{"id":285,"date":"2025-07-19T22:31:32","date_gmt":"2025-07-19T22:31:32","guid":{"rendered":"https:\/\/evolvetofitness.com\/?page_id=285"},"modified":"2025-07-19T22:31:32","modified_gmt":"2025-07-19T22:31:32","slug":"health-intake-forms","status":"publish","type":"page","link":"https:\/\/evolvetofitness.com\/index.php\/health-intake-forms\/","title":{"rendered":"Health Intake Forms"},"content":{"rendered":"<style id=\"wpforms-css-vars-224-block-389a3b8f-6e99-420d-ae01-6a5f452596b5\">\n\t\t\t\t#wpforms-224.wpforms-block-389a3b8f-6e99-420d-ae01-6a5f452596b5 {\n\t\t\t\t--wpforms-label-color: #3d3835;\n--wpforms-label-sublabel-color: #79716b;\n--wpforms-label-error-color: #edb254;\n--wpforms-page-break-color: #ef8225;\n--wpforms-field-border-color: #cbc6c2;\n--wpforms-field-border-color-spare: #cbc6c2;\n--wpforms-field-text-color: #3d3835;\n--wpforms-container-border-radius: 0px;\n--wpforms-button-background-color: #111111;\n--wpforms-button-text-color: #edb254;\n--wpforms-button-border-color: #ff4500;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-389a3b8f-6e99-420d-ae01-6a5f452596b5 wpforms-render-modern\" id=\"wpforms-224\"><form id=\"wpforms-form-224\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"224\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/285\" data-token=\"8a1853ab3a50ebda61e0a4227ac456d5\" data-token-time=\"1777512743\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"12\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> &#8211; <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 12<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:8.3333333333333%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-224-field_26-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"26\"><\/div><div id=\"wpforms-224-field_142-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"142\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-224-field_142\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][142][first]\" aria-errormessage=\"wpforms-224-field_142-error\" required><label for=\"wpforms-224-field_142\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-224-field_142-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][142][last]\" aria-errormessage=\"wpforms-224-field_142-last-error\" required><label for=\"wpforms-224-field_142-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-224-field_143-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"143\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_143\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-224-field_143\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][143]\" spellcheck=\"false\" aria-errormessage=\"wpforms-224-field_143-error\" required><\/div><div id=\"wpforms-224-field_144-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"144\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_144\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-224-field_144\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][144]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-224-field_144-error\" required><\/div><div id=\"wpforms-224-field_141-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"141\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-224-field_1-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Your main motive for this change is for your own reasons and not because other people think you should. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_1\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_1_1\" name=\"wpforms[fields][1]\" value=\"True\" aria-errormessage=\"wpforms-224-field_1_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_1_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_1_2\" name=\"wpforms[fields][1]\" value=\"False\" aria-errormessage=\"wpforms-224-field_1_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_1_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_11-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">You have more than one reason why you believe you want to change your behavior (e.g., lose weight) which may positively impact your overall quality of life. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_11\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_11_1\" name=\"wpforms[fields][11]\" value=\"True\" aria-errormessage=\"wpforms-224-field_11_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_11_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_11_2\" name=\"wpforms[fields][11]\" value=\"False\" aria-errormessage=\"wpforms-224-field_11_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_11_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_12-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">You do not believe you are capable of participating in the activity and tasks that are needed in order for you to make successful changes. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_12_1\" name=\"wpforms[fields][12]\" value=\"True\" aria-errormessage=\"wpforms-224-field_12_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_12_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_12_2\" name=\"wpforms[fields][12]\" value=\"False\" aria-errormessage=\"wpforms-224-field_12_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_12_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_15-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">You are unwilling to make the commitment of time and effort needed to change your current behavior as your life is already quite stressful. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_15\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_15_1\" name=\"wpforms[fields][15]\" value=\"True\" aria-errormessage=\"wpforms-224-field_15_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_15_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_15_2\" name=\"wpforms[fields][15]\" value=\"False\" aria-errormessage=\"wpforms-224-field_15_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_15_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_14-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">You will accept the fact that sustained success may be a slow and challenging process, yet you will continue your efforts despite the disappointments. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_14_1\" name=\"wpforms[fields][14]\" value=\"True\" aria-errormessage=\"wpforms-224-field_14_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_14_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_14_2\" name=\"wpforms[fields][14]\" value=\"False\" aria-errormessage=\"wpforms-224-field_14_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_14_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_13-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">You are not prepared to be patient with yourself and will most likely give in or quit when you encounter obstacles, backlashes or barriers. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_13_1\" name=\"wpforms[fields][13]\" value=\"True\" aria-errormessage=\"wpforms-224-field_13_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_13_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_13_2\" name=\"wpforms[fields][13]\" value=\"False\" aria-errormessage=\"wpforms-224-field_13_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_13_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_16-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"16\"><fieldset><legend class=\"wpforms-field-label\">You do not have the support for this change from friends, family or loved ones. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_16\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_16_1\" name=\"wpforms[fields][16]\" value=\"True\" aria-errormessage=\"wpforms-224-field_16_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_16_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_16_2\" name=\"wpforms[fields][16]\" value=\"False\" aria-errormessage=\"wpforms-224-field_16_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_16_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_17-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">You have never before tried to change this behavior or a behavior similar to this one. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_17_1\" name=\"wpforms[fields][17]\" value=\"True\" aria-errormessage=\"wpforms-224-field_17_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_17_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_17_2\" name=\"wpforms[fields][17]\" value=\"False\" aria-errormessage=\"wpforms-224-field_17_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_17_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_18-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">You accept the reality that your ultimate success requires sustainable behaviors as opposed to temporary changes regardless of your rates of success. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_18\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_18_1\" name=\"wpforms[fields][18]\" value=\"True\" aria-errormessage=\"wpforms-224-field_18_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_18_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_18_2\" name=\"wpforms[fields][18]\" value=\"False\" aria-errormessage=\"wpforms-224-field_18_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_18_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_19-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">You recognize that a structured and disciplined approach to making and sustaining healthier behaviors will be needed for indefinite periods of time to help achieve the goal(s) you desire. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_19_1\" name=\"wpforms[fields][19]\" value=\"True\" aria-errormessage=\"wpforms-224-field_19_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_19_1\">True<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_19_2\" name=\"wpforms[fields][19]\" value=\"False\" aria-errormessage=\"wpforms-224-field_19_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_19_2\">False<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_25-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"25\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-224-field_66-container\" class=\"wpforms-field wpforms-field-likert_scale\" data-field-id=\"66\"><fieldset><legend class=\"wpforms-field-label\">Perceived Stress Scale <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend>\n\t\t<table class=\"wpforms-field-large modern\">\n\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<th style=\"width:20%;\"><\/th><th style=\"width:16%;\">Never<\/th><th style=\"width:16%;\">Almost Never<\/th><th style=\"width:16%;\">Sometimes<\/th><th style=\"width:16%;\">Often<\/th><th style=\"width:16%;\">Very Often<\/th>\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t<tbody>\n\t\t\t\t<tr><th>In the last month, how often have you been upset because of something that happened unexpectedly?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_1_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][1]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_1_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_1_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been upset because of something that happened unexpectedly? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_1_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][1]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_1_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_1_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been upset because of something that happened unexpectedly? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_1_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][1]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_1_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_1_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been upset because of something that happened unexpectedly? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_1_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][1]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_1_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_1_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been upset because of something that happened unexpectedly? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_1_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][1]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_1_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_1_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been upset because of something that happened unexpectedly? Very Often<\/span><\/label><\/div><\/td><\/tr><tr><th>In the last month, how often have you felt tha t you were unable to control the important things in your life?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_2_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][2]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_2_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_2_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt tha t you were unable to control the important things in your life? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_2_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][2]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_2_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_2_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt tha t you were unable to control the important things in your life? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_2_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][2]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_2_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_2_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt tha t you were unable to control the important things in your life? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_2_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][2]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_2_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_2_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt tha t you were unable to control the important things in your life? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_2_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][2]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_2_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_2_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt tha t you were unable to control the important things in your life? Very Often<\/span><\/label><\/div><\/td><\/tr><tr><th>In the last month, how often have you felt nervous and \u201cstressed\u201d?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_3_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][3]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_3_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_3_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt nervous and \u201cstressed\u201d? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_3_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][3]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_3_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_3_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt nervous and \u201cstressed\u201d? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_3_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][3]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_3_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_3_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt nervous and \u201cstressed\u201d? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_3_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][3]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_3_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_3_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt nervous and \u201cstressed\u201d? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_3_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][3]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_3_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_3_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt nervous and \u201cstressed\u201d? Very Often<\/span><\/label><\/div><\/td><\/tr><tr><th>In the last month, how often have you felt confident about your ability to handle your personal problems?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_4_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][4]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_4_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_4_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt confident about your ability to handle your personal problems? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_4_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][4]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_4_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_4_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt confident about your ability to handle your personal problems? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_4_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][4]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_4_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_4_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt confident about your ability to handle your personal problems? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_4_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][4]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_4_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_4_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt confident about your ability to handle your personal problems? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_4_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][4]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_4_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_4_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt confident about your ability to handle your personal problems? Very Often<\/span><\/label><\/div><\/td><\/tr><tr><th>In the last month, how often have you felt that things were going your way?