{"id":369,"date":"2020-06-06T11:14:56","date_gmt":"2020-06-06T08:14:56","guid":{"rendered":"https:\/\/tunded.ee\/eek\/"},"modified":"2020-10-21T23:13:52","modified_gmt":"2020-10-21T20:13:52","slug":"eek","status":"publish","type":"page","link":"https:\/\/tunded.ee\/en\/tests\/eek\/","title":{"rendered":"EWT"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;3.29.2&#8243; custom_padding=&#8221;0px||||false|false&#8221; fb_built=&#8221;1&#8243; _i=&#8221;0&#8243; _address=&#8221;0&#8243;][et_pb_row custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;3.29.2&#8243; custom_padding=&#8221;||0px||false|false&#8221; custom_padding_phone=&#8221;||5px||false|false&#8221; _i=&#8221;0&#8243; _address=&#8221;0.0&#8243;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.29.2&#8243; _i=&#8221;0&#8243; _address=&#8221;0.0.0&#8243;][et_pb_text _builder_version=&#8221;3.29.2&#8243; header_font=&#8221;|700|||on|||#e5b538|&#8221; hover_enabled=&#8221;0&#8243; header_font_size_phone=&#8221;35px&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; _i=&#8221;0&#8243; _address=&#8221;0.0.0.0&#8243;]<\/p>\n<h1>Emotional well-being test<\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;3.29.2&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; custom_padding=&#8221;0px||||false|false&#8221; _i=&#8221;1&#8243; _address=&#8221;0.1&#8243;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;3.25&#8243; custom_padding=&#8221;|||&#8221; _i=&#8221;0&#8243; _address=&#8221;0.1.0&#8243; custom_padding__hover=&#8221;|||&#8221;][et_pb_text _builder_version=&#8221;3.27.4&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; _i=&#8221;0&#8243; _address=&#8221;0.1.0.0&#8243;]<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/en\/wp-json\/wp\/v2\/pages\/369#gf_1' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_2\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_2\"><h2 class=\"gsection_title\">Your information<\/h2><div class='gsection_description' id='gfield_description_1_2'>1 \/ 7<\/div><\/li><li id=\"field_1_53\"  class=\"gfield gfield--type-text gf_section_right gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_53\"><label class='gfield_label gform-field-label' for='input_1_53' >Name or ID<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_1_53' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_60\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_60\"><div class='ginput_container ginput_container_text'><input name='input_60' id='input_1_60' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='07\/04\/2026' \/><\/div><\/li><li id=\"field_1_59\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_59\"><label class='gfield_label gform-field-label' for='input_1_59' >Age<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_1_59' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_69\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_69\"><label class='gfield_label gform-field-label'  >Sex<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_69'>\n\t\t\t<li class='gchoice gchoice_1_69_0'>\n\t\t\t\t<input name='input_69' type='radio' value='Female'  id='choice_1_69_0'    \/>\n\t\t\t\t<label for='choice_1_69_0' id='label_1_69_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_69_1'>\n\t\t\t\t<input name='input_69' type='radio' value='Male'  id='choice_1_69_1'    \/>\n\t\t\t\t<label for='choice_1_69_1' id='label_1_69_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_69_2'>\n\t\t\t\t<input name='input_69' type='radio' value='Choose not to disclose'  id='choice_1_69_2'    \/>\n\t\t\t\t<label for='choice_1_69_2' id='label_1_69_2' class='gform-field-label gform-field-label--type-inline'>Choose not to disclose<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_70\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_70\"><label class='gfield_label gform-field-label'  >Would you like to send results to a doctor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_70'>\n\t\t\t<li class='gchoice gchoice_1_70_0'>\n\t\t\t\t<input name='input_70' type='radio' value='No'  id='choice_1_70_0'    \/>\n\t\t\t\t<label for='choice_1_70_0' id='label_1_70_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_70_1'>\n\t\t\t\t<input name='input_70' type='radio' value='Yes'  id='choice_1_70_1'    \/>\n\t\t\t\t<label for='choice_1_70_1' id='label_1_70_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_71\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_71\"><label class='gfield_label gform-field-label' for='input_1_71' >Choose a doctor<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_71' id='input_1_71' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Mari-Liis Laanetu' >Mari-Liis Laanetu<\/option><option value='Mall Lepiksoo' >Mall Lepiksoo<\/option><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_3' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-3' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_63\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_63\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_63'>2 \/ 7 <\/div><\/li><li id=\"field_1_11\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_11\"><label class='gfield_label gform-field-label'  >1. Feelings of sadness<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_11'>\n\t\t\t<li class='gchoice gchoice_1_11_0'>\n\t\t\t\t<input name='input_11' type='radio' value='0'  id='choice_1_11_0'    \/>\n\t\t\t\t<label for='choice_1_11_0' id='label_1_11_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_11_1'>\n\t\t\t\t<input name='input_11' type='radio' value='1'  id='choice_1_11_1'    \/>\n\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_11_2'>\n\t\t\t\t<input name='input_11' type='radio' value='2'  id='choice_1_11_2'    \/>\n\t\t\t\t<label for='choice_1_11_2' id='label_1_11_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_11_3'>\n\t\t\t\t<input name='input_11' type='radio' value='3'  id='choice_1_11_3'    \/>\n\t\t\t\t<label for='choice_1_11_3' id='label_1_11_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_11_4'>\n\t\t\t\t<input name='input_11' type='radio' value='4'  id='choice_1_11_4'    \/>\n\t\t\t\t<label for='choice_1_11_4' id='label_1_11_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_12\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_12\"><label class='gfield_label gform-field-label'  >2. Feeling no interest or pleasure in things<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_12'>\n\t\t\t<li class='gchoice gchoice_1_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='0'  id='choice_1_12_0'    \/>\n\t\t\t\t<label for='choice_1_12_0' id='label_1_12_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='1'  id='choice_1_12_1'    \/>\n\t\t\t\t<label for='choice_1_12_1' id='label_1_12_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='2'  id='choice_1_12_2'    \/>\n\t\t\t\t<label for='choice_1_12_2' id='label_1_12_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_3'>\n\t\t\t\t<input name='input_12' type='radio' value='3'  id='choice_1_12_3'    \/>\n\t\t\t\t<label for='choice_1_12_3' id='label_1_12_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_4'>\n\t\t\t\t<input name='input_12' type='radio' value='4'  id='choice_1_12_4'    \/>\n\t\t\t\t<label for='choice_1_12_4' id='label_1_12_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_13\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_13\"><label class='gfield_label gform-field-label'  >3. Feelings of worthlessness<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_13'>\n\t\t\t<li class='gchoice gchoice_1_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='0'  id='choice_1_13_0'    \/>\n\t\t\t\t<label for='choice_1_13_0' id='label_1_13_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='1'  id='choice_1_13_1'    \/>\n\t\t\t\t<label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_13_2'>\n\t\t\t\t<input name='input_13' type='radio' value='2'  id='choice_1_13_2'    \/>\n\t\t\t\t<label for='choice_1_13_2' id='label_1_13_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_13_3'>\n\t\t\t\t<input name='input_13' type='radio' value='3'  id='choice_1_13_3'    \/>\n\t\t\t\t<label for='choice_1_13_3' id='label_1_13_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_13_4'>\n\t\t\t\t<input name='input_13' type='radio' value='4'  id='choice_1_13_4'    \/>\n\t\t\t\t<label for='choice_1_13_4' id='label_1_13_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_14\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_14\"><label class='gfield_label gform-field-label'  >4. Self-accusations<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_14'>\n\t\t\t<li class='gchoice gchoice_1_14_0'>\n\t\t\t\t<input name='input_14' type='radio' value='0'  id='choice_1_14_0'    \/>\n\t\t\t\t<label for='choice_1_14_0' id='label_1_14_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_14_1'>\n\t\t\t\t<input name='input_14' type='radio' value='1'  id='choice_1_14_1'    \/>\n\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_14_2'>\n\t\t\t\t<input name='input_14' type='radio' value='2'  id='choice_1_14_2'    \/>\n\t\t\t\t<label for='choice_1_14_2' id='label_1_14_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_14_3'>\n\t\t\t\t<input name='input_14' type='radio' value='3'  id='choice_1_14_3'    \/>\n\t\t\t\t<label for='choice_1_14_3' id='label_1_14_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_14_4'>\n\t\t\t\t<input name='input_14' type='radio' value='4'  id='choice_1_14_4'    \/>\n\t\t\t\t<label for='choice_1_14_4' id='label_1_14_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_16\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_16\"><label class='gfield_label gform-field-label'  >5. Recurrent thoughts of death or suicide<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_16'>\n\t\t\t<li class='gchoice gchoice_1_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='0'  id='choice_1_16_0'    \/>\n\t\t\t\t<label for='choice_1_16_0' id='label_1_16_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='1'  id='choice_1_16_1'    \/>\n\t\t\t\t<label for='choice_1_16_1' id='label_1_16_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_16_2'>\n\t\t\t\t<input name='input_16' type='radio' value='2'  id='choice_1_16_2'    \/>\n\t\t\t\t<label for='choice_1_16_2' id='label_1_16_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_16_3'>\n\t\t\t\t<input name='input_16' type='radio' value='3'  id='choice_1_16_3'    \/>\n\t\t\t\t<label for='choice_1_16_3' id='label_1_16_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_16_4'>\n\t\t\t\t<input name='input_16' type='radio' value='4'  