Intake-Form – Helios Home Health

img:is([sizes="auto" i],[sizes^="auto," i]){contain-intrinsic-size:3000px 1500px;}img.wp-smiley,img.emoji{display:inline !important;border:none !important;box-shadow:none !important;height:1em !important;width:1em !important;margin:0 .07em !important;vertical-align:-.1em !important;background:none !important;padding:0 !important;}:root{--wp--preset--aspect-ratio--square:1;--wp--preset--aspect-ratio--4-3:4/3;--wp--preset--aspect-ratio--3-4:3/4;--wp--preset--aspect-ratio--3-2:3/2;--wp--preset--aspect-ratio--2-3:2/3;--wp--preset--aspect-ratio--16-9:16/9;--wp--preset--aspect-ratio--9-16:9/16;--wp--preset--color--black:#000;--wp--preset--color--cyan-bluish-gray:#abb8c3;--wp--preset--color--white:#fff;--wp--preset--color--pale-pink:#f78da7;--wp--preset--color--vivid-red:#cf2e2e;--wp--preset--color--luminous-vivid-orange:#ff6900;--wp--preset--color--luminous-vivid-amber:#fcb900;--wp--preset--color--light-green-cyan:#7bdcb5;--wp--preset--color--vivid-green-cyan:#00d084;--wp--preset--color--pale-cyan-blue:#8ed1fc;--wp--preset--color--vivid-cyan-blue:#0693e3;--wp--preset--color--vivid-purple:#9b51e0;--wp--preset--gradient--vivid-cyan-blue-to-vivid-purple:linear-gradient(135deg,rgba(6,147,227,1) 0%,#9b51e0 100%);--wp--preset--gradient--light-green-cyan-to-vivid-green-cyan:linear-gradient(135deg,#7adcb4 0%,#00d082 100%);--wp--preset--gradient--luminous-vivid-amber-to-luminous-vivid-orange:linear-gradient(135deg,rgba(252,185,0,1) 0%,rgba(255,105,0,1) 100%);--wp--preset--gradient--luminous-vivid-orange-to-vivid-red:linear-gradient(135deg,rgba(255,105,0,1) 0%,#cf2e2e 100%);--wp--preset--gradient--very-light-gray-to-cyan-bluish-gray:linear-gradient(135deg,#eee 0%,#a9b8c3 100%);--wp--preset--gradient--cool-to-warm-spectrum:linear-gradient(135deg,#4aeadc 0%,#9778d1 20%,#cf2aba 40%,#ee2c82 60%,#fb6962 80%,#fef84c 100%);--wp--preset--gradient--blush-light-purple:linear-gradient(135deg,#ffceec 0%,#9896f0 100%);--wp--preset--gradient--blush-bordeaux:linear-gradient(135deg,#fecda5 0%,#fe2d2d 50%,#6b003e 100%);--wp--preset--gradient--luminous-dusk:linear-gradient(135deg,#ffcb70 0%,#c751c0 50%,#4158d0 100%);--wp--preset--gradient--pale-ocean:linear-gradient(135deg,#fff5cb 0%,#b6e3d4 50%,#33a7b5 100%);--wp--preset--gradient--electric-grass:linear-gradient(135deg,#caf880 0%,#71ce7e 100%);--wp--preset--gradient--midnight:linear-gradient(135deg,#020381 0%,#2874fc 100%);--wp--preset--font-size--small:13px;--wp--preset--font-size--medium:20px;--wp--preset--font-size--large:36px;--wp--preset--font-size--x-large:42px;--wp--preset--spacing--20:.44rem;--wp--preset--spacing--30:.67rem;--wp--preset--spacing--40:1rem;--wp--preset--spacing--50:1.5rem;--wp--preset--spacing--60:2.25rem;--wp--preset--spacing--70:3.38rem;--wp--preset--spacing--80:5.06rem;--wp--preset--shadow--natural:6px 6px 9px rgba(0,0,0,.2);--wp--preset--shadow--deep:12px 12px 50px rgba(0,0,0,.4);--wp--preset--shadow--sharp:6px 6px 0px rgba(0,0,0,.2);--wp--preset--shadow--outlined:6px 6px 0px -3px rgba(255,255,255,1),6px 6px rgba(0,0,0,1);--wp--preset--shadow--crisp:6px 6px 0px rgba(0,0,0,1);}:root{--wp--style--global--content-size:800px;--wp--style--global--wide-size:1200px;}:where(body){margin:0;}.wp-site-blocks > .alignleft{float:left;margin-right:2em;}.wp-site-blocks > .alignright{float:right;margin-left:2em;}.wp-site-blocks > .aligncenter{justify-content:center;margin-left:auto;margin-right:auto;}:where(.wp-site-blocks) > *{margin-block-start:24px;margin-block-end:0;}:where(.wp-site-blocks) > :first-child{margin-block-start:0;}:where(.wp-site-blocks) > :last-child{margin-block-end:0;}:root{--wp--style--block-gap:24px;}:root :where(.is-layout-flow) > :first-child{margin-block-start:0;}:root :where(.is-layout-flow) > :last-child{margin-block-end:0;}:root :where(.is-layout-flow) > *{margin-block-start:24px;margin-block-end:0;}:root :where(.is-layout-constrained) > :first-child{margin-block-start:0;}:root :where(.is-layout-constrained) > :last-child{margin-block-end:0;}:root :where(.is-layout-constrained) > *{margin-block-start:24px;margin-block-end:0;}:root :where(.is-layout-flex){gap:24px;}:root :where(.is-layout-grid){gap:24px;}.is-layout-flow > .alignleft{float:left;margin-inline-start:0;margin-inline-end:2em;}.is-layout-flow > .alignright{float:right;margin-inline-start:2em;margin-inline-end:0;}.is-layout-flow > .aligncenter{margin-left:auto !important;margin-right:auto !important;}.is-layout-constrained > .alignleft{float:left;margin-inline-start:0;margin-inline-end:2em;}.is-layout-constrained > .alignright{float:right;margin-inline-start:2em;margin-inline-end:0;}.is-layout-constrained > .aligncenter{margin-left:auto !important;margin-right:auto !important;}.is-layout-constrained > :where(:not(.alignleft):not(.alignright):not(.alignfull)){max-width:var(--wp--style--global--content-size);margin-left:auto !important;margin-right:auto !important;}.is-layout-constrained > .alignwide{max-width:var(--wp--style--global--wide-size);}body .is-layout-flex{display:flex;}.is-layout-flex{flex-wrap:wrap;align-items:center;}.is-layout-flex > :is(*,div){margin:0;}body .is-layout-grid{display:grid;}.is-layout-grid > :is(*,div){margin:0;}body{padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}a:where(:not(.wp-element-button)){text-decoration:underline;}:root :where(.wp-element-button,.wp-block-button__link){background-color:#32373c;border-width:0;color:#fff;font-family:inherit;font-size:inherit;line-height:inherit;padding:calc(.667em + 2px) calc(1.333em + 2px);text-decoration:none;}.has-black-color{color:var(--wp--preset--color--black) !important;}.has-cyan-bluish-gray-color{color:var(--wp--preset--color--cyan-bluish-gray) !important;}.has-white-color{color:var(--wp--preset--color--white) !important;}.has-pale-pink-color{color:var(--wp--preset--color--pale-pink) !important;}.has-vivid-red-color{color:var(--wp--preset--color--vivid-red) !important;}.has-luminous-vivid-orange-color{color:var(--wp--preset--color--luminous-vivid-orange) !important;}.has-luminous-vivid-amber-color{color:var(--wp--preset--color--luminous-vivid-amber) !important;}.has-light-green-cyan-color{color:var(--wp--preset--color--light-green-cyan) !important;}.has-vivid-green-cyan-color{color:var(--wp--preset--color--vivid-green-cyan) !important;}.has-pale-cyan-blue-color{color:var(--wp--preset--color--pale-cyan-blue) !important;}.has-vivid-cyan-blue-color{color:var(--wp--preset--color--vivid-cyan-blue) !important;}.has-vivid-purple-color{color:var(--wp--preset--color--vivid-purple) !important;}.has-black-background-color{background-color:var(--wp--preset--color--black) !important;}.has-cyan-bluish-gray-background-color{background-color:var(--wp--preset--color--cyan-bluish-gray) !important;}.has-white-background-color{background-color:var(--wp--preset--color--white) !important;}.has-pale-pink-background-color{background-color:var(--wp--preset--color--pale-pink) !important;}.has-vivid-red-background-color{background-color:var(--wp--preset--color--vivid-red) !important;}.has-