{"id":245905,"date":"2025-08-14T14:18:22","date_gmt":"2025-08-14T18:18:22","guid":{"rendered":"https:\/\/screening.mhanational.org\/?post_type=screen&#038;p=245905"},"modified":"2026-03-23T13:00:33","modified_gmt":"2026-03-23T17:00:33","slug":"ocd","status":"publish","type":"screen","link":"https:\/\/screening.mhanational.org\/es\/screening-tools\/ocd\/","title":{"rendered":"Prueba de TOC"},"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' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_84' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">OCD 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_84'  class='clearfix' action='\/es\/wp-json\/wp\/v2\/screen\/245905' data-formid='84' 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_84_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_84' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_84_139\" 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_84_139'>Name<\/label><div class='gfield_description' id='gfield_description_84_139'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_139' id='input_84_139' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_84_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_84_38' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_84_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_84_39\" type=\"hidden\" class=\"gform_hidden\" aria-invalid=\"false\" value=\"245905\"><\/div><div id=\"field_84_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_84_40\" type=\"hidden\" class=\"gform_hidden\" aria-invalid=\"false\" value=\"4d4e72b2bed86d105388245749ea2a56\"><\/div><div id=\"field_84_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_84_41' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_84_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_84_47' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_84_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_84_58' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_84_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_84_59' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_84_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_84_60' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_84_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_84_73' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_84_99\" 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_99' id='input_84_99' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/screen\/245905' \/><\/div><\/div><div id=\"field_84_136\" 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_136' id='input_84_136' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='lang--es' \/><\/div><\/div><div id=\"field_84_104\" 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>Some people have times when one thought or idea comes into their mind over and over again. When people have these thoughts they usually get upset because the thoughts are strange. No matter how hard they try, the thoughts keep coming back.<\/p>\n<p>Now we're going to ask you if you have had thoughts like these in the last three months.<\/p>\n<\/div><div id=\"field_84_105\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full 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>In the last 3 months...<\/h2>\n<\/div><fieldset id=\"field_84_101\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you had to count things over and over again or make yourself do things a certain number of times?<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_84_101'>\n\t\t\t<div class='gchoice gchoice_84_101_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='1'  id='choice_84_101_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_101_0' id='label_84_101_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_84_101_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='0'  id='choice_84_101_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_101_1' id='label_84_101_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_106\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Was there a time when you washed your hands or body over and over again or changed your clothes many times each day because you thought they were dirty?<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_84_106'>\n\t\t\t<div class='gchoice gchoice_84_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='1'  id='choice_84_106_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_106_0' id='label_84_106_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_84_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='0'  id='choice_84_106_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_106_1' id='label_84_106_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_107\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you often felt you should check on things over and over again?  For example, checking that the front door is locked, or the stove is turned off, or that something else was done even though you knew it had been done?<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_84_107'>\n\t\t\t<div class='gchoice gchoice_84_107_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='1'  id='choice_84_107_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_107_0' id='label_84_107_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_84_107_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='0'  id='choice_84_107_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_107_1' id='label_84_107_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_108\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you often worried over and over again that things you touch are dirty or have germs?<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_84_108'>\n\t\t\t<div class='gchoice gchoice_84_108_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='1'  id='choice_84_108_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_108_0' id='label_84_108_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_84_108_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='0'  id='choice_84_108_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_108_1' id='label_84_108_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_109\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you had any other thoughts that kept coming into your mind over and over again that you couldn&#039;t get rid of?<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_84_109'>\n\t\t\t<div class='gchoice gchoice_84_109_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_109' type='radio' value='1'  id='choice_84_109_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_109_0' id='label_84_109_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_84_109_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_109' type='radio' value='0'  id='choice_84_109_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_109_1' id='label_84_109_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_138\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you done things like counting, checking, washing, over and over again because you like to do these 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_84_138'>\n\t\t\t<div class='gchoice gchoice_84_138_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_138' type='radio' value='1'  id='choice_84_138_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_138_0' id='label_84_138_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_84_138_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_138' type='radio' value='0'  id='choice_84_138_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_138_1' id='label_84_138_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_113\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you done things like counting, checking, washing, over and over again, only because you&#039;ve been told by someone else to make sure that you&#039;ve done them right?<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_84_113'>\n\t\t\t<div class='gchoice gchoice_84_113_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_113' type='radio' value='1'  id='choice_84_113_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_113_0' id='label_84_113_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_84_113_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_113' type='radio' value='0'  id='choice_84_113_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_113_1' id='label_84_113_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_115\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you wished you could stop yourself from doing things like counting, checking or washing over and over again?