id='choice_1_16_4'    \/>\n\t\t\t\t<label for='choice_1_16_4' id='label_1_16_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_15' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_15' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_64\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_64\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_64'>3 \/ 7<\/div><\/li><li id=\"field_1_17\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_17\"><label class='gfield_label gform-field-label'  >6. Feeling lonely<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_17'>\n\t\t\t<li class='gchoice gchoice_1_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='0'  id='choice_1_17_0'    \/>\n\t\t\t\t<label for='choice_1_17_0' id='label_1_17_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='1'  id='choice_1_17_1'    \/>\n\t\t\t\t<label for='choice_1_17_1' id='label_1_17_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_17_2'>\n\t\t\t\t<input name='input_17' type='radio' value='2'  id='choice_1_17_2'    \/>\n\t\t\t\t<label for='choice_1_17_2' id='label_1_17_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_17_3'>\n\t\t\t\t<input name='input_17' type='radio' value='3'  id='choice_1_17_3'    \/>\n\t\t\t\t<label for='choice_1_17_3' id='label_1_17_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_17_4'>\n\t\t\t\t<input name='input_17' type='radio' value='4'  id='choice_1_17_4'    \/>\n\t\t\t\t<label for='choice_1_17_4' id='label_1_17_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_18\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_18\"><label class='gfield_label gform-field-label'  >7. Hopelessness about the future<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_18'>\n\t\t\t<li class='gchoice gchoice_1_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='0'  id='choice_1_18_0'    \/>\n\t\t\t\t<label for='choice_1_18_0' id='label_1_18_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='1'  id='choice_1_18_1'    \/>\n\t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_2'>\n\t\t\t\t<input name='input_18' type='radio' value='2'  id='choice_1_18_2'    \/>\n\t\t\t\t<label for='choice_1_18_2' id='label_1_18_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_3'>\n\t\t\t\t<input name='input_18' type='radio' value='3'  id='choice_1_18_3'    \/>\n\t\t\t\t<label for='choice_1_18_3' id='label_1_18_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_4'>\n\t\t\t\t<input name='input_18' type='radio' value='4'  id='choice_1_18_4'    \/>\n\t\t\t\t<label for='choice_1_18_4' id='label_1_18_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_19\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_19\"><label class='gfield_label gform-field-label'  >8. Impossible to enjoy things<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_19'>\n\t\t\t<li class='gchoice gchoice_1_19_0'>\n\t\t\t\t<input name='input_19' type='radio' value='0'  id='choice_1_19_0'    \/>\n\t\t\t\t<label for='choice_1_19_0' id='label_1_19_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_19_1'>\n\t\t\t\t<input name='input_19' type='radio' value='1'  id='choice_1_19_1'    \/>\n\t\t\t\t<label for='choice_1_19_1' id='label_1_19_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_19_2'>\n\t\t\t\t<input name='input_19' type='radio' value='2'  id='choice_1_19_2'    \/>\n\t\t\t\t<label for='choice_1_19_2' id='label_1_19_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_19_3'>\n\t\t\t\t<input name='input_19' type='radio' value='3'  id='choice_1_19_3'    \/>\n\t\t\t\t<label for='choice_1_19_3' id='label_1_19_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_19_4'>\n\t\t\t\t<input name='input_19' type='radio' value='4'  id='choice_1_19_4'    \/>\n\t\t\t\t<label for='choice_1_19_4' id='label_1_19_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_20\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_20\"><label class='gfield_label gform-field-label'  >9. Feeling easily irritated or annoyed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_20'>\n\t\t\t<li class='gchoice gchoice_1_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='0'  id='choice_1_20_0'    \/>\n\t\t\t\t<label for='choice_1_20_0' id='label_1_20_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='1'  id='choice_1_20_1'    \/>\n\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_2'>\n\t\t\t\t<input name='input_20' type='radio' value='2'  id='choice_1_20_2'    \/>\n\t\t\t\t<label for='choice_1_20_2' id='label_1_20_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_3'>\n\t\t\t\t<input name='input_20' type='radio' value='3'  id='choice_1_20_3'    \/>\n\t\t\t\t<label for='choice_1_20_3' id='label_1_20_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_4'>\n\t\t\t\t<input name='input_20' type='radio' value='4'  id='choice_1_20_4'    \/>\n\t\t\t\t<label for='choice_1_20_4' id='label_1_20_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_21\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_21\"><label class='gfield_label gform-field-label'  >10. Feeling anxious or fearful<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_21'>\n\t\t\t<li class='gchoice gchoice_1_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='0'  id='choice_1_21_0'    \/>\n\t\t\t\t<label for='choice_1_21_0' id='label_1_21_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='1'  id='choice_1_21_1'    \/>\n\t\t\t\t<label for='choice_1_21_1' id='label_1_21_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_21_2'>\n\t\t\t\t<input name='input_21' type='radio' value='2'  id='choice_1_21_2'    \/>\n\t\t\t\t<label for='choice_1_21_2' id='label_1_21_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_21_3'>\n\t\t\t\t<input name='input_21' type='radio' value='3'  id='choice_1_21_3'    \/>\n\t\t\t\t<label for='choice_1_21_3' id='label_1_21_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_21_4'>\n\t\t\t\t<input name='input_21' type='radio' value='4'  id='choice_1_21_4'    \/>\n\t\t\t\t<label for='choice_1_21_4' id='label_1_21_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_26' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_26' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' data-js='page-field-id-26' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_65\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_65\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_65'>4 \/ 7<\/div><\/li><li id=\"field_1_22\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_22\"><label class='gfield_label gform-field-label'  >11. Tension or inability to relax<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_22'>\n\t\t\t<li class='gchoice gchoice_1_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='0'  id='choice_1_22_0'    \/>\n\t\t\t\t<label for='choice_1_22_0' id='label_1_22_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='1'  id='choice_1_22_1'    \/>\n\t\t\t\t<label for='choice_1_22_1' id='label_1_22_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_22_2'>\n\t\t\t\t<input name='input_22' type='radio' value='2'  id='choice_1_22_2'    \/>\n\t\t\t\t<label for='choice_1_22_2' id='label_1_22_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_22_3'>\n\t\t\t\t<input name='input_22' type='radio' value='3'  id='choice_1_22_3'    \/>\n\t\t\t\t<label for='choice_1_22_3' id='label_1_22_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_22_4'>\n\t\t\t\t<input name='input_22' type='radio' value='4'  id='choice_1_22_4'    \/>\n\t\t\t\t<label for='choice_1_22_4' id='label_1_22_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_23\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_23\"><label class='gfield_label gform-field-label'  >12. Excessive worry about several different things<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_23'>\n\t\t\t<li class='gchoice gchoice_1_23_0'>\n\t\t\t\t<input name='input_23' type='radio' value='0'  id='choice_1_23_0'    \/>\n\t\t\t\t<label for='choice_1_23_0' id='label_1_23_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_23_1'>\n\t\t\t\t<input name='input_23' type='radio' value='1'  id='choice_1_23_1'    \/>\n\t\t\t\t<label for='choice_1_23_1' id='label_1_23_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_23_2'>\n\t\t\t\t<input name='input_23' type='radio' value='2'  id='choice_1_23_2'    \/>\n\t\t\t\t<label for='choice_1_23_2' id='label_1_23_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_23_3'>\n\t\t\t\t<input name='input_23' type='radio' value='3'  id='choice_1_23_3'    \/>\n\t\t\t\t<label for='choice_1_23_3' id='label_1_23_3' class='gform-field-label gform-field-label--type-inline'>Sageli<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_23_4'>\n\t\t\t\t<input name='input_23' type='radio' value='4'  id='choice_1_23_4'    \/>\n\t\t\t\t<label for='choice_1_23_4' id='label_1_23_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_24\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_24\"><label class='gfield_label gform-field-label'  >13. Feeling so restless that it\u2019s hard to sit still<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_24'>\n\t\t\t<li class='gchoice gchoice_1_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='0'  id='choice_1_24_0'    \/>\n\t\t\t\t<label for='choice_1_24_0' id='label_1_24_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='1'  id='choice_1_24_1'    \/>\n\t\t\t\t<label for='choice_1_24_1' id='label_1_24_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_24_2'>\n\t\t\t\t<input name='input_24' type='radio' value='2'  id='choice_1_24_2'    \/>\n\t\t\t\t<label for='choice_1_24_2' id='label_1_24_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_24_3'>\n\t\t\t\t<input name='input_24' type='radio' value='3'  id='choice_1_24_3'    \/>\n\t\t\t\t<label for='choice_1_24_3' id='label_1_24_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_24_4'>\n\t\t\t\t<input name='input_24' type='radio' value='4'  id='choice_1_24_4'    \/>\n\t\t\t\t<label for='choice_1_24_4' id='label_1_24_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_25\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_25\"><label class='gfield_label gform-field-label'  >14. Easily startled<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_25'>\n\t\t\t<li class='gchoice gchoice_1_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='0'  id='choice_1_25_0'    \/>\n\t\t\t\t<label for='choice_1_25_0' id='label_1_25_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='1'  id='choice_1_25_1'    \/>\n\t\t\t\t<label for='choice_1_25_1' id='label_1_25_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_25_2'>\n\t\t\t\t<input