{"id":1410,"date":"2025-01-28T17:23:23","date_gmt":"2025-01-28T17:23:23","guid":{"rendered":"https:\/\/griggsydownunder.com\/?page_id=1410"},"modified":"2025-02-28T20:08:12","modified_gmt":"2025-02-28T20:08:12","slug":"wellness-quiz","status":"publish","type":"page","link":"https:\/\/griggsydownunder.com\/?page_id=1410","title":{"rendered":"Wellness Quiz"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1410\" class=\"elementor elementor-1410\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-783514d e-flex e-con-boxed e-con e-parent\" data-id=\"783514d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-337040d e-flex e-con-boxed e-con e-parent\" data-id=\"337040d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-610bf53 elementor-widget elementor-widget-spacer\" data-id=\"610bf53\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-fb78530 e-flex e-con-boxed e-con e-parent\" data-id=\"fb78530\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-20c4a74 elementor-widget elementor-widget-heading\" data-id=\"20c4a74\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Our Wellness Quiz<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f7fe0f8 elementor-widget elementor-widget-text-editor\" data-id=\"f7fe0f8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div>Not sure which program or treatment is right for you? Take our short <span class=\"il\">quiz<\/span>\u00a0to find out! Answer a few quick questions, and our team will personally review your responses to recommend the best health program or therapy for your needs. Our goal is to guide you toward the most effective path to optimal\u00a0<span class=\"il\">wellness<\/span>.<\/div><div>\u00a0<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7f07967 elementor-widget elementor-widget-text-editor\" data-id=\"7f07967\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div><div>At the end of the\u00a0<span class=\"il\">quiz<\/span>, you\u2019ll receive a link to schedule a consultation for expert guidance.<\/div><\/div><div>\u00a0<\/div><div>Our Experts will also review your responses and get back to you personally.<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-beb9a6a e-flex e-con-boxed e-con e-parent\" data-id=\"beb9a6a\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4e0115e elementor-widget elementor-widget-rform\" data-id=\"4e0115e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t            <form id=\"rform\" data-form=\"2196\">\r\n                <div class=\"require-login msg\">\r\n                    <div class=\"require-msg-body\">\r\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"35\" height=\"35\" fill=\"#FF0000\" class=\"bi bi-exclamation-circle-fill\" viewBox=\"0 0 16 16\">\r\n                            <path d=\"M16 8A8 8 0 1 1 0 8a8 8 0 0 1 16 0zM8 4a.905.905 0 0 0-.9.995l.35 3.507a.552.552 0 0 0 1.1 0l.35-3.507A.905.905 0 0 0 8 4zm.002 6a1 1 0 1 0 0 2 1 1 0 0 0 0-2z\" \/>\r\n                        <\/svg>\r\n                        <div style=\"width: 100% ;\">\r\n                            <h5 class=\"required-title\">Required Login<\/h5>\r\n                            Please Login for Submit Form.\r\n                        <\/div>\r\n                        <div>\r\n                            <a type=\"button\" class=\"close-msg\">Close<\/a>\r\n                        <\/div>\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"success-submit msg\"\r\n                    >\r\n                    <div class=\"success-body\">\r\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"35\" height=\"35\" class=\"bi bi-check-circle-fill success-icon\" viewBox=\"0 0 16 16\">\r\n                            <path d=\"M16 8A8 8 0 1 1 0 8a8 8 0 0 1 16 0zm-3.97-3.03a.75.75 0 0 0-1.08.022L7.477 9.417 5.384 7.323a.75.75 0 0 0-1.06 1.06L6.97 11.03a.75.75 0 0 0 1.079-.02l3.992-4.99a.75.75 0 0 0-.01-1.05z\" \/>\r\n                        <\/svg>\r\n                        <div style=\"width: 100%;\">\r\n                            <h5 class=\"success-title\">Success<\/h5>\r\n                            <p class=\"success-description\">\r\n                                Thank you! Quiz submittes successfully                            <\/p>\r\n                        <\/div>\r\n                        <div>\r\n                            <button class=\"close-msg\"><\/button>\r\n                        <\/div>\r\n                    <\/div>\r\n                <\/div>\r\n                <style>.elementor-2196 .elementor-element.elementor-element-1d81973{--display:flex;}.elementor-2196 .elementor-element.elementor-element-0f42fd3 .rform-label-input{margin:0px 0px 10px 0px;}.elementor-2196 .elementor-element.elementor-element-0f42fd3 .rform-error{text-align:left;}.elementor-2196 .elementor-element.elementor-element-a548b6f .rform-label-input{margin:0px 0px 10px 0px;}.elementor-2196 .elementor-element.elementor-element-a548b6f .rform-error{text-align:left;}.elementor-2196 .elementor-element.elementor-element-822f223 .rform-radio-button{flex-direction:column;}.elementor-2196 .elementor-element.elementor-element-822f223 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.rform-button-submit{flex-direction:row;font-family:var( --e-global-typography-accent-font-family ), Sans-serif;font-size:var( --e-global-typography-accent-font-size );font-weight:var( --e-global-typography-accent-font-weight );color:#FFFFFF;}.elementor-2196 .elementor-element.elementor-element-2c5825b .rform-button-container{justify-content:start;}.elementor-2196 .elementor-element.elementor-element-2c5825b #loading{border-top-color:#FFFFFF;}.elementor-2196 .elementor-element.elementor-element-2c5825b .rform-button-submit {background-color:var( --e-global-color-accent );}.elementor-2196 .elementor-element.elementor-element-2c5825b .rform-button-submit:hover{color:var( --e-global-color-accent );}.elementor-2196 .elementor-element.elementor-element-2c5825b .rform-button-submit:hover {background-color:#FFFFFF;}@media(max-width:1024px){.elementor-2196 .elementor-element.elementor-element-07f7f98 .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-fc0e76e .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-4292302 .