(158,'2020-12-25 22:37:28','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - fsdfs fsd fds fdds sfdsd','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>fsdfs fsd fds fdds sfdsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>April</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>15</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>54543fdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Widowed</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>fdsfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>432</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>4234</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>holi chakla</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>rakesh.gupta@salesforce.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>gfdgfd</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>dfgdfg</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>gdfgfdg</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>gdfgdfgdg</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>gdgdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>12</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/17/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>fdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(159,'2020-12-25 22:49:35','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - sdfsd fssd f sdf','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>sdfsd fssd f sdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>January</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>16</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>fsdf32423</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>fddsfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>123</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>345</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>holi chakla</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>dsfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>dfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/25/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>sfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>fsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>fsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(160,'2020-12-25 22:59:49','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - fhgf hgfh gfh fghgf','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>fhgf hgfh gfh fghgf</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>April</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>15</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>5435435</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>fdgdfg</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>gdfg</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>gdfg</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>gdfgdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>gdfgdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>gfdgfd</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>123</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>4324</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>holi chakla</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>dsf fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>123</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>dasdas</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>dasdsad</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/16/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>dasdsad</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>dasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>dasdas</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(161,'2020-12-25 23:52:03','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - dsad dsad dsada12','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>dsad dsad dsada12</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>June</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>16</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>fdsds32423</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>fdsfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>fdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>12</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>324</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>holi chakla</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>fsdfsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>fsdfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/18/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>fsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>sdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>fsdfsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td>fsdfsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>fsdfsdfd</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>fsdfsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>fsdfsfsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(162,'2020-12-26 00:15:23','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - fsdfs fdfsd fsdf13','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>fsdfs fdfsd fsdf13</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>November</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>20</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>fdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>fdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>dfssdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>123</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>23</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>holi chakla</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Kheda</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>dfsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>fdsf fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>sdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/24/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>fdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>fdsfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(163,'2020-12-26 00:24:43','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - fsdfs fdsfds fsdfsd56','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>fsdfs fdsfds fsdfsd56</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>May</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>16</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>fsdf43543</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>sdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>fdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>sdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>34</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>34</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>holi chakla</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>fdsfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>fdsfsd fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/22/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>fsdfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>fsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>fsdfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(164,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>212.58.121.150</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(165,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>212.58.121.150</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(166,'2020-12-26 06:42:57','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - dasdas dasda dasd 20','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>dasdas dasda dasd 20</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>September</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>19</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>32432432</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>fdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>fsdfsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>dsadsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>321</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>32</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>Holi Chakla, Desai Vago, Rabari vad.</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>dsadasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>dasdad</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>dasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>dsadasda</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>dasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>dasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>dasdas</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/17/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>dasdasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>dasdsad</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>dasdas</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Have you ever received psychiatric treatment?</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td>Prior suicide attempts?</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>sadas</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>dasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>das</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>dasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td>Allergies (Medications, Food, etc.)?</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>past surgeries</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Hospitalization in the last two years?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Adverse reactions to anesthesia in the past?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Emergency room visits in the last year?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Accidents? (work, car etc)\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Head Injuries?</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Loss of consciousness?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Loss of consciousness Seizures?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>heart dieases</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>Lung disease?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Liver disease / infections?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Kidney disease / problem?</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>Diabetes?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>Ulcers?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>High Blood Pressure?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>Asthma or shortness of breath?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Obstructive sleep apnea?\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>Pregnancy?\n</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(167,'2020-12-26 09:06:38','45.79.210.65','janetadelgado30@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Janet Delgado</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>janetadelgado30@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>201-446-9503</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>My son is 24 has been a heroin addict for 4 years. Has done just about every treatment out there for his addiction. In and out of MANY rehabs, detoxes, etc. This treatment seems to be the only one so far that has made any sense. </td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(168,'2020-12-26 09:06:38','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Janet Delgado - Contact Page','</p>\n<p>Janet Delgado</p>\n<p>janetadelgado30@gmail.com</p>\n<p>201-446-9503</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: janetadelgado30@gmail.com <janetadelgado30@gmail.com>','',NULL,'1.9.7'),(169,'2020-12-26 11:13:50','45.79.210.65','patricksjackson.psj@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>patrick jackson</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>patricksjackson.psj@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8569796206</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>I have been looking into treatment for alcoholism. Ketamin treatment and Niacinamide treatment. I believe all these imbalances are treatable. Has your process worked on alcoholism?</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(170,'2020-12-26 11:13:50','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from patrick jackson - Contact Page','</p>\n<p>patrick jackson</p>\n<p>patricksjackson.psj@gmail.com</p>\n<p>8569796206</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: patricksjackson.psj@gmail.com <patricksjackson.psj@gmail.com>','',NULL,'1.9.7'),(171,'2020-12-26 14:55:43','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>James robinson</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Robinsonjames4229@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>5709212663</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Need help with opioid addiction asap</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Robinsonjames4229@gmail.com <Robinsonjames4229@gmail.com>','',NULL,'1.9.7'),(172,'2020-12-26 14:55:43','45.79.210.65','Robinsonjames4229@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>James robinson</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Robinsonjames4229@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>5709212663</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Need help with opioid addiction asap</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(173,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>2400:adc5:13b:5300:38ba:3f2:be3b:4e72</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(174,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>178.138.99.203</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(175,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>178.138.99.203</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(176,'2020-12-26 18:30:56','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Arianne Ciarlo</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Arianne.ciarlo@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9543488485</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I need to get off subutex. Its making my me/cfs worse and i sleep till 3 pm every day. Is ANR right for me?</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Arianne.ciarlo@gmail.com <Arianne.ciarlo@gmail.com>','',NULL,'1.9.7'),(177,'2020-12-26 18:30:56','45.79.210.65','Arianne.ciarlo@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Arianne Ciarlo</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Arianne.ciarlo@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9543488485</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I need to get off subutex. Its making my me/cfs worse and i sleep till 3 pm every day. Is ANR right for me?</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(178,'2020-12-26 20:29:30','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Edwin Amex Santoni</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>edwin.a.santoni@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4342342433</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I will like to know how much is the cost of the treatment.</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: edwin.a.santoni@gmail.com <edwin.a.santoni@gmail.com>','',NULL,'1.9.7'),(179,'2020-12-26 20:29:30','45.79.210.65','edwin.a.santoni@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Edwin Amex Santoni</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>edwin.a.santoni@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4342342433</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I will like to know how much is the cost of the treatment.</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(180,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>2a02:c7f:b838:c000:193a:aa62:ae1d:3ead</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(181,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>2400:adc5:13b:5300:38ba:3f2:be3b:4e72</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(182,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>2a02:c7f:b838:c000:193a:aa62:ae1d:3ead</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(183,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>24.252.227.2</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(184,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>24.252.227.2</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(185,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>203.192.215.100</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(186,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>203.192.215.100</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(187,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>2409:4072:6185:41b:d9d1:efb4:23d2:17e5</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(188,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>185.234.241.6</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(189,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>2a01:cb08:883d:a900:b021:c799:652a:3f3d</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(190,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>2409:4072:6185:41b:d9d1:efb4:23d2:17e5</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(191,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>185.234.241.6</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(192,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>182.185.242.111</b> and it was blocked for 20 minutes<br>Last user attempted: <b>admin</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(193,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>2a01:cb08:883d:a900:b021:c799:652a:3f3d</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(194,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>182.185.242.111</b> and it was blocked for 24 hours<br>Last user attempted: <b>admin</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(195,'2020-12-27 09:35:17','45.79.210.65','waismannben@gmail.com,\\ngal@bemedia.co.il','New message from  - Landing Page - Michelle ','<table>\n<tr>\n<td valign=\"top\">Full Name:</td>\n<td>Michelle </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Mickyomarx@aol.