{"id":4043,"date":"2014-03-26T09:51:43","date_gmt":"2014-03-26T09:51:43","guid":{"rendered":"http:\/\/nova-creative.com\/plv\/?page_id=4043"},"modified":"2020-10-13T09:20:51","modified_gmt":"2020-10-13T01:20:51","slug":"is-it-right-for-me","status":"publish","type":"page","link":"http:\/\/103.11.207.10\/~perthlas\/is-it-right-for-me\/","title":{"rendered":"LASIK, is it right for me?"},"content":{"rendered":"\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_14' style='display:none'><div id='gf_14' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_14' id='gform_14'  action='\/~perthlas\/wp-json\/wp\/v2\/pages\/4043#gf_14' >\n                        <div class='gform_body gform-body'><ul id='gform_fields_14' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_14_26\" class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_26' >How old are you?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_14_26' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_14_27\" class=\"gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_27' >Do you have trouble seeing?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_27' id='input_14_27' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select -<\/option><option value='Far away' >Far away<\/option><option value='Close up' >Close up<\/option><option value='Both' >Both<\/option><\/select><\/div><\/li><li id=\"field_14_28\" class=\"gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_28' >Has your prescription changed significantly in the last 2 years?<\/label><div class='ginput_container ginput_container_select'><select name='input_28' id='input_14_28' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select - <\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_14_29\" class=\"gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_29' >Do you usually wear glasses or contact lenses?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_29' id='input_14_29' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select - <\/option><option value='Glasses' >Glasses<\/option><option value='Soft contact lenses' >Soft contact lenses<\/option><option value='Hard contact lenses' >Hard contact lenses<\/option><option value='Both glasses and contact lenses' >Both glasses and contact lenses<\/option><option value='I don\u2019t wear any' >I don\u2019t wear any<\/option><\/select><\/div><\/li><li id=\"field_14_31\" class=\"gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_31' >Have you been diagnosed with any of these eye conditions?<\/label><div class='ginput_container ginput_container_select'><select name='input_31' id='input_14_31' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select - <\/option><option value='Kerataconus' >Kerataconus<\/option><option value='Cataracts' >Cataracts<\/option><option value='Glaucoma' >Glaucoma<\/option><option value='Retinal disease' >Retinal disease<\/option><option value='Severe dry eye' >Severe dry eye<\/option><option value='Corneal scarring' >Corneal scarring<\/option><option value='Lazy eye' >Lazy eye<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_14_32\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_32' >Which Other Eye Condition?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_14_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_14_2\" class=\"gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_2' >Have you previously had eye surgery?<\/label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_14_2' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select - <\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_14_33\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_33' >Please advise, which surgery you have had<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_14_33' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_14_34\" class=\"gfield gf_left_half field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_14_34' >Have you been told that you are NOT a good candidate for LASIK surgery?<\/label><div class='gfield_description' id='gfield_description_14_34'>(We can tell you about other options.)<\/div><div class='ginput_container ginput_container_select'><select name='input_34' id='input_14_34' class='large gfield_select'  aria-describedby=\"gfield_description_14_34\"   aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select -<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_14_35\" class=\"gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_35' >Do you suffer from any of the following medical conditions?<\/label><div class='ginput_container ginput_container_select'><select name='input_35' id='input_14_35' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select - <\/option><option value='None- I am healthy' >None- I am healthy<\/option><option value='Diabetes' >Diabetes<\/option><option value='Rheumatoid arthritis' >Rheumatoid arthritis<\/option><option value='Autoimmune diseases such as lupus' >Autoimmune diseases such as lupus<\/option><option value='Multiple Sclerosis' >Multiple Sclerosis<\/option><option value='Collagen vascular disease' >Collagen vascular disease<\/option><option value='I am currently pregnant' >I am currently pregnant<\/option><\/select><\/div><\/li><li id=\"field_14_3\" class=\"gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_3' >What is your biggest concern about having LASIK surgery?<\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_14_3' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select -<\/option><option value='No concerns' >No concerns<\/option><option value='Moving my eyes or head during laser treatment' >Moving my eyes or head during laser treatment<\/option><option value='Expense' >Expense<\/option><option value='Achieving the best vision possible' >Achieving the best vision possible<\/option><option value='Needing glasses or contacts again' >Needing glasses or contacts again<\/option><option value='Having to still wear reading glasses when I\u2019m older' >Having to still wear reading glasses when I\u2019m older<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_14_11\" class=\"gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_11' >How soon would you like to improve your vision?<\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_14_11' class='large gfield_select'     aria-invalid=\"false\" ><option value='Within the next 3 months' >Within the next 3 months<\/option><option value='3 to 6 months' >3 to 6 months<\/option><option value='More than 6 months' >More than 6 months<\/option><option value='I\u2019m not sure' >I\u2019m not sure<\/option><\/select><\/div><\/li><li id=\"field_14_10\" class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_10' >Would you like more information or to book a consultation?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_14_10' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select -<\/option><option value='Information only' >Information only<\/option><option value='Book a consultation with Dr Phil at Murdoch' >Book a consultation with Dr Phil at Murdoch<\/option><option value='Book a consultation with Dr Phil at Subiaco' >Book a consultation with Dr Phil at Subiaco<\/option><\/select><\/div><\/li><li id=\"field_14_12\" class=\"gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_12' >How did you hear about Perth Laser Vision?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_14_12' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Please Select -<\/option><option value='Family\/friend' >Family\/friend<\/option><option value='Google' >Google<\/option><option value='Facebook' >Facebook<\/option><option value='Radio' >Radio<\/option><option value='Online Banner Ad' >Online Banner Ad<\/option><option value='GP' >GP<\/option><option value='Optometrist' >Optometrist<\/option><\/select><\/div><\/li><li id=\"field_14_39\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Your Contact Details<\/h2><\/li><li id=\"field_14_5\" class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_5' >First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_14_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_14_36\" class=\"gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_36' >Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_14_36' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_14_6\" class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_6' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_6' id='input_14_6' type='text' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_14_7\" class=\"gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_7' >Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_14_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_14_37\" class=\"gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_14_37' >Date of Birth<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_37' id='input_14_37' type='text' value='' class='datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_14_37_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_14_37_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_14_37' class='gform_hidden' value='http:\/\/103.11.207.10\/~perthlas\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_14_38\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip has_country ginput_container_address' id='input_14_38' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_14_38_1_container' >\n                                        <input type='text' name='input_38.1' id='input_14_38_1' value=''    aria-required='true'    \/>\n                                        <label for='input_14_38_1' id='input_14_38_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_14_38_3_container' >\n                                    <input type='text' name='input_38.3' id='input_14_38_3' value=''    aria-required='true'    \/>\n                                    <label for='input_14_38_3' id='input_14_38_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_14_38_4_container' >\n                                        <input type='text' name='input_38.4' id='input_14_38_4' value=''      aria-required='true'    \/>\n                                        <label for='input_14_38_4' id='input_14_38_4_label' >State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_14_38_5_container' >\n                                    <input type='text' name='input_38.5' id='input_14_38_5' value=''    aria-required='true'    \/>\n                                    <label for='input_14_38_5' id='input_14_38_5_label' >Post Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country' id='input_14_38_6_container' >\n                                        <select name='input_38.6' id='input_14_38_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' selected='selected'>Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' 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Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, 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