{"id":20797,"date":"2025-11-10T18:19:17","date_gmt":"2025-11-10T23:19:17","guid":{"rendered":"https:\/\/csrsommets.ca\/depistage-en-ligne\/"},"modified":"2025-11-26T08:55:57","modified_gmt":"2025-11-26T13:55:57","slug":"online-sleep-assessment-test","status":"publish","type":"page","link":"https:\/\/csrsommets.ca\/en\/online-sleep-assessment-test\/","title":{"rendered":"Online Sleep Assessment Test"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"20797\" class=\"elementor elementor-20797 elementor-20528\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-29e5a46 e-flex e-con-boxed e-con e-parent\" data-id=\"29e5a46\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;21dfd2c&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:null,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}],&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-6362105 e-con-full e-flex e-con e-child\" data-id=\"6362105\" data-element_type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-31312ef elementor-widget elementor-widget-heading\" data-id=\"31312ef\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Online Sleep Assessment Test<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e1773d6 elementor-widget elementor-widget-text-editor\" data-id=\"e1773d6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Quickly detect possible signs of sleep 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   <h2 class=\"gform_title\">D\u00e9pistage en ligne - EN<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/en\/wp-json\/wp\/v2\/pages\/20797#gf_2' data-formid='2' novalidate>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>12<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_8' style='width:8%;'><span>8%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_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_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_5\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><!-- Ic\u00f4nes Font Awesome -->\n<link rel=\"stylesheet\" href=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/font-awesome\/6.5.0\/css\/all.min.css\">\n\n<section class=\"intro-questionnaire\">\n  <style>\n    .intro-questionnaire h2 {\n      font-size: 1.6rem; \/* ~25px *\/\n      font-weight: 600;\n      margin-bottom: 0.75rem;\n      hyphens: none;\n      -webkit-hyphens: none;\n      -moz-hyphens: none;\n      text-align: left;\n    }\n    .intro-questionnaire h3 {\n      font-size: 1.2rem; \/* ~19px *\/\n      font-weight: 600;\n      margin-top: 1.5rem;\n      margin-bottom: 0.5rem;\n      hyphens: none;\n      -webkit-hyphens: none;\n      -moz-hyphens: none;\n      text-align: left;\n    }\n    .intro-questionnaire p {\n      font-size: 1rem; \/* ~16px *\/\n      margin-bottom: 1rem;\n      hyphens: none;\n      -webkit-hyphens: none;\n      -moz-hyphens: none;\n      text-align: left;\n    }\n    .intro-questionnaire .badge {\n      display: inline-flex;\n      align-items: center;\n      background: #f7f7f7;\n      border-radius: 20px;\n      padding: 6px 12px;\n      font-size: 0.9rem;\n      margin-right: 8px;\n      margin-bottom: 8px;\n    }\n    .intro-questionnaire .badge i {\n      margin-right: 6px;\n      color: #254F83;\n    }\n  <\/style>\n\n  <h2>\n    Welcome to our Sleep Disorder Assessment Tool\n  <\/h2>\n\n  <div style=\"margin-bottom: 1.1rem;\">\n    <span class=\"badge\">\n      <i class=\"fa-solid fa-clock\"><\/i>\n      About 5 minutes\n    <\/span>\n    <span class=\"badge\">\n      <i class=\"fa-solid fa-lock\"><\/i>\n      Confidential\n    <\/span>\n  <\/div>\n\n  <h3>Discover your sleep profile<\/h3>\n\n  <p>\n    This short questionnaire is designed to help you better understand the quality of your sleep\n    and to detect possible signs of a sleep disorder. Your answers will allow us to guide you toward the most suitable evaluation or screening options.\n  <\/p>\n\n  <p>\n    There\u2019s no time limit, take a few minutes to answer calmly, according to your situation.\n  <\/p>\n\n  <h3>Privacy and Consent<\/h3>\n\n  <p>\n    I agree that the Clinique de sant\u00e9 respiratoire des Sommets may use my personal information and my responses to this questionnaire for analysis and recommendations, as well as to send me informational or promotional messages related to its services.\n  <\/p>\n\n  <p>\n    I understand that I can unsubscribe at any time,\n    without it affecting the services offered by the clinic.\n  <\/p>\n<\/section><\/div><fieldset id=\"field_2_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Consentement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_6'>\n\t\t\t<div class='gchoice gchoice_2_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Oui'  id='choice_2_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_0' id='label_2_6_0' class='gform-field-label gform-field-label--type-inline'>I agree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Non'  id='choice_2_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_1' id='label_2_6_1' class='gform-field-label gform-field-label--type-inline'>I refuse<\/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_2_8' 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_2_2' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_11\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><section class=\"bloc-refus\" role=\"alert\" aria-labelledby=\"refus-titre\">\n  <p id=\"refus-titre\">\nSince you did not accept the clinic\u2019s privacy consent policy,\nwe are unable to proceed with the screening test.\n  <\/p>\n\n  <p style=\"margin-bottom: 0px\">\nCollecting this information is essential to analyze your situation\nand provide recommendations tailored to your condition.