aem-GridColumn--default--12">   <link rel="stylesheet" href="/etc.clientlibs/nncorp/components/content/image-video/clientlibs.min.d6f3af1e3efca5e63b4d0dbb00c396bd.css" type="text/css"> <div> <a target="_self"> <div class="image-video-wrapper"> <div class="right-arrow-animation"> <h3 class="color-blue subtext subheadline paragraph-s rtl-text" v-html="applyContentStyle('Product Inquiries')"> </h3> <p class="color-blue subtext paragraph-s paragraph-line-break rtl-text" v-html="applyContentStyle('Please call 1\u002D800\u002D727\u002D6500 or use the form below to submit.\r\n\r\nIf your question relates to the supply of our chronic weight management medicine, we encourage you to check the above update.\r\n\r\n')"> </p> </div> </div> </a> </div> </div> </div> </div> <div class="columns-2 column has-content-true column-1 top_align contentgrid_column"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="image-video image aem-GridColumn aem-GridColumn--default--12">   <div> <div class="image-video-wrapper"> <div> <h3 class="color-blue subtext subheadline paragraph-s rtl-text" v-html="applyContentStyle('Report a Side Effect or Product Complaint')"> </h3> <p class="color-blue subtext paragraph-s paragraph-line-break rtl-text" v-html="applyContentStyle('Please submit online using the link below or call 1\u002D800\u002D727\u002D6500.')"> </p> <div class="link m-xs-top right-arrow-animation"> <a href="https://www.novonordisk.com/patients/report-a-side-effect.html" class="color-blue link-label m-xxs-right paragraph-s" target="_blank"> <span v-html="applyContentStyle('Report a side effect')"></span> <span class="icon icon-right-arrow m-xxs-left"></span> </a> </div> </div> </div> </div> </div> </div> </div> </div> <div class="contentgrid_row"> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="container responsivegrid aem-GridColumn aem-GridColumn--default--12"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/clientlibs/vuejs/components/loading-indicator.min.8ee2484d306137fa7bb66d7c0730909a.css" type="text/css"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/clientlibs/vuejs/components/loading-button.min.13ce63c7cec1fd0d83f972e8923d9766.css" type="text/css"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/clientlibs/vuejs/form-components/singleselect.min.cfb02a6d5ae1ecbca186a7f8f4c8c325.css" type="text/css"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/clientlibs/vuejs/form-components/multiselect.min.03524b97bec855b9db1d835e51b4037a.css" type="text/css"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/clientlibs/vuejs/components/form-multiple-products.min.d41d8cd98f00b204e9800998ecf8427e.css" type="text/css"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/components/content/form/form-recaptcha/clientlibs.min.d41d8cd98f00b204e9800998ecf8427e.css" type="text/css"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/components/content/form/multiupload/clientlibs.min.44492d4d021a0636443e9962f589015a.css" type="text/css"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/components/content/form/form-date-picker/clientlibs.min.6b61762a2bb149294f65b444b16c1b09.css" type="text/css"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/components/content/form/container/clientlibs.min.d75af82e6d7d6ab6cb96f077a5a64f6d.css" type="text/css"> <div class="form-container-wrapper gutters component-padding" :class="{loaded: loaded }"> <form v-on:submit.prevent="submitForm" class="cmp-form light" method="post"> <input type="hidden" ref="endpoint" value="/bin/nncorp/contact-us-email"/> <input type="hidden" ref="submitErrMsg" value=" , , "/> <input type="hidden" ref="pageHeader"/> <input type="hidden" ref="resourcePath" value="/content/nncorp/us/en_us/contact-us/jcr:content/root/container"/> <input type="hidden" ref="redirect" value="/content/nncorp/us/en_us/contact-us/thank-you-contact-us.html"/> <input ref="redirect" type="hidden" name=":redirect" value="/content/nncorp/us/en_us/contact-us/thank-you-contact-us.html"/> <input type="hidden" id="fieldsCrossValidation" ref="fieldsCrossValidation"/> <div