{"id":1603,"date":"2019-07-02T05:11:45","date_gmt":"2019-07-02T05:11:45","guid":{"rendered":"https:\/\/deborahlevinecounseling.com\/?page_id=1603"},"modified":"2023-11-20T15:43:22","modified_gmt":"2023-11-20T15:43:22","slug":"contact-us","status":"publish","type":"page","link":"http:\/\/deborahlevinecounseling.com\/?page_id=1603","title":{"rendered":"Contact Us"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"1603\" class=\"elementor elementor-1603\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6be1657 e-flex e-con-boxed e-con e-parent\" data-id=\"6be1657\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-4d83d67 e-flex e-con-boxed e-con e-child\" data-id=\"4d83d67\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-278087c elementor-widget elementor-widget-heading\" data-id=\"278087c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Getting Started with our ESA Quiz<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1471613 elementor-widget elementor-widget-heading\" data-id=\"1471613\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Find out if you might qualify for an Emotional Support Animal or a Psychiatric Support Dog by completing the Eligibility Quiz Below.<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-26651cc elementor-invisible elementor-widget elementor-widget-shortcode\" data-id=\"26651cc\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;slideInLeft&quot;}\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div id=\"forminator-quiz-leads-1698\" class=\"forminator-ui forminator-quiz-leads forminator-quiz--list\" data-design=\"default\" data-spacing=&quot;default&quot; data-alignment=&quot;left&quot;><div class=\"forminator-quiz-intro\">\n\t\t\n\t\t\t\t\t<img\n\t\t\t\tsrc=\"http:\/\/deborahlevinecounseling.com\/wp-content\/uploads\/2023\/11\/dog-pet-containment-4977599-1024x682.jpg\"\n\t\t\t\tclass=\"forminator-quiz--image\"\n\t\t\t\talt=\"dog, pet, containment-4977599.jpg\"\t\t\t\/>\n\t\t\n\t\t\t\t\t<div class=\"forminator-quiz--description\"><h3 class=\"elementor-image-box-title\">Unlock Your ESA Letter Consultation from Home!<\/h3>\n<p class=\"elementor-image-box-description\">EmBARK on the journey to secure our authentic ESA Letter Consultation right from the comfort of your home. Simply complete our easy pre-screening, and if you qualify, seize the opportunity to purchase your ESA Letter Consultation while connecting with a licensed mental health professional.<\/p><\/div>\n\t\t\n\t\t<button class=\"forminator-button forminator-quiz-start\" style=\"margin: 0 auto; display: block;\">Start Quiz<\/button><\/div><form\n\t\t\t\tid=\"forminator-module-1698\"\n\t\t\t\tclass=\"forminator-ui forminator-quiz forminator-quiz-1698 forminator-quiz--list forminator-design--default  \"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1698\"\n\t\t\t\tdata-quiz=\"nowrong\"\n\t\t\t\tdata-design=\"default\"\n\t\t\t\tdata-spacing=\"default\"\n\t\t\t\t\n\t\t\t\tdata-alignment=\"left\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\taria-live=\"polite\"\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"6a0e40af5a5c7\"\n\t\t\t><div role=\"tabpanel\" id=\"forminator-custom-form-1698--page-0\" class=\"forminator-pagination forminator-hidden\" aria-labelledby=\"forminator-custom-form-1698--page-0-label\" data-step=\"0\" data-label=\"Page 0\"><div class=\"forminator-pagination--content\"><div class=\"forminator-page-indicator\"><span>Page 1 of 5<\/span><\/div>\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-1003-6024\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-1003-6024-label\"\n\t\t\taria-describedby=\"question-1003-6024-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-1003-6024-label\" class=\"forminator-legend\">Where do you live?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-1003-6024-0-6a0e40af5b462\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1003-6024]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-1003-6024-0-6a0e40af5b462\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1003-6024-0-6a0e40af5b462\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">CA<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1003-6024-1-6a0e40af5b462\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1003-6024]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-1003-6024-1-6a0e40af5b462\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1003-6024-1-6a0e40af5b462\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Some other place<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-4351-8063\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-4351-8063-label\"\n\t\t\taria-describedby=\"question-4351-8063-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-4351-8063-label\" class=\"forminator-legend\">Do you have a pet?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-4351-8063-0-6a0e40af5b4bd\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-4351-8063]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-4351-8063-0-6a0e40af5b4bd\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-4351-8063-0-6a0e40af5b4bd\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Yes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-4351-8063-1-6a0e40af5b4bd\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-4351-8063]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-4351-8063-1-6a0e40af5b4bd\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-4351-8063-1-6a0e40af5b4bd\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">No<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-4351-8063-2-6a0e40af5b4bd\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-4351-8063]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-4351-8063-2-6a0e40af5b4bd\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-4351-8063-2-6a0e40af5b4bd\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">I want one<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-7352-7803\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-7352-7803-label\"\n\t\t\taria-describedby=\"question-7352-7803-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-7352-7803-label\" class=\"forminator-legend\">If you have a pet, what kind?