\n  <\/p>\n<\/section>\n\n<style>\n  \/* === Bloc Refus (m\u00eame style que le CTA, sans bouton) === *\/\n  .bloc-refus {\n    max-width: 720px;\n    margin: 1.5rem auto;\n    padding: 1.25rem 1.5rem;\n    background: #e6f3f9;\n    border: 1px solid #254f83;\n    border-radius: 12px;\n    text-align: center;\n  }\n\n  .bloc-refus p {\n    margin: 0 0 1rem 0;\n    font-size: 1rem;\n    color: #254f83;\n    font-weight: 600;\n    text-align: center;\n    hyphens: none;\n    -webkit-hyphens: none;\n    -moz-hyphens: none;\n  }\n<\/style><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_7' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_7' 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_2_3' class='gform_page' data-js='page-field-id-7' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you already have a prescription for a sleep diagnostic test?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_12'>\n\t\t\t<div class='gchoice gchoice_2_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Yes'  id='choice_2_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_12_0' id='label_2_12_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_2_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='No'  id='choice_2_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_12_1' id='label_2_12_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_previous_button_2_13' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_13' 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_2_4' class='gform_page' data-js='page-field-id-13' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Select the test indicated on your prescription<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_14'>\n\t\t\t<div class='gchoice gchoice_2_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='At-Home Sleep Apnea Test'  id='choice_2_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_0' id='label_2_14_0' class='gform-field-label gform-field-label--type-inline'>At-Home Sleep Apnea Test<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='In-Lab Polysomnography (Comprehensive Sleep Study)'  id='choice_2_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_1' id='label_2_14_1' class='gform-field-label gform-field-label--type-inline'>In-Lab Polysomnography (Comprehensive Sleep Study)<\/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_previous_button_2_15' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_15' 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_2_5' class='gform_page' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_16\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><section class=\"bloc-cta\" role=\"region\" aria-labelledby=\"cta-title\">\n  <p id=\"cta-title\">\n    Since you already have a prescription for an at-home sleep apnea test, you can book your test right away.\n  <\/p>\n\n  <a href=\"https:\/\/cdsrds.juvonno.com\/portal\/publicbook.php?step=clinicPractService\" class=\"btn-cta\">\n    Book an appointment\n  <\/a>\n<\/section>\n\n<style>\n  \/* === Bloc CTA === *\/\n  .bloc-cta {\n    max-width: 720px;\n    margin: 1.5rem auto;\n    padding: 1.25rem 1.5rem;\n    background: #E6F3F9; \/* m\u00eame fond que le bloc Refus *\/\n    border: 1px solid #254f83;\n    border-radius: 12px;\n    text-align: center;\n  }\n\n  .bloc-cta p {\n    margin: 0 0 1rem 0;\n    font-size: 1rem;\n    color: #254f83;\n    font-weight: 600;\n    text-align: center;\n    hyphens: none;\n    -webkit-hyphens: none;\n    -moz-hyphens: none;\n  }\n\n  \/* === Bouton CTA === *\/\n  .btn-cta {\n    display: inline-block;\n    padding: 0.6rem 1.4rem;\n    border-radius: 999px;\n    text-decoration: none;\n    font-weight: 600;\n    font-size: 0.95rem;\n    background: #fdc753;\n    border: 1px solid #fdc753;\n    color: #254f83;\n    box-shadow: 0 3px 8px rgba(253, 199, 83, 0.35);\n    transition: all 0.25s ease;\n  }\n\n  .btn-cta:hover {\n    background: #254f83;\n    border-color: #254f83;\n    color: #fff !important;\n    box-shadow: 0 4px 12px rgba(37, 79, 131, 0.35);\n  }\n\n  .btn-cta:active {\n    transform: translateY(1px);\n  }\n<\/style><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_17' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_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_2_6' class='gform_page' data-js='page-field-id-17' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_18\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><section class=\"bloc-cta\" role=\"region\" aria-labelledby=\"cta-title\">\n  <p id=\"cta-title\">\n    Since you already have a prescription for an in-lab polysomnography (comprehensive sleep study), you can book your test right away.\n  <\/p>\n\n  <a href=\"https:\/\/cdsrds.juvonno.com\/portal\/publicbook.php?step=clinicPractService\" class=\"btn-cta\">\n    Book an appointment\n  <\/a>\n<\/section>\n\n<style>\n  \/* === Bloc CTA === *\/\n  .bloc-cta {\n    max-width: 720px;\n    margin: 1.5rem auto;\n    padding: 1.25rem 1.5rem;\n    background: #E6F3F9; \/* m\u00eame fond que le bloc Refus *\/\n    border: 1px solid #254f83;\n    border-radius: 12px;\n    text-align: center;\n  }\n\n  .bloc-cta p {\n    margin: 0 0 1rem 0;\n    font-size: 1rem;\n    color: #254f83;\n    font-weight: 600;\n    text-align: center;\n    hyphens: none;\n    -webkit-hyphens: none;\n    -moz-hyphens: none;\n  }\n\n  \/* === Bouton CTA === *\/\n  .btn-cta {\n    display: inline-block;\n    padding: 0.6rem 1.4rem;\n    border-radius: 999px;\n    text-decoration: none;\n    font-weight: 600;\n    font-size: 0.95rem;\n    background: #fdc753;\n    border: 1px solid #fdc753;\n    color: #254f83;\n    box-shadow: 0 3px 8px rgba(253, 199, 83, 0.35);\n    transition: all 0.25s ease;\n  }\n\n  .btn-cta:hover {\n    background: #254f83;\n    border-color: #254f83;\n    color: #fff !important;\n    box-shadow: 0 4px 12px rgba(37, 79, 131, 0.35);\n  }\n\n  .btn-cta:active {\n    transform: translateY(1px);\n  }\n<\/style><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_19' 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_2_7' class='gform_page' data-js='page-field-id-19' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_21\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"font-size: 1.6rem; font-weight: 600; margin-bottom: 0.75rem; hyphens: none; -webkit-hyphens: none; -moz-hyphens: none; text-align: left; color: #254F83;\">Your Daily Sleep\n<\/h2><\/div><fieldset id=\"field_2_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you wake up feeling tired, even after a full night\u2019s sleep?