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-50cb46e .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-68bc3d8 .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-36266d9 .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-2c5825b .rform-button-submit{font-size:var( --e-global-typography-accent-font-size );}}@media(max-width:767px){.elementor-2196 .elementor-element.elementor-element-07f7f98 .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-fc0e76e .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-4292302 .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-50cb46e .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-68bc3d8 .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-36266d9 .rform-label-input{font-size:var( --e-global-typography-accent-font-size );}.elementor-2196 .elementor-element.elementor-element-2c5825b .rform-button-submit{font-size:var( --e-global-typography-accent-font-size );}}<\/style>\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"2196\" class=\"elementor elementor-2196\" data-elementor-post-type=\"romethemeform_form\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1d81973 e-flex e-con-boxed e-con e-parent\" data-id=\"1d81973\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d5f64c9 elementor-widget elementor-widget-heading\" data-id=\"d5f64c9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Your Info<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0f42fd3 elementor-widget elementor-widget-text\" data-id=\"0f42fd3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-16003027\">\r\n                        Name                        <span> * <\/span>                    <\/label>\r\n                                <input name=\"rform-text\" placeholder=\"Input Text Here\" class=\"rform-input\" id=\"rform-input-text-16003027\" type=\"text\" onblur=\"validate_input( 'rform-input-text-' , 'rform-input-err-' ,'16003027')\" aria-invalid=false data-val=\"by_char\"   required>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-16003027\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a548b6f elementor-widget elementor-widget-email\" data-id=\"a548b6f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"email.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-email-173312879\">\r\n                        Email                        <span> * <\/span>                    <\/label>\r\n                                <input name=\"rform-email\" placeholder=\"Input Email Here\" class=\"rform-input\" id=\"rform-input-email-173312879\" type=\"email\" onblur=\"validate_input( 'rform-input-email-' , 'rform-input-err-' ,'173312879')\" aria-invalid=false data-val=\"by_char\"   required>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-173312879\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c4f85a3 elementor-widget elementor-widget-heading\" data-id=\"c4f85a3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Wellness<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-822f223 elementor-widget elementor-widget-rform-radio-widget\" data-id=\"822f223\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-radio-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-left\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-136507939\">\r\n                        Do you experience any of the following digestive issues?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-radio-button\">\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"option_1\" name=\"rform-radiobtn\" checked required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Frequent Bloating or Gas<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"option_2\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Irregular bowel movements (constipation, diarrhea, or both)<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"option_3\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Acid reflux, heartburn, or indigestion<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"option_3\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Food sensitivities or unexplained digestive discomfort<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-136507939\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-34e6db9 elementor-widget elementor-widget-rform-radio-widget\" data-id=\"34e6db9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-radio-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-left\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-55471545\">\r\n                        How would you describe your daily energy levels?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-radio-button\">\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I feel energized and alert most of the time\" name=\"rform-radiobtn\" checked required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I feel energized and alert most of the time<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I have occasional energy dips, especially in the afternoon\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I have occasional energy dips, especially in the afternoon<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I often feel sluggish or rely on caffeine to get through the day\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I often feel sluggish or rely on caffeine to get through the day<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I struggle with chronic fatigue and burnout\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I struggle with chronic fatigue and burnout<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-55471545\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b9bc4ab elementor-widget elementor-widget-rform-radio-widget\" data-id=\"b9bc4ab\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-radio-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-left\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-194757803\">\r\n                        Have you been exposed to environmental toxins (mold, heavy metals, chronic infections)?