{"id":5686,"date":"2020-10-19T07:42:52","date_gmt":"2020-10-19T07:42:52","guid":{"rendered":"https:\/\/allurionkliniek.nl\/lsc-nutrition-anamnesis\/"},"modified":"2023-03-06T21:20:25","modified_gmt":"2023-03-06T21:20:25","slug":"lsc-nutrition-anamnesis","status":"publish","type":"page","link":"https:\/\/allurionkliniek.nl\/en\/lsc-nutrition-anamnesis\/","title":{"rendered":"LSC Nutrition Anamnesis"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5686\" class=\"elementor elementor-5686 elementor-2287\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5e2d003 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5e2d003\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4c7987b\" data-id=\"4c7987b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a63ac76 elementor-widget elementor-widget-heading\" data-id=\"a63ac76\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">LSC Nutrition Anamnesis<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7106393 elementor-widget elementor-widget-wp-widget-gform_widget\" data-id=\"7106393\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wp-widget-gform_widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel='stylesheet' id='gforms_reset_css-css' href='https:\/\/allurionkliniek.nl\/wp-content\/plugins\/gravityforms\/legacy\/css\/formreset.min.css?ver=2.10.4' media='all' \/>\n<link rel='stylesheet' id='gforms_formsmain_css-css' href='https:\/\/allurionkliniek.nl\/wp-content\/plugins\/gravityforms\/legacy\/css\/formsmain.min.css?ver=2.10.4' media='all' \/>\n<link rel='stylesheet' id='gforms_ready_class_css-css' href='https:\/\/allurionkliniek.nl\/wp-content\/plugins\/gravityforms\/legacy\/css\/readyclass.min.css?ver=2.10.4' media='all' \/>\n<link rel='stylesheet' id='gforms_browsers_css-css' href='https:\/\/allurionkliniek.nl\/wp-content\/plugins\/gravityforms\/legacy\/css\/browsers.min.css?ver=2.10.4' media='all' \/>\n<script id=\"wp-dom-ready-js\" src=\"https:\/\/allurionkliniek.nl\/wp-includes\/js\/dist\/dom-ready.min.js?ver=a06281ae5cf5500e9317\"><\/script>\n<script id=\"wp-hooks-js\" src=\"https:\/\/allurionkliniek.nl\/wp-includes\/js\/dist\/hooks.min.js?ver=7496969728ca0f95732d\"><\/script>\n<script id=\"wp-i18n-js\" src=\"https:\/\/allurionkliniek.nl\/wp-includes\/js\/dist\/i18n.min.js?ver=781d11515ad3d91786ec\"><\/script>\n<script id=\"wp-i18n-js-after\">\nwp.i18n.setLocaleData( { 'text direction\\u0004ltr': [ 'ltr' ] } );\n\/\/# sourceURL=wp-i18n-js-after\n<\/script>\n<script id=\"wp-a11y-js\" src=\"https:\/\/allurionkliniek.nl\/wp-includes\/js\/dist\/a11y.min.js?ver=af934e5259bc51b8718e\"><\/script>\n<script id=\"jquery-core-js\" src=\"https:\/\/allurionkliniek.nl\/wp-includes\/js\/jquery\/jquery.min.js?ver=3.7.1\"><\/script>\n<script id=\"jquery-migrate-js\" src=\"https:\/\/allurionkliniek.nl\/wp-includes\/js\/jquery\/jquery-migrate.min.js?ver=3.4.1\"><\/script>\n<script id=\"gform_json-js\" defer='defer' src=\"https:\/\/allurionkliniek.nl\/wp-content\/plugins\/gravityforms\/js\/jquery.json.min.js?ver=2.10.4\"><\/script>\n<script id=\"gform_gravityforms-js-extra\">\nvar gf_global = {\"gf_currency_config\":{\"name\":\"Euro\",\"symbol_left\":\"\",\"symbol_right\":\"&#8364;\",\"symbol_padding\":\" \",\"thousand_separator\":\".\",\"decimal_separator\":\",\",\"decimals\":2,\"code\":\"EUR\"},\"base_url\":\"https:\/\/allurionkliniek.nl\/wp-content\/plugins\/gravityforms\",\"number_formats\":[],\"spinnerUrl\":\"https:\/\/allurionkliniek.nl\/wp-content\/plugins\/gravityforms\/images\/spinner.svg\",\"version_hash\":\"1f7522cf10ebc47249a2fa8202ea1752\",\"strings\":{\"newRowAdded\":\"New row added.\",\"rowRemoved\":\"Row removed\",\"formSaved\":\"The form has been saved.  The content contains the link to return and complete the form.\"}};\n\/\/# sourceURL=gform_gravityforms-js-extra\n<\/script>\n<script id=\"gform_gravityforms-js\" defer='defer' src=\"https:\/\/allurionkliniek.nl\/wp-content\/plugins\/gravityforms\/js\/gravityforms.min.js?ver=2.10.4\"><\/script>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\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_33' ><form method='post' enctype='multipart\/form-data'  id='gform_33'  action='\/en\/wp-json\/wp\/v2\/pages\/5686' data-formid='33' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_33' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_33_139\" class=\"gfield gfield--type-text gfield--input-type-adminonly_hidden field_admin_only field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_administrative\"  ><input name='input_139' id='input_33_139' class='gform_hidden' type='hidden' value=''\/><\/li><li id=\"field_33_2\" class=\"gfield gfield--type-text gf_left_half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_2'>Marital status\/family situation<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_33_2' type='text' value='' class='medium'   tabindex='1'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_3\" class=\"gfield gfield--type-text gf_right_half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_3'>Profession<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_33_3' type='text' value='' class='medium'   tabindex='2'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_108\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><hr\/><\/br><\/br><\/li><li id=\"field_33_10\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you currently have specific nutrition and lifestyle questions?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_10'>\n\t\t\t<li class='gchoice gchoice_33_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='yes'  id='choice_33_10_0' tabindex='3'   \/>\n\t\t\t\t<label for='choice_33_10_0' id='label_33_10_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='no'  id='choice_33_10_1' tabindex='4'   \/>\n\t\t\t\t<label for='choice_33_10_1' id='label_33_10_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_5\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_5'>specific_questions_lifestyle_yes<\/label><div class='gfield_description' id='gfield_description_33_5'>If yes, what is your question?<\/div><div class='ginput_container ginput_container_text'><input name='input_5' id='input_33_5' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_5\" tabindex='5'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_113\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_9\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >What do you think is the relationship between your complaint(s) and your lifestyle?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_33_9'><li class='gchoice gchoice_33_9_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.1' type='checkbox'  value='Unhealthy food'  id='choice_33_9_1' tabindex='6'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_9_1' id='label_33_9_1' class='gform-field-label gform-field-label--type-inline'>Unhealthy food<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_9_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.2' type='checkbox'  value='Not enough exercise'  id='choice_33_9_2' tabindex='7'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_9_2' id='label_33_9_2' class='gform-field-label gform-field-label--type-inline'>Not enough exercise<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_9_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.3' type='checkbox'  value='No idea'  id='choice_33_9_3' tabindex='8'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_9_3' id='label_33_9_3' class='gform-field-label gform-field-label--type-inline'>No idea<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_9_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.4' type='checkbox'  value='Eating too much'  id='choice_33_9_4' tabindex='9'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_9_4' id='label_33_9_4' class='gform-field-label gform-field-label--type-inline'>Eating too much<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_9_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.5' type='checkbox'  value='Stress'  id='choice_33_9_5' tabindex='10'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_9_5' id='label_33_9_5' class='gform-field-label gform-field-label--type-inline'>Stress<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_9_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.6' type='checkbox'  value='Emotion Eating'  id='choice_33_9_6' tabindex='11'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_9_6' id='label_33_9_6' class='gform-field-label gform-field-label--type-inline'>Emotion Eating<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_9_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.7' type='checkbox'  value='Hereditary'  id='choice_33_9_7' tabindex='12'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_9_7' id='label_33_9_7' class='gform-field-label gform-field-label--type-inline'>Hereditary<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_8\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_33_8'>Other, viz.<\/label><div class='gfield_description' id='gfield_description_33_8'>Other, viz.<\/div><div class='ginput_container ginput_container_text'><input name='input_8' id='input_33_8' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_8\" tabindex='13'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_142\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_7\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are your symptoms periodically dependent?