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_22'>\n\t\t\t<div class='gchoice gchoice_2_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Yes, almost every morning'  id='choice_2_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_0' id='label_2_22_0' class='gform-field-label gform-field-label--type-inline'>Yes, almost every morning<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Sometimes'  id='choice_2_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_1' id='label_2_22_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='No, I feel rested.'  id='choice_2_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_2' id='label_2_22_2' class='gform-field-label gform-field-label--type-inline'>No, I feel rested.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have difficulty falling asleep or staying asleep?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_23'>\n\t\t\t<div class='gchoice gchoice_2_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes, often'  id='choice_2_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_0' id='label_2_23_0' class='gform-field-label gform-field-label--type-inline'>Yes, often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Sometimes'  id='choice_2_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_1' id='label_2_23_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_23_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_2_23_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_2' id='label_2_23_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you often take naps or feel the need to sleep during the day?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_24'>\n\t\t\t<div class='gchoice gchoice_2_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Yes, every day'  id='choice_2_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_0' id='label_2_24_0' class='gform-field-label gform-field-label--type-inline'>Yes, every day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Sometimes'  id='choice_2_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_1' id='label_2_24_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='No, never'  id='choice_2_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_2' id='label_2_24_2' class='gform-field-label gform-field-label--type-inline'>No, never<\/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_previous_button_2_20' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_20' 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_2_8' class='gform_page' data-js='page-field-id-20' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_25\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"font-size: 1.6rem; font-weight: 600; margin-bottom: 0.75rem; hyphens: none; -webkit-hyphens: none; -moz-hyphens: none; text-align: left; color: #254F83;\">Your Sleep Habits\n<\/h2><\/div><fieldset id=\"field_2_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What time do you usually go to bed?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_26'>\n\t\t\t<div class='gchoice gchoice_2_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Before 9 p.m.'  id='choice_2_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_0' id='label_2_26_0' class='gform-field-label gform-field-label--type-inline'>Before 9 p.m.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Between 9 p.m. and 11 p.m.'  id='choice_2_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_1' id='label_2_26_1' class='gform-field-label gform-field-label--type-inline'>Between 9 p.m. and 11 p.m.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='After 11 p.m.'  id='choice_2_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_2' id='label_2_26_2' class='gform-field-label gform-field-label--type-inline'>After 11 p.m.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is your sleep disturbed by frequent awakenings?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_27'>\n\t\t\t<div class='gchoice gchoice_2_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Yes, several times a night'  id='choice_2_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_0' id='label_2_27_0' class='gform-field-label gform-field-label--type-inline'>Yes, several times a night<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Sometimes'  id='choice_2_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_1' id='label_2_27_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Rarely or never'  id='choice_2_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_2' id='label_2_27_2' class='gform-field-label gform-field-label--type-inline'>Rarely or never<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >How many hours do you sleep on average per night?