{"id":3166,"date":"2021-01-02T15:37:37","date_gmt":"2021-01-02T15:37:37","guid":{"rendered":"https:\/\/screening.mhanational.org\/?post_type=screen&#038;p=3166"},"modified":"2026-07-02T14:12:12","modified_gmt":"2026-07-02T18:12:12","slug":"psychosis","status":"publish","type":"screen","link":"https:\/\/screening.mhanational.org\/es\/screening-tools\/psychosis\/","title":{"rendered":"Test de psicosis y esquizofrenia"},"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 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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_9' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Psychosis 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_9'  class='clearfix' action='\/es\/wp-json\/wp\/v2\/screen\/3166' data-formid='9' 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_9_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_9' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_9_157\" 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_9_157'>Comments<\/label><div class='gfield_description' id='gfield_description_9_157'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_157' id='input_9_157' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_9_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_9_38' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_9_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_9_39\" type=\"hidden\" class=\"gform_hidden\" aria-invalid=\"false\" value=\"3166\"><\/div><div id=\"field_9_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_9_40\" type=\"hidden\" class=\"gform_hidden\" aria-invalid=\"false\" value=\"ede172135ec766ed8990c671404079fd\"><\/div><div id=\"field_9_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_9_41' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_9_89\" 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_89' id='input_9_89' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_9_119\" 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_119' id='input_9_119' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_9_120\" 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_120' id='input_9_120' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_9_121\" 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_121' id='input_9_121' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_9_133\" 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_133' id='input_9_133' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='' \/><\/div><\/div><div id=\"field_9_134\" 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_134' id='input_9_134' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='https:\/\/screening.mhanational.org\/es\/wp-json\/wp\/v2\/screen\/3166' \/><\/div><\/div><div id=\"field_9_156\" 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_156' id='input_9_156' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='lang--es' \/><\/div><\/div><div id=\"field_9_4\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><p>Have you recently had the following thoughts, feelings, or experiences? Check \u201cyes\u201d or \u201cno\u201d for each item.<\/p>\n\n<p>Do not include experiences that occur only while under the influence of alcohol, drugs or medications that were not prescribed to you.<\/p>\n\n<p>If you answer \u201cYES\u201d to an item, also indicate how distressing that experience has been for you.<\/p>\n\n<p>Please note, all fields are required.<\/p><\/div><div id=\"field_9_145\" 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\"  ><h2 class=\"section-title\">In the last 3 months...<\/h2><\/div><fieldset id=\"field_9_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>, did you ever hear the voice of someone talking that other people cannot hear?<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_9_135'>\n\t\t\t<div class='gchoice gchoice_9_135_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_135' type='radio' value='Yes'  id='choice_9_135_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_135_0' id='label_9_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_9_135_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_135' type='radio' value='No'  id='choice_9_135_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_135_1' id='label_9_135_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_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>, had you ever felt that someone was playing with your mind?<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_9_136'>\n\t\t\t<div class='gchoice gchoice_9_136_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_136' type='radio' value='Yes'  id='choice_9_136_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_136_0' id='label_9_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_9_136_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_136' type='radio' value='No'  id='choice_9_136_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_136_1' id='label_9_136_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_137\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months<\/strong>, have familiar surroundings sometimes seemed unreal to you?<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_9_137'>\n\t\t\t<div class='gchoice gchoice_9_137_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='Yes'  id='choice_9_137_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_137_0' id='label_9_137_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_137_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='No'  id='choice_9_137_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_137_1' id='label_9_137_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_138\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><strong>In the last three months<\/strong>, have you seen things that other people can't see or don't seem to see?<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_9_138'>\n\t\t\t<div class='gchoice gchoice_9_138_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_138' type='radio' value='Yes'  id='choice_9_138_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_138_0' id='label_9_138_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_138_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_138' type='radio' value='No'  id='choice_9_138_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_138_1' id='label_9_138_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_143\" 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\"  ><h2 class=\"section-title\">In the past month...<\/h2><\/div><fieldset id=\"field_9_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. Do familiar surroundings sometimes seem strange, confusing, threatening or unreal to you?<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_9_47'>\n\t\t\t<div class='gchoice gchoice_9_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='No'  id='choice_9_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_47_0' id='label_9_47_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='Yes'  id='choice_9_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_47_1' id='label_9_47_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_48\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q1):<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_9_48'>\n\t\t\t<div class='gchoice gchoice_9_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='1'  id='choice_9_48_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_48_0' id='label_9_48_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='2'  id='choice_9_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_48_1' id='label_9_48_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_48_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='3'  id='choice_9_48_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_48_2' id='label_9_48_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_48_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='4'  id='choice_9_48_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_48_3' id='label_9_48_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_48_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='5'  id='choice_9_48_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_48_4' id='label_9_48_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_49\" 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. Have you heard unusual sounds like banging, clicking, hissing, clapping or ringing in your ears?<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_9_49'>\n\t\t\t<div class='gchoice gchoice_9_49_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='No'  id='choice_9_49_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_49_0' id='label_9_49_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_49_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='Yes'  id='choice_9_49_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_49_1' id='label_9_49_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_50\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q2):<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_9_50'>\n\t\t\t<div class='gchoice gchoice_9_50_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='1'  id='choice_9_50_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_50_0' id='label_9_50_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_50_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='2'  id='choice_9_50_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_50_1' id='label_9_50_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_50_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='3'  id='choice_9_50_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_50_2' id='label_9_50_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_50_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='4'  id='choice_9_50_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_50_3' id='label_9_50_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_50_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='5'  id='choice_9_50_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_50_4' id='label_9_50_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_51\" 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. Do things that you see appear different from the way they usually do?