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                  <div class="col-lg-11"><span class="hero-subtitle text-uppercase" data-aos="fade-up" data-aos-delay="0">Paying Too Much for Your Ozempic Prescription?</span>
                    <h1 class="hero-title mb-3" data-aos="fade-up" data-aos-delay="100">You Could Qualify for Free Ozempic Through ASC's Assistance Program</h1>
                    <p class="hero-description mb-4 mb-lg-5" data-aos="fade-up" data-aos-delay="200">Managing Type 2 diabetes shouldn’t come with overwhelming medication costs. If you’ve been prescribed Ozempic, you might be eligible to receive it at no cost through the Access Support Center (ASC) Patient Assistance Program. Thousands of patients have already qualified — now it's your turn to find out if you can too.

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                  <div class="col-md-11 mb-4 mb-md-0"><span class="subtitle text-uppercase mb-3" data-aos="fade-up" data-aos-delay="0">See If You Qualify Today!</span>
                    <h2 class="mb-4" data-aos="fade-up" data-aos-delay="100">Struggling to Afford Ozempic? You May Be Eligible for the ASC Patient Assistance Program.</h2>
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                      <p>Struggling to Afford Ozempic? You May Be Eligible for the ASC Patient Assistance Program (PAP).</p>
                      <p>At no cost to you, we’ll help determine if you meet the eligibility criteria for this life-changing prescription at zero out-of-pocket cost.</p>
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                      <h3 class="text-uppercase fw-bold">Mission Statement</h3>
                      <p class="fs-5 mb-0">Our mission is to help individuals access free, life-changing medications like Ozempic quickly, securely, and with ease.</p>
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                              <h2 class="mb-4">Why Choose us</h2>
                              <p class="mb-5">Get the help you need to access Ozempic at no cost — without the stress. We make the patient assistance process fast, secure, and easy to understand. Our dedicated team is here to guide you every step of the way, so you can focus on your health, not the paperwork.</p>
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                <h2 class="mb-3" data-aos="fade-up" data-aos-delay="100">Support tailored to your needs</h2>
                <p data-aos="fade-up" data-aos-delay="200">We help individuals get access to free Ozempic through trusted patient assistance programs — no insurance required.</p>
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                  <h3>For Individuals</h3>
                  <p>If you're struggling to afford Ozempic and managing Type 2 diabetes, we’ll walk you through the process to apply for free medication — step by step.</p>
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        <!-- ======= How it works =======-->
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              <div class="col-md-6 text-center mx-auto"><span class="subtitle text-uppercase mb-3" data-aos="fade-up" data-aos-delay="0">How it works</span>
                <h2 data-aos="fade-up" data-aos-delay="100">Start Your Application</h2>
                <p data-aos="fade-up" data-aos-delay="200">Getting help with the cost of Ozempic has never been easier. Follow these simple steps to see if you qualify for free medication through the ASC Patient Assistance Program:</p>
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                    <h3 class="fs-5 mb-4">Start Your Application</h3>
                    <p>Visit our website or download our app to sign up. Provide basic information to set up your secure account.</p>
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                  <h3 class="fs-5 mb-4">Submit Required Info</h3>
                  <p>We'll help you gather and submit the necessary documents — like proof of income, prescription, and ID.</p>
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                  <h3 class="fs-5 mb-4">Get Verified</h3>
                  <p>Once submitted, your application is reviewed by the program. We’ll keep you updated every step of the way.</p>
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                    <h3 class="fs-5 mb-4">Receive Your Medication</h3>
                    <p>If approved, you’ll receive Ozempic shipped directly to your home or doctor’s office — completely free.</p>
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                    <h3 class="fs-5 mb-3"><h3 class="fs-5 mb-3">Prescription Assistance</h3></h3>
                    <p class="mb-4">We specialize in helping eligible individuals access free or low-cost Ozempic through manufacturer-sponsored Patient Assistance Programs (PAPs).</p>
                  </div><a class="special-link d-inline-flex gap-2 align-items-center text-decoration-none" href="#contact"><span class="icons"><i class="icon-1 bi bi-arrow-right-short"></i><i class="icon-2 bi bi-arrow-right-short"> </i></span><span>Get Started</span></a>
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                    <h3 class="fs-5 mb-3">Eligibility Screening</h3>
                    <p class="mb-4">Our quick, confidential screening process helps determine if you meet the requirements for receiving Ozempic at no cost — with no guesswork.</p>
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                    <h3 class="fs-5 mb-3">Application Support</h3>
                  <p class="mb-4">We guide you through the entire process gathering documents, completing forms, and submitting your application — so you don’t have to do it alone.</p>