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-7352-7803-0-6a0e40af5b50b\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-7352-7803]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-7352-7803-0-6a0e40af5b50b\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-7352-7803-0-6a0e40af5b50b\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Dog<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-7352-7803-1-6a0e40af5b50b\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-7352-7803]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-7352-7803-1-6a0e40af5b50b\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-7352-7803-1-6a0e40af5b50b\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Cat<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-7352-7803-2-6a0e40af5b50b\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-7352-7803]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-7352-7803-2-6a0e40af5b50b\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-7352-7803-2-6a0e40af5b50b\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rabbit<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-7352-7803-3-6a0e40af5b50b\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-7352-7803]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-7352-7803-3-6a0e40af5b50b\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-7352-7803-3-6a0e40af5b50b\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Something else<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t<\/div><\/div><div role=\"tabpanel\" id=\"forminator-custom-form-1698--page-1\" class=\"forminator-pagination forminator-hidden\" aria-labelledby=\"forminator-custom-form-1698--page-1-label\" data-step=\"1\" data-label=\"Page 1\"><div class=\"forminator-pagination--content\"><div class=\"forminator-page-indicator\"><span>Page 2 of 5<\/span><\/div>\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-4959-3246\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-4959-3246-label\"\n\t\t\taria-describedby=\"question-4959-3246-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-4959-3246-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you had little interest or pleasure in doing things that you usually like to do?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-4959-3246-0-6a0e40af5b57e\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-4959-3246]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-4959-3246-0-6a0e40af5b57e\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-4959-3246-0-6a0e40af5b57e\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-4959-3246-1-6a0e40af5b57e\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-4959-3246]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-4959-3246-1-6a0e40af5b57e\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-4959-3246-1-6a0e40af5b57e\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-4959-3246-2-6a0e40af5b57e\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-4959-3246]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-4959-3246-2-6a0e40af5b57e\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-4959-3246-2-6a0e40af5b57e\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-4959-3246-3-6a0e40af5b57e\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-4959-3246]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-4959-3246-3-6a0e40af5b57e\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-4959-3246-3-6a0e40af5b57e\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-4959-3246-4-6a0e40af5b57e\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-4959-3246]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-4959-3246-4-6a0e40af5b57e\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-4959-3246-4-6a0e40af5b57e\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-1591-8863\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-1591-8863-label\"\n\t\t\taria-describedby=\"question-1591-8863-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-1591-8863-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you felt sad or depressed?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-1591-8863-0-6a0e40af5b5f5\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1591-8863]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-1591-8863-0-6a0e40af5b5f5\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1591-8863-0-6a0e40af5b5f5\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1591-8863-1-6a0e40af5b5f5\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1591-8863]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-1591-8863-1-6a0e40af5b5f5\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1591-8863-1-6a0e40af5b5f5\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1591-8863-2-6a0e40af5b5f5\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1591-8863]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-1591-8863-2-6a0e40af5b5f5\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1591-8863-2-6a0e40af5b5f5\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1591-8863-3-6a0e40af5b5f5\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1591-8863]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-1591-8863-3-6a0e40af5b5f5\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1591-8863-3-6a0e40af5b5f5\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1591-8863-4-6a0e40af5b5f5\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1591-8863]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-1591-8863-4-6a0e40af5b5f5\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1591-8863-4-6a0e40af5b5f5\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-3668-5123\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-3668-5123-label\"\n\t\t\taria-describedby=\"question-3668-5123-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-3668-5123-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you felt more angry or more irritated than usual?