<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_9_51'>\n\t\t\t<div class='gchoice gchoice_9_51_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_51' type='radio' value='No'  id='choice_9_51_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_51_0' id='label_9_51_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_51_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_51' type='radio' value='Yes'  id='choice_9_51_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_51_1' id='label_9_51_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_52\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q3):<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_9_52'>\n\t\t\t<div class='gchoice gchoice_9_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='1'  id='choice_9_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_52_0' id='label_9_52_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='2'  id='choice_9_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_52_1' id='label_9_52_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_52_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='3'  id='choice_9_52_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_52_2' id='label_9_52_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_52_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='4'  id='choice_9_52_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_52_3' id='label_9_52_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_52_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='5'  id='choice_9_52_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_52_4' id='label_9_52_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_55\" 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. Have you had experiences with telepathy, psychic forces, or fortune telling?<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_9_55'>\n\t\t\t<div class='gchoice gchoice_9_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='No'  id='choice_9_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_55_0' id='label_9_55_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Yes'  id='choice_9_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_55_1' id='label_9_55_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_54\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q4):<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_9_54'>\n\t\t\t<div class='gchoice gchoice_9_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='1'  id='choice_9_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_54_0' id='label_9_54_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='2'  id='choice_9_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_54_1' id='label_9_54_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_54_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='3'  id='choice_9_54_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_54_2' id='label_9_54_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_54_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='4'  id='choice_9_54_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_54_3' id='label_9_54_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_54_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='5'  id='choice_9_54_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_54_4' id='label_9_54_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_53\" 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. Have you felt that you are not in control of your own ideas or thoughts?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_53'>\n\t\t\t<div class='gchoice gchoice_9_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='No'  id='choice_9_53_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_53_0' id='label_9_53_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Yes'  id='choice_9_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_53_1' id='label_9_53_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_56\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q5):<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_9_56'>\n\t\t\t<div class='gchoice gchoice_9_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='1'  id='choice_9_56_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_56_0' id='label_9_56_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='2'  id='choice_9_56_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_56_1' id='label_9_56_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_56_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='3'  id='choice_9_56_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_56_2' id='label_9_56_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_56_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='4'  id='choice_9_56_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_56_3' id='label_9_56_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_56_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='5'  id='choice_9_56_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_56_4' id='label_9_56_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_57\" 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. Do you have difficulty getting your point across, because you ramble or go off the track a lot when you talk?<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_9_57'>\n\t\t\t<div class='gchoice gchoice_9_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='No'  id='choice_9_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_57_0' id='label_9_57_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Yes'  id='choice_9_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_57_1' id='label_9_57_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_58\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q6):<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_9_58'>\n\t\t\t<div class='gchoice gchoice_9_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='1'  id='choice_9_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_58_0' id='label_9_58_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='2'  id='choice_9_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_58_1' id='label_9_58_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_58_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='3'  id='choice_9_58_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_58_2' id='label_9_58_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_58_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='4'  id='choice_9_58_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_58_3' id='label_9_58_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_58_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='5'  id='choice_9_58_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_58_4' id='label_9_58_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_59\" 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. Do you have strong feelings or beliefs about being unusually gifted or talented in some way?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_59'>\n\t\t\t<div class='gchoice gchoice_9_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='No'  id='choice_9_59_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_59_0' id='label_9_59_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Yes'  id='choice_9_59_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_59_1' id='label_9_59_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_60\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q7):<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_9_60'>\n\t\t\t<div class='gchoice gchoice_9_60_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='1'  id='choice_9_60_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_60_0' id='label_9_60_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_60_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='2'  id='choice_9_60_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_60_1' id='label_9_60_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_60_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='3'  id='choice_9_60_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_60_2' id='label_9_60_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_60_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='4'  id='choice_9_60_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_60_3' id='label_9_60_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_60_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='5'  id='choice_9_60_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_60_4' id='label_9_60_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_61\" 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. Do you feel that other people are watching you or talking about you?<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_9_61'>\n\t\t\t<div class='gchoice gchoice_9_61_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='No'  id='choice_9_61_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_61_0' id='label_9_61_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_61_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Yes'  id='choice_9_61_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_61_1' id='label_9_61_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_62\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q8):<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_9_62'>\n\t\t\t<div class='gchoice gchoice_9_62_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='1'  id='choice_9_62_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_62_0' id='label_9_62_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_62_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='2'  id='choice_9_62_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_62_1' id='label_9_62_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_62_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='3'  id='choice_9_62_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_62_2' id='label_9_62_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_62_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='4'  id='choice_9_62_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_62_3' id='label_9_62_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_62_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='5'  id='choice_9_62_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_62_4' id='label_9_62_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_63\" 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. Do you sometimes get strange feelings on or just beneath your skin, like bugs crawling?