Eligibility Questionnaire

:root{--wpr-bg-38e006e1-35da-4ef1-9569-28d56ab9cd31: url('../../../../../../../../../../../../wp-content/cache/min/1/wp-content/uploads/oxygen/css/');}:root{--wpr-bg-46b809c0-5f38-48e1-8c0c-13dce8480af9: url('https://godrvhealth-com-107249.hostingersite.com/wp-content/uploads/2025/08/ico-white.png');}:root{--wpr-bg-078b5553-52f4-4687-905a-00773536230c: url('https://godrvhealth-com-107249.hostingersite.com/wp-content/uploads/2025/08/bef-icon.png');}:root{--wpr-bg-bdc9adf8-d194-4ff3-a37a-3838a48cd83e: url('https://godrvhealth-com-107249.hostingersite.com/wp-content/uploads/2025/08/ico-white.png');}:root{--wpr-bg-88e8b2a3-2bd9-48c1-968d-7c6cf611e08d: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/theme/chosen/chosen-sprite.png');}:root{--wpr-bg-8dba6bbb-a675-4f14-8e9f-6747495956c4: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/theme/chosen/chosen-sprite.png');}:root{--wpr-bg-a3d80f62-82ae-4a8c-a5d8-4441c052fdf7: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/theme/chosen/chosen-sprite.png');}:root{--wpr-bg-b155d683-6138-4825-9d82-5ff473d8107b: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/theme/chosen/chosen-sprite.png');}:root{--wpr-bg-0c53aa63-0e13-46e0-94ca-7ab8ef79e43c: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/gf-creditcards-check.svg');}:root{--wpr-bg-455fc6df-3be9-4715-921f-169162dd97dc: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/theme/down-arrow.svg');}:root{--wpr-bg-295644ba-32bf-4e4c-ae11-f24f06ced330: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/theme/down-arrow.svg');}:root{--wpr-bg-0c346291-3441-4cab-ad80-3b46823950cf: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/theme/chosen/chosen-sprite@2x.png');}:root{--wpr-bg-cdcffa50-1532-46d7-a3d0-f6b56c33348f: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/gf-creditcards.svg');}:root{--wpr-bg-36fa95d0-e328-4347-8166-3cbb2936273e: url('../../../../../../../../../../wp-content/plugins/gravityforms/images/gf-creditcards.svg');}:root{--wpr-bg-ffc22d54-4016-4079-9c62-9fe99877b1ea: url('https://godrvhealth.com/wp-content/uploads/2025/08/Rounded-Rectangle-5-copy-6.png');}