<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_84_115'>\n\t\t\t<div class='gchoice gchoice_84_115_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_115' type='radio' value='1'  id='choice_84_115_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_115_0' id='label_84_115_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_84_115_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_115' type='radio' value='0'  id='choice_84_115_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_115_1' id='label_84_115_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_116\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you spent a lot of time each day doing things like counting, checking or washing over and over again ... say, for as long as an hour?<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_84_116'>\n\t\t\t<div class='gchoice gchoice_84_116_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='1'  id='choice_84_116_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_116_0' id='label_84_116_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_84_116_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='0'  id='choice_84_116_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_116_1' id='label_84_116_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_84_94\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full 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\"  ><hr class=\"layout-action show-actions_b\" \/>\n\n<p>The following statements refer to experiences that many people have in their everyday lives. Select the option that best describes <strong>how much that experience has distressed or bothered you<\/strong> during the past month.<\/p>\n\n<h2>During the past month...<\/h2><\/div><fieldset id=\"field_84_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question exclude 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. I have saved up so many things that they get in the way.<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_84_5'>\n\t\t\t<div class='gchoice gchoice_84_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='0'  id='choice_84_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_5_0' id='label_84_5_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='1'  id='choice_84_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_5_1' id='label_84_5_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='2'  id='choice_84_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_5_2' id='label_84_5_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_5_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='3'  id='choice_84_5_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_5_3' id='label_84_5_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_5_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='4'  id='choice_84_5_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_5_4' id='label_84_5_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_75\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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. I check things more often than necessary.<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_84_75'>\n\t\t\t<div class='gchoice gchoice_84_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='0'  id='choice_84_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_75_0' id='label_84_75_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='1'  id='choice_84_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_75_1' id='label_84_75_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_75_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='2'  id='choice_84_75_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_75_2' id='label_84_75_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_75_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='3'  id='choice_84_75_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_75_3' id='label_84_75_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_75_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='4'  id='choice_84_75_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_75_4' id='label_84_75_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_76\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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. I get upset if objects are not arranged properly.<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_84_76'>\n\t\t\t<div class='gchoice gchoice_84_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='0'  id='choice_84_76_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_76_0' id='label_84_76_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='1'  id='choice_84_76_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_76_1' id='label_84_76_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_76_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='2'  id='choice_84_76_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_76_2' id='label_84_76_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_76_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='3'  id='choice_84_76_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_76_3' id='label_84_76_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_76_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='4'  id='choice_84_76_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_76_4' id='label_84_76_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_77\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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. I feel compelled to count while I am 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_84_77'>\n\t\t\t<div class='gchoice gchoice_84_77_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='0'  id='choice_84_77_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_77_0' id='label_84_77_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_77_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='1'  id='choice_84_77_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_77_1' id='label_84_77_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_77_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='2'  id='choice_84_77_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_77_2' id='label_84_77_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_77_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='3'  id='choice_84_77_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_77_3' id='label_84_77_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_77_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='4'  id='choice_84_77_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_77_4' id='label_84_77_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_78\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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. I find it difficult to touch an object when I know it has been touched by strangers or certain 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_84_78'>\n\t\t\t<div class='gchoice gchoice_84_78_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='0'  id='choice_84_78_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_78_0' id='label_84_78_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_78_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='1'  id='choice_84_78_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_78_1' id='label_84_78_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_78_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='2'  id='choice_84_78_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_78_2' id='label_84_78_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_78_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='3'  id='choice_84_78_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_78_3' id='label_84_78_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_78_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='4'  id='choice_84_78_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_78_4' id='label_84_78_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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. I find it difficult to control my own thoughts.<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_84_79'>\n\t\t\t<div class='gchoice gchoice_84_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='0'  id='choice_84_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_79_0' id='label_84_79_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='1'  id='choice_84_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_79_1' id='label_84_79_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_79_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='2'  id='choice_84_79_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_79_2' id='label_84_79_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_79_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='3'  id='choice_84_79_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_79_3' id='label_84_79_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_79_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='4'  id='choice_84_79_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_79_4' id='label_84_79_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full question exclude 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. I collect things I don\u2019t need.