<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_9_63'>\n\t\t\t<div class='gchoice gchoice_9_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='No'  id='choice_9_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_63_0' id='label_9_63_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Yes'  id='choice_9_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_63_1' id='label_9_63_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_64\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q9):<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_9_64'>\n\t\t\t<div class='gchoice gchoice_9_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='1'  id='choice_9_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_64_0' id='label_9_64_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='2'  id='choice_9_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_64_1' id='label_9_64_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_64_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='3'  id='choice_9_64_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_64_2' id='label_9_64_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_64_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='4'  id='choice_9_64_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_64_3' id='label_9_64_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_64_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='5'  id='choice_9_64_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_64_4' id='label_9_64_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_65\" 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. Do you sometimes feel suddenly distracted by distant sounds that you are not normally aware of?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_65'>\n\t\t\t<div class='gchoice gchoice_9_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='No'  id='choice_9_65_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_65_0' id='label_9_65_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Yes'  id='choice_9_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_65_1' id='label_9_65_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_66\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q10):<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_9_66'>\n\t\t\t<div class='gchoice gchoice_9_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='1'  id='choice_9_66_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_66_0' id='label_9_66_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='2'  id='choice_9_66_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_66_1' id='label_9_66_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_66_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='3'  id='choice_9_66_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_66_2' id='label_9_66_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_66_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='4'  id='choice_9_66_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_66_3' id='label_9_66_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_66_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='5'  id='choice_9_66_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_66_4' id='label_9_66_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_67\" 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' >11. Have you had the sense that some person or force is around you, although you couldn\u2019t see anyone?<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_9_67'>\n\t\t\t<div class='gchoice gchoice_9_67_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='No'  id='choice_9_67_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_67_0' id='label_9_67_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_67_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Yes'  id='choice_9_67_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_67_1' id='label_9_67_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_68\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q11):<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_9_68'>\n\t\t\t<div class='gchoice gchoice_9_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='1'  id='choice_9_68_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_68_0' id='label_9_68_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='2'  id='choice_9_68_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_68_1' id='label_9_68_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_68_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='3'  id='choice_9_68_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_68_2' id='label_9_68_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_68_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='4'  id='choice_9_68_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_68_3' id='label_9_68_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_68_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='5'  id='choice_9_68_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_68_4' id='label_9_68_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_69\" 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' >12. Do you worry at times that something may be wrong with your mind?<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_9_69'>\n\t\t\t<div class='gchoice gchoice_9_69_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='No'  id='choice_9_69_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_69_0' id='label_9_69_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_69_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Yes'  id='choice_9_69_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_69_1' id='label_9_69_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_70\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q12):<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_9_70'>\n\t\t\t<div class='gchoice gchoice_9_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='1'  id='choice_9_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_70_0' id='label_9_70_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='2'  id='choice_9_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_70_1' id='label_9_70_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_70_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='3'  id='choice_9_70_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_70_2' id='label_9_70_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_70_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='4'  id='choice_9_70_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_70_3' id='label_9_70_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_70_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='5'  id='choice_9_70_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_70_4' id='label_9_70_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_71\" 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' >13. Have you ever felt that you don&#039;t exist, the world does not exist, or that you are dead?<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_9_71'>\n\t\t\t<div class='gchoice gchoice_9_71_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='No'  id='choice_9_71_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_71_0' id='label_9_71_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_71_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='Yes'  id='choice_9_71_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_71_1' id='label_9_71_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_72\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q13):<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_9_72'>\n\t\t\t<div class='gchoice gchoice_9_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='1'  id='choice_9_72_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_72_0' id='label_9_72_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='2'  id='choice_9_72_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_72_1' id='label_9_72_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_72_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='3'  id='choice_9_72_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_72_2' id='label_9_72_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_72_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='4'  id='choice_9_72_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_72_3' id='label_9_72_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_72_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='5'  id='choice_9_72_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_72_4' id='label_9_72_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_73\" 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' >14. Have you been confused at times whether something you experienced was real or imaginary?<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_9_73'>\n\t\t\t<div class='gchoice gchoice_9_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='No'  id='choice_9_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_73_0' id='label_9_73_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Yes'  id='choice_9_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_73_1' id='label_9_73_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_74\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q14):<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_9_74'>\n\t\t\t<div class='gchoice gchoice_9_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='1'  id='choice_9_74_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_74_0' id='label_9_74_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='2'  id='choice_9_74_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_74_1' id='label_9_74_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_74_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='3'  id='choice_9_74_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_74_2' id='label_9_74_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_74_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='4'  id='choice_9_74_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_74_3' id='label_9_74_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_74_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='5'  id='choice_9_74_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_74_4' id='label_9_74_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_75\" 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' >15. Do you hold beliefs that other people would find unusual or bizarre?