{"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":"2026-05-15T15:37:49","modified_gmt":"2026-05-15T19:37:49","slug":"ocd","status":"publish","type":"screen","link":"https:\/\/screening.mhanational.org\/es\/screening-tools\/ocd\/","title":{"rendered":"Test de TOC (OCD)"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework trp-contextual-choices_wrapper trp-ctx-ocd_wrapper' 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='trp-contextual-choices trp-ctx-ocd' 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'>URL<\/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=\"b838d33d0c42a66c229e698151c32040\"><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-not-at-all\">Not at all<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-little\">A little<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-moderately\">Moderately<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-a-lot\">A lot<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-extremely\">Extremely<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-take-another-mental-health-test\">Take another mental health test<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-understand-what-ocd-is-like-reading-articles\">Understand what OCD is like (reading articles)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-understand-and-manage-self-harm-or-suicidal-thoughts\">Understand and manage self-harm or suicidal thoughts<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-tips-for-managing-ocd-reading-articles\">Tips for managing OCD (reading articles)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-learn-and-practice-skills-for-how-to-manage-depression-try-a-free-self-help-tool\">Learn and practice skills for how to manage depression (try a free self-help tool)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-learn-about-what-therapy-treatment-is-like-reading-articles\">Learn about what therapy\/treatment is like (reading articles)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-find-a-treatment-provider-near-you\">Find a treatment provider near you<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-find-a-forum-or-support-group-for-people-with-ocd\">Find a forum or support group for people with OCD<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-other\">Other...<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-dont-want-to-do-anything\">I don\u2019t want to do anything<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-for-myself\">For myself<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-for-someone-else\">For someone else<\/span><\/span><\/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'  class=\"translation-block trp-ctx-ocd-8-10\">8-10<\/option><option value='11-13'  class=\"translation-block trp-ctx-ocd-11-13\">11-13<\/option><option value='14-15'  class=\"translation-block trp-ctx-ocd-14-15\">14-15<\/option><option value='16-17'  class=\"translation-block trp-ctx-ocd-16-17\">16-17<\/option><option value='18-24'  class=\"translation-block trp-ctx-ocd-18-24\">18-24<\/option><option value='25-34'  class=\"translation-block trp-ctx-ocd-25-34\">25-34<\/option><option value='35-44'  class=\"translation-block trp-ctx-ocd-35-44\">35-44<\/option><option value='45-54'  class=\"translation-block trp-ctx-ocd-45-54\">45-54<\/option><option value='55-64'  class=\"translation-block trp-ctx-ocd-55-64\">55-64<\/option><option value='65+'  class=\"translation-block trp-ctx-ocd-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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-female\">Female<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-male\">Male<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-non-binary\">Non-Binary<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'  class=\"translation-block trp-ctx-ocd-american-indian-or-alaska-native\">American Indian or Alaska Native<\/option><option value='Asian'  class=\"translation-block trp-ctx-ocd-asian\">Asian<\/option><option value='Black or African American (non-Hispanic)'  class=\"translation-block trp-ctx-ocd-black-or-african-american-non-hispanic\">Black or African American (non-Hispanic)<\/option><option value='Hispanic or Latino'  class=\"translation-block trp-ctx-ocd-hispanic-or-latino\">Hispanic or Latino<\/option><option value='Middle Eastern or North African'  class=\"translation-block trp-ctx-ocd-middle-eastern-or-north-african\">Middle Eastern or North African<\/option><option value='Native Hawaiian or other Pacific Islander'  class=\"translation-block trp-ctx-ocd-native-hawaiian-or-other-pacific-islander\">Native Hawaiian or other Pacific Islander<\/option><option value='White (non-Hispanic)'  class=\"translation-block trp-ctx-ocd-white-non-hispanic\">White (non-Hispanic)<\/option><option value='More than one of the above'  class=\"translation-block trp-ctx-ocd-more-than-one-of-the-above\">More than one of the above<\/option><option value='Other'  class=\"translation-block trp-ctx-ocd-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'  class=\"translation-block trp-ctx-ocd-less-than-20000\">Less than $20,000<\/option><option value='$20,000 - $39,999'  class=\"translation-block trp-ctx-ocd-20000-39999\">$20,000 - $39,999<\/option><option value='$40,000 - $59,999'  class=\"translation-block trp-ctx-ocd-40000-59999\">$40,000 - $59,999<\/option><option value='$60,000 - $79,999'  class=\"translation-block trp-ctx-ocd-60000-79999\">$60,000 - $79,999<\/option><option value='$80,000 - $99,999'  class=\"translation-block trp-ctx-ocd-80000-99999\">$80,000 - $99,999<\/option><option value='$100,000 - $149,999'  class=\"translation-block trp-ctx-ocd-100000-149999\">$100,000 - $149,999<\/option><option value='$150,000+'  class=\"translation-block