{"id":845,"date":"2026-01-05T15:49:47","date_gmt":"2026-01-05T15:49:47","guid":{"rendered":"https:\/\/dreamrevivalpsychiatry.com\/?page_id=845"},"modified":"2026-01-05T19:00:22","modified_gmt":"2026-01-05T19:00:22","slug":"adhd-intake-questionnaire","status":"publish","type":"page","link":"https:\/\/dreamrevivalpsychiatry.com\/es\/adhd-intake-questionnaire\/","title":{"rendered":"ADHD Intake Questionnaire"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"845\" class=\"elementor elementor-845\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b5fd065 e-flex e-con-boxed e-con e-parent\" data-id=\"b5fd065\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e444321 elementor-widget elementor-widget-heading\" data-id=\"e444321\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Book Your ADHD Intake Appointment<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-deb0a58 e-flex e-con-boxed e-con e-parent\" data-id=\"deb0a58\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9b9da1d elementor-widget elementor-widget-shortcode\" data-id=\"9b9da1d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"mf-form-shortcode\">\r\n\t\t<div\r\n\t\t\tid=\"metform-wrap-847-847\"\r\n\t\t\tclass=\"mf-form-wrapper\"\r\n\t\t\tdata-form-id=\"847\"\r\n\t\t\tdata-action=\"https:\/\/dreamrevivalpsychiatry.com\/es\/wp-json\/metform\/v1\/entries\/insert\/847\"\r\n\t\t\tdata-wp-nonce=\"9b0f06f5f3\"\r\n\t\t\tdata-form-nonce=\"3a1e4daa9f\"\r\n\t\t\tdata-quiz-summery = \"false\"\r\n\t\t\tdata-save-progress = \"false\"\r\n\t\t\tdata-form-type=\"general-form\"\r\n\t\t\tdata-stop-vertical-effect=\"\"\r\n\t\t\t><\/div>\r\n\r\n\r\n\t\t<!----------------------------- \r\n\t\t\t* controls_data : find the the props passed indie of data attribute\r\n\t\t\t* props.SubmitResponseMarkup : contains the markup of error or success message\r\n\t\t\t* https:\/\/developer.mozilla.org\/en-US\/docs\/Web\/JavaScript\/Reference\/Template_literals\r\n\t\t--------------------------- -->\r\n\r\n\t\t\t\t<script type=\"text\/mf\" class=\"mf-template\">\r\n\t\t\tfunction controls_data (value){\r\n\t\t\t\tlet currentWrapper = \"mf-response-props-id-847\";\r\n\t\t\t\tlet currentEl = document.getElementById(currentWrapper);\r\n\t\t\t\t\r\n\t\t\t\treturn currentEl ? currentEl.dataset[value] : false\r\n\t\t\t}\r\n\r\n\r\n\t\t\tlet is_edit_mode = '' ? true : false;\r\n\t\t\tlet message_position = controls_data('messageposition') || 'top';\r\n\r\n\t\t\t\r\n\t\t\tlet message_successIcon = controls_data('successicon') || '';\r\n\t\t\tlet message_errorIcon = controls_data('erroricon') || '';\r\n\t\t\tlet message_editSwitch = controls_data('editswitchopen') === 'yes' ? true : false;\r\n\t\t\tlet message_proClass = controls_data('editswitchopen') === 'yes' ? 'mf_pro_activated' : '';\r\n\t\t\t\r\n\t\t\tlet is_dummy_markup = is_edit_mode && message_editSwitch ? true : false;\r\n\r\n\t\t\t\r\n\t\t\treturn html`\r\n\t\t\t\t<form\r\n\t\t\t\t\tclassName=\"metform-form-content\"\r\n\t\t\t\t\tref=${parent.formContainerRef}\r\n\t\t\t\t\tonSubmit=${ validation.handleSubmit( parent.handleFormSubmit ) }\r\n\t\t\t\t\r\n\t\t\t\t\t>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\t\t${is_dummy_markup ? message_position === 'top' ?  props.ResponseDummyMarkup(message_successIcon, message_proClass) : '' : ''}\r\n\t\t\t\t\t${is_dummy_markup ? ' ' :  message_position === 'top' ? props.SubmitResponseMarkup`${parent}${state}${message_successIcon}${message_errorIcon}${message_proClass}` : ''}\r\n\r\n\t\t\t\t\t<!--------------------------------------------------------\r\n\t\t\t\t\t*** IMPORTANT \/ DANGEROUS ***\r\n\t\t\t\t\t${html``} must be used as in immediate child of \"metform-form-main-wrapper\"\r\n\t\t\t\t\tclass otherwise multistep form will not run at all\r\n\t\t\t\t\t---------------------------------------------------------->\r\n\r\n\t\t\t\t\t<div className=\"metform-form-main-wrapper\" key=${'hide-form-after-submit'} ref=${parent.formRef}>\r\n\t\t\t\t\t${html`\r\n\t\t\t\t\t\t\t\t<div data-elementor-type=\"wp-post\" key=\"2\" data-elementor-id=\"847\" className=\"elementor elementor-847\" data-elementor-post-type=\"metform-form\">\n\t\t\t\t<div className=\"elementor-element elementor-element-6419d87 e-flex e-con-boxed e-con e-parent\" data-id=\"6419d87\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div className=\"e-con-inner\">\n\t\t<div className=\"elementor-element elementor-element-929300f e-con-full e-flex e-con e-child\" data-id=\"929300f\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div className=\"elementor-element elementor-element-07c6690 e-con-full e-flex e-con e-child\" data-id=\"07c6690\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div className=\"elementor-element elementor-element-2ee3a95 elementor-widget elementor-widget-mf-listing-fname\" data-id=\"2ee3a95\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-listing-fname&quot;}\" data-widget_type=\"mf-listing-fname.default\">\n\t\t\t\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-text-2ee3a95\">\n\t\t\t\t\t${ parent.decodeEntities(`1. Full Name`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n\t\t\t\n\t\t\t<input type=\"text\" className=\"mf-input \" id=\"mf-input-text-2ee3a95\" \n\t\t\t\tname=\"mf-listing-fname\" \n\t\t\t\tplaceholder=\"${ parent.decodeEntities(`Enter full legal name`) } \"\n\t\t\t\tonInput=${ parent.handleChange }\n\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-listing-fname'] ? 