diff --git a/application/third_party/order/views/confirm_order.php b/application/third_party/order/views/confirm_order.php
index d72a5874..18051367 100644
--- a/application/third_party/order/views/confirm_order.php
+++ b/application/third_party/order/views/confirm_order.php
@@ -787,11 +787,7 @@ select.gender_pick {border: 1px solid #d1d1d1;
 					</div>
 				</div>
 
-				<div id="inquiryBox">
-					<h2>Your Special Request (optional)</h2>
-					<p></p>
-					<textarea id="special_request" name="special_request" style="resize:none;"></textarea>
-				</div>
+			
 
 				<div id="inquiryBox">
 					<h2>Emergency Contact Information (optional)</h2>
@@ -831,12 +827,11 @@ select.gender_pick {border: 1px solid #d1d1d1;
 						</div>
 					</div>
 				</div>
-
 				<div id="inquiryBox">
-					<h2>Your Insurance Information (Optional)</h2>
-					<textarea id="insurance_information" name="insurance_information" style="resize:none;"></textarea>
+					<h2>Your Insurance Information and Other Special Request (optional)</h2>
+					
+					<textarea id="special_request" name="special_request" style="resize:none;"></textarea>
 				</div>
-
 				<div class="inquiryBtn">          
           <input type="hidden" name="toname" value="<?php echo $userinfo[0]->OPI_FirstName; ?>">
           <input type="hidden" name="tomail" value="<?php echo $userinfo[0]->OPI_Email; ?>">