{"id":251896,"date":"2025-12-04T12:39:12","date_gmt":"2025-12-04T17:39:12","guid":{"rendered":"https:\/\/screening.mhanational.org\/?post_type=screen&#038;p=251896"},"modified":"2026-03-23T13:00:36","modified_gmt":"2026-03-23T17:00:36","slug":"social-anxiety","status":"publish","type":"screen","link":"https:\/\/screening.mhanational.org\/es\/screening-tools\/social-anxiety\/","title":{"rendered":"Prueba de ansiedad social"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_88' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Social Anxiety 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_88'  class='clearfix' action='\/es\/wp-json\/wp\/v2\/screen\/251896' data-formid='88' 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_88_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_88' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_88_145\" 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_88_145'>Company<\/label><div class='gfield_description' id='gfield_description_88_145'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_145' id='input_88_145' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_88_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_88_38' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_88_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_88_39\" type=\"hidden\" class=\"gform_hidden\" aria-invalid=\"false\" value=\"251896\"><\/div><div id=\"field_88_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_88_40\" type=\"hidden\" class=\"gform_hidden\" aria-invalid=\"false\" value=\"4b228fc59730a89c41b10c5cdfd6dcad\"><\/div><div id=\"field_88_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_88_41' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_88_54\" 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_54' id='input_88_54' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_88_84\" 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_84' id='input_88_84' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_88_85\" 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_85' id='input_88_85' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_88_86\" 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_86' id='input_88_86' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_88_96\" 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_96' id='input_88_96' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_88_97\" 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_97' id='input_88_97' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/screen\/251896' \/><\/div><\/div><div id=\"field_88_144\" 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_144' id='input_88_144' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='lang--es' \/><\/div><\/div><div id=\"field_88_120\" 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>\nThe following questions ask about thoughts, feelings, and behaviors that you may have had about <strong>social situations<\/strong>. Usual social situations include:\n<\/p>\n<ul>\n<li>\npublic speaking\n<\/li><li>\nspeaking in meetings\n<\/li><li>\nattending social events or parties\n<\/li><li>\nintroducing yourself to others\n<\/li><li>\nhaving conversations\n<\/li><li>\ngiving and receiving compliments\n<\/li><li>\nmaking requests of others\n<\/li><li>\neating and writing in public\n<\/li><\/ul>\n\n<p>Please note, all questions are required.<\/p><\/div><div id=\"field_88_113\" 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 \/>\nWe're testing different ways to ask people about their social anxiety symptoms.<\/div><fieldset id=\"field_88_114\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Can you help us answer 2 extra questions about your experiences over different periods of time (7 days vs. 3 months)?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_88_114'>\n\t\t\t<div class='gchoice gchoice_88_114_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_114' type='radio' value='Yes'  id='choice_88_114_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_114_0' id='label_88_114_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_114_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_114' type='radio' value='No'  id='choice_88_114_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_114_1' id='label_88_114_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_115\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Thank you for your help!<\/div><div id=\"field_88_116\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >Okay! You will only see the normal questions we always ask.<\/div><div id=\"field_88_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 \/><\/div><fieldset id=\"field_88_98\" 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' ><strong>In the last three months<\/strong>, have you often felt very nervous or uncomfortable when you have been with a group of people (like at lunch or at a party)?<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_88_98'>\n\t\t\t<div class='gchoice gchoice_88_98_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_98' type='radio' value='Yes'  id='choice_88_98_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_98_0' id='label_88_98_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_98_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_98' type='radio' value='No'  id='choice_88_98_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_98_1' id='label_88_98_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_134\" 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' ><strong>In the last three months<\/strong>, have you often felt very nervous when you've had to do things in front of 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_88_134'>\n\t\t\t<div class='gchoice gchoice_88_134_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_134' type='radio' value='Yes'  id='choice_88_134_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_134_0' id='label_88_134_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_134_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_134' type='radio' value='No'  id='choice_88_134_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_134_1' id='label_88_134_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_122\" 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_88_123\" 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>During the past 7 days, I have...<\/h2><\/div><fieldset id=\"field_88_47\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >1. Felt moments of sudden terror, fear, or fright in social situations<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_88_47'>\n\t\t\t<div class='gchoice gchoice_88_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='0'  id='choice_88_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_47_0' id='label_88_47_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='1'  id='choice_88_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_47_1' id='label_88_47_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_47_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='2'  id='choice_88_47_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_47_2' id='label_88_47_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_47_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='3'  id='choice_88_47_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_47_3' id='label_88_47_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_47_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='4'  id='choice_88_47_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_47_4' id='label_88_47_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_131\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >2. Felt anxious, worried, or nervous about social situations<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_88_131'>\n\t\t\t<div