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9492359826</td>\n</tr>\n<tr>\n<td valign=\"top\">Paragraph Text:</td>\n<td>Do you offer help in Orange County CA ??</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(196,'2020-12-27 10:55:30','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Julian Villalba','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Julian Villalba</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>October</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>13</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>2013</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>590-37-1284</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>White</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>American</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Publix</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>Seffener 813 643-0016</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>138</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5\'8\"</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>12245 Broadwater Loop</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Thonotosassa</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>FL</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>33592</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>813 708-4247</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>drjjv@tampabay.rr.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>813 708-2728</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Jorge Villalba MD</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>father</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>maisyv2019@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>813 708-2728</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>Have had problems with Opioid use for the past 10 years. </td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Heroin</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>40 dollars per day</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>IVDA </td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>ACTS</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/18/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>Have been clean for as long a year but relapsed.</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Severe</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>Even have dreams that I am using.</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>Prescribed multiple times used Suboxone for 6 months, Methadone currently prescribed but not compliant. Was on Vivitrol for 3 months.</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Have seen Dr. Kawliche for ADHD</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td>Penicillin developed a rash</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Tonsillectomy age 6</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>History of Hepatitis C treated 2 years ago by gastroeneterologist</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(197,'2020-12-27 11:30:33','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Jeffrey disko</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Diskomr2@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9083342523</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Major withdrawal</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Diskomr2@yahoo.com <Diskomr2@yahoo.com>','',NULL,'1.9.7'),(198,'2020-12-27 11:30:33','45.79.210.65','Diskomr2@yahoo.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Jeffrey disko</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Diskomr2@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9083342523</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Major withdrawal</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(199,'2020-12-27 12:27:12','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>doug hines</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>dphines1964@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>239-994-6901</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>i want info on your prevention of opiate withdrawles.</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: dphines1964@gmail.com <dphines1964@gmail.com>','',NULL,'1.9.7'),(200,'2020-12-27 12:27:12','45.79.210.65','dphines1964@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>doug hines</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>dphines1964@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>239-994-6901</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>i want info on your prevention of opiate withdrawles.</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(201,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>87.16.147.163</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(202,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>87.16.147.163</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(203,'2020-12-27 13:04:59','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Megan Kirschner ','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Megan Kirschner </td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>February</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>9</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1993</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>White</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>White</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Walgreens </td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>7038600300</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>115</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5’7”</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>2108 golf course dr</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Reston</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>VA</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>20191</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>5713820432</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>megankirschner@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Daryl Jahnke</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Friend </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>maybaummovers@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>2406036918</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>Opiate detox </td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Heroin </td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>1.5grams daily </td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Smoking</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>Coleman institute </td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>06/15/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>Have tried multiple detox programs, was on suboxone for 4 years, tried naltrexone for 2 months recently but the depression that followed caused a relapse </td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>The depression caused by post acute withdrawal lead me to relapse</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>4 years </td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Diagnosed with PTSD, depression, anxiety, and ADD</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>Adderall </td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>30mg</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>Daily</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>Oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>Clonidine </td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>.1mg</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>Daily</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>Oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>Ambien</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>10mg</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>Daily</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>Oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Septoplasty for broken nose</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Once for opiate detox </td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(204,'2020-12-27 13:22:35','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Larry D Carter</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>larrycarter68@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>3103864813</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I can\'t take addiction</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: larrycarter68@gmail.com <larrycarter68@gmail.com>','',NULL,'1.9.7'),(205,'2020-12-27 13:22:35','45.79.210.65','larrycarter68@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Larry D Carter</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>larrycarter68@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>3103864813</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I can\'t take addiction</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(206,'2020-12-27 14:02:58','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Chris day</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>rberard146@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4012691208</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Heroin problem</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: rberard146@yahoo.com <rberard146@yahoo.com>','',NULL,'1.9.7'),(207,'2020-12-27 14:02:58','45.79.210.65','rberard146@yahoo.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Chris day</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>rberard146@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4012691208</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Heroin problem</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(208,'2020-12-27 14:54:45','45.79.210.65','waildawud@comcast.net','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Wail Dawud</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>waildawud@comcast.net</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>15038066256</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Hello.<br />\nMy brother, who lives in Israel, is in need of an effective treatment of his addiction. I understand that the ANR clinic in Ashkelon, Israel is no longer open. Therefore, I am trying to find out if it is feasible to admin my brother into the Florida, USA clinic - yours. Also, would you be able to provide me with an idea as to the cost of the treatment?</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(209,'2020-12-27 14:54:45','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Wail Dawud - Contact Page','</p>\n<p>Wail Dawud</p>\n<p>waildawud@comcast.net</p>\n<p>15038066256</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: waildawud@comcast.net <waildawud@comcast.net>','',NULL,'1.9.7'),(210,'2020-12-27 14:57:02','45.79.210.65','test@test.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>test@test.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>0526453423</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>TG</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Word of Mouth</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(211,'2020-12-27 14:57:02','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from test - Contact Page','</p>\n<p>test</p>\n<p>test@test.com</p>\n<p>0526453423</p>\n<p>TG</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: test@test.com <test@test.com>','',NULL,'1.9.7'),(212,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>2400:adc1:192:5500:152b:8f33:6f2f:6427</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(213,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>2600:1700:8540:b2b0:a8a5:cc4f:daf1:247d</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(214,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>2400:adc1:192:5500:152b:8f33:6f2f:6427</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(215,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>2600:1700:8540:b2b0:a8a5:cc4f:daf1:247d</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(216,'2020-12-27 17:44:53','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Cody Bolick','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Cody Bolick</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>May</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>4</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1992</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>591230995</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English </td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>Caucasian </td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>Orlando</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>N/A</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>N/A</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>N/A</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>170</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5\'11\'\'</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>776 n Orange Ave</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Orlando </td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Florida </td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>32801</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>4079049845</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>codiene2@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>Timeshare sales representative </td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>William montaltos</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Friend </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>bmontaltos@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4074941035</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Heroin </td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>1g</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Injection </td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>Orange county jail </td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>09/14/2019</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>I\'m constantly thinking of it. The physical need isn\'t there but I still feel the urge to use </td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(217,'2020-12-27 18:00:35','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Matthew ward</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>wardm4989@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>7277126277</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I need help to get off of opiates</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: wardm4989@gmail.com <wardm4989@gmail.com>','',NULL,'1.9.7'),(218,'2020-12-27 18:00:35','45.79.210.65','wardm4989@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Matthew ward</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>wardm4989@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>7277126277</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I need help to get off of opiates</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(219,'2020-12-27 18:00:41','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Katherine Zwalinski </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>kzldds@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8564199824</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I want to be off any opiates </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: kzldds@gmail.com <kzldds@gmail.com>','',NULL,'1.9.7'),(220,'2020-12-27 18:00:42','45.79.210.65','kzldds@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Katherine Zwalinski </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>kzldds@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8564199824</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I want to be off any opiates </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(221,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>2400:adc1:192:5500:8026:53e1:bff5:3412</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(222,'2020-12-27 18:25:27','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Katherine Zwalinski ','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Katherine Zwalinski </td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>July</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>13</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1982</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>175682327</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English </td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>Caucasian </td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>Polish/Irish</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>CVS</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>7500 Maple Ave Pennsauken, NJ 08109</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>230</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5’7”</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>510 Chapel Ave West </td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Cherry Hill </td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Nj</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>08002</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>8564199824</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>kzldds@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>Unemployment </td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Chrissie Bendler</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Sister</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>318kayzee@comcast.net</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8564199824</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Methadone </td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>110 mgs/ every day</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Liquid </td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>Bergman Regional </td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>09/30/2018</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>I completely the detox but starting using the next day </td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Severe</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>January 2010- October 2012<br />\nAugust 2019- October 2019<br />\nJuly 2020 - till present </td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>But not since 2012</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Wisdom teeth removed  year 2000<br />\nC-section year 2005<br />\nKidney stone ( urine drainage bag) year 2016\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(223,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>2400:adc1:192:5500:8026:53e1:bff5:3412</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(224,'2020-12-27 18:43:51','45.79.210.65','waismannben@gmail.com,\\ngal@bemedia.co.il','New message from  - Landing Page - Donnie','<table>\n<tr>\n<td valign=\"top\">Full Name:</td>\n<td>Donnie</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>donnievalentine45@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9785185789</td>\n</tr>\n<tr>\n<td valign=\"top\">Paragraph Text:</td>\n<td>Opioid addiction  heroin </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(225,'2020-12-27 18:51:49','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Robert Singer</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>singerbob86@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>6074344815</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Getting off 4 years of suboxone.  