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-3668-5123-0-6a0e40af5b654\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-3668-5123]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-3668-5123-0-6a0e40af5b654\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-3668-5123-0-6a0e40af5b654\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-3668-5123-1-6a0e40af5b654\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-3668-5123]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-3668-5123-1-6a0e40af5b654\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-3668-5123-1-6a0e40af5b654\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-3668-5123-2-6a0e40af5b654\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-3668-5123]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-3668-5123-2-6a0e40af5b654\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-3668-5123-2-6a0e40af5b654\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-3668-5123-3-6a0e40af5b654\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-3668-5123]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-3668-5123-3-6a0e40af5b654\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-3668-5123-3-6a0e40af5b654\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-3668-5123-4-6a0e40af5b654\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-3668-5123]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-3668-5123-4-6a0e40af5b654\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-3668-5123-4-6a0e40af5b654\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t<\/div><\/div><div role=\"tabpanel\" id=\"forminator-custom-form-1698--page-2\" class=\"forminator-pagination forminator-hidden\" aria-labelledby=\"forminator-custom-form-1698--page-2-label\" data-step=\"2\" data-label=\"Page 2\"><div class=\"forminator-pagination--content\"><div class=\"forminator-page-indicator\"><span>Page 3 of 5<\/span><\/div>\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-1297-1938\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-1297-1938-label\"\n\t\t\taria-describedby=\"question-1297-1938-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-1297-1938-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you felt worried, anxious, or on edge?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-1297-1938-0-6a0e40af5b6b0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1297-1938]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-1297-1938-0-6a0e40af5b6b0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1297-1938-0-6a0e40af5b6b0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1297-1938-1-6a0e40af5b6b0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1297-1938]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-1297-1938-1-6a0e40af5b6b0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1297-1938-1-6a0e40af5b6b0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1297-1938-2-6a0e40af5b6b0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1297-1938]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-1297-1938-2-6a0e40af5b6b0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1297-1938-2-6a0e40af5b6b0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1297-1938-3-6a0e40af5b6b0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1297-1938]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-1297-1938-3-6a0e40af5b6b0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1297-1938-3-6a0e40af5b6b0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1297-1938-4-6a0e40af5b6b0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1297-1938]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-1297-1938-4-6a0e40af5b6b0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1297-1938-4-6a0e40af5b6b0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-5706-5214\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-5706-5214-label\"\n\t\t\taria-describedby=\"question-5706-5214-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-5706-5214-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you felt afraid or panicked?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-5706-5214-0-6a0e40af5b707\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5706-5214]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-5706-5214-0-6a0e40af5b707\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5706-5214-0-6a0e40af5b707\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-5706-5214-1-6a0e40af5b707\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5706-5214]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-5706-5214-1-6a0e40af5b707\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5706-5214-1-6a0e40af5b707\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-5706-5214-2-6a0e40af5b707\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5706-5214]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-5706-5214-2-6a0e40af5b707\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