class='gchoice gchoice_88_131_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='0'  id='choice_88_131_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_131_0' id='label_88_131_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_131_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='1'  id='choice_88_131_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_131_1' id='label_88_131_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_131_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='2'  id='choice_88_131_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_131_2' id='label_88_131_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_131_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='3'  id='choice_88_131_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_131_3' id='label_88_131_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_131_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_131' type='radio' value='4'  id='choice_88_131_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_131_4' id='label_88_131_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_130\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >3. Have had thoughts of being rejected, humiliated, embarrassed, ridiculed, or offending others<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_88_130'>\n\t\t\t<div class='gchoice gchoice_88_130_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='0'  id='choice_88_130_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_130_0' id='label_88_130_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_130_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='1'  id='choice_88_130_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_130_1' id='label_88_130_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_130_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='2'  id='choice_88_130_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_130_2' id='label_88_130_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_130_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='3'  id='choice_88_130_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_130_3' id='label_88_130_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_130_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='4'  id='choice_88_130_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_130_4' id='label_88_130_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_129\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >4. Felt a racing heart, sweaty, trouble breathing, faint, or shaky in social situations<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_88_129'>\n\t\t\t<div class='gchoice gchoice_88_129_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='0'  id='choice_88_129_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_129_0' id='label_88_129_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_129_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='1'  id='choice_88_129_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_129_1' id='label_88_129_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_129_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='2'  id='choice_88_129_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_129_2' id='label_88_129_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_129_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='3'  id='choice_88_129_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_129_3' id='label_88_129_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_129_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_129' type='radio' value='4'  id='choice_88_129_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_129_4' id='label_88_129_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_128\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5. Felt tense muscles, felt on edge or restless, or had trouble relaxing in social situations<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_88_128'>\n\t\t\t<div class='gchoice gchoice_88_128_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='0'  id='choice_88_128_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_128_0' id='label_88_128_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_128_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='1'  id='choice_88_128_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_128_1' id='label_88_128_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_128_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='2'  id='choice_88_128_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_128_2' id='label_88_128_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_128_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='3'  id='choice_88_128_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_128_3' id='label_88_128_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_128_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='4'  id='choice_88_128_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_128_4' id='label_88_128_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_127\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >6. Avoided, or did not approach or enter, social situations<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_88_127'>\n\t\t\t<div class='gchoice gchoice_88_127_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='0'  id='choice_88_127_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_127_0' id='label_88_127_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_127_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='1'  id='choice_88_127_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_127_1' id='label_88_127_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_127_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='2'  id='choice_88_127_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_127_2' id='label_88_127_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_127_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='3'  id='choice_88_127_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_127_3' id='label_88_127_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_127_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_127' type='radio' value='4'  id='choice_88_127_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_127_4' id='label_88_127_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_126\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >7. Left social situations early or participated only minimally (e.g., said little, avoided eye contact)<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_88_126'>\n\t\t\t<div class='gchoice gchoice_88_126_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='0'  id='choice_88_126_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_126_0' id='label_88_126_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_126_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='1'  id='choice_88_126_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_126_1' id='label_88_126_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_126_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='2'  id='choice_88_126_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_126_2' id='label_88_126_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_126_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='3'  id='choice_88_126_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_126_3' id='label_88_126_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_126_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='4'  id='choice_88_126_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_126_4' id='label_88_126_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_125\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >8. Spent a lot