                  </div><a class="special-link d-inline-flex gap-2 align-items-center text-decoration-none" href="#contact"><span class="icons"><i class="icon-1 bi bi-arrow-right-short"></i><i class="icon-2 bi bi-arrow-right-short"> </i></span><span>Get Started</span></a>
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                    <h3 class="fs-5 mb-3">Caregiver Support</h3>
                    <p class="mb-4">Helping someone else apply? We provide caregiver-specific resources and one-on-one help to make the process as smooth as possible.</p>
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                    <h3 class="fs-5 mb-3">Follow-Up & Renewal Assistance</h3>
                    <p class="mb-4">Once approved, we help ensure you continue receiving your medication on time by assisting with renewals and follow-up paperwork.</p>
                  </div><a class="special-link d-inline-flex gap-2 align-items-center text-decoration-none" href="#contact"><span class="icons"><i class="icon-1 bi bi-arrow-right-short"></i><i class="icon-2 bi bi-arrow-right-short"> </i></span><span>Get Started</span></a>
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                    <h3 class="fs-5 mb-3">Access to Additional Programs</h3>
                    <p class="mb-4">We can also connect eligible patients to other medication assistance programs for diabetes or chronic health needs, expanding your support options.</p>
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                        <button class="accordion-button" type="button" data-bs-toggle="collapse" data-bs-target="#panelsStayOpen-collapseOne" aria-expanded="true" aria-controls="panelsStayOpen-collapseOne"> What services do you offer? </button>
                      </h2>
                      <div class="accordion-collapse collapse show" id="panelsStayOpen-collapseOne">
                        <div class="accordion-body">We assist patients in applying for the Ozempic Patient Assistance Program (PAP). Our services include eligibility screening, help with paperwork, application submission, and follow-up support — all at no cost to you.</div>
                      </div>
                    </div>
                    <div class="accordion-item">
                      <h2 class="accordion-header">
                        <button class="accordion-button collapsed" type="button" data-bs-toggle="collapse" data-bs-target="#panelsStayOpen-collapseTwo" aria-expanded="false" aria-controls="panelsStayOpen-collapseTwo">How much does it cost to apply?</button>
                      </h2>
                      <div class="accordion-collapse collapse" id="panelsStayOpen-collapseTwo">
                        <div class="accordion-body">There is no cost to use our service. We help you apply for Ozempic through the manufacturer’s assistance program, which can provide the medication 100% free to eligible individuals.</div>
                      </div>
                    </div>
                    <div class="accordion-item">
                      <h2 class="accordion-header">
                        <button class="accordion-button collapsed" type="button" data-bs-toggle="collapse" data-bs-target="#panelsStayOpen-collapseThree" aria-expanded="false" aria-controls="panelsStayOpen-collapseThree"> How long does it take to design and develop a website? </button>
                      </h2>
                      <div class="accordion-collapse collapse" id="panelsStayOpen-collapseThree">
                        <div class="accordion-body">The timeline for designing and developing a website depends on the project&apos;s complexity and scope. Typically, a standard business website takes about 4-6 weeks to complete, while more complex projects like e-commerce sites or custom applications may take longer. We work closely with our clients to establish a realistic timeline and keep you informed throughout the process.</div>
                      </div>
                    </div>
                    <div class="accordion-item">
                      <h2 class="accordion-header">
                        <button class="accordion-button collapsed" type="button" data-bs-toggle="collapse" data-bs-target="#panelsStayOpen-collapseFour" aria-expanded="false" aria-controls="panelsStayOpen-collapseFour"> 
                          How long does the approval process take?
                        </button>
                      </h2>
                      <div class="accordion-collapse collapse" id="panelsStayOpen-collapseFour">
                        <div class="accordion-body">
                          Most applications are processed within 7 to 14 business days, depending on how quickly we receive the necessary documents. We keep you updated every step of the way and help speed things up whenever possible.
                        </div>
                      </div>
                    </div>
                    <div class="accordion-item">
                      <h2 class="accordion-header"> 
                        <button class="accordion-button collapsed" type="button" data-bs-toggle="collapse" data-bs-target="#panelsStayOpen-collapseFive" aria-expanded="false" aria-controls="panelsStayOpen-collapseFive"> Who qualifies for free Ozempic?</button>
                      </h2>
                      <div class="accordion-collapse collapse" id="panelsStayOpen-collapseFive">
                        <div class="accordion-body">
                          Eligibility is typically based on income, insurance status, and having a valid prescription for Ozempic. We’ll walk you through the full criteria during your initial screening to see if you qualify.
                      </div>
                      </div>
                    </div>