5706-5214-2-6a0e40af5b707\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-5706-5214-3-6a0e40af5b707\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5706-5214]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-5706-5214-3-6a0e40af5b707\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5706-5214-3-6a0e40af5b707\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-5706-5214-4-6a0e40af5b707\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5706-5214]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-5706-5214-4-6a0e40af5b707\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5706-5214-4-6a0e40af5b707\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-7577-3328\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-7577-3328-label\"\n\t\t\taria-describedby=\"question-7577-3328-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-7577-3328-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you had irregular sleep? (Sleeping too much or too little)<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-7577-3328-0-6a0e40af5b753\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-7577-3328]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-7577-3328-0-6a0e40af5b753\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-7577-3328-0-6a0e40af5b753\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-7577-3328-1-6a0e40af5b753\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-7577-3328]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-7577-3328-1-6a0e40af5b753\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-7577-3328-1-6a0e40af5b753\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-7577-3328-2-6a0e40af5b753\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-7577-3328]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-7577-3328-2-6a0e40af5b753\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-7577-3328-2-6a0e40af5b753\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-7577-3328-3-6a0e40af5b753\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-7577-3328]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-7577-3328-3-6a0e40af5b753\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-7577-3328-3-6a0e40af5b753\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-7577-3328-4-6a0e40af5b753\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-7577-3328]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-7577-3328-4-6a0e40af5b753\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-7577-3328-4-6a0e40af5b753\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t<\/div><\/div><div role=\"tabpanel\" id=\"forminator-custom-form-1698--page-3\" class=\"forminator-pagination forminator-hidden\" aria-labelledby=\"forminator-custom-form-1698--page-3-label\" data-step=\"3\" data-label=\"Page 3\"><div class=\"forminator-pagination--content\"><div class=\"forminator-page-indicator\"><span>Page 4 of 5<\/span><\/div>\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-1988-8597\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-1988-8597-label\"\n\t\t\taria-describedby=\"question-1988-8597-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-1988-8597-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you been acting impulsively? (Shopping too much, sudden use of drugs or alcohol, feeling like you\u2019re \u201con top of the world\u201d)<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-1988-8597-0-6a0e40af5b7a7\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1988-8597]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-1988-8597-0-6a0e40af5b7a7\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1988-8597-0-6a0e40af5b7a7\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1988-8597-1-6a0e40af5b7a7\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1988-8597]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-1988-8597-1-6a0e40af5b7a7\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1988-8597-1-6a0e40af5b7a7\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1988-8597-2-6a0e40af5b7a7\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1988-8597]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-1988-8597-2-6a0e40af5b7a7\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1988-8597-2-6a0e40af5b7a7\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1988-8597-3-6a0e40af5b7a7\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1988-8597]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-1988-8597-3-6a0e40af5b7a7\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1988-8597-3-6a0e40af5b7a7\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-1988-8597-4-6a0e40af5b7a7\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-1988-8597]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-1988-8597-4-6a0e40af5b7a7\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-1988-8597-4-6a0e40af5b7a7\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-6616-6035\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-6616-6035-label\"\n\t\t\taria-describedby=\"question-6616-6035-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-6616-6035-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you avoided situations that make you nervous?