<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_84_80'>\n\t\t\t<div class='gchoice gchoice_84_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='0'  id='choice_84_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_80_0' id='label_84_80_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='1'  id='choice_84_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_80_1' id='label_84_80_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_80_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='2'  id='choice_84_80_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_80_2' id='label_84_80_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_80_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='3'  id='choice_84_80_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_80_3' id='label_84_80_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_80_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='4'  id='choice_84_80_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_80_4' id='label_84_80_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >8. I repeatedly check doors, windows, drawers, etc.<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_84_81'>\n\t\t\t<div class='gchoice gchoice_84_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='0'  id='choice_84_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_81_0' id='label_84_81_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='1'  id='choice_84_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_81_1' id='label_84_81_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_81_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='2'  id='choice_84_81_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_81_2' id='label_84_81_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_81_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='3'  id='choice_84_81_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_81_3' id='label_84_81_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_81_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='4'  id='choice_84_81_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_81_4' id='label_84_81_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_82\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >9. I get upset if others change the way I have arranged 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_84_82'>\n\t\t\t<div class='gchoice gchoice_84_82_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='0'  id='choice_84_82_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_82_0' id='label_84_82_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_82_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='1'  id='choice_84_82_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_82_1' id='label_84_82_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_82_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='2'  id='choice_84_82_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_82_2' id='label_84_82_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_82_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='3'  id='choice_84_82_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_82_3' id='label_84_82_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_82_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='4'  id='choice_84_82_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_82_4' id='label_84_82_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_83\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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. I feel I have to repeat certain numbers.<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_84_83'>\n\t\t\t<div class='gchoice gchoice_84_83_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='0'  id='choice_84_83_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_83_0' id='label_84_83_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_83_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='1'  id='choice_84_83_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_83_1' id='label_84_83_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_83_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='2'  id='choice_84_83_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_83_2' id='label_84_83_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_83_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='3'  id='choice_84_83_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_83_3' id='label_84_83_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_83_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='4'  id='choice_84_83_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_83_4' id='label_84_83_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_84\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >11. I sometimes have to wash or clean myself simply because I feel contaminated.<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_84_84'>\n\t\t\t<div class='gchoice gchoice_84_84_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='0'  id='choice_84_84_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_84_0' id='label_84_84_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_84_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='1'  id='choice_84_84_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_84_1' id='label_84_84_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_84_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='2'  id='choice_84_84_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_84_2' id='label_84_84_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_84_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='3'  id='choice_84_84_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_84_3' id='label_84_84_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_84_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='4'  id='choice_84_84_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_84_4' id='label_84_84_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_85\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >12. I am upset by unpleasant thoughts that come into my mind against my will.<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_84_85'>\n\t\t\t<div class='gchoice gchoice_84_85_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='0'  id='choice_84_85_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_85_0' id='label_84_85_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_85_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='1'  id='choice_84_85_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_85_1' id='label_84_85_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_85_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='2'  id='choice_84_85_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_85_2' id='label_84_85_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_85_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='3'  id='choice_84_85_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_85_3' id='label_84_85_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_85_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='4'  id='choice_84_85_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_85_4' id='label_84_85_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_86\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full question exclude 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' >13. I avoid throwing things away because I am afraid I might need them later.<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_84_86'>\n\t\t\t<div class='gchoice gchoice_84_86_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='0'  id='choice_84_86_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_86_0' id='label_84_86_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_86_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='1'  id='choice_84_86_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_86_1' id='label_84_86_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_86_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='2'  id='choice_84_86_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_86_2' id='label_84_86_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_86_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='3'  id='choice_84_86_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_86_3' id='label_84_86_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_86_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='4'  id='choice_84_86_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_86_4' id='label_84_86_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_87\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >14. I repeatedly check gas and water taps and light switches after turning them off.