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_7'>\n\t\t\t<li class='gchoice gchoice_33_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='again'  id='choice_33_7_0' tabindex='14'   \/>\n\t\t\t\t<label for='choice_33_7_0' id='label_33_7_0' class='gform-field-label gform-field-label--type-inline'>again<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='season'  id='choice_33_7_1' tabindex='15'   \/>\n\t\t\t\t<label for='choice_33_7_1' id='label_33_7_1' class='gform-field-label gform-field-label--type-inline'>season<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_7_2'>\n\t\t\t\t<input name='input_7' type='radio' value='daily'  id='choice_33_7_2' tabindex='16'   \/>\n\t\t\t\t<label for='choice_33_7_2' id='label_33_7_2' class='gform-field-label gform-field-label--type-inline'>daily<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_7_3'>\n\t\t\t\t<input name='input_7' type='radio' value='menstruation'  id='choice_33_7_3' tabindex='17'   \/>\n\t\t\t\t<label for='choice_33_7_3' id='label_33_7_3' class='gform-field-label gform-field-label--type-inline'>menstruation<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_11\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_33_11'>Other, viz.<\/label><div class='gfield_description' id='gfield_description_33_11'>Other, viz.<\/div><div class='ginput_container ginput_container_text'><input name='input_11' id='input_33_11' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_11\" tabindex='18'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_114\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><hr><strong>Questions regarding dietary habits:<\/strong><\/br><\/br><\/li><li id=\"field_33_13\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >In general, how much do you eat?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_13'>\n\t\t\t<li class='gchoice gchoice_33_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='very much'  id='choice_33_13_0' tabindex='19'   \/>\n\t\t\t\t<label for='choice_33_13_0' id='label_33_13_0' class='gform-field-label gform-field-label--type-inline'>very much<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='much'  id='choice_33_13_1' tabindex='20'   \/>\n\t\t\t\t<label for='choice_33_13_1' id='label_33_13_1' class='gform-field-label gform-field-label--type-inline'>much<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_13_2'>\n\t\t\t\t<input name='input_13' type='radio' value='normal'  id='choice_33_13_2' tabindex='21'   \/>\n\t\t\t\t<label for='choice_33_13_2' id='label_33_13_2' class='gform-field-label gform-field-label--type-inline'>normal<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_13_3'>\n\t\t\t\t<input name='input_13' type='radio' value='moderate'  id='choice_33_13_3' tabindex='22'   \/>\n\t\t\t\t<label for='choice_33_13_3' id='label_33_13_3' class='gform-field-label gform-field-label--type-inline'>moderate<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_13_4'>\n\t\t\t\t<input name='input_13' type='radio' value='few'  id='choice_33_13_4' tabindex='23'   \/>\n\t\t\t\t<label for='choice_33_13_4' id='label_33_13_4' class='gform-field-label gform-field-label--type-inline'>few<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_16\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >What kind of food do you prefer?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_16'>\n\t\t\t<li class='gchoice gchoice_33_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='sweet'  id='choice_33_16_0' tabindex='24'   \/>\n\t\t\t\t<label for='choice_33_16_0' id='label_33_16_0' class='gform-field-label gform-field-label--type-inline'>sweet<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='salt'  id='choice_33_16_1' tabindex='25'   \/>\n\t\t\t\t<label for='choice_33_16_1' id='label_33_16_1' class='gform-field-label gform-field-label--type-inline'>salt<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_16_2'>\n\t\t\t\t<input name='input_16' type='radio' value='fat'  id='choice_33_16_2' tabindex='26'   \/>\n\t\t\t\t<label for='choice_33_16_2' id='label_33_16_2' class='gform-field-label gform-field-label--type-inline'>fat<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_17\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >What do you eat very regularly?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_33_17'><li class='gchoice gchoice_33_17_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.1' type='checkbox'  value='pasta'  id='choice_33_17_1' tabindex='27'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_17_1' id='label_33_17_1' class='gform-field-label gform-field-label--type-inline'>pasta<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_17_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.2' type='checkbox'  value='rice'  id='choice_33_17_2' tabindex='28'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_17_2' id='label_33_17_2' class='gform-field-label gform-field-label--type-inline'>rice<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_17_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.3' type='checkbox'  value='potato'  id='choice_33_17_3' tabindex='29'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_17_3' id='label_33_17_3' class='gform-field-label gform-field-label--type-inline'>potato<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_17_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.4' type='checkbox'  value='bread'  id='choice_33_17_4' tabindex='30'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_17_4' id='label_33_17_4' class='gform-field-label gform-field-label--type-inline'>bread<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_17_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.5' type='checkbox'  value='none of them'  id='choice_33_17_5' tabindex='31'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_17_5' id='label_33_17_5' class='gform-field-label gform-field-label--type-inline'>none of them<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_18\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >What do you usually eat?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_33_18'><li class='gchoice gchoice_33_18_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.1' type='checkbox'  value='meat'  id='choice_33_18_1' tabindex='32'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_18_1' id='label_33_18_1' class='gform-field-label gform-field-label--type-inline'>meat<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_18_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.2' type='checkbox'  value='chicken'  id='choice_33_18_2' tabindex='33'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_18_2' id='label_33_18_2' class='gform-field-label gform-field-label--type-inline'>chicken<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_18_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.3' type='checkbox'  value='fish'  id='choice_33_18_3' tabindex='34'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_18_3' id='label_33_18_3' class='gform-field-label gform-field-label--type-inline'>fish<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_18_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.4' type='checkbox'  value='vegetarian'  id='choice_33_18_4' tabindex='35'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_18_4' id='label_33_18_4' class='gform-field-label gform-field-label--type-inline'>vegetarian<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_20\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >How many grams of vegetables\/raw vegetables do you usually eat?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_20'>\n\t\t\t<li class='gchoice gchoice_33_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='0'  id='choice_33_20_0' tabindex='36'   \/>\n\t\t\t\t<label for='choice_33_20_0' id='label_33_20_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='&lt;50'  id='choice_33_20_1' tabindex='37'   \/>\n\t\t\t\t<label for='choice_33_20_1' id='label_33_20_1' class='gform-field-label gform-field-label--type-inline'>&lt;50<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_20_2'>\n\t\t\t\t<input name='input_20' type='radio' value='50-100'  id='choice_33_20_2' tabindex='38'   \/>\n\t\t\t\t<label for='choice_33_20_2' id='label_33_20_2' class='gform-field-label gform-field-label--type-inline'>50-100<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_20_3'>\n\t\t\t\t<input name='input_20' type='radio' value='100-200'  id='choice_33_20_3' tabindex='39'   \/>\n\t\t\t\t<label for='choice_33_20_3' id='label_33_20_3' class='gform-field-label gform-field-label--type-inline'>100-200<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_20_4'>\n\t\t\t\t<input name='input_20' type='radio' value='&gt;200'  id='choice_33_20_4' tabindex='40'   \/>\n\t\t\t\t<label for='choice_33_20_4' id='label_33_20_4' class='gform-field-label gform-field-label--type-inline'>&gt;200<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_21\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you eat (unroasted) nuts and seeds regularly?