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-6616-6035-0-6a0e40af5b7f0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-6616-6035]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-6616-6035-0-6a0e40af5b7f0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-6616-6035-0-6a0e40af5b7f0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-6616-6035-1-6a0e40af5b7f0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-6616-6035]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-6616-6035-1-6a0e40af5b7f0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-6616-6035-1-6a0e40af5b7f0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-6616-6035-2-6a0e40af5b7f0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-6616-6035]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-6616-6035-2-6a0e40af5b7f0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-6616-6035-2-6a0e40af5b7f0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-6616-6035-3-6a0e40af5b7f0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-6616-6035]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-6616-6035-3-6a0e40af5b7f0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-6616-6035-3-6a0e40af5b7f0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-6616-6035-4-6a0e40af5b7f0\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-6616-6035]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-6616-6035-4-6a0e40af5b7f0\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-6616-6035-4-6a0e40af5b7f0\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-5251-7585\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-5251-7585-label\"\n\t\t\taria-describedby=\"question-5251-7585-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-5251-7585-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you heard things other people couldn\u2019t hear and seen things other people couldn\u2019t see?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-5251-7585-0-6a0e40af5b836\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5251-7585]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-5251-7585-0-6a0e40af5b836\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5251-7585-0-6a0e40af5b836\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-5251-7585-1-6a0e40af5b836\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5251-7585]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-5251-7585-1-6a0e40af5b836\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5251-7585-1-6a0e40af5b836\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-5251-7585-2-6a0e40af5b836\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5251-7585]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-5251-7585-2-6a0e40af5b836\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5251-7585-2-6a0e40af5b836\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-5251-7585-3-6a0e40af5b836\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5251-7585]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-5251-7585-3-6a0e40af5b836\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5251-7585-3-6a0e40af5b836\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-5251-7585-4-6a0e40af5b836\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-5251-7585]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-5251-7585-4-6a0e40af5b836\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-5251-7585-4-6a0e40af5b836\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t<\/div><\/div><div role=\"tabpanel\" id=\"forminator-custom-form-1698--page-4\" class=\"forminator-pagination forminator-hidden\" aria-labelledby=\"forminator-custom-form-1698--page-4-label\" data-step=\"4\" data-label=\"Page 4\"><div class=\"forminator-pagination--content\"><div class=\"forminator-page-indicator\"><span>Page 5 of 5<\/span><\/div>\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-8344-6100\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-8344-6100-label\"\n\t\t\taria-describedby=\"question-8344-6100-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-8344-6100-label\" class=\"forminator-legend\">Over the past two (2) weeks, how often have you felt paranoid or fearful you are in danger?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-8344-6100-0-6a0e40af5b8af\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-8344-6100]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-8344-6100-0-6a0e40af5b8af\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-8344-6100-0-6a0e40af5b8af\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Never<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-8344-6100-1-6a0e40af5b8af\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-8344-6100]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-8344-6100-1-6a0e40af5b8af\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-8344-6100-1-6a0e40af5b8af\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Rarely<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-8344-6100-2-6a0e40af5b8af\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-8344-6100]\"\n\t\t\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\tid=\"question-8344-6100-2-6a0e40af5b8af\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-8344-6100-2-6a0e40af5b8af\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Sometimes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-8344-6100-3-6a0e40af5b8af\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-8344-6100]\"\n\t\t\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\tid=\"question-8344-6100-3-6a0e40af5b8af\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-8344-6100-3-6a0e40af5b8af\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Often<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-8344-6100-4-6a0e40af5b8af\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-8344-6100]\"\n\t\t\t\t\t\t\tvalue=\"4\"\n\t\t\t\t\t\t\tid=\"question-8344-6100-4-6a0e40af5b8af\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-8344-6100-4-6a0e40af5b8af\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Always<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t\n\t\t<div\n\t\t\ttabindex=\"0\"\n\t\t\trole=\"radiogroup\"\n\t\t\tid=\"question-9173-4199\"\n\t\t\tclass=\"forminator-question\"\n\t\t\tdata-question-type=\"personality\"\n\t\t\taria-labelledby=\"question-9173-4199-label\"\n\t\t\taria-describedby=\"question-9173-4199-description\"\n\t\t\taria-required=\"true\"\n\t\t>\n\n\t\t\t<span id=\"question-9173-4199-label\" class=\"forminator-legend\">Over the past two (2) weeks, have you had thoughts of suicide?