<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_84_87'>\n\t\t\t<div class='gchoice gchoice_84_87_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='0'  id='choice_84_87_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_87_0' id='label_84_87_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_87_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='1'  id='choice_84_87_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_87_1' id='label_84_87_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_87_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='2'  id='choice_84_87_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_87_2' id='label_84_87_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_87_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='3'  id='choice_84_87_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_87_3' id='label_84_87_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_87_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='4'  id='choice_84_87_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_87_4' id='label_84_87_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_88\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >15. I need things to be arranged in a particular way.<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_84_88'>\n\t\t\t<div class='gchoice gchoice_84_88_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='0'  id='choice_84_88_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_88_0' id='label_84_88_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_88_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='1'  id='choice_84_88_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_88_1' id='label_84_88_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_88_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='2'  id='choice_84_88_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_88_2' id='label_84_88_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_88_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='3'  id='choice_84_88_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_88_3' id='label_84_88_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_88_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='4'  id='choice_84_88_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_88_4' id='label_84_88_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_89\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >16. I feel that there are good and bad numbers.<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_84_89'>\n\t\t\t<div class='gchoice gchoice_84_89_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='0'  id='choice_84_89_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_89_0' id='label_84_89_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_89_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='1'  id='choice_84_89_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_89_1' id='label_84_89_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_89_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='2'  id='choice_84_89_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_89_2' id='label_84_89_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_89_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='3'  id='choice_84_89_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_89_3' id='label_84_89_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_89_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='4'  id='choice_84_89_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_89_4' id='label_84_89_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_90\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >17. I wash my hands more often and longer than necessary.<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_84_90'>\n\t\t\t<div class='gchoice gchoice_84_90_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='0'  id='choice_84_90_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_90_0' id='label_84_90_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_90_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='1'  id='choice_84_90_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_90_1' id='label_84_90_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_90_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='2'  id='choice_84_90_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_90_2' id='label_84_90_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_90_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='3'  id='choice_84_90_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_90_3' id='label_84_90_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_90_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='4'  id='choice_84_90_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_90_4' id='label_84_90_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_91\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >18. I frequently get nasty thoughts and have difficulty in getting rid of them.<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_84_91'>\n\t\t\t<div class='gchoice gchoice_84_91_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='0'  id='choice_84_91_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_91_0' id='label_84_91_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_91_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='1'  id='choice_84_91_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_91_1' id='label_84_91_1' class='gform-field-label gform-field-label--type-inline'>A little<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_91_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='2'  id='choice_84_91_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_91_2' id='label_84_91_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_91_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='3'  id='choice_84_91_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_91_3' id='label_84_91_3' class='gform-field-label gform-field-label--type-inline'>A lot<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_91_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='4'  id='choice_84_91_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_91_4' id='label_84_91_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_84_117\" 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 \/>\n<p>Some people have times when one thought or idea comes into their mind over and over again. When people have these thoughts they usually get upset because the thoughts are strange. No matter how hard they try, the thoughts keep coming back.<\/p>\n<p>Now we're going to ask you if you have had thoughts like these in the last three months.<\/p>\n<\/div><div id=\"field_84_119\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full 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>In the last 3 months...<\/h2>\n<\/div><fieldset id=\"field_84_120\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you had to count things over and over again or make yourself do things a certain number of times?<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_84_120'>\n\t\t\t<div class='gchoice gchoice_84_120_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_120' type='radio' value='1'  id='choice_84_120_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_120_0' id='label_84_120_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_84_120_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_120' type='radio' value='0'  id='choice_84_120_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_120_1' id='label_84_120_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_121\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Was there a time when you washed your hands or body over and over again or changed your clothes many times each day because you thought they were dirty?<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_84_121'>\n\t\t\t<div class='gchoice gchoice_84_121_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_121' type='radio' value='1'  id='choice_84_121_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_121_0' id='label_84_121_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_84_121_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_121' type='radio' value='0'  id='choice_84_121_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_121_1' id='label_84_121_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_122\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you often felt you should check on things over and over again?  For example, checking that the front door is locked, or the stove is turned off, or that something else was done even though you knew it had been done?