Lost Submission Confirmation

For some reason our confirmation of submission has disappeared. Can anyone help figure out why it suddenly stopped.

<div class="row">
   <div class="col-md-12 form-group">
      <label class="control-label">Date
      <span class="required">*</span>
      </label>
      [date* Date placeholder "yyyy-mm-dd"]
   </div>
   <div class="col-md-6 form-group">
      <label class="control-label">First Name
      <span class="required">*</span>
      </label>
      [text* your-name class:form-control class:input-md]
   </div>
   <div class="col-md-6 form-group">
      <label class="control-label">Last Name
      <span class="required">*</span>
      </label>
      [text* last-name class:form-control class:input-md]
   </div>
   <div class="col-md-12 form-group">
      <strong>Are you currently experiencing any of these symptoms? Choose any/all that apply.</strong>
   </div>
   <div class="col-md-6 form-group">
      <label class="control-label">Cough that's new or worsening (continuous, more than usual)</label>
      [radio Question1 default:0 "YES" "NO"]
      <label class="control-label">Runny or Stuffy Nose (not related to seasonal allergies or other known causes or conditions)</label>
      [radio Question2 default:0 "YES" "NO"]
      <label class="control-label">Shortness of breath (out of breath, unable to breathe deeply)</label>
      [radio Question3 default:0 "YES" "NO"]
      <label class="control-label">Extreme tiredness that is unusual (fatigue, lack of energy)</label>
      [radio Question4 default:0 "YES" "NO"]
      <label class="control-label">Muscle aches (different than usual)</label>
      [radio Question5 default:0 "YES" "NO"]
      <label class="control-label">Sore throat/Difficulty swallowing</label>
      [radio Question6 default:0 "YES" "NO"]
   </div>
   <div class="col-md-6 form-group">
      <label class="control-label">Fever (feeling hot to the touch, a temperature of 37.8° Celsius or higher)</label>
      [radio Question7 default:0 "YES" "NO"]
      <label class="control-label">Headache (non-injury related)</label>
      [radio Question8 default:0 "YES" "NO"]
      <label class="control-label">Digestive issues (nausea/vomiting, diarrhea)</label>
      [radio Question9 default:0 "YES" "NO"]
      <label class="control-label">Lost sense of taste or smell</label>
      [radio Question10 default:0 "YES" "NO"]
      <label class="control-label">If you have travelled outside the country in the past 10 days, did you have a positive Covid test? </label>
      [radio Question11 default:0 "YES" "NO"]
      <label class="control-label">Have you been in contact with anyone who has tested positive for the COVID-19 virus or experienced the symptoms above within the past 10 days?</label>
      [radio Question12 default:0 "YES" "NO"]
   </div>
   <div class="col-md-12 form-group">
      <strong>IF YOU ARE EXPOSED TO COVID FROM A FAMILY MEMBER YOU LIVE WITH OR CLOSE CONTACT OR IF YOU TEST POSITIVE, WE ARE REQUIRING 10 DAYS OF ISOLATION AND BEING COMPLETELY SYMPTOM FREE FOR 24HRS BEFORE RETURNING TO OUR CLINIC.</strong>
   </div>
   <div>
      <strong>If you have said YES to any of the above questions, please call the clinic you will be attending to clarify what the next step may be.</strong>
   </div>
   <div class="col-md-4 form-group">
      <strong>Mississauga (ORC) 905.822.1823</strong>
   </div>
   <div class="col-md-4 form-group">
      <strong>Oakville 905.337.2122</strong>
   </div>
   <div class="col-md-12 form-group">
      [acceptance Accept] I hereby acknowledge that the above answers are true to the best of my knowledge. I acknowledge and accept that there is a risk that I could be exposed to COVID-19 while attending Club Physio Plus. I also acknowledge and accept that while receiving services, the therapist may need to be closer than the recommended social distancing guidelines in order to assess and/or treat me. I acknowledge and confirm that I am willing to accept this risk as a condition of attending at Club Physio Plus to receive services from the therapist. In consideration of the therapist agreeing to see me in person at Club Physio Plus, I agree to release the therapist and Club Physio Plus (if applicable), their officers, directors, employees, agents and volunteers (the “Releasees”) from any and all causes of action, claims, demands, requests, damages or any recourse whatsoever in respect of any personal injuries or other damages which may occur or arise as a result of exposure to COVID-19 during my visit to Club Physio Plus and/or through the provision of services to me by the therapist. I do hereby acknowledge and agree that notwithstanding the generality of the foregoing, I declare that I will not commence litigation or otherwise seek to recover damages or other compensation against the Releasees based on any action, claim, demand, request, loss or any recourse whatsoever arising from any potential or actual exposure to COVID-19 while attending at Club Physio Plus and/or through the provision of services to me by the therapist. I further acknowledge that the Releasees can rely on this Release of Liability, Waiver of all Possible Claims and Assumption of Risk as a complete defence to any and all claims, damages, causes of action, or recourse or liability that may arise at any time. I have carefully reviewed this Release of Liability, Waiver of all Possible Claims and Assumption of Risk and acknowledge that I fully understand the terms as set out above. I acknowledge that I am signing this Release of Liability, Waiver of all Possible Claims and Assumption of Risk voluntarily.[/acceptance]
   </div>
   <div class="col-md-12 form-group">[recaptcha]</div>
   <div class="col-md-12 form-group">
      <label class="control-label">Please submit the completed consent to the appropriate clinic prior to your appointment: 
      PLEASE CLICK THE BOX AND PICK THE CLINIC LOCATION YOU ARE ATTENDING</label>
      [select your-recipient "Mississauga|ORC|[email protected]"
      "Oakville|[email protected]"]
      [submit id:submit class:btn class:btn-default "Submit"]

<h3>[response]</h3> 
   </div>
</div>

The page I need help with: [log in to see the link]