I am taking more and more everyday lately because it just stopped working all of a sudden.it is destroying my body and mind .it has also induced a form of psychosis.....</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: singerbob86@yahoo.com <singerbob86@yahoo.com>','',NULL,'1.9.7'),(226,'2020-12-27 18:51:49','45.79.210.65','singerbob86@yahoo.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Robert Singer</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>singerbob86@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>6074344815</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Getting off 4 years of suboxone.  I am taking more and more everyday lately because it just stopped working all of a sudden.it is destroying my body and mind .it has also induced a form of psychosis.....</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(227,'2020-12-27 19:49:35','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Preston Leigh</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>jpleigh1@charter.net</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>7575826911</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Opioid addiction/recovery </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: jpleigh1@charter.net <jpleigh1@charter.net>','',NULL,'1.9.7'),(228,'2020-12-27 19:49:35','45.79.210.65','jpleigh1@charter.net','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Preston Leigh</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>jpleigh1@charter.net</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>7575826911</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Opioid addiction/recovery </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(229,'2020-12-27 20:13:58','45.79.210.65','anrclinicflorida@gmail.com','Form Entry - Gabriel E Marintez -SUMMARY OF THE FLORIDA PATIENT’S BILL OF RIGHTS AND RESPONSIBILITIES','<p><table></table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(230,'2020-12-27 20:17:40','45.79.210.65','waismannben@gmail.com,\\nolga@anrclinicus.com,\\nanrclinicflorida@gmail.com','Gabriel E Martinez - Authorization Form – Consent to Medical Treatment','<p><table></table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','/2020/12/ninja-forms-submission.csv',NULL,'1.9.7'),(231,'2020-12-27 20:18:52','45.79.210.65','anrclinicflorida@gmail.com','Gabriel E Martinez - Authorization to Disclose Health Information to Family Members and Friends','<p><table></table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(232,'2020-12-27 22:14:00','45.79.210.65','shaneandnoah36@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Heather Gimmy</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>shaneandnoah36@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>561-674-1904</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>My husband and I are looking for a facility that can help my husband and myself with opiate addiction. We desperately need help to get our lives back. We have private insurance and hoping you can help us. I have tried repeatedly to detox cold turkey but every time I try, the detox almost kills me and puts me in the hospital. Please call me ASAP. Looking to complete the detox during New Years break and start the new year off right. </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(233,'2020-12-27 22:14:00','45.79.210.65','waismannben@gmail.com','New message from Heather Gimmy','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Heather Gimmy</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>shaneandnoah36@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>561-674-1904</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>My husband and I are looking for a facility that can help my husband and myself with opiate addiction. We desperately need help to get our lives back. We have private insurance and hoping you can help us. I have tried repeatedly to detox cold turkey but every time I try, the detox almost kills me and puts me in the hospital. Please call me ASAP. Looking to complete the detox during New Years break and start the new year off right. </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: shaneandnoah36@gmail.com <shaneandnoah36@gmail.com>','',NULL,'1.9.7'),(234,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>190.39.94.65</b> and it was blocked for 20 minutes<br>Last user attempted: <b>admin</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(235,'2020-12-27 22:33:18','45.79.210.65','shaneandnoah36@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Heather Gimmy</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>shaneandnoah36@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>5616741904</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>My husband and I are looking for a facility that can assist with our opiate addiction and seeking treatment immediately. I have tried to detox several times unsuccessfully where the detox almost killed me, shut down my organs due to uncontrollable nausea and dehydration. We desperately need help and want to start off the new year addiction free. Please call ASAP. </td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(236,'2020-12-27 22:33:18','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Heather Gimmy - Contact Page','</p>\n<p>Heather Gimmy</p>\n<p>shaneandnoah36@gmail.com</p>\n<p>5616741904</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: shaneandnoah36@gmail.com <shaneandnoah36@gmail.com>','',NULL,'1.9.7'),(237,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>190.39.94.65</b> and it was blocked for 24 hours<br>Last user attempted: <b>admin</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(238,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>77.231.219.149</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(239,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>77.231.219.149</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(240,'2020-12-28 04:37:12','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test Bugendaitech</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Hello</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(241,'2020-12-28 04:37:12','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test Bugendaitech - Contact Page','</p>\n<p>Test Bugendaitech</p>\n<p>Test@bugendaitech.com</p>\n<p>08874632864</p>\n<p>IN</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(242,'2020-12-28 04:50:29','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Test ','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Test </td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>June</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>7</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1997</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>34343</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>Human</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>23432</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>hello</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>delhi</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>45</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>Sector 76</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>delhi</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Uttar Pradesh</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>284001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>UM</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Test</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Test</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>5</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/25/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(243,'2020-12-28 04:59:31','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test 28/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Helloo </td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(244,'2020-12-28 04:59:31','45.79.210.65','waismannben@gmail.com','New message from test 28/12/2020','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test 28/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Helloo </td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(245,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>192.99.0.98</b> and it was blocked for 20 minutes<br>Last user attempted: <b>waismannben</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(246,'2020-12-28 05:12:07','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test 28/12/2020 123</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Hello new</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(247,'2020-12-28 05:12:07','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test 28/12/2020 123 - Contact Page','</p>\n<p>Test 28/12/2020 123</p>\n<p>Test@bugendaitech.com</p>\n<p>08874632864</p>\n<p>IN</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(248,'2020-12-28 05:27:48','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Test 123 28/12/2020','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Test 123 28/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>August</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>16</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1997</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>56</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>6</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>878990</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>GB</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>5</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/23/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(249,'2020-12-28 06:42:56','45.79.210.65','testbugendaitech@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test contactus lead</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>testbugendaitech@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>How can we help you...</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(250,'2020-12-28 06:42:56','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test contactus lead - Contact Page','</p>\n<p>Test contactus lead</p>\n<p>testbugendaitech@gmail.com</p>\n<p>8128884151</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: testbugendaitech@gmail.com <testbugendaitech@gmail.com>','',NULL,'1.9.7'),(251,'2020-12-28 06:50:47','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test contact Lead123456</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test message test</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(252,'2020-12-28 06:50:47','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test contact Lead123456 - Contact Page','</p>\n<p>Test contact Lead123456</p>\n<p>harsh@bugendaitech.com</p>\n<p>8128884151</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(253,'2020-12-28 06:59:30','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test contactus lead 8888888888</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(254,'2020-12-28 06:59:30','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test contactus lead 8888888888 - Contact Page','</p>\n<p>Test contactus lead 8888888888</p>\n<p>harsh@bugendaitech.com</p>\n<p>8128884151</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(255,'2020-12-28 07:01:21','45.79.210.65','harsh12321@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>gdfgdfgd gdfgfd</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh12321@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>sdsadasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(256,'2020-12-28 07:01:21','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from gdfgdfgd gdfgfd - Contact Page','</p>\n<p>gdfgdfgd gdfgfd</p>\n<p>harsh12321@bugendaitech.com</p>\n<p>8128884151</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh12321@bugendaitech.com <harsh12321@bugendaitech.com>','',NULL,'1.9.7'),(257,'2020-12-28 08:18:08','45.79.210.65','yoges@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>test new contact</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>yoges@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>hjello</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mius</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(258,'2020-12-28 08:18:08','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from test new contact - Contact Page','</p>\n<p>test new contact</p>\n<p>yoges@bugendaitech.com</p>\n<p>08874632864</p>\n<p>IN</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: yoges@bugendaitech.com <yoges@bugendaitech.com>','',NULL,'1.9.7'),(259,'2020-12-28 08:31:56','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test 888888888</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>sdfdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mius</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(260,'2020-12-28 08:31:56','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test 888888888 - Contact Page','</p>\n<p>Test 888888888</p>\n<p>harsh@bugendaitech.com</p>\n<p>8128884151</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(261,'2020-12-28 08:33:20','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>fdsfsd 43543534534</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>UA</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>fdsfsdf fssdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mius</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(262,'2020-12-28 08:33:20','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from fdsfsd 43543534534 - Contact Page','</p>\n<p>fdsfsd 43543534534</p>\n<p>harsh@bugendaitech.com</p>\n<p>8128884151</p>\n<p>UA</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(263,'2020-12-28 08:36:57','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>fdsfds fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>AE</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>fsdfsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Social Media</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mius</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(264,'2020-12-28 08:36:57','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from fdsfds fsdfsdf - Contact Page','</p>\n<p>fdsfds fsdfsdf</p>\n<p>harsh@bugendaitech.com</p>\n<p>8128884151</p>\n<p>AE</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(265,'2020-12-28 08:59:22','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test 123457hello</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>hello anr clicnic</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(266,'2020-12-28 08:59:22','45.79.210.65','waismannben@gmail.com','New message from test 123457hello','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test 123457hello</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>hello anr clicnic</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(267,'2020-12-28 09:05:26','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>test 1234 helloo</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>gfeefefefe</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mius</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(268,'2020-12-28 