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-radio-button\">\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"No known exposure\" name=\"rform-radiobtn\" checked required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">No known exposure<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"Yes, confirmed mold or toxin exposure\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Yes, confirmed mold or toxin exposure<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"Yes, but I\u2019m unsure of how it\u2019s affecting me\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Yes, but I\u2019m unsure of how it\u2019s affecting me<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"No known exposure, but I have unexplained symptoms like brain fog, fatigue, or inflammation\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">No known exposure, but I have unexplained symptoms like brain fog, fatigue, or inflammation<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-194757803\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d2d9402 elementor-widget elementor-widget-rform-radio-widget\" data-id=\"d2d9402\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-radio-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-left\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-221090818\">\r\n                        Are you interested in hair restoration, skincare, or anti-aging treatments?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-radio-button\">\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"No\" name=\"rform-radiobtn\" checked required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">No<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"Yes, I\u2019m experiencing hair thinning and want solutions\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Yes, I\u2019m experiencing hair thinning and want solutions<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"Yes, I want to improve my skin\u2019s health and appearance\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Yes, I want to improve my skin\u2019s health and appearance<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"Yes, I want to optimize my longevity and anti-aging plan\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Yes, I want to optimize my longevity and anti-aging plan<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-221090818\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f896f41 elementor-widget elementor-widget-rform-radio-widget\" data-id=\"f896f41\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-radio-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-left\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-260665153\">\r\n                        How would you describe your sleep quality?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-radio-button\">\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I sleep well and wake up refreshed\" name=\"rform-radiobtn\" checked required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I sleep well and wake up refreshed<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\" I wake up during the night but usually fall back asleep\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\"> I wake up during the night but usually fall back asleep<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I have trouble falling asleep or staying asleep\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I have trouble falling asleep or staying asleep<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I often feel unrested no matter how much I sleep\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I often feel unrested no matter how much I sleep<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-260665153\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0a62e3f elementor-widget elementor-widget-rform-radio-widget\" data-id=\"0a62e3f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-radio-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-left\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-10890815\">\r\n                        How would you describe your physical activity level?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-radio-button\">\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I exercise regularly and feel strong\" name=\"rform-radiobtn\" checked required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I exercise regularly and feel strong<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I exercise occasionally but don\u2019t feel very fit\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I exercise occasionally but don\u2019t feel very fit<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I want to be more active but struggle with energy or pain\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I want to be more active but struggle with energy or pain<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I experience fatigue, joint pain, or inflammation that limits my ability to exercise\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I experience fatigue, joint pain, or inflammation that limits my ability to exercise<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-10890815\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-757686f elementor-widget elementor-widget-rform-radio-widget\" data-id=\"757686f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-radio-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-left\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-123168879\">\r\n                        How do you manage stress in your daily life?