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_21'>\n\t\t\t<li class='gchoice gchoice_33_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='yes'  id='choice_33_21_0' tabindex='41'   \/>\n\t\t\t\t<label for='choice_33_21_0' id='label_33_21_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='no'  id='choice_33_21_1' tabindex='42'   \/>\n\t\t\t\t<label for='choice_33_21_1' id='label_33_21_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_22\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >What fats do you use for baking and frying?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_33_22'><li class='gchoice gchoice_33_22_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.1' type='checkbox'  value='no'  id='choice_33_22_1' tabindex='43'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_22_1' id='label_33_22_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_22_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.2' type='checkbox'  value='buttercream'  id='choice_33_22_2' tabindex='44'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_22_2' id='label_33_22_2' class='gform-field-label gform-field-label--type-inline'>buttercream<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_22_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.3' type='checkbox'  value='coconut oil'  id='choice_33_22_3' tabindex='45'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_22_3' id='label_33_22_3' class='gform-field-label gform-field-label--type-inline'>coconut oil<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_22_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.4' type='checkbox'  value='margarine'  id='choice_33_22_4' tabindex='46'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_22_4' id='label_33_22_4' class='gform-field-label gform-field-label--type-inline'>margarine<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_22_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.5' type='checkbox'  value='liquid butter'  id='choice_33_22_5' tabindex='47'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_22_5' id='label_33_22_5' class='gform-field-label gform-field-label--type-inline'>liquid butter<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_22_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.6' type='checkbox'  value='olive oil'  id='choice_33_22_6' tabindex='48'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_22_6' id='label_33_22_6' class='gform-field-label gform-field-label--type-inline'>olive oil<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_22_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.7' type='checkbox'  value='halvarine'  id='choice_33_22_7' tabindex='49'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_22_7' id='label_33_22_7' class='gform-field-label gform-field-label--type-inline'>halvarine<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_22_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.8' type='checkbox'  value='vegetable oil'  id='choice_33_22_8' tabindex='50'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_22_8' id='label_33_22_8' class='gform-field-label gform-field-label--type-inline'>vegetable oil<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_22_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.9' type='checkbox'  value='frying fat'  id='choice_33_22_9' tabindex='51'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_22_9' id='label_33_22_9' class='gform-field-label gform-field-label--type-inline'>frying fat<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_23\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_33_23'>Other, viz.<\/label><div class='gfield_description' id='gfield_description_33_23'>Other, viz.<\/div><div class='ginput_container ginput_container_text'><input name='input_23' id='input_33_23' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_23\" tabindex='52'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_115\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_24\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you often have extreme cravings for sweets?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_24'>\n\t\t\t<li class='gchoice gchoice_33_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='yes'  id='choice_33_24_0' tabindex='53'   \/>\n\t\t\t\t<label for='choice_33_24_0' id='label_33_24_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='no'  id='choice_33_24_1' tabindex='54'   \/>\n\t\t\t\t<label for='choice_33_24_1' id='label_33_24_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_25\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you adding sugar?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_25'>\n\t\t\t<li class='gchoice gchoice_33_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='yes'  id='choice_33_25_0' tabindex='55'   \/>\n\t\t\t\t<label for='choice_33_25_0' id='label_33_25_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='no'  id='choice_33_25_1' tabindex='56'   \/>\n\t\t\t\t<label for='choice_33_25_1' id='label_33_25_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_26\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you add salt?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_26'>\n\t\t\t<li class='gchoice gchoice_33_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='yes'  id='choice_33_26_0' tabindex='57'   \/>\n\t\t\t\t<label for='choice_33_26_0' id='label_33_26_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='no'  id='choice_33_26_1' tabindex='58'   \/>\n\t\t\t\t<label for='choice_33_26_1' id='label_33_26_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_27\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Can you easily skip a meal?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_27'>\n\t\t\t<li class='gchoice gchoice_33_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='yes'  id='choice_33_27_0' tabindex='59'   \/>\n\t\t\t\t<label for='choice_33_27_0' id='label_33_27_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='no'  id='choice_33_27_1' tabindex='60'   \/>\n\t\t\t\t<label for='choice_33_27_1' id='label_33_27_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_28\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >If yes, which meal do you skip?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_33_28'><li class='gchoice gchoice_33_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='breakfast'  id='choice_33_28_1' tabindex='61'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_28_1' id='label_33_28_1' class='gform-field-label gform-field-label--type-inline'>breakfast<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_28_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.2' type='checkbox'  value='lunch'  id='choice_33_28_2' tabindex='62'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_28_2' id='label_33_28_2' class='gform-field-label gform-field-label--type-inline'>lunch<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_28_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.3' type='checkbox'  value='dinner'  id='choice_33_28_3' tabindex='63'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_28_3' id='label_33_28_3' class='gform-field-label gform-field-label--type-inline'>dinner<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_29\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have frequent binge eating?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_29'>\n\t\t\t<li class='gchoice gchoice_33_29_0'>\n\t\t\t\t<input name='input_29' type='radio' value='yes'  id='choice_33_29_0' tabindex='64'   \/>\n\t\t\t\t<label for='choice_33_29_0' id='label_33_29_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_29_1'>\n\t\t\t\t<input name='input_29' type='radio' value='no'  id='choice_33_29_1' tabindex='65'   \/>\n\t\t\t\t<label for='choice_33_29_1' id='label_33_29_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_30\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you often suffer from bloating after a meal?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_30'>\n\t\t\t<li class='gchoice gchoice_33_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='yes'  id='choice_33_30_0' tabindex='66'   \/>\n\t\t\t\t<label for='choice_33_30_0' id='label_33_30_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='no'  id='choice_33_30_1' tabindex='67'   \/>\n\t\t\t\t<label for='choice_33_30_1' id='label_33_30_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_111\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you allergic to certain foods?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_111'>\n\t\t\t<li class='gchoice gchoice_33_111_0'>\n\t\t\t\t<input name='input_111' type='radio' value='yes'  id='choice_33_111_0' tabindex='68'   \/>\n\t\t\t\t<label for='choice_33_111_0' id='label_33_111_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_111_1'>\n\t\t\t\t<input name='input_111' type='radio' value='no'  id='choice_33_111_1' tabindex='69'   \/>\n\t\t\t\t<label for='choice_33_111_1' id='label_33_111_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_111_2'>\n\t\t\t\t<input name='input_111' type='radio' value='maybe'  id='choice_33_111_2' tabindex='70'   \/>\n\t\t\t\t<label for='choice_33_111_2' id='label_33_111_2' class='gform-field-label gform-field-label--type-inline'>maybe<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_32\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_33_32'>If yes or maybe, which one?