<\/span>\n\t\t\t\n\t\t\t\t\t<label for=\"question-9173-4199-0-6a0e40af5b8fe\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-9173-4199]\"\n\t\t\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\tid=\"question-9173-4199-0-6a0e40af5b8fe\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-9173-4199-0-6a0e40af5b8fe\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">No<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t\t\t\t<label for=\"question-9173-4199-1-6a0e40af5b8fe\" class=\"forminator-answer forminator-only--text\">\n\n\t\t\t\t\t\t<input\n\t\t\t\t\t\t\ttype=\"radio\"\n\t\t\t\t\t\t\tname=\"answers[question-9173-4199]\"\n\t\t\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\tid=\"question-9173-4199-1-6a0e40af5b8fe\"\n\t\t\t\t\t\t\tclass=\"\"\n\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t<span class=\"forminator-answer--design\" for=\"question-9173-4199-1-6a0e40af5b8fe\">\n\t\t\t\t\t\t\n\t\t\t\t\t\t<span class=\"forminator-answer--status\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t<i class=\"forminator-icon-check\"><\/i>\n\t\t\t\t\t\t<\/span>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"forminator-answer--name\">Yes<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/label>\n\n\t\t\t\t\t\n\t\t<\/div>\n\n\t\t<\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div role=\"tabpanel\" id=\"forminator-custom-form-1698--page-5\" class=\"forminator-pagination forminator-hidden\" aria-labelledby=\"forminator-custom-form-1698--page-5-label\" data-step=\"5\" data-label=\"Page 5\"><div class=\"forminator-pagination--content\"><div class=\"forminator-quiz--result\"><button class=\"forminator-button forminator-button-submit  forminator-pagination-submit\" data-loading=\"Calculating Result\" >Ready to send<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"9486a2171e\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F1603\" \/><input type=\"hidden\" name=\"has_lead\" value=\"1\"><input type=\"hidden\" name=\"form_id\" value=\"1698\"><input type=\"hidden\" name=\"page_id\" value=\"1603\"><input type=\"hidden\" name=\"current_url\" value=\"http:\/\/deborahlevinecounseling.com\/?page_id=1603\"><input type=\"hidden\" name=\"entry_id\" value=\"\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_quizzes\" \/><\/form><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1697 forminator-design--default  forminator_ajax forminator-leads-form\" data-forminator-render=\"0\" data-form=\"forminator-module-1697\" data-uid=\"6a0e40af5bc94\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1697\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1697 forminator-design--default  forminator_ajax forminator-leads-form\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1697\"\n\t\t\t\t\n\t\t\t\tdata-design=\"default\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"6a0e40af5bc94\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><p>Please provide your contact information to proceed.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a0e40af5bc94\" id=\"forminator-field-email-1_6a0e40af5bc94-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_6a0e40af5bc94\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a0e40af5bc94\" id=\"forminator-field-name-1_6a0e40af5bc94-label\" class=\"forminator-label\">First Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John\" id=\"forminator-field-name-1_6a0e40af5bc94\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6a0e40af5bc94\" id=\"forminator-field-consent-1_6a0e40af5bc94-label\" class=\"forminator-label\">Consent <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label for=\"forminator-field-consent-1_6a0e40af5bc94\" id=\"forminator-field-consent-1_6a0e40af5bc94__label\" class=\"forminator-checkbox forminator-consent\" style=\"margin: 0;\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6a0e40af5bc94\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6a0e40af5bc94-label\" aria-describedby=\"forminator-field-consent-1_6a0e40af5bc94__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6a0e40af5bc94__description\" class=\"forminator-checkbox__label forminator-consent__label\">Yes, I agree with the <a href=\"#\" target=\"_blank\">privacy policy<\/a> and <a href=\"#\" target=\"_blank\">terms and conditions<\/a>.<\/div><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"9486a2171e\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F1603\" \/><input type=\"hidden\" name=\"form_id\" value=\"1697\"><input type=\"hidden\" name=\"page_id\" value=\"1603\"><input type=\"hidden\" name=\"form_type\" value=\"leads\"><input type=\"hidden\" name=\"current_url\" value=\"http:\/\/deborahlevinecounseling.com\/?page_id=1603\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"lead_quiz\" value=\"1698\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><div class=\"forminator-quiz--skip forminator-lead-form-skip\"><button>Skip and Continue<\/button><\/div><\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Getting Started with our ESA Quiz Find out if you might qualify for an Emotional Support Animal or a Psychiatric Support Dog by completing the Eligibility Quiz Below.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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