<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_84_122'>\n\t\t\t<div class='gchoice gchoice_84_122_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_122' type='radio' value='1'  id='choice_84_122_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_122_0' id='label_84_122_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_84_122_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_122' type='radio' value='0'  id='choice_84_122_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_122_1' id='label_84_122_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_123\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you often worried over and over again that things you touch are dirty or have germs?<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_84_123'>\n\t\t\t<div class='gchoice gchoice_84_123_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_123' type='radio' value='1'  id='choice_84_123_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_123_0' id='label_84_123_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_84_123_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_123' type='radio' value='0'  id='choice_84_123_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_123_1' id='label_84_123_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_124\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you had any other thoughts that kept coming into your mind over and over again that you couldn&#039;t get rid of?<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_84_124'>\n\t\t\t<div class='gchoice gchoice_84_124_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_124' type='radio' value='1'  id='choice_84_124_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_124_0' id='label_84_124_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_84_124_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_124' type='radio' value='0'  id='choice_84_124_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_124_1' id='label_84_124_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_137\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you done things like counting, checking, washing, over and over again because you like to do these 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_84_137'>\n\t\t\t<div class='gchoice gchoice_84_137_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='1'  id='choice_84_137_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_137_0' id='label_84_137_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_84_137_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='0'  id='choice_84_137_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_137_1' id='label_84_137_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_127\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you done things like counting, checking, washing, over and over again, only because you&#039;ve been told by someone else to make sure that you&#039;ve done them right?<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_84_127'>\n\t\t\t<div class='gchoice gchoice_84_127_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='1'  id='choice_84_127_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_127_0' id='label_84_127_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_84_127_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='0'  id='choice_84_127_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_127_1' id='label_84_127_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_128\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you wished you could stop yourself from doing things like counting, checking or washing over and over again?<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_84_128'>\n\t\t\t<div class='gchoice gchoice_84_128_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='1'  id='choice_84_128_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_128_0' id='label_84_128_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_84_128_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='0'  id='choice_84_128_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_128_1' id='label_84_128_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_129\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Have you spent a lot of time each day doing things like counting, checking or washing over and over again ... say, for as long as an hour?<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_84_129'>\n\t\t\t<div class='gchoice gchoice_84_129_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='1'  id='choice_84_129_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_129_0' id='label_84_129_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_84_129_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='0'  id='choice_84_129_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_129_1' id='label_84_129_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_84_130\" 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_84_92\" 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_84_92'>Optional: What is most distressing to you about the OCD symptoms you&#039;ve been experiencing?<\/label><div class='ginput_container ginput_container_text'><input name='input_92' id='input_84_92' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_84_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_84_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_84_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_84_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_84_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_84_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_84_69'>\n\t\t\t<div class='gchoice gchoice_84_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_84_69_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_0' id='label_84_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_84_69_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Understand what OCD is like (reading articles)'  id='choice_84_69_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_1' id='label_84_69_1' class='gform-field-label gform-field-label--type-inline'>Understand what OCD is like (reading articles)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_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_84_69_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_2' id='label_84_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_84_69_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Tips for managing OCD (reading articles)'  id='choice_84_69_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_3' id='label_84_69_3' class='gform-field-label gform-field-label--type-inline'>Tips for managing OCD (reading articles)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_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_84_69_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_4' id='label_84_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_84_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_84_69_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_5' id='label_84_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_84_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_84_69_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_6' id='label_84_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_84_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 OCD'  id='choice_84_69_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_7' id='label_84_69_7' class='gform-field-label gform-field-label--type-inline'>Find a forum or support group for people with OCD<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_69_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Other...'  id='choice_84_69_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_8' id='label_84_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_84_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_84_69_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_69_9' id='label_84_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_84_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_84_70'>Next Steps - Other<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_84_70' type='text' value='' class='medium'    placeholder='Enter other...