{"id":22,"date":"2020-09-23T21:04:14","date_gmt":"2020-09-23T21:04:14","guid":{"rendered":"http:\/\/screening.mhanational.org\/?post_type=screen&#038;p=22"},"modified":"2026-07-10T13:03:06","modified_gmt":"2026-07-10T17:03:06","slug":"depression","status":"publish","type":"screen","link":"https:\/\/screening.mhanational.org\/es\/screening-tools\/depression\/","title":{"rendered":"Test de depresi\u00f3n"},"content":{"rendered":"<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 gravity-theme gform-theme--no-framework trp-no-demographics_wrapper trp-answers_wrapper trp-contextual-choices_wrapper trp-ctx-depression_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Depression Test<\/h2>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1' class='trp-no-demographics trp-answers trp-contextual-choices trp-ctx-depression' class='clearfix' action='\/es\/wp-json\/wp\/v2\/screen\/22' data-formid='1' novalidate><ol class=\"screen-progress-bar clearfix step-1-of-3\">\n\t\t\t\t\t<li class=\"step-1\"><span>Test<br \/>Questions<\/span><\/li>\n\t\t\t\t\t<li class=\"step-2\"><span>Optional<br \/>Questions<\/span><\/li>\n\t\t\t\t\t<li class=\"step-3\"><span>Your<br \/>Results<\/span><\/li>\n\t\t\t\t<\/ol>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_1_114\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_114'>Instagram<\/label><div class='gfield_description' id='gfield_description_1_114'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_114' id='input_1_114' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_1_80\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><p>The Depression Test is for people experiencing overwhelming sadness or despair, low energy, or negative self-image.<\/p>\n\n<p><em>Please note: all questions are required.<\/em><\/p>\n\n<hr \/><\/div><div id=\"field_1_38\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_38' id='input_1_38' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_1_39\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><input name=\"input_39\" id=\"input_1_39\" type=\"hidden\" class=\"gform_hidden\" aria-invalid=\"false\" value=\"22\"><\/div><div id=\"field_1_40\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><input name=\"input_40\" id=\"input_1_40\" type=\"hidden\" class=\"gform_hidden\" aria-invalid=\"false\" value=\"101f6c7cb1ff9824a8e00a3ffdf7dc49\"><\/div><div id=\"field_1_41\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_41' id='input_1_41' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_1_47\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_47' id='input_1_47' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_1_58\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_58' id='input_1_58' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_1_59\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_59' id='input_1_59' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_1_60\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_60' id='input_1_60' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_1_73\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_73' id='input_1_73' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_1_77\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_77' id='input_1_77' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/screen\/22' \/><\/div><\/div><div id=\"field_1_113\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_113' id='input_1_113' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='lang--es' \/><\/div><\/div><div id=\"field_1_105\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >We're testing different ways to ask people about their depression symptoms.<\/div><fieldset id=\"field_1_106\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Can you help us answer 9 extra questions about your experiences over different periods of time (2 weeks vs. 3 months)?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_106'>\n\t\t\t<div class='gchoice gchoice_1_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Yes'  id='choice_1_106_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_106_0' id='label_1_106_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='No'  id='choice_1_106_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_106_1' id='label_1_106_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_107\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Thank you for your help!<\/div><div id=\"field_1_108\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Okay! You will only see the normal questions we always ask.<\/div><div id=\"field_1_109\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><hr \/><\/div><fieldset id=\"field_1_82\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when nothing was fun for you and you just weren't interested in anything?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_82'>\n\t\t\t<div class='gchoice gchoice_1_82_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='Yes'  id='choice_1_82_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_82_0' id='label_1_82_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_82_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='No'  id='choice_1_82_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_82_1' id='label_1_82_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_83\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you had less energy than you usually do?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_83'>\n\t\t\t<div class='gchoice gchoice_1_83_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='Yes'  id='choice_1_83_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_83_0' id='label_1_83_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_83_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='No'  id='choice_1_83_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_83_1' id='label_1_83_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_84\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you felt you couldn't do anything well or that you weren't as good-looking or as smart as other people?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_84'>\n\t\t\t<div class='gchoice gchoice_1_84_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='Yes'  id='choice_1_84_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_84_0' id='label_1_84_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_84_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='No'  id='choice_1_84_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_84_1' id='label_1_84_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_85\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you thought seriously about killing yourself?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_85'>\n\t\t\t<div class='gchoice gchoice_1_85_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='Yes'  id='choice_1_85_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_85_0' id='label_1_85_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_85_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='No'  id='choice_1_85_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_85_1' id='label_1_85_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_86\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you tried to kill yourself in the last year?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_86'>\n\t\t\t<div class='gchoice gchoice_1_86_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='Yes'  id='choice_1_86_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_86_0' id='label_1_86_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_86_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='No'  id='choice_1_86_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_86_1' id='label_1_86_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_87\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when doing even little things made you feel really tired?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_87'>\n\t\t\t<div class='gchoice gchoice_1_87_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='Yes'  id='choice_1_87_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_87_0' id='label_1_87_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_87_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='No'  id='choice_1_87_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_87_1' id='label_1_87_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_88\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you couldn't think as clearly or as fast as usual?