09:05:26','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from test 1234 helloo - Contact Page','</p>\n<p>test 1234 helloo</p>\n<p>Test@bugendaitech.com</p>\n<p>08874632864</p>\n<p>IN</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(269,'2020-12-28 09:15:39','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>test 28/12/2020 Contact</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Hello Thank you</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mius</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(270,'2020-12-28 09:15:39','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from test 28/12/2020 Contact - Contact Page','</p>\n<p>test 28/12/2020 Contact</p>\n<p>Test@bugendaitech.com</p>\n<p>08874632864</p>\n<p>IN</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(271,'2020-12-28 09:17:34','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - test 28/12/2020 Quesstionare','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>test 28/12/2020 Quesstionare</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>April</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>16</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1977</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>34</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/02/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(272,'2020-12-28 09:18:11','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test 28/12/2020 Opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Hello dddf</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(273,'2020-12-28 09:18:11','45.79.210.65','waismannben@gmail.com','New message from Test 28/12/2020 Opoid','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test 28/12/2020 Opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Hello dddf</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(274,'2020-12-28 09:21:45','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Test 28/12/2020','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Test 28/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>April</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>3</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1997</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>44</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>7</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>TZ</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/09/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(275,'2020-12-28 11:02:11','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test Bugendaitech opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Hello</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(276,'2020-12-28 11:02:11','45.79.210.65','waismannben@gmail.com','New message from test Bugendaitech opoid','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test Bugendaitech opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Hello</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(277,'2020-12-28 11:06:33','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Hello Opooid</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(278,'2020-12-28 11:06:33','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoid','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Hello Opooid</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(279,'2020-12-28 11:10:51','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Eric Sandler','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Eric Sandler</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>January</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>26</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1978</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>Caucasian</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>Caucasian</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Cvs</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>Ny</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>5166067243</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>160</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5\'7</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>18 acorn street</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>RONKONKOMA</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>NY</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>11779</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>5165199268</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>nevernotready567@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>5166067243</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>Carpentry /Construction</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Jayme Sandler</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Wife</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Jme.sandler@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>5165199268</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>After years of opiod use and abuse due to physical pain and surgical procedures i want my life back. Have tried to detox in the past hut unsuccessful due to the physical withdrawal.</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Oxycodone</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>30mg  6times a day</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>PO</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Oxycontin ER</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>30mg 3times a day  </td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>PO</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>Home</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>09/27/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>Physically sick, very volatile, aggressive anxious,  cold sweats, muscle cramps and restless limbs. Horrible. Couldn\'t last more throat 2 days.</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>Pain in severe enough to make me want medication. Haven\'t been completely clean in years.</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>Tried suboxone once during the last attempt to withdraw. Did not work. Was very sick </td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>Diclofenca sodium</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>100mg</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>Once daily </td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>Po</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>Testosterone </td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>100mg</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>Once week</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>IM</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>Anastrozole</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>1mg</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>Once week</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>Po</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td>Food allergies: apples, plums, pomegranate,  Berch</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>B/L inguinal hernia repair 2013<br />\nLeft knee arthroscopic repair,  2013, 2015<br />\nRigh ankle tendon repair 2014<br />\nSeptoplasty 2015</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(280,'2020-12-28 11:12:23','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast12345 opoid </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>fvgfefwfsfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(281,'2020-12-28 11:12:23','45.79.210.65','waismannben@gmail.com','New message from Test Testlast12345 opoid ','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast12345 opoid </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>fvgfefwfsfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(282,'2020-12-28 11:16:47','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dhnhnudqqed</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(283,'2020-12-28 11:16:47','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoid','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dhnhnudqqed</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(284,'2020-12-28 11:18:15','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>ddfddff</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(285,'2020-12-28 11:18:15','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoid','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>ddfddff</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(286,'2020-12-28 11:19:57','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dvvdvdfd</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(287,'2020-12-28 11:19:57','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoid','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dvvdvdfd</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(288,'2020-12-28 11:21:14','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dvffefefef</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(289,'2020-12-28 11:21:14','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoid','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dvffefefef</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(290,'2020-12-28 11:22:32','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>ffefefe</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(291,'2020-12-28 11:22:32','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoid new','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>ffefefe</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(292,'2020-12-28 11:24:34','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opioid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dfasfefaf</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(293,'2020-12-28 11:24:35','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opioid new','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opioid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dfasfefaf</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(294,'2020-12-28 11:27:05','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>v vfvfvvd</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(295,'2020-12-28 11:27:05','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoid new','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>v vfvfvvd</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(296,'2020-12-28 11:28:30','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>jfnnfnfnw</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(297,'2020-12-28 11:28:30','45.79.210.65','waismannben@gmail.com','New message from Test Testlast new','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>jfnnfnfnw</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(298,'2020-12-28 11:30:07','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dfssssssds</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(299,'2020-12-28 11:30:07','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoid new','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dfssssssds</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(300,'2020-12-28 11:33:04','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>gbbbjbjbjbj</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(301,'2020-12-28 11:33:04','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoid new','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoid new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>gbbbjbjbjbj</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(302,'2020-12-28 11:34:42','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoiod new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>yuguuhh</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(303,'2020-12-28 11:34:42','45.79.210.65','waismannben@gmail.com','New message from Test Testlast opoiod new','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast opoiod new</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>yuguuhh</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitl</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(304,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>88.230.132.26</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(305,'2020-12-28 11:49:29','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlastopoid new </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>fdfasfsdfsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(306,'2020-12-28 11:49:29','45.79.210.65','waismannben@gmail.com','New message from Test Testlastopoid new ','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlastopoid new </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>fdfasfsdfsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(307,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>88.230.132.26</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(308,'2020-12-28 13:16:35','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Steve Bright','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Steve Bright</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>August</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>14</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1964</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>266-65-9495</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>Caucasian</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>Caucasian</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Publix</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>Inverness, Florida 352-341-2602</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>Ana C. Cruz-Diaz MD</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>352-765-3003</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>160</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5\'6\"</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>3003 S. Jean Avenue </td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Inverness</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Florida</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>34450</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>352-302-2366</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>brightelec1@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>Self Employed</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Teresa Bright</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Wife</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>teresabright76@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>352-302-7349</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Oxycotin</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>3 - 30 mg. pills per day</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>At Home</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/26/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>Tried for two days, kept feeling worse and worse.  Made call to ANR Clinic, thinking this is best option.  read about other places and all they want to do is to give you pills and taper down or something like that.  I want to be drug free, I want to have my life back.  </td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Mild</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>Cravings are minimal at best, as long as I stay away from people that are doing it and not to have anything on hand or readily available.   </td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td>Codeine, it gives me a rash all over.</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Gallbladder removed ten years ago.</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(309,'2020-12-28 13:23:12','45.79.210.65','megankirschner@yahoo.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Megan Kirschner </td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>megankirschner@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>5713820432</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Opiate detox as soon as possible</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>924968167.1609179688</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(310,'2020-12-28 13:23:12','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Megan Kirschner  - Contact Page','</p>\n<p>Megan Kirschner </p>\n<p>megankirschner@yahoo.com</p>\n<p>5713820432</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: megankirschner@yahoo.com <megankirschner@yahoo.com>','',NULL,'1.9.7'),(311,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>69.157.34.40</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(312,'2020-12-28 13:27:32','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Teresa Bright','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Teresa Bright</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>March</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>1</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1953</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>285-52-3019</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>White</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>Caucasian</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Publix</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>1012 W. Main Street 352-341-2602</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>Ana C. Cruz-Diaz</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>352-765-3003</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>110</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5\'1\"</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>3003 S. Jean Avenue</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Inverness</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Florida</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>34450</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>352-302-7349</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>teresabright76@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>Retired</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Steve Bright</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Husband</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>brightelec1@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>352-302-2366</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>OxyContin</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>90 mg. 3 -30mg per day</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>None</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/28/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Mild</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>Don\'t even think about them while clean.