                    <div class="accordion-item">
                      <h2 class="accordion-header">
                        <button class="accordion-button collapsed" type="button" data-bs-toggle="collapse" data-bs-target="#panelsStayOpen-collapseFour" aria-expanded="false" aria-controls="panelsStayOpen-collapseFour"> 
                           Do you help with renewals or reapplying?
                        </button>
                      </h2>
                      <div class="accordion-collapse collapse" id="panelsStayOpen-collapseFour">
                        <div class="accordion-body">
Yes! If you’ve been approved before or your coverage period is ending, we can assist with renewals or resubmitting your application to ensure continued access to your medication.                        </div>
                      </div>
                    </div>
                  </div>
                </div>
              </div>
            </div>
          </div>
          <!-- End FAQ-->
        </section>
        <!-- End FAQ-->
        
        <!-- ======= Contact =======-->
        <section class="section contact__v2" id="contact">
          <div class="container">
            <div class="row mb-5">
              <div class="col-md-6 col-lg-7 mx-auto text-center"><span class="subtitle text-uppercase mb-3" data-aos="fade-up" data-aos-delay="0">Contact</span>
                <h2 class="h2 fw-bold mb-3" data-aos="fade-up" data-aos-delay="0">Contact Us</h2>
                <p data-aos="fade-up" data-aos-delay="100">For Ozempic-related services, please complete the contact form before reaching out to us.



</p>
              </div>
            </div>
            <div class="row">
              <div class="col-md-6">
                <div class="d-flex gap-5 flex-column">
                  <div class="d-flex align-items-start gap-3" data-aos="fade-up" data-aos-delay="0">
                    <div class="icon d-block"><i class="bi bi-telephone"></i></div><span> <span class="d-block">Phone</span><strong>+1 (888) 595-9633<br>
+1 (888) 595-9MED</strong></span>
                  </div>
                  <div class="d-flex align-items-start gap-3" data-aos="fade-up" data-aos-delay="100">
                    <div class="icon d-block"><i class="bi bi-send"></i></div><span> <span class="d-block">Email</span><strong>[email protected]</strong></span>
                  </div>
                  <div class="d-flex align-items-start gap-3" data-aos="fade-up" data-aos-delay="200">
                    <div class="icon d-block"><i class="bi bi-geo-alt"></i></div><span> <span class="d-block">Address</span>
                      <address class="fw-bold">Boca Raton, FL</address></span>
                  </div>
                </div>
              </div>
              <div class="col-md-6">
                <div class="form-wrapper" data-aos="fade-up" data-aos-delay="300">



<form id="valForm" name="valForm" method="POST" action="sendmail.php" style="padding: 1em">

  <!-- Form fields -->
  <div class="row">
    <h3 class="mb-4 text-center">Who are we speaking to?</h3>

    <div class="col-md-6">
      <div class="form-floating mb-4">
        <input id="firstname" type="text" name="firstname" class="form-control register-input level" placeholder="First Name" required>
        <label for="firstname">First Name</label>
        <div class="valid-feedback">Looks good!</div>
        <div class="invalid-feedback">Please enter your First Name.</div>
      </div>
    </div>

    <div class="col-md-6">
      <div class="form-floating mb-4">
        <input id="lastname" type="text" name="lastname" class="form-control register-input level" placeholder="Last Name" required>
        <label for="lastname">Last Name</label>
        <div class="valid-feedback">Looks good!</div>
        <div class="invalid-feedback">Please enter your Last Name.</div>
      </div>
    </div>

    <div class="col-md-6">
      <div class="form-floating mb-4">
        <input type="text" class="form-control register-input level" name="phone" id="phone" placeholder="Phone Number" minlength="10" maxlength="10" required>
        <label for="phone">Phone Number</label>
        <div class="valid-feedback">Looks good!</div>
        <div class="invalid-feedback">Please enter your Phone Number.</div>
      </div>
    </div>

    <div class="col-md-6">
      <div class="form-floating mb-4">
        <input id="email" type="email" name="email" class="form-control register-input level" placeholder="Email Address" required>
        <label for="email">Email Address</label>
        <div class="valid-feedback">Looks good!</div>
        <div class="invalid-feedback">Please enter your Email Address.</div>
      </div>
    </div>
  </div>

  <!-- Date of Birth -->
  <div class="row">
    <h3 class="mb-4 mt-3 text-center">What is your Date of Birth?</h3>

    <div class="col-md-4 col-sm-12">
      <select id="dobmonth" class="form-select register-input level" name="month" required>
        <option value="">Month</option>
        <option value="01">01 - January</option>
        <option value="02">02 - February</option>
        <!-- Add all months -->
      </select>
    </div>