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_88'>\n\t\t\t<div class='gchoice gchoice_1_88_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='Yes'  id='choice_1_88_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_88_0' id='label_1_88_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_88_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='No'  id='choice_1_88_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_88_1' id='label_1_88_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_89\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you felt very sad, blue, depressed, or down?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_89'>\n\t\t\t<div class='gchoice gchoice_1_89_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='Yes'  id='choice_1_89_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_89_0' id='label_1_89_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_89_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='No'  id='choice_1_89_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_89_1' id='label_1_89_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_90\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you were easily annoyed or irritable, or often in a bad mood, so that even little things would make you mad?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_90'>\n\t\t\t<div class='gchoice gchoice_1_90_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='Yes'  id='choice_1_90_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_90_0' id='label_1_90_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_90_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='No'  id='choice_1_90_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_90_1' id='label_1_90_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_91\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><hr \/><\/div><div id=\"field_1_4\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><p><strong>Over the last 2 weeks<\/strong>, how often have you been bothered by any of the following problems?<\/p>\n<\/div><fieldset id=\"field_1_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >1. Little interest or pleasure in doing things<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_5'>\n\t\t\t<div class='gchoice gchoice_1_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='0'  id='choice_1_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_5_0' id='label_1_5_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-at-all\">Not at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='1'  id='choice_1_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_5_1' id='label_1_5_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-several-days\">Several days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='2'  id='choice_1_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_5_2' id='label_1_5_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-more-than-half-the-days\">More than half the days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_5_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='3'  id='choice_1_5_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_5_3' id='label_1_5_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-nearly-every-day\">Nearly every day<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >2. Feeling down, depressed, or hopeless<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_6'>\n\t\t\t<div class='gchoice gchoice_1_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='0'  id='choice_1_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_6_0' id='label_1_6_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-at-all\">Not at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='1'  id='choice_1_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_6_1' id='label_1_6_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-several-days\">Several days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_6_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='2'  id='choice_1_6_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_6_2' id='label_1_6_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-more-than-half-the-days\">More than half the days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_6_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='3'  id='choice_1_6_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_6_3' id='label_1_6_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-nearly-every-day\">Nearly every day<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >3. Trouble falling or staying asleep, or sleeping too much<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_7'>\n\t\t\t<div class='gchoice gchoice_1_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='0'  id='choice_1_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_7_0' id='label_1_7_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-at-all\">Not at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='1'  id='choice_1_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_7_1' id='label_1_7_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-several-days\">Several days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='2'  id='choice_1_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_7_2' id='label_1_7_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-more-than-half-the-days\">More than half the days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='3'  id='choice_1_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_7_3' id='label_1_7_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-nearly-every-day\">Nearly every day<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >4. Feeling tired or having little energy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_8'>\n\t\t\t<div class='gchoice gchoice_1_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='0'  id='choice_1_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_8_0' id='label_1_8_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-at-all\">Not at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='1'  id='choice_1_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_8_1' id='label_1_8_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-several-days\">Several days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='2'  id='choice_1_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_8_2' id='label_1_8_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-more-than-half-the-days\">More than half the days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='3'  id='choice_1_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_8_3' id='label_1_8_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-nearly-every-day\">Nearly every day<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5. Poor appetite or overeating<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_9'>\n\t\t\t<div class='gchoice gchoice_1_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='0'  id='choice_1_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_9_0' id='label_1_9_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-at-all\">Not at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='1'  id='choice_1_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_9_1' id='label_1_9_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-several-days\">Several days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='2'  id='choice_1_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_9_2' id='label_1_9_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-more-than-half-the-days\">More than half the days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='3'  id='choice_1_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_9_3' id='label_1_9_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-nearly-every-day\">Nearly every day<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_10'>\n\t\t\t<div class='gchoice gchoice_1_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='0'  id='choice_1_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_10_0' id='label_1_10_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-at-all\">Not at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='1'  id='choice_1_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_10_1' id='label_1_10_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-several-days\">Several