<\/label><div class='gfield_description' id='gfield_description_33_32'>If yes or maybe, which one?<\/div><div class='ginput_container ginput_container_text'><input name='input_32' id='input_33_32' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_32\" tabindex='71'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_116\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_33\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you ever been on a diet?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_33'>\n\t\t\t<li class='gchoice gchoice_33_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='yes'  id='choice_33_33_0' tabindex='72'   \/>\n\t\t\t\t<label for='choice_33_33_0' id='label_33_33_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_33_1'>\n\t\t\t\t<input name='input_33' type='radio' value='no'  id='choice_33_33_1' tabindex='73'   \/>\n\t\t\t\t<label for='choice_33_33_1' id='label_33_33_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_34\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_33_34'>If yes, what diet(s)?<\/label><div class='gfield_description' id='gfield_description_33_34'>If yes, what diet(s)?<\/div><div class='ginput_container ginput_container_text'><input name='input_34' id='input_33_34' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_34\" tabindex='74'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_117\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_35\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >What short-term results did that produce?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_35'>\n\t\t\t<li class='gchoice gchoice_33_35_0'>\n\t\t\t\t<input name='input_35' type='radio' value='no'  id='choice_33_35_0' tabindex='75'   \/>\n\t\t\t\t<label for='choice_33_35_0' id='label_33_35_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_33_35_1'>\n\t\t\t\t<input name='input_35' type='radio' value='insufficient'  id='choice_33_35_1' tabindex='76'   \/>\n\t\t\t\t<label for='choice_33_35_1' id='label_33_35_1' class='gform-field-label gform-field-label--type-inline'>insufficient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_35_2'>\n\t\t\t\t<input name='input_35' type='radio' value='sufficient'  id='choice_33_35_2' tabindex='77'   \/>\n\t\t\t\t<label for='choice_33_35_2' id='label_33_35_2' class='gform-field-label gform-field-label--type-inline'>sufficient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_35_3'>\n\t\t\t\t<input name='input_35' type='radio' value='good'  id='choice_33_35_3' tabindex='78'   \/>\n\t\t\t\t<label for='choice_33_35_3' id='label_33_35_3' class='gform-field-label gform-field-label--type-inline'>good<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_36\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_33_36'>How many kg maximum lost?<\/label><div class='gfield_description' id='gfield_description_33_36'>How many kg maximum lost?<\/div><div class='ginput_container ginput_container_text'><input name='input_36' id='input_33_36' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_36\" tabindex='79'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_118\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_37\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >What were the long-term results?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_37'>\n\t\t\t<li class='gchoice gchoice_33_37_0'>\n\t\t\t\t<input name='input_37' type='radio' value='no'  id='choice_33_37_0' tabindex='80'   \/>\n\t\t\t\t<label for='choice_33_37_0' id='label_33_37_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_33_37_1'>\n\t\t\t\t<input name='input_37' type='radio' value='insufficient'  id='choice_33_37_1' tabindex='81'   \/>\n\t\t\t\t<label for='choice_33_37_1' id='label_33_37_1' class='gform-field-label gform-field-label--type-inline'>insufficient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_37_2'>\n\t\t\t\t<input name='input_37' type='radio' value='sufficient'  id='choice_33_37_2' tabindex='82'   \/>\n\t\t\t\t<label for='choice_33_37_2' id='label_33_37_2' class='gform-field-label gform-field-label--type-inline'>sufficient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_37_3'>\n\t\t\t\t<input name='input_37' type='radio' value='good'  id='choice_33_37_3' tabindex='83'   \/>\n\t\t\t\t<label for='choice_33_37_3' id='label_33_37_3' class='gform-field-label gform-field-label--type-inline'>good<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_38\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_33_38'>How many kg lost or gained?<\/label><div class='gfield_description' id='gfield_description_33_38'>How many kg lost or gained?<\/div><div class='ginput_container ginput_container_text'><input name='input_38' id='input_33_38' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_38\" tabindex='84'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_119\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_39\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have dietary restrictions?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_39'>\n\t\t\t<li class='gchoice gchoice_33_39_0'>\n\t\t\t\t<input name='input_39' type='radio' value='yes'  id='choice_33_39_0' tabindex='85'   \/>\n\t\t\t\t<label for='choice_33_39_0' id='label_33_39_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_39_1'>\n\t\t\t\t<input name='input_39' type='radio' value='no'  id='choice_33_39_1' tabindex='86'   \/>\n\t\t\t\t<label for='choice_33_39_1' id='label_33_39_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_40\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_40'>dietary restrictions_yes<\/label><div class='gfield_description' id='gfield_description_33_40'>Dietary restrictions<\/div><div class='ginput_container ginput_container_text'><input name='input_40' id='input_33_40' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_40\" tabindex='87'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_120\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_41\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you use dietary supplements?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_41'>\n\t\t\t<li class='gchoice gchoice_33_41_0'>\n\t\t\t\t<input name='input_41' type='radio' value='yes'  id='choice_33_41_0' tabindex='88'   \/>\n\t\t\t\t<label for='choice_33_41_0' id='label_33_41_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_41_1'>\n\t\t\t\t<input name='input_41' type='radio' value='no'  id='choice_33_41_1' tabindex='89'   \/>\n\t\t\t\t<label for='choice_33_41_1' id='label_33_41_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_42\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_42'>supplements_yes<\/label><div class='gfield_description' id='gfield_description_33_42'>If yes, which and how many?<\/div><div class='ginput_container ginput_container_text'><input name='input_42' id='input_33_42' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_42\" tabindex='90'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_121\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_44\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you cook for others?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_44'>\n\t\t\t<li class='gchoice gchoice_33_44_0'>\n\t\t\t\t<input name='input_44' type='radio' value='yes'  id='choice_33_44_0' tabindex='91'   \/>\n\t\t\t\t<label for='choice_33_44_0' id='label_33_44_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_44_1'>\n\t\t\t\t<input name='input_44' type='radio' value='no'  id='choice_33_44_1' tabindex='92'   \/>\n\t\t\t\t<label for='choice_33_44_1' id='label_33_44_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_43\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_43'>cooking for othershow often<\/label><div class='gfield_description' id='gfield_description_33_43'>If yes how many times a week<\/div><div class='ginput_container ginput_container_text'><input name='input_43' id='input_33_43' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_43\" tabindex='93'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_122\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_45\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >What do you drink very regularly?