class="tb-Grid tb-Grid--l--24"> <div class="tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--offset--l--2 desktop large"> </div> </div> <div class="tb-Grid tb-Grid--l--24 frame-padding large" style="background-color:#fcf2f5;"> <div class="tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--offset--l--2 title-frame mobile"> <div class="tagline color-blue"></div> <p class="color-blue h1-l" v-html="applyContentStyle('')"> </p> </div> <input type="hidden" id="validationConfig" ref="validationConfig" value='{"validations": { "firstname": { "required": "true", "type": "text", "groupName": "" }, "question": { "required": "true", "type": "textarea", "groupName": "" }, "address2": { "maxLength": "36", "type": "text", "groupName": "" }, "address1": { "required": "true", "maxLength": "90", "type": "text", "groupName": "" }, "telephone": { "required": "true", "minLength": "10", "maxLength": "10", "type": "number", "groupName": "" }, "addresspostcode": { "required": "true", "minLength": "5", "maxLength": "5", "type": "number", "groupName": "" }, "lastname": { "required": "true", "type": "text", "groupName": "" }, "addresscity": { "required": "true", "type": "text", "groupName": "" }, "iam": { "required": "true", "type": "drop-down", "groupName": "" }, "therapyArea": { "required": "true", "type": "drop-down", "groupName": "" }, "Submit": { "type": "submit", "groupName": "" }, "salutation": { "required": "true", "type": "drop-down", "groupName": "" }, "state": { "required": "true", "type": "drop-down", "groupName": "" }, "email": { "required": "true", "email": "true", "type": "email", "groupName": "" } }, "groups": ""}'/> <div class="tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--offset--l--2"> <div class="tb-Grid tb-Grid--l--20 tb-Grid--m--20 tb-Grid--s--20 tb-Grid--xs--20"> <div class="options tb-GridColumn--m--9 tb-GridColumn--offset--m--0 tb-GridColumn tb-GridColumn--offset--l--0 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <fieldset class="cmp-form-options cmp-form-options--drop-down m-m-bottom form-control"> <div class="form-control" :class="{'error': $v.model['iam'].$invalid || $v.modelCrossValidation['iam'] && $v.modelCrossValidation['iam'].$error, 'valid': !$v.model['iam'].$invalid, 'touched': $v.model['iam'].$dirty || $v.modelCrossValidation['iam'] && $v.modelCrossValidation['iam'].$dirty}"> <singleselect :options="[{"text":"Customer","value":"customer"},{"text":"Health Care Professional","value":"hcp"}]" :label="'I am'" :return-value-only="true" v-model="model['iam']" :sorting="false" @blur="crossValidateFields('iam', true); $v.model['iam'].$touch()" :api-url="''" :required="true" :required-cross-validation="$v.modelCrossValidation['iam'] && $v.modelCrossValidation['iam'].$invalid" :empty-option-text="''" :plain-text-enabled="false" placeholder="Select option"> </singleselect> <span class="infotext error-mgs" v-if="!$v.model['iam'].required"></span> </div> <span class="infotext color-blue"></span> </fieldset> </div> <div class="options tb-GridColumn--m--9 tb-GridColumn tb-GridColumn--offset--m--2 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <fieldset class="cmp-form-options cmp-form-options--drop-down m-m-bottom form-control"> <div class="form-control" :class="{'error': $v.model['salutation'].$invalid || $v.modelCrossValidation['salutation'] && $v.modelCrossValidation['salutation'].$error, 'valid': !$v.model['salutation'].$invalid, 'touched': $v.model['salutation'].$dirty || $v.modelCrossValidation['salutation'] && $v.modelCrossValidation['salutation'].$dirty}"> <singleselect :options="[{"text":"Mr.","value":"mr."},{"text":"Ms.","value":"ms."},{"text":"Mrs.","value":"mrs."},{"text":"Dr.","value":"dr."},{"text":"Sr.","value":"sr."},{"text":"Sra.","value":"sra."},{"text":"Rev.","value":"rev."}]" :label="'Salutation'" :return-value-only="true" v-model="model['salutation']" :sorting="false" @blur="crossValidateFields('salutation', true); $v.model['salutation'].