days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='2'  id='choice_1_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_10_2' id='label_1_10_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-more-than-half-the-days\">More than half the days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='3'  id='choice_1_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_10_3' id='label_1_10_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-nearly-every-day\">Nearly every day<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >7. Trouble concentrating on things, such as reading the newspaper or watching television<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_11'>\n\t\t\t<div class='gchoice gchoice_1_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='0'  id='choice_1_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_11_0' id='label_1_11_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-at-all\">Not at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='1'  id='choice_1_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-several-days\">Several days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='2'  id='choice_1_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_11_2' id='label_1_11_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-more-than-half-the-days\">More than half the days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_11_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='3'  id='choice_1_11_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_11_3' id='label_1_11_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-nearly-every-day\">Nearly every day<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >8. Moving or speaking so slowly that other people could have noticed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_12'>Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_12'>\n\t\t\t<div class='gchoice gchoice_1_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='0'  id='choice_1_12_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_12\"   \/>\n\t\t\t\t\t<label for='choice_1_12_0' id='label_1_12_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-at-all\">Not at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='1'  id='choice_1_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_12_1' id='label_1_12_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-several-days\">Several days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='2'  id='choice_1_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_12_2' id='label_1_12_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-more-than-half-the-days\">More than half the days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='3'  id='choice_1_12_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_12_3' id='label_1_12_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-nearly-every-day\">Nearly every day<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question alert gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >9. Thoughts that you would be better off dead, or of hurting yourself<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_13'>\n\t\t\t<div class='gchoice gchoice_1_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='0'  id='choice_1_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_0' id='label_1_13_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-at-all\">Not at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='1'  id='choice_1_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-several-days\">Several days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='2'  id='choice_1_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_2' id='label_1_13_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-more-than-half-the-days\">More than half the days<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='3'  id='choice_1_13_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_3' id='label_1_13_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-nearly-every-day\">Nearly every day<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >10. If you checked off any problems, how difficult have these problems made it for you at work, home, or with other people?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_14'>\n\t\t\t<div class='gchoice gchoice_1_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Not difficult at all'  id='choice_1_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_0' id='label_1_14_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-not-difficult-at-all\">Not difficult at all<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Somewhat difficult'  id='choice_1_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-somewhat-difficult\">Somewhat difficult<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Very difficult'  id='choice_1_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_2' id='label_1_14_2' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-very-difficult\">Very difficult<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Extremely difficult'  id='choice_1_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_3' id='label_1_14_3' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-extremely-difficult\">Extremely difficult<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_103\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><hr \/><\/div><fieldset id=\"field_1_94\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when nothing was fun for you and you just weren't interested in anything?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_94'>\n\t\t\t<div class='gchoice gchoice_1_94_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_94' type='radio' value='Yes'  id='choice_1_94_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_94_0' id='label_1_94_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_94_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_94' type='radio' value='No'  id='choice_1_94_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_94_1' id='label_1_94_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_95\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you had less energy than you usually do?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_95'>\n\t\t\t<div class='gchoice gchoice_1_95_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_95' type='radio' value='Yes'  id='choice_1_95_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_95_0' id='label_1_95_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_95_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_95' type='radio' value='No'  id='choice_1_95_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_95_1' id='label_1_95_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_96\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you felt you couldn't do anything well or that you weren't as good-looking or as smart as other people?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_96'>\n\t\t\t<div class='gchoice gchoice_1_96_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='Yes'  id='choice_1_96_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_96_0' id='label_1_96_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_96_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_96' type='radio' value='No'  id='choice_1_96_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_96_1' id='label_1_96_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_97\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you thought seriously about killing yourself?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_97'>\n\t\t\t<div class='gchoice gchoice_1_97_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_97' type='radio' value='Yes'  id='choice_1_97_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_97_0' id='label_1_97_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_97_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_97' type='radio' value='No'  id='choice_1_97_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_97_1' id='label_1_97_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_98\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you tried to kill yourself in the last year?