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_28'>\n\t\t\t<div class='gchoice gchoice_2_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Less than 5 hours'  id='choice_2_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_0' id='label_2_28_0' class='gform-field-label gform-field-label--type-inline'>Less than 5 hours<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Between 5 and 7 hours'  id='choice_2_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_1' id='label_2_28_1' class='gform-field-label gform-field-label--type-inline'>Between 5 and 7 hours<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='7 hours or more'  id='choice_2_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_2' id='label_2_28_2' class='gform-field-label gform-field-label--type-inline'>7 hours or more<\/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_previous_button_2_30' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_30' 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_2_9' class='gform_page' data-js='page-field-id-30' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_31\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"font-size: 1.6rem; font-weight: 600; margin-bottom: 0.75rem; hyphens: none; -webkit-hyphens: none; -moz-hyphens: none; text-align: left; color: #254F83;\">Physical Signs and Symptoms<\/h2><\/div><fieldset id=\"field_2_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Has anyone ever noticed that you snore loudly at night?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_32'>\n\t\t\t<div class='gchoice gchoice_2_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Yes, regularly'  id='choice_2_32_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_32_0' id='label_2_32_0' class='gform-field-label gform-field-label--type-inline'>Yes, regularly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Sometimes'  id='choice_2_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_32_1' id='label_2_32_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_32_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='No \/ I don&#039;t know'  id='choice_2_32_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_32_2' id='label_2_32_2' class='gform-field-label gform-field-label--type-inline'>No \/ I don't know<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_33\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Has anyone ever noticed that you stop breathing during your sleep?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_33'>\n\t\t\t<div class='gchoice gchoice_2_33_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Yes'  id='choice_2_33_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_33_0' id='label_2_33_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_2_33_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='No'  id='choice_2_33_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_33_1' id='label_2_33_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_2_33_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='I don&#039;t know'  id='choice_2_33_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_33_2' id='label_2_33_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_2_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you often wake up with a dry mouth or a sore throat?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_34'>\n\t\t\t<div class='gchoice gchoice_2_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Yes'  id='choice_2_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_34_0' id='label_2_34_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_2_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Sometimes'  id='choice_2_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_34_1' id='label_2_34_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_34_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='No'  id='choice_2_34_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_34_2' id='label_2_34_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you suffer from morning headaches?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_35'>\n\t\t\t<div class='gchoice gchoice_2_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Yes, frequently'  id='choice_2_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_35_0' id='label_2_35_0' class='gform-field-label gform-field-label--type-inline'>Yes, frequently<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Sometimes'  id='choice_2_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_35_1' id='label_2_35_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_35_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='No'  id='choice_2_35_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_35_2' id='label_2_35_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_37\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you feel sleepy or have trouble concentrating during the day?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_37'>\n\t\t\t<div class='gchoice gchoice_2_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Yes, almost every day'  id='choice_2_37_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_0' id='label_2_37_0' class='gform-field-label gform-field-label--type-inline'>Yes, almost every day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Sometimes'  id='choice_2_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_1' id='label_2_37_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_37_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='No'  id='choice_2_37_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_2' id='label_2_37_2' 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_previous_button_2_36' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_36' 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_2_10' class='gform_page' data-js='page-field-id-36' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_38\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"font-size: 1.6rem; font-weight: 600; margin-bottom: 0.75rem; hyphens: none; -webkit-hyphens: none; -moz-hyphens: none; text-align: left; color: #254F83;\">Epworth Sleepiness Scale<\/h2><\/div><div id=\"field_2_40\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"color: #254F83;\"><b>What are the chances that I would fall asleep...