</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td>Codeine and Penicillin</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Hysterectomy</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>October 2020, when hysterectomy was performed.</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>I have an inhaler Ventollin/Albuterol only use when needed.  </td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(313,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>69.157.34.40</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(314,'2020-12-28 13:53:50','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Catherine Kyler</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Cassykyler04@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>7162253607</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I want to get off suboxone </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Cassykyler04@gmail.com <Cassykyler04@gmail.com>','',NULL,'1.9.7'),(315,'2020-12-28 13:53:50','45.79.210.65','Cassykyler04@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Catherine Kyler</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Cassykyler04@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>7162253607</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I want to get off suboxone </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(316,'2020-12-28 14:22:04','45.79.210.65','ramo1932cr@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Charles Ramos</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>ramo1932cr@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>425-273-3365</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Waiting for Christy and Finanicial Info for Financing. ? Never received in my email</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>How did you hear about us?</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>1970433536.1609183010</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(317,'2020-12-28 14:22:04','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Charles Ramos - Contact Page','</p>\n<p>Charles Ramos</p>\n<p>ramo1932cr@gmail.com</p>\n<p>425-273-3365</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: ramo1932cr@gmail.com <ramo1932cr@gmail.com>','',NULL,'1.9.7'),(318,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>192.95.30.65</b> and it was blocked for 20 minutes<br>Last user attempted: <b>waismannben</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(319,'2020-12-28 14:43:36','45.79.210.65','waismannben@gmail.com,\\ngal@bemedia.co.il','New message from  - Landing Page - Tony Palermo','<table>\n<tr>\n<td valign=\"top\">Full Name:</td>\n<td>Tony Palermo</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>halcorp@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Paragraph Text:</td>\n<td>Hi<br />\nWould the patient be required to stay on Subaxon after treatment at your facilities?<br />\nWould your treatment eliminate the PAWS? Or does it only address the physical dependency?<br />\nthx</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(320,'2020-12-28 15:42:01','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>David Ruiz</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>davidru125@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>7814699911</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Good afternoon in methadone clinic for 15 years.olso I used heroin.</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: davidru125@yahoo.com <davidru125@yahoo.com>','',NULL,'1.9.7'),(321,'2020-12-28 15:42:01','45.79.210.65','davidru125@yahoo.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>David Ruiz</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>davidru125@yahoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>7814699911</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Good afternoon in methadone clinic for 15 years.olso I used heroin.</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(322,'2020-12-28 17:38:16','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - abduallah rabei','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>abduallah rabei</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>December</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>16</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1995</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>636544225</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>english</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>white</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>arab</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>walmart</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>tampa 727-277-8925</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>150</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>6.1</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>6817 altier estates ct </td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>tampa</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>florida</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>33610</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>7272778925</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>ahnadrabei@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>7274857777</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>cellphone repair</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>yousef rabei</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>brother</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>mail@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>7274857777</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Oxycodone</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>6-10 x 10mg</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>snort </td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>none</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>11/27/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Severe</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(323,'2020-12-28 18:08:00','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Savanna cole</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>savannacole42@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>3473406506</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I’m asking for help. I’m addicted to perks and Oxys I jus wanna stop </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: savannacole42@gmail.com <savannacole42@gmail.com>','',NULL,'1.9.7'),(324,'2020-12-28 18:08:00','45.79.210.65','savannacole42@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Savanna cole</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>savannacole42@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>3473406506</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I’m asking for help. I’m addicted to perks and Oxys I jus wanna stop </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(325,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>188.165.210.14</b> and it was blocked for 20 minutes<br>Last user attempted: <b>waismannben</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(326,'2020-12-28 23:03:02','45.79.210.65','pedrojineto@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Pedro Jesuino Isaias Neto</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>pedrojineto@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>+5534998914131</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>BR</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Socorro!!! Doutor Andre Waismann, meu nome é Pedro Jesuino Isaias Neto, sou brasileiro, 34 anos, sou viciado em morfina, faço uso diário em uma única dose por dia de 120mg (4 comprimidos de Dimorf 30mg) de Cloridado de Morfina, desde 19 de janeiro de 2019 devido a um acidente de moto que tive nessa data informada, fui para Medicina da UFU em Uberlândia-MG e lá os médicos ficaram decidindo por 15 dias ou mais se iam me operar ou fazer tratamento conservador devido a minha fratura que tive no acetábulo e meu fêmur saiu do lugar, enquanto a espera da cirurgia foram administrados 10 mg de Morfina a cada 4 horas intravenosa ou até mais, quando percebi que aquela droga era maravilhosa, \"tirava a dor com a mão\" eu me apaixonei pela droga e até hoje, nesse exato momento que te escrevo não consigo pensar em ficar sem ela, agora mesmo tenho no meu quarto uma caixa lacrada com 50 compridos de Dimorf 30mg;<br />\nOu seja já se passaram exatamente 2 anos que faço uso dessa droga e meses atrás pensando no meu filho pequeno de 6 anos que tenho, na minha família queria me livrar disso de uma vez por todas e isso me desencadeou diversos problemas como constipação intestinal, ansiedade e depressão, Hoje quando fico sem ela não sinto dor nos primeiros momentos, mas uma terrível vontade de morrer de desprazer total, Já tentei ficar sem mas não consigo, Já procurei ajuda no CAPS aqui no Brasil, porém me receitaram Carbazepina e depois Bupropiona, Eu mesmo sei que eles não estão capacitados para tratar essa síndrome da abstinência de opióide, Só queria me livrar dessa droga, A coisa que mais quero na vida hoje, se puder me ajudar, Seria eternamente grato e acredito que a ciência e a medicina vai salvar e melhorar minha qualidade de vida!</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Media (Newspaper, Magazine, TV, or Radio)</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>484475042.1609212845</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(327,'2020-12-28 23:03:03','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Pedro Jesuino Isaias Neto - Contact Page','</p>\n<p>Pedro Jesuino Isaias Neto</p>\n<p>pedrojineto@gmail.com</p>\n<p>+5534998914131</p>\n<p>BR</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: pedrojineto@gmail.com <pedrojineto@gmail.com>','',NULL,'1.9.7'),(328,'2020-12-28 23:48:20','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Jessa Fritzges','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Jessa Fritzges</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>April</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>8</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1981</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>187684575</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>White</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>White</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Cvs</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>6105307385</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>Dr lyons</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>6104020101</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>240</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5’7”</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>5736 Cetronia Rd</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Allentown</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Pennsylvania</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>18106</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>6109721953</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>jessa.fritzges@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>6105971549</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>Pet groomer</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Linda uhrich</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>mother</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>lcuhrich@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4846027402</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>Please do not contact her until I know this is possible. Our relationship is complicated, she is also my landlord and could put me out of home and business. I may have to take my father or sister. </td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Fentanyl </td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>30 bags weening down</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Injection</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>Pyramid</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>02/14/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>Can’t take suboxen/subutex so they didn’t know what to do with me. Basically told me there was nothing they could do for after 12 days of throwing up bile. No food or even water could stay down. </td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Severe</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>I have pain from Lyme and fibromyalgia </td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>Tried methadone for maybe two years, couldn’t stop using</p>\n<p>Did suboxen years ago...worked fine then when I tried to go back on it I had a severe reaction and they had to drill a hole into my bone marrow for fluids. I waited 3 full days before taking it. They think I’m allergic. </td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td>20 years ago</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>Armour thyroid</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>240 mgs</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>1 daily</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>Oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>Clonazipam</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>2mgs</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>Twice daily</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>Oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td>Suboxen/subutex?</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Total thyroidectomy<br />\nTotal adnoidectomy<br />\nBunionectomy left foot<br />\nLumpectomy back shoulderblade</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Emergency dental extractions</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Over 7 years ago. No major injuries</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Hep c.... undetected<br />\nTook holistic approach</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(329,'2020-12-29 00:19:47','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>test contact66666</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>UG</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>dffds</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mius</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(330,'2020-12-29 00:19:47','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from test contact66666 - Contact Page','</p>\n<p>test contact66666</p>\n<p>harsh@bugendaitech.com</p>\n<p>8128884151</p>\n<p>UG</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(331,'2020-12-29 00:20:50','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test opioid4324324234</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>sdfsdfsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(332,'2020-12-29 00:20:50','45.79.210.65','waismannben@gmail.com','New message from test opioid4324324234','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test opioid4324324234</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>sdfsdfsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(333,'2020-12-29 00:45:23','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>dasdas dasdas</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dasdsad</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(334,'2020-12-29 00:45:23','45.79.210.65','waismannben@gmail.com','New message from dasdas dasdas','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>dasdas dasdas</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dasdsad</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(335,'2020-12-29 01:01:26','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test Bugendaitech 29/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>fsfsdfdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mius</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(336,'2020-12-29 01:01:26','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test Bugendaitech 29/12/2020 - Contact Page','</p>\n<p>Test Bugendaitech 29/12/2020</p>\n<p>Test@bugendaitech.com</p>\n<p>08874632864</p>\n<p>IN</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(337,'2020-12-29 01:07:33','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test Testlast 29/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>sfgsdsvsfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(338,'2020-12-29 01:07:33','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test Testlast 29/12/2020 - Contact Page','</p>\n<p>Test Testlast 29/12/2020</p>\n<p>Test@bugendaitech.com</p>\n<p>08874632864</p>\n<p>IN</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(339,'2020-12-29 