trp-ctx-ocd-150000\">$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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-live-in-the-united-states\">I live in the United States<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-live-in-another-country\">I live in another country<\/span><\/span><\/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'  class=\"translation-block trp-ctx-ocd-alabama\">Alabama<\/option><option value='Alaska'  class=\"translation-block trp-ctx-ocd-alaska\">Alaska<\/option><option value='Arizona'  class=\"translation-block trp-ctx-ocd-arizona\">Arizona<\/option><option value='Arkansas'  class=\"translation-block trp-ctx-ocd-arkansas\">Arkansas<\/option><option value='California'  class=\"translation-block trp-ctx-ocd-california\">California<\/option><option value='Colorado'  class=\"translation-block trp-ctx-ocd-colorado\">Colorado<\/option><option value='Connecticut'  class=\"translation-block trp-ctx-ocd-connecticut\">Connecticut<\/option><option value='Delaware'  class=\"translation-block trp-ctx-ocd-delaware\">Delaware<\/option><option value='District of Columbia'  class=\"translation-block trp-ctx-ocd-district-of-columbia\">District of Columbia<\/option><option value='Florida'  class=\"translation-block trp-ctx-ocd-florida\">Florida<\/option><option value='Georgia'  class=\"translation-block trp-ctx-ocd-georgia\">Georgia<\/option><option value='Hawaii'  class=\"translation-block trp-ctx-ocd-hawaii\">Hawaii<\/option><option value='Idaho'  class=\"translation-block trp-ctx-ocd-idaho\">Idaho<\/option><option value='Illinois'  class=\"translation-block trp-ctx-ocd-illinois\">Illinois<\/option><option value='Indiana'  class=\"translation-block trp-ctx-ocd-indiana\">Indiana<\/option><option value='Iowa'  class=\"translation-block trp-ctx-ocd-iowa\">Iowa<\/option><option value='Kansas'  class=\"translation-block trp-ctx-ocd-kansas\">Kansas<\/option><option value='Kentucky'  class=\"translation-block trp-ctx-ocd-kentucky\">Kentucky<\/option><option value='Louisiana'  class=\"translation-block trp-ctx-ocd-louisiana\">Louisiana<\/option><option value='Maine'  class=\"translation-block trp-ctx-ocd-maine\">Maine<\/option><option value='Maryland'  class=\"translation-block trp-ctx-ocd-maryland\">Maryland<\/option><option value='Massachusetts'  class=\"translation-block trp-ctx-ocd-massachusetts\">Massachusetts<\/option><option value='Michigan'  class=\"translation-block trp-ctx-ocd-michigan\">Michigan<\/option><option value='Minnesota'  class=\"translation-block trp-ctx-ocd-minnesota\">Minnesota<\/option><option value='Mississippi'  class=\"translation-block trp-ctx-ocd-mississippi\">Mississippi<\/option><option value='Missouri'  class=\"translation-block trp-ctx-ocd-missouri\">Missouri<\/option><option value='Montana'  class=\"translation-block trp-ctx-ocd-montana\">Montana<\/option><option value='Nebraska'  class=\"translation-block trp-ctx-ocd-nebraska\">Nebraska<\/option><option value='Nevada'  class=\"translation-block trp-ctx-ocd-nevada\">Nevada<\/option><option value='New Hampshire'  class=\"translation-block trp-ctx-ocd-new-hampshire\">New Hampshire<\/option><option value='New Jersey'  class=\"translation-block trp-ctx-ocd-new-jersey\">New Jersey<\/option><option value='New Mexico'  class=\"translation-block trp-ctx-ocd-new-mexico\">New Mexico<\/option><option value='New York'  class=\"translation-block trp-ctx-ocd-new-york\">New York<\/option><option value='North Carolina'  class=\"translation-block trp-ctx-ocd-north-carolina\">North Carolina<\/option><option value='North Dakota'  class=\"translation-block trp-ctx-ocd-north-dakota\">North Dakota<\/option><option value='Ohio'  class=\"translation-block trp-ctx-ocd-ohio\">Ohio<\/option><option value='Oklahoma'  class=\"translation-block trp-ctx-ocd-oklahoma\">Oklahoma<\/option><option value='Oregon'  class=\"translation-block trp-ctx-ocd-oregon\">Oregon<\/option><option value='Pennsylvania'  class=\"translation-block trp-ctx-ocd-pennsylvania\">Pennsylvania<\/option><option value='Rhode Island'  class=\"translation-block trp-ctx-ocd-rhode-island\">Rhode Island<\/option><option value='South Carolina'  class=\"translation-block trp-ctx-ocd-south-carolina\">South Carolina<\/option><option value='South Dakota'  class=\"translation-block trp-ctx-ocd-south-dakota\">South Dakota<\/option><option value='Tennessee'  class=\"translation-block trp-ctx-ocd-tennessee\">Tennessee<\/option><option value='Texas'  class=\"translation-block trp-ctx-ocd-texas\">Texas<\/option><option value='Utah'  class=\"translation-block trp-ctx-ocd-utah\">Utah<\/option><option value='Vermont'  class=\"translation-block trp-ctx-ocd-vermont\">Vermont<\/option><option value='Virginia'  class=\"translation-block trp-ctx-ocd-virginia\">Virginia<\/option><option value='Washington'  class=\"translation-block trp-ctx-ocd-washington\">Washington<\/option><option value='West Virginia'  class=\"translation-block trp-ctx-ocd-west-virginia\">West Virginia<\/option><option value='Wisconsin'  class=\"translation-block trp-ctx-ocd-wisconsin\">Wisconsin<\/option><option value='Wyoming'  class=\"translation-block trp-ctx-ocd-wyoming\">Wyoming<\/option><option value='I live in a U.S. Territory'  class=\"translation-block trp-ctx-ocd-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'  class=\"translation-block trp-ctx-ocd-afghanistan\">Afghanistan<\/option><option value='Albania'  class=\"translation-block trp-ctx-ocd-albania\">Albania<\/option><option value='Algeria'  class=\"translation-block trp-ctx-ocd-algeria\">Algeria<\/option><option value='American Samoa'  class=\"translation-block trp-ctx-ocd-american-samoa\">American Samoa<\/option><option value='Andorra'  class=\"translation-block trp-ctx-ocd-andorra\">Andorra<\/option><option value='Angola'  class=\"translation-block