    <div class="col-md-4 col-sm-12">
      <select id="dobday" class="form-select register-input level" name="day" required>
        <option value="">Day</option>
        <!-- Add day options 01-31 -->
      </select>
    </div>

    <div class="col-md-4 col-sm-12">
      <select id="dobyear" class="form-select register-input level" name="year" required>
        <option value="">Year</option>
        <!-- Add year options, e.g. 1900-2025 -->
      </select>
    </div>
  </div>

  <!-- Address -->
  <h3 class="mb-3 mt-5 text-center">What is your current address?</h3>
  <div class="row">

    <div class="col-md-12">
      <div class="form-floating mb-4">
        <input id="address" type="text" name="address" class="form-control register-input level" placeholder="Street Address" required>
        <label for="address">Street Address</label>
      </div>
    </div>

    <div class="col-md-4">
      <div class="form-floating mb-4">
        <input type="text" class="form-control register-input level" minlength="5" maxlength="5" name="zip" id="zipCode" placeholder="Zip Code" required>
        <label for="zipCode">Zip Code</label>
      </div>
    </div>

    <div class="col-md-4">
      <div class="form-floating mb-4">
        <input type="text" class="form-control register-input level" name="city" id="city" placeholder="City" required>
        <label for="city">City</label>
      </div>
    </div>

    <div class="col-md-4">
      <div class="form-floating mb-4">
        <input type="text" class="form-control register-input level" name="state" id="state" placeholder="State" required>
        <label for="state">State</label>
      </div>
    </div>
  </div>

  <!-- Communication Channels -->
  <div class="container text-center">
    <p>When you enter your phone number and email address and submit this form, you agree to receive communications from Free Ozempic regarding your enrollment application and account. You may receive messages via phone, SMS, email, or mail depending on your selections. Message and data rates may apply. You can reply “HELP” for assistance or “STOP” to unsubscribe at any time. Consent is not required to purchase any goods or services, and you may revoke your consent at any time.  </p>

    <p>Please select the communication channels through which you would like to receive information:</p>
    <div class="row justify-content-center mb-4">
      <div class="col-3 d-flex justify-content-center">
        <input type="checkbox" class="form-check-input register-input level" id="phonecheckbox" name="channels[]" value="Phone">
        <label for="phonecheckbox">Phone</label>
      </div>

      <div class="col-3 d-flex justify-content-center">
        <input type="checkbox" class="form-check-input register-input level" id="smscheckbox" name="channels[]" value="SMS">
        <label for="smscheckbox">SMS</label>
      </div>

      <div class="col-3 d-flex justify-content-center">
        <input type="checkbox" class="form-check-input register-input level" id="emailcheckbox" name="channels[]" value="Email">
        <label for="emailcheckbox">Email</label>
      </div>

      <div class="col-3 d-flex justify-content-center">
        <input type="checkbox" class="form-check-input register-input level" id="mailcheckbox" name="channels[]" value="Mail">
        <label for="mailcheckbox">Mail</label>
      </div>
    </div>

    <p>Would you like to receive updates regarding your healthcare application status?</p>
    <div class="row justify-content-center">
      <div class="form-check col-md-2 col-sm-12">
        <input class="form-check-input register-input level" type="radio" name="updates" id="yes" value="Yes" required>
        <label class="form-check-label" for="yes">Yes</label>
      </div>

      <div class="form-check col-md-2 col-sm-12">
        <input class="form-check-input register-input level" type="radio" name="updates" id="no" value="No">
        <label class="form-check-label" for="no">No</label>
      </div>
    </div>

    <div style="display:none;">
      <input type="text" name="website" value="" class="register-input level">
    </div>

    <button type="submit" id="submitButton" class="btn btn-primary mt-4 register-input level">Submit</button>
  </div>
</form>

<div id="formResponse" style="margin-top: 1em;"></div>


                  
                  
                </div>
              </div>
            </div>
          </div>
        </section>
        <!-- End Contact-->
        
        <!-- ======= Footer =======-->
        <footer class="footer pt-5 pb-5">
          <div class="container">
           
            
      

          
            <div class="row credits">
              <div class="col-xl-8 text-center text-xl-start mb-3 mb-xl-0">
                <!--
                Note:
                =>>> Please keep all the footer links intact. <<<=
                =>>> You can only remove the links if you buy the pro version. <<<=
                =>>> Buy the pro version, which includes a functional PHP/AJAX contact form and many additional features.: https://freebootstrap.net/template/vertex-pro-bootstrap-website-template-for-portfolio/ <<<=
                --> 
                &copy;
                <script>document.write(new Date().getFullYear());</script> Free Ozempic 
                 All rights reserved.             </div>
              <div class="col-xl-4 justify-content-start justify-content-xl-end quick-links d-flex flex-column flex-xl-row text-center text-xl-start gap-1">Privacy Policy | Terms and Conditions</a></div>
            </div>
          </div>
        </footer>
        <!-- End Footer-->
        