$touch()" :api-url="''" :required="true" :required-cross-validation="$v.modelCrossValidation['salutation'] && $v.modelCrossValidation['salutation'].$invalid" :empty-option-text="''" :plain-text-enabled="false" placeholder="Select option"> </singleselect> <span class="infotext error-mgs" v-if="!$v.model['salutation'].required"></span> </div> <span class="infotext color-blue"></span> </fieldset> </div> <div class="text tb-GridColumn--m--9 tb-GridColumn--offset--m--0 tb-GridColumn tb-GridColumn--offset--l--0 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <div class="form-control m-m-bottom" :class="{'error': $v.model['firstname'].$invalid || $v.modelCrossValidation['firstname'] && $v.modelCrossValidation['firstname'].$error, 'touched': $v.model['firstname'].$dirty || $v.modelCrossValidation['firstname'] && $v.modelCrossValidation['firstname'].$dirty}"> <h4 class="h4 label">First Name <span class="asterisk">*</span> </h4> <div class="position-relative"> <button type="button" class="left-button" v-if="'text' == 'email'"> <span class="icon icon-email"></span> </button> <input class="textbox" :class="{'has-left-icon': 'text' == 'email'}" data-cmp-hook-form-text="input" type="text" id="form-text-1039668776" v-model="model.firstname" name="firstname" @blur="crossValidateFields('firstname'); $v.model['firstname'].$touch()"/> </div> <span class="infotext color-blue"></span> <span class="infotext error-mgs" v-if="!$v.model['firstname'].required"></span> <span class="infotext error-mgs" v-if="!$v.model['firstname'].email"></span> <span class="infotext error-mgs" v-if="!$v.model['firstname'].sameAs"></span> <span class="infotext error-mgs" v-if="$v.model['firstname'].minLength === false"> </span> <span class="infotext error-mgs" v-if="!$v.model['firstname'].maxLength"></span> </div> </div> <div class="text tb-GridColumn--m--9 tb-GridColumn tb-GridColumn--offset--m--2 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <div class="form-control m-m-bottom" :class="{'error': $v.model['lastname'].$invalid || $v.modelCrossValidation['lastname'] && $v.modelCrossValidation['lastname'].$error, 'touched': $v.model['lastname'].$dirty || $v.modelCrossValidation['lastname'] && $v.modelCrossValidation['lastname'].$dirty}"> <h4 class="h4 label">Last Name <span class="asterisk">*</span> </h4> <div class="position-relative"> <button type="button" class="left-button" v-if="'text' == 'email'"> <span class="icon icon-email"></span> </button> <input class="textbox" :class="{'has-left-icon': 'text' == 'email'}" data-cmp-hook-form-text="input" type="text" id="form-text-280426897" v-model="model.lastname" name="lastname" @blur="crossValidateFields('lastname'); $v.model['lastname'].$touch()"/> </div> <span class="infotext color-blue"></span> <span class="infotext error-mgs" v-if="!$v.model['lastname'].required"></span> <span class="infotext error-mgs" v-if="!$v.model['lastname'].email"></span> <span class="infotext error-mgs" v-if="!$v.model['lastname'].sameAs"></span> <span class="infotext error-mgs" v-if="$v.model['lastname'].minLength === false"> </span> <span class="infotext error-mgs" v-if="!$v.model['lastname'].maxLength"></span> </div> </div> <div class="text tb-GridColumn--m--9 tb-GridColumn--offset--m--0 tb-GridColumn tb-GridColumn--offset--l--0 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <div class="form-control m-m-bottom" :class="{'error': $v.model['address1'].$invalid || $v.modelCrossValidation['address1'] && $v.modelCrossValidation['address1'].$error, 'touched': $v.model['address1'].$dirty || $v.modelCrossValidation['address1'] && $v.modelCrossValidation['address1'].$dirty}"> <h4 class="h4 label">Address 1 <span class="asterisk">*</span> </h4> <div class="position-relative"> <button type="button" class="left-button" v-if="'text' == 'email'"> <span class="icon icon-email"></span> </button> <input class="textbox" :class="{'has-left-icon': 'text' == 'email'}" data-cmp-hook-form-text="input" type="text" id="form-text-991248328" v-model="model.address1" name="address1" @blur="crossValidateFields('address1'); $v.model['address1'].