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_33_45'><li class='gchoice gchoice_33_45_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.1' type='checkbox'  value='coffee'  id='choice_33_45_1' tabindex='94'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_45_1' id='label_33_45_1' class='gform-field-label gform-field-label--type-inline'>coffee<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_45_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.2' type='checkbox'  value='water'  id='choice_33_45_2' tabindex='95'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_45_2' id='label_33_45_2' class='gform-field-label gform-field-label--type-inline'>water<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_45_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.3' type='checkbox'  value='soda'  id='choice_33_45_3' tabindex='96'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_45_3' id='label_33_45_3' class='gform-field-label gform-field-label--type-inline'>soda<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_45_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.4' type='checkbox'  value='alcohol'  id='choice_33_45_4' tabindex='97'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_45_4' id='label_33_45_4' class='gform-field-label gform-field-label--type-inline'>alcohol<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_45_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.5' type='checkbox'  value='tea'  id='choice_33_45_5' tabindex='98'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_45_5' id='label_33_45_5' class='gform-field-label gform-field-label--type-inline'>tea<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_45_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.6' type='checkbox'  value='milk'  id='choice_33_45_6' tabindex='99'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_45_6' id='label_33_45_6' class='gform-field-label gform-field-label--type-inline'>milk<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_45_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.7' type='checkbox'  value='fruit juice'  id='choice_33_45_7' tabindex='100'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_45_7' id='label_33_45_7' class='gform-field-label gform-field-label--type-inline'>fruit juice<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_33_45_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.8' type='checkbox'  value='none of them'  id='choice_33_45_8' tabindex='101'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_33_45_8' id='label_33_45_8' class='gform-field-label gform-field-label--type-inline'>none of them<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_46\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you drink coffee?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_46'>\n\t\t\t<li class='gchoice gchoice_33_46_0'>\n\t\t\t\t<input name='input_46' type='radio' value='yes'  id='choice_33_46_0' tabindex='102'   \/>\n\t\t\t\t<label for='choice_33_46_0' id='label_33_46_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_46_1'>\n\t\t\t\t<input name='input_46' type='radio' value='no'  id='choice_33_46_1' tabindex='103'   \/>\n\t\t\t\t<label for='choice_33_46_1' id='label_33_46_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_47\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >If yes, how many cups per day?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_47'>\n\t\t\t<li class='gchoice gchoice_33_47_0'>\n\t\t\t\t<input name='input_47' type='radio' value='1-3'  id='choice_33_47_0' tabindex='104'   \/>\n\t\t\t\t<label for='choice_33_47_0' id='label_33_47_0' class='gform-field-label gform-field-label--type-inline'>1-3<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_47_1'>\n\t\t\t\t<input name='input_47' type='radio' value='3-5'  id='choice_33_47_1' tabindex='105'   \/>\n\t\t\t\t<label for='choice_33_47_1' id='label_33_47_1' class='gform-field-label gform-field-label--type-inline'>3-5<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_47_2'>\n\t\t\t\t<input name='input_47' type='radio' value='5&gt;'  id='choice_33_47_2' tabindex='106'   \/>\n\t\t\t\t<label for='choice_33_47_2' id='label_33_47_2' class='gform-field-label gform-field-label--type-inline'>5&gt;<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_48\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you consume alcoholic beverages?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_48'>\n\t\t\t<li class='gchoice gchoice_33_48_0'>\n\t\t\t\t<input name='input_48' type='radio' value='yes'  id='choice_33_48_0' tabindex='107'   \/>\n\t\t\t\t<label for='choice_33_48_0' id='label_33_48_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_48_1'>\n\t\t\t\t<input name='input_48' type='radio' value='no'  id='choice_33_48_1' tabindex='108'   \/>\n\t\t\t\t<label for='choice_33_48_1' id='label_33_48_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_49\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_49'>drinks_yes<\/label><div class='gfield_description' id='gfield_description_33_49'>If yes, what beverages?<\/div><div class='ginput_container ginput_container_text'><input name='input_49' id='input_33_49' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_49\" tabindex='109'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_123\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_50\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_50'>drinks_ja2<\/label><div class='gfield_description' id='gfield_description_33_50'>If yes, how many glasses per week?<\/div><div class='ginput_container ginput_container_text'><input name='input_50' id='input_33_50' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_50\" tabindex='110'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_124\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_106\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><hr><strong>Questions related to health (past):<\/strong><\/br><\/br><\/li><li id=\"field_33_53\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have concerns and\/or fears regarding your health?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_53'>\n\t\t\t<li class='gchoice gchoice_33_53_0'>\n\t\t\t\t<input name='input_53' type='radio' value='yes'  id='choice_33_53_0' tabindex='111'   \/>\n\t\t\t\t<label for='choice_33_53_0' id='label_33_53_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_53_1'>\n\t\t\t\t<input name='input_53' type='radio' value='no'  id='choice_33_53_1' tabindex='112'   \/>\n\t\t\t\t<label for='choice_33_53_1' id='label_33_53_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_54\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_54'>worry_yes<\/label><div class='gfield_description' id='gfield_description_33_54'>If yes, what for?<\/div><div class='ginput_container ginput_container_text'><input name='input_54' id='input_33_54' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_54\" tabindex='113'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_125\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_55\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have health issues?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_55'>\n\t\t\t<li class='gchoice gchoice_33_55_0'>\n\t\t\t\t<input name='input_55' type='radio' value='yes'  id='choice_33_55_0' tabindex='114'   \/>\n\t\t\t\t<label for='choice_33_55_0' id='label_33_55_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_55_1'>\n\t\t\t\t<input name='input_55' type='radio' value='no'  id='choice_33_55_1' tabindex='115'   \/>\n\t\t\t\t<label for='choice_33_55_1' id='label_33_55_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_56\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_56'>health complaints_yes<\/label><div class='gfield_description' id='gfield_description_33_56'>If so, which one?<\/div><div class='ginput_container ginput_container_text'><input name='input_56' id='input_33_56' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_56\" tabindex='116'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_126\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_57\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you smoke?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_57'>\n\t\t\t<li class='gchoice gchoice_33_57_0'>\n\t\t\t\t<input name='input_57' type='radio' value='yes'  id='choice_33_57_0' tabindex='117'   \/>\n\t\t\t\t<label for='choice_33_57_0' id='label_33_57_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_57_1'>\n\t\t\t\t<input name='input_57' type='radio' value='no'  id='choice_33_57_1' tabindex='118'   \/>\n\t\t\t\t<label for='choice_33_57_1' id='label_33_57_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_58\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_58'>smoking_yes<\/label><div class='gfield_description' id='gfield_description_33_58'>If yes, how much?<\/div><div class='ginput_container ginput_container_text'><input name='input_58' id='input_33_58' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_58\" tabindex='119'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_127\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_61\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you taking any medications\/painkillers?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_61'>\n\t\t\t<li class='gchoice gchoice_33_61_0'>\n\t\t\t\t<input name='input_61' type='radio' value='yes'  id='choice_33_61_0' tabindex='120'   \/>\n\t\t\t\t<label for='choice_33_61_0' id='label_33_61_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_61_1'>\n\t\t\t\t<input name='input_61' type='radio' value='no'  id='choice_33_61_1' tabindex='121'   \/>\n\t\t\t\t<label for='choice_33_61_1' id='label_33_61_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_60\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_60'>medicine_yes<\/label><div class='gfield_description' id='gfield_description_33_60'>If so, which one?<\/div><div class='ginput_container ginput_container_text'><input name='input_60' id='input_33_60' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_60\" tabindex='122'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_128\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_59\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you use drugs?