<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_9_75'>\n\t\t\t<div class='gchoice gchoice_9_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='No'  id='choice_9_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_75_0' id='label_9_75_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Yes'  id='choice_9_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_75_1' id='label_9_75_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_76\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q15):<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_9_76'>\n\t\t\t<div class='gchoice gchoice_9_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='1'  id='choice_9_76_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_76_0' id='label_9_76_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='2'  id='choice_9_76_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_76_1' id='label_9_76_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_76_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='3'  id='choice_9_76_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_76_2' id='label_9_76_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_76_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='4'  id='choice_9_76_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_76_3' id='label_9_76_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_76_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='5'  id='choice_9_76_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_76_4' id='label_9_76_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_77\" 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' >16. Do you feel that parts of your body have changed in some way, or that parts of your body are working differently?<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_9_77'>\n\t\t\t<div class='gchoice gchoice_9_77_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='No'  id='choice_9_77_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_77_0' id='label_9_77_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_77_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='Yes'  id='choice_9_77_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_77_1' id='label_9_77_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_78\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q16):<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_9_78'>\n\t\t\t<div class='gchoice gchoice_9_78_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='1'  id='choice_9_78_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_78_0' id='label_9_78_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_78_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='2'  id='choice_9_78_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_78_1' id='label_9_78_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_78_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='3'  id='choice_9_78_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_78_2' id='label_9_78_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_78_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='4'  id='choice_9_78_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_78_3' id='label_9_78_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_78_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='5'  id='choice_9_78_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_78_4' id='label_9_78_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_79\" 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' >17. Are your thoughts sometimes so strong that you can almost hear them?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_79'>\n\t\t\t<div class='gchoice gchoice_9_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='No'  id='choice_9_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_79_0' id='label_9_79_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Yes'  id='choice_9_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_79_1' id='label_9_79_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_80\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q17):<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_9_80'>\n\t\t\t<div class='gchoice gchoice_9_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='1'  id='choice_9_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_80_0' id='label_9_80_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='2'  id='choice_9_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_80_1' id='label_9_80_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_80_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='3'  id='choice_9_80_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_80_2' id='label_9_80_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_80_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='4'  id='choice_9_80_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_80_3' id='label_9_80_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_80_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='5'  id='choice_9_80_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_80_4' id='label_9_80_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_81\" 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' >18. Do you find yourself feeling mistrustful or suspicious of other people?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_81'>\n\t\t\t<div class='gchoice gchoice_9_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='No'  id='choice_9_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_81_0' id='label_9_81_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Yes'  id='choice_9_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_81_1' id='label_9_81_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_82\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q18):<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_9_82'>\n\t\t\t<div class='gchoice gchoice_9_82_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='1'  id='choice_9_82_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_82_0' id='label_9_82_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_82_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='2'  id='choice_9_82_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_82_1' id='label_9_82_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_82_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='3'  id='choice_9_82_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_82_2' id='label_9_82_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_82_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='4'  id='choice_9_82_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_82_3' id='label_9_82_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_82_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='5'  id='choice_9_82_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_82_4' id='label_9_82_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_83\" 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' >19. Have you seen unusual things like flashes, flames, blinding light, or geometric figures?<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_9_83'>\n\t\t\t<div class='gchoice gchoice_9_83_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='No'  id='choice_9_83_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_83_0' id='label_9_83_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_83_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='Yes'  id='choice_9_83_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_83_1' id='label_9_83_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_84\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q19):<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_9_84'>\n\t\t\t<div class='gchoice gchoice_9_84_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='1'  id='choice_9_84_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_84_0' id='label_9_84_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_84_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='2'  id='choice_9_84_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_84_1' id='label_9_84_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_84_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='3'  id='choice_9_84_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_84_2' id='label_9_84_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_84_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='4'  id='choice_9_84_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_84_3' id='label_9_84_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_84_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='5'  id='choice_9_84_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_84_4' id='label_9_84_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_85\" 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' >20. Have you seen things that other people can&#039;t see or don&#039;t seem to see?<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_9_85'>\n\t\t\t<div class='gchoice gchoice_9_85_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='No'  id='choice_9_85_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_85_0' id='label_9_85_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_85_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='Yes'  id='choice_9_85_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_85_1' id='label_9_85_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_86\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q20):<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_9_86'>\n\t\t\t<div class='gchoice gchoice_9_86_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='1'  id='choice_9_86_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_86_0' id='label_9_86_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_86_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='2'  id='choice_9_86_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_86_1' id='label_9_86_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_86_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='3'  id='choice_9_86_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_86_2' id='label_9_86_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_86_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='4'  id='choice_9_86_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_86_3' id='label_9_86_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_86_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='5'  id='choice_9_86_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_86_4' id='label_9_86_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_87\" 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' >21. Do people sometimes find it hard to understand what you are saying?