$touch()"/> </div> <span class="infotext color-blue"></span> <span class="infotext error-mgs" v-if="!$v.model['address1'].required"></span> <span class="infotext error-mgs" v-if="!$v.model['address1'].email"></span> <span class="infotext error-mgs" v-if="!$v.model['address1'].sameAs"></span> <span class="infotext error-mgs" v-if="$v.model['address1'].minLength === false"> </span> <span class="infotext error-mgs" v-if="!$v.model['address1'].maxLength">Maximum 90 characters</span> </div> </div> <div class="text tb-GridColumn--m--9 tb-GridColumn tb-GridColumn--offset--m--2 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <div class="form-control m-m-bottom" :class="{'error': $v.model['address2'].$invalid || $v.modelCrossValidation['address2'] && $v.modelCrossValidation['address2'].$error, 'touched': $v.model['address2'].$dirty || $v.modelCrossValidation['address2'] && $v.modelCrossValidation['address2'].$dirty}"> <h4 class="h4 label">Address 2 <span v-if="$v.modelCrossValidation['address2'] && $v.modelCrossValidation['address2'].$invalid" class="asterisk">*</span> </h4> <div class="position-relative"> <button type="button" class="left-button" v-if="'text' == 'email'"> <span class="icon icon-email"></span> </button> <input class="textbox" :class="{'has-left-icon': 'text' == 'email'}" data-cmp-hook-form-text="input" type="text" id="form-text-50173125" v-model="model.address2" name="address2" @blur="crossValidateFields('address2'); $v.model['address2'].$touch()"/> </div> <span class="infotext color-blue"></span> <span class="infotext error-mgs" v-if="!$v.model['address2'].required"></span> <span class="infotext error-mgs" v-if="!$v.model['address2'].email"></span> <span class="infotext error-mgs" v-if="!$v.model['address2'].sameAs"></span> <span class="infotext error-mgs" v-if="$v.modelCrossValidation['address2'] && $v.modelCrossValidation['address2'].$invalid && !$v.modelCrossValidation['address2'].required"> {{crossValidationError['address2'].crossValidationErrorMessage}} </span> <span class="infotext error-mgs" v-if="$v.model['address2'].minLength === false"> </span> <span class="infotext error-mgs" v-if="!$v.model['address2'].maxLength">Maximum 36 characters</span> </div> </div> <div class="text tb-GridColumn--m--9 tb-GridColumn--offset--m--0 tb-GridColumn tb-GridColumn--offset--l--0 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <div class="form-control m-m-bottom" :class="{'error': $v.model['addresscity'].$invalid || $v.modelCrossValidation['addresscity'] && $v.modelCrossValidation['addresscity'].$error, 'touched': $v.model['addresscity'].$dirty || $v.modelCrossValidation['addresscity'] && $v.modelCrossValidation['addresscity'].$dirty}"> <h4 class="h4 label">City <span class="asterisk">*</span> </h4> <div class="position-relative"> <button type="button" class="left-button" v-if="'text' == 'email'"> <span class="icon icon-email"></span> </button> <input class="textbox" :class="{'has-left-icon': 'text' == 'email'}" data-cmp-hook-form-text="input" type="text" id="form-text-599344351" v-model="model.addresscity" name="addresscity" @blur="crossValidateFields('addresscity'); $v.model['addresscity'].$touch()"/> </div> <span class="infotext color-blue"></span> <span class="infotext error-mgs" v-if="!$v.model['addresscity'].required"></span> <span class="infotext error-mgs" v-if="!$v.model['addresscity'].email"></span> <span class="infotext error-mgs" v-if="!$v.model['addresscity'].sameAs"></span> <span class="infotext error-mgs" v-if="$v.model['addresscity'].minLength === false"> </span> <span class="infotext error-mgs" v-if="!$v.model['addresscity'].maxLength"></span> </div> </div> <div class="options tb-GridColumn--m--9 tb-GridColumn tb-GridColumn--offset--m--2 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <fieldset class="cmp-form-options cmp-form-options--drop-down m-m-bottom form-control"> <div class="form-control" :class="{'error': $v.model['state'].$invalid || $v.modelCrossValidation['state'] && $v.modelCrossValidation['state'].$error, 'valid': !$v.model['state'].