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_98'>\n\t\t\t<div class='gchoice gchoice_1_98_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_98' type='radio' value='Yes'  id='choice_1_98_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_98_0' id='label_1_98_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_98_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_98' type='radio' value='No'  id='choice_1_98_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_98_1' id='label_1_98_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_99\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when doing even little things made you feel really tired?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_99'>\n\t\t\t<div class='gchoice gchoice_1_99_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_99' type='radio' value='Yes'  id='choice_1_99_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_99_0' id='label_1_99_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_99_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_99' type='radio' value='No'  id='choice_1_99_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_99_1' id='label_1_99_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_100\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you couldn't think as clearly or as fast as usual?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_100'>\n\t\t\t<div class='gchoice gchoice_1_100_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='Yes'  id='choice_1_100_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_100_0' id='label_1_100_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_100_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='No'  id='choice_1_100_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_100_1' id='label_1_100_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_101\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you felt very sad, blue, depressed, or down?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_101'>\n\t\t\t<div class='gchoice gchoice_1_101_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='Yes'  id='choice_1_101_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_101_0' id='label_1_101_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_101_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='No'  id='choice_1_101_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_101_1' id='label_1_101_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_102\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months,<\/strong> has there been a time when you were easily annoyed or irritable, or often in a bad mood, so that even little things would make you mad?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_102'>\n\t\t\t<div class='gchoice gchoice_1_102_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_102' type='radio' value='Yes'  id='choice_1_102_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_102_0' id='label_1_102_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_102_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_102' type='radio' value='No'  id='choice_1_102_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_102_1' id='label_1_102_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-depression-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_16\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full warning gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >If you need immediate help, you can reach the Suicide &amp; Crisis Lifeline by calling or texting <a href=\"tel:+1-988\">988<\/a> or using the chat box at <a href=\"http:\/\/988lifeline.org\/\">988lifeline.org<\/a>. You can also <a href=\"sms:+1-741-741;?&body=MHA\">text \u201cMHA\u201d to 741-741<\/a> to reach the Crisis Text Line. <a href=\"https:\/\/screening.mhanational.org\/content\/need-talk-someone-warmlines\/\">Warmlines<\/a> are an excellent place for non-crisis support.<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_17' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page demographics' data-js='page-field-id-17' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_1_18\" class=\"gfield gfield--type-html gfield--input-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\"  ><p>Please take a moment to answer the following <strong>optional<\/strong> questions. Your answers are totally anonymous\u2014we won't be able to identify you based on this information. Your answers help us provide better information and support for people like you.<\/p>\n\n<p>You can answer as many or as few questions as you would like. When you are done, scroll to the bottom of the survey and click \"submit\" to receive your screening results.<\/p><\/div><div id=\"field_1_61\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><hr \/><\/div><fieldset id=\"field_1_69\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full traditional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What is the main thing you want to do after taking this mental health test? (Select one)<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_69'>\n\t\t\t<div class='gchoice gchoice_1_69_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Take another mental health test'  id='choice_1_69_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_0' id='label_1_69_0' class='gform-field-label gform-field-label--type-inline'>Take another mental health test<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_69_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Understand what depression is like (reading articles)'  id='choice_1_69_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_1' id='label_1_69_1' class='gform-field-label gform-field-label--type-inline'>Understand what depression is like (reading articles)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_69_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Understand and manage self-harm or suicidal thoughts'  id='choice_1_69_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_2' id='label_1_69_2' class='gform-field-label gform-field-label--type-inline'>Understand and manage self-harm or suicidal thoughts<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_69_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Tips for managing depression (reading articles)'  id='choice_1_69_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_3' id='label_1_69_3' class='gform-field-label gform-field-label--type-inline'>Tips for managing depression (reading articles)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_69_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Learn and practice skills for how to manage depression (try a free self-help tool)'  id='choice_1_69_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_4' id='label_1_69_4' class='gform-field-label gform-field-label--type-inline'>Learn and practice skills for how to manage depression (try a free self-help tool)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_69_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Learn about what therapy\/treatment is like (reading articles)'  id='choice_1_69_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_5' id='label_1_69_5' class='gform-field-label gform-field-label--type-inline'>Learn about what therapy\/treatment is like (reading articles)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_69_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Find a treatment provider near you'  id='choice_1_69_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_6' id='label_1_69_6' class='gform-field-label gform-field-label--type-inline'>Find a treatment provider near you<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_69_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Find a forum or support group for people with depression'  id='choice_1_69_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_7' id='label_1_69_7' class='gform-field-label gform-field-label--type-inline'>Find a forum or support group for people with depression<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_69_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Other...'  id='choice_1_69_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_8' id='label_1_69_8' class='gform-field-label gform-field-label--type-inline'>Other...<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_69_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='I don\u2019t want to do anything'  id='choice_1_69_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_69_9' id='label_1_69_9' class='gform-field-label gform-field-label--type-inline'>I don\u2019t want to do anything<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_70'>Next Steps - Other<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_1_70' type='text' value='' class='medium'    placeholder='Enter other...