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_5_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][5]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_5_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_5_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that things were going your way? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_5_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][5]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_5_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_5_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that things were going your way? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_5_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][5]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_5_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_5_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that things were going your way? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_5_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][5]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_5_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_5_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that things were going your way? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_5_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][5]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_5_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_5_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that things were going your way? Very Often<\/span><\/label><\/div><\/td><\/tr><tr><th>In the last month, how often have you found that you could not cope with all the things that you had to do?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_6_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][6]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_6_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_6_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you found that you could not cope with all the things that you had to do? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_6_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][6]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_6_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_6_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you found that you could not cope with all the things that you had to do? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_6_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][6]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_6_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_6_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you found that you could not cope with all the things that you had to do? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_6_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][6]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_6_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_6_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you found that you could not cope with all the things that you had to do? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_6_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][6]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_6_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_6_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you found that you could not cope with all the things that you had to do? Very Often<\/span><\/label><\/div><\/td><\/tr><tr><th>In the last month, how often have you been able to control irritations in your life?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_7_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][7]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_7_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_7_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been able to control irritations in your life? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_7_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][7]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_7_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_7_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been able to control irritations in your life? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_7_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][7]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_7_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_7_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been able to control irritations in your life? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_7_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][7]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_7_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_7_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been able to control irritations in your life? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_7_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][7]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_7_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_7_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been able to control irritations in your life? Very Often<\/span><\/label><\/div><\/td><\/tr><tr><th>In the last month, how often have you felt that you were on top of things?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_8_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][8]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_8_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_8_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that you were on top of things? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_8_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][8]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_8_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_8_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that you were on top of things? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_8_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][8]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_8_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_8_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that you were on top of things? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_8_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][8]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_8_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_8_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that you were on top of things? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_8_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][8]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_8_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_8_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt that you were on top of things? Very Often<\/span><\/label><\/div><\/td><\/tr><tr><th>In the last month, how often have you been angered because of things that were outside of your control?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_9_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][9]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_9_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_9_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been angered because of things that were outside of your control? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_9_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][9]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_9_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_9_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been angered because of things that were outside of your control? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_9_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][9]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_9_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_9_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been angered because of things that were outside of your control? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_9_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][9]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_9_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_9_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been angered because of things that were outside of your control? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_9_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][9]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_9_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_9_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you been angered because of things that were outside of your control? Very Often<\/span><\/label><\/div><\/td><\/tr><tr><th>In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?