of time preparing what to say or how to act in social situations<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_88_125'>\n\t\t\t<div class='gchoice gchoice_88_125_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='0'  id='choice_88_125_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_125_0' id='label_88_125_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_125_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='1'  id='choice_88_125_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_125_1' id='label_88_125_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_125_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='2'  id='choice_88_125_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_125_2' id='label_88_125_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_125_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='3'  id='choice_88_125_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_125_3' id='label_88_125_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_125_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='4'  id='choice_88_125_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_125_4' id='label_88_125_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_124\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >9. Distracted myself to avoid thinking about social situations<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_88_124'>\n\t\t\t<div class='gchoice gchoice_88_124_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_124' type='radio' value='0'  id='choice_88_124_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_124_0' id='label_88_124_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_124_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_124' type='radio' value='1'  id='choice_88_124_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_124_1' id='label_88_124_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_124_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_124' type='radio' value='2'  id='choice_88_124_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_124_2' id='label_88_124_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_124_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_124' type='radio' value='3'  id='choice_88_124_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_124_3' id='label_88_124_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_124_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_124' type='radio' value='4'  id='choice_88_124_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_124_4' id='label_88_124_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_133\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio question gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >10. Needed help to cope with social situations (e.g., alcohol or medications, superstitious objects)<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_88_133'>\n\t\t\t<div class='gchoice gchoice_88_133_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='0'  id='choice_88_133_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_133_0' id='label_88_133_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_133_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='1'  id='choice_88_133_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_133_1' id='label_88_133_1' class='gform-field-label gform-field-label--type-inline'>Occasionally<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_133_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='2'  id='choice_88_133_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_133_2' id='label_88_133_2' class='gform-field-label gform-field-label--type-inline'>Half of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_133_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='3'  id='choice_88_133_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_133_3' id='label_88_133_3' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_133_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='4'  id='choice_88_133_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_133_4' id='label_88_133_4' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_121\" 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_88_135\" 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' ><strong>In the last three months<\/strong>, have you often felt very nervous or uncomfortable when you have been with a group of people (like at lunch or at a party)?<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_88_135'>\n\t\t\t<div class='gchoice gchoice_88_135_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_135' type='radio' value='Yes'  id='choice_88_135_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_135_0' id='label_88_135_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_135_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_135' type='radio' value='No'  id='choice_88_135_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_135_1' id='label_88_135_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_136\" 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' ><strong>In the last three months<\/strong>, have you often felt very nervous when you've had to do things in front of 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_88_136'>\n\t\t\t<div class='gchoice gchoice_88_136_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_136' type='radio' value='Yes'  id='choice_88_136_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_136_0' id='label_88_136_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_136_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_136' type='radio' value='No'  id='choice_88_136_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_136_1' id='label_88_136_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_139\" 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_88_140\" 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_88_140'>Optional: What is most distressing to you about the social anxiety symptoms you&#039;ve been experiencing?<\/label><div class='ginput_container ginput_container_text'><input name='input_140' id='input_88_140' 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_88_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_88_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_88_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_88_55\" 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_88_87\" 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_88_88\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >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_88_88'>\n\t\t\t<div class='gchoice gchoice_88_88_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='For myself'  id='choice_88_88_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_88_0' id='label_88_88_0' class='gform-field-label gform-field-label--type-inline'>For myself<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_88_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='For someone else'  id='choice_88_88_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_88_1' id='label_88_88_1' class='gform-field-label gform-field-label--type-inline'>For someone else<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_89\" 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_88_56\" 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_88_57\" 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_88_57'>Age Range<\/label><div class='ginput_container ginput_container_select'><select name='input_57' id='input_88_57' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='8-10' >8-10<\/option><option value='11-13' >11-13<\/option><option value='14-15' >14-15<\/option><option value='16-17' >16-17<\/option><option value='18-24' >18-24<\/option><option value='25-34' >25-34<\/option><option