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_72\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full layout-action show-actions_b gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><hr \/><\/div><fieldset id=\"field_1_62\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you taking this test for yourself or for someone else?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_62'>\n\t\t\t<div class='gchoice gchoice_1_62_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='For myself'  id='choice_1_62_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_62_0' id='label_1_62_0' class='gform-field-label gform-field-label--type-inline'>For myself<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_62_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='For someone else'  id='choice_1_62_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_62_1' id='label_1_62_1' class='gform-field-label gform-field-label--type-inline'>For someone else<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_63\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >If you are taking this test for someone else, <strong>please use that person's information<\/strong> for the questions below, or leave them blank if you don't know the answer. Remember, <em>these questions are optional<\/em>.<\/div><div id=\"field_1_42\" class=\"gfield gfield--type-html gfield--input-type-html section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2>About You<\/h2><\/div><div id=\"field_1_19\" class=\"gfield gfield--type-select gfield--input-type-select optional taxonomy field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_19'>Age Range<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_1_19' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='8-10' >8-10<\/option><option value='11-13' >11-13<\/option><option value='14-15' >14-15<\/option><option value='16-17' >16-17<\/option><option value='18-24' >18-24<\/option><option value='25-34' >25-34<\/option><option value='35-44' >35-44<\/option><option value='45-54' >45-54<\/option><option value='55-64' >55-64<\/option><option value='65+' >65+<\/option><\/select><\/div><\/div><fieldset id=\"field_1_46\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gender<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_46'>\n\t\t\t<div class='gchoice gchoice_1_46_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Female'  id='choice_1_46_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_46_0' id='label_1_46_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_46_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Male'  id='choice_1_46_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_46_1' id='label_1_46_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_46_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Non-Binary'  id='choice_1_46_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_46_2' id='label_1_46_2' class='gform-field-label gform-field-label--type-inline'>Non-Binary<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_110\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you identify as transgender?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_110'>\n\t\t\t<div class='gchoice gchoice_1_110_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_110' type='radio' value='Yes'  id='choice_1_110_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_110_0' id='label_1_110_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_110_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_110' type='radio' value='No'  id='choice_1_110_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_110_1' id='label_1_110_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_48\" class=\"gfield gfield--type-text gfield--input-type-text optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_48'>How would you describe your gender?<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_1_48' type='text' value='' class='small'    placeholder='Enter gender...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_22\" class=\"gfield gfield--type-select gfield--input-type-select optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_22'>Race\/Ethnicity<\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_1_22' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='American Indian or Alaska Native' >American Indian or Alaska Native<\/option><option value='Asian' >Asian<\/option><option value='Black or African American (non-Hispanic)' >Black or African American (non-Hispanic)<\/option><option value='Hispanic or Latino' >Hispanic or Latino<\/option><option value='Middle Eastern or North African' >Middle Eastern or North African<\/option><option value='Native Hawaiian or other Pacific Islander' >Native Hawaiian or other Pacific Islander<\/option><option value='White (non-Hispanic)' >White (non-Hispanic)<\/option><option value='More than one of the above' >More than one of the above<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_1_23\" class=\"gfield gfield--type-select gfield--input-type-select optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_23'>Household Income<\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_1_23' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Less than $20,000' >Less than $20,000<\/option><option value='$20,000 - $39,999' >$20,000 - $39,999<\/option><option value='$40,000 - $59,999' >$40,000 - $59,999<\/option><option value='$60,000 - $79,999' >$60,000 - $79,999<\/option><option value='$80,000 - $99,999' >$80,000 - $99,999<\/option><option value='$100,000 - $149,999' >$100,000 - $149,999<\/option><option value='$150,000+' >$150,000+<\/option><\/select><\/div><\/div><fieldset id=\"field_1_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you live in the United States or another country?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_64'>\n\t\t\t<div class='gchoice gchoice_1_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='I live in the United States'  id='choice_1_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_0' id='label_1_64_0' class='gform-field-label gform-field-label--type-inline'>I live in the United States<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='I live in another country'  id='choice_1_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_1' id='label_1_64_1' class='gform-field-label gform-field-label--type-inline'>I live in another country<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_32\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_32'>State<\/label><div class='ginput_container ginput_container_select'><select name='input_32' id='input_1_32' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='I live in a U.S. Territory' >I live in a U.S. Territory<\/option><\/select><\/div><\/div><div id=\"field_1_36\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_36'>What country do you live in?<\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_1_36' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' >Saint Helena<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select><\/div><\/div><div id=\"field_1_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_34'>Zip\/Postal Code<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_1_34' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_28\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox optional traditional field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Which of the following populations describes you?