<\/th><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_10_1\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][10]\" value=\"1\" aria-errormessage=\"wpforms-224-field_66_10_1-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_10_1\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Almost Never<\/span><input type=\"radio\" id=\"wpforms-224-field_66_10_2\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][10]\" value=\"2\" aria-errormessage=\"wpforms-224-field_66_10_2-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_10_2\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? Almost Never<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Sometimes<\/span><input type=\"radio\" id=\"wpforms-224-field_66_10_3\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][10]\" value=\"3\" aria-errormessage=\"wpforms-224-field_66_10_3-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_10_3\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? Sometimes<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_10_4\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][10]\" value=\"4\" aria-errormessage=\"wpforms-224-field_66_10_4-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_10_4\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? Often<\/span><\/label><\/div><\/td><td><div class=\"wpforms-likert-scale-mobile-flex\"><span class=\"wpforms-likert-scale-mobile-label\">Very Often<\/span><input type=\"radio\" id=\"wpforms-224-field_66_10_5\" class=\"wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required\" name=\"wpforms[fields][66][10]\" value=\"5\" aria-errormessage=\"wpforms-224-field_66_10_5-error\" aria-describedby=\"wpforms-224-field_66-description\" required><label for=\"wpforms-224-field_66_10_5\"><span class=\"wpforms-screen-reader-element\">In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? Very Often<\/span><\/label><\/div><\/td><\/tr>\t\t\t<\/tbody>\n\t\t<\/table>\n\t\t<div id=\"wpforms-224-field_66-description\" class=\"wpforms-field-description\">The questions in this scale ask you about your feelings and thoughts during the last month. In\neach case, you will be asked to indicate by circling how often you felt or thought a certain way.<\/div><\/fieldset><\/div><div id=\"wpforms-224-field_35-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"35\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-224-field_122-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"122\"><h3 id=\"wpforms-224-field_122\" aria-errormessage=\"wpforms-224-field_122-error\" aria-describedby=\"wpforms-224-field_122-description\">Your Action Plan<\/h3><div id=\"wpforms-224-field_122-description\" class=\"wpforms-field-description\">Most likely you\u2019ve done some coaching goal planning in the past. This time I want you\nto make your plan by answering the following questions thoughtfully and intentionally.\nBe specific, please. (One-liners won\u2019t do.)<\/div><\/div><div id=\"wpforms-224-field_36-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_36\">Please list your motivation(s) for choosing to complete health coaching and the reasons you want to make a positive change in and for your health <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_36\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-224-field_36-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_38-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_38\">On a scale of 1 to 10 how motivated and willing are you to change<\/label>\n<input\n\ttype=\"range\"\n\tid=\"wpforms-224-field_38\" class=\"wpforms-field-medium\" name=\"wpforms[fields][38]\" value=\"0\" aria-errormessage=\"wpforms-224-field_38-error\"\t\tmin=\"0\"\n\tmax=\"10\"\n\tstep=\"1\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Selected Value: {value}\">\n\tSelected Value: <b>0<\/b><\/div>\n<\/div><div id=\"wpforms-224-field_39-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_39\">What obstacles have kept you from making positive health changes in the past <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_39\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][39]\" aria-errormessage=\"wpforms-224-field_39-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_40-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_40\">What are you willing to do in order to remove these obstacles? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_40\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-224-field_40-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_41-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_41\">List your top 3 physical health goals <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_41\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-224-field_41-error\" aria-describedby=\"wpforms-224-field_41-description\" required><\/textarea><div id=\"wpforms-224-field_41-description\" class=\"wpforms-field-description\">Example: Reduce blood pressure so my doctor discontinues medication<\/div><\/div><div id=\"wpforms-224-field_42-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_42\">List your top 3 spiritual health goals <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_42\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][42]\" aria-errormessage=\"wpforms-224-field_42-error\" aria-describedby=\"wpforms-224-field_42-description\" required><\/textarea><div id=\"wpforms-224-field_42-description\" class=\"wpforms-field-description\">Example: Grow in kindness toward myself and others<\/div><\/div><div id=\"wpforms-224-field_43-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_43\">What are you hoping to learn from this action plan? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_43\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][43]\" aria-errormessage=\"wpforms-224-field_43-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_44-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"44\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-224-field_123-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"123\"><h3 id=\"wpforms-224-field_123\" aria-errormessage=\"wpforms-224-field_123-error\">LIFE ASSESSMENT<\/h3><\/div><div id=\"wpforms-224-field_46-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_46\">Is anything keeping you from being the most authentic you? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_46\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][46]\" aria-errormessage=\"wpforms-224-field_46-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_47-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_47\">What is holding you back? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_47\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][47]\" aria-errormessage=\"wpforms-224-field_47-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_48-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_48\">What do you love and celebrate about yourself? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_48\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][48]\" aria-errormessage=\"wpforms-224-field_48-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_49-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_49\">What is missing in your life? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_49\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-224-field_49-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_50-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_50\">Are you in a romantic relationship? If so, what is the best part about that relationship? What is the most challenging? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_50\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-224-field_50-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_51-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_51\">Are you fulfilled in your work? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_51\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][51]\" aria-errormessage=\"wpforms-224-field_51-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_52-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_52\">How do you express yourself creatively? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_52\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][52]\" aria-errormessage=\"wpforms-224-field_52-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_53-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_53\">What is the dream inside of you dying to come out? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_53\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][53]\" aria-errormessage=\"wpforms-224-field_53-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_54-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_54\">Are you financially healthy or stressed? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_54\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-224-field_54-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_55-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_55\">What rules do you follow that you wish you could break <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_55\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][55]\" aria-errormessage=\"wpforms-224-field_55-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_56-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"56\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"5\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6  \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-224-field_57-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_57\">Is there an event in your life that you wish you could break? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-224-field_57-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_58-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_58\">Do you have a friend or group of friends who you feel safe to be fully known by? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_58\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][58]\" aria-errormessage=\"wpforms-224-field_58-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_59-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_59\">When you think about a God who loves you, what comes to mind? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_59\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][59]\" aria-errormessage=\"wpforms-224-field_59-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_60-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_60\">Is there anyone you need to forgive? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_60\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][60]\" aria-errormessage=\"wpforms-224-field_60-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_61-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_61\">What do you think might lie at the root of your health challenges? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_61\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][61]\" aria-errormessage=\"wpforms-224-field_61-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_62-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_62\">Have you ever been involved with witchcraft of the cult? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_62\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][62]\" aria-errormessage=\"wpforms-224-field_62-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_63-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_63\">What does your body need to heal? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_63\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][63]\" aria-errormessage=\"wpforms-224-field_63-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_64-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_64\">What would it take to live a life your body would love? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_64\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][64]\" aria-errormessage=\"wpforms-224-field_64-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_65-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"65\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"6\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-7  \" data-page=\"7\" style=\"display:none;\"><div id=\"wpforms-224-field_119-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"119\"><h3 id=\"wpforms-224-field_119\" aria-errormessage=\"wpforms-224-field_119-error\">HEALTH ASSESSMENT EXERCISE HABITS<\/h3><\/div><div id=\"wpforms-224-field_120-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"120\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_120\">In the past 6 months, how often have you engaged in physical activity? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_120\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][120]\" aria-errormessage=\"wpforms-224-field_120-error\" aria-describedby=\"wpforms-224-field_120-description\" required><\/textarea><div id=\"wpforms-224-field_120-description\" class=\"wpforms-field-description\">Always &#8211; 7 days a week\nRegularly &#8211; 3 to 4x a week\nSemi regularly &#8211; 1-2 x a week\nSporadically &#8211; 1-2 x a month<\/div><\/div><div id=\"wpforms-224-field_67-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_67\">Please explain your current exercise regime or activities performed in the past: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_67\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][67]\" aria-errormessage=\"wpforms-224-field_67-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_68-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_68\">Please list any cardiovascular activities that you enjoy: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_68\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][68]\" aria-errormessage=\"wpforms-224-field_68-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_69-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_69\">Please list any strength training exercises that you enjoy: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_69\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][69]\" aria-errormessage=\"wpforms-224-field_69-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_70-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_70\">What are your personal barriers for exercising or sticking to a program? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_70\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][70]\" aria-errormessage=\"wpforms-224-field_70-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_71-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_71\">How much time do you plan on spending on your workout program? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_71\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][71]\" aria-errormessage=\"wpforms-224-field_71-error\" aria-describedby=\"wpforms-224-field_71-description\" required><\/textarea><div id=\"wpforms-224-field_71-description\" class=\"wpforms-field-description\">Min\/Day\nDay\/Week<\/div><\/div><div id=\"wpforms-224-field_72-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"72\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"7\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-8  \" data-page=\"8\" style=\"display:none;\"><div id=\"wpforms-224-field_121-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"121\"><h3 id=\"wpforms-224-field_121\" aria-errormessage=\"wpforms-224-field_121-error\">WELLNESS GOALS<\/h3><\/div><div id=\"wpforms-224-field_73-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_73\">Why have you decided to begin or improve your exercise\/ wellness program? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_73\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][73]\" aria-errormessage=\"wpforms-224-field_73-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_74-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_74\">Specifically describe what you would like to accomplish in your sessions. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_74\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][74]\" aria-errormessage=\"wpforms-224-field_74-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_75-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_75\">Specifically describe what you would like to accomplish through your fitness\/wellness program during the next: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_75\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][75]\" aria-errormessage=\"wpforms-224-field_75-error\" aria-describedby=\"wpforms-224-field_75-description\" required><\/textarea><div id=\"wpforms-224-field_75-description\" class=\"wpforms-field-description\">1 Month\n6 Months\n1 Year<\/div><\/div><div id=\"wpforms-224-field_76-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_76\">List your top 3 physical health goals? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_76\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][76]\" aria-errormessage=\"wpforms-224-field_76-error\" aria-describedby=\"wpforms-224-field_76-description\" required><\/textarea><div id=\"wpforms-224-field_76-description\" class=\"wpforms-field-description\">Example: reduce blood pressure so my doctor discontinues medications<\/div><\/div><div id=\"wpforms-224-field_77-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_77\">List your top 3 spiritual goals? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_77\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][77]\" aria-errormessage=\"wpforms-224-field_77-error\" aria-describedby=\"wpforms-224-field_77-description\" required><\/textarea><div id=\"wpforms-224-field_77-description\" class=\"wpforms-field-description\">Example: Grow in kindness toward myself and others<\/div><\/div><div id=\"wpforms-224-field_78-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_78\">What obstacles have kept you from making positive health changes in the past? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_78\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][78]\" aria-errormessage=\"wpforms-224-field_78-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_124-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"124\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_124\">What are you willing to do in order to remove these obstacles? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_124\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][124]\" aria-errormessage=\"wpforms-224-field_124-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_79-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"79\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"8\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-9  \" data-page=\"9\" style=\"display:none;\"><div id=\"wpforms-224-field_125-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"125\"><h3 id=\"wpforms-224-field_125\" aria-errormessage=\"wpforms-224-field_125-error\" aria-describedby=\"wpforms-224-field_125-description\">PERSONAL HISTORY<\/h3><div id=\"wpforms-224-field_125-description\" class=\"wpforms-field-description\">In order to design a safe and effective coaching program, it is important that you complete the\nfollowing Health History. It is crucial that you answer all the questions honestly and to the best\nof your ability. Please be advised that all information is kept strictly confidential.<\/div><\/div><div id=\"wpforms-224-field_81-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"81\"><fieldset><legend class=\"wpforms-field-label\">Has your doctor ever told you that you have heart problems? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_81\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_81_1\" name=\"wpforms[fields][81]\" value=\"Yes\" aria-errormessage=\"wpforms-224-field_81_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_81_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_81_2\" name=\"wpforms[fields][81]\" value=\"No\" aria-errormessage=\"wpforms-224-field_81_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_81_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_126-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"126\"><fieldset><legend class=\"wpforms-field-label\">Has your doctor ever told you that you have high blood pressure? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_126\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_126_1\" name=\"wpforms[fields][126]\" value=\"Yes\" aria-errormessage=\"wpforms-224-field_126_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_126_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_126_2\" name=\"wpforms[fields][126]\" value=\"No\" aria-errormessage=\"wpforms-224-field_126_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_126_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_127-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"127\"><fieldset><legend class=\"wpforms-field-label\">Have you ever had stroke or heart attack? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_127\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_127_1\" name=\"wpforms[fields][127]\" value=\"Yes\" aria-errormessage=\"wpforms-224-field_127_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_127_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_127_2\" name=\"wpforms[fields][127]\" value=\"No\" aria-errormessage=\"wpforms-224-field_127_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_127_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_128-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"128\"><fieldset><legend class=\"wpforms-field-label\">Have you ever had pain in your chest that concerned you? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_128\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_128_1\" name=\"wpforms[fields][128]\" value=\"Yes\" aria-errormessage=\"wpforms-224-field_128_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_128_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_128_2\" name=\"wpforms[fields][128]\" value=\"No\" aria-errormessage=\"wpforms-224-field_128_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_128_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_129-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"129\"><fieldset><legend class=\"wpforms-field-label\">Do you ever feel faint or have dizzy spells? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_129\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_129_1\" name=\"wpforms[fields][129]\" value=\"Yes\" aria-errormessage=\"wpforms-224-field_129_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_129_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_129_2\" name=\"wpforms[fields][129]\" value=\"No\" aria-errormessage=\"wpforms-224-field_129_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_129_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_130-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"130\"><fieldset><legend class=\"wpforms-field-label\">Have you had surgery in the last six months? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_130\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_130_1\" name=\"wpforms[fields][130]\" value=\"Yes\" aria-errormessage=\"wpforms-224-field_130_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_130_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_130_2\" name=\"wpforms[fields][130]\" value=\"No\" aria-errormessage=\"wpforms-224-field_130_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_130_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_87-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"87\"><fieldset><legend class=\"wpforms-field-label\">Check the appropriate condition(s) that apply to you below:<\/legend><ul id=\"wpforms-224-field_87\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_87_1\" name=\"wpforms[fields][87][]\" value=\"Diabetes\" aria-errormessage=\"wpforms-224-field_87_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_87_1\">Diabetes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_87_2\" name=\"wpforms[fields][87][]\" value=\"Asthma\" aria-errormessage=\"wpforms-224-field_87_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_87_2\">Asthma<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_87_3\" name=\"wpforms[fields][87][]\" value=\"Heart Condition\" aria-errormessage=\"wpforms-224-field_87_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_87_3\">Heart Condition<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_87_4\" name=\"wpforms[fields][87][]\" value=\"Epilepsy\" aria-errormessage=\"wpforms-224-field_87_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_87_4\">Epilepsy<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_87_5\" name=\"wpforms[fields][87][]\" value=\"Pregnancy\" aria-errormessage=\"wpforms-224-field_87_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_87_5\">Pregnancy<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_87_7\" name=\"wpforms[fields][87][]\" value=\"Blood Pressure Concerns\" aria-errormessage=\"wpforms-224-field_87_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_87_7\">Blood Pressure Concerns<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_87_8\" name=\"wpforms[fields][87][]\" value=\"High Cholesterol\" aria-errormessage=\"wpforms-224-field_87_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_87_8\">High Cholesterol<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_87_9\" name=\"wpforms[fields][87][]\" value=\"Osteoporosis\" aria-errormessage=\"wpforms-224-field_87_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_87_9\">Osteoporosis<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_88-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"88\"><fieldset><legend class=\"wpforms-field-label\">Have you injured or have chronic pain in the following areas?<\/legend><ul id=\"wpforms-224-field_88\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_88_1\" name=\"wpforms[fields][88][]\" value=\"Neck\" aria-errormessage=\"wpforms-224-field_88_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_88_1\">Neck<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_88_2\" name=\"wpforms[fields][88][]\" value=\"Elbows\" aria-errormessage=\"wpforms-224-field_88_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_88_2\">Elbows<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_88_3\" name=\"wpforms[fields][88][]\" value=\"Wrists\" aria-errormessage=\"wpforms-224-field_88_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_88_3\">Wrists<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_88_4\" name=\"wpforms[fields][88][]\" value=\"Upper Back\" aria-errormessage=\"wpforms-224-field_88_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_88_4\">Upper Back<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_88_5\" name=\"wpforms[fields][88][]\" value=\"Knees\" aria-errormessage=\"wpforms-224-field_88_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_88_5\">Knees<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_88_6\" name=\"wpforms[fields][88][]\" value=\"Lower Back\" aria-errormessage=\"wpforms-224-field_88_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_88_6\">Lower