name='input_25' type='radio' value='2'  id='choice_1_25_2'    \/>\n\t\t\t\t<label for='choice_1_25_2' id='label_1_25_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_25_3'>\n\t\t\t\t<input name='input_25' type='radio' value='3'  id='choice_1_25_3'    \/>\n\t\t\t\t<label for='choice_1_25_3' id='label_1_25_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_25_4'>\n\t\t\t\t<input name='input_25' type='radio' value='4'  id='choice_1_25_4'    \/>\n\t\t\t\t<label for='choice_1_25_4' id='label_1_25_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_30\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_30\"><label class='gfield_label gform-field-label'  >15. Sudden attacks of panic with palpitations, shortness of breath, fainting,or other frightening bodily sensations<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_30'>\n\t\t\t<li class='gchoice gchoice_1_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='0'  id='choice_1_30_0'    \/>\n\t\t\t\t<label for='choice_1_30_0' id='label_1_30_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='1'  id='choice_1_30_1'    \/>\n\t\t\t\t<label for='choice_1_30_1' id='label_1_30_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_2'>\n\t\t\t\t<input name='input_30' type='radio' value='2'  id='choice_1_30_2'    \/>\n\t\t\t\t<label for='choice_1_30_2' id='label_1_30_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_3'>\n\t\t\t\t<input name='input_30' type='radio' value='3'  id='choice_1_30_3'    \/>\n\t\t\t\t<label for='choice_1_30_3' id='label_1_30_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_4'>\n\t\t\t\t<input name='input_30' type='radio' value='4'  id='choice_1_30_4'    \/>\n\t\t\t\t<label for='choice_1_30_4' id='label_1_30_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_29' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_29' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' data-js='page-field-id-29' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_66\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_66\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_66'>5 \/ 7<\/div><\/li><li id=\"field_1_31\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_31\"><label class='gfield_label gform-field-label'  >16. Fear of being alone away from home<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_31'>\n\t\t\t<li class='gchoice gchoice_1_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='0'  id='choice_1_31_0'    \/>\n\t\t\t\t<label for='choice_1_31_0' id='label_1_31_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='1'  id='choice_1_31_1'    \/>\n\t\t\t\t<label for='choice_1_31_1' id='label_1_31_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_2'>\n\t\t\t\t<input name='input_31' type='radio' value='2'  id='choice_1_31_2'    \/>\n\t\t\t\t<label for='choice_1_31_2' id='label_1_31_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_3'>\n\t\t\t\t<input name='input_31' type='radio' value='3'  id='choice_1_31_3'    \/>\n\t\t\t\t<label for='choice_1_31_3' id='label_1_31_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_4'>\n\t\t\t\t<input name='input_31' type='radio' value='4'  id='choice_1_31_4'    \/>\n\t\t\t\t<label for='choice_1_31_4' id='label_1_31_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_32\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_32\"><label class='gfield_label gform-field-label'  >17. Fear of being on streets or at open places<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_32'>\n\t\t\t<li class='gchoice gchoice_1_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='0'  id='choice_1_32_0'    \/>\n\t\t\t\t<label for='choice_1_32_0' id='label_1_32_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_32_1'>\n\t\t\t\t<input name='input_32' type='radio' value='1'  id='choice_1_32_1'    \/>\n\t\t\t\t<label for='choice_1_32_1' id='label_1_32_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_32_2'>\n\t\t\t\t<input name='input_32' type='radio' value='2'  id='choice_1_32_2'    \/>\n\t\t\t\t<label for='choice_1_32_2' id='label_1_32_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_32_3'>\n\t\t\t\t<input name='input_32' type='radio' value='3'  id='choice_1_32_3'    \/>\n\t\t\t\t<label for='choice_1_32_3' id='label_1_32_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_32_4'>\n\t\t\t\t<input name='input_32' type='radio' value='4'  id='choice_1_32_4'    \/>\n\t\t\t\t<label for='choice_1_32_4' id='label_1_32_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_33\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_33\"><label class='gfield_label gform-field-label'  >18. Fear of fainting in public<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_33'>\n\t\t\t<li class='gchoice gchoice_1_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='0'  id='choice_1_33_0'    \/>\n\t\t\t\t<label for='choice_1_33_0' id='label_1_33_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_1'>\n\t\t\t\t<input name='input_33' type='radio' value='1'  id='choice_1_33_1'    \/>\n\t\t\t\t<label for='choice_1_33_1' id='label_1_33_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_2'>\n\t\t\t\t<input name='input_33' type='radio' value='2'  id='choice_1_33_2'    \/>\n\t\t\t\t<label for='choice_1_33_2' id='label_1_33_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_3'>\n\t\t\t\t<input name='input_33' type='radio' value='3'  id='choice_1_33_3'    \/>\n\t\t\t\t<label for='choice_1_33_3' id='label_1_33_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_4'>\n\t\t\t\t<input name='input_33' type='radio' value='4'  id='choice_1_33_4'    \/>\n\t\t\t\t<label for='choice_1_33_4' id='label_1_33_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_34\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_34\"><label class='gfield_label gform-field-label'  >19. Fear of travelling by bus, tram, train, or car<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_34'>\n\t\t\t<li class='gchoice gchoice_1_34_0'>\n\t\t\t\t<input name='input_34' type='radio' value='0'  id='choice_1_34_0'    \/>\n\t\t\t\t<label for='choice_1_34_0' id='label_1_34_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_34_1'>\n\t\t\t\t<input name='input_34' type='radio' value='1'  id='choice_1_34_1'    \/>\n\t\t\t\t<label for='choice_1_34_1' id='label_1_34_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_34_2'>\n\t\t\t\t<input name='input_34' type='radio' value='2'  id='choice_1_34_2'    \/>\n\t\t\t\t<label for='choice_1_34_2' id='label_1_34_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_34_3'>\n\t\t\t\t<input name='input_34' type='radio' value='3'  id='choice_1_34_3'    \/>\n\t\t\t\t<label for='choice_1_34_3' id='label_1_34_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_34_4'>\n\t\t\t\t<input name='input_34' type='radio' value='4'  id='choice_1_34_4'    \/>\n\t\t\t\t<label for='choice_1_34_4' id='label_1_34_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_35\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_35\"><label class='gfield_label gform-field-label'  >20. Fear of being in the centre of attention<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_35'>\n\t\t\t<li class='gchoice gchoice_1_35_0'>\n\t\t\t\t<input name='input_35' type='radio' value='0'  id='choice_1_35_0'    \/>\n\t\t\t\t<label for='choice_1_35_0' id='label_1_35_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_1'>\n\t\t\t\t<input name='input_35' type='radio' value='1'  id='choice_1_35_1'    \/>\n\t\t\t\t<label for='choice_1_35_1' id='label_1_35_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_2'>\n\t\t\t\t<input name='input_35' type='radio' value='2'  id='choice_1_35_2'    \/>\n\t\t\t\t<label for='choice_1_35_2' id='label_1_35_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_3'>\n\t\t\t\t<input name='input_35' type='radio' value='3'  id='choice_1_35_3'    \/>\n\t\t\t\t<label for='choice_1_35_3' id='label_1_35_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_4'>\n\t\t\t\t<input name='input_35' type='radio' value='4'  id='choice_1_35_4'    \/>\n\t\t\t\t<label for='choice_1_35_4' id='label_1_35_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_37' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_37' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' data-js='page-field-id-37' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_67\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_67\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_67'>6 \/ 7<\/div><\/li><li id=\"field_1_36\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_36\"><label class='gfield_label gform-field-label'  >21. Fear of talking to strangers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_36'>\n\t\t\t<li class='gchoice gchoice_1_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='0'  id='choice_1_36_0'    \/>\n\t\t\t\t<label for='choice_1_36_0' id='label_1_36_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_36_1'>\n\t\t\t\t<input name='input_36' type='radio' value='1'  id='choice_1_36_1'    \/>\n\t\t\t\t<label for='choice_1_36_1' id='label_1_36_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_36_2'>\n\t\t\t\t<input name='input_36' type='radio' value='2'  id='choice_1_36_2'    \/>\n\t\t\t\t<label for='choice_1_36_2' id='label_1_36_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_36_3'>\n\t\t\t\t<input name='input_36' type='radio' value='3'  id='choice_1_36_3'    \/>\n\t\t\t\t<label for='choice_1_36_3' id='label_1_36_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_36_4'>\n\t\t\t\t<input name='input_36' type='radio' value='4'  id='choice_1_36_4'    \/>\n\t\t\t\t<label for='choice_1_36_4' id='label_1_36_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_38\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_38\"><label class='gfield_label gform-field-label'  >22. Fatigue or loss of energy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_38'>\n\t\t\t<li class='gchoice gchoice_1_38_0'>\n\t\t\t\t<input name='input_38' type='radio' value='0'  id='choice_1_38_0'    \/>\n\t\t\t\t<label for='choice_1_38_0' id='label_1_38_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_38_1'>\n\t\t\t\t<input name='input_38' type='radio' value='1'  id='choice_1_38_1'    \/>\n\t\t\t\t<label for='choice_1_38_1' id='label_1_38_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_38_2'>\n\t\t\t\t<input name='input_38' type='radio' value='2'  id='choice_1_38_2'    \/>\n\t\t\t\t<label for='choice_1_38_2' id='label_1_38_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_38_3'>\n\t\t\t\t<input name='input_38' type='radio' value='3'  