<\/legend><div class='gfield_description' id='gfield_description_1_28'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_28'><div class='gchoice gchoice_1_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='Veteran or active-duty military'  id='choice_1_28_1'   aria-describedby=\"gfield_description_1_28\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_28_1' id='label_1_28_1' class='gform-field-label gform-field-label--type-inline'>Veteran or active-duty military<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_28_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.2' type='checkbox'  value='Caregiver of someone living with emotional or physical illness'  id='choice_1_28_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_28_2' id='label_1_28_2' class='gform-field-label gform-field-label--type-inline'>Caregiver of someone living with emotional or physical illness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_28_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.3' type='checkbox'  value='LGBTQ+'  id='choice_1_28_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_28_3' id='label_1_28_3' class='gform-field-label gform-field-label--type-inline'>LGBTQ+<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_28_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.4' type='checkbox'  value='Student'  id='choice_1_28_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_28_4' id='label_1_28_4' class='gform-field-label gform-field-label--type-inline'>Student<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_28_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.5' type='checkbox'  value='Trauma survivor'  id='choice_1_28_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_28_5' id='label_1_28_5' class='gform-field-label gform-field-label--type-inline'>Trauma survivor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_28_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.6' type='checkbox'  value='New or expecting parent'  id='choice_1_28_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_28_6' id='label_1_28_6' class='gform-field-label gform-field-label--type-inline'>New or expecting parent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_28_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.7' type='checkbox'  value='Healthcare worker'  id='choice_1_28_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_28_7' id='label_1_28_7' class='gform-field-label gform-field-label--type-inline'>Healthcare worker<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full traditional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you caring for someone with a mental or physical health condition?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_65'>\n\t\t\t<div class='gchoice gchoice_1_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Mental health condition'  id='choice_1_65_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_65_0' id='label_1_65_0' class='gform-field-label gform-field-label--type-inline'>Mental health condition<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Physical health condition'  id='choice_1_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_65_1' id='label_1_65_1' class='gform-field-label gform-field-label--type-inline'>Physical health condition<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_65_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Both mental and physical health conditions'  id='choice_1_65_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_65_2' id='label_1_65_2' class='gform-field-label gform-field-label--type-inline'>Both mental and physical health conditions<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_66\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_66'>Which of the following best describes your sexual orientation?<\/label><div class='ginput_container ginput_container_select'><select name='input_66' id='input_1_66' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Lesbian or Gay' >Lesbian or Gay<\/option><option value='Bisexual' >Bisexual<\/option><option value='Queer' >Queer<\/option><option value='Pansexual' >Pansexual<\/option><option value='Asexual' >Asexual<\/option><option value='Straight' >Straight<\/option><option value='Other...' >Other...<\/option><\/select><\/div><\/div><div id=\"field_1_50\" class=\"gfield gfield--type-text gfield--input-type-text optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_50'>What is your sexual orientation?<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_1_50' type='text' value='' class='small'    placeholder='Enter sexual orientation...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_67\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full traditional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Which of the following describe your experience of trauma?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_67'><div class='gchoice gchoice_1_67_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.1' type='checkbox'  value='Child abuse\/violence'  id='choice_1_67_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_1' id='label_1_67_1' class='gform-field-label gform-field-label--type-inline'>Child abuse\/violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_67_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.2' type='checkbox'  value='Intimate partner violence'  id='choice_1_67_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_2' id='label_1_67_2' class='gform-field-label gform-field-label--type-inline'>Intimate partner violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_67_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.3' type='checkbox'  value='Sexual assault\/violence'  id='choice_1_67_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_3' id='label_1_67_3' class='gform-field-label gform-field-label--type-inline'>Sexual assault\/violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_67_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.4' type='checkbox'  value='Serious illness\/injury\/assault'  id='choice_1_67_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_4' id='label_1_67_4' class='gform-field-label gform-field-label--type-inline'>Serious illness\/injury\/assault<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_67_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.5' type='checkbox'  value='Family conflict (identity acceptance\/separation\/divorce)'  id='choice_1_67_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_5' id='label_1_67_5' class='gform-field-label gform-field-label--type-inline'>Family conflict (identity acceptance\/separation\/divorce)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_67_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.6' type='checkbox'  value='Traumatic event (natural disaster, accident, witnessing violence, etc.)'  id='choice_1_67_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_6' id='label_1_67_6' class='gform-field-label gform-field-label--type-inline'>Traumatic event (natural disaster, accident, witnessing violence, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_67_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.7' type='checkbox'  value='Death of a loved one'  id='choice_1_67_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_7' id='label_1_67_7' class='gform-field-label gform-field-label--type-inline'>Death of a loved one<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_67_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.8' type='checkbox'  value='Other and\/or tell us more about your trauma'  id='choice_1_67_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_67_8' id='label_1_67_8' class='gform-field-label gform-field-label--type-inline'>Other and\/or tell us more about your trauma<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_68\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_68'>Please tell us more about your experience of trauma:<\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_1_68' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_43\" class=\"gfield gfield--type-html gfield--input-type-html section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2>About Your Mental Health<\/h2><\/div><fieldset id=\"field_1_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio optional short field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you ever received treatment\/support for a mental health problem?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_25'>\n\t\t\t<div class='gchoice gchoice_1_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_1_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_25_0' id='label_1_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_1_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_25_1' id='label_1_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio optional short field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you receiving treatment\/support now?