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_84_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_84_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_84_62'>\n\t\t\t<div class='gchoice gchoice_84_62_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='For myself'  id='choice_84_62_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_62_0' id='label_84_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_84_62_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='For someone else'  id='choice_84_62_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_62_1' id='label_84_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_84_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_84_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_84_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_84_19'>Age Range<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_84_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_84_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_84_46'>\n\t\t\t<div class='gchoice gchoice_84_46_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Female'  id='choice_84_46_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_46_0' id='label_84_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_84_46_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Male'  id='choice_84_46_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_46_1' id='label_84_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_84_46_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Non-Binary'  id='choice_84_46_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_46_2' id='label_84_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_84_133\" 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_84_133'>\n\t\t\t<div class='gchoice gchoice_84_133_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='Yes'  id='choice_84_133_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_133_0' id='label_84_133_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_84_133_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='No'  id='choice_84_133_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_133_1' id='label_84_133_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_84_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_84_48'>How would you describe your gender?<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_84_48' type='text' value='' class='small'    placeholder='Enter gender...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_84_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_84_22'>Race\/Ethnicity<\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_84_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_84_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_84_23'>Household Income<\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_84_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_84_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_84_64'>\n\t\t\t<div class='gchoice gchoice_84_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_84_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_64_0' id='label_84_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_84_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_84_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_64_1' id='label_84_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_84_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_84_32'>State<\/label><div class='ginput_container ginput_container_select'><select name='input_32' id='input_84_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_84_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_84_36'>What country do you live in?<\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_84_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_84_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_84_34'>Zip\/Postal Code<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_84_34' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_84_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_84_28'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_84_28'><div class='gchoice gchoice_84_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_84_28_1'   aria-describedby=\"gfield_description_84_28\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_84_28_1' id='label_84_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_84_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_84_28_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_28_2' id='label_84_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_84_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_84_28_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_28_3' id='label_84_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_84_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_84_28_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_28_4' id='label_84_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_84_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_84_28_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_28_5' id='label_84_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_84_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_84_28_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_28_6' id='label_84_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_84_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_84_28_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_28_7' id='label_84_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_84_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_84_65'>\n\t\t\t<div class='gchoice gchoice_84_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Mental health condition'  id='choice_84_65_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_65_0' id='label_84_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_84_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Physical health condition'  id='choice_84_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_65_1' id='label_84_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_84_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_84_65_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_65_2' id='label_84_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_84_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_84_66'>Which of the following best describes your sexual orientation?<\/label><div class='ginput_container ginput_container_select'><select name='input_66' id='input_84_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_84_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_84_50'>What is your sexual orientation?<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_84_50' type='text' value='' class='small'    placeholder='Enter sexual orientation...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_84_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_84_67'><div class='gchoice gchoice_84_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_84_67_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_67_1' id='label_84_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_84_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_84_67_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_67_2' id='label_84_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_84_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_84_67_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_67_3' id='label_84_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_84_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_84_67_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_67_4' id='label_84_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_84_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_84_67_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_67_5' id='label_84_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_84_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_84_67_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_67_6' id='label_84_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_84_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_84_67_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_67_7' id='label_84_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_84_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_84_67_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_67_8' id='label_84_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_84_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_84_68'>Please tell us more about your experience of trauma:<\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_84_68' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_84_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_84_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_84_25'>\n\t\t\t<div class='gchoice gchoice_84_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_84_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_25_0' id='label_84_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_84_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_84_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_25_1' id='label_84_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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_84_57'>\n\t\t\t<div class='gchoice gchoice_84_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Yes'  id='choice_84_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_57_0' id='label_84_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_84_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='No'  id='choice_84_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_57_1' id='label_84_57_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_134\" 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_84_134'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_84_134'><div class='gchoice gchoice_84_134_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.1' type='checkbox'  