value='35-44' >35-44<\/option><option value='45-54' >45-54<\/option><option value='55-64' >55-64<\/option><option value='65+' >65+<\/option><\/select><\/div><\/div><fieldset id=\"field_88_58\" 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_88_58'>\n\t\t\t<div class='gchoice gchoice_88_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Female'  id='choice_88_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_58_0' id='label_88_58_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Male'  id='choice_88_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_58_1' id='label_88_58_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_58_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Non-Binary'  id='choice_88_58_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_58_2' id='label_88_58_2' class='gform-field-label gform-field-label--type-inline'>Non-Binary<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_141\" 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_88_141'>\n\t\t\t<div class='gchoice gchoice_88_141_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_141' type='radio' value='Yes'  id='choice_88_141_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_141_0' id='label_88_141_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_141_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_141' type='radio' value='No'  id='choice_88_141_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_141_1' id='label_88_141_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_59\" 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_88_59'>How would you describe your gender?<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_88_59' type='text' value='' class='small'    placeholder='Enter gender...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_88_61\" 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_88_61'>Race\/Ethnicity<\/label><div class='ginput_container ginput_container_select'><select name='input_61' id='input_88_61' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='American Indian or Alaska Native' >American Indian or Alaska Native<\/option><option value='Asian' >Asian<\/option><option value='Black or African American (non-Hispanic)' >Black or African American (non-Hispanic)<\/option><option value='Hispanic or Latino' >Hispanic or Latino<\/option><option value='Middle Eastern or North African' >Middle Eastern or North African<\/option><option value='Native Hawaiian or other Pacific Islander' >Native Hawaiian or other Pacific Islander<\/option><option value='White (non-Hispanic)' >White (non-Hispanic)<\/option><option value='More than one of the above' >More than one of the above<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_88_62\" 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_88_62'>Household Income<\/label><div class='ginput_container ginput_container_select'><select name='input_62' id='input_88_62' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Less than $20,000' >Less than $20,000<\/option><option value='$20,000 - $39,999' >$20,000 - $39,999<\/option><option value='$40,000 - $59,999' >$40,000 - $59,999<\/option><option value='$60,000 - $79,999' >$60,000 - $79,999<\/option><option value='$80,000 - $99,999' >$80,000 - $99,999<\/option><option value='$100,000 - $149,999' >$100,000 - $149,999<\/option><option value='$150,000+' >$150,000+<\/option><\/select><\/div><\/div><fieldset id=\"field_88_90\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you live in the United States or another country?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_88_90'>\n\t\t\t<div class='gchoice gchoice_88_90_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='I live in the United States'  id='choice_88_90_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_90_0' id='label_88_90_0' class='gform-field-label gform-field-label--type-inline'>I live in the United States<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_90_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='I live in another country'  id='choice_88_90_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_90_1' id='label_88_90_1' class='gform-field-label gform-field-label--type-inline'>I live in another country<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_81\" 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_88_81'>State<\/label><div class='ginput_container ginput_container_select'><select name='input_81' id='input_88_81' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='I live in a U.S. Territory' >I live in a U.S. Territory<\/option><\/select><\/div><\/div><div id=\"field_88_83\" 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_88_83'>What country do you live in?<\/label><div class='ginput_container ginput_container_select'><select name='input_83' id='input_88_83' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' >Saint Helena<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select><\/div><\/div><div id=\"field_88_82\" 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_88_82'>Zip\/Postal Code<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_88_82' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_88_63\" 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_88_63'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_88_63'><div class='gchoice gchoice_88_63_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.1' type='checkbox'  value='Veteran or active-duty military'  id='choice_88_63_1'   aria-describedby=\"gfield_description_88_63\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_88_63_1' id='label_88_63_1' class='gform-field-label gform-field-label--type-inline'>Veteran or active-duty military<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_63_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.2' type='checkbox'  value='Caregiver of someone living with emotional or physical illness'  id='choice_88_63_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_63_2' id='label_88_63_2' class='gform-field-label gform-field-label--type-inline'>Caregiver of someone living with emotional or physical illness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_63_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.3' type='checkbox'  value='LGBTQ+'  id='choice_88_63_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_63_3' id='label_88_63_3' class='gform-field-label gform-field-label--type-inline'>LGBTQ+<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_63_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.4' type='checkbox'  value='Student'  id='choice_88_63_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_63_4' id='label_88_63_4' class='gform-field-label gform-field-label--type-inline'>Student<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_63_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.5' type='checkbox'  value='Trauma survivor'  id='choice_88_63_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_63_5' id='label_88_63_5' class='gform-field-label gform-field-label--type-inline'>Trauma survivor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_63_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.6' type='checkbox'  value='New or expecting parent'  id='choice_88_63_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_63_6' id='label_88_63_6' class='gform-field-label gform-field-label--type-inline'>New or expecting parent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_63_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.7' type='checkbox'  value='Healthcare worker'  id='choice_88_63_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_63_7' id='label_88_63_7' class='gform-field-label gform-field-label--type-inline'>Healthcare worker<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_94\" 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_88_94'>\n\t\t\t<div