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_57'>\n\t\t\t<div class='gchoice gchoice_1_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Yes'  id='choice_1_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_57_0' id='label_1_57_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='No'  id='choice_1_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_57_1' id='label_1_57_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_111\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full optional traditional limit-3 field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >What has prevented you from seeking treatment in the past?<\/legend><div class='gfield_description' id='gfield_description_1_111'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_111'><div class='gchoice gchoice_1_111_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.1' type='checkbox'  value='I wanted to handle my mental health on my own'  id='choice_1_111_1'   aria-describedby=\"gfield_description_1_111\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_1' id='label_1_111_1' class='gform-field-label gform-field-label--type-inline'>I wanted to handle my mental health on my own<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.2' type='checkbox'  value='I didn\u2019t know how or where to start'  id='choice_1_111_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_2' id='label_1_111_2' class='gform-field-label gform-field-label--type-inline'>I didn\u2019t know how or where to start<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.3' type='checkbox'  value='I thought it would cost too much'  id='choice_1_111_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_3' id='label_1_111_3' class='gform-field-label gform-field-label--type-inline'>I thought it would cost too much<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.4' type='checkbox'  value='I didn\u2019t have time'  id='choice_1_111_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_4' id='label_1_111_4' class='gform-field-label gform-field-label--type-inline'>I didn\u2019t have time<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.5' type='checkbox'  value='I didn\u2019t think it would help me'  id='choice_1_111_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_5' id='label_1_111_5' class='gform-field-label gform-field-label--type-inline'>I didn\u2019t think it would help me<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.6' type='checkbox'  value='I didn&#039;t feel ready to start treatment'  id='choice_1_111_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_6' id='label_1_111_6' class='gform-field-label gform-field-label--type-inline'>I didn't feel ready to start treatment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.7' type='checkbox'  value='I was worried about what people would think or say if I got treatment'  id='choice_1_111_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_7' id='label_1_111_7' class='gform-field-label gform-field-label--type-inline'>I was worried about what people would think or say if I got treatment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.8' type='checkbox'  value='I was afraid of being forced into a hospital or forced to take medication'  id='choice_1_111_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_8' id='label_1_111_8' class='gform-field-label gform-field-label--type-inline'>I was afraid of being forced into a hospital or forced to take medication<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.9' type='checkbox'  value='I tried, but couldn\u2019t find available treatment (no openings, wouldn\u2019t take insurance, etc.)'  id='choice_1_111_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_9' id='label_1_111_9' class='gform-field-label gform-field-label--type-inline'>I tried, but couldn\u2019t find available treatment (no openings, wouldn\u2019t take insurance, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.11' type='checkbox'  value='My parent(s) or guardian wouldn&#039;t let me, or I didn&#039;t want to ask'  id='choice_1_111_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_11' id='label_1_111_11' class='gform-field-label gform-field-label--type-inline'>My parent(s) or guardian wouldn't let me, or I didn't want to ask<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_111_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.12' type='checkbox'  value='Other...'  id='choice_1_111_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_111_12' id='label_1_111_12' class='gform-field-label gform-field-label--type-inline'>Other...<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_112\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_112'>What else has prevented you from seeking treatment in the past?<\/label><div class='ginput_container ginput_container_text'><input name='input_112' id='input_1_112' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_26\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox optional traditional limit-3 field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Think about your mental health test. What are the main things contributing to your mental health problems right now?<\/legend><div class='gfield_description' id='gfield_description_1_26'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_26'><div class='gchoice gchoice_1_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='Abuse or violence'  id='choice_1_26_1'   aria-describedby=\"gfield_description_1_26\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_1' id='label_1_26_1' class='gform-field-label gform-field-label--type-inline'>Abuse or violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='Relationship problems (friends, family, or significant other)'  id='choice_1_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_2' id='label_1_26_2' class='gform-field-label gform-field-label--type-inline'>Relationship problems (friends, family, or significant other)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.3' type='checkbox'  value='Body image'  id='choice_1_26_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_3' id='label_1_26_3' class='gform-field-label gform-field-label--type-inline'>Body image<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.4' type='checkbox'  value='Low self-esteem or self-image'  id='choice_1_26_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_4' id='label_1_26_4' class='gform-field-label gform-field-label--type-inline'>Low self-esteem or self-image<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.5' type='checkbox'  value='School or work problems'  id='choice_1_26_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_5' id='label_1_26_5' class='gform-field-label gform-field-label--type-inline'>School or work problems<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.6' type='checkbox'  value='Financial problems'  id='choice_1_26_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_6' id='label_1_26_6' class='gform-field-label gform-field-label--type-inline'>Financial problems<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.7' type='checkbox'  value='Loneliness or isolation'  id='choice_1_26_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_7' id='label_1_26_7' class='gform-field-label gform-field-label--type-inline'>Loneliness or isolation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.8' type='checkbox'  value='Grief or loss of someone or something'  id='choice_1_26_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_8' id='label_1_26_8' class='gform-field-label gform-field-label--type-inline'>Grief or loss of someone or something<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.9' type='checkbox'  value='Experiencing hate\/bullying (including racism, homophobia, transphobia, or discrimination)'  id='choice_1_26_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_9' id='label_1_26_9' class='gform-field-label gform-field-label--type-inline'>Experiencing hate\/bullying (including racism, homophobia, transphobia, or discrimination)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.11' type='checkbox'  value='State of the world (war, climate, politics, immigration)'  id='choice_1_26_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_11' id='label_1_26_11' class='gform-field-label gform-field-label--type-inline'>State of the world (war, climate, politics, immigration)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.12' type='checkbox'  value='I don\u2019t know (something just feels wrong)'  id='choice_1_26_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_12' id='label_1_26_12' class='gform-field-label gform-field-label--type-inline'>I don\u2019t know (something just feels wrong)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_26_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.13' type='checkbox'  value='Other...'  