'true' : 'false'}\n\t\t\t\t\tref=${ el => parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el) }\n\t\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-listing-fname\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-03e47e6 elementor-widget elementor-widget-mf-telephone\" data-id=\"03e47e6\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-telephone&quot;}\" data-widget_type=\"mf-telephone.default\">\n\t\t\t\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-telephone-03e47e6\">\n\t\t\t\t\t${ parent.decodeEntities(`2. Phone Number`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n\t\t\t\n\t\t\t<input\n\t\t\t\ttype=\"tel\"\n\t\t\t\tclassName=\"mf-input \"\n\t\t\t\tid=\"mf-input-telephone-03e47e6\" \n\t\t\t\tname=\"mf-telephone\"\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(`Enter your number`) } \"\n\t\t\t\t\t\t\t\t\tonInput=${parent.handleChange}\n\t\t\t\t\taria-invalid=${validation.errors['mf-telephone'] ? 'true' : 'false'}\n\t\t\t\t\tref=${el => parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\n\t\t\t\t\t\t\t\t\/>\n\t\t\t\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-telephone\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\n\t\t\t\n\t\t<\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-a4bd289 elementor-widget elementor-widget-mf-email\" data-id=\"a4bd289\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-email&quot;}\" data-widget_type=\"mf-email.default\">\n\t\t\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-email-a4bd289\">\r\n\t\t\t\t\t${ parent.decodeEntities(`3.\tEmail Address`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<input \r\n\t\t\t\ttype=\"email\" \r\n\t\t\t\t \r\n\t\t\t\tdefaultValue=\"\" \r\n\t\t\t\tclassName=\"mf-input \" \r\n\t\t\t\tid=\"mf-input-email-a4bd289\" \r\n\t\t\t\tname=\"mf-email\" \r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(`Enter your email`) } \" \r\n\t\t\t\t \r\n\t\t\t\tonBlur=${parent.handleChange} onFocus=${parent.handleChange} aria-invalid=${validation.errors['mf-email'] ? 'true' : 'false' } \r\n\t\t\t\tref=${el=> parent.activateValidation({\"message\":\"This field is required.\",\"emailMessage\":\"Please enter a valid Email address\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t<${validation.ErrorMessage} \r\n\t\t\t\terrors=${validation.errors} \r\n\t\t\t\tname=\"mf-email\" \r\n\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div className=\"elementor-element elementor-element-34a873e e-con-full e-transform e-flex e-con e-child\" data-id=\"34a873e\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_transform_translateX_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\">\n\t\t\t\t<div className=\"elementor-element elementor-element-700fa85 elementor-widget elementor-widget-mf-radio\" data-id=\"700fa85\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;ADHD_before&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;A. Yes&quot;,&quot;mf_input_option_value&quot;:&quot;A. Yes&quot;,&quot;_id&quot;:&quot;055a34b&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;B. No&quot;,&quot;mf_input_option_value&quot;:&quot;B. No&quot;,&quot;_id&quot;:&quot;c84e80e&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-radio.default\">\n\t\t\t\t\t\t\r\n\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-radio-700fa85\">\r\n\t\t\t\t\t${ parent.decodeEntities(`4.\tHave you been treated for ADHD before ?