class='gchoice gchoice_88_94_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_94' type='radio' value='Mental health condition'  id='choice_88_94_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_94_0' id='label_88_94_0' class='gform-field-label gform-field-label--type-inline'>Mental health condition<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_94_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_94' type='radio' value='Physical health condition'  id='choice_88_94_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_94_1' id='label_88_94_1' class='gform-field-label gform-field-label--type-inline'>Physical health condition<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_94_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_94' type='radio' value='Both mental and physical health conditions'  id='choice_88_94_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_94_2' id='label_88_94_2' class='gform-field-label gform-field-label--type-inline'>Both mental and physical health conditions<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_91\" 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_88_91'>Which of the following best describes your sexual orientation?<\/label><div class='ginput_container ginput_container_select'><select name='input_91' id='input_88_91' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Lesbian or Gay' >Lesbian or Gay<\/option><option value='Bisexual' >Bisexual<\/option><option value='Queer' >Queer<\/option><option value='Pansexual' >Pansexual<\/option><option value='Asexual' >Asexual<\/option><option value='Straight' >Straight<\/option><option value='Other...' >Other...<\/option><\/select><\/div><\/div><div id=\"field_88_69\" 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_88_69'>What is your sexual orientation?<\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_88_69' type='text' value='' class='small'    placeholder='Enter sexual orientation...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_88_92\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full 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 describe your experience of trauma?<\/legend><div class='gfield_description' id='gfield_description_88_92'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_88_92'><div class='gchoice gchoice_88_92_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.1' type='checkbox'  value='Child abuse\/violence'  id='choice_88_92_1'   aria-describedby=\"gfield_description_88_92\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_88_92_1' id='label_88_92_1' class='gform-field-label gform-field-label--type-inline'>Child abuse\/violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_92_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.2' type='checkbox'  value='Intimate partner violence'  id='choice_88_92_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_92_2' id='label_88_92_2' class='gform-field-label gform-field-label--type-inline'>Intimate partner violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_92_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.3' type='checkbox'  value='Sexual assault\/violence'  id='choice_88_92_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_92_3' id='label_88_92_3' class='gform-field-label gform-field-label--type-inline'>Sexual assault\/violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_92_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.4' type='checkbox'  value='Serious illness\/injury\/assault'  id='choice_88_92_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_92_4' id='label_88_92_4' class='gform-field-label gform-field-label--type-inline'>Serious illness\/injury\/assault<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_92_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.5' type='checkbox'  value='Family conflict (identity acceptance\/separation\/divorce)'  id='choice_88_92_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_92_5' id='label_88_92_5' class='gform-field-label gform-field-label--type-inline'>Family conflict (identity acceptance\/separation\/divorce)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_92_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.6' type='checkbox'  value='Traumatic event (natural disaster, accident, witnessing violence, etc.)'  id='choice_88_92_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_92_6' id='label_88_92_6' class='gform-field-label gform-field-label--type-inline'>Traumatic event (natural disaster, accident, witnessing violence, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_92_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.7' type='checkbox'  value='Death of a loved one'  id='choice_88_92_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_92_7' id='label_88_92_7' class='gform-field-label gform-field-label--type-inline'>Death of a loved one<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_92_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_92.8' type='checkbox'  value='Other and\/or tell us more about your trauma'  id='choice_88_92_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_92_8' id='label_88_92_8' class='gform-field-label gform-field-label--type-inline'>Other and\/or tell us more about your trauma<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_93\" 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_88_93'>Please tell us more about your experience of trauma:<\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_88_93' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_88_70\" 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_88_72\" 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_88_72'>\n\t\t\t<div class='gchoice gchoice_88_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Yes'  id='choice_88_72_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_72_0' id='label_88_72_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='No'  id='choice_88_72_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_72_1' id='label_88_72_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio optional short field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you receiving treatment\/support now?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_88_73'>\n\t\t\t<div class='gchoice gchoice_88_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Yes'  id='choice_88_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_73_0' id='label_88_73_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='No'  id='choice_88_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_73_1' id='label_88_73_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_142\" 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_88_142'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_88_142'><div class='gchoice gchoice_88_142_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.1' type='checkbox'  value='I wanted to handle my mental health on my own'  id='choice_88_142_1'   aria-describedby=\"gfield_description_88_142\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_1' id='label_88_142_1' class='gform-field-label gform-field-label--type-inline'>I wanted to handle my mental health on my own<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.2' type='checkbox'  value='I didn\u2019t know how or where to start'  id='choice_88_142_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_2' id='label_88_142_2' class='gform-field-label gform-field-label--type-inline'>I didn\u2019t know how or where to start<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.3' type='checkbox'  value='I thought it would cost too much'  id='choice_88_142_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_3' id='label_88_142_3' class='gform-field-label gform-field-label--type-inline'>I thought it would cost too