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-radio-button\">\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I have strong stress-management habits and feel balanced\" name=\"rform-radiobtn\" checked required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I have strong stress-management habits and feel balanced<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I get overwhelmed but try to manage it well\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I get overwhelmed but try to manage it well<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"I often feel anxious, irritable, or emotionally drained\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">I often feel anxious, irritable, or emotionally drained<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-radiobtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"radio\" value=\"Stress has taken a toll on my health and energy levels\" name=\"rform-radiobtn\"  required>\r\n                                <span class=\"rform-radio-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-radio-label\">Stress has taken a toll on my health and energy levels<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-123168879\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5f2af50 elementor-widget elementor-widget-heading\" data-id=\"5f2af50\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Choose All That Apply<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-07f7f98 elementor-widget elementor-widget-rform-checkbox-widget\" data-id=\"07f7f98\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-checkbox-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-8355736\">\r\n                        Are you experiencing any hormonal symptoms? (Select All that Apply)                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-checkbox-button\"\r\n                 required \r\n                data-min=\"1\"                                >\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"No symptoms\" name=\"rform-checkboxbtn[]\" checked>\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">No symptoms<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Unexplained weight gain or difficulty losing weight\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Unexplained weight gain or difficulty losing weight<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Low libido or motivation\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Low libido or motivation<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Mood swings, anxiety, or depression\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Mood swings, anxiety, or depression<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Hot flashes, night sweats, or irregular menstrual cycles (for women)\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Hot flashes, night sweats, or irregular menstrual cycles (for women)<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Hair thinning, brittle nails, or dry skin\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Hair thinning, brittle nails, or dry skin<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-8355736\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fc0e76e elementor-widget elementor-widget-rform-checkbox-widget\" data-id=\"fc0e76e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-checkbox-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-264300398\">\r\n                        Do you have a history of cardiovascular or metabolic concerns? (Select All that Apply)                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-checkbox-button\"\r\n                 required \r\n                data-min=\"1\"                                >\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"No known issues\" name=\"rform-checkboxbtn[]\" checked>\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">No known issues<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"High cholesterol or triglycerides\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">High cholesterol or triglycerides<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"High blood pressure\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">High blood pressure<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Blood sugar imbalances, insulin resistance, or prediabetes\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Blood sugar imbalances, insulin resistance, or prediabetes<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Family history of heart disease or stroke\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Family history of heart disease or stroke<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-264300398\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4292302 elementor-widget elementor-widget-rform-checkbox-widget\" data-id=\"4292302\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-checkbox-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-69804802\">\r\n                        Do you experience any of the following chronic pain or inflammation issues?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-checkbox-button\"\r\n                 required \r\n                data-min=\"1\"                                >\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"No chronic pain\" name=\"rform-checkboxbtn[]\" checked>\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">No chronic pain<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Joint pain, stiffness, or arthritis\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Joint pain, stiffness, or arthritis<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Nerve pain, tingling, or burning sensations in hands or feet\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Nerve pain, tingling, or burning sensations in hands or feet<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Muscle aches, tension, or slow injury recovery\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Muscle aches, tension, or slow injury recovery<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Chronic headaches or migraines\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Chronic headaches or migraines<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-69804802\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-50cb46e elementor-widget elementor-widget-rform-checkbox-widget\" data-id=\"50cb46e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-checkbox-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-84718702\">\r\n                        Have you noticed any changes in your cognitive function?