<\/b><\/p><\/div><fieldset id=\"field_2_39\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >In a seated position<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_39'>\n\t\t\t<div class='gchoice gchoice_2_39_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='0'  id='choice_2_39_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_39_0' id='label_2_39_0' class='gform-field-label gform-field-label--type-inline'>No chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_39_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='1'  id='choice_2_39_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_39_1' id='label_2_39_1' class='gform-field-label gform-field-label--type-inline'>Low chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_39_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='2'  id='choice_2_39_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_39_2' id='label_2_39_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_39_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='3'  id='choice_2_39_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_39_3' id='label_2_39_3' class='gform-field-label gform-field-label--type-inline'>Strong chance<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_41\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >While watching television<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_41'>\n\t\t\t<div class='gchoice gchoice_2_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='0'  id='choice_2_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_41_0' id='label_2_41_0' class='gform-field-label gform-field-label--type-inline'>No chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='1'  id='choice_2_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_41_1' id='label_2_41_1' class='gform-field-label gform-field-label--type-inline'>Low chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_41_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='2'  id='choice_2_41_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_41_2' id='label_2_41_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_41_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='3'  id='choice_2_41_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_41_3' id='label_2_41_3' class='gform-field-label gform-field-label--type-inline'>Strong chance<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_42\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >While sitting inactive in a public place (meeting rooms, classes, cinema, etc.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_42'>\n\t\t\t<div class='gchoice gchoice_2_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='0'  id='choice_2_42_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_42_0' id='label_2_42_0' class='gform-field-label gform-field-label--type-inline'>No chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='1'  id='choice_2_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_42_1' id='label_2_42_1' class='gform-field-label gform-field-label--type-inline'>Low chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_42_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='2'  id='choice_2_42_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_42_2' id='label_2_42_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_42_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='3'  id='choice_2_42_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_42_3' id='label_2_42_3' class='gform-field-label gform-field-label--type-inline'>Strong chance<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >While being a passenger for more than an hour in a vehicle<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_43'>\n\t\t\t<div class='gchoice gchoice_2_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='0'  id='choice_2_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_0' id='label_2_43_0' class='gform-field-label gform-field-label--type-inline'>No chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='1'  id='choice_2_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_1' id='label_2_43_1' class='gform-field-label gform-field-label--type-inline'>Low chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_43_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='2'  id='choice_2_43_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_2' id='label_2_43_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_43_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='3'  id='choice_2_43_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_3' id='label_2_43_3' class='gform-field-label gform-field-label--type-inline'>Strong chance<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >While lying down to rest in the afternoon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_44'>\n\t\t\t<div class='gchoice gchoice_2_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='0'  id='choice_2_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_44_0' id='label_2_44_0' class='gform-field-label gform-field-label--type-inline'>No chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='1'  id='choice_2_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_44_1' id='label_2_44_1' class='gform-field-label gform-field-label--type-inline'>Low chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_44_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='2'  id='choice_2_44_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_44_2' id='label_2_44_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_44_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='3'  id='choice_2_44_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_44_3' id='label_2_44_3' class='gform-field-label gform-field-label--type-inline'>Strong chance<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_45\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >While talking to someone while seated<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_45'>\n\t\t\t<div class='gchoice