much<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.4' type='checkbox'  value='I didn\u2019t have time'  id='choice_88_142_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_4' id='label_88_142_4' class='gform-field-label gform-field-label--type-inline'>I didn\u2019t have time<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.5' type='checkbox'  value='I didn\u2019t think it would help me'  id='choice_88_142_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_5' id='label_88_142_5' class='gform-field-label gform-field-label--type-inline'>I didn\u2019t think it would help me<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.6' type='checkbox'  value='I didn&#039;t feel ready to start treatment'  id='choice_88_142_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_6' id='label_88_142_6' class='gform-field-label gform-field-label--type-inline'>I didn't feel ready to start treatment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.7' type='checkbox'  value='I was worried about what people would think or say if I got treatment'  id='choice_88_142_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_7' id='label_88_142_7' class='gform-field-label gform-field-label--type-inline'>I was worried about what people would think or say if I got treatment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.8' type='checkbox'  value='I was afraid of being forced into a hospital or forced to take medication'  id='choice_88_142_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_8' id='label_88_142_8' class='gform-field-label gform-field-label--type-inline'>I was afraid of being forced into a hospital or forced to take medication<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.9' type='checkbox'  value='I tried, but couldn\u2019t find available treatment (no openings, wouldn\u2019t take insurance, etc.)'  id='choice_88_142_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_9' id='label_88_142_9' class='gform-field-label gform-field-label--type-inline'>I tried, but couldn\u2019t find available treatment (no openings, wouldn\u2019t take insurance, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.11' type='checkbox'  value='My parent(s) or guardian wouldn&#039;t let me, or I didn&#039;t want to ask'  id='choice_88_142_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_11' id='label_88_142_11' class='gform-field-label gform-field-label--type-inline'>My parent(s) or guardian wouldn't let me, or I didn't want to ask<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_142_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.12' type='checkbox'  value='Other...'  id='choice_88_142_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_142_12' id='label_88_142_12' class='gform-field-label gform-field-label--type-inline'>Other...<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_143\" 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_88_143'>What else has prevented you from seeking treatment in the past?<\/label><div class='ginput_container ginput_container_text'><input name='input_143' id='input_88_143' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_88_74\" 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_88_74'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_88_74'><div class='gchoice gchoice_88_74_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.1' type='checkbox'  value='Abuse or violence'  id='choice_88_74_1'   aria-describedby=\"gfield_description_88_74\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_1' id='label_88_74_1' class='gform-field-label gform-field-label--type-inline'>Abuse or violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.2' type='checkbox'  value='Relationship problems (friends, family, or significant other)'  id='choice_88_74_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_2' id='label_88_74_2' class='gform-field-label gform-field-label--type-inline'>Relationship problems (friends, family, or significant other)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.3' type='checkbox'  value='Body image'  id='choice_88_74_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_3' id='label_88_74_3' class='gform-field-label gform-field-label--type-inline'>Body image<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.4' type='checkbox'  value='Low self-esteem or self-image'  id='choice_88_74_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_4' id='label_88_74_4' class='gform-field-label gform-field-label--type-inline'>Low self-esteem or self-image<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.5' type='checkbox'  value='School or work problems'  id='choice_88_74_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_5' id='label_88_74_5' class='gform-field-label gform-field-label--type-inline'>School or work problems<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.6' type='checkbox'  value='Financial problems'  id='choice_88_74_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_6' id='label_88_74_6' class='gform-field-label gform-field-label--type-inline'>Financial problems<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.7' type='checkbox'  value='Loneliness or isolation'  id='choice_88_74_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_7' id='label_88_74_7' class='gform-field-label gform-field-label--type-inline'>Loneliness or isolation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.8' type='checkbox'  value='Grief or loss of someone or something'  id='choice_88_74_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_8' id='label_88_74_8' class='gform-field-label gform-field-label--type-inline'>Grief or loss of someone or something<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.9' type='checkbox'  value='Experiencing hate\/bullying (including racism, homophobia, transphobia, or discrimination)'  id='choice_88_74_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_9' id='label_88_74_9' class='gform-field-label gform-field-label--type-inline'>Experiencing hate\/bullying (including racism, homophobia, transphobia, or discrimination)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.11' type='checkbox'  value='State of the world (war, climate, politics, immigration)'  id='choice_88_74_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_11' id='label_88_74_11' class='gform-field-label gform-field-label--type-inline'>State of the world (war, climate, politics, immigration)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.12' type='checkbox'  value='I don\u2019t know (something just feels wrong)'  id='choice_88_74_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_12' id='label_88_74_12' class='gform-field-label gform-field-label--type-inline'>I don\u2019t know (something just feels wrong)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_74_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_74.13' type='checkbox'  value='Other...'  id='choice_88_74_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_74_13' id='label_88_74_13' class='gform-field-label gform-field-label--type-inline'>Other...<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_75\" 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_88_75'>What else is contributing to your mental health problems right now?<\/label><div class='ginput_container ginput_container_text'><input name='input_75' id='input_88_75' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_88_95\" 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_88_95'>What about the state of the world is affecting you the most?