trp-ctx-ocd-angola\">Angola<\/option><option value='Anguilla'  class=\"translation-block trp-ctx-ocd-anguilla\">Anguilla<\/option><option value='Antarctica'  class=\"translation-block trp-ctx-ocd-antarctica\">Antarctica<\/option><option value='Antigua and Barbuda'  class=\"translation-block trp-ctx-ocd-antigua-and-barbuda\">Antigua and Barbuda<\/option><option value='Argentina'  class=\"translation-block trp-ctx-ocd-argentina\">Argentina<\/option><option value='Armenia'  class=\"translation-block trp-ctx-ocd-armenia\">Armenia<\/option><option value='Aruba'  class=\"translation-block trp-ctx-ocd-aruba\">Aruba<\/option><option value='Australia'  class=\"translation-block trp-ctx-ocd-australia\">Australia<\/option><option value='Austria'  class=\"translation-block trp-ctx-ocd-austria\">Austria<\/option><option value='Azerbaijan'  class=\"translation-block trp-ctx-ocd-azerbaijan\">Azerbaijan<\/option><option value='Bahamas'  class=\"translation-block trp-ctx-ocd-bahamas\">Bahamas<\/option><option value='Bahrain'  class=\"translation-block trp-ctx-ocd-bahrain\">Bahrain<\/option><option value='Bangladesh'  class=\"translation-block trp-ctx-ocd-bangladesh\">Bangladesh<\/option><option value='Barbados'  class=\"translation-block trp-ctx-ocd-barbados\">Barbados<\/option><option value='Belarus'  class=\"translation-block trp-ctx-ocd-belarus\">Belarus<\/option><option value='Belgium'  class=\"translation-block trp-ctx-ocd-belgium\">Belgium<\/option><option value='Belize'  class=\"translation-block trp-ctx-ocd-belize\">Belize<\/option><option value='Benin'  class=\"translation-block trp-ctx-ocd-benin\">Benin<\/option><option value='Bermuda'  class=\"translation-block trp-ctx-ocd-bermuda\">Bermuda<\/option><option value='Bhutan'  class=\"translation-block trp-ctx-ocd-bhutan\">Bhutan<\/option><option value='Bolivia'  class=\"translation-block trp-ctx-ocd-bolivia\">Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba'  class=\"translation-block trp-ctx-ocd-bonaire-sint-eustatius-and-saba\">Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina'  class=\"translation-block trp-ctx-ocd-bosnia-and-herzegovina\">Bosnia and Herzegovina<\/option><option value='Botswana'  class=\"translation-block trp-ctx-ocd-botswana\">Botswana<\/option><option value='Bouvet Island'  class=\"translation-block trp-ctx-ocd-bouvet-island\">Bouvet Island<\/option><option value='Brazil'  class=\"translation-block trp-ctx-ocd-brazil\">Brazil<\/option><option value='British Indian Ocean Territory'  class=\"translation-block trp-ctx-ocd-british-indian-ocean-territory\">British Indian Ocean Territory<\/option><option value='Brunei Darussalam'  class=\"translation-block trp-ctx-ocd-brunei-darussalam\">Brunei Darussalam<\/option><option value='Bulgaria'  class=\"translation-block trp-ctx-ocd-bulgaria\">Bulgaria<\/option><option value='Burkina Faso'  class=\"translation-block trp-ctx-ocd-burkina-faso\">Burkina Faso<\/option><option value='Burundi'  class=\"translation-block trp-ctx-ocd-burundi\">Burundi<\/option><option value='Cambodia'  class=\"translation-block trp-ctx-ocd-cambodia\">Cambodia<\/option><option value='Cameroon'  class=\"translation-block trp-ctx-ocd-cameroon\">Cameroon<\/option><option value='Canada'  class=\"translation-block trp-ctx-ocd-canada\">Canada<\/option><option value='Cape Verde'  class=\"translation-block trp-ctx-ocd-cape-verde\">Cape Verde<\/option><option value='Cayman Islands'  class=\"translation-block trp-ctx-ocd-cayman-islands\">Cayman Islands<\/option><option value='Central African Republic'  class=\"translation-block trp-ctx-ocd-central-african-republic\">Central African Republic<\/option><option value='Chad'  class=\"translation-block trp-ctx-ocd-chad\">Chad<\/option><option value='Chile'  class=\"translation-block trp-ctx-ocd-chile\">Chile<\/option><option value='China'  class=\"translation-block trp-ctx-ocd-china\">China<\/option><option value='Christmas Island'  class=\"translation-block trp-ctx-ocd-christmas-island\">Christmas Island<\/option><option value='Cocos Islands'  class=\"translation-block trp-ctx-ocd-cocos-islands\">Cocos Islands<\/option><option value='Colombia'  class=\"translation-block trp-ctx-ocd-colombia\">Colombia<\/option><option value='Comoros'  class=\"translation-block trp-ctx-ocd-comoros\">Comoros<\/option><option value='Congo, Democratic Republic of the'  class=\"translation-block trp-ctx-ocd-congo-democratic-republic-of-the\">Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the'  class=\"translation-block trp-ctx-ocd-congo-republic-of-the\">Congo, Republic of the<\/option><option value='Cook Islands'  class=\"translation-block trp-ctx-ocd-cook-islands\">Cook Islands<\/option><option value='Costa Rica'  class=\"translation-block trp-ctx-ocd-costa-rica\">Costa Rica<\/option><option value='Croatia'  class=\"translation-block trp-ctx-ocd-croatia\">Croatia<\/option><option value='Cuba'  class=\"translation-block trp-ctx-ocd-cuba\">Cuba<\/option><option value='Cura\u00e7ao'  class=\"translation-block trp-ctx-ocd-curacao\">Cura\u00e7ao<\/option><option value='Cyprus'  class=\"translation-block trp-ctx-ocd-cyprus\">Cyprus<\/option><option value='Czech Republic'  class=\"translation-block trp-ctx-ocd-czech-republic\">Czech Republic<\/option><option value='C\u00f4te d&#039;Ivoire'  class=\"translation-block trp-ctx-ocd-cote-divoire\">C\u00f4te d&#039;Ivoire<\/option><option value='Denmark'  class=\"translation-block trp-ctx-ocd-denmark\">Denmark<\/option><option value='Djibouti'  class=\"translation-block trp-ctx-ocd-djibouti\">Djibouti<\/option><option value='Dominica'  class=\"translation-block trp-ctx-ocd-dominica\">Dominica<\/option><option value='Dominican Republic'  class=\"translation-block trp-ctx-ocd-dominican-republic\">Dominican Republic<\/option><option