[et_pb_section fb_built="1" fullwidth="on" _builder_version="3.12.2"][et_pb_fullwidth_slider _builder_version="3.12.2" body_font="||||||||" header_font="Arial||||||||"][et_pb_slide heading="Know Yourself " _builder_version="3.12.2" background_image="http://www.dalabsmit.in/wp-content/uploads/2018/09/space-backgrounds-tumblr-hd-background-desktop-1.jpg" header_font="||||||||" header_text_color="#e02b20" body_font="||||||||" body_text_color="#e09900"]<p>Take a moment to answer the following questions to test yourself and to know yourself</p>
[/et_pb_slide][/et_pb_fullwidth_slider][/et_pb_section][et_pb_section fb_built="1" admin_label="section" _builder_version="3.0.47"][et_pb_row admin_label="row" _builder_version="3.0.48" background_size="initial" background_position="top_left" background_repeat="repeat"][et_pb_column type="4_4" _builder_version="3.0.47" parallax="off" parallax_method="on"][et_pb_text admin_label="Text" _builder_version="3.0.74" background_size="initial" background_position="top_left" background_repeat="repeat"]<h1>Please select the appropriate answers for the below questions:</h1>
<p>&nbsp;</p>
<table class="wp-list-table widefat fixed striped posts">
<tbody>
<tr>
<td>
<h5><code>
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<form class="wpuf-form-add wpuf-style weforms-104  " action="" method="post" id="">
<ul class="wpuf-form form-label-above">
<li class="wpuf-el gender field-size-large" data-label="Gender">
<div class="wpuf-label"><label for="gender_104">Gender <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="gender" class="wpuf_gender_104" type="radio" value="male" /> Male </label> <label class="wpuf-radio-block"> <input name="gender" class="wpuf_gender_104" type="radio" value="female" /> Female </label> <label class="wpuf-radio-block"> <input name="gender" class="wpuf_gender_104" type="radio" value="others" /> Others </label></div>
</li>
<li class="wpuf-el district field-size-large" data-label="District">
<div class="wpuf-label"><label for="district_104">District <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="district" class="wpuf_district_104" type="radio" value="east_sikkim" /> East Sikkim </label> <label class="wpuf-radio-block"> <input name="district" class="wpuf_district_104" type="radio" value="west_sikkim" /> West Sikkim </label> <label class="wpuf-radio-block"> <input name="district" class="wpuf_district_104" type="radio" value="north_sikkim" /> North Sikkim </label> <label class="wpuf-radio-block"> <input name="district" class="wpuf_district_104" type="radio" value="south_sikkim" /> South Sikkim </label></div>
</li>
<li class="wpuf-el area_ field-size-large" data-label="Area ">
<div class="wpuf-label"><label for="area__104">Area <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="area_" class="wpuf_area__104" type="radio" value="urban" /> Urban </label> <label class="wpuf-radio-block"> <input name="area_" class="wpuf_area__104" type="radio" value="rural" /> Rural </label></div>
</li>
<li class="wpuf-el community_ field-size-large" data-label="Community ">
<div class="wpuf-label"><label for="community__104">Community <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="community_" class="wpuf_community__104" type="radio" value="st" /> ST </label> <label class="wpuf-radio-block"> <input name="community_" class="wpuf_community__104" type="radio" value="sc" /> SC </label> <label class="wpuf-radio-block"> <input name="community_" class="wpuf_community__104" type="radio" value="obc" /> OBC </label> <label class="wpuf-radio-block"> <input name="community_" class="wpuf_community__104" type="radio" value="mbc" /> MBC </label> <label class="wpuf-radio-block"> <input name="community_" class="wpuf_community__104" type="radio" value="general" /> GENERAL </label></div>
</li>
<li class="wpuf-el qualification field-size-large" data-label="Qualification">