`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<div className=\"mf-radio multi-option-input-type\" id=\"mf-input-radio-700fa85\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"ADHD_before\"\r\n\t\t\t\t\t\t\t\tvalue=\"A. Yes\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['ADHD_before'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":true}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'A. Yes' === parent.getValue('ADHD_before')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`A. Yes`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"ADHD_before\"\r\n\t\t\t\t\t\t\t\tvalue=\"B. No\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['ADHD_before'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":true}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'B. No' === parent.getValue('ADHD_before')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`B. No`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"ADHD_before\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"ADHD_before\" value=\"\" \/>\r\n\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div className=\"elementor-element elementor-element-50b8607 e-con-full e-transform e-flex e-con e-child\" data-id=\"50b8607\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_transform_translateX_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\">\n\t\t\t\t<div className=\"elementor-element elementor-element-3642fba elementor-widget elementor-widget-mf-radio\" data-id=\"3642fba\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;health_insurance&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;A. Yes&quot;,&quot;mf_input_option_value&quot;:&quot;A. Yes&quot;,&quot;_id&quot;:&quot;055a34b&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot; B. No I am cash or self pay&quot;,&quot;mf_input_option_value&quot;:&quot; B. No I am cash or self pay&quot;,&quot;_id&quot;:&quot;c84e80e&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-radio.default\">\n\t\t\t\t\t\t\r\n\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-radio-3642fba\">\r\n\t\t\t\t\t${ parent.decodeEntities(`5. Do you currently have health insurance ?`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<div className=\"mf-radio multi-option-input-type\" id=\"mf-input-radio-3642fba\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"health_insurance\"\r\n\t\t\t\t\t\t\t\tvalue=\"A. Yes\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['health_insurance'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":true}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'A. Yes' === parent.getValue('health_insurance')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`A. Yes`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"health_insurance\"\r\n\t\t\t\t\t\t\t\tvalue=\" B. No I am cash or self pay\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['health_insurance'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":true}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${' B. No I am cash or self pay' === parent.getValue('health_insurance')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(` B. No I am cash or self pay`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"health_insurance\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"health_insurance\" value=\"\" \/>\r\n\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div className=\"elementor-element elementor-element-094ff3f e-con-full e-transform e-flex e-con e-child\" data-id=\"094ff3f\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_transform_translateX_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\">\n\t\t\t\t<div className=\"elementor-element elementor-element-1acf452 elementor-widget elementor-widget-mf-checkbox\" data-id=\"1acf452\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-checkbox&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;A. Getting distracted easily or not being able to finish tasks&quot;,&quot;mf_input_option_value&quot;:&quot;A. Getting distracted easily or not being able to finish tasks&quot;,&quot;_id&quot;:&quot;6a3350c&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;B. Easily forgetting people&#039;s names right after meeting&quot;,&quot;mf_input_option_value&quot;:&quot;B. Easily forgetting people&#039;s names right after meeting&quot;,&quot;_id&quot;:&quot;897f49f&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;C. Lack of productivity&quot;,&quot;mf_input_option_value&quot;:&quot;C. Lack of productivity&quot;,&quot;_id&quot;:&quot;555b476&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;D. Racing thoughts or inability to sleep at night &quot;,&quot;mf_input_option_value&quot;:&quot;D. Racing thoughts or inability to sleep at night &quot;,&quot;_id&quot;:&quot;ca89a9e&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;E. Struggling to meet deadlines&quot;,&quot;mf_input_option_value&quot;:&quot;E. Struggling to meet deadlines&quot;,&quot;_id&quot;:&quot;22a6723&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-checkbox.default\">\n\t\t\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-checkbox-1acf452\">\r\n\t\t\t\t\t${ parent.decodeEntities(`6.\tWhich of the following symptoms sound familiar to you ?