id='choice_1_38_3'    \/>\n\t\t\t\t<label for='choice_1_38_3' id='label_1_38_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_38_4'>\n\t\t\t\t<input name='input_38' type='radio' value='4'  id='choice_1_38_4'    \/>\n\t\t\t\t<label for='choice_1_38_4' id='label_1_38_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_39\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_39\"><label class='gfield_label gform-field-label'  >23. Diminished ability to focus or concentrate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_39'>\n\t\t\t<li class='gchoice gchoice_1_39_0'>\n\t\t\t\t<input name='input_39' type='radio' value='0'  id='choice_1_39_0'    \/>\n\t\t\t\t<label for='choice_1_39_0' id='label_1_39_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_39_1'>\n\t\t\t\t<input name='input_39' type='radio' value='1'  id='choice_1_39_1'    \/>\n\t\t\t\t<label for='choice_1_39_1' id='label_1_39_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_39_2'>\n\t\t\t\t<input name='input_39' type='radio' value='2'  id='choice_1_39_2'    \/>\n\t\t\t\t<label for='choice_1_39_2' id='label_1_39_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_39_3'>\n\t\t\t\t<input name='input_39' type='radio' value='3'  id='choice_1_39_3'    \/>\n\t\t\t\t<label for='choice_1_39_3' id='label_1_39_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_39_4'>\n\t\t\t\t<input name='input_39' type='radio' value='4'  id='choice_1_39_4'    \/>\n\t\t\t\t<label for='choice_1_39_4' id='label_1_39_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_40\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_40\"><label class='gfield_label gform-field-label'  >24. Rest does not restore strength<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_40'>\n\t\t\t<li class='gchoice gchoice_1_40_0'>\n\t\t\t\t<input name='input_40' type='radio' value='0'  id='choice_1_40_0'    \/>\n\t\t\t\t<label for='choice_1_40_0' id='label_1_40_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_40_1'>\n\t\t\t\t<input name='input_40' type='radio' value='1'  id='choice_1_40_1'    \/>\n\t\t\t\t<label for='choice_1_40_1' id='label_1_40_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_40_2'>\n\t\t\t\t<input name='input_40' type='radio' value='2'  id='choice_1_40_2'    \/>\n\t\t\t\t<label for='choice_1_40_2' id='label_1_40_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_40_3'>\n\t\t\t\t<input name='input_40' type='radio' value='3'  id='choice_1_40_3'    \/>\n\t\t\t\t<label for='choice_1_40_3' id='label_1_40_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_40_4'>\n\t\t\t\t<input name='input_40' type='radio' value='4'  id='choice_1_40_4'    \/>\n\t\t\t\t<label for='choice_1_40_4' id='label_1_40_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_41\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_41\"><label class='gfield_label gform-field-label'  >25. Being easily fatigued<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_41'>\n\t\t\t<li class='gchoice gchoice_1_41_0'>\n\t\t\t\t<input name='input_41' type='radio' value='0'  id='choice_1_41_0'    \/>\n\t\t\t\t<label for='choice_1_41_0' id='label_1_41_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_41_1'>\n\t\t\t\t<input name='input_41' type='radio' value='1'  id='choice_1_41_1'    \/>\n\t\t\t\t<label for='choice_1_41_1' id='label_1_41_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_41_2'>\n\t\t\t\t<input name='input_41' type='radio' value='2'  id='choice_1_41_2'    \/>\n\t\t\t\t<label for='choice_1_41_2' id='label_1_41_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_41_3'>\n\t\t\t\t<input name='input_41' type='radio' value='3'  id='choice_1_41_3'    \/>\n\t\t\t\t<label for='choice_1_41_3' id='label_1_41_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_41_4'>\n\t\t\t\t<input name='input_41' type='radio' value='4'  id='choice_1_41_4'    \/>\n\t\t\t\t<label for='choice_1_41_4' id='label_1_41_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_58' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_58' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_7' class='gform_page' data-js='page-field-id-58' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_7' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_68\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_68\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_68'>7 \/ 7<\/div><\/li><li id=\"field_1_43\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_43\"><label class='gfield_label gform-field-label'  >26. Difficulty falling asleep<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_43'>\n\t\t\t<li class='gchoice gchoice_1_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='0'  id='choice_1_43_0'    \/>\n\t\t\t\t<label for='choice_1_43_0' id='label_1_43_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='1'  id='choice_1_43_1'    \/>\n\t\t\t\t<label for='choice_1_43_1' id='label_1_43_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='2'  id='choice_1_43_2'    \/>\n\t\t\t\t<label for='choice_1_43_2' id='label_1_43_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_3'>\n\t\t\t\t<input name='input_43' type='radio' value='3'  id='choice_1_43_3'    \/>\n\t\t\t\t<label for='choice_1_43_3' id='label_1_43_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_4'>\n\t\t\t\t<input name='input_43' type='radio' value='4'  id='choice_1_43_4'    \/>\n\t\t\t\t<label for='choice_1_43_4' id='label_1_43_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_44\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_44\"><label class='gfield_label gform-field-label'  >27. Restless or disturbed sleep<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_44'>\n\t\t\t<li class='gchoice gchoice_1_44_0'>\n\t\t\t\t<input name='input_44' type='radio' value='0'  id='choice_1_44_0'    \/>\n\t\t\t\t<label for='choice_1_44_0' id='label_1_44_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_44_1'>\n\t\t\t\t<input name='input_44' type='radio' value='1'  id='choice_1_44_1'    \/>\n\t\t\t\t<label for='choice_1_44_1' id='label_1_44_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_44_2'>\n\t\t\t\t<input name='input_44' type='radio' value='2'  id='choice_1_44_2'    \/>\n\t\t\t\t<label for='choice_1_44_2' id='label_1_44_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_44_3'>\n\t\t\t\t<input name='input_44' type='radio' value='3'  id='choice_1_44_3'    \/>\n\t\t\t\t<label for='choice_1_44_3' id='label_1_44_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_44_4'>\n\t\t\t\t<input name='input_44' type='radio' value='4'  id='choice_1_44_4'    \/>\n\t\t\t\t<label for='choice_1_44_4' id='label_1_44_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_45\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_45\"><label class='gfield_label gform-field-label'  >28. Waking up too early<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_45'>\n\t\t\t<li class='gchoice gchoice_1_45_0'>\n\t\t\t\t<input name='input_45' type='radio' value='0'  id='choice_1_45_0'    \/>\n\t\t\t\t<label for='choice_1_45_0' id='label_1_45_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_45_1'>\n\t\t\t\t<input name='input_45' type='radio' value='1'  id='choice_1_45_1'    \/>\n\t\t\t\t<label for='choice_1_45_1' id='label_1_45_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_45_2'>\n\t\t\t\t<input name='input_45' type='radio' value='2'  id='choice_1_45_2'    \/>\n\t\t\t\t<label for='choice_1_45_2' id='label_1_45_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_45_3'>\n\t\t\t\t<input name='input_45' type='radio' value='3'  id='choice_1_45_3'    \/>\n\t\t\t\t<label for='choice_1_45_3' id='label_1_45_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_45_4'>\n\t\t\t\t<input name='input_45' type='radio' value='4'  id='choice_1_45_4'    \/>\n\t\t\t\t<label for='choice_1_45_4' id='label_1_45_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_28\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_28\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_28' >Depressioon (1-8)<\/label><div class='ginput_container ginput_container_number'><input name='input_28' id='input_1_28' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_46\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_46\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_46' >\u00dcldistunud \u00e4revus (9-14)<\/label><div class='ginput_container ginput_container_number'><input name='input_46' id='input_1_46' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_47\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_47\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_47' >Paanikah\u00e4ire (15-19)<\/label><div class='ginput_container ginput_container_number'><input name='input_47' id='input_1_47' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_48\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_48\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_48' >Sotsiaal\u00e4revus (20-21)<\/label><div class='ginput_container ginput_container_number'><input name='input_48' id='input_1_48' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_49\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_49\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_49' >Asteenia (22-25)<\/label><div class='ginput_container ginput_container_number'><input name='input_49' id='input_1_49' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_50\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_50\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_50' >Insomnia (26-28)<\/label><div class='ginput_container ginput_container_number'><input name='input_50' id='input_1_50' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  jQuery(\"#gform_1\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_1' class='gform_button button' value='FINISH'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  jQuery(\"#gform_1\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='WyJbXSIsIjM0YWJmMTExZDAwMzEyYWVlNzYyNzYzMDM3ZDFkMDA5Il0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 1, 'https:\/\/tunded.ee\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_1').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_1').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_1').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_1').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_1').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_1').val();gformInitSpinner( 1, 'https:\/\/tunded.ee\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [1, current_page]);window['gf_submitting_1'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_1').