<div class="wpuf-label"><label for="qualification_104">Qualification <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="qualification" class="wpuf_qualification_104" type="radio" value="matriculation" /> Matriculation </label> <label class="wpuf-radio-block"> <input name="qualification" class="wpuf_qualification_104" type="radio" value="senior_secondary" /> Senior Secondary </label> <label class="wpuf-radio-block"> <input name="qualification" class="wpuf_qualification_104" type="radio" value="graduation" /> Graduation </label> <label class="wpuf-radio-block"> <input name="qualification" class="wpuf_qualification_104" type="radio" value="post-graduation" /> Post-Graduation </label> <label class="wpuf-radio-block"> <input name="qualification" class="wpuf_qualification_104" type="radio" value="none" /> None </label></div>
</li>
<li class="wpuf-el job_type field-size-large" data-label="Job type">
<div class="wpuf-label"><label for="job_type_104">Job type <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="job_type" class="wpuf_job_type_104" type="radio" value="government_" /> Government </label> <label class="wpuf-radio-block"> <input name="job_type" class="wpuf_job_type_104" type="radio" value="semi-government" /> Semi-Government </label> <label class="wpuf-radio-block"> <input name="job_type" class="wpuf_job_type_104" type="radio" value="private" /> Private </label> <label class="wpuf-radio-block"> <input name="job_type" class="wpuf_job_type_104" type="radio" value="self-employed" /> Self-employed </label> <label class="wpuf-radio-block"> <input name="job_type" class="wpuf_job_type_104" type="radio" value="unemployed_" /> Unemployed </label> <label class="wpuf-radio-block"> <input name="job_type" class="wpuf_job_type_104" type="radio" value="student" /> Student </label></div>
</li>
<li class="wpuf-el age field-size-small" data-label="Age">
<div class="wpuf-label"><label for="age_104">Age <span class="required">*</span></label></div>
<div class="wpuf-fields"><textarea class="textareafield  wpuf_age_104" id="age_104" name="age" data-required="yes" data-type="textarea" placeholder="" rows="1" cols="1"></textarea> <span class="wpuf-wordlimit-message wpuf-help"></span></div>
</li>
<li class="wpuf-el section_break" data-label="In the last 'Two Weeks'How often have you been bothered by any of the following problems?">
<div class="wpuf-section-wrap wpuf-fields section_104 wpuf_section_break_104">
<h2 class="wpuf-section-title">In the last  Two Weeks How often have you been bothered by any of the following problems?</h2>
<div class="wpuf-section-details"></div>
</div>
</li>
<li class="wpuf-el little_interest_or_pleasure_in_doing_things field-size-large" data-label="Little interest or pleasure in doing things">
<div class="wpuf-label"><label for="little_interest_or_pleasure_in_doing_things_104">Little interest or pleasure in doing things <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="little_interest_or_pleasure_in_doing_things" class="wpuf_little_interest_or_pleasure_in_doing_things_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="little_interest_or_pleasure_in_doing_things" class="wpuf_little_interest_or_pleasure_in_doing_things_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="little_interest_or_pleasure_in_doing_things" class="wpuf_little_interest_or_pleasure_in_doing_things_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="little_interest_or_pleasure_in_doing_things" class="wpuf_little_interest_or_pleasure_in_doing_things_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el feeling_down__depressed__or_hopeless field-size-large" data-label="Feeling down, depressed, or hopeless">
<div class="wpuf-label"><label for="feeling_down__depressed__or_hopeless_104">Feeling down, depressed, or hopeless <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="feeling_down__depressed__or_hopeless" class="wpuf_feeling_down__depressed__or_hopeless_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="feeling_down__depressed__or_hopeless" class="wpuf_feeling_down__depressed__or_hopeless_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="feeling_down__depressed__or_hopeless" class="wpuf_feeling_down__depressed__or_hopeless_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="feeling_down__depressed__or_hopeless" class="wpuf_feeling_down__depressed__or_hopeless_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el trouble_falling_or_staying_asleep__or_sleeping_too_much_copy field-size-large" data-label="Trouble falling or staying asleep, or sleeping too much">
<div class="wpuf-label"><label for="trouble_falling_or_staying_asleep__or_