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_59'>\n\t\t\t<li class='gchoice gchoice_33_59_0'>\n\t\t\t\t<input name='input_59' type='radio' value='yes'  id='choice_33_59_0' tabindex='123'   \/>\n\t\t\t\t<label for='choice_33_59_0' id='label_33_59_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_59_1'>\n\t\t\t\t<input name='input_59' type='radio' value='no'  id='choice_33_59_1' tabindex='124'   \/>\n\t\t\t\t<label for='choice_33_59_1' id='label_33_59_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_62\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_62'>drug_yes<\/label><div class='gfield_description' id='gfield_description_33_62'>If yes, which and how many?<\/div><div class='ginput_container ginput_container_text'><input name='input_62' id='input_33_62' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_62\" tabindex='125'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_129\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_63\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you ever taken a course of antibiotics?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_63'>\n\t\t\t<li class='gchoice gchoice_33_63_0'>\n\t\t\t\t<input name='input_63' type='radio' value='yes'  id='choice_33_63_0' tabindex='126'   \/>\n\t\t\t\t<label for='choice_33_63_0' id='label_33_63_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_63_1'>\n\t\t\t\t<input name='input_63' type='radio' value='no'  id='choice_33_63_1' tabindex='127'   \/>\n\t\t\t\t<label for='choice_33_63_1' id='label_33_63_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_64\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_64'>antibiotics_yes<\/label><div class='gfield_description' id='gfield_description_33_64'>If yes, for what conditions?<\/div><div class='ginput_container ginput_container_text'><input name='input_64' id='input_33_64' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_64\" tabindex='128'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_130\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_65\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >If yes did you follow a probiotic treatment afterwards?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_65'>\n\t\t\t<li class='gchoice gchoice_33_65_0'>\n\t\t\t\t<input name='input_65' type='radio' value='yes'  id='choice_33_65_0' tabindex='129'   \/>\n\t\t\t\t<label for='choice_33_65_0' id='label_33_65_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_65_1'>\n\t\t\t\t<input name='input_65' type='radio' value='no'  id='choice_33_65_1' tabindex='130'   \/>\n\t\t\t\t<label for='choice_33_65_1' id='label_33_65_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_66\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_66'>mancos<\/label><div class='gfield_description' id='gfield_description_33_66'>What health cancers have manifested themselves over the years?<\/div><div class='ginput_container ginput_container_text'><input name='input_66' id='input_33_66' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_66\" tabindex='131'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_132\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_67\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you undergone any surgeries?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_67'>\n\t\t\t<li class='gchoice gchoice_33_67_0'>\n\t\t\t\t<input name='input_67' type='radio' value='yes'  id='choice_33_67_0' tabindex='132'   \/>\n\t\t\t\t<label for='choice_33_67_0' id='label_33_67_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_67_1'>\n\t\t\t\t<input name='input_67' type='radio' value='no'  id='choice_33_67_1' tabindex='133'   \/>\n\t\t\t\t<label for='choice_33_67_1' id='label_33_67_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_68\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_68'>operations_yes<\/label><div class='gfield_description' id='gfield_description_33_68'>If so, which one?<\/div><div class='ginput_container ginput_container_text'><input name='input_68' id='input_33_68' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_68\" tabindex='134'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_133\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_69\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you ever been diagnosed with hypoglycemia (too low sugar)?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_69'>\n\t\t\t<li class='gchoice gchoice_33_69_0'>\n\t\t\t\t<input name='input_69' type='radio' value='yes'  id='choice_33_69_0' tabindex='135'   \/>\n\t\t\t\t<label for='choice_33_69_0' id='label_33_69_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_69_1'>\n\t\t\t\t<input name='input_69' type='radio' value='no'  id='choice_33_69_1' tabindex='136'   \/>\n\t\t\t\t<label for='choice_33_69_1' id='label_33_69_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_69_2'>\n\t\t\t\t<input name='input_69' type='radio' value='never measured'  id='choice_33_69_2' tabindex='137'   \/>\n\t\t\t\t<label for='choice_33_69_2' id='label_33_69_2' class='gform-field-label gform-field-label--type-inline'>never measured<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_70\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you transpire a lot?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_70'>\n\t\t\t<li class='gchoice gchoice_33_70_0'>\n\t\t\t\t<input name='input_70' type='radio' value='yes'  id='choice_33_70_0' tabindex='138'   \/>\n\t\t\t\t<label for='choice_33_70_0' id='label_33_70_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_70_1'>\n\t\t\t\t<input name='input_70' type='radio' value='no'  id='choice_33_70_1' tabindex='139'   \/>\n\t\t\t\t<label for='choice_33_70_1' id='label_33_70_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_72\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have skin complaints?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_72'>\n\t\t\t<li class='gchoice gchoice_33_72_0'>\n\t\t\t\t<input name='input_72' type='radio' value='yes'  id='choice_33_72_0' tabindex='140'   \/>\n\t\t\t\t<label for='choice_33_72_0' id='label_33_72_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_72_1'>\n\t\t\t\t<input name='input_72' type='radio' value='no'  id='choice_33_72_1' tabindex='141'   \/>\n\t\t\t\t<label for='choice_33_72_1' id='label_33_72_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_73\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are your joints bothering you?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_73'>\n\t\t\t<li class='gchoice gchoice_33_73_0'>\n\t\t\t\t<input name='input_73' type='radio' value='yes'  id='choice_33_73_0' tabindex='142'   \/>\n\t\t\t\t<label for='choice_33_73_0' id='label_33_73_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_73_1'>\n\t\t\t\t<input name='input_73' type='radio' value='no'  id='choice_33_73_1' tabindex='143'   \/>\n\t\t\t\t<label for='choice_33_73_1' id='label_33_73_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_73_2'>\n\t\t\t\t<input name='input_73' type='radio' value='sometimes'  id='choice_33_73_2' tabindex='144'   \/>\n\t\t\t\t<label for='choice_33_73_2' id='label_33_73_2' class='gform-field-label gform-field-label--type-inline'>sometimes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_74\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you suffering from intestinal problems?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_74'>\n\t\t\t<li class='gchoice gchoice_33_74_0'>\n\t\t\t\t<input name='input_74' type='radio' value='yes'  id='choice_33_74_0' tabindex='145'   \/>\n\t\t\t\t<label for='choice_33_74_0' id='label_33_74_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_74_1'>\n\t\t\t\t<input name='input_74' type='radio' value='no'  id='choice_33_74_1' tabindex='146'   \/>\n\t\t\t\t<label for='choice_33_74_1' id='label_33_74_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_74_2'>\n\t\t\t\t<input name='input_74' type='radio' value='sometimes'  id='choice_33_74_2' tabindex='147'   \/>\n\t\t\t\t<label for='choice_33_74_2' id='label_33_74_2' class='gform-field-label gform-field-label--type-inline'>sometimes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_75\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have normal bowel movements?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_75'>\n\t\t\t<li class='gchoice gchoice_33_75_0'>\n\t\t\t\t<input name='input_75' type='radio' value='yes'  id='choice_33_75_0' tabindex='148'   \/>\n\t\t\t\t<label for='choice_33_75_0' id='label_33_75_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_75_1'>\n\t\t\t\t<input name='input_75' type='radio' value='no'  id='choice_33_75_1' tabindex='149'   \/>\n\t\t\t\t<label for='choice_33_75_1' id='label_33_75_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_75_2'>\n\t\t\t\t<input name='input_75' type='radio' value='sometimes'  id='choice_33_75_2' tabindex='150'   \/>\n\t\t\t\t<label for='choice_33_75_2' id='label_33_75_2' class='gform-field-label gform-field-label--type-inline'>sometimes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_76\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >If no or sometimes, in what does it differ?<\/label><div class='gfield_description' id='gfield_description_33_76'>(*compaction, mucus, foam, indigestible remains, blood etc.)