value='Ecuador'  class=\"translation-block trp-ctx-ocd-ecuador\">Ecuador<\/option><option value='Egypt'  class=\"translation-block trp-ctx-ocd-egypt\">Egypt<\/option><option value='El Salvador'  class=\"translation-block trp-ctx-ocd-el-salvador\">El Salvador<\/option><option value='Equatorial Guinea'  class=\"translation-block trp-ctx-ocd-equatorial-guinea\">Equatorial Guinea<\/option><option value='Eritrea'  class=\"translation-block trp-ctx-ocd-eritrea\">Eritrea<\/option><option value='Estonia'  class=\"translation-block trp-ctx-ocd-estonia\">Estonia<\/option><option value='Eswatini (Swaziland)'  class=\"translation-block trp-ctx-ocd-eswatini-swaziland\">Eswatini (Swaziland)<\/option><option value='Ethiopia'  class=\"translation-block trp-ctx-ocd-ethiopia\">Ethiopia<\/option><option value='Falkland Islands'  class=\"translation-block trp-ctx-ocd-falkland-islands\">Falkland Islands<\/option><option value='Faroe Islands'  class=\"translation-block trp-ctx-ocd-faroe-islands\">Faroe Islands<\/option><option value='Fiji'  class=\"translation-block trp-ctx-ocd-fiji\">Fiji<\/option><option value='Finland'  class=\"translation-block trp-ctx-ocd-finland\">Finland<\/option><option value='France'  class=\"translation-block trp-ctx-ocd-france\">France<\/option><option value='French Guiana'  class=\"translation-block trp-ctx-ocd-french-guiana\">French Guiana<\/option><option value='French Polynesia'  class=\"translation-block trp-ctx-ocd-french-polynesia\">French Polynesia<\/option><option value='French Southern Territories'  class=\"translation-block trp-ctx-ocd-french-southern-territories\">French Southern Territories<\/option><option value='Gabon'  class=\"translation-block trp-ctx-ocd-gabon\">Gabon<\/option><option value='Gambia'  class=\"translation-block trp-ctx-ocd-gambia\">Gambia<\/option><option value='Georgia'  class=\"translation-block trp-ctx-ocd-georgia\">Georgia<\/option><option value='Germany'  class=\"translation-block trp-ctx-ocd-germany\">Germany<\/option><option value='Ghana'  class=\"translation-block trp-ctx-ocd-ghana\">Ghana<\/option><option value='Gibraltar'  class=\"translation-block trp-ctx-ocd-gibraltar\">Gibraltar<\/option><option value='Greece'  class=\"translation-block trp-ctx-ocd-greece\">Greece<\/option><option value='Greenland'  class=\"translation-block trp-ctx-ocd-greenland\">Greenland<\/option><option value='Grenada'  class=\"translation-block trp-ctx-ocd-grenada\">Grenada<\/option><option value='Guadeloupe'  class=\"translation-block trp-ctx-ocd-guadeloupe\">Guadeloupe<\/option><option value='Guam'  class=\"translation-block trp-ctx-ocd-guam\">Guam<\/option><option value='Guatemala'  class=\"translation-block trp-ctx-ocd-guatemala\">Guatemala<\/option><option value='Guernsey'  class=\"translation-block trp-ctx-ocd-guernsey\">Guernsey<\/option><option value='Guinea'  class=\"translation-block trp-ctx-ocd-guinea\">Guinea<\/option><option value='Guinea-Bissau'  class=\"translation-block trp-ctx-ocd-guinea-bissau\">Guinea-Bissau<\/option><option value='Guyana'  class=\"translation-block trp-ctx-ocd-guyana\">Guyana<\/option><option value='Haiti'  class=\"translation-block trp-ctx-ocd-haiti\">Haiti<\/option><option value='Heard and McDonald Islands'  class=\"translation-block trp-ctx-ocd-heard-and-mcdonald-islands\">Heard and McDonald Islands<\/option><option value='Holy See'  class=\"translation-block trp-ctx-ocd-holy-see\">Holy See<\/option><option value='Honduras'  class=\"translation-block trp-ctx-ocd-honduras\">Honduras<\/option><option value='Hong Kong'  class=\"translation-block trp-ctx-ocd-hong-kong\">Hong Kong<\/option><option value='Hungary'  class=\"translation-block trp-ctx-ocd-hungary\">Hungary<\/option><option value='Iceland'  class=\"translation-block trp-ctx-ocd-iceland\">Iceland<\/option><option value='India'  class=\"translation-block trp-ctx-ocd-india\">India<\/option><option value='Indonesia'  class=\"translation-block trp-ctx-ocd-indonesia\">Indonesia<\/option><option value='Iran'  class=\"translation-block trp-ctx-ocd-iran\">Iran<\/option><option value='Iraq'  class=\"translation-block trp-ctx-ocd-iraq\">Iraq<\/option><option value='Ireland'  class=\"translation-block trp-ctx-ocd-ireland\">Ireland<\/option><option value='Isle of Man'  class=\"translation-block trp-ctx-ocd-isle-of-man\">Isle of Man<\/option><option value='Israel'  class=\"translation-block trp-ctx-ocd-israel\">Israel<\/option><option value='Italy'  class=\"translation-block trp-ctx-ocd-italy\">Italy<\/option><option value='Jamaica'  class=\"translation-block trp-ctx-ocd-jamaica\">Jamaica<\/option><option value='Japan'  class=\"translation-block trp-ctx-ocd-japan\">Japan<\/option><option value='Jersey'  class=\"translation-block trp-ctx-ocd-jersey\">Jersey<\/option><option value='Jordan'  class=\"translation-block trp-ctx-ocd-jordan\">Jordan<\/option><option value='Kazakhstan'  class=\"translation-block trp-ctx-ocd-kazakhstan\">Kazakhstan<\/option><option value='Kenya'  class=\"translation-block trp-ctx-ocd-kenya\">Kenya<\/option><option value='Kiribati'  class=\"translation-block trp-ctx-ocd-kiribati\">Kiribati<\/option><option value='Kuwait'  class=\"translation-block trp-ctx-ocd-kuwait\">Kuwait<\/option><option value='Kyrgyzstan'  class=\"translation-block trp-ctx-ocd-kyrgyzstan\">Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic'  class=\"translation-block trp-ctx-ocd-lao-peoples-democratic-republic\">Lao People&#039;s Democratic Republic<\/option><option value='Latvia'  class=\"translation-block trp-ctx-ocd-latvia\">Latvia<\/option><option value='Lebanon'  class=\"translation-block trp-ctx-ocd-lebanon\">Lebanon<\/option><option value='Lesotho'  class=\"translation-block trp-ctx-ocd-lesotho\">Lesotho<\/option><option value='Liberia'  class=\"translation-block