01:10:56','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast buygendaitech 29/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dsvsvdvs</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(340,'2020-12-29 01:10:56','45.79.210.65','waismannben@gmail.com','New message from Test Testlast buygendaitech 29/12/2020','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast buygendaitech 29/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dsvsvdvs</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(341,'2020-12-29 01:15:10','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast Bugendaitech 29/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dfssvdsvs</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(342,'2020-12-29 01:15:10','45.79.210.65','waismannben@gmail.com','New message from Test Testlast Bugendaitech 29/12/2020','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast Bugendaitech 29/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dfssvdsvs</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(343,'2020-12-29 01:16:40','45.79.210.65','Test@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast bugendaitech </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>faffasfafa</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(344,'2020-12-29 01:16:40','45.79.210.65','waismannben@gmail.com','New message from Test Testlast bugendaitech ','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test Testlast bugendaitech </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>faffasfafa</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Test@bugendaitech.com <Test@bugendaitech.com>','',NULL,'1.9.7'),(345,'2020-12-29 01:55:45','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>test contactus</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>UG</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>sfsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(346,'2020-12-29 01:55:45','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from test contactus - Contact Page','</p>\n<p>test contactus</p>\n<p>harsh@bugendaitech.com</p>\n<p>8128884151</p>\n<p>UG</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(347,'2020-12-29 02:05:28','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test opioid form123</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dsadasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(348,'2020-12-29 02:05:28','45.79.210.65','waismannben@gmail.com','New message from test opioid form123','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>test opioid form123</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>dsadasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(349,'2020-12-29 02:18:15','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - test questinaie12','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>test questinaie12</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>March</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>15</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>1234567890</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>Race</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>Ethnicty</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>fsdfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>123</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>234</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>holi chakla</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>asdas</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>asdas dasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>dasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>dasdas</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>dasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>123</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/17/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>dasdadas</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Moderate</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>dadada</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>For how long</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>safdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>fdsfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(350,'2020-12-29 02:25:57','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - test Questionarie12345555','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>test Questionarie12345555</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>July</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>16</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>1221321321</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>sadas</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>sdasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>dsadasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>dasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>dsadada</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>dasdasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>123</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>345</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>holi chakla</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>asdasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>dasdas dasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>asfdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>fdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>123</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>dsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/16/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>fsdfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Mild</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>fdsfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">Form record id:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead record type id:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(351,'2020-12-29 03:29:06','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Test Bugendaitech 29/12/2020','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Test Bugendaitech 29/12/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>April</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>5</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1997</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>234334</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Widowed</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>34</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>284001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>TL</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>yoges@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Test@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>08874632864</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>35</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>34</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/03/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Severe</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>test</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>48697531.1606233097</td>\n</tr>\n<tr>\n<td valign=\"top\">Form record id:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead record type id:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(352,'2020-12-29 05:13:01','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Armen Zhamaryan','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Armen Zhamaryan</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>March</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>17</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1986</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>White</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>Caucasian</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Thriftway Pharmacy</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>646 10th Ave New York, NY 10036 (212) 956-1100</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9177573177</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>185</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5\'9\"</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>530 W45 street #5N</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>new york</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>NY</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>10036</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>9177573177</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>armenzhamaryan@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Svetlana Zhamaryan</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Mother</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>svetlanaya@hotmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>(917)841-3387</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>I would like to find out how the procedure works. What part of the body is going to get operated on? What should I expect to feel after a few days of rest? Will I feel cravings? Are ALL withdrawal symptoms dealt with while under anesthesia (anxiety/sleep problems/lethargy/etc.) or just the physical? Please call me 12/29 at (917)757-3177 any time (preferably after 12PM eastern if possible). Thank you.</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Heroin</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>1 gram</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Intranasal </td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Xanax</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>1 MG</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>None/Cold Turkey</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>10/01/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>I was able to push through the physical part of the withdrawals (stomach problems were the hardest) but was having a very hard time with anxiety, irritability and mood instability. Slowly everything seemed to be going a tad bit better but I constantly felt that feeling of \"something missing\" and then I had my accident on 10/23 and due to surgery and pain levels I was given and prescribed opiates. </td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Severe</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>I can sometimes will myself through the physical withdrawal symptoms but the mental and emotional is what makes me relapse.</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>Benadryl</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>400-800 MG</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>Daily</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>Oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Car accident 10/23/20 which led to having my triceps surgically reconnected. I am doing much better now and have significantly more ROM.</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Car accident 10/23/20 which led to having my triceps surgically reconnected.</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Car accident 10/23/20 which led to having my triceps surgically reconnected.</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Car accident 10/23/20 which led to having my triceps surgically reconnected.</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Form record id:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lead record type id:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(353,'2020-12-29 05:47:49','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Test question latest555','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Test question latest555</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>August</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>17</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>sdfdsfde3432</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>fdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>32</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>321</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>holi chakla</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Nadiad</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Gujarat</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>sdfdsfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>fsdfsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>fsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>123</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>sdfdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/22/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>fsdfs</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Mild</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">Form record id:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead record type id:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(354,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>85.247.167.104</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(355,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>85.247.167.104</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(356,'2020-12-29 09:36:05','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test contact us latest</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>TM</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>dasdsada</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(357,'2020-12-29 09:36:05','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test contact us latest - Contact Page','</p>\n<p>Test contact us latest</p>\n<p>harsh@bugendaitech.com</p>\n<p>8128884151</p>\n<p>TM</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(358,'2020-12-29 09:44:16','45.79.210.65','harsh@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test contasdas dadasd</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>UG</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>sadasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Social Media</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(359,'2020-12-29 09:44:16','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test contasdas dadasd - Contact Page','</p>\n<p>Test contasdas dadasd</p>\n<p>harsh@bugendaitech.com</p>\n<p>8128884151</p>\n<p>UG</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh@bugendaitech.com <harsh@bugendaitech.com>','',NULL,'1.9.7'),(360,'2020-12-29 09:45:29','45.79.210.65','harsh1321321@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>fdsfds dsfsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh1321321@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>fsdfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(361,'2020-12-29 09:45:29','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from fdsfds dsfsdf - Contact Page','</p>\n<p>fdsfds dsfsdf</p>\n<p>harsh1321321@bugendaitech.com</p>\n<p>8128884151</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh1321321@bugendaitech.com <harsh1321321@bugendaitech.com>','',NULL,'1.9.7'),(362,'2020-12-29 09:47:23','45.79.210.65','harsh44444@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test contact latest1231</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh44444@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>TM</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>sdfdsfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(363,'2020-12-29 09:47:23','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test contact latest1231 - Contact Page','</p>\n<p>Test contact latest1231</p>\n<p>harsh44444@bugendaitech.com</p>\n<p>8128884151</p>\n<p>TM</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh44444@bugendaitech.com <harsh44444@bugendaitech.com>','',NULL,'1.9.7'),(364,'2020-12-29 09:48:14','45.79.210.65','harsh554874547@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test opioid12333</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh554874547@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Test Message</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(365,'2020-12-29 09:48:14','45.79.210.65','waismannben@gmail.com','New message from Test opioid12333','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Test opioid12333</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh554874547@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Test Message</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">form record type id:</td>\n<td>0123t000000mitlAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead Record Type ID:</td>\n<td>0123t000000meiDAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh554874547@bugendaitech.com <harsh554874547@bugendaitech.com>','',NULL,'1.9.7'),(366,'2020-12-29 09:52:36','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Test questretre','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Test questretre</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>February</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>3</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1900</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>fdsfds5345345</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>sdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>fsdfsd</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>4324</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>56546</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>asdasdas</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>fsdfds</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>fsdf</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>387001</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>IN</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>fsdfdsf</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh00000@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>9974274528</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>dasdsad</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>dasdsad</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>dasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>harsh554488744@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>dasdasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/17/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>dasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Mild</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>dasdsa</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>dasda</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>dasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>dasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>dasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>dasd</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">Form record id:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead record type id:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(367,'2020-12-29 10:17:55','45.79.210.65','harsh845745544@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test creafs</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>harsh845745544@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8128884151</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>fdsfds</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>626717683.1604736493</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(368,'2020-12-29 10:17:55','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Test creafs - Contact Page','</p>\n<p>Test creafs</p>\n<p>harsh845745544@bugendaitech.com</p>\n<p>8128884151</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: harsh845745544@bugendaitech.com <harsh845745544@bugendaitech.com>','',NULL,'1.9.7'),(369,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>120.56.117.132</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(370,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>188.123.115.242</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(371,'2020-12-29 11:38:00','45.79.210.65','ardianga25@getnada.