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-checkbox-button\"\r\n                 required \r\n                data-min=\"1\"                                >\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"No concerns with memory or focus\" name=\"rform-checkboxbtn[]\" checked>\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">No concerns with memory or focus<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"I sometimes feel mentally foggy or forgetful\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">I sometimes feel mentally foggy or forgetful<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"I struggle with focus and concentration\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">I struggle with focus and concentration<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"I have anxiety, depression, or mood swings\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">I have anxiety, depression, or mood swings<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-84718702\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-68bc3d8 elementor-widget elementor-widget-rform-checkbox-widget\" data-id=\"68bc3d8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-checkbox-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-109822936\">\r\n                        Have you noticed any changes in your cognitive function?                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-checkbox-button\"\r\n                 required \r\n                data-min=\"1\"                                >\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"No concerns with memory or focus\" name=\"rform-checkboxbtn[]\" checked>\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">No concerns with memory or focus<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"I sometimes feel mentally foggy or forgetful\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">I sometimes feel mentally foggy or forgetful<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"I struggle with focus and concentration\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">I struggle with focus and concentration<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"I have anxiety, depression, or mood swings\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">I have anxiety, depression, or mood swings<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-109822936\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-36266d9 elementor-widget elementor-widget-rform-checkbox-widget\" data-id=\"36266d9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform-checkbox-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-56780505\">\r\n                        Do you frequently experience any of the following immune-related symptoms? (Select all that apply.)                        <span> * <\/span>                    <\/label>\r\n                                <div class=\"rform-checkbox-button\"\r\n                 required \r\n                data-min=\"1\"                                >\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"No frequent illnesses\" name=\"rform-checkboxbtn[]\" checked>\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">No frequent illnesses<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Recurrent colds, sinus infections, or respiratory issues\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Recurrent colds, sinus infections, or respiratory issues<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"History of chronic infections (Lyme, Epstein-Barr, long-haul COVID)\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">History of chronic infections (Lyme, Epstein-Barr, long-haul COVID)<\/span>\r\n                        <\/label>\r\n                                            <label class=\"rform-checkboxbtn-container\">\r\n                            <div>\r\n                                <input class=\"rform-input\" type=\"checkbox\" value=\"Diagnosed autoimmune condition or unexplained inflammation\" name=\"rform-checkboxbtn[]\" >\r\n                                <span class=\"rform-checkbox-checkmark\"><\/span>\r\n                            <\/div>\r\n                            <span class=\"rform-checkbox-label\">Diagnosed autoimmune condition or unexplained inflammation<\/span>\r\n                        <\/label>\r\n                                    <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-56780505\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2c5825b elementor-widget elementor-widget-rform_button_submit\" data-id=\"2c5825b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform_button_submit.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-button-container\">\r\n            <button class=\"rform-button-submit \" type=\"button\" id=\"rform-button-submit\">\r\n                <div class=\"rform-btn-icon-container\">\r\n                                    <\/div>\r\n                Submit            <\/button>\r\n        <\/div>\r\n\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t            <\/form>\r\n            \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Our Wellness Quiz Not sure which program or treatment is right for you? Take our short quiz\u00a0to find out! Answer a few quick questions, and our team will personally review your responses to recommend the best health program or therapy for your needs. Our goal is to guide you toward the most effective path to [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1410","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/griggsydownunder.com\/index.php?rest_route=\/wp\/v2\/pages\/1410","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/griggsydownunder.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/griggsydownunder.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/griggsydownunder.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/griggsydownunder.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1410"}],"version-history":[{"count":46,"href":"https:\/\/griggsydownunder.com\/index.php?rest_route=\/wp\/v2\/pages\/1410\/revisions"}],"predecessor-version":[{"id":2839,"href":"https:\/\/griggsydownunder.com\/index.php?rest_route=\/wp\/v2\/pages\/1410\/revisions\/2839"}],"wp:attachment":[{"href":"https:\/\/griggsydownunder.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1410"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}