trp-ctx-ocd-liberia\">Liberia<\/option><option value='Libya'  class=\"translation-block trp-ctx-ocd-libya\">Libya<\/option><option value='Liechtenstein'  class=\"translation-block trp-ctx-ocd-liechtenstein\">Liechtenstein<\/option><option value='Lithuania'  class=\"translation-block trp-ctx-ocd-lithuania\">Lithuania<\/option><option value='Luxembourg'  class=\"translation-block trp-ctx-ocd-luxembourg\">Luxembourg<\/option><option value='Macau'  class=\"translation-block trp-ctx-ocd-macau\">Macau<\/option><option value='Macedonia'  class=\"translation-block trp-ctx-ocd-macedonia\">Macedonia<\/option><option value='Madagascar'  class=\"translation-block trp-ctx-ocd-madagascar\">Madagascar<\/option><option value='Malawi'  class=\"translation-block trp-ctx-ocd-malawi\">Malawi<\/option><option value='Malaysia'  class=\"translation-block trp-ctx-ocd-malaysia\">Malaysia<\/option><option value='Maldives'  class=\"translation-block trp-ctx-ocd-maldives\">Maldives<\/option><option value='Mali'  class=\"translation-block trp-ctx-ocd-mali\">Mali<\/option><option value='Malta'  class=\"translation-block trp-ctx-ocd-malta\">Malta<\/option><option value='Marshall Islands'  class=\"translation-block trp-ctx-ocd-marshall-islands\">Marshall Islands<\/option><option value='Martinique'  class=\"translation-block trp-ctx-ocd-martinique\">Martinique<\/option><option value='Mauritania'  class=\"translation-block trp-ctx-ocd-mauritania\">Mauritania<\/option><option value='Mauritius'  class=\"translation-block trp-ctx-ocd-mauritius\">Mauritius<\/option><option value='Mayotte'  class=\"translation-block trp-ctx-ocd-mayotte\">Mayotte<\/option><option value='Mexico'  class=\"translation-block trp-ctx-ocd-mexico\">Mexico<\/option><option value='Micronesia'  class=\"translation-block trp-ctx-ocd-micronesia\">Micronesia<\/option><option value='Moldova'  class=\"translation-block trp-ctx-ocd-moldova\">Moldova<\/option><option value='Monaco'  class=\"translation-block trp-ctx-ocd-monaco\">Monaco<\/option><option value='Mongolia'  class=\"translation-block trp-ctx-ocd-mongolia\">Mongolia<\/option><option value='Montenegro'  class=\"translation-block trp-ctx-ocd-montenegro\">Montenegro<\/option><option value='Montserrat'  class=\"translation-block trp-ctx-ocd-montserrat\">Montserrat<\/option><option value='Morocco'  class=\"translation-block trp-ctx-ocd-morocco\">Morocco<\/option><option value='Mozambique'  class=\"translation-block trp-ctx-ocd-mozambique\">Mozambique<\/option><option value='Myanmar'  class=\"translation-block trp-ctx-ocd-myanmar\">Myanmar<\/option><option value='Namibia'  class=\"translation-block trp-ctx-ocd-namibia\">Namibia<\/option><option value='Nauru'  class=\"translation-block trp-ctx-ocd-nauru\">Nauru<\/option><option value='Nepal'  class=\"translation-block trp-ctx-ocd-nepal\">Nepal<\/option><option value='Netherlands'  class=\"translation-block trp-ctx-ocd-netherlands\">Netherlands<\/option><option value='New Caledonia'  class=\"translation-block trp-ctx-ocd-new-caledonia\">New Caledonia<\/option><option value='New Zealand'  class=\"translation-block trp-ctx-ocd-new-zealand\">New Zealand<\/option><option value='Nicaragua'  class=\"translation-block trp-ctx-ocd-nicaragua\">Nicaragua<\/option><option value='Niger'  class=\"translation-block trp-ctx-ocd-niger\">Niger<\/option><option value='Nigeria'  class=\"translation-block trp-ctx-ocd-nigeria\">Nigeria<\/option><option value='Niue'  class=\"translation-block trp-ctx-ocd-niue\">Niue<\/option><option value='Norfolk Island'  class=\"translation-block trp-ctx-ocd-norfolk-island\">Norfolk Island<\/option><option value='North Korea'  class=\"translation-block trp-ctx-ocd-north-korea\">North Korea<\/option><option value='Northern Mariana Islands'  class=\"translation-block trp-ctx-ocd-northern-mariana-islands\">Northern Mariana Islands<\/option><option value='Norway'  class=\"translation-block trp-ctx-ocd-norway\">Norway<\/option><option value='Oman'  class=\"translation-block trp-ctx-ocd-oman\">Oman<\/option><option value='Pakistan'  class=\"translation-block trp-ctx-ocd-pakistan\">Pakistan<\/option><option value='Palau'  class=\"translation-block trp-ctx-ocd-palau\">Palau<\/option><option value='Palestine, State of'  class=\"translation-block trp-ctx-ocd-palestine-state-of\">Palestine, State of<\/option><option value='Panama'  class=\"translation-block trp-ctx-ocd-panama\">Panama<\/option><option value='Papua New Guinea'  class=\"translation-block trp-ctx-ocd-papua-new-guinea\">Papua New Guinea<\/option><option value='Paraguay'  class=\"translation-block trp-ctx-ocd-paraguay\">Paraguay<\/option><option value='Peru'  class=\"translation-block trp-ctx-ocd-peru\">Peru<\/option><option value='Philippines'  class=\"translation-block trp-ctx-ocd-philippines\">Philippines<\/option><option value='Pitcairn'  class=\"translation-block trp-ctx-ocd-pitcairn\">Pitcairn<\/option><option value='Poland'  class=\"translation-block trp-ctx-ocd-poland\">Poland<\/option><option value='Portugal'  class=\"translation-block trp-ctx-ocd-portugal\">Portugal<\/option><option value='Puerto Rico'  class=\"translation-block trp-ctx-ocd-puerto-rico\">Puerto Rico<\/option><option value='Qatar'  class=\"translation-block trp-ctx-ocd-qatar\">Qatar<\/option><option value='Romania'  class=\"translation-block trp-ctx-ocd-romania\">Romania<\/option><option value='Russia'  class=\"translation-block trp-ctx-ocd-russia\">Russia<\/option><option value='Rwanda'  class=\"translation-block trp-ctx-ocd-rwanda\">Rwanda<\/option><option value='R\u00e9union'  class=\"translation-block trp-ctx-ocd-reunion\">R\u00e9union<\/option><option value='Saint Barth\u00e9lemy'  class=\"translation-block trp-ctx-ocd-saint-barthelemy\">Saint Barth\u00e9lemy<\/option><option value='Saint Helena'  class=\"translation-block