Back<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_88_7\" name=\"wpforms[fields][88][]\" value=\"Shoulders\" aria-errormessage=\"wpforms-224-field_88_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_88_7\">Shoulders<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_88_8\" name=\"wpforms[fields][88][]\" value=\"Hips\" aria-errormessage=\"wpforms-224-field_88_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_88_8\">Hips<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-224-field_88_9\" name=\"wpforms[fields][88][]\" value=\"Feet\" aria-errormessage=\"wpforms-224-field_88_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_88_9\">Feet<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_89-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"89\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_89\">If yes, please explain:<\/label><textarea id=\"wpforms-224-field_89\" class=\"wpforms-field-medium\" name=\"wpforms[fields][89]\" aria-errormessage=\"wpforms-224-field_89-error\" ><\/textarea><\/div><div id=\"wpforms-224-field_90-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_90\">Please list any prescribed medications with dosages : <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_90\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][90]\" aria-errormessage=\"wpforms-224-field_90-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_91-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_91\">Please list any supplements or over the counter medications with dosages :<\/label><textarea id=\"wpforms-224-field_91\" class=\"wpforms-field-medium\" name=\"wpforms[fields][91]\" aria-errormessage=\"wpforms-224-field_91-error\" ><\/textarea><\/div><div id=\"wpforms-224-field_92-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_92\">Please write any known reactions to exercise your medication can have on you: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_92\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][92]\" aria-errormessage=\"wpforms-224-field_92-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_93-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"93\"><fieldset><legend class=\"wpforms-field-label\">Do you smoke?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_93\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_93_1\" name=\"wpforms[fields][93]\" value=\"Yes\" aria-errormessage=\"wpforms-224-field_93_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_93_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_93_2\" name=\"wpforms[fields][93]\" value=\"No\" aria-errormessage=\"wpforms-224-field_93_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_93_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_94-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"94\"><fieldset><legend class=\"wpforms-field-label\">Do you drink alcohol? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-224-field_94\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_94_1\" name=\"wpforms[fields][94]\" value=\"Yes\" aria-errormessage=\"wpforms-224-field_94_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_94_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-224-field_94_2\" name=\"wpforms[fields][94]\" value=\"No\" aria-errormessage=\"wpforms-224-field_94_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-224-field_94_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-224-field_95-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"95\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_95\">If so, how many drinks per week?<\/label><input type=\"text\" id=\"wpforms-224-field_95\" class=\"wpforms-field-medium\" name=\"wpforms[fields][95]\" aria-errormessage=\"wpforms-224-field_95-error\" ><\/div><div id=\"wpforms-224-field_96-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"96\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_96\">Are there any other reasons (health or personal) that may limit or prevent you from exercising? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_96\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][96]\" aria-errormessage=\"wpforms-224-field_96-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_97-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"97\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"9\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-10  \" data-page=\"10\" style=\"display:none;\"><div id=\"wpforms-224-field_131-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"131\"><h3 id=\"wpforms-224-field_131\" aria-errormessage=\"wpforms-224-field_131-error\">READINESS TO CHANGE QUESTIONNARIE<\/h3><\/div><div id=\"wpforms-224-field_132-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"132\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_132\">Are you looking to change a specific behavior? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_132\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-224-field_132-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_134-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"134\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_134\">Are you willing to make this behavioral change a top priority? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_134\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][134]\" aria-errormessage=\"wpforms-224-field_134-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_133-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"133\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_133\">Have you tried to change this behavior before? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_133\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][133]\" aria-errormessage=\"wpforms-224-field_133-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_135-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"135\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_135\">Do you believe there are inherent risks\/dangers associated with not making this behavioral change? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_135\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][135]\" aria-errormessage=\"wpforms-224-field_135-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_136-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"136\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_136\">Do you have support for making this change from family, friends and loved ones? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_136\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][136]\" aria-errormessage=\"wpforms-224-field_136-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_137-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"137\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_137\">Besides health reasons, do you have other reasons for wanting to change this behavior? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_137\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][137]\" aria-errormessage=\"wpforms-224-field_137-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_138-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"138\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_138\">Are you prepared to be patient with yourself if you encounter obstacles, barriers, and \/or setbacks? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-224-field_138\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][138]\" aria-errormessage=\"wpforms-224-field_138-error\" required><\/textarea><\/div><div id=\"wpforms-224-field_105-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"105\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"10\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-11  \" data-page=\"11\" style=\"display:none;\"><div id=\"wpforms-224-field_139-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"139\"><h3 id=\"wpforms-224-field_139\" aria-errormessage=\"wpforms-224-field_139-error\">Coaching Agreement<\/h3><\/div><div id=\"wpforms-224-field_106-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"106\"><div id=\"wpforms-224-field_106\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-224-field_106-error\"><p>By electronically signing this Agreement, the Client affirms understanding and agreement to the terms below.<\/p>\n<hr \/>\n<h3><strong>1. Coaching Relationship<\/strong><\/h3>\n<p>Coaching is a collaborative, strengths-based, and forward-looking relationship. The Coach partners with the Client to support behavioral change and goal progression. The coaching agenda is developed together by the Client and Coach.<\/p>\n<p>The Client acknowledges that coaching is <strong>not<\/strong> therapy, counseling, or consulting.<\/p>\n<hr \/>\n<h3><strong>2. Confidentiality<\/strong><\/h3>\n<p>The Coach agrees to keep all Client communications and shared information private and confidential, in accordance with applicable laws. Information will not be shared without the Client\u2019s explicit consent, unless required to prevent serious harm to the Client or others.<\/p>\n<hr \/>\n<h3><strong>3. Coaching Commitment<\/strong><\/h3>\n<p>The Client acknowledges that meaningful change takes time and agrees to engage in a coaching relationship for a <strong>minimum duration of three (3) months<\/strong>.<\/p>\n<hr \/>\n<h3><strong>4. Session Procedures<\/strong><\/h3>\n<p>Sessions may be held:<\/p>\n<ul>\n<li>In person<\/li>\n<li>By phone<\/li>\n<li>Through video conference<\/li>\n<li>By email<\/li>\n<\/ul>\n<p>The format will be determined based on the selected coaching package.