value='I wanted to handle my mental health on my own'  id='choice_84_134_1'   aria-describedby=\"gfield_description_84_134\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_1' id='label_84_134_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_84_134_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.2' type='checkbox'  value='I didn\u2019t know how or where to start'  id='choice_84_134_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_2' id='label_84_134_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_84_134_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.3' type='checkbox'  value='I thought it would cost too much'  id='choice_84_134_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_3' id='label_84_134_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_84_134_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.4' type='checkbox'  value='I didn\u2019t have time'  id='choice_84_134_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_4' id='label_84_134_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_84_134_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.5' type='checkbox'  value='I didn\u2019t think it would help me'  id='choice_84_134_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_5' id='label_84_134_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_84_134_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.6' type='checkbox'  value='I didn&#039;t feel ready to start treatment'  id='choice_84_134_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_6' id='label_84_134_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_84_134_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.7' type='checkbox'  value='I was worried about what people would think or say if I got treatment'  id='choice_84_134_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_7' id='label_84_134_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_84_134_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.8' type='checkbox'  value='I was afraid of being forced into a hospital or forced to take medication'  id='choice_84_134_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_8' id='label_84_134_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_84_134_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.9' type='checkbox'  value='I tried, but couldn\u2019t find available treatment (no openings, wouldn\u2019t take insurance, etc.)'  id='choice_84_134_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_9' id='label_84_134_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_84_134_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.11' type='checkbox'  value='My parent(s) or guardian wouldn&#039;t let me, or I didn&#039;t want to ask'  id='choice_84_134_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_11' id='label_84_134_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_84_134_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_134.12' type='checkbox'  value='Other...'  id='choice_84_134_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_134_12' id='label_84_134_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_84_135\" 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_84_135'>What else has prevented you from seeking treatment in the past?<\/label><div class='ginput_container ginput_container_text'><input name='input_135' id='input_84_135' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_84_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_84_26'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_84_26'><div class='gchoice gchoice_84_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_84_26_1'   aria-describedby=\"gfield_description_84_26\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_1' id='label_84_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_84_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_84_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_2' id='label_84_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_84_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_84_26_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_3' id='label_84_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_84_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_84_26_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_4' id='label_84_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_84_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_84_26_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_5' id='label_84_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_84_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_84_26_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_6' id='label_84_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_84_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_84_26_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_7' id='label_84_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_84_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_84_26_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_8' id='label_84_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_84_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_84_26_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_9' id='label_84_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_84_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_84_26_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_11' id='label_84_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_84_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_84_26_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_12' id='label_84_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_84_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_84_26_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_26_13' id='label_84_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_84_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_84_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_84_27' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_84_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_84_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_84_74' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_84_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_84_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_84_29'>\n\t\t\t<div class='gchoice gchoice_84_29_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Yes'  id='choice_84_29_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_29_0' id='label_84_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_84_29_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='No'  id='choice_84_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_29_1' id='label_84_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_84_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_84_29_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_29_2' id='label_84_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_84_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_84_30'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_84_30'><div class='gchoice gchoice_84_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_84_30_1'   aria-describedby=\"gfield_description_84_30\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_1' id='label_84_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_84_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_84_30_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_2' id='label_84_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_84_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_84_30_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_3' id='label_84_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_84_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_84_30_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_4' id='label_84_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_84_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_84_30_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_5' id='label_84_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_84_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_84_30_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_6' id='label_84_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_84_30_7'>\n\t\t\t\t\t\t\t\t<input 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(2002). The Obsessive-Complusive Inventory: Development and validation of a short version. <em>Psychological Assessment 14<\/em>(4), pp. 485\u2013495. Retrieved from <a href=\"https:\/\/doi.org\/10.1037\/\/1040-3590.14.4.485\">https:\/\/doi.org\/10.1037\/\/1040-3590.14.4.485<\/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><strong><em>Please note:<\/em><\/strong><em> Online screening tools are not diagnostic instruments. You are encouraged to share your results with a physician or healthcare provider. 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