$invalid, 'touched': $v.model['state'].$dirty || $v.modelCrossValidation['state'] && $v.modelCrossValidation['state'].$dirty}"> <singleselect :options="[{"text":"AL","value":"al"},{"text":"AK","value":"ak"},{"text":"AZ聽聽","value":"az"},{"text":"AR","value":"ar"},{"text":"CA","value":"ca"},{"text":"CO","value":"co"},{"text":"CT","value":"ct"},{"text":"DC","value":"dc"},{"text":"DE","value":"de"},{"text":"FL","value":"fl"},{"text":"GA","value":"ga"},{"text":"HI","value":"hi"},{"text":"ID","value":"id"},{"text":"IL","value":"il"},{"text":"IN","value":"in"},{"text":"IA","value":"ia"},{"text":"KS","value":"ks"},{"text":"KY","value":"ky"},{"text":"LA","value":"la"},{"text":"ME","value":"me"},{"text":"MD","value":"md"},{"text":"MA","value":"ma"},{"text":"MI","value":"mi"},{"text":"MN","value":"mn"},{"text":"MS","value":"ms"},{"text":"MO","value":"mo"},{"text":"MT","value":"mt"},{"text":"NE","value":"ne"},{"text":"NV","value":"nv"},{"text":"NH","value":"nh"},{"text":"NJ","value":"nj"},{"text":"NM","value":"nm"},{"text":"NY","value":"ny"},{"text":"NC","value":"nc"},{"text":"ND","value":"nd"},{"text":"OH","value":"oh"},{"text":"OK","value":"ok"},{"text":"OR","value":"or"},{"text":"PA","value":"pa"},{"text":"PR","value":"pr"},{"text":"RI","value":"ri"},{"text":"SC","value":"sc"},{"text":"SD","value":"sd"},{"text":"TN","value":"tn"},{"text":"TX","value":"tx"},{"text":"UT","value":"ut"},{"text":"VT","value":"vt"},{"text":"VA","value":"va"},{"text":"WA","value":"wa"},{"text":"WV","value":"wv"},{"text":"WI","value":"wi"},{"text":"WY","value":"wy"}]" :label="'State'" :return-value-only="true" v-model="model['state']" :sorting="false" @blur="crossValidateFields('state', true); $v.model['state'].$touch()" :api-url="''" :required="true" :required-cross-validation="$v.modelCrossValidation['state'] && $v.modelCrossValidation['state'].$invalid" :empty-option-text="''" :plain-text-enabled="false" placeholder="Select option"> </singleselect> <span class="infotext error-mgs" v-if="!$v.model['state'].required"></span> </div> <span class="infotext color-blue"></span> </fieldset> </div> <div class="text tb-GridColumn--m--9 tb-GridColumn--offset--m--0 tb-GridColumn tb-GridColumn--offset--l--0 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <div class="form-control m-m-bottom" :class="{'error': $v.model['addresspostcode'].$invalid || $v.modelCrossValidation['addresspostcode'] && $v.modelCrossValidation['addresspostcode'].$error, 'touched': $v.model['addresspostcode'].$dirty || $v.modelCrossValidation['addresspostcode'] && $v.modelCrossValidation['addresspostcode'].$dirty}"> <h4 class="h4 label">Post/Zip code <span class="asterisk">*</span> </h4> <div class="position-relative"> <button type="button" class="left-button" v-if="'number' == 'email'"> <span class="icon icon-email"></span> </button> <input class="textbox" :class="{'has-left-icon': 'number' == 'email'}" data-cmp-hook-form-text="input" type="number" id="form-text-332153047" v-model="model.addresspostcode" name="addresspostcode" @blur="crossValidateFields('addresspostcode'); $v.model['addresspostcode'].$touch()"/> </div> <span class="infotext color-blue"></span> <span class="infotext error-mgs" v-if="!$v.model['addresspostcode'].required"></span> <span class="infotext error-mgs" v-if="!$v.model['addresspostcode'].email"></span> <span class="infotext error-mgs" v-if="!$v.model['addresspostcode'].sameAs"></span> <span class="infotext error-mgs" v-if="$v.model['addresspostcode'].minLength === false"> Postal code should be 5 digits</span> <span class="infotext error-mgs" v-if="!$v.model['addresspostcode'].maxLength">Postal code should be 5 digits</span> </div> </div> <div class="text tb-GridColumn--m--9 tb-GridColumn tb-GridColumn--offset--m--2 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--l--2 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <div class="form-control m-m-bottom" :class="{'error': $v.model['email'].$invalid || $v.modelCrossValidation['email'] && $v.modelCrossValidation['email'].$error, 'touched': $v.model['email'].