{"id":78,"date":"2021-04-08T21:13:15","date_gmt":"2021-04-08T21:13:15","guid":{"rendered":"https:\/\/patients.expressmarijuanacard.com\/?page_id=78"},"modified":"2021-04-08T21:13:29","modified_gmt":"2021-04-08T21:13:29","slug":"test-survey","status":"publish","type":"page","link":"https:\/\/patients.expressmarijuanacard.com\/test-survey\/","title":{"rendered":"Test Survey"},"content":{"rendered":"\n\n\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-77\"><form id=\"wpforms-form-77\" class=\"wpforms-validate wpforms-form\" data-formid=\"77\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/wp-json\/wp\/v2\/pages\/78\" data-token=\"7fb263758da9f97793dacb35d26bc354\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 2<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:50%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-77-field_28-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"28\"><\/div><div id=\"wpforms-77-field_23-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_23\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-77-field_23\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][23][first]\" required><label for=\"wpforms-77-field_23\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-77-field_23-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][23][last]\" required><label for=\"wpforms-77-field_23-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-77-field_26-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half wpforms-first\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_26\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-77-field_26\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][26]\" required><\/div><div id=\"wpforms-77-field_24-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_24\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-77-field_24\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][24]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-77-field_27-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"27\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"77\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2 last \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-77-field_1-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"1\"><h3 id=\"wpforms-77-field_1\" name=\"wpforms[fields][1]\">Complete all questions to submit your test<\/h3><div class=\"wpforms-field-description\">This questionnaire called the GAD-7 screening tool can help you find out if you might have an\r\nanxiety disorder that needs treatment. It calculates how many common symptoms you have and based\r\non your answers suggests where you might be on a scale, from mild to severe anxiety. \r\n<p>-<\/p>\r\n<p>GAD-7 stands for \"generalized anxiety disorder\" and the 7 questions in the tool. Choose one answer for each of the 7 questions below:<\/p><\/div><\/div><div id=\"wpforms-77-field_3-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"3\"><h3 id=\"wpforms-77-field_3\" name=\"wpforms[fields][3]\">Over the last 2 weeks, how often have you been bothered by the following problems?<\/h3><\/div><div id=\"wpforms-77-field_30-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-list-inline\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_30\">1) Feeling nervous, anxious or on edge <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-77-field_30\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-77-field_30_1\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][30]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_30_1\">(0) Not at all<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-77-field_30_2\" class=\"wpforms-payment-price\" data-amount=\"1.00\" name=\"wpforms[fields][30]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_30_2\">(1) Several days<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-77-field_30_3\" class=\"wpforms-payment-price\" data-amount=\"2.00\" name=\"wpforms[fields][30]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_30_3\">(2) More than half the days<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-77-field_30_4\" class=\"wpforms-payment-price\" data-amount=\"3.00\" name=\"wpforms[fields][30]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_30_4\">(3) Nearly every day<\/label><\/li><\/ul><\/div><div id=\"wpforms-77-field_31-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-list-inline\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_31\">2)  Not being able to stop or control worrying <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-77-field_31\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-77-field_31_1\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][31]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_31_1\">(0) Not at all<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-77-field_31_2\" class=\"wpforms-payment-price\" data-amount=\"1.00\" name=\"wpforms[fields][31]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_31_2\">(1) Several days<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-77-field_31_3\" class=\"wpforms-payment-price\" data-amount=\"2.00\" name=\"wpforms[fields][31]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_31_3\">(2) More than half the days<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-77-field_31_4\" class=\"wpforms-payment-price\" data-amount=\"3.00\" name=\"wpforms[fields][31]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_31_4\">(3) Nearly every day<\/label><\/li><\/ul><\/div><div id=\"wpforms-77-field_32-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-list-inline\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_32\">3)  Worrying too much about different things <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-77-field_32\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-77-field_32_1\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][32]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_32_1\">(0) Not at all<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-77-field_32_2\" class=\"wpforms-payment-price\" data-amount=\"1.00\" name=\"wpforms[fields][32]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_32_2\">(1) Several days<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-77-field_32_3\" class=\"wpforms-payment-price\" data-amount=\"2.00\" name=\"wpforms[fields][32]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_32_3\">(2) More than half the days<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-77-field_32_4\" class=\"wpforms-payment-price\" data-amount=\"3.00\" name=\"wpforms[fields][32]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_32_4\">(3) Nearly every day<\/label><\/li><\/ul><\/div><div id=\"wpforms-77-field_33-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-list-inline\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_33\">4)  Trouble relaxing <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-77-field_33\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-77-field_33_1\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][33]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_33_1\">(0) Not at all<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-77-field_33_2\" class=\"wpforms-payment-price\" data-amount=\"1.00\" name=\"wpforms[fields][33]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_33_2\">(1) Several days<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-77-field_33_3\" class=\"wpforms-payment-price\" data-amount=\"2.00\" name=\"wpforms[fields][33]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_33_3\">(2) More than half the days<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-77-field_33_4\" class=\"wpforms-payment-price\" data-amount=\"3.00\" name=\"wpforms[fields][33]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_33_4\">(3) Nearly every day<\/label><\/li><\/ul><\/div><div id=\"wpforms-77-field_34-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-list-inline\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_34\">5)  Being so restless that it&#039;s hard to sit still <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-77-field_34\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-77-field_34_1\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][34]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_34_1\">(0) Not at all<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-77-field_34_2\" class=\"wpforms-payment-price\" data-amount=\"1.00\" name=\"wpforms[fields][34]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_34_2\">(1) Several days<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-77-field_34_3\" class=\"wpforms-payment-price\" data-amount=\"2.00\" name=\"wpforms[fields][34]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_34_3\">(2) More than half the days<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-77-field_34_4\" class=\"wpforms-payment-price\" data-amount=\"3.00\" name=\"wpforms[fields][34]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_34_4\">(3) Nearly every day<\/label><\/li><\/ul><\/div><div id=\"wpforms-77-field_35-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-list-inline\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_35\">6)  Becoming easily annoyed or irritable <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-77-field_35\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-77-field_35_1\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][35]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_35_1\">(0) Not at all<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-77-field_35_2\" class=\"wpforms-payment-price\" data-amount=\"1.00\" name=\"wpforms[fields][35]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_35_2\">(1) Several days<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-77-field_35_3\" class=\"wpforms-payment-price\" data-amount=\"2.00\" name=\"wpforms[fields][35]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_35_3\">(2) More than half the days<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-77-field_35_4\" class=\"wpforms-payment-price\" data-amount=\"3.00\" name=\"wpforms[fields][35]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_35_4\">(3) Nearly every day<\/label><\/li><\/ul><\/div><div id=\"wpforms-77-field_36-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-list-inline\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_36\">7)  Feeling afraid, as if something awful might happen <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-77-field_36\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-77-field_36_1\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][36]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_36_1\">(0) Not at all<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-77-field_36_2\" class=\"wpforms-payment-price\" data-amount=\"1.00\" name=\"wpforms[fields][36]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_36_2\">(1) Several days<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-77-field_36_3\" class=\"wpforms-payment-price\" data-amount=\"2.00\" name=\"wpforms[fields][36]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_36_3\">(2) More than half the days<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-77-field_36_4\" class=\"wpforms-payment-price\" data-amount=\"3.00\" name=\"wpforms[fields][36]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-77-field_36_4\">(3) Nearly every day<\/label><\/li><\/ul><\/div><div id=\"wpforms-77-field_37-container\" class=\"wpforms-field wpforms-field-payment-total\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_37\">Total Score <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-payment-total\">= 0.00<\/div><input type=\"text\" id=\"wpforms-77-field_37\" class=\"wpforms-field-required wpforms-payment-total\" data-rule-required-payment=\"1\" name=\"wpforms[fields][37]\" value=\"0\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" readonly=\"readonly\"><\/div><div id=\"wpforms-77-field_21-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"21\"><h3 id=\"wpforms-77-field_21\" name=\"wpforms[fields][21]\">What your total score means<\/h3><div class=\"wpforms-field-description\">Your total score is a guide to how severe your anxiety disorder may be:<p>\r\n-<p>\r\n\u2022 0 to 4 = mild anxiety<br>\r\n\u2022 5 to 9 = moderate anxiety<br>\r\n\u2022 10 to 14 = moderately severe anxiety<br>\r\n\u2022 15 to 21 = severe anxiety<p><\/div><\/div><div id=\"wpforms-77-field_22-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-77-field_22\">Signature <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-77-field_22\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][22]\" autocomplete=\"off\" required><div class=\"wpforms-signature-wrap wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-77-field_22-signature\" data-color=\"#000000\"><\/canvas><button class=\"wpforms-signature-clear\" title=\"Clear Signature\">Clear Signature<\/button><\/div><\/div><div id=\"wpforms-77-field_29-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"29\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"77\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-77\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/patients.expressmarijuanacard.com\/wp-json\/wp\/v2\/pages\/78"}],"collection":[{"href":"https:\/\/patients.expressmarijuanacard.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/patients.expressmarijuanacard.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/patients.expressmarijuanacard.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/patients.expressmarijuanacard.com\/wp-json\/wp\/v2\/comments?post=78"}],"version-history":[{"count":0,"href":"https:\/\/patients.expressmarijuanacard.com\/wp-json\/wp\/v2\/pages\/78\/revisions"}],"wp:attachment":[{"href":"https:\/\/patients.expressmarijuanacard.com\/wp-json\/wp\/v2\/media?parent=78"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}