id='choice_1_26_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_26_13' id='label_1_26_13' class='gform-field-label gform-field-label--type-inline'>Other...<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_27\" class=\"gfield gfield--type-text gfield--input-type-text optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_27'>What else is contributing to your mental health problems right now?<\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_1_27' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_74\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_74'>What about the state of the world is affecting you the most?<\/label><div class='ginput_container ginput_container_text'><input name='input_74' id='input_1_74' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_44\" class=\"gfield gfield--type-html gfield--input-type-html section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2>About Your Health<\/h2><\/div><fieldset id=\"field_1_29\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio optional short field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you currently have health insurance?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_29'>\n\t\t\t<div class='gchoice gchoice_1_29_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Yes'  id='choice_1_29_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_29_0' id='label_1_29_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_29_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='No'  id='choice_1_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_29_1' id='label_1_29_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_29_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='I don&#039;t know'  id='choice_1_29_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_29_2' id='label_1_29_2' class='gform-field-label gform-field-label--type-inline'>I don't know<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_30\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox optional traditional field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Do you have any of the following physical health conditions?<\/legend><div class='gfield_description' id='gfield_description_1_30'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_30'><div class='gchoice gchoice_1_30_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.1' type='checkbox'  value='Heart disease'  id='choice_1_30_1'   aria-describedby=\"gfield_description_1_30\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_1' id='label_1_30_1' class='gform-field-label gform-field-label--type-inline'>Heart disease<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_30_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.2' type='checkbox'  value='Reproductive health concerns (PCOS, endometriosis, infertility, etc.)'  id='choice_1_30_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_2' id='label_1_30_2' class='gform-field-label gform-field-label--type-inline'>Reproductive health concerns (PCOS, endometriosis, infertility, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_30_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.3' type='checkbox'  value='Diabetes'  id='choice_1_30_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_3' id='label_1_30_3' class='gform-field-label gform-field-label--type-inline'>Diabetes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_30_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.4' type='checkbox'  value='Cancer'  id='choice_1_30_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_4' id='label_1_30_4' class='gform-field-label gform-field-label--type-inline'>Cancer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_30_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.5' type='checkbox'  value='Arthritis or other chronic pain'  id='choice_1_30_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_5' id='label_1_30_5' class='gform-field-label gform-field-label--type-inline'>Arthritis or other chronic pain<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_30_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.6' type='checkbox'  value='Asthma, COPD or other lung conditions'  id='choice_1_30_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_6' id='label_1_30_6' class='gform-field-label gform-field-label--type-inline'>Asthma, COPD or other lung conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_30_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.7' type='checkbox'  value='Movement Disorders (involuntary tics, tardive dyskinesia, etc.)'  id='choice_1_30_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_7' id='label_1_30_7' class='gform-field-label gform-field-label--type-inline'>Movement Disorders (involuntary tics, tardive dyskinesia, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_30_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.8' type='checkbox'  value='Digestive problems (Crohn\u2019s, colitis, IBS, etc.)'  id='choice_1_30_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_8' id='label_1_30_8' class='gform-field-label gform-field-label--type-inline'>Digestive problems (Crohn\u2019s, colitis, IBS, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_30_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.9' type='checkbox'  value='Neurological conditions (epilepsy, etc.) or traumatic brain injury (TBI)'  id='choice_1_30_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_9' id='label_1_30_9' class='gform-field-label gform-field-label--type-inline'>Neurological conditions (epilepsy, etc.) or traumatic brain injury (TBI)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_30_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.11' type='checkbox'  value='Other...'  id='choice_1_30_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_30_11' id='label_1_30_11' class='gform-field-label gform-field-label--type-inline'>Other...<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_31\" class=\"gfield gfield--type-text gfield--input-type-text optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_31'>What other physical health conditions do you have?<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_1_31' type='text' value='' class='large'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_75\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full short field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have a pet that supports your mental health?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_75'>\n\t\t\t<div class='gchoice gchoice_1_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Yes'  id='choice_1_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_75_0' id='label_1_75_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='No'  id='choice_1_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_75_1' id='label_1_75_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_76\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full short field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you interested in having a pet that supports your mental health?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_76'>\n\t\t\t<div class='gchoice gchoice_1_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Yes'  id='choice_1_76_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_76_0' id='label_1_76_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice 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All rights reserved. No permission required to reproduce, translate, display or distribute the PHQ-9. PRIME-MD \u00ae is a trademark of Pfizer Inc.<\/p>\n<p>Kroenke, Spitzer, &amp; Williams. (2001). The PHQ\u20109. <i>Journal of General Internal Medicine 16<\/i>(9), 606-613. Retrieved from\u00a0<a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/10.1046\/j.1525-1497.2001.016009606.x\/pdf\"><br \/>\nhttps:\/\/onlinelibrary.wiley.com\/doi\/10.1046\/j.1525-1497.2001.016009606.x\/pdf<\/a><\/p>\n<p><a href=\"https:\/\/screening.mhanational.org\/about-our-mental-health-tests\/\" target=\"_blank\" rel=\"noopener\">For more information about our screening tools, please click here.<\/a><\/p>\n<p><em><strong>Please note:<\/strong> Online screening tools are not diagnostic instruments. You are encouraged to share your results with a physician or healthcare provider. 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