<\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_88_95' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_88_76\" 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_88_77\" 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_88_77'>\n\t\t\t<div class='gchoice gchoice_88_77_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='Yes'  id='choice_88_77_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_77_0' id='label_88_77_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_77_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='No'  id='choice_88_77_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_77_1' id='label_88_77_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_77_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='I don&#039;t know'  id='choice_88_77_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_77_2' id='label_88_77_2' class='gform-field-label gform-field-label--type-inline'>I don't know<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_78\" 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_88_78'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_88_78'><div class='gchoice gchoice_88_78_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.1' type='checkbox'  value='Heart disease'  id='choice_88_78_1'   aria-describedby=\"gfield_description_88_78\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_1' id='label_88_78_1' class='gform-field-label gform-field-label--type-inline'>Heart disease<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_78_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.2' type='checkbox'  value='Reproductive health concerns (PCOS, endometriosis, infertility, etc.)'  id='choice_88_78_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_2' id='label_88_78_2' class='gform-field-label gform-field-label--type-inline'>Reproductive health concerns (PCOS, endometriosis, infertility, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_78_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.3' type='checkbox'  value='Diabetes'  id='choice_88_78_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_3' id='label_88_78_3' class='gform-field-label gform-field-label--type-inline'>Diabetes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_78_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.4' type='checkbox'  value='Cancer'  id='choice_88_78_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_4' id='label_88_78_4' class='gform-field-label gform-field-label--type-inline'>Cancer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_78_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.5' type='checkbox'  value='Arthritis or other chronic pain'  id='choice_88_78_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_5' id='label_88_78_5' class='gform-field-label gform-field-label--type-inline'>Arthritis or other chronic pain<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_78_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.6' type='checkbox'  value='Asthma, COPD or other lung conditions'  id='choice_88_78_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_6' id='label_88_78_6' class='gform-field-label gform-field-label--type-inline'>Asthma, COPD or other lung conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_78_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.7' type='checkbox'  value='Movement Disorders (involuntary tics, tardive dyskinesia, etc.)'  id='choice_88_78_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_7' id='label_88_78_7' class='gform-field-label gform-field-label--type-inline'>Movement Disorders (involuntary tics, tardive dyskinesia, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_78_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.8' type='checkbox'  value='Digestive problems (Crohn\u2019s, colitis, IBS, etc.)'  id='choice_88_78_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_8' id='label_88_78_8' class='gform-field-label gform-field-label--type-inline'>Digestive problems (Crohn\u2019s, colitis, IBS, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_78_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.9' type='checkbox'  value='Neurological conditions (epilepsy, etc.) or traumatic brain injury (TBI)'  id='choice_88_78_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_9' id='label_88_78_9' class='gform-field-label gform-field-label--type-inline'>Neurological conditions (epilepsy, etc.) or traumatic brain injury (TBI)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_88_78_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.11' type='checkbox'  value='Other...'  id='choice_88_78_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_88_78_11' id='label_88_78_11' class='gform-field-label gform-field-label--type-inline'>Other...<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_88_79\" 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_88_79'>What other physical health conditions do you have?<\/label><div class='ginput_container ginput_container_text'><input name='input_79' id='input_88_79' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_88_106\" 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_88_106'>\n\t\t\t<div class='gchoice gchoice_88_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Yes'  id='choice_88_106_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_106_0' id='label_88_106_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='No'  id='choice_88_106_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_106_1' id='label_88_106_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_88_107\" 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_88_107'>\n\t\t\t<div class='gchoice gchoice_88_107_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='Yes'  id='choice_88_107_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_107_0' id='label_88_107_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_88_107_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='No'  id='choice_88_107_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_88_107_1' id='label_88_107_1' class='gform-field-label gform-field-label--type-inline'>No<\/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_88' 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_88' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='View Results'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_88' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_88' id='gform_theme_88' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_88' id='gform_style_settings_88' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_88' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='88' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='k1fVIdDCCoAocL\/kRHSPeOCfoC1lwtW9J++STlLv6s1svgvfLNsvPUaWFU1WYNXtMS2OrUW5YAcnWInE23z8bgZQ1HgtZL\/jQFCfkOt0bOPhBEY=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_88' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_88' id='gform_target_page_number_88' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_88' id='gform_source_page_number_88' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div><script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 88, 'https:\/\/screening.mhanational.org\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_88').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_88');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_88').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_88').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_88').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_88').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_88').val();gformInitSpinner( 88, 'https:\/\/screening.mhanational.org\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [88, current_page]);window['gf_submitting_88'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_88').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [88]);window['gf_submitting_88'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_88').text());}else{jQuery('#gform_88').