<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_76'>\n\t\t\t<li class='gchoice gchoice_33_76_0'>\n\t\t\t\t<input name='input_76' type='radio' value='frequency'  id='choice_33_76_0' tabindex='151'   \/>\n\t\t\t\t<label for='choice_33_76_0' id='label_33_76_0' class='gform-field-label gform-field-label--type-inline'>frequency<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_76_1'>\n\t\t\t\t<input name='input_76' type='radio' value='color'  id='choice_33_76_1' tabindex='152'   \/>\n\t\t\t\t<label for='choice_33_76_1' id='label_33_76_1' class='gform-field-label gform-field-label--type-inline'>color<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_76_2'>\n\t\t\t\t<input name='input_76' type='radio' value='scent'  id='choice_33_76_2' tabindex='153'   \/>\n\t\t\t\t<label for='choice_33_76_2' id='label_33_76_2' class='gform-field-label gform-field-label--type-inline'>scent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_76_3'>\n\t\t\t\t<input name='input_76' type='radio' value='*composition'  id='choice_33_76_3' tabindex='154'   \/>\n\t\t\t\t<label for='choice_33_76_3' id='label_33_76_3' class='gform-field-label gform-field-label--type-inline'>*composition<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_77\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Is your body weight stable?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_77'>\n\t\t\t<li class='gchoice gchoice_33_77_0'>\n\t\t\t\t<input name='input_77' type='radio' value='yes'  id='choice_33_77_0' tabindex='155'   \/>\n\t\t\t\t<label for='choice_33_77_0' id='label_33_77_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_77_1'>\n\t\t\t\t<input name='input_77' type='radio' value='no'  id='choice_33_77_1' tabindex='156'   \/>\n\t\t\t\t<label for='choice_33_77_1' id='label_33_77_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_78\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >How is your blood pressure?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_78'>\n\t\t\t<li class='gchoice gchoice_33_78_0'>\n\t\t\t\t<input name='input_78' type='radio' value='low'  id='choice_33_78_0' tabindex='157'   \/>\n\t\t\t\t<label for='choice_33_78_0' id='label_33_78_0' class='gform-field-label gform-field-label--type-inline'>low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_78_1'>\n\t\t\t\t<input name='input_78' type='radio' value='normal'  id='choice_33_78_1' tabindex='158'   \/>\n\t\t\t\t<label for='choice_33_78_1' id='label_33_78_1' class='gform-field-label gform-field-label--type-inline'>normal<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_78_2'>\n\t\t\t\t<input name='input_78' type='radio' value='high'  id='choice_33_78_2' tabindex='159'   \/>\n\t\t\t\t<label for='choice_33_78_2' id='label_33_78_2' class='gform-field-label gform-field-label--type-inline'>high<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_78_3'>\n\t\t\t\t<input name='input_78' type='radio' value='changing'  id='choice_33_78_3' tabindex='160'   \/>\n\t\t\t\t<label for='choice_33_78_3' id='label_33_78_3' class='gform-field-label gform-field-label--type-inline'>changing<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_78_4'>\n\t\t\t\t<input name='input_78' type='radio' value='don&#039;t know'  id='choice_33_78_4' tabindex='161'   \/>\n\t\t\t\t<label for='choice_33_78_4' id='label_33_78_4' class='gform-field-label gform-field-label--type-inline'>don't know<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_79\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you having trouble sleeping?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_79'>\n\t\t\t<li class='gchoice gchoice_33_79_0'>\n\t\t\t\t<input name='input_79' type='radio' value='always'  id='choice_33_79_0' tabindex='162'   \/>\n\t\t\t\t<label for='choice_33_79_0' id='label_33_79_0' class='gform-field-label gform-field-label--type-inline'>always<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_79_1'>\n\t\t\t\t<input name='input_79' type='radio' value='sometimes'  id='choice_33_79_1' tabindex='163'   \/>\n\t\t\t\t<label for='choice_33_79_1' id='label_33_79_1' class='gform-field-label gform-field-label--type-inline'>sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_79_2'>\n\t\t\t\t<input name='input_79' type='radio' value='never'  id='choice_33_79_2' tabindex='164'   \/>\n\t\t\t\t<label for='choice_33_79_2' id='label_33_79_2' class='gform-field-label gform-field-label--type-inline'>never<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_80\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you get up easily and rested in the morning?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_80'>\n\t\t\t<li class='gchoice gchoice_33_80_0'>\n\t\t\t\t<input name='input_80' type='radio' value='always'  id='choice_33_80_0' tabindex='165'   \/>\n\t\t\t\t<label for='choice_33_80_0' id='label_33_80_0' class='gform-field-label gform-field-label--type-inline'>always<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_80_1'>\n\t\t\t\t<input name='input_80' type='radio' value='sometimes'  id='choice_33_80_1' tabindex='166'   \/>\n\t\t\t\t<label for='choice_33_80_1' id='label_33_80_1' class='gform-field-label gform-field-label--type-inline'>sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_80_2'>\n\t\t\t\t<input name='input_80' type='radio' value='never'  id='choice_33_80_2' tabindex='167'   \/>\n\t\t\t\t<label for='choice_33_80_2' id='label_33_80_2' class='gform-field-label gform-field-label--type-inline'>never<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_81\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_81'>how many hours<\/label><div class='gfield_description' id='gfield_description_33_81'>On average, how many hours do you sleep?<\/div><div class='ginput_container ginput_container_text'><input name='input_81' id='input_33_81' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_81\" tabindex='168'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_134\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_82\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you experiencing a lot of stress?<\/label><div class='gfield_description' id='gfield_description_33_82'>Scale 1 in 10.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_82'>\n\t\t\t<li class='gchoice gchoice_33_82_0'>\n\t\t\t\t<input name='input_82' type='radio' value='1'  id='choice_33_82_0' tabindex='169'   \/>\n\t\t\t\t<label for='choice_33_82_0' id='label_33_82_0' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_82_1'>\n\t\t\t\t<input name='input_82' type='radio' value='2'  id='choice_33_82_1' tabindex='170'   \/>\n\t\t\t\t<label for='choice_33_82_1' id='label_33_82_1' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_82_2'>\n\t\t\t\t<input name='input_82' type='radio' value='3'  id='choice_33_82_2' tabindex='171'   \/>\n\t\t\t\t<label for='choice_33_82_2' id='label_33_82_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_82_3'>\n\t\t\t\t<input name='input_82' type='radio' value='4'  id='choice_33_82_3' tabindex='172'   \/>\n\t\t\t\t<label for='choice_33_82_3' id='label_33_82_3' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_82_4'>\n\t\t\t\t<input name='input_82' type='radio' value='5'  id='choice_33_82_4' tabindex='173'   \/>\n\t\t\t\t<label for='choice_33_82_4' id='label_33_82_4' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_82_5'>\n\t\t\t\t<input name='input_82' type='radio' value='6'  id='choice_33_82_5' tabindex='174'   \/>\n\t\t\t\t<label for='choice_33_82_5' id='label_33_82_5' class='gform-field-label gform-field-label--type-inline'>6<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_82_6'>\n\t\t\t\t<input name='input_82' type='radio' value='7'  id='choice_33_82_6' tabindex='175'   \/>\n\t\t\t\t<label for='choice_33_82_6' id='label_33_82_6' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_82_7'>\n\t\t\t\t<input name='input_82' type='radio' value='8'  id='choice_33_82_7' tabindex='176'   \/>\n\t\t\t\t<label for='choice_33_82_7' id='label_33_82_7' class='gform-field-label gform-field-label--type-inline'>8<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_82_8'>\n\t\t\t\t<input name='input_82' type='radio' value='9'  id='choice_33_82_8' tabindex='177'   \/>\n\t\t\t\t<label for='choice_33_82_8' id='label_33_82_8' class='gform-field-label gform-field-label--type-inline'>9<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_82_9'>\n\t\t\t\t<input name='input_82' type='radio' value='10'  id='choice_33_82_9' tabindex='178'   \/>\n\t\t\t\t<label for='choice_33_82_9' id='label_33_82_9' class='gform-field-label gform-field-label--type-inline'>10<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_135\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_104\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><hr><strong>General questions regarding current condition:<\/strong><\/br><\/br><\/li><li id=\"field_33_91\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >How was your condition over the years?