{"SUCCESS":true,"html":"<div class=\"modal__content\">\n    <p class=\"modal__title\">\u0417\u0430\u043f\u0438\u0441\u044c \u043d\u0430 \u043f\u0440\u0438\u0451\u043c<\/p>\n    <form action=\"\/ajax\/form\/handlerDiagnosticForm.php\" method=\"post\" name=\"RECORD_RECEPTION\" enctype=\"application\/x-www-form-urlencoded\" class=\"diagnostic-form\"\n          data-vv-scope=\"diagnostic_form\"\n          @submit.prevent=\"ajaxSubmit('diagnostic_form')\"\n          data-layer='{\"event\":\"Submitform1\", \"eventAction\":\"\u0423\u0441\u043f\u0435\u0448\u043d\u043e \u0437\u0430\u043f\u043e\u043b\u043d\u0435\u043d\u0430 \u0444\u043e\u0440\u043c\u0430\"}'\n    >\n\t    <input type=\"hidden\" name=\"WEB_FORM_ID\" value=\"1\">\n        <select-group\n            name=\"form_text_1\"\n            placeholder=\"\u0412\u044b\u0431\u0435\u0440\u0438\u0442\u0435 \u0441\u0430\u043b\u043e\u043d\"\n            :has-error=\"errors.has('diagnostic_form.form_text_1')\"\n            error-msg=\"\u041e\u0431\u044f\u0437\u0430\u0442\u0435\u043b\u044c\u043d\u043e\u0435 \u043f\u043e\u043b\u0435\"\n            v-validate=\"'required'\"\n        >\n\t        \t\t        <option value=\"2 \u043f\u0435\u0440. \u041c\u0438\u0440\u0430, 24\">2 \u043f\u0435\u0440. \u041c\u0438\u0440\u0430, 24<\/option>\n\t\t        \t\t        <option value=\"\u0422\u0426 \u00ab\u041f\u041b\u0410\u0417\u0410\u00bb\">\u0422\u0426 \u00ab\u041f\u041b\u0410\u0417\u0410\u00bb<\/option>\n\t\t        \t\t        <option value=\"\u0422\u0426 \u00ab\u0412\u0430\u0432\u0438\u043b\u043e\u043d\u00bb\">\u0422\u0426 \u00ab\u0412\u0430\u0432\u0438\u043b\u043e\u043d\u00bb<\/option>\n\t\t                <\/select-group>\n        <text-input\n            val=\"\"\n            name=\"form_text_2\"\n            type=\"text\"\n            label=\"\"\n            placeholder=\"\u0418\u043c\u044f\"\n            error-msg=\"error msg\"\n            :disabled=\"false\"\n            text-input=\"\u0412\u0432\u0435\u0434\u0438\u0442\u0435 \u0412\u0430\u0448\u0435 \u0438\u043c\u044f\"\n            :has-error=\"errors.has('diagnostic_form.form_text_2')\"\n        ><\/text-input>\n        <phone-input\n            val=\"\"\n            name=\"form_text_3\"\n            type=\"text\"\n            label=\"\"\n            placeholder=\"\u0422\u0435\u043b\u0435\u0444\u043e\u043d\"\n            error-msg=\"\u041e\u0431\u044f\u0437\u044f\u0442\u0435\u043b\u044c\u043d\u043e\u0435 \u043f\u043e\u043b\u0435\"\n            :disabled=\"false\"\n            v-validate=\"'required|phone'\"\n            text-input=\"+7 (XXX) XXX-XX-XX\"\n            :has-error=\"errors.has('diagnostic_form.form_text_3')\"\n        ><\/phone-input>\n\t\t<div class=\"form-block\">\n\t\t\t<fieldset class=\"form-input\">\n\t\t\t\t<input name=\"captcha_code\" value=\"0fc5c96e1ec5f600795d67cbe55e7c01\" type=\"hidden\">\n\t\t\t\t<img src=\"\/bitrix\/tools\/captcha.php?captcha_code=0fc5c96e1ec5f600795d67cbe55e7c01\" style=\"margin-bottom: 10px;\">\n\t\t\t\t<label class=\"form-input__label\" for=\"captcha_word\">\n\t\t\t\t\t<input id=\"captcha_word\" name=\"captcha_word\" type=\"text\">\n\t\t\t\t\t<span class=\"form-input__placeholder\">\u041a\u0430\u043f\u0447\u0430<\/span>\n\t\t\t\t<\/label>\n\n\t\t\t<\/fieldset>\n\t\t<\/div>\n        <div class=\"confirm-block\">\n            <checkbox\n                name=\"DIAGNOSTIC_CONFIRM\"\n                label=\"\u042f \u0441\u043e\u0433\u043b\u0430\u0441\u0435\u043d \u043d\u0430 \u043e\u0431\u0440\u0430\u0431\u043e\u0442\u043a\u0443 \u0438 \u0445\u0440\u0430\u043d\u0435\u043d\u0438\u0435 \u043c\u043e\u0438\u0445 \u043f\u0435\u0440\u0441\u043e\u043d\u0430\u043b\u044c\u043d\u044b\u0445 \u0434\u0430\u043d\u043d\u044b\u0445 \u0441\u043e\u0433\u043b\u0430\u0441\u043d\u043e <a href='\/privacy-policy\/' class='link'>\u043f\u043e\u043b\u0438\u0442\u0438\u043a\u0435 \u043a\u043e\u043d\u0444\u0438\u0434\u0435\u043d\u0446\u0438\u0430\u043b\u044c\u043d\u043e\u0441\u0442\u0438<\/a>\"\n                v-model=\"confirm\"\n                :check-value=\"'confirm'\"\n                :disabled=\"false\"\n                v-validate=\"'required'\"\n                :has-error=\"errors.has('diagnostic_form.DIAGNOSTIC_CONFIRM')\"\n                error-msg=\"error msg\"\n            ><\/checkbox>\n        <\/div>\n        <button class=\"btn\" type=\"submit\">\u041e\u0442\u043f\u0440\u0430\u0432\u0438\u0442\u044c<\/button>\n\t    <input type=\"hidden\" value=\"\u041e\u0442\u043f\u0440\u0430\u0432\u0438\u0442\u044c\" name=\"web_form_submit\">\n\t    <input type=\"hidden\" name=\"sessid\" id=\"sessid_1\" value=\"2672769860b1fb8e30e7c0bdc11c285c\" \/>    <\/form>\n<\/div>\n"}