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"88\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_88\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_88\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_88\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 88, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n\n<p>&nbsp;<\/p>\n<hr \/>\n<h2 class=\"smaller\">Source:<\/h2>\n<div class=\"references\">\n<p>Severity Measure for Social Anxiety Disorder (Social Phobia) &#8211; SAD-D<\/p>\n<p>Lebeau, R. T., et al. (2012). A dimensional approach to measuring anxiety for DSM-5. <i>International journal of methods in psychiatric research<\/i>\u00a0<i>21<\/i>(4), 258\u2013272. Retrieved from <a href=\"https:\/\/doi.org\/10.1002\/mpr.1369\">https:\/\/doi.org\/10.1002\/mpr.1369<\/a><\/p>\n<p><a href=\"https:\/\/screening.mhanational.org\/about-our-mental-health-tests\/\" target=\"_blank\" rel=\"noopener\">For more information about our screening tools, please click here.<\/a><\/p>\n<p><em><strong>Please note:<\/strong> Online screening tools are not diagnostic instruments. You are encouraged to share your results with a physician or healthcare provider. Mental Health America Inc., sponsors, partners, and advertisers disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, from the use and application of these screens.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Para personas que experimentan una preocupaci\u00f3n o un miedo extremos en situaciones sociales.<\/p>","protected":false},"template":"","tags":[],"age_group":[],"condition":[83,35],"class_list":["post-251896","screen","type-screen","status-publish","hentry","condition-anxiety","condition-loneliness"],"acf":[],"yoast_head":"<title>Social Anxiety Test &#8211; Free mental health tests from Mental Health America<\/title>\n<meta name=\"description\" content=\"Do social situations overwhelm you with worry and fear? Our online test is free, quick, confidential, and scientifically validated.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/screening.mhanational.org\/es\/screening-tools\/social-anxiety\/\" \/>\n<meta property=\"og:locale\" content=\"es_MX\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Social Anxiety Test &#8211; Mental Health America\" \/>\n<meta property=\"og:description\" content=\"Do social situations overwhelm you with worry and fear? Our online test is free, quick, confidential, and scientifically validated.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/screening.mhanational.org\/es\/screening-tools\/social-anxiety\/\" \/>\n<meta property=\"og:site_name\" content=\"Mental Health America\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/mentalhealthamerica\" \/>\n<meta property=\"article:modified_time\" content=\"2026-03-23T17:00:36+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/screening.mhanational.org\/wp-content\/uploads\/2022\/04\/Social-media-share-preview.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"631\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:title\" content=\"Social Anxiety Test &#8211; Mental Health America\" \/>\n<meta name=\"twitter:description\" content=\"Do social situations overwhelm you with worry and fear? Our online test is free, quick, confidential, and scientifically validated. %\" \/>\n<meta name=\"twitter:site\" content=\"@mentalhealtham\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/screening.mhanational.org\\\/screening-tools\\\/social-anxiety\\\/\",\"url\":\"https:\\\/\\\/screening.mhanational.org\\\/screening-tools\\\/social-anxiety\\\/\",\"name\":\"Social Anxiety Test &#8211; Free mental health tests from Mental Health America\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/screening.mhanational.org\\\/#website\"},\"datePublished\":\"2025-12-04T17:39:12+00:00\",\"dateModified\":\"2026-03-23T17:00:36+00:00\",\"description\":\"Do social situations overwhelm you with worry and fear? Our online test is free, quick, confidential, and scientifically validated.\",\"inLanguage\":\"es\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/screening.mhanational.org\\\/screening-tools\\\/social-anxiety\\\/\"]}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/screening.mhanational.org\\\/#website\",\"url\":\"https:\\\/\\\/screening.mhanational.org\\\/\",\"name\":\"MHA Screening\",\"description\":\"Start your mental health journey here.\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/screening.mhanational.org\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"es\"}]}<\/script>","yoast_head_json":{"title":"Prueba de ansiedad social: pruebas de salud mental gratuitas de Mental Health America.","description":"\u00bfLas situaciones sociales te abruman con preocupaci\u00f3n y miedo? Nuestra prueba en l\u00ednea es gratuita, r\u00e1pida, confidencial y est\u00e1 validada cient\u00edficamente.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/screening.mhanational.org\/es\/screening-tools\/social-anxiety\/","og_locale":"es_MX","og_type":"article","og_title":"Social Anxiety Test &#8211; Mental Health America","og_description":"Do social situations overwhelm you with worry and fear? Our online test is free, quick, confidential, and scientifically validated.","og_url":"https:\/\/screening.mhanational.org\/es\/screening-tools\/social-anxiety\/","og_site_name":"Mental Health America","article_publisher":"https:\/\/www.facebook.com\/mentalhealthamerica","article_modified_time":"2026-03-23T17:00:36+00:00","og_image":[{"width":1200,"height":631,"url":"https:\/\/screening.mhanational.org\/wp-content\/uploads\/2022\/04\/Social-media-share-preview.png","type":"image\/png"}],"twitter_card":"summary_large_image","twitter_title":"Social Anxiety Test &#8211; Mental Health America","twitter_description":"Do social situations overwhelm you with worry and fear? Our online test is free, quick, confidential, and scientifically validated. %","twitter_site":"@mentalhealtham","twitter_misc":{"Est. reading time":"3 minutos"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/screening.mhanational.org\/screening-tools\/social-anxiety\/","url":"https:\/\/screening.mhanational.org\/screening-tools\/social-anxiety\/","name":"Prueba de ansiedad social: pruebas de salud mental gratuitas de Mental Health America.","isPartOf":{"@id":"https:\/\/screening.mhanational.org\/#website"},"datePublished":"2025-12-04T17:39:12+00:00","dateModified":"2026-03-23T17:00:36+00:00","description":"\u00bfLas situaciones sociales te abruman con preocupaci\u00f3n y miedo? Nuestra prueba en l\u00ednea es gratuita, r\u00e1pida, confidencial y est\u00e1 validada cient\u00edficamente.","inLanguage":"es","potentialAction":[{"@type":"ReadAction","target":["https:\/\/screening.mhanational.org\/screening-tools\/social-anxiety\/"]}]},{"@type":"WebSite","@id":"https:\/\/screening.mhanational.org\/#website","url":"https:\/\/screening.mhanational.org\/","name":"Evaluaci\u00f3n de MHA","description":"Comienza aqu\u00ed tu camino hacia la salud mental.","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/screening.mhanational.org\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"es"}]}},"_links":{"self":[{"href":"https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/screen\/251896","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/screen"}],"about":[{"href":"https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/types\/screen"}],"wp:attachment":[{"href":"https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/media?parent=251896"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/tags?post=251896"},{"taxonomy":"age_group","embeddable":true,"href":"https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/age_group?post=251896"},{"taxonomy":"condition","embeddable":true,"href":"https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/condition?post=251896"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}