      </main>
    </div>
    
    <!-- ======= Back to Top =======-->
    <button id="back-to-top"><i class="bi bi-arrow-up-short"></i></button>
    <!-- End Back to top-->
    


  <!-- TrustedForm -->
  <script type="text/javascript">
(function() {
var tf = document.createElement('script');
tf.type = 'text/javascript'; tf.async = true;
tf.src = ("https:" == document.location.protocol ? 'https' : 'http') + "://api.trustedform.com/trustedform.js?field=xxTrustedFormCertUrl&identifier=VHQ&ping_field=xxTrustedFormPingUrl&l=" + new Date().getTime() + Math.random();
var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(tf, s);
})();
</script>
<noscript>
<img src="https://api.trustedform.com/ns.gif" />
</noscript>
<!-- End TrustedForm -->


<script>

$("#valForm").validate({
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    phone: {
      required: true,
      minlength: 10,
      maxlength: 10
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    firstname: {
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    lastname: {
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    email: {
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    city: {
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    state: {
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      minlength: 5,
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    month: {
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    day: {
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    year: {
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  messages: {
    phone: {
      required: "Please enter a valid phone number"
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  submitHandler: function (form) {
    $("#submitButton").prop("disabled", true).text("Sending...");

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        $("#submitButton").prop("disabled", false).text("Submit");
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});

/*-----------------------------------------------------------------------*/
/*----------------------- Phone Number Input Mask -----------------------*/
/*-----------------------------------------------------------------------*/

$(document).ready(function(){
$('#phone').mask('0000000000');
});

/*-----------------------------------------------------------------------*/
/*---------------------------- Zip Code Lookup --------------------------*/
/*-----------------------------------------------------------------------*/


$('#zipCode').on("input",function(){
var zipCode = $('#zipCode').val();
if(zipCode.length == 5)
{
$.ajax({
type: 'GET',
url:'https://ziplookup.visualyzers.com/Ziplookup?zipcode=' + zipCode,
success:function(results){
$('#city').val(results.city);
$('#state').val(results.state);
}

})
}
});



$(function() {
$( "#datepicker" ).datepicker({
dateFormat : 'mm/dd/yy',
changeMonth : true,
changeYear : true,
yearRange: '-100y:c+nn',
maxDate: '-1d'
});
});




/*-----------------------------------------------------------------------*/
/*--------------------------- Date of Birth  ----------------------------*/
/*-----------------------------------------------------------------------*/

$(document).ready(function() {
$.getJSON('https://api.ipify.org?format=jsonp&callback=?', function(data) {
$('#IpAddress').val(data.ip);
});

$.dobPicker({
daySelector: '#dobday',
/* Required */
monthSelector: '#dobmonth',
/* Required */
yearSelector: '#dobyear',
/* Required */
dayDefault: 'Day',
/* Optional */
monthDefault: 'Month',
/* Optional */
yearDefault: 'Year',
/* Optional */
minimumAge: 18,
/* Optional */
maximumAge: 100 /* Optional */
});
});




window.dataLayer = window.dataLayer || [];
$.dataLayer.push({
'event':'ec_formsubmit',
'enhanced_conversion_data': {
first_name: $('#firstname').val(),
last_name: $('#lastname').val(),
phone_number: $('#phone').val(),
email_address: $('#email').val(),
street: $('#street').val(),
city: $('#city').val(),
postal_code: $('#zip').val(),
dobday: $('#dobday').val(),
dobmonth: $('#dobmonth').val(),
dobyear: $('#dobyear').val(),     
date_of_birth: $('#dob').val(),  
plan_condition: $('.planConditions').val(),        
plan_option: $('.planOption').val(),       
}
})



</script>



<script>
document.getElementById("valForm").addEventListener("submit", function(e) {
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  let state = document.getElementById("state").value.trim();
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  if (!valid) {
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    alert("Form errors:\n- " + errors.join("\n- "));
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});
</script>


    <!--Vendor-JS-->
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    <!--Plugin-JS-->


    <!-- ======= Javascripts =======-->
    <script src="assets/vendors/bootstrap/bootstrap.bundle.min.js"></script>
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    <script src="assets/js/custom.js"></script>
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</html>