<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_9_87'>\n\t\t\t<div class='gchoice gchoice_9_87_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='No'  id='choice_9_87_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_87_0' id='label_9_87_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_87_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='Yes'  id='choice_9_87_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_87_1' id='label_9_87_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_88\" 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' >If YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q21):<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_9_88'>\n\t\t\t<div class='gchoice gchoice_9_88_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='1'  id='choice_9_88_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_88_0' id='label_9_88_0' class='gform-field-label gform-field-label--type-inline'>Strongly disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_88_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='2'  id='choice_9_88_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_88_1' id='label_9_88_1' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_88_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='3'  id='choice_9_88_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_88_2' id='label_9_88_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_88_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='4'  id='choice_9_88_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_88_3' id='label_9_88_3' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_88_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='5'  id='choice_9_88_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_88_4' id='label_9_88_4' class='gform-field-label gform-field-label--type-inline'>Strongly agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_144\" 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\"  ><h2 class=\"section-title\">In the last 3 months...<\/h2><\/div><fieldset id=\"field_9_139\" 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>, did you ever hear the voice of someone talking that other people cannot hear?<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_9_139'>\n\t\t\t<div class='gchoice gchoice_9_139_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_139' type='radio' value='Yes'  id='choice_9_139_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_139_0' id='label_9_139_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_9_139_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_139' type='radio' value='No'  id='choice_9_139_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_139_1' id='label_9_139_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_140\" 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>, had you ever felt that someone was playing with your mind?<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_9_140'>\n\t\t\t<div class='gchoice gchoice_9_140_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_140' type='radio' value='Yes'  id='choice_9_140_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_140_0' id='label_9_140_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_9_140_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_140' type='radio' value='No'  id='choice_9_140_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_140_1' id='label_9_140_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_141\" 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 familiar surroundings sometimes seemed unreal to you?<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_9_141'>\n\t\t\t<div class='gchoice gchoice_9_141_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_141' type='radio' value='Yes'  id='choice_9_141_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_141_0' id='label_9_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_9_141_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_141' type='radio' value='No'  id='choice_9_141_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_141_1' id='label_9_141_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_142\" 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 seen things that other people can't see or don't seem to see?<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_9_142'>\n\t\t\t<div class='gchoice gchoice_9_142_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_142' type='radio' value='Yes'  id='choice_9_142_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_142_0' id='label_9_142_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_9_142_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_142' type='radio' value='No'  id='choice_9_142_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_142_1' id='label_9_142_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_9_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_9_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_9_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_9_90\" 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_9_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><fieldset id=\"field_9_146\" 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 believe you need to do something to improve your emotional or mental health?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_146'>\n\t\t\t<div class='gchoice gchoice_9_146_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='Yes'  id='choice_9_146_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_146_0' id='label_9_146_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_9_146_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='No'  id='choice_9_146_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_146_1' id='label_9_146_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_9_146_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='I&#039;m not sure'  id='choice_9_146_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_146_2' id='label_9_146_2' class='gform-field-label gform-field-label--type-inline'>I'm not sure<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_147\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full 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 next steps would you be most interested in taking in the next month to feel better?<\/legend><div class='gfield_description' id='gfield_description_9_147'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_147'><div class='gchoice gchoice_9_147_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_147.1' type='checkbox'  value='Learn more about my mental health (material to read or watch)'  id='choice_9_147_1'   aria-describedby=\"gfield_description_9_147\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_9_147_1' id='label_9_147_1' class='gform-field-label gform-field-label--type-inline'>Learn more about my mental health (material to read or watch)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_147_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_147.2' type='checkbox'  value='Share how I&#039;m feeling with someone in my life (friend or relative)'  id='choice_9_147_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_147_2' id='label_9_147_2' class='gform-field-label gform-field-label--type-inline'>Share how I'm feeling with someone in my life (friend or relative)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_147_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_147.3' type='checkbox'  value='Talk to someone who&#039;s been through a similar experience (peer supporter or mentor)'  id='choice_9_147_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_147_3' id='label_9_147_3' class='gform-field-label gform-field-label--type-inline'>Talk to someone who's been through a similar experience (peer supporter or mentor)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_147_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_147.4' type='checkbox'  value='Learn about therapy or treatment options'  id='choice_9_147_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_147_4' id='label_9_147_4' class='gform-field-label gform-field-label--type-inline'>Learn about therapy or treatment options<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_147_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_147.5' type='checkbox'  value='Obtain a diagnosis\/understand what I\u2019ve been experiencing'  id='choice_9_147_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_147_5' id='label_9_147_5' class='gform-field-label gform-field-label--type-inline'>Obtain a diagnosis\/understand what I\u2019ve been experiencing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_147_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_147.6' type='checkbox'  value='Learn and practice skills to manage mental health on my own'  id='choice_9_147_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_147_6' id='label_9_147_6' class='gform-field-label gform-field-label--type-inline'>Learn and practice skills to manage mental health on my own<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_147_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_147.7' type='checkbox'  value='None'  id='choice_9_147_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_147_7' id='label_9_147_7' class='gform-field-label gform-field-label--type-inline'>None<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_147_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_147.8' type='checkbox'  value='Other...'  