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Ardian</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>ardianga25@getnada.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>86524215</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Test GA</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>2133370079.1609259744</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(372,'2020-12-29 11:38:00','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Ardian - Contact Page','</p>\n<p>Ardian</p>\n<p>ardianga25@getnada.com</p>\n<p>86524215</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: ardianga25@getnada.com <ardianga25@getnada.com>','',NULL,'1.9.7'),(373,'2020-12-29 11:38:03','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Denver p McCabe</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>DENVERMCCABE122@GMAIL.COM</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4435976074</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Opiod adiction</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: DENVERMCCABE122@GMAIL.COM <DENVERMCCABE122@GMAIL.COM>','',NULL,'1.9.7'),(374,'2020-12-29 11:38:03','45.79.210.65','DENVERMCCABE122@GMAIL.COM','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Denver p McCabe</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>DENVERMCCABE122@GMAIL.COM</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4435976074</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Opiod adiction</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(375,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>120.56.117.132</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(376,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>90.157.190.140</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(377,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>188.123.115.242</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(378,'2020-12-29 12:02:12','45.79.210.65','Elizabeths2angels@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Elizabeth A Hayes</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Elizabeths2angels@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>6023775277</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>I would like to find out more about this treatment please.</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(379,'2020-12-29 12:02:12','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Elizabeth A Hayes - Contact Page','</p>\n<p>Elizabeth A Hayes</p>\n<p>Elizabeths2angels@gmail.com</p>\n<p>6023775277</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: Elizabeths2angels@gmail.com <Elizabeths2angels@gmail.com>','',NULL,'1.9.7'),(380,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>90.157.190.140</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(381,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>15 failed login attempts (3 lockout(s)) from IP <b>90.157.190.140</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(382,'2020-12-29 12:29:49','45.79.210.65','waismannben@gmail.com,\\ngal@bemedia.co.il','New message from  - Landing Page - Ray Russell','<table>\n<tr>\n<td valign=\"top\">Full Name:</td>\n<td>Ray Russell</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>ray.russell.2nd@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Paragraph Text:</td>\n<td>How much does ANR treatment cost. Is it covered by Medicare or any other insurance companies?</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(383,'2020-12-29 12:40:43','45.79.210.65','christyortiz.55@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Christy Ortiz</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>christyortiz.55@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>5058621552</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>I want to stop using fetanayl but I can’t because I withdraw from it </td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td></td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(384,'2020-12-29 12:40:43','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Christy Ortiz - Contact Page','</p>\n<p>Christy Ortiz</p>\n<p>christyortiz.55@gmail.com</p>\n<p>5058621552</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: christyortiz.55@gmail.com <christyortiz.55@gmail.com>','',NULL,'1.9.7'),(385,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>122.168.92.42</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(386,'2020-12-29 13:12:13','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Michael Mastandrea</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>michaelmastandrea30@mail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8572587304</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Please I need to get back to REALITY. I\'M on a 120 milligrams of methadone and I want to get OFF Please help me. </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: michaelmastandrea30@mail.com <michaelmastandrea30@mail.com>','',NULL,'1.9.7'),(387,'2020-12-29 13:12:13','45.79.210.65','michaelmastandrea30@mail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Michael Mastandrea</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>michaelmastandrea30@mail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8572587304</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>Please I need to get back to REALITY. I\'M on a 120 milligrams of methadone and I want to get OFF Please help me. </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(388,'2020-12-29 13:22:03','45.79.210.65','anderson.lindsey@icloud.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Lindsey Anderson</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>anderson.lindsey@icloud.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4054233461</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>I am interested in pricing and more information about this treatment. </td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>1709185966.1609265988</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(389,'2020-12-29 13:22:03','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Lindsey Anderson - Contact Page','</p>\n<p>Lindsey Anderson</p>\n<p>anderson.lindsey@icloud.com</p>\n<p>4054233461</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: anderson.lindsey@icloud.com <anderson.lindsey@icloud.com>','',NULL,'1.9.7'),(390,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>122.168.92.42</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(391,'2020-12-29 13:35:06','45.79.210.65','ardiardiga9@getnada.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>ArdianGAGA</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>ardiardiga9@getnada.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8624512135</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>GA</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Referral</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>2133370079.1609259744</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(392,'2020-12-29 13:35:06','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from ArdianGAGA - Contact Page','</p>\n<p>ArdianGAGA</p>\n<p>ardiardiga9@getnada.com</p>\n<p>8624512135</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: ardiardiga9@getnada.com <ardiardiga9@getnada.com>','',NULL,'1.9.7'),(393,'2020-12-29 13:37:45','45.79.210.65','waismannben@gmail.com,\\nolga@anrclinicus.com,\\nanrclinicflorida@gmail.com','Bradley Porche - Authorization Form – Consent to Medical Treatment','<p><table></table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','/2020/12/ninja-forms-submission.csv',NULL,'1.9.7'),(394,'2020-12-29 13:40:30','45.79.210.65','anrclinicflorida@gmail.com','Bradley Porche - Authorization to Disclose Health Information to Family Members and Friends','<p><table></table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(395,'2020-12-29 14:27:31','45.79.210.65','anr@bugendaitech.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>AdrainTestBuhendaitech</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>anr@bugendaitech.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>454845845</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>Hi</td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>How did you hear about us?</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>1409396737.1605792064</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(396,'2020-12-29 14:27:31','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from AdrainTestBuhendaitech - Contact Page','</p>\n<p>AdrainTestBuhendaitech</p>\n<p>anr@bugendaitech.com</p>\n<p>454845845</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: anr@bugendaitech.com <anr@bugendaitech.com>','',NULL,'1.9.7'),(397,'2020-12-29 15:19:59','45.79.210.65','waismannben@gmail.com,\\ngal@bemedia.co.il','New message from  - Landing Page - Donnie Valentine','<table>\n<tr>\n<td valign=\"top\">Full Name:</td>\n<td>Donnie Valentine</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>chewypeanut@comcast.net</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>978-518-5789</td>\n</tr>\n<tr>\n<td valign=\"top\">Paragraph Text:</td>\n<td>I would like to participate in your program as soon as possible.<br />\nPlease contact me with availability.<br />\n978-518-5789</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(398,'2020-12-29 16:56:08','45.79.210.65','gabbybowman@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">:</td>\n<td>Gabrielle Carr </td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>gabbybowman@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4237163553</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">:</td>\n<td>I’ve been addicted to opiates for over a year now and sought treatment with Suboxone August of 2019 and want to be free of medication and dependency.   </td>\n</tr>\n<tr>\n<td valign=\"top\">Select:</td>\n<td>Search Engine</td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>1022002042.1609278035</td>\n</tr>\n<tr>\n<td valign=\"top\">record type id:</td>\n<td>0123t000000miusAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">lead record type id:</td>\n<td>0123t000000meiCAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(399,'2020-12-29 16:56:08','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com','New message from Gabrielle Carr  - Contact Page','</p>\n<p>Gabrielle Carr </p>\n<p>gabbybowman@gmail.com</p>\n<p>4237163553</p>\n<p>US</p>\n<p></p>\n</p>\n<p></p>\n<p></p>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: gabbybowman@gmail.com <gabbybowman@gmail.com>','',NULL,'1.9.7'),(400,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>12 failed login attempts (3 lockout(s)) from IP <b>5.133.138.86</b> and it was blocked for 20 minutes<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(401,'2022-10-01 17:56:14','45.79.210.65','contact@anrclinicus.com','[ANR Clinic - Advanced Opioid Treatment Center] Failed login attempts','<p>Hello,</p><p>16 failed login attempts (4 lockout(s)) from IP <b>5.133.138.86</b> and it was blocked for 24 hours<br>Last user attempted: <b>anrclinic</b></p><p>Under Attack? Learn more about <a href=\"https://www.limitloginattempts.com/am-i-under-attack/?from=plugin-lockout-email\">brute force attacks</a>. Have Questions? Visit our <a href=\"https://www.limitloginattempts.com/resources/?from=plugin-lockout-email\" target=\"_blank\">help section</a>.<br><a href=\"https://anrclinic.nirazo.me/wp-admin/options-general.php?page=limit-login-attempts&tab=settings\">Unsubscribe</a> from these notifications.</p><hr><p>This notification was sent automatically via <b>Limit Login Attempts Reloaded Plugin</b>.</p>','content-type: text/html','',NULL,'1.9.7'),(402,'2020-12-29 18:14:06','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - DANIEL M DURANTE','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>DANIEL M DURANTE</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>January</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>1</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Married</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>WHITE</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>ITALIAN</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>WALGREENS</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>7723345886</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>159</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5\' 4</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>3275 NW STONEY CREEK</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>JENSEN BEACH</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>FL</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>34957</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>772-485-9752</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>maria.sostre@allegianceadvisor.net</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>772-405-8041</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>DOCTOR</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>DEBORAH DURANTE</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>WIFE</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>ICBEAUTIFUL19@AOL.COM</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>772-361-9688</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td>MARY INDIVIGILO SISTER 561-350-4347</td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>OXYCOD</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>8</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>pill</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>nona</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/24/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Mild</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>ASPIRIN</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>81MG</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>MORNING </td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>ONE </td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>CLOPIDOGREL</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>75MG</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>MORNING </td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>ONE</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td>GABAPENTIN</td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td>100MG</td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td>3X TIME</td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td>2 CAPSULES</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td>IODINE</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>QUADRUPLE CORONARY ARTERY BYPASS</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>DEC 14, 2020 - DEC 24, 2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>DEC 14, 2020</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td>QUADRUPLE CORONARY ARTERY BYPASS</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>MODERATE</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>1352174667.1609278543</td>\n</tr>\n<tr>\n<td valign=\"top\">Form record id:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead record type id:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(403,'2020-12-29 18:19:59','45.79.210.65','waismannben@gmail.com,\\ngal@bemedia.co.il','New message from  - Landing Page - Ronald Christopher James Bennett ','<table>\n<tr>\n<td valign=\"top\">Full Name:</td>\n<td>Ronald Christopher James Bennett </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>rcjbennett5150@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8012327908</td>\n</tr>\n<tr>\n<td valign=\"top\">Paragraph Text:</td>\n<td>I have been going to the methadone clinic for 2 years and was just recently tapered out due to not having the funds to keep on the treatment.  