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_91'>\n\t\t\t<li class='gchoice gchoice_33_91_0'>\n\t\t\t\t<input name='input_91' type='radio' value='bad'  id='choice_33_91_0' tabindex='179'   \/>\n\t\t\t\t<label for='choice_33_91_0' id='label_33_91_0' class='gform-field-label gform-field-label--type-inline'>bad<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_91_1'>\n\t\t\t\t<input name='input_91' type='radio' value='moderate'  id='choice_33_91_1' tabindex='180'   \/>\n\t\t\t\t<label for='choice_33_91_1' id='label_33_91_1' class='gform-field-label gform-field-label--type-inline'>moderate<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_91_2'>\n\t\t\t\t<input name='input_91' type='radio' value='good'  id='choice_33_91_2' tabindex='181'   \/>\n\t\t\t\t<label for='choice_33_91_2' id='label_33_91_2' class='gform-field-label gform-field-label--type-inline'>good<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_92\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have sufficient energy?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_92'>\n\t\t\t<li class='gchoice gchoice_33_92_0'>\n\t\t\t\t<input name='input_92' type='radio' value='yes'  id='choice_33_92_0' tabindex='182'   \/>\n\t\t\t\t<label for='choice_33_92_0' id='label_33_92_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_92_1'>\n\t\t\t\t<input name='input_92' type='radio' value='no'  id='choice_33_92_1' tabindex='183'   \/>\n\t\t\t\t<label for='choice_33_92_1' id='label_33_92_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_92_2'>\n\t\t\t\t<input name='input_92' type='radio' value='moderate'  id='choice_33_92_2' tabindex='184'   \/>\n\t\t\t\t<label for='choice_33_92_2' id='label_33_92_2' class='gform-field-label gform-field-label--type-inline'>moderate<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_93\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >How is your general resistance?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_93'>\n\t\t\t<li class='gchoice gchoice_33_93_0'>\n\t\t\t\t<input name='input_93' type='radio' value='good'  id='choice_33_93_0' tabindex='185'   \/>\n\t\t\t\t<label for='choice_33_93_0' id='label_33_93_0' class='gform-field-label gform-field-label--type-inline'>good<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_93_1'>\n\t\t\t\t<input name='input_93' type='radio' value='moderate'  id='choice_33_93_1' tabindex='186'   \/>\n\t\t\t\t<label for='choice_33_93_1' id='label_33_93_1' class='gform-field-label gform-field-label--type-inline'>moderate<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_93_2'>\n\t\t\t\t<input name='input_93' type='radio' value='bad'  id='choice_33_93_2' tabindex='187'   \/>\n\t\t\t\t<label for='choice_33_93_2' id='label_33_93_2' class='gform-field-label gform-field-label--type-inline'>bad<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_94\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >How much do you exercise in a day (walking, biking, etc.) in minutes?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_94'>\n\t\t\t<li class='gchoice gchoice_33_94_0'>\n\t\t\t\t<input name='input_94' type='radio' value='not'  id='choice_33_94_0' tabindex='188'   \/>\n\t\t\t\t<label for='choice_33_94_0' id='label_33_94_0' class='gform-field-label gform-field-label--type-inline'>not<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_94_1'>\n\t\t\t\t<input name='input_94' type='radio' value='&lt;15'  id='choice_33_94_1' tabindex='189'   \/>\n\t\t\t\t<label for='choice_33_94_1' id='label_33_94_1' class='gform-field-label gform-field-label--type-inline'>&lt;15<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_94_2'>\n\t\t\t\t<input name='input_94' type='radio' value='15-30'  id='choice_33_94_2' tabindex='190'   \/>\n\t\t\t\t<label for='choice_33_94_2' id='label_33_94_2' class='gform-field-label gform-field-label--type-inline'>15-30<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_94_3'>\n\t\t\t\t<input name='input_94' type='radio' value='30-60'  id='choice_33_94_3' tabindex='191'   \/>\n\t\t\t\t<label for='choice_33_94_3' id='label_33_94_3' class='gform-field-label gform-field-label--type-inline'>30-60<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_94_4'>\n\t\t\t\t<input name='input_94' type='radio' value='&gt;60'  id='choice_33_94_4' tabindex='192'   \/>\n\t\t\t\t<label for='choice_33_94_4' id='label_33_94_4' class='gform-field-label gform-field-label--type-inline'>&gt;60<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_95\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you play sports?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_95'>\n\t\t\t<li class='gchoice gchoice_33_95_0'>\n\t\t\t\t<input name='input_95' type='radio' value='yes'  id='choice_33_95_0' tabindex='193'   \/>\n\t\t\t\t<label for='choice_33_95_0' id='label_33_95_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_95_1'>\n\t\t\t\t<input name='input_95' type='radio' value='no'  id='choice_33_95_1' tabindex='194'   \/>\n\t\t\t\t<label for='choice_33_95_1' id='label_33_95_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_96\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_96'>sport_well<\/label><div class='gfield_description' id='gfield_description_33_96'>If so, which one?<\/div><div class='ginput_container ginput_container_text'><input name='input_96' id='input_33_96' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_96\" tabindex='195'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_137\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_97\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_33_97'>sport_how much<\/label><div class='gfield_description' id='gfield_description_33_97'>How many times a week?<\/div><div class='ginput_container ginput_container_text'><input name='input_97' id='input_33_97' type='text' value='' class='large'  aria-describedby=\"gfield_description_33_97\" tabindex='196'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_33_138\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><\/li><li id=\"field_33_103\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><hr><strong>Desired goal: What do you hope to achieve with lifestyle counseling?<\/strong><\/li><li id=\"field_33_141\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_33_141'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_141' id='input_33_141' class='textarea medium' tabindex='197'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_33_105\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><\/br><hr><strong>Women only:<\/strong><\/br><\/br><\/li><li id=\"field_33_85\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you in transition?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_85'>\n\t\t\t<li class='gchoice gchoice_33_85_0'>\n\t\t\t\t<input name='input_85' type='radio' value='yes'  id='choice_33_85_0' tabindex='198'   \/>\n\t\t\t\t<label for='choice_33_85_0' id='label_33_85_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_85_1'>\n\t\t\t\t<input name='input_85' type='radio' value='no'  id='choice_33_85_1' tabindex='199'   \/>\n\t\t\t\t<label for='choice_33_85_1' id='label_33_85_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_86\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >If yes since when?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_86'>\n\t\t\t<li class='gchoice gchoice_33_86_0'>\n\t\t\t\t<input name='input_86' type='radio' value='&lt;1 year'  id='choice_33_86_0' tabindex='200'   \/>\n\t\t\t\t<label for='choice_33_86_0' id='label_33_86_0' class='gform-field-label gform-field-label--type-inline'>&lt;1 year<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_86_1'>\n\t\t\t\t<input name='input_86' type='radio' value='1-2 years'  id='choice_33_86_1' tabindex='201'   \/>\n\t\t\t\t<label for='choice_33_86_1' id='label_33_86_1' class='gform-field-label gform-field-label--type-inline'>1-2 years<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_86_2'>\n\t\t\t\t<input name='input_86' type='radio' value='2-5 years'  id='choice_33_86_2' tabindex='202'   \/>\n\t\t\t\t<label for='choice_33_86_2' id='label_33_86_2' class='gform-field-label gform-field-label--type-inline'>2-5 years<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_86_3'>\n\t\t\t\t<input name='input_86' type='radio' value='5-10 years'  id='choice_33_86_3' tabindex='203'   \/>\n\t\t\t\t<label for='choice_33_86_3' id='label_33_86_3' class='gform-field-label gform-field-label--type-inline'>5-10 years<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_86_4'>\n\t\t\t\t<input name='input_86' type='radio' value='10 years&gt;'  id='choice_33_86_4' tabindex='204'   \/>\n\t\t\t\t<label for='choice_33_86_4' id='label_33_86_4' class='gform-field-label gform-field-label--type-inline'>10 years&gt;<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_87\" class=\"gfield gfield--type-radio gfield--type-choice gf_list_inline field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have (or used to have) problems with menstruation?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_33_87'>\n\t\t\t<li class='gchoice gchoice_33_87_0'>\n\t\t\t\t<input name='input_87' type='radio' value='yes'  id='choice_33_87_0' tabindex='205'   \/>\n\t\t\t\t<label for='choice_33_87_0' id='label_33_87_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_33_87_1'>\n\t\t\t\t<input name='input_87' type='radio' value='no'  id='choice_33_87_1' tabindex='206'   \/>\n\t\t\t\t<label for='choice_33_87_1' id='label_33_87_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_33_88\" class=\"gfield gfield--type-text gf_list_inline field_sublabel_below gfield--has-description field_description_above hidden_label 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