trp-ctx-ocd-saint-helena\">Saint Helena<\/option><option value='Saint Kitts and Nevis'  class=\"translation-block trp-ctx-ocd-saint-kitts-and-nevis\">Saint Kitts and Nevis<\/option><option value='Saint Lucia'  class=\"translation-block trp-ctx-ocd-saint-lucia\">Saint Lucia<\/option><option value='Saint Martin'  class=\"translation-block trp-ctx-ocd-saint-martin\">Saint Martin<\/option><option value='Saint Pierre and Miquelon'  class=\"translation-block trp-ctx-ocd-saint-pierre-and-miquelon\">Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines'  class=\"translation-block trp-ctx-ocd-saint-vincent-and-the-grenadines\">Saint Vincent and the Grenadines<\/option><option value='Samoa'  class=\"translation-block trp-ctx-ocd-samoa\">Samoa<\/option><option value='San Marino'  class=\"translation-block trp-ctx-ocd-san-marino\">San Marino<\/option><option value='Sao Tome and Principe'  class=\"translation-block trp-ctx-ocd-sao-tome-and-principe\">Sao Tome and Principe<\/option><option value='Saudi Arabia'  class=\"translation-block trp-ctx-ocd-saudi-arabia\">Saudi Arabia<\/option><option value='Senegal'  class=\"translation-block trp-ctx-ocd-senegal\">Senegal<\/option><option value='Serbia'  class=\"translation-block trp-ctx-ocd-serbia\">Serbia<\/option><option value='Seychelles'  class=\"translation-block trp-ctx-ocd-seychelles\">Seychelles<\/option><option value='Sierra Leone'  class=\"translation-block trp-ctx-ocd-sierra-leone\">Sierra Leone<\/option><option value='Singapore'  class=\"translation-block trp-ctx-ocd-singapore\">Singapore<\/option><option value='Sint Maarten'  class=\"translation-block trp-ctx-ocd-sint-maarten\">Sint Maarten<\/option><option value='Slovakia'  class=\"translation-block trp-ctx-ocd-slovakia\">Slovakia<\/option><option value='Slovenia'  class=\"translation-block trp-ctx-ocd-slovenia\">Slovenia<\/option><option value='Solomon Islands'  class=\"translation-block trp-ctx-ocd-solomon-islands\">Solomon Islands<\/option><option value='Somalia'  class=\"translation-block trp-ctx-ocd-somalia\">Somalia<\/option><option value='South Africa'  class=\"translation-block trp-ctx-ocd-south-africa\">South Africa<\/option><option value='South Georgia'  class=\"translation-block trp-ctx-ocd-south-georgia\">South Georgia<\/option><option value='South Korea'  class=\"translation-block trp-ctx-ocd-south-korea\">South Korea<\/option><option value='South Sudan'  class=\"translation-block trp-ctx-ocd-south-sudan\">South Sudan<\/option><option value='Spain'  class=\"translation-block trp-ctx-ocd-spain\">Spain<\/option><option value='Sri Lanka'  class=\"translation-block trp-ctx-ocd-sri-lanka\">Sri Lanka<\/option><option value='Sudan'  class=\"translation-block trp-ctx-ocd-sudan\">Sudan<\/option><option value='Suriname'  class=\"translation-block trp-ctx-ocd-suriname\">Suriname<\/option><option value='Svalbard and Jan Mayen Islands'  class=\"translation-block trp-ctx-ocd-svalbard-and-jan-mayen-islands\">Svalbard and Jan Mayen Islands<\/option><option value='Sweden'  class=\"translation-block trp-ctx-ocd-sweden\">Sweden<\/option><option value='Switzerland'  class=\"translation-block trp-ctx-ocd-switzerland\">Switzerland<\/option><option value='Syria'  class=\"translation-block trp-ctx-ocd-syria\">Syria<\/option><option value='Taiwan'  class=\"translation-block trp-ctx-ocd-taiwan\">Taiwan<\/option><option value='Tajikistan'  class=\"translation-block trp-ctx-ocd-tajikistan\">Tajikistan<\/option><option value='Tanzania'  class=\"translation-block trp-ctx-ocd-tanzania\">Tanzania<\/option><option value='Thailand'  class=\"translation-block trp-ctx-ocd-thailand\">Thailand<\/option><option value='Timor-Leste'  class=\"translation-block trp-ctx-ocd-timor-leste\">Timor-Leste<\/option><option value='Togo'  class=\"translation-block trp-ctx-ocd-togo\">Togo<\/option><option value='Tokelau'  class=\"translation-block trp-ctx-ocd-tokelau\">Tokelau<\/option><option value='Tonga'  class=\"translation-block trp-ctx-ocd-tonga\">Tonga<\/option><option value='Trinidad and Tobago'  class=\"translation-block trp-ctx-ocd-trinidad-and-tobago\">Trinidad and Tobago<\/option><option value='Tunisia'  class=\"translation-block trp-ctx-ocd-tunisia\">Tunisia<\/option><option value='Turkey'  class=\"translation-block trp-ctx-ocd-turkey\">Turkey<\/option><option value='Turkmenistan'  class=\"translation-block trp-ctx-ocd-turkmenistan\">Turkmenistan<\/option><option value='Turks and Caicos Islands'  class=\"translation-block trp-ctx-ocd-turks-and-caicos-islands\">Turks and Caicos Islands<\/option><option value='Tuvalu'  class=\"translation-block trp-ctx-ocd-tuvalu\">Tuvalu<\/option><option value='US Minor Outlying Islands'  class=\"translation-block trp-ctx-ocd-us-minor-outlying-islands\">US Minor Outlying Islands<\/option><option value='Uganda'  class=\"translation-block trp-ctx-ocd-uganda\">Uganda<\/option><option value='Ukraine'  class=\"translation-block trp-ctx-ocd-ukraine\">Ukraine<\/option><option value='United Arab Emirates'  class=\"translation-block trp-ctx-ocd-united-arab-emirates\">United Arab Emirates<\/option><option value='United Kingdom'  class=\"translation-block trp-ctx-ocd-united-kingdom\">United Kingdom<\/option><option value='Uruguay'  class=\"translation-block trp-ctx-ocd-uruguay\">Uruguay<\/option><option value='Uzbekistan'  class=\"translation-block trp-ctx-ocd-uzbekistan\">Uzbekistan<\/option><option value='Vanuatu'  class=\"translation-block trp-ctx-ocd-vanuatu\">Vanuatu<\/option><option value='Venezuela'  class=\"translation-block trp-ctx-ocd-venezuela\">Venezuela<\/option><option value='Vietnam'  class=\"translation-block trp-ctx-ocd-vietnam\">Vietnam<\/option><option value='Virgin Islands, British'  class=\"translation-block trp-ctx-ocd-virgin-islands-british\">Virgin Islands, British<\/option><option value='Virgin Islands, U.S.'  class=\"translation-block trp-ctx-ocd-virgin-islands-u-s\">Virgin Islands, U.S.