`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<div \r\n\t\t\t\t\t\t\t\t\tref=${el => parent.handleCheckbox(el, 'onLoad')}\r\n\t\t\t\t\t\t\t\t\tclassName=\"mf-checkbox multi-option-input-type\"\r\n\t\t\t\t\tid=\"mf-input-checkbox-1acf452\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-checkbox-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"checkbox\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-checkbox-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-checkbox\"\r\n\t\t\t\t\t\t\t\tvalue=\"A. Getting distracted easily or not being able to finish tasks\"\r\n\t\t\t\t\t\t\t\tdefaultChecked=\"\"\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonInput=${ el =>  parent.handleCheckbox(el.target, 'onClick') }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-checkbox'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el => {\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\t\t}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`A. Getting distracted easily or not being able to finish tasks`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-checkbox-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"checkbox\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-checkbox-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-checkbox\"\r\n\t\t\t\t\t\t\t\tvalue=\"B. Easily forgetting people&#039;s names right after meeting\"\r\n\t\t\t\t\t\t\t\tdefaultChecked=\"\"\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonInput=${ el =>  parent.handleCheckbox(el.target, 'onClick') }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-checkbox'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el => {\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\t\t}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`B. Easily forgetting people&#039;s names right after meeting`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-checkbox-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"checkbox\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-checkbox-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-checkbox\"\r\n\t\t\t\t\t\t\t\tvalue=\"C. Lack of productivity\"\r\n\t\t\t\t\t\t\t\tdefaultChecked=\"\"\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonInput=${ el =>  parent.handleCheckbox(el.target, 'onClick') }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-checkbox'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el => {\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\t\t}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`C. Lack of productivity`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-checkbox-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"checkbox\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-checkbox-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-checkbox\"\r\n\t\t\t\t\t\t\t\tvalue=\"D. Racing thoughts or inability to sleep at night \"\r\n\t\t\t\t\t\t\t\tdefaultChecked=\"\"\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonInput=${ el =>  parent.handleCheckbox(el.target, 'onClick') }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-checkbox'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el => {\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\t\t}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`D. Racing thoughts or inability to sleep at night `) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-checkbox-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"checkbox\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-checkbox-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-checkbox\"\r\n\t\t\t\t\t\t\t\tvalue=\"E. Struggling to meet deadlines\"\r\n\t\t\t\t\t\t\t\tdefaultChecked=\"\"\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonInput=${ el =>  parent.handleCheckbox(el.target, 'onClick') }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-checkbox'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el => {\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\t\t}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`E. Struggling to meet deadlines`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t<input type=\"hidden\" name=\"mf-checkbox\" value=\"\" \/>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-checkbox\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t<span className=\"mf-input-help\"> ${ parent.decodeEntities(`Select all that apply`) }  <\/span>\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div className=\"elementor-element elementor-element-a0873ed e-con-full e-transform e-flex e-con e-child\" data-id=\"a0873ed\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_transform_translateX_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\">\n\t\t\t\t<div className=\"elementor-element elementor-element-822d1ad elementor-widget elementor-widget-mf-radio\" data-id=\"822d1ad\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;like_to_be_seen&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;A. As