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_1').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [1]);window['gf_submitting_1'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_1').text());}, 50);}else{jQuery('#gform_1').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [1, current_page]);gform.utils.trigger({ event: 'gform\/postRender', native: false, data: { formId: 1, currentPage: current_page } });} );} ); \n\/* ]]> *\/\n<\/script>\n<br \/>\n[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;3.25&#8243; custom_padding=&#8221;|||&#8221; _i=&#8221;1&#8243; _address=&#8221;0.1.1&#8243; custom_padding__hover=&#8221;|||&#8221;][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;3.29.2&#8243; fb_built=&#8221;1&#8243; _i=&#8221;1&#8243; _address=&#8221;1&#8243;][et_pb_row _builder_version=&#8221;3.29.2&#8243; _i=&#8221;0&#8243; _address=&#8221;1.0&#8243;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.29.2&#8243; _i=&#8221;0&#8243; _address=&#8221;1.0.0&#8243;][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;3.29.2&#8243; custom_padding=&#8221;||0px||false|false&#8221; global_module=&#8221;274&#8243; fb_built=&#8221;1&#8243; _i=&#8221;2&#8243; _address=&#8221;2&#8243;][et_pb_row _builder_version=&#8221;3.29.2&#8243; _i=&#8221;0&#8243; _address=&#8221;2.0&#8243;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.29.2&#8243; _i=&#8221;0&#8243; _address=&#8221;2.0.0&#8243;][et_pb_text _builder_version=&#8221;3.29.2&#8243; text_font=&#8221;|300|||||||&#8221; text_font_size=&#8221;12px&#8221; text_orientation=&#8221;center&#8221; _i=&#8221;0&#8243; _address=&#8221;2.0.0.0&#8243;]<\/p>\n<p>V\u00f5ta \u00fchendust @\u00a0<span><a href=\"mailto:support@pilatre.com\">info@tunded.ee<\/a><\/span><\/p>\n<p>Kalev Meedia O\u00dc<br \/> K\u00f5ik \u00f5igused kaitstud\u00a0<span>|\u00a02019<\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Emotional well-being test \n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/en\/wp-json\/wp\/v2\/pages\/369#gf_1' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_2\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_2\"><h2 class=\"gsection_title\">Your information<\/h2><div class='gsection_description' id='gfield_description_1_2'>1 \/ 7<\/div><\/li><li id=\"field_1_53\"  class=\"gfield gfield--type-text gf_section_right gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_53\"><label class='gfield_label gform-field-label' for='input_1_53' >Name or ID<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_1_53' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_60\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_60\"><div class='ginput_container ginput_container_text'><input name='input_60' id='input_1_60' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='07\/04\/2026' \/><\/div><\/li><li id=\"field_1_59\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_59\"><label class='gfield_label gform-field-label' for='input_1_59' >Age<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_1_59' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_69\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_69\"><label class='gfield_label gform-field-label'  >Sex<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_69'>\n\t\t\t<li class='gchoice gchoice_1_69_0'>\n\t\t\t\t<input name='input_69' type='radio' value='Female'  id='choice_1_69_0'    \/>\n\t\t\t\t<label for='choice_1_69_0' id='label_1_69_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_69_1'>\n\t\t\t\t<input name='input_69' type='radio' value='Male'  id='choice_1_69_1'    \/>\n\t\t\t\t<label for='choice_1_69_1' id='label_1_69_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_69_2'>\n\t\t\t\t<input name='input_69' type='radio' value='Choose not to disclose'  id='choice_1_69_2'    \/>\n\t\t\t\t<label for='choice_1_69_2' id='label_1_69_2' class='gform-field-label gform-field-label--type-inline'>Choose not to disclose<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_70\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_70\"><label class='gfield_label gform-field-label'  >Would you like to send results to a doctor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_70'>\n\t\t\t<li class='gchoice gchoice_1_70_0'>\n\t\t\t\t<input name='input_70' type='radio' value='No'  id='choice_1_70_0'    \/>\n\t\t\t\t<label for='choice_1_70_0' id='label_1_70_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_70_1'>\n\t\t\t\t<input name='input_70' type='radio' value='Yes'  id='choice_1_70_1'    \/>\n\t\t\t\t<label for='choice_1_70_1' id='label_1_70_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_71\"  class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_71\"><label class='gfield_label gform-field-label' for='input_1_71' >Choose a doctor<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_71' id='input_1_71' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Mari-Liis Laanetu' >Mari-Liis Laanetu<\/option><option value='Mall Lepiksoo' >Mall Lepiksoo<\/option><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_3' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-3' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_63\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_63\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_63'>2 \/ 7 <\/div><\/li><li id=\"field_1_11\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_11\"><label class='gfield_label gform-field-label'  >1. Feelings of sadness<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_11'>\n\t\t\t<li class='gchoice gchoice_1_11_0'>\n\t\t\t\t<input name='input_11' type='radio' value='0'  id='choice_1_11_0'    \/>\n\t\t\t\t<label for='choice_1_11_0' id='label_1_11_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_11_1'>\n\t\t\t\t<input name='input_11' type='radio' value='1'  id='choice_1_11_1'    \/>\n\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_11_2'>\n\t\t\t\t<input name='input_11' type='radio' value='2'  id='choice_1_11_2'    \/>\n\t\t\t\t<label for='choice_1_11_2' id='label_1_11_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_11_3'>\n\t\t\t\t<input name='input_11' type='radio' value='3'  id='choice_1_11_3'    \/>\n\t\t\t\t<label for='choice_1_11_3' id='label_1_11_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_11_4'>\n\t\t\t\t<input name='input_11' type='radio' value='4'  id='choice_1_11_4'    \/>\n\t\t\t\t<label for='choice_1_11_4' id='label_1_11_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_12\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_12\"><label class='gfield_label gform-field-label'  >2. Feeling no interest or pleasure in things<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_12'>\n\t\t\t<li class='gchoice gchoice_1_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='0'  id='choice_1_12_0'    \/>\n\t\t\t\t<label for='choice_1_12_0' id='label_1_12_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='1'  id='choice_1_12_1'    \/>\n\t\t\t\t<label for='choice_1_12_1' id='label_1_12_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='2'  id='choice_1_12_2'    \/>\n\t\t\t\t<label for='choice_1_12_2' id='label_1_12_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_3'>\n\t\t\t\t<input name='input_12' type='radio' value='3'  id='choice_1_12_3'    \/>\n\t\t\t\t<label for='choice_1_12_3' id='label_1_12_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_12_4'>\n\t\t\t\t<input name='input_12' type='radio' value='4'  id='choice_1_12_4'    \/>\n\t\t\t\t<label for='choice_1_12_4' id='label_1_12_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_13\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_13\"><label class='gfield_label gform-field-label'  >3. Feelings of worthlessness<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_13'>\n\t\t\t<li class='gchoice gchoice_1_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='0'  id='choice_1_13_0'    \/>\n\t\t\t\t<label for='choice_1_13_0' id='label_1_13_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='1'  id='choice_1_13_1'    \/>\n\t\t\t\t<label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_13_2'>\n\t\t\t\t<input name='input_13' type='radio' value='2'  id='choice_1_13_2'    \/>\n\t\t\t\t<label for='choice_1_13_2' id='label_1_13_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_13_3'>\n\t\t\t\t<input name='input_13' type='radio' value='3'  id='choice_1_13_3'    \/>\n\t\t\t\t<label for='choice_1_13_3' id='label_1_13_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_13_4'>\n\t\t\t\t<input name='input_13' type='radio' value='4'  id='choice_1_13_4'    \/>\n\t\t\t\t<label for='choice_1_13_4' id='label_1_13_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_14\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_14\"><label class='gfield_label gform-field-label'  >4. Self-accusations<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_14'>\n\t\t\t<li class='gchoice gchoice_1_14_0'>\n\t\t\t\t<input name='input_14' type='radio' value='0'  id='choice_1_14_0'    \/>\n\t\t\t\t<label for='choice_1_14_0' id='label_1_14_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_14_1'>\n\t\t\t\t<input name='input_14' type='radio' value='1'  id='choice_1_14_1'    \/>\n\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_14_2'>\n\t\t\t\t<input name='input_14' type='radio' value='2'  id='choice_1_14_2'    \/>\n\t\t\t\t<label for='choice_1_14_2' id='label_1_14_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_14_3'>\n\t\t\t\t<input name='input_14' type='radio' value='3'  id='choice_1_14_3'    \/>\n\t\t\t\t<label for='choice_1_14_3' id='label_1_14_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_14_4'>\n\t\t\t\t<input name='input_14' type='radio' value='4'  id='choice_1_14_4'    \/>\n\t\t\t\t<label for='choice_1_14_4' id='label_1_14_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_16\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_16\"><label class='gfield_label gform-field-label'  >5. Recurrent thoughts of death or suicide<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_16'>\n\t\t\t<li class='gchoice gchoice_1_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='0'  id='choice_1_16_0'    \/>\n\t\t\t\t<label for='choice_1_16_0' id='label_1_16_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='1'  id='choice_1_16_1'    \/>\n\t\t\t\t<label for='choice_1_16_1' id='label_1_16_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_16_2'>\n\t\t\t\t<input name='input_16' type='radio' value='2'  id='choice_1_16_2'    \/>\n\t\t\t\t<label for='choice_1_16_2' id='label_1_16_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_16_3'>\n\t\t\t\t<input