[et_pb_section fb_built="1" admin_label="Contact" _builder_version="3.22.3" background_color="#f4f4f4" template_type="section"][et_pb_row background_position_1="top_left" background_repeat_1="no-repeat" _builder_version="3.22.3" custom_width_px="710px" locked="off"][et_pb_column type="4_4" _builder_version="3.0.47"][et_pb_divider show_divider="off" disabled_on="off|off|off" _builder_version="3.2" background_color_gradient_direction="90deg" max_width="100px" module_alignment="center" height="5px" custom_margin="||20px|" custom_padding="||20px|" animation_style="slide" animation_direction="bottom" saved_tabs="all" locked="off"][/et_pb_divider][et_pb_text admin_label="Contact Section Title" _builder_version="3.0.79" header_font="Montserrat||||" header_text_color="#1f1f1f" header_font_size="36px" text_orientation="center" max_width="710px" module_alignment="center" animation_style="fold" animation_direction="bottom" animation_intensity_fold="20%"]<h1>SEND US A MESSAGE</h1>[/et_pb_text][/et_pb_column][/et_pb_row][et_pb_row _builder_version="3.22.3" max_width="900px" use_custom_width="on" custom_width_px="900px"][et_pb_column type="4_4" _builder_version="3.0.47"][et_pb_contact_form captcha="off" email="ben@valleywaymedia.com" submit_button_text="Send Message" module_id="et_pb_contact_form_1" _builder_version="3.24" form_field_background_color="rgba(255,255,255,0)" title_font="Montserrat||||" title_font_size="22px" form_field_font="||||||||" border_width_all="1px" border_color_all="rgba(0,0,0,0.12)" border_style_all="solid" custom_button="on" button_text_size="18px" button_text_color="#ffffff" button_bg_color="#5b3559" button_border_width="2px" button_border_color="#5b3559" button_border_radius="0px" button_letter_spacing="2px" button_font="Montserrat|||on|" button_use_icon="off" animation_style="fold" animation_direction="bottom" animation_intensity_fold="20%" use_border_color="on" border_color="rgba(0,0,0,0.12)" form_background_color="rgba(255,255,255,0)" locked="off" button_text_color_hover="#6eba01" button_bg_color_hover="rgba(0,0,0,0)" button_border_color_hover="#6eba01" button_border_radius_hover="0px" button_letter_spacing_hover="2px"][et_pb_contact_field field_id="Name" field_title="Name" _builder_version="3.16" border_radii="on||||" button_text_size__hover_enabled="off" button_one_text_size__hover_enabled="off" button_two_text_size__hover_enabled="off" button_text_color__hover_enabled="off" button_one_text_color__hover_enabled="off" button_two_text_color__hover_enabled="off" button_border_width__hover_enabled="off" button_one_border_width__hover_enabled="off" button_two_border_width__hover_enabled="off" button_border_color__hover_enabled="off" button_one_border_color__hover_enabled="off" button_two_border_color__hover_enabled="off" button_border_radius__hover_enabled="off" button_one_border_radius__hover_enabled="off" button_two_border_radius__hover_enabled="off" button_letter_spacing__hover_enabled="off" button_one_letter_spacing__hover_enabled="off" button_two_letter_spacing__hover_enabled="off" button_bg_color__hover_enabled="off" button_one_bg_color__hover_enabled="off" button_two_bg_color__hover_enabled="off"][/et_pb_contact_field][et_pb_contact_field field_id="Email" field_title="Email Address" field_type="email" _builder_version="3.16" border_radii="on||||" button_text_size__hover_enabled="off" button_one_text_size__hover_enabled="off" button_two_text_size__hover_enabled="off" button_text_color__hover_enabled="off" button_one_text_color__hover_enabled="off" button_two_text_color__hover_enabled="off" button_border_width__hover_enabled="off" button_one_border_width__hover_enabled="off" button_two_border_width__hover_enabled="off" button_border_color__hover_enabled="off" button_one_border_color__hover_enabled="off" button_two_border_color__hover_enabled="off" button_border_radius__hover_enabled="off" button_one_border_radius__hover_enabled="off" button_two_border_radius__hover_enabled="off" button_letter_spacing__hover_enabled="off" button_one_letter_spacing__hover_enabled="off" button_two_letter_spacing__hover_enabled="off" button_bg_color__hover_enabled="off" button_one_bg_color__hover_enabled="off" button_two_bg_color__hover_enabled="off"][/et_pb_contact_field][et_pb_contact_field field_id="Phone" field_title="Phone" _builder_version="3.24"][/et_pb_contact_field][et_pb_contact_field field_id="Interest" field_title="I'm Interested In... (check all that apply)" field_type="checkbox" checkbox_options="%91{%22value%22:%22BodyTite | Minimally Invasive Body Contouring%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Viveve | Vaginal Rejuvination%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Verju Fat Laser%22,%22checked%22:0,%22dragID%22:1},{%22value%22:%22Morpheus8 | Radio Frequency Microneedling%22,%22checked%22:0,%22dragID%22:2},{%22value%22:%22Botox / Fillers%22,%22checked%22:0,%22dragID%22:3}%93" _builder_version="3.24"][/et_pb_contact_field][et_pb_contact_field field_id="Message" field_title="Message" field_type="text" fullwidth_field="on" _builder_version="3.16" border_radii="on||||" button_text_size__hover_enabled="off" button_one_text_size__hover_enabled="off" button_two_text_size__hover_enabled="off" button_text_color__hover_enabled="off" button_one_text_color__hover_enabled="off" button_two_text_color__hover_enabled="off" button_border_width__hover_enabled="off" button_one_border_width__hover_enabled="off" button_two_border_width__hover_enabled="off" button_border_color__hover_enabled="off" button_one_border_color__hover_enabled="off" button_two_border_color__hover_enabled="off" button_border_radius__hover_enabled="off" button_one_border_radius__hover_enabled="off" button_two_border_radius__hover_enabled="off" button_letter_spacing__hover_enabled="off" button_one_letter_spacing__hover_enabled="off" button_two_letter_spacing__hover_enabled="off" button_bg_color__hover_enabled="off" button_one_bg_color__hover_enabled="off" button_two_bg_color__hover_enabled="off"][/et_pb_contact_field][/et_pb_contact_form][/et_pb_column][/et_pb_row][/et_pb_section]