soon as possible&quot;,&quot;mf_input_option_value&quot;:&quot;A. As soon as possible&quot;,&quot;_id&quot;:&quot;14fadc9&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;B. Within 24 to 48 hours&quot;,&quot;mf_input_option_value&quot;:&quot;B. Within 24 to 48 hours&quot;,&quot;_id&quot;:&quot;459d3a4&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;C. Within a week&quot;,&quot;mf_input_option_value&quot;:&quot;C. Within a week&quot;,&quot;_id&quot;:&quot;84e401f&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-radio.default\">\n\t\t\t\t\t\t\r\n\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-radio-822d1ad\">\r\n\t\t\t\t\t${ parent.decodeEntities(`7.\tHow soon would you like to be seen ?`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<div className=\"mf-radio multi-option-input-type\" id=\"mf-input-radio-822d1ad\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"like_to_be_seen\"\r\n\t\t\t\t\t\t\t\tvalue=\"A. As soon as possible\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['like_to_be_seen'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":true}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'A. As soon as possible' === parent.getValue('like_to_be_seen')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`A. As soon as possible`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"like_to_be_seen\"\r\n\t\t\t\t\t\t\t\tvalue=\"B. Within 24 to 48 hours\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['like_to_be_seen'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":true}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'B. Within 24 to 48 hours' === parent.getValue('like_to_be_seen')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`B. Within 24 to 48 hours`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"like_to_be_seen\"\r\n\t\t\t\t\t\t\t\tvalue=\"C. Within a week\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['like_to_be_seen'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":true}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'C. Within a week' === parent.getValue('like_to_be_seen')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`C. Within a week`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"like_to_be_seen\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"like_to_be_seen\" value=\"\" \/>\r\n\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div className=\"elementor-element elementor-element-b99611f e-con-full e-flex e-con e-child\" data-id=\"b99611f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div className=\"elementor-element elementor-element-749855d mf-btn--justify mf-btn--tablet-justify mf-btn--mobile-justify elementor-widget elementor-widget-mf-button\" data-id=\"749855d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"mf-button.default\">\n\t\t\t\t\t\t\t<div className=\"mf-btn-wraper \" data-mf-form-conditional-logic-requirement=\"\">\r\n\t\t\t\t\t\t\t<button type=\"submit\" className=\"metform-btn metform-submit-btn \" id=\"\">\r\n\t\t\t\t\t<span>${ parent.decodeEntities(`Submit`) } <\/span>\r\n\t\t\t\t<\/button>\r\n\t\t\t        <\/div>\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t`}\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t${is_dummy_markup ? message_position === 'bottom' ? props.ResponseDummyMarkup(message_successIcon, message_proClass) : '' : ''}\r\n\t\t\t\t\t${is_dummy_markup ? ' ' : message_position === 'bottom' ? props.SubmitResponseMarkup`${parent}${state}${message_successIcon}${message_errorIcon}${message_proClass}` : ''}\r\n\t\t\t\t\r\n\t\t\t\t<\/form>\r\n\t\t\t`\r\n\t\t<\/script>\r\n\r\n\t\t<\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Book Your ADHD Intake Appointment<\/p>","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-845","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/dreamrevivalpsychiatry.com\/es\/wp-json\/wp\/v2\/pages\/845","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dreamrevivalpsychiatry.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dreamrevivalpsychiatry.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dreamrevivalpsychiatry.com\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/dreamrevivalpsychiatry.com\/es\/wp-json\/wp\/v2\/comments?post=845"}],"version-history":[{"count":28,"href":"https:\/\/dreamrevivalpsychiatry.com\/es\/wp-json\/wp\/v2\/pages\/845\/revisions"}],"predecessor-version":[{"id":948,"href":"https:\/\/dreamrevivalpsychiatry.com\/es\/wp-json\/wp\/v2\/pages\/845\/revisions\/948"}],"wp:attachment":[{"href":"https:\/\/dreamrevivalpsychiatry.com\/es\/wp-json\/wp\/v2\/media?parent=845"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}