id='choice_9_147_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_147_8' id='label_9_147_8' 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_9_148\" 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_9_148'><strong>What other next steps<\/strong> would you be most interested in taking in the next month to feel better?<\/label><div class='ginput_container ginput_container_text'><input name='input_148' id='input_9_148' type='text' value='' class='large'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_9_154\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full 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 might keep you from taking these next steps if you wanted to?<\/legend><div class='gfield_description' id='gfield_description_9_154'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_154'><div class='gchoice gchoice_9_154_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.1' type='checkbox'  value='I am concerned about what others might think about me'  id='choice_9_154_1'   aria-describedby=\"gfield_description_9_154\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_1' id='label_9_154_1' class='gform-field-label gform-field-label--type-inline'>I am concerned about what others might think about me<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.2' type='checkbox'  value='I&#039;m worried about what my experiences mean for me and my future'  id='choice_9_154_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_2' id='label_9_154_2' class='gform-field-label gform-field-label--type-inline'>I'm worried about what my experiences mean for me and my future<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.3' type='checkbox'  value='I feel I can help myself well enough without treatment'  id='choice_9_154_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_3' id='label_9_154_3' class='gform-field-label gform-field-label--type-inline'>I feel I can help myself well enough without treatment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.4' type='checkbox'  value='I can&#039;t afford it'  id='choice_9_154_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_4' id='label_9_154_4' class='gform-field-label gform-field-label--type-inline'>I can't afford it<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.5' type='checkbox'  value='I am concerned about my privacy\/confidentiality'  id='choice_9_154_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_5' id='label_9_154_5' class='gform-field-label gform-field-label--type-inline'>I am concerned about my privacy\/confidentiality<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.6' type='checkbox'  value='I don&#039;t know if I can trust a professional'  id='choice_9_154_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_6' id='label_9_154_6' class='gform-field-label gform-field-label--type-inline'>I don't know if I can trust a professional<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.7' type='checkbox'  value='I am concerned about getting parental\/caregiver consent or involvement'  id='choice_9_154_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_7' id='label_9_154_7' class='gform-field-label gform-field-label--type-inline'>I am concerned about getting parental\/caregiver consent or involvement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.8' type='checkbox'  value='I don&#039;t have time'  id='choice_9_154_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_8' id='label_9_154_8' class='gform-field-label gform-field-label--type-inline'>I don't have time<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.9' type='checkbox'  value='It&#039;s too big of an effort\/I don&#039;t have the energy'  id='choice_9_154_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_9' id='label_9_154_9' class='gform-field-label gform-field-label--type-inline'>It's too big of an effort\/I don't have the energy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.11' type='checkbox'  value='Logistical problems (transportation, wi-fi access, private space to talk)'  id='choice_9_154_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_11' id='label_9_154_11' class='gform-field-label gform-field-label--type-inline'>Logistical problems (transportation, wi-fi access, private space to talk)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.12' type='checkbox'  value='I don&#039;t think it will work\/make me feel better'  id='choice_9_154_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_12' id='label_9_154_12' class='gform-field-label gform-field-label--type-inline'>I don't think it will work\/make me feel better<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.13' type='checkbox'  value='I&#039;m confused about what to do next'  id='choice_9_154_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_13' id='label_9_154_13' class='gform-field-label gform-field-label--type-inline'>I'm confused about what to do next<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_154_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_154.14' type='checkbox'  value='Other...'  id='choice_9_154_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_154_14' id='label_9_154_14' 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_9_155\" 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_9_155'><strong>What else<\/strong> might keep you from taking these next steps?<\/label><div class='ginput_container ginput_container_text'><input name='input_155' id='input_9_155' type='text' value='' class='large'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_9_123\" 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_9_123'>\n\t\t\t<div class='gchoice gchoice_9_123_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_123' type='radio' value='For myself'  id='choice_9_123_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_123_0' id='label_9_123_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_9_123_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_123' type='radio' value='For someone else'  id='choice_9_123_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_123_1' id='label_9_123_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_9_124\" 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_9_91\" 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_9_92\" 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_9_92'>Age Range<\/label><div class='ginput_container ginput_container_select'><select name='input_92' id='input_9_92' 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_9_93\" 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_9_93'>\n\t\t\t<div class='gchoice gchoice_9_93_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='Female'  id='choice_9_93_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_93_0' id='label_9_93_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_9_93_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='Male'  id='choice_9_93_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_93_1' id='label_9_93_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_9_93_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='Non-Binary'  id='choice_9_93_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_93_2' id='label_9_93_2' class='gform-field-label gform-field-label--type-inline'>Non-Binary<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_151\" 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_9_151'>\n\t\t\t<div class='gchoice gchoice_9_151_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_151' type='radio' value='Yes'  id='choice_9_151_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_151_0' id='label_9_151_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_9_151_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_151' type='radio' value='No'  id='choice_9_151_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_151_1' id='label_9_151_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_94\" 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_9_94'>How would you describe your gender?<\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_9_94' type='text' value='' class='small'    placeholder='Enter gender...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_96\" 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_9_96'>Race\/Ethnicity<\/label><div class='ginput_container ginput_container_select'><select name='input_96' id='input_9_96' 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_9_97\" 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_9_97'>Household Income<\/label><div class='ginput_container ginput_container_select'><select name='input_97' id='input_9_97' 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_9_125\" 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_9_125'>\n\t\t\t<div class='gchoice gchoice_9_125_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='I live in the United States'  id='choice_9_125_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_125_0' id='label_9_125_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_9_125_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='I live in another country'  id='choice_9_125_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_125_1' id='label_9_125_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_9_116\" 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_9_116'>State<\/label><div class='ginput_container ginput_container_select'><select name='input_116' id='input_9_116' 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_9_118\" 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_9_118'>What country do you live in?