<\/option><option value='Wallis and Futuna'  class=\"translation-block trp-ctx-ocd-wallis-and-futuna\">Wallis and Futuna<\/option><option value='Western Sahara'  class=\"translation-block trp-ctx-ocd-western-sahara\">Western Sahara<\/option><option value='Yemen'  class=\"translation-block trp-ctx-ocd-yemen\">Yemen<\/option><option value='Zambia'  class=\"translation-block trp-ctx-ocd-zambia\">Zambia<\/option><option value='Zimbabwe'  class=\"translation-block trp-ctx-ocd-zimbabwe\">Zimbabwe<\/option><option value='\u00c5land Islands'  class=\"translation-block trp-ctx-ocd-aland-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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-veteran-or-active-duty-military\">Veteran or active-duty military<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-caregiver-of-someone-living-with-emotional-or-physical-illness\">Caregiver of someone living with emotional or physical illness<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-lgbtq\">LGBTQ+<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-student\">Student<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-trauma-survivor\">Trauma survivor<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-new-or-expecting-parent\">New or expecting parent<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-healthcare-worker\">Healthcare worker<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-mental-health-condition\">Mental health condition<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-physical-health-condition\">Physical health condition<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-both-mental-and-physical-health-conditions\">Both mental and physical health conditions<\/span><\/span><\/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'  class=\"translation-block trp-ctx-ocd-lesbian-or-gay\">Lesbian or Gay<\/option><option value='Bisexual'  class=\"translation-block trp-ctx-ocd-bisexual\">Bisexual<\/option><option value='Queer'  class=\"translation-block trp-ctx-ocd-queer\">Queer<\/option><option value='Pansexual'  class=\"translation-block trp-ctx-ocd-pansexual\">Pansexual<\/option><option value='Asexual'  class=\"translation-block trp-ctx-ocd-asexual\">Asexual<\/option><option value='Straight'  class=\"translation-block trp-ctx-ocd-straight\">Straight<\/option><option value='Other...'  class=\"translation-block trp-ctx-ocd-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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-child-abuse-violence\">Child abuse\/violence<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-intimate-partner-violence\">Intimate partner violence<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-sexual-assault-violence\">Sexual assault\/violence<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-serious-illness-injury-assault\">Serious illness\/injury\/assault<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-family-conflict-identity-acceptance-separation-divorce\">Family conflict (identity acceptance\/separation\/divorce)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-traumatic-event-natural-disaster-accident-witnessing-violence-etc\">Traumatic event (natural disaster, accident, witnessing violence, etc.)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-death-of-a-loved-one\">Death of a loved one<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-other-and-or-tell-us-more-about-your-trauma\">Other and\/or tell us more about your trauma<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-wanted-to-handle-my-mental-health-on-my-own\">I wanted to handle my mental health on my own<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-didnt-know-how-or-where-to-start\">I didn\u2019t know how or where to start<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-thought-it-would-cost-too-much\">I thought it would cost too much<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-didnt-have-time\">I didn\u2019t have time<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-didnt-think-it-would-help-me\">I didn\u2019t think it would help me<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-didnt-feel-ready-to-start-treatment\">I didn't feel ready to start treatment<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-was-worried-about-what-people-would-think-or-say-if-i-got-treatment\">I was worried about what people would think or say if I got treatment<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-was-afraid-of-being-forced-into-a-hospital-or-forced-to-take-medication\">I was afraid of being forced into a hospital or forced to take medication<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-tried-but-couldnt-find-available-treatment-no-openings-wouldnt-take-insurance-etc\">I tried, but couldn\u2019t find available treatment (no openings, wouldn\u2019t take insurance, etc.)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-my-parents-or-guardian-wouldnt-let-me-or-i-didnt-want-to-ask\">My parent(s) or guardian wouldn't let me, or I didn't want to ask<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-other\">Other...