name='input_16' type='radio' value='3'  id='choice_1_16_3'    \/>\n\t\t\t\t<label for='choice_1_16_3' id='label_1_16_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_16_4'>\n\t\t\t\t<input name='input_16' type='radio' value='4'  id='choice_1_16_4'    \/>\n\t\t\t\t<label for='choice_1_16_4' id='label_1_16_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_15' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_15' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_64\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_64\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_64'>3 \/ 7<\/div><\/li><li id=\"field_1_17\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_17\"><label class='gfield_label gform-field-label'  >6. Feeling lonely<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_17'>\n\t\t\t<li class='gchoice gchoice_1_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='0'  id='choice_1_17_0'    \/>\n\t\t\t\t<label for='choice_1_17_0' id='label_1_17_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='1'  id='choice_1_17_1'    \/>\n\t\t\t\t<label for='choice_1_17_1' id='label_1_17_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_17_2'>\n\t\t\t\t<input name='input_17' type='radio' value='2'  id='choice_1_17_2'    \/>\n\t\t\t\t<label for='choice_1_17_2' id='label_1_17_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_17_3'>\n\t\t\t\t<input name='input_17' type='radio' value='3'  id='choice_1_17_3'    \/>\n\t\t\t\t<label for='choice_1_17_3' id='label_1_17_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_17_4'>\n\t\t\t\t<input name='input_17' type='radio' value='4'  id='choice_1_17_4'    \/>\n\t\t\t\t<label for='choice_1_17_4' id='label_1_17_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_18\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_18\"><label class='gfield_label gform-field-label'  >7. Hopelessness about the future<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_18'>\n\t\t\t<li class='gchoice gchoice_1_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='0'  id='choice_1_18_0'    \/>\n\t\t\t\t<label for='choice_1_18_0' id='label_1_18_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='1'  id='choice_1_18_1'    \/>\n\t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_2'>\n\t\t\t\t<input name='input_18' type='radio' value='2'  id='choice_1_18_2'    \/>\n\t\t\t\t<label for='choice_1_18_2' id='label_1_18_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_3'>\n\t\t\t\t<input name='input_18' type='radio' value='3'  id='choice_1_18_3'    \/>\n\t\t\t\t<label for='choice_1_18_3' id='label_1_18_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_4'>\n\t\t\t\t<input name='input_18' type='radio' value='4'  id='choice_1_18_4'    \/>\n\t\t\t\t<label for='choice_1_18_4' id='label_1_18_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_19\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_19\"><label class='gfield_label gform-field-label'  >8. Impossible to enjoy things<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_19'>\n\t\t\t<li class='gchoice gchoice_1_19_0'>\n\t\t\t\t<input name='input_19' type='radio' value='0'  id='choice_1_19_0'    \/>\n\t\t\t\t<label for='choice_1_19_0' id='label_1_19_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_19_1'>\n\t\t\t\t<input name='input_19' type='radio' value='1'  id='choice_1_19_1'    \/>\n\t\t\t\t<label for='choice_1_19_1' id='label_1_19_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_19_2'>\n\t\t\t\t<input name='input_19' type='radio' value='2'  id='choice_1_19_2'    \/>\n\t\t\t\t<label for='choice_1_19_2' id='label_1_19_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_19_3'>\n\t\t\t\t<input name='input_19' type='radio' value='3'  id='choice_1_19_3'    \/>\n\t\t\t\t<label for='choice_1_19_3' id='label_1_19_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_19_4'>\n\t\t\t\t<input name='input_19' type='radio' value='4'  id='choice_1_19_4'    \/>\n\t\t\t\t<label for='choice_1_19_4' id='label_1_19_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_20\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_20\"><label class='gfield_label gform-field-label'  >9. Feeling easily irritated or annoyed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_20'>\n\t\t\t<li class='gchoice gchoice_1_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='0'  id='choice_1_20_0'    \/>\n\t\t\t\t<label for='choice_1_20_0' id='label_1_20_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='1'  id='choice_1_20_1'    \/>\n\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_2'>\n\t\t\t\t<input name='input_20' type='radio' value='2'  id='choice_1_20_2'    \/>\n\t\t\t\t<label for='choice_1_20_2' id='label_1_20_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_3'>\n\t\t\t\t<input name='input_20' type='radio' value='3'  id='choice_1_20_3'    \/>\n\t\t\t\t<label for='choice_1_20_3' id='label_1_20_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_20_4'>\n\t\t\t\t<input name='input_20' type='radio' value='4'  id='choice_1_20_4'    \/>\n\t\t\t\t<label for='choice_1_20_4' id='label_1_20_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_21\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_21\"><label class='gfield_label gform-field-label'  >10. Feeling anxious or fearful<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_21'>\n\t\t\t<li class='gchoice gchoice_1_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='0'  id='choice_1_21_0'    \/>\n\t\t\t\t<label for='choice_1_21_0' id='label_1_21_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='1'  id='choice_1_21_1'    \/>\n\t\t\t\t<label for='choice_1_21_1' id='label_1_21_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_21_2'>\n\t\t\t\t<input name='input_21' type='radio' value='2'  id='choice_1_21_2'    \/>\n\t\t\t\t<label for='choice_1_21_2' id='label_1_21_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_21_3'>\n\t\t\t\t<input name='input_21' type='radio' value='3'  id='choice_1_21_3'    \/>\n\t\t\t\t<label for='choice_1_21_3' id='label_1_21_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_21_4'>\n\t\t\t\t<input name='input_21' type='radio' value='4'  id='choice_1_21_4'    \/>\n\t\t\t\t<label for='choice_1_21_4' id='label_1_21_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_26' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_26' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' data-js='page-field-id-26' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_65\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_65\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_65'>4 \/ 7<\/div><\/li><li id=\"field_1_22\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_22\"><label class='gfield_label gform-field-label'  >11. Tension or inability to relax<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_22'>\n\t\t\t<li class='gchoice gchoice_1_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='0'  id='choice_1_22_0'    \/>\n\t\t\t\t<label for='choice_1_22_0' id='label_1_22_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='1'  id='choice_1_22_1'    \/>\n\t\t\t\t<label for='choice_1_22_1' id='label_1_22_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_22_2'>\n\t\t\t\t<input name='input_22' type='radio' value='2'  id='choice_1_22_2'    \/>\n\t\t\t\t<label for='choice_1_22_2' id='label_1_22_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_22_3'>\n\t\t\t\t<input name='input_22' type='radio' value='3'  id='choice_1_22_3'    \/>\n\t\t\t\t<label for='choice_1_22_3' id='label_1_22_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_22_4'>\n\t\t\t\t<input name='input_22' type='radio' value='4'  id='choice_1_22_4'    \/>\n\t\t\t\t<label for='choice_1_22_4' id='label_1_22_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_23\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_23\"><label class='gfield_label gform-field-label'  >12. Excessive worry about several different things<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_23'>\n\t\t\t<li class='gchoice gchoice_1_23_0'>\n\t\t\t\t<input name='input_23' type='radio' value='0'  id='choice_1_23_0'    \/>\n\t\t\t\t<label for='choice_1_23_0' id='label_1_23_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_23_1'>\n\t\t\t\t<input name='input_23' type='radio' value='1'  id='choice_1_23_1'    \/>\n\t\t\t\t<label for='choice_1_23_1' id='label_1_23_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_23_2'>\n\t\t\t\t<input name='input_23' type='radio' value='2'  id='choice_1_23_2'    \/>\n\t\t\t\t<label for='choice_1_23_2' id='label_1_23_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_23_3'>\n\t\t\t\t<input name='input_23' type='radio' value='3'  id='choice_1_23_3'    \/>\n\t\t\t\t<label for='choice_1_23_3' id='label_1_23_3' class='gform-field-label gform-field-label--type-inline'>Sageli<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_23_4'>\n\t\t\t\t<input name='input_23' type='radio' value='4'  id='choice_1_23_4'    \/>\n\t\t\t\t<label for='choice_1_23_4' id='label_1_23_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_24\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_24\"><label class='gfield_label gform-field-label'  >13. Feeling so restless that it\u2019s hard to sit still<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_24'>\n\t\t\t<li class='gchoice gchoice_1_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='0'  id='choice_1_24_0'    \/>\n\t\t\t\t<label for='choice_1_24_0' id='label_1_24_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='1'  id='choice_1_24_1'    \/>\n\t\t\t\t<label for='choice_1_24_1' id='label_1_24_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_24_2'>\n\t\t\t\t<input name='input_24' type='radio' value='2'  id='choice_1_24_2'    \/>\n\t\t\t\t<label for='choice_1_24_2' id='label_1_24_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_24_3'>\n\t\t\t\t<input name='input_24' type='radio' value='3'  id='choice_1_24_3'    \/>\n\t\t\t\t<label for='choice_1_24_3' id='label_1_24_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_24_4'>\n\t\t\t\t<input name='input_24' type='radio' value='4'  id='choice_1_24_4'    \/>\n\t\t\t\t<label for='choice_1_24_4' id='label_1_24_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_25\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_25\"><label class='gfield_label gform-field-label'  >14. Easily startled<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_25'>\n\t\t\t<li class='gchoice gchoice_1_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='0'  