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[custom_html]
                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework myform1_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' ><div id='gf_1' class='gform_anchor' tabindex='-1'></div><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1' class='myform1' action='/contact/#gf_1' data-formid='1' novalidate>
                        <div class='gform-body gform_body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id="field_1_1" class="gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >שם מלא<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>
                            
                            <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >
                                                    <input type='text' name='input_1.3' id='input_1_1_3' value='' tabindex='50'  aria-required='true'     />
                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>שם פרטי</label>
                                                </span>
                            
                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >
                                                    <input type='text' name='input_1.6' id='input_1_1_6' value='' tabindex='52'  aria-required='true'     />
                                                    <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>שם משפחה</label>
                                                </span>
                            
                        </div></li><li id="field_1_2" class="gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' for='input_1_2'>טלפון</label><div class='ginput_container ginput_container_phone'><input name='input_2' id='input_1_2' type='tel' value='' class='medium' tabindex='54'   aria-invalid="false"   /></div></li><li id="field_1_3" class="gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' for='input_1_3'>דואר אלקטרוני<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'>
                            <input name='input_3' id='input_1_3' type='email' value='' class='medium' tabindex='55'   aria-required="true" aria-invalid="false"  />
                        </div></li><li id="field_1_4" class="gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' for='input_1_4'>תוכן הפנייה<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_textarea'><textarea name='input_4' id='input_1_4' class='textarea small' tabindex='56'    aria-required="true" aria-invalid="false"   rows='10' cols='50'>
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סוגי קבצים מורשים: jpg, png, gif, pdf, bmp, tif, Max. file size: 3 MB.
<img src="https://drlaviv.co.il/wp-content/uploads/2020/12/logo-for-contact1.jpg"/>[/custom_html]
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