luminous-vivid-orange-background-color{background-color:var(--wp--preset--color--luminous-vivid-orange) !important;}.has-luminous-vivid-amber-background-color{background-color:var(--wp--preset--color--luminous-vivid-amber) !important;}.has-light-green-cyan-background-color{background-color:var(--wp--preset--color--light-green-cyan) !important;}.has-vivid-green-cyan-background-color{background-color:var(--wp--preset--color--vivid-green-cyan) !important;}.has-pale-cyan-blue-background-color{background-color:var(--wp--preset--color--pale-cyan-blue) !important;}.has-vivid-cyan-blue-background-color{background-color:var(--wp--preset--color--vivid-cyan-blue) !important;}.has-vivid-purple-background-color{background-color:var(--wp--preset--color--vivid-purple) !important;}.has-black-border-color{border-color:var(--wp--preset--color--black) !important;}.has-cyan-bluish-gray-border-color{border-color:var(--wp--preset--color--cyan-bluish-gray) !important;}.has-white-border-color{border-color:var(--wp--preset--color--white) !important;}.has-pale-pink-border-color{border-color:var(--wp--preset--color--pale-pink) !important;}.has-vivid-red-border-color{border-color:var(--wp--preset--color--vivid-red) !important;}.has-luminous-vivid-orange-border-color{border-color:var(--wp--preset--color--luminous-vivid-orange) !important;}.has-luminous-vivid-amber-border-color{border-color:var(--wp--preset--color--luminous-vivid-amber) !important;}.has-light-green-cyan-border-color{border-color:var(--wp--preset--color--light-green-cyan) !important;}.has-vivid-green-cyan-border-color{border-color:var(--wp--preset--color--vivid-green-cyan) !important;}.has-pale-cyan-blue-border-color{border-color:var(--wp--preset--color--pale-cyan-blue) !important;}.has-vivid-cyan-blue-border-color{border-color:var(--wp--preset--color--vivid-cyan-blue) !important;}.has-vivid-purple-border-color{border-color:var(--wp--preset--color--vivid-purple) !important;}.has-vivid-cyan-blue-to-vivid-purple-gradient-background{background:var(--wp--preset--gradient--vivid-cyan-blue-to-vivid-purple) !important;}.has-light-green-cyan-to-vivid-green-cyan-gradient-background{background:var(--wp--preset--gradient--light-green-cyan-to-vivid-green-cyan) !important;}.has-luminous-vivid-amber-to-luminous-vivid-orange-gradient-background{background:var(--wp--preset--gradient--luminous-vivid-amber-to-luminous-vivid-orange) !important;}.has-luminous-vivid-orange-to-vivid-red-gradient-background{background:var(--wp--preset--gradient--luminous-vivid-orange-to-vivid-red) !important;}.has-very-light-gray-to-cyan-bluish-gray-gradient-background{background:var(--wp--preset--gradient--very-light-gray-to-cyan-bluish-gray) !important;}.has-cool-to-warm-spectrum-gradient-background{background:var(--wp--preset--gradient--cool-to-warm-spectrum) !important;}.has-blush-light-purple-gradient-background{background:var(--wp--preset--gradient--blush-light-purple) !important;}.has-blush-bordeaux-gradient-background{background:var(--wp--preset--gradient--blush-bordeaux) !important;}.has-luminous-dusk-gradient-background{background:var(--wp--preset--gradient--luminous-dusk) !important;}.has-pale-ocean-gradient-background{background:var(--wp--preset--gradient--pale-ocean) !important;}.has-electric-grass-gradient-background{background:var(--wp--preset--gradient--electric-grass) !important;}.has-midnight-gradient-background{background:var(--wp--preset--gradient--midnight) !important;}.has-small-font-size{font-size:var(--wp--preset--font-size--small) !important;}.has-medium-font-size{font-size:var(--wp--preset--font-size--medium) !important;}.has-large-font-size{font-size:var(--wp--preset--font-size--large) !important;}.has-x-large-font-size{font-size:var(--wp--preset--font-size--x-large) !important;}:root :where(.wp-block-pullquote){font-size:1.5em;line-height:1.6;}.e-con.e-parent:nth-of-type(n+4):not(.e-lazyloaded):not(.e-no-lazyload),.e-con.e-parent:nth-of-type(n+4):not(.e-lazyloaded):not(.e-no-lazyload) *{background-image:none !important;}@media screen and (max-height: 1024px){.e-con.e-parent:nth-of-type(n+3):not(.e-lazyloaded):not(.e-no-lazyload),.e-con.e-parent:nth-of-type(n+3):not(.e-lazyloaded):not(.e-no-lazyload) *{background-image:none !important;}.e-con.e-parent:nth-of-type(n+3):not(.e-lazyloaded):not(.e-no-lazyload).nitro-lazy,.e-con.e-parent:nth-of-type(n+3):not(.e-lazyloaded):not(.e-no-lazyload) *.nitro-lazy{background-image:none !important;}}@media screen and (max-height: 640px){.e-con.e-parent:nth-of-type(n+2):not(.e-lazyloaded):not(.e-no-lazyload),.e-con.e-parent:nth-of-type(n+2):not(.e-lazyloaded):not(.e-no-lazyload) *{background-image:none !important;}.e-con.e-parent:nth-of-type(n+2):not(.e-lazyloaded):not(.e-no-lazyload).nitro-lazy,.e-con.e-parent:nth-of-type(n+2):not(.e-lazyloaded):not(.e-no-lazyload) *.nitro-lazy{background-image:none !important;}}.e-con.e-parent:nth-of-type(n+4):not(.e-lazyloaded):not(.e-no-lazyload).nitro-lazy,.e-con.e-parent:nth-of-type(n+4):not(.e-lazyloaded):not(.e-no-lazyload) *.nitro-lazy{background-image:none !important;}.pswp.pafe-lightbox-modal{display:none;}#site-header,#site-footer{display:none;}:root{--wpforms-field-border-radius:3px;--wpforms-field-border-style:solid;--wpforms-field-border-size:1px;--wpforms-field-background-color:#fff;--wpforms-field-border-color:rgba(0,0,0,.25);--wpforms-field-border-color-spare:rgba(0,0,0,.25);--wpforms-field-text-color:rgba(0,0,0,.7);--wpforms-field-menu-color:#fff;--wpforms-label-color:rgba(0,0,0,.85);--wpforms-label-sublabel-color:rgba(0,0,0,.55);--wpforms-label-error-color:#d63637;--wpforms-button-border-radius:3px;--wpforms-button-border-style:none;--wpforms-button-border-size:1px;--wpforms-button-background-color:#066aab;--wpforms-button-border-color:#066aab;--wpforms-button-text-color:#fff;--wpforms-page-break-color:#066aab;--wpforms-background-image:none;--wpforms-background-position:center center;--wpforms-background-repeat:no-repeat;--wpforms-background-size:cover;--wpforms-background-width:100px;--wpforms-background-height:100px;--wpforms-background-color:rgba(0,0,0,0);--wpforms-background-url:none;--wpforms-container-padding:0px;--wpforms-container-border-style:none;--wpforms-container-border-width:1px;--wpforms-container-border-color:#000;--wpforms-container-border-radius:3px;--wpforms-field-size-input-height:43px;--wpforms-field-size-input-spacing:15px;--wpforms-field-size-font-size:16px;--wpforms-field-size-line-height:19px;--wpforms-field-size-padding-h:14px;--wpforms-field-size-checkbox-size:16px;--wpforms-field-size-sublabel-spacing:5px;--wpforms-field-size-icon-size:1;--wpforms-label-size-font-size:16px;--wpforms-label-size-line-height:19px;--wpforms-label-size-sublabel-font-size:14px;--wpforms-label-size-sublabel-line-height:17px;--wpforms-button-size-font-size:17px;--wpforms-button-size-height:41px;--wpforms-button-size-padding-h:15px;--wpforms-button-size-margin-top:10px;--wpforms-container-shadow-size-box-shadow:none;}.login #login,.login #lostpasswordform{min-width:350px !important;}