$dirty || $v.modelCrossValidation['email'] && $v.modelCrossValidation['email'].$dirty}"> <h4 class="h4 label">E-mail <span class="asterisk">*</span> </h4> <div class="position-relative"> <button type="button" class="left-button" v-if="'email' == 'email'"> <span class="icon icon-email"></span> </button> <input class="textbox" :class="{'has-left-icon': 'email' == 'email'}" data-cmp-hook-form-text="input" type="email" id="form-text-19731733" v-model="model.email" name="email" @blur="crossValidateFields('email'); $v.model['email'].$touch()"/> </div> <span class="infotext color-blue"></span> <span class="infotext error-mgs" v-if="!$v.model['email'].required"></span> <span class="infotext error-mgs" v-if="!$v.model['email'].email">Please enter valid email address</span> <span class="infotext error-mgs" v-if="!$v.model['email'].sameAs"></span> <span class="infotext error-mgs" v-if="$v.model['email'].minLength === false"> </span> <span class="infotext error-mgs" v-if="!$v.model['email'].maxLength"></span> </div> </div> <div class="text tb-GridColumn--m--9 tb-GridColumn--offset--m--0 tb-GridColumn tb-GridColumn--offset--l--0 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--9"> <div class="form-control m-m-bottom" :class="{'error': $v.model['telephone'].$invalid || $v.modelCrossValidation['telephone'] && $v.modelCrossValidation['telephone'].$error, 'touched': $v.model['telephone'].$dirty || $v.modelCrossValidation['telephone'] && $v.modelCrossValidation['telephone'].$dirty}"> <h4 class="h4 label">Telephone (numbers only please) <span class="asterisk">*</span> </h4> <div class="position-relative"> <button type="button" class="left-button" v-if="'number' == 'email'"> <span class="icon icon-email"></span> </button> <input class="textbox" :class="{'has-left-icon': 'number' == 'email'}" data-cmp-hook-form-text="input" type="number" id="form-text-1340770556" v-model="model.telephone" name="telephone" @blur="crossValidateFields('telephone'); $v.model['telephone'].$touch()"/> </div> <span class="infotext color-blue"></span> <span class="infotext error-mgs" v-if="!$v.model['telephone'].required"></span> <span class="infotext error-mgs" v-if="!$v.model['telephone'].email"></span> <span class="infotext error-mgs" v-if="!$v.model['telephone'].sameAs"></span> <span class="infotext error-mgs" v-if="$v.model['telephone'].minLength === false"> Please enter 10 digits</span> <span class="infotext error-mgs" v-if="!$v.model['telephone'].maxLength">Please enter 10 digits</span> </div> </div> <div class="options tb-GridColumn--offset--m--0 tb-GridColumn tb-GridColumn--offset--l--0 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--20 tb-GridColumn--m--20"> <fieldset class="cmp-form-options cmp-form-options--drop-down m-m-bottom form-control"> <div class="form-control" :class="{'error': $v.model['therapyArea'].$invalid || $v.modelCrossValidation['therapyArea'] && $v.modelCrossValidation['therapyArea'].$error, 'valid': !$v.model['therapyArea'].$invalid, 'touched': $v.model['therapyArea'].$dirty || $v.modelCrossValidation['therapyArea'] && $v.modelCrossValidation['therapyArea'].$dirty}"> <singleselect :options="[{"text":"Chronic Weight Management","value":"cwm"},{"text":"Diabetes","value":"diabetes"},{"text":"Growth Hormone-Related Disorders","value":"gh"},{"text":"Rare Diseases","value":"rarediseases"},{"text":"Women's Health","value":"womenshealth"},{"text":"Other","value":"other"}]" :label="'Therapy Area'" :return-value-only="true" v-model="model['therapyArea']" :sorting="false" @blur="crossValidateFields('therapyArea', true); $v.model['therapyArea'].$touch()" :api-url="''" :required="true" :required-cross-validation="$v.modelCrossValidation['therapyArea'] && $v.modelCrossValidation['therapyArea'].$invalid" :empty-option-text="''" :plain-text-enabled="false" placeholder="Select option"> </singleselect> <span class="infotext error-mgs" v-if="!