id='choice_1_25_0'    \/>\n\t\t\t\t<label for='choice_1_25_0' id='label_1_25_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='1'  id='choice_1_25_1'    \/>\n\t\t\t\t<label for='choice_1_25_1' id='label_1_25_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_25_2'>\n\t\t\t\t<input name='input_25' type='radio' value='2'  id='choice_1_25_2'    \/>\n\t\t\t\t<label for='choice_1_25_2' id='label_1_25_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_25_3'>\n\t\t\t\t<input name='input_25' type='radio' value='3'  id='choice_1_25_3'    \/>\n\t\t\t\t<label for='choice_1_25_3' id='label_1_25_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_25_4'>\n\t\t\t\t<input name='input_25' type='radio' value='4'  id='choice_1_25_4'    \/>\n\t\t\t\t<label for='choice_1_25_4' id='label_1_25_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_30\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_30\"><label class='gfield_label gform-field-label'  >15. Sudden attacks of panic with palpitations, shortness of breath, fainting,or other frightening bodily sensations<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_30'>\n\t\t\t<li class='gchoice gchoice_1_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='0'  id='choice_1_30_0'    \/>\n\t\t\t\t<label for='choice_1_30_0' id='label_1_30_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='1'  id='choice_1_30_1'    \/>\n\t\t\t\t<label for='choice_1_30_1' id='label_1_30_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_2'>\n\t\t\t\t<input name='input_30' type='radio' value='2'  id='choice_1_30_2'    \/>\n\t\t\t\t<label for='choice_1_30_2' id='label_1_30_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_3'>\n\t\t\t\t<input name='input_30' type='radio' value='3'  id='choice_1_30_3'    \/>\n\t\t\t\t<label for='choice_1_30_3' id='label_1_30_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_4'>\n\t\t\t\t<input name='input_30' type='radio' value='4'  id='choice_1_30_4'    \/>\n\t\t\t\t<label for='choice_1_30_4' id='label_1_30_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_29' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_29' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' data-js='page-field-id-29' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_66\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_66\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_66'>5 \/ 7<\/div><\/li><li id=\"field_1_31\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_31\"><label class='gfield_label gform-field-label'  >16. Fear of being alone away from home<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_31'>\n\t\t\t<li class='gchoice gchoice_1_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='0'  id='choice_1_31_0'    \/>\n\t\t\t\t<label for='choice_1_31_0' id='label_1_31_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='1'  id='choice_1_31_1'    \/>\n\t\t\t\t<label for='choice_1_31_1' id='label_1_31_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_2'>\n\t\t\t\t<input name='input_31' type='radio' value='2'  id='choice_1_31_2'    \/>\n\t\t\t\t<label for='choice_1_31_2' id='label_1_31_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_3'>\n\t\t\t\t<input name='input_31' type='radio' value='3'  id='choice_1_31_3'    \/>\n\t\t\t\t<label for='choice_1_31_3' id='label_1_31_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_31_4'>\n\t\t\t\t<input name='input_31' type='radio' value='4'  id='choice_1_31_4'    \/>\n\t\t\t\t<label for='choice_1_31_4' id='label_1_31_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_32\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_32\"><label class='gfield_label gform-field-label'  >17. Fear of being on streets or at open places<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_32'>\n\t\t\t<li class='gchoice gchoice_1_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='0'  id='choice_1_32_0'    \/>\n\t\t\t\t<label for='choice_1_32_0' id='label_1_32_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_32_1'>\n\t\t\t\t<input name='input_32' type='radio' value='1'  id='choice_1_32_1'    \/>\n\t\t\t\t<label for='choice_1_32_1' id='label_1_32_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_32_2'>\n\t\t\t\t<input name='input_32' type='radio' value='2'  id='choice_1_32_2'    \/>\n\t\t\t\t<label for='choice_1_32_2' id='label_1_32_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_32_3'>\n\t\t\t\t<input name='input_32' type='radio' value='3'  id='choice_1_32_3'    \/>\n\t\t\t\t<label for='choice_1_32_3' id='label_1_32_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_32_4'>\n\t\t\t\t<input name='input_32' type='radio' value='4'  id='choice_1_32_4'    \/>\n\t\t\t\t<label for='choice_1_32_4' id='label_1_32_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_33\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_33\"><label class='gfield_label gform-field-label'  >18. Fear of fainting in public<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_33'>\n\t\t\t<li class='gchoice gchoice_1_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='0'  id='choice_1_33_0'    \/>\n\t\t\t\t<label for='choice_1_33_0' id='label_1_33_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_1'>\n\t\t\t\t<input name='input_33' type='radio' value='1'  id='choice_1_33_1'    \/>\n\t\t\t\t<label for='choice_1_33_1' id='label_1_33_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_2'>\n\t\t\t\t<input name='input_33' type='radio' value='2'  id='choice_1_33_2'    \/>\n\t\t\t\t<label for='choice_1_33_2' id='label_1_33_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_3'>\n\t\t\t\t<input name='input_33' type='radio' value='3'  id='choice_1_33_3'    \/>\n\t\t\t\t<label for='choice_1_33_3' id='label_1_33_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_4'>\n\t\t\t\t<input name='input_33' type='radio' value='4'  id='choice_1_33_4'    \/>\n\t\t\t\t<label for='choice_1_33_4' id='label_1_33_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_34\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_34\"><label class='gfield_label gform-field-label'  >19. Fear of travelling by bus, tram, train, or car<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_34'>\n\t\t\t<li class='gchoice gchoice_1_34_0'>\n\t\t\t\t<input name='input_34' type='radio' value='0'  id='choice_1_34_0'    \/>\n\t\t\t\t<label for='choice_1_34_0' id='label_1_34_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_34_1'>\n\t\t\t\t<input name='input_34' type='radio' value='1'  id='choice_1_34_1'    \/>\n\t\t\t\t<label for='choice_1_34_1' id='label_1_34_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_34_2'>\n\t\t\t\t<input name='input_34' type='radio' value='2'  id='choice_1_34_2'    \/>\n\t\t\t\t<label for='choice_1_34_2' id='label_1_34_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_34_3'>\n\t\t\t\t<input name='input_34' type='radio' value='3'  id='choice_1_34_3'    \/>\n\t\t\t\t<label for='choice_1_34_3' id='label_1_34_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_34_4'>\n\t\t\t\t<input name='input_34' type='radio' value='4'  id='choice_1_34_4'    \/>\n\t\t\t\t<label for='choice_1_34_4' id='label_1_34_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_35\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_35\"><label class='gfield_label gform-field-label'  >20. Fear of being in the centre of attention<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_35'>\n\t\t\t<li class='gchoice gchoice_1_35_0'>\n\t\t\t\t<input name='input_35' type='radio' value='0'  id='choice_1_35_0'    \/>\n\t\t\t\t<label for='choice_1_35_0' id='label_1_35_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_1'>\n\t\t\t\t<input name='input_35' type='radio' value='1'  id='choice_1_35_1'    \/>\n\t\t\t\t<label for='choice_1_35_1' id='label_1_35_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_2'>\n\t\t\t\t<input name='input_35' type='radio' value='2'  id='choice_1_35_2'    \/>\n\t\t\t\t<label for='choice_1_35_2' id='label_1_35_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_3'>\n\t\t\t\t<input name='input_35' type='radio' value='3'  id='choice_1_35_3'    \/>\n\t\t\t\t<label for='choice_1_35_3' id='label_1_35_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_35_4'>\n\t\t\t\t<input name='input_35' type='radio' value='4'  id='choice_1_35_4'    \/>\n\t\t\t\t<label for='choice_1_35_4' id='label_1_35_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_37' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_37' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' data-js='page-field-id-37' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_67\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_67\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_67'>6 \/ 7<\/div><\/li><li id=\"field_1_36\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_36\"><label class='gfield_label gform-field-label'  >21. Fear of talking to strangers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_36'>\n\t\t\t<li class='gchoice gchoice_1_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='0'  id='choice_1_36_0'    \/>\n\t\t\t\t<label for='choice_1_36_0' id='label_1_36_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_36_1'>\n\t\t\t\t<input name='input_36' type='radio' value='1'  id='choice_1_36_1'    \/>\n\t\t\t\t<label for='choice_1_36_1' id='label_1_36_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_36_2'>\n\t\t\t\t<input name='input_36' type='radio' value='2'  id='choice_1_36_2'    \/>\n\t\t\t\t<label for='choice_1_36_2' id='label_1_36_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_36_3'>\n\t\t\t\t<input name='input_36' type='radio' value='3'  id='choice_1_36_3'    \/>\n\t\t\t\t<label for='choice_1_36_3' id='label_1_36_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_36_4'>\n\t\t\t\t<input name='input_36' type='radio' value='4'  id='choice_1_36_4'    \/>\n\t\t\t\t<label for='choice_1_36_4' id='label_1_36_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_38\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_38\"><label class='gfield_label gform-field-label'  >22. Fatigue or loss of energy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_38'>\n\t\t\t<li class='gchoice gchoice_1_38_0'>\n\t\t\t\t<input name='input_38' type='radio' value='0'  id='choice_1_38_0'    \/>\n\t\t\t\t<label for='choice_1_38_0' id='label_1_38_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_38_1'>\n\t\t\t\t<input name='input_38' type='radio' value='1'  id='choice_1_38_1'    \/>\n\t\t\t\t<label for='choice_1_38_1' id='label_1_38_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_38_2'>\n\t\t\t\t<input