<\/p>\n<p><strong>Session Policies:<\/strong><\/p>\n<ul>\n<li>Both parties will begin and end sessions on time.<\/li>\n<li>If the Client is more than 15 minutes late, the session will be considered canceled, and the full fee will apply.<\/li>\n<li>If the Coach is more than 15 minutes late, the Client will not be billed for the session.<\/li>\n<\/ul>\n<p><strong>Cancellation Policy:<\/strong><\/p>\n<ul>\n<li>The Client agrees to cancel or reschedule sessions at least 24 hours in advance.<\/li>\n<li>Sessions canceled with less than 24 hours&#8217; notice will be subject to a <strong>50% cancellation fee<\/strong>.<\/li>\n<\/ul>\n<hr \/>\n<h3><strong>5. Coaching Fees<\/strong><\/h3>\n<p>Details of coaching packages and fees are provided in <strong>Schedule 1<\/strong>.<\/p>\n<ul>\n<li>A 3-month minimum commitment is required.<\/li>\n<li>If the Client wishes to terminate before the 3 months, <strong>30 days&#8217; notice<\/strong> must be provided to receive a refund for any unused sessions.<\/li>\n<li>Payment is due on the <strong>1st of each month<\/strong>, before coaching services begin.<\/li>\n<\/ul>\n<p><strong>Accepted payment methods include:<\/strong><\/p>\n<ul>\n<li>Check<\/li>\n<li>Credit\/Debit Card<\/li>\n<li>Electronic Funds Transfer (EFT)<\/li>\n<\/ul>\n<hr \/>\n<h3><strong>6. Client Authorization and Signature<\/strong><\/h3>\n<p>By signing below, the Client confirms that they:<\/p>\n<ul>\n<li>Have read and understood this Agreement in full<\/li>\n<li>Agree to the terms and conditions as stated<\/li>\n<li>Consent to participate in coaching under this Agreement<\/li>\n<\/ul>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-224-field_107-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"107\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-224-field_107\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][107][first]\" aria-errormessage=\"wpforms-224-field_107-error\" required><label for=\"wpforms-224-field_107\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-224-field_107-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][107][last]\" aria-errormessage=\"wpforms-224-field_107-last-error\" required><label for=\"wpforms-224-field_107-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-224-field_111-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"111\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_111\">Date <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-224-field_111\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][111][date]\" aria-errormessage=\"wpforms-224-field_111-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-224-field_110-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-224-field_110\">Signature <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-224-field_110\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][110]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-224-field_110-error\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-224-field_110-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-224-field_112-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"112\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"11\" data-formid=\"224\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-12 last \" data-page=\"12\" style=\"display:none;\"><div id=\"wpforms-224-field_140-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"140\"><h3 id=\"wpforms-224-field_140\" aria-errormessage=\"wpforms-224-field_140-error\">Release of Liability Form<\/h3><\/div><div id=\"wpforms-224-field_114-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"114\"><div id=\"wpforms-224-field_114\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-224-field_114-error\"><p>By electronically signing this agreement, the Client acknowledges and agrees to the following terms:<\/p>\n<hr \/>\n<h3><strong>1. Voluntary Participation<\/strong><\/h3>\n<p>I, <em>[Client Name]<\/em>, acknowledge that I am voluntarily participating in health coaching services provided by <strong>Evolve to Fitness LLC<\/strong>.<\/p>\n<p>I understand that these services may include physical activity, emotional growth challenges, and dietary or lifestyle recommendations, all of which carry inherent risks.<\/p>\n<hr \/>\n<h3><strong>2. Assumption of Risk<\/strong><\/h3>\n<p>In consideration of being permitted to participate, I accept full responsibility for any risks, injuries, or damages\u2014known or unknown\u2014that may result from my participation in the program.<\/p>\n<hr \/>\n<h3><strong>3. Release of Liability<\/strong><\/h3>\n<p>I hereby <strong>release, waive, discharge, and agree not to sue<\/strong> Evolve to Fitness LLC, its officers, employees, or agents for any and all claims, demands, actions, or causes of action relating to loss, damage, or injury (including death) that may be sustained by me or my property during participation in the services provided.<\/p>\n<hr \/>\n<h3><strong>4. Medical Disclaimer &amp; Responsibility<\/strong><\/h3>\n<ul>\n<li>I affirm that I have consulted or will consult with a physician regarding my participation in this program.<\/li>\n<li>I confirm that I am physically fit and have no medical condition that would prevent my full participation.<\/li>\n<li>I understand that <strong>Evolve to Fitness LLC is not a licensed healthcare provider<\/strong> and does not diagnose, treat, or cure any medical conditions.<\/li>\n<li>All information provided is for <strong>educational and informational purposes only<\/strong>, and should not be considered medical advice.<\/li>\n<\/ul>\n<hr \/>\n<h3><strong>5. Acknowledgment &amp; Electronic Signature<\/strong><\/h3>\n<p>I confirm that I have read and understood this Liability Waiver and Release Form in its entirety.<br \/>\nI fully understand that I am <strong>waiving substantial legal rights<\/strong>, including my right to sue.<br \/>\nI acknowledge that I am signing this agreement <strong>freely and voluntarily<\/strong> and intend it to be a complete and unconditional release of liability to the fullest extent permitted by law.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-224-field_115-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"115\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-224-field_115\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][115][first]\" aria-errormessage=\"wpforms-224-field_115-error\" required><label for=\"wpforms-224-field_115\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-224-field_115-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][115][last]\" aria-errormessage=\"wpforms-224-field_115-last-error\" required><label for=\"wpforms-224-field_115-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-224-field_116-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"116\"><fieldset><legend class=\"wpforms-field-label\">Date <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-date-type-datepicker\"><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-224-field_116\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][116][date]\" aria-errormessage=\"wpforms-224-field_116-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><label for=\"wpforms-224-field_116\" class=\"wpforms-field-sublabel after\">Date<\/label><\/div><div class=\"wpforms-field-row-block\"><input type=\"text\" id=\"wpforms-224-field_116-time\" class=\"wpforms-field-date-time-time wpforms-timepicker wpforms-field-required\" data-time-format=\"g:i A\" data-step=\"30\" data-rule-time12h=\"true\" name=\"wpforms[fields][116][time]\" aria-errormessage=\"wpforms-224-field_116-time-error\" required><label for=\"wpforms-224-field_116-time\" class=\"wpforms-field-sublabel 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preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-224-field_27-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"27\"><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"224\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/evolvetofitness.com\/index.php\/wp-json\/wp\/v2\/pages\/285\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-224\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/evolvetofitness.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/evolvetofitness.com\/index.php\/wp-json\/wp\/v2\/pages\/285"}],"collection":[{"href":"https:\/\/evolvetofitness.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/evolvetofitness.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/evolvetofitness.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/evolvetofitness.com\/index.php\/wp-json\/wp\/v2\/comments?post=285"}],"version-history":[{"count":1,"href":"https:\/\/evolvetofitness.com\/index.php\/wp-json\/wp\/v2\/pages\/285\/revisions"}],"predecessor-version":[{"id":287,"href":"https:\/\/evolvetofitness.com\/index.php\/wp-json\/wp\/v2\/pages\/285\/revisions\/287"}],"wp:attachment":[{"href":"https:\/\/evolvetofitness.com\/index.php\/wp-json\/wp\/v2\/media?parent=285"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}