I was on 90mgs the entire time. And now that I am completely off of the methadone I am having the worst symptoms. Even relapsed and begun using my drug of choice to feel normal. “Heroin”. I have been battling this disease for 6 years now and I cannot take another day of it. </td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(404,'2020-12-29 19:13:04','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Nathan Israel','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Nathan Israel</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>July</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>8</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1985</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>Caucasian</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>Judiasm</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Kinney Drugs</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>Middlebury, VT (802) 388-0973</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>Jonathan Singer</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>(303) 488-0034</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>165</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>6\'0</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>PO Box 712</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Middlebury</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>VT</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>05753</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>802-989-3443</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>israelnj@eckerd.edu</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>802-388-9551</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Paula Israel</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Mother</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Smalla123@aol.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>802-989-2022</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Oxycodone</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>300 mg/day</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Sniffed</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Triazolam</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>0.25 mg/day</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Alprazolam</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>2 mg/day</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Oral</td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>N/A</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>11/01/2014</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>Never been to a rehab facility.<br />\nExperience nasty side effects - body is hyper sensitive.</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Severe</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>Aches. Chills. Hot and cold sweats. </td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>I had a methadone prescription for a few years (about 2015). Doctor preferred Oxycodone to Methadone so I was switched.</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>2014, Concussion on I-70 in CO, rear ended on highway at high speed. </td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>1437928082.1609174914</td>\n</tr>\n<tr>\n<td valign=\"top\">Form record id:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead record type id:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(405,'2020-12-29 19:20:11','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Lisa King','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Lisa King</td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>June</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>26</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>1969</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English</td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Female</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Divorced</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>White</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>West allis</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Serve-u</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>Milwaukee</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4145107832</td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>120</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5\'8\"</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>2065 s.91 street</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>West allis</td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Wisconsin</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>53227</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>4145107832</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>Bigdogsfan6@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>4149311222</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td>Disabled</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Paul Rotta</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Fianc\'e</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>saintsroadking@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4149311222</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Heroin</td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>1g per day</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Snort</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>Home</td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>11/04/2019</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>It was after my last of many surgeries.  The hardest part is withdrawal.  Usually ends up with seizures.</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Mild</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>I don\'t have the cravings as long as I\'m not in withdrawal.  I hate having to do it just not to be sick.</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>A few months.  But it\'s all the same!  I just want to be off it all!!</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>Suboxone doctor was one.  They all say the same thing.  MAINTAIN</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td>Lower back, 2 major neck and right foot reconstruction.</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Major right foot reconstruction, so I can wear a shoe and walk with a cane.</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>Several severe car accidents, all my ex-husband driving, resulting in PTSD when in a vehicle.</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td>When trying to get clean by myself, starting with severe panic attacks.</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>1917813807.1609283962</td>\n</tr>\n<tr>\n<td valign=\"top\">Form record id:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead record type id:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(406,'2020-12-29 19:28:44','45.79.210.65','contact@anrclinicus.com,\\nben@anrclinicus.com','New Landing Page Form Submission','<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Vince Benson</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>dadtnb@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4127597275</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I\'m currently on methadone. Liquid. I really don\'t want to be dependent on it anymore!  Would your facility be able to help?</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>,\\nReply-to: dadtnb@gmail.com <dadtnb@gmail.com>','',NULL,'1.9.7'),(407,'2020-12-29 19:28:44','45.79.210.65','dadtnb@gmail.com','Submission Confirmation ','<p>Thank you for contacting us – we will get back to you soon.</p>\n<table>\n<tr>\n<td valign=\"top\">Name:</td>\n<td>Vince Benson</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>dadtnb@gmail.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>4127597275</td>\n</tr>\n<tr>\n<td valign=\"top\">Message:</td>\n<td>I\'m currently on methadone. Liquid. I really don\'t want to be dependent on it anymore!  Would your facility be able to help?</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),(408,'2020-12-29 21:52:48','45.79.210.65','ben@anrclinicus.com,\\ncontact@anrclinicus.com,\\nwaismannben@gmail.com,\\nolgamedowska@gmail.com','New Form Submission - Questionnaire - Ethan gouge ','</p>\n<table>\n<tr>\n<td valign=\"top\">HTML:</td>\n<td>\n<h3>Patient Information</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name:</td>\n<td>Ethan gouge </td>\n</tr>\n<tr>\n<td valign=\"top\">Date of Birth:</td>\n<td>\n<h4>Date of Birth</h4>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Month:</td>\n<td>June</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Day:</td>\n<td>26</td>\n</tr>\n<tr>\n<td valign=\"top\">DOB - Year:</td>\n<td>2003</td>\n</tr>\n<tr>\n<td valign=\"top\">Social Security #:</td>\n<td>403616490</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Language:</td>\n<td>English </td>\n</tr>\n<tr>\n<td valign=\"top\">SEX:</td>\n<td>\n<h3>Sex</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">MARITAL STATUS:</td>\n<td>\n<h3>Marital Status</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Sex:</td>\n<td>Male</td>\n</tr>\n<tr>\n<td valign=\"top\">Marital Status:</td>\n<td>Single</td>\n</tr>\n<tr>\n<td valign=\"top\">Race:</td>\n<td>White</td>\n</tr>\n<tr>\n<td valign=\"top\">Ethnicity:</td>\n<td>None</td>\n</tr>\n<tr>\n<td valign=\"top\">Preferred Pharmacy:</td>\n<td>Grant county drugs</td>\n</tr>\n<tr>\n<td valign=\"top\">Location:</td>\n<td>Dry ridge</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Care Doctor:</td>\n<td>Dr.burke</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Weight:</td>\n<td>145</td>\n</tr>\n<tr>\n<td valign=\"top\">Height:</td>\n<td>5’11</td>\n</tr>\n<tr>\n<td valign=\"top\">Address:</td>\n<td>\n<h3>Address</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Street:</td>\n<td>265 Sherman mt Zion rd</td>\n</tr>\n<tr>\n<td valign=\"top\">City:</td>\n<td>Dry ridge </td>\n</tr>\n<tr>\n<td valign=\"top\">State:</td>\n<td>Kentucky</td>\n</tr>\n<tr>\n<td valign=\"top\">Zip:</td>\n<td>41035</td>\n</tr>\n<tr>\n<td valign=\"top\">Country:</td>\n<td>US</td>\n</tr>\n<tr>\n<td valign=\"top\">Primary Phone:</td>\n<td>+15025147835 </td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>ethangouge23@gmaim.con</td>\n</tr>\n<tr>\n<td valign=\"top\">Alternate Phone:</td>\n<td>8594286086</td>\n</tr>\n<tr>\n<td valign=\"top\">Occupation:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency Contact:</td>\n<td>\n<h3>Emergency Contact</h3>\n<p></p>\n<p>- Please list the person who will be accompanying you during treatment</p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">First and Last Name - Emergency:</td>\n<td>Johnny penn</td>\n</tr>\n<tr>\n<td valign=\"top\">Relationship to Patient:</td>\n<td>Uncle</td>\n</tr>\n<tr>\n<td valign=\"top\">Email:</td>\n<td>egouge062603@yaoo.com</td>\n</tr>\n<tr>\n<td valign=\"top\">Phone:</td>\n<td>8596288908</td>\n</tr>\n<tr>\n<td valign=\"top\">Other Relevant Personal Remarks::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">DRUGS CURRENTLY BEING USED:</td>\n<td>\n<h3>Drugs Currently Being Used</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Fentanyl </td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>.5 gram</td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Snort</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td>Marijuana </td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td>1-2gs a day </td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td>Smoke</td>\n</tr>\n<tr>\n<td valign=\"top\">Drug Name:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Amount Per Day:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Method of Use:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Most Recent Attempt to Withdraw:</td>\n<td>\n<h3>Most Recent Attempt to Withdraw</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Institution or Clinic:</td>\n<td>Home </td>\n</tr>\n<tr>\n<td valign=\"top\">Date:</td>\n<td>12/25/2020</td>\n</tr>\n<tr>\n<td valign=\"top\">General remarks about your withdrawal attempts:</td>\n<td>Can’t do it with the pain lol</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>\n<h3>Craving scale while “clean\":</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Craving scale while “clean\"::</td>\n<td>Mild</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify:</td>\n<td>No want none</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>\n<h3>Methadone or Suboxone Maintenance?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Methadone or Suboxone Maintenance?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">For How Long?:</td>\n<td>None </td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>\n<h3>Have you ever received psychiatric treatment?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Have you ever received psychiatric treatment?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>\n<h3>Prior suicide attempts?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Prior suicide attempts?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">If so, when?:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Past Medical History:</td>\n<td>\n<h3>Past Medical History</h3>\n<p><i>Medication currently being used (other than drugs mentioned above)</i></p>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Medication:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Dose:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Frequency:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Route:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>\n<h3>Allergies (Medications, Food, etc.)?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Allergies (Medications, Food, etc.)?:</td>\n<td>Yes</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify and describe reactions::</td>\n<td>Amoxicillin </td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>\n<h3>Past Surgeries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Past Surgeries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>\n<h3>Hospitalization in the last two years?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Hospitalization in the last two years?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>\n<h3>Adverse reactions to anesthesia in the past?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Adverse reactions to anesthesia in the past?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>\n<h3>Emergency room visits in the last year?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Emergency room visits in the last year?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>\n<h3>Accidents? (work, car etc)</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Accidents? (work, car etc):</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>\n<h3>Head Injuries?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Head Injuries?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>\n<h3>Loss of consciousness?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>\n<h3>Seizures?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Loss of consciousness? Seizures?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>\n<h3>Heart disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Heart disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>\n<h3>Lung disease?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Lung disease?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>\n<h3>Liver disease / infections?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Liver disease / infections?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>\n<h3>Kidney disease / problem?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Kidney disease / problem?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify:</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>\n<h3>Diabetes?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Diabetes?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>\n<h3>Ulcers?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Ulcers?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>\n<h3>High Blood Pressure?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">High Blood Pressure?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>\n<h3>Asthma or shortness of breath?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Asthma or shortness of breath?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>\n<h3>Obstructive sleep apnea?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Obstructive sleep apnea?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please Specify::</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>\n<h3>Pregnancy?</h3>\n</td>\n</tr>\n<tr>\n<td valign=\"top\">Pregnancy?:</td>\n<td>No</td>\n</tr>\n<tr>\n<td valign=\"top\">Please specify :</td>\n<td></td>\n</tr>\n<tr>\n<td valign=\"top\">Hidden:</td>\n<td>1221492496.1609285282</td>\n</tr>\n<tr>\n<td valign=\"top\">Form record id:</td>\n<td>0123t000000mitmAAA</td>\n</tr>\n<tr>\n<td valign=\"top\">Lead record type id:</td>\n<td>0123t000000meiEAAQ</td>\n</tr>\n</table>\n<p></p>\n','Content-Type: text/html,\\ncharset=UTF-8,\\nX-Ninja-Forms:ninja-forms,\\nFrom: ANR Clinic - Advanced Opioid Treatment Center <contact@anrclinicus.com>','',NULL,'1.9.7'),