name='input_38' type='radio' value='2'  id='choice_1_38_2'    \/>\n\t\t\t\t<label for='choice_1_38_2' id='label_1_38_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_38_3'>\n\t\t\t\t<input name='input_38' type='radio' value='3'  id='choice_1_38_3'    \/>\n\t\t\t\t<label for='choice_1_38_3' id='label_1_38_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_38_4'>\n\t\t\t\t<input name='input_38' type='radio' value='4'  id='choice_1_38_4'    \/>\n\t\t\t\t<label for='choice_1_38_4' id='label_1_38_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_39\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_39\"><label class='gfield_label gform-field-label'  >23. Diminished ability to focus or concentrate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_39'>\n\t\t\t<li class='gchoice gchoice_1_39_0'>\n\t\t\t\t<input name='input_39' type='radio' value='0'  id='choice_1_39_0'    \/>\n\t\t\t\t<label for='choice_1_39_0' id='label_1_39_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_39_1'>\n\t\t\t\t<input name='input_39' type='radio' value='1'  id='choice_1_39_1'    \/>\n\t\t\t\t<label for='choice_1_39_1' id='label_1_39_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_39_2'>\n\t\t\t\t<input name='input_39' type='radio' value='2'  id='choice_1_39_2'    \/>\n\t\t\t\t<label for='choice_1_39_2' id='label_1_39_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_39_3'>\n\t\t\t\t<input name='input_39' type='radio' value='3'  id='choice_1_39_3'    \/>\n\t\t\t\t<label for='choice_1_39_3' id='label_1_39_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_39_4'>\n\t\t\t\t<input name='input_39' type='radio' value='4'  id='choice_1_39_4'    \/>\n\t\t\t\t<label for='choice_1_39_4' id='label_1_39_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_40\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_40\"><label class='gfield_label gform-field-label'  >24. Rest does not restore strength<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_40'>\n\t\t\t<li class='gchoice gchoice_1_40_0'>\n\t\t\t\t<input name='input_40' type='radio' value='0'  id='choice_1_40_0'    \/>\n\t\t\t\t<label for='choice_1_40_0' id='label_1_40_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_40_1'>\n\t\t\t\t<input name='input_40' type='radio' value='1'  id='choice_1_40_1'    \/>\n\t\t\t\t<label for='choice_1_40_1' id='label_1_40_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_40_2'>\n\t\t\t\t<input name='input_40' type='radio' value='2'  id='choice_1_40_2'    \/>\n\t\t\t\t<label for='choice_1_40_2' id='label_1_40_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_40_3'>\n\t\t\t\t<input name='input_40' type='radio' value='3'  id='choice_1_40_3'    \/>\n\t\t\t\t<label for='choice_1_40_3' id='label_1_40_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_40_4'>\n\t\t\t\t<input name='input_40' type='radio' value='4'  id='choice_1_40_4'    \/>\n\t\t\t\t<label for='choice_1_40_4' id='label_1_40_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_41\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_41\"><label class='gfield_label gform-field-label'  >25. Being easily fatigued<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_41'>\n\t\t\t<li class='gchoice gchoice_1_41_0'>\n\t\t\t\t<input name='input_41' type='radio' value='0'  id='choice_1_41_0'    \/>\n\t\t\t\t<label for='choice_1_41_0' id='label_1_41_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_41_1'>\n\t\t\t\t<input name='input_41' type='radio' value='1'  id='choice_1_41_1'    \/>\n\t\t\t\t<label for='choice_1_41_1' id='label_1_41_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_41_2'>\n\t\t\t\t<input name='input_41' type='radio' value='2'  id='choice_1_41_2'    \/>\n\t\t\t\t<label for='choice_1_41_2' id='label_1_41_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_41_3'>\n\t\t\t\t<input name='input_41' type='radio' value='3'  id='choice_1_41_3'    \/>\n\t\t\t\t<label for='choice_1_41_3' id='label_1_41_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_41_4'>\n\t\t\t\t<input name='input_41' type='radio' value='4'  id='choice_1_41_4'    \/>\n\t\t\t\t<label for='choice_1_41_4' id='label_1_41_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_58' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_58' class='gform_next_button gform-theme-button button' value='NEXT'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"7\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_7' class='gform_page' data-js='page-field-id-58' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_1_7' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_68\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_68\"><h2 class=\"gsection_title\">Questions<\/h2><div class='gsection_description' id='gfield_description_1_68'>7 \/ 7<\/div><\/li><li id=\"field_1_43\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_43\"><label class='gfield_label gform-field-label'  >26. Difficulty falling asleep<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_43'>\n\t\t\t<li class='gchoice gchoice_1_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='0'  id='choice_1_43_0'    \/>\n\t\t\t\t<label for='choice_1_43_0' id='label_1_43_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='1'  id='choice_1_43_1'    \/>\n\t\t\t\t<label for='choice_1_43_1' id='label_1_43_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='2'  id='choice_1_43_2'    \/>\n\t\t\t\t<label for='choice_1_43_2' id='label_1_43_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_3'>\n\t\t\t\t<input name='input_43' type='radio' value='3'  id='choice_1_43_3'    \/>\n\t\t\t\t<label for='choice_1_43_3' id='label_1_43_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_43_4'>\n\t\t\t\t<input name='input_43' type='radio' value='4'  id='choice_1_43_4'    \/>\n\t\t\t\t<label for='choice_1_43_4' id='label_1_43_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_44\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_44\"><label class='gfield_label gform-field-label'  >27. Restless or disturbed sleep<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_44'>\n\t\t\t<li class='gchoice gchoice_1_44_0'>\n\t\t\t\t<input name='input_44' type='radio' value='0'  id='choice_1_44_0'    \/>\n\t\t\t\t<label for='choice_1_44_0' id='label_1_44_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_44_1'>\n\t\t\t\t<input name='input_44' type='radio' value='1'  id='choice_1_44_1'    \/>\n\t\t\t\t<label for='choice_1_44_1' id='label_1_44_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_44_2'>\n\t\t\t\t<input name='input_44' type='radio' value='2'  id='choice_1_44_2'    \/>\n\t\t\t\t<label for='choice_1_44_2' id='label_1_44_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_44_3'>\n\t\t\t\t<input name='input_44' type='radio' value='3'  id='choice_1_44_3'    \/>\n\t\t\t\t<label for='choice_1_44_3' id='label_1_44_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_44_4'>\n\t\t\t\t<input name='input_44' type='radio' value='4'  id='choice_1_44_4'    \/>\n\t\t\t\t<label for='choice_1_44_4' id='label_1_44_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_45\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_45\"><label class='gfield_label gform-field-label'  >28. Waking up too early<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_45'>\n\t\t\t<li class='gchoice gchoice_1_45_0'>\n\t\t\t\t<input name='input_45' type='radio' value='0'  id='choice_1_45_0'    \/>\n\t\t\t\t<label for='choice_1_45_0' id='label_1_45_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_45_1'>\n\t\t\t\t<input name='input_45' type='radio' value='1'  id='choice_1_45_1'    \/>\n\t\t\t\t<label for='choice_1_45_1' id='label_1_45_1' class='gform-field-label gform-field-label--type-inline'>Seldom<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_45_2'>\n\t\t\t\t<input name='input_45' type='radio' value='2'  id='choice_1_45_2'    \/>\n\t\t\t\t<label for='choice_1_45_2' id='label_1_45_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_45_3'>\n\t\t\t\t<input name='input_45' type='radio' value='3'  id='choice_1_45_3'    \/>\n\t\t\t\t<label for='choice_1_45_3' id='label_1_45_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_45_4'>\n\t\t\t\t<input name='input_45' type='radio' value='4'  id='choice_1_45_4'    \/>\n\t\t\t\t<label for='choice_1_45_4' id='label_1_45_4' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_28\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_28\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_28' >Depressioon (1-8)<\/label><div class='ginput_container ginput_container_number'><input name='input_28' id='input_1_28' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_46\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_46\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_46' >\u00dcldistunud \u00e4revus (9-14)<\/label><div class='ginput_container ginput_container_number'><input name='input_46' id='input_1_46' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_47\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_47\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_47' >Paanikah\u00e4ire (15-19)<\/label><div class='ginput_container ginput_container_number'><input name='input_47' id='input_1_47' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_48\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_48\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_48' >Sotsiaal\u00e4revus (20-21)<\/label><div class='ginput_container ginput_container_number'><input name='input_48' id='input_1_48' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_49\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_49\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_49' >Asteenia (22-25)<\/label><div class='ginput_container ginput_container_number'><input name='input_49' id='input_1_49' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_1_50\"  class=\"gfield gfield--type-number exclude gfield_calculation field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_1_50\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_50' >Insomnia (26-28)<\/label><div class='ginput_container ginput_container_number'><input name='input_50' id='input_1_50' type='text' step='any'   value='' class='medium'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='BACK'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  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\n\/* ]]> *\/\n<\/script>\n V\u00f5ta \u00fchendust @\u00a0info@tunded.ee Kalev Meedia O\u00dc K\u00f5ik \u00f5igused 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