gchoice_2_45_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='0'  id='choice_2_45_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_45_0' id='label_2_45_0' class='gform-field-label gform-field-label--type-inline'>No chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_45_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='1'  id='choice_2_45_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_45_1' id='label_2_45_1' class='gform-field-label gform-field-label--type-inline'>Low chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_45_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='2'  id='choice_2_45_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_45_2' id='label_2_45_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_45_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='3'  id='choice_2_45_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_45_3' id='label_2_45_3' class='gform-field-label gform-field-label--type-inline'>Strong chance<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_46\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >In a seated position after a non-alcoholic dinner<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_46'>\n\t\t\t<div class='gchoice gchoice_2_46_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='0'  id='choice_2_46_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_46_0' id='label_2_46_0' class='gform-field-label gform-field-label--type-inline'>No chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_46_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='1'  id='choice_2_46_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_46_1' id='label_2_46_1' class='gform-field-label gform-field-label--type-inline'>Low chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_46_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='2'  id='choice_2_46_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_46_2' id='label_2_46_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_46_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='3'  id='choice_2_46_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_46_3' id='label_2_46_3' class='gform-field-label gform-field-label--type-inline'>Strong chance<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_47\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Behind the wheel of a car stuck in traffic for a few minutes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_47'>\n\t\t\t<div class='gchoice gchoice_2_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='0'  id='choice_2_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_0' id='label_2_47_0' class='gform-field-label gform-field-label--type-inline'>No chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='1'  id='choice_2_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_1' id='label_2_47_1' class='gform-field-label gform-field-label--type-inline'>Low chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='2'  id='choice_2_47_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_2' id='label_2_47_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_47_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='3'  id='choice_2_47_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_3' id='label_2_47_3' class='gform-field-label gform-field-label--type-inline'>Strong chance<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_50\" class=\"gfield gfield--type-number gfield--width-full gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_2_50'>R\u00e9sultat - Test Epworth<\/label><div class='ginput_container ginput_container_number'><input name='input_50' id='input_2_50' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_48' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_48' 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_2_11' class='gform_page' data-js='page-field-id-48' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_49\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"font-size: 1.6rem; font-weight: 600; margin-bottom: 0.75rem; hyphens: none; -webkit-hyphens: none; -moz-hyphens: none; text-align: left; color: #254F83;\">General Health<\/h2><\/div><fieldset id=\"field_2_51\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have a medical history of high blood pressure, diabetes, or heart problems?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_51'>\n\t\t\t<div class='gchoice gchoice_2_51_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_51' type='radio' value='Yes'  id='choice_2_51_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_51_0' id='label_2_51_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_2_51_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_51' type='radio' value='No'  id='choice_2_51_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_51_1' id='label_2_51_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Enter your height<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_52'>\n\t\t\t<div class='gchoice gchoice_2_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Centimeters (cm)'  id='choice_2_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_52_0' id='label_2_52_0' class='gform-field-label gform-field-label--type-inline'>Centimeters (cm)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Feet\/Inches (ft\/in)'  id='choice_2_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_52_1' id='label_2_52_1' class='gform-field-label gform-field-label--type-inline'>Feet\/Inches (ft\/in)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_53\" class=\"gfield gfield--type-number gfield--width-full field-shrink gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_53'>Centimeters (cm)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_53' id='input_2_53' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_2_54\" class=\"gfield gfield--type-number gfield--width-full field-shrink gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_54'>Feet (ft)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_54' id='input_2_54' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_2_55\" class=\"gfield gfield--type-number gfield--width-full field-shrink gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_55'>Inches (in)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_55' id='input_2_55' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_2_56\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Enter your weight<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_56'>\n\t\t\t<div class='gchoice gchoice_2_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Pounds (lb)'  id='choice_2_56_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_0' id='label_2_56_0' class='gform-field-label gform-field-label--type-inline'>Pounds (lb)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Kilograms (kg)'  id='choice_2_56_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_56_1' id='label_2_56_1' class='gform-field-label gform-field-label--type-inline'>Kilograms (kg)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_57\" class=\"gfield gfield--type-number gfield--width-full field-shrink gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_57'>Pounds (lb)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_57' id='input_2_57' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_2_58\" class=\"gfield gfield--type-number gfield--width-full field-shrink gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_58'>Kilograms (kg)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_58' id='input_2_58' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_2_59\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full buttonized gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What is your gender identity?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_59'>\n\t\t\t<div class='gchoice gchoice_2_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Man'  id='choice_2_59_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_59_0' id='label_2_59_0' class='gform-field-label gform-field-label--type-inline'>Man<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Woman'  id='choice_2_59_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_59_1' id='label_2_59_1' class='gform-field-label gform-field-label--type-inline'>Woman<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_59_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Other \/ Prefer not to answer'  id='choice_2_59_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_59_2' id='label_2_59_2' class='gform-field-label gform-field-label--type-inline'>Other \/ Prefer not to answer<\/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_previous_button_2_61' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_61' 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_2_12' class='gform_page' data-js='page-field-id-61' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_60\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"font-size: 1.6rem; font-weight: 600; margin-bottom: 0.75rem; hyphens: none; -webkit-hyphens: none; -moz-hyphens: none; text-align: left; color: #254F83;\">Contact Information<\/h2><\/div><div id=\"field_2_64\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_64'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_64' id='input_2_64' type='text' value='' class='datepicker gform-datepicker dmy_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_2_64_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_64_date_format' class='screen-reader-text'>DD dash MM dash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_64' class='gform_hidden' value='https:\/\/csrsommets.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_2_62\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_62'>First name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_2_62' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_63\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_63'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_2_63' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_67\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_67'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_67' id='input_2_67' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_68\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_68'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_68' id='input_2_68' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_69\" class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_69' id='input_2_69' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='Anglais' \/><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Send'  \/> <input type='hidden' name='gform_ajax' value='form_id=2&amp;title=1&amp;description=1&amp;tabindex=0&amp;theme=orbital&amp;styles=[]&amp;hash=65ee8a9e8e5af7928cbabdfd6a377bce' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n             <\/div><\/div>\n                        <p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"224\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_2' id='gform_ajax_frame_2' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 2, 'https:\/\/csrsommets.ca\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', false );jQuery('#gform_ajax_frame_2').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_2').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https:\/\/csrsommets.ca\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', false );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_2').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_2').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"2\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_2\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_2\";            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