$v.model['therapyArea'].required"></span> </div> <span class="infotext color-blue"></span> </fieldset> </div> <div class="text tb-GridColumn--offset--m--0 tb-GridColumn tb-GridColumn--offset--l--0 tb-GridColumn--s--20 tb-GridColumn--xs--20 tb-GridColumn--offset--s--0 tb-GridColumn--offset--xs--0 tb-GridColumn--l--20 tb-GridColumn--m--20"> <div class="form-control m-m-bottom" :class="{'error': $v.model['question'].$invalid || $v.modelCrossValidation['question'] && $v.modelCrossValidation['question'].$error, 'touched': $v.model['question'].$dirty || $v.modelCrossValidation['question'] && $v.modelCrossValidation['question'].$dirty}"> <h4 class="h4 label">Question <span class="asterisk">* </span> </h4> <textarea class="textbox paragraph-s" data-cmp-hook-form-text="input" id="form-text-1494546454" name="question" v-model="model.question" rows="2" @blur="crossValidateFields('question'); $v.model['question'].$touch()"></textarea> <span class="infotext color-blue"></span> <span class="infotext error-mgs" v-if="!$v.model['question'].required"></span> <span class="infotext error-mgs" v-if="$v.model['question'].minLength === false"></span> <span class="infotext error-mgs" v-if="$v.model['question'].maxLength === false"></span> </div> </div> <div class="form-button button tb-GridColumn"> <link rel="stylesheet" href="/etc.clientlibs/nncorp/components/content/form/form-button/clientlibs.min.018dcb5a50472b99b1583d3575ad899c.css" type="text/css"> <div class="form-button m-m-bottom"> <loading-button :loading="submitting" :text="'Submit'" :mouse-over-effect="true" :mouse-over-effect-desktop-only="true"></loading-button> </div> </div> </div> </div> </div> </form> </div> <script src="/etc.clientlibs/nncorp/clientlibs/vuejs/services/base-http.min.0977b3d22d6ef3c04a2b1fc94d6581bc.js"></script> <script src="/etc.clientlibs/nncorp/clientlibs/vuejs/components/loading-indicator.min.e3b95aaade780b8c0cf0a84fb6343e54.js"></script> <script src="/etc.clientlibs/nncorp/clientlibs/vuejs/components/loading-button.min.a69ad6ac1ccbd5250c93423f12806fde.js"></script> <script src="/etc.clientlibs/nncorp/clientlibs/vuejs/form-components/singleselect.min.29ad457e9b535d669a85127fc4b7d0a7.js"></script> <script src="/etc.clientlibs/nncorp/clientlibs/vuejs/form-components/multiselect.min.e660c8a9708ee64b3264b08c8311a7aa.js"></script> <script src="/etc.clientlibs/nncorp/clientlibs/vendor/clientlib-vuejs-validate.min.b4bc1f9921397315b031319786c2bab1.js"></script> <script src="/etc.clientlibs/nncorp/clientlibs/vuejs/components/form-multiple-products.min.dc307d822bc6f3889fb41ed16884bff7.js"></script> <script src="/etc.clientlibs/nncorp/components/content/form/form-recaptcha/clientlibs.min.d41d8cd98f00b204e9800998ecf8427e.js"></script> <script src="/etc.clientlibs/nncorp/clientlibs/vendor/clientlib-vuejs-datepicker.min.df75ec774fcbb815b13287bdcfd79962.js"></script> <script src="/etc.clientlibs/nncorp/components/content/form/form-date-picker/clientlibs.min.8f9c112fdaf8a5a4898b7e5a826c1065.js"></script> <script src="/etc.clientlibs/clientlibs/granite/jquery/granite/csrf.min.652a558c3774088b61b0530c184710d1.js"></script> <script src="/etc.clientlibs/nncorp/components/content/form/container/clientlibs.min.2d0bd70974e33057df9696ae3b2d784c.js"></script> </div> <div class="layoutcontainergrid responsivegrid aem-GridColumn aem-GridColumn--default--12"> <div class="layout-container-grid"> <div class="gutters component-padding-topAndBottom white outer-container" style="background-color: white"> <div class="tb-Grid tb-Grid--24 tb-Grid--l--24 tb-Grid--m--24 tb-Grid--s--24"> <div class="frame-padding tb-GridColumn tb-GridColumn--l--24 tb-GridColumn--m--22 tb-GridColumn--s--22 tb-GridColumn--offset--l--none tb-GridColumn--offset--m--1 tb-GridColumn--offset--s--1" style="background-color: white"> <div class="tb-Grid tb-Grid--24 tb-Grid--l--22 tb-Grid--m--24 tb-Grid--s--24"> <div class="tb-GridColumn tb-GridColumn--l--20 tb-GridColumn--m--22 tb-GridColumn--s--22 tb-GridColumn--offset--l--2 tb-GridColumn--offset--m--1 tb-GridColumn--offset--s--1"> <div> <div class="rowcontainer"> <div> <div class="contentgrid_row"> <div 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