<\/label><div class='ginput_container ginput_container_select'><select name='input_118' id='input_9_118' 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_9_117\" 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_9_117'>Zip\/Postal Code<\/label><div class='ginput_container ginput_container_text'><input name='input_117' id='input_9_117' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_9_98\" 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_9_98'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_98'><div class='gchoice gchoice_9_98_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.1' type='checkbox'  value='Veteran or active-duty military'  id='choice_9_98_1'   aria-describedby=\"gfield_description_9_98\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_9_98_1' id='label_9_98_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_9_98_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.2' type='checkbox'  value='Caregiver of someone living with emotional or physical illness'  id='choice_9_98_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_98_2' id='label_9_98_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_9_98_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.3' type='checkbox'  value='LGBTQ+'  id='choice_9_98_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_98_3' id='label_9_98_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_9_98_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.4' type='checkbox'  value='Student'  id='choice_9_98_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_98_4' id='label_9_98_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_9_98_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.5' type='checkbox'  value='Trauma survivor'  id='choice_9_98_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_98_5' id='label_9_98_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_9_98_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.6' type='checkbox'  value='New or expecting parent'  id='choice_9_98_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_98_6' id='label_9_98_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_9_98_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.7' type='checkbox'  value='Healthcare worker'  id='choice_9_98_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_98_7' id='label_9_98_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_9_126\" 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_9_126'>\n\t\t\t<div class='gchoice gchoice_9_126_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='Mental health condition'  id='choice_9_126_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_126_0' id='label_9_126_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_9_126_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='Physical health condition'  id='choice_9_126_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_126_1' id='label_9_126_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_9_126_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_126' type='radio' value='Both mental and physical health conditions'  id='choice_9_126_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_126_2' id='label_9_126_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_9_127\" 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_9_127'>Which of the following best describes your sexual orientation?<\/label><div class='ginput_container ginput_container_select'><select name='input_127' id='input_9_127' 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_9_104\" 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_9_104'>What is your sexual orientation?<\/label><div class='ginput_container ginput_container_text'><input name='input_104' id='input_9_104' type='text' value='' class='small'    placeholder='Enter sexual orientation...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_9_128\" 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_9_128'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_128'><div class='gchoice gchoice_9_128_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.1' type='checkbox'  value='Child abuse\/violence'  id='choice_9_128_1'   aria-describedby=\"gfield_description_9_128\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_9_128_1' id='label_9_128_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_9_128_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.2' type='checkbox'  value='Intimate partner violence'  id='choice_9_128_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_128_2' id='label_9_128_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_9_128_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.3' type='checkbox'  value='Sexual assault\/violence'  id='choice_9_128_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_128_3' id='label_9_128_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_9_128_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.4' type='checkbox'  value='Serious illness\/injury\/assault'  id='choice_9_128_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_128_4' id='label_9_128_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_9_128_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.5' type='checkbox'  value='Family conflict (identity acceptance\/separation\/divorce)'  id='choice_9_128_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_128_5' id='label_9_128_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_9_128_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.6' type='checkbox'  value='Traumatic event (natural disaster, accident, witnessing violence, etc.)'  id='choice_9_128_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_128_6' id='label_9_128_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_9_128_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.7' type='checkbox'  value='Death of a loved one'  id='choice_9_128_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_128_7' id='label_9_128_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_9_128_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.8' type='checkbox'  value='Other and\/or tell us more about your trauma'  id='choice_9_128_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_128_8' id='label_9_128_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_9_129\" 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_9_129'>Please tell us more about your experience of trauma:<\/label><div class='ginput_container ginput_container_text'><input name='input_129' id='input_9_129' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_105\" 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_9_107\" 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_9_107'>\n\t\t\t<div class='gchoice gchoice_9_107_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='Yes'  id='choice_9_107_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_107_0' id='label_9_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_9_107_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_107' type='radio' value='No'  id='choice_9_107_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_107_1' id='label_9_107_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_108\" 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_9_108'>\n\t\t\t<div class='gchoice gchoice_9_108_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='Yes'  id='choice_9_108_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_108_0' id='label_9_108_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_108_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_108' type='radio' value='No'  id='choice_9_108_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_108_1' id='label_9_108_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_152\" 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_9_152'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_152'><div class='gchoice gchoice_9_152_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.1' type='checkbox'  value='I wanted to handle my mental health on my own'  id='choice_9_152_1'   aria-describedby=\"gfield_description_9_152\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_1' id='label_9_152_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_9_152_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.2' type='checkbox'  value='I didn\u2019t know how or where to start'  id='choice_9_152_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_2' id='label_9_152_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_9_152_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.3' type='checkbox'  value='I thought it would cost too much'  id='choice_9_152_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_3' id='label_9_152_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_9_152_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.4' type='checkbox'  value='I didn\u2019t have time'  id='choice_9_152_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_4' id='label_9_152_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_9_152_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.5' type='checkbox'  value='I didn\u2019t think it would help me'  id='choice_9_152_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_5' id='label_9_152_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_9_152_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.6' type='checkbox'  value='I didn&#039;t feel ready to start treatment'  id='choice_9_152_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_6' id='label_9_152_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_9_152_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.7' type='checkbox'  value='I was worried about what people would think or say if I got treatment'  id='choice_9_152_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_7' id='label_9_152_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_9_152_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.8' type='checkbox'  value='I was afraid of being forced into a hospital or forced to take medication'  id='choice_9_152_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_8' id='label_9_152_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_9_152_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.9' type='checkbox'  value='I tried, but couldn\u2019t find available treatment (no openings, wouldn\u2019t take insurance, etc.)'  id='choice_9_152_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_9' id='label_9_152_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_9_152_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.11' type='checkbox'  value='My parent(s) or guardian wouldn&#039;t let me, or I didn&#039;t want to ask'  id='choice_9_152_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_11' id='label_9_152_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_9_152_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_152.12' type='checkbox'  value='Other...'  id='choice_9_152_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_152_12' id='label_9_152_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_9_153\" 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_9_153'>What else has prevented you from seeking treatment in the past?