<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-abuse-or-violence\">Abuse or violence<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-relationship-problems-friends-family-or-significant-other\">Relationship problems (friends, family, or significant other)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-body-image\">Body image<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-low-self-esteem-or-self-image\">Low self-esteem or self-image<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-school-or-work-problems\">School or work problems<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-financial-problems\">Financial problems<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-loneliness-or-isolation\">Loneliness or isolation<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-grief-or-loss-of-someone-or-something\">Grief or loss of someone or something<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-experiencing-hate-bullying-including-racism-homophobia-transphobia-or-discrimination\">Experiencing hate\/bullying (including racism, homophobia, transphobia, or discrimination)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-state-of-the-world-war-climate-politics-immigration\">State of the world (war, climate, politics, immigration)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-dont-know-something-just-feels-wrong\">I don\u2019t know (something just feels wrong)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-other\">Other...<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-i-dont-know\">I don't know<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-heart-disease\">Heart disease<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-reproductive-health-concerns-pcos-endometriosis-infertility-etc\">Reproductive health concerns (PCOS, endometriosis, infertility, etc.)<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-diabetes\">Diabetes<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-cancer\">Cancer<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-arthritis-or-other-chronic-pain\">Arthritis or other chronic pain<\/span><\/span><\/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'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-asthma-copd-or-other-lung-conditions\">Asthma, COPD or other lung conditions<\/span><\/span><\/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 class='gfield-choice-input' name='input_30.7' type='checkbox'  value='Movement Disorders (involuntary tics, tardive dyskinesia, etc.)'  id='choice_84_30_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_7' id='label_84_30_7' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-movement-disorders-involuntary-tics-tardive-dyskinesia-etc\">Movement Disorders (involuntary tics, tardive dyskinesia, etc.)<\/span><\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_84_30_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.8' type='checkbox'  value='Digestive problems (Crohn\u2019s, colitis, IBS, etc.)'  id='choice_84_30_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_8' id='label_84_30_8' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-digestive-problems-crohns-colitis-ibs-etc\">Digestive problems (Crohn\u2019s, colitis, IBS, etc.)<\/span><\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_84_30_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.9' type='checkbox'  value='Neurological conditions (epilepsy, etc.) or traumatic brain injury (TBI)'  id='choice_84_30_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_9' id='label_84_30_9' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-neurological-conditions-epilepsy-etc-or-traumatic-brain-injury-tbi\">Neurological conditions (epilepsy, etc.) or traumatic brain injury (TBI)<\/span><\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_84_30_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.11' type='checkbox'  value='Other...'  id='choice_84_30_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_84_30_11' id='label_84_30_11' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-other\">Other...<\/span><\/span><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_84_31\" class=\"gfield gfield--type-text gfield--input-type-text optional field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_84_31'>What other physical health conditions do you have?<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_84_31' type='text' value='' class='large'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_84_131\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full short field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have a pet that supports your mental health?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_84_131'>\n\t\t\t<div class='gchoice gchoice_84_131_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='Yes'  id='choice_84_131_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_131_0' id='label_84_131_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_131_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='No'  id='choice_84_131_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_131_1' id='label_84_131_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_84_132\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full short field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you interested in having a pet that supports your mental health?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_84_132'>\n\t\t\t<div class='gchoice gchoice_84_132_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_132' type='radio' value='Yes'  id='choice_84_132_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_132_0' id='label_84_132_0' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-yes\">Yes<\/span><\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_84_132_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_132' type='radio' value='No'  id='choice_84_132_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_84_132_1' id='label_84_132_1' class='gform-field-label gform-field-label--type-inline'><span class=\"translation-block\"><span class=\"trp-ctx-ocd-no\">No<\/span><\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_84' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_84' class='gform_button button' 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