[cp:scripting
key='FormLabel'
targetFormId='PayOnline'
cssclass='form__label'
LabelText='Payment Option: ' /]
[cp:scripting
key='//FormListBox'
id='PayOnline'
cssclass='form__input'
AddListItems='<listItem index="1" value="Yes">Pay Online</listItem><listItem index="2" value="No">Pay at the Door or I Have Medicaid</listItem>'
PleaseSelect='Please select your payment option' /]