<\/label><div class='ginput_container ginput_container_text'><input name='input_153' id='input_9_153' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_9_109\" 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_9_109'>Choose up to 3.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_109'><div class='gchoice gchoice_9_109_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.1' type='checkbox'  value='Abuse or violence'  id='choice_9_109_1'   aria-describedby=\"gfield_description_9_109\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_1' id='label_9_109_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_9_109_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.2' type='checkbox'  value='Relationship problems (friends, family, or significant other)'  id='choice_9_109_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_2' id='label_9_109_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_9_109_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.3' type='checkbox'  value='Body image'  id='choice_9_109_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_3' id='label_9_109_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_9_109_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.4' type='checkbox'  value='Low self-esteem or self-image'  id='choice_9_109_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_4' id='label_9_109_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_9_109_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.5' type='checkbox'  value='School or work problems'  id='choice_9_109_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_5' id='label_9_109_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_9_109_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.6' type='checkbox'  value='Financial problems'  id='choice_9_109_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_6' id='label_9_109_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_9_109_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.7' type='checkbox'  value='Loneliness or isolation'  id='choice_9_109_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_7' id='label_9_109_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_9_109_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.8' type='checkbox'  value='Grief or loss of someone or something'  id='choice_9_109_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_8' id='label_9_109_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_9_109_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.9' type='checkbox'  value='Experiencing hate\/bullying (including racism, homophobia, transphobia, or discrimination)'  id='choice_9_109_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_9' id='label_9_109_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_9_109_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.11' type='checkbox'  value='State of the world (war, climate, politics, immigration)'  id='choice_9_109_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_11' id='label_9_109_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_9_109_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.12' type='checkbox'  value='I don\u2019t know (something just feels wrong)'  id='choice_9_109_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_12' id='label_9_109_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_9_109_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.13' type='checkbox'  value='Other...'  id='choice_9_109_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_109_13' id='label_9_109_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_9_110\" 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_9_110'>What else is contributing to your mental health problems right now?<\/label><div class='ginput_container ginput_container_text'><input name='input_110' id='input_9_110' type='text' value='' class='medium'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_132\" 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_9_132'>What about the state of the world is affecting you the most?<\/label><div class='ginput_container ginput_container_text'><input name='input_132' id='input_9_132' type='text' value='' class='large'    placeholder='Tell us more...'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_111\" 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_9_112\" 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_9_112'>\n\t\t\t<div class='gchoice gchoice_9_112_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_112' type='radio' value='Yes'  id='choice_9_112_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_112_0' id='label_9_112_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_9_112_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_112' type='radio' value='No'  id='choice_9_112_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_112_1' id='label_9_112_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_9_112_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_112' type='radio' value='I don&#039;t know'  id='choice_9_112_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_112_2' id='label_9_112_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_9_113\" 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_9_113'>Select all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_113'><div class='gchoice gchoice_9_113_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.1' type='checkbox'  value='Heart disease'  id='choice_9_113_1'   aria-describedby=\"gfield_description_9_113\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_1' id='label_9_113_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_9_113_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.2' type='checkbox'  value='Reproductive health concerns (PCOS, endometriosis, infertility, etc.)'  id='choice_9_113_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_2' id='label_9_113_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_9_113_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.3' type='checkbox'  value='Diabetes'  id='choice_9_113_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_3' id='label_9_113_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_9_113_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.4' type='checkbox'  value='Cancer'  id='choice_9_113_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_4' id='label_9_113_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_9_113_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.5' type='checkbox'  value='Arthritis or other chronic pain'  id='choice_9_113_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_5' id='label_9_113_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_9_113_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.6' type='checkbox'  value='Asthma, COPD or other lung conditions'  id='choice_9_113_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_6' id='label_9_113_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_9_113_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.7' type='checkbox'  value='Movement Disorders (involuntary tics, tardive dyskinesia, etc.)'  id='choice_9_113_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_7' id='label_9_113_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_9_113_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.8' type='checkbox'  value='Digestive problems (Crohn\u2019s, colitis, IBS, etc.)'  id='choice_9_113_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_8' id='label_9_113_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_9_113_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.9' type='checkbox'  value='Neurological conditions (epilepsy, etc.) or traumatic brain injury (TBI)'  id='choice_9_113_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_9' id='label_9_113_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_9_113_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.11' type='checkbox'  value='Other...'  id='choice_9_113_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_113_11' id='label_9_113_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_9_114\" 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_9_114'>What other physical health conditions do you have?<\/label><div class='ginput_container 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(2011). Psychosis risk screening with the Prodromal Questionnaire\u2014Brief Version (PQ-B). <em>Schizophrenia Research 12<\/em>(1) pp. 42-46. <a href=\"https:\/\/doi.org\/10.1016\/j.schres.2011.03.029\">DOI: 10.1016\/j.schres.2011.03.029<\/a><\/p>\n<p>Savill, M., D&#8217;Ambrosio, J., Cannon, T. D., Loewy, R. (2017). Psychosis risk screening in different populations using the Prodromal Questionnaire: A systematic review. <em>Early Intervention in Psychiatry 12<\/em>(1), pp. 3-14. <a href=\"https:\/\/doi.org\/10.1111\/eip.12446\">DOI: 10.1111\/eip.12446<\/a><\/p>\n<p>A positive score on the Prodromal Questionnaire-Brief Version (PQ-B) suggests the need for further evaluation by a qualified health (M.D., R.N.) or mental health (Ph.D., Psy.D., LCSW) professional who is trained in recognizing the early signs of psychosis.\u00a0 The PQ-B is designed to test for Prodrome or Ultra high-risk of Psychosis and is considered the first step in a two-stage screening process.<\/p>\n<p><a href=\"https:\/\/screening.mhanational.org\/about-our-mental-health-tests\/\" target=\"_blank\" rel=\"noopener\">For more information about our screening tools, please click here.<\/a><\/p>\n<p><strong><em>Please note:<\/em><\/strong><span style=\"font-style: normal !msorm;\"><em> 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><\/span><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Para personas que sienten que su cerebro les juega malas pasadas (ven, oyen o creen cosas que no parecen reales o del todo correctas).<\/p>","protected":false},"template":"","tags":[],"age_group":[],"condition":[89],"class_list":["post-3166","screen","type-screen","status-publish","hentry","condition-psychosis"],"acf":[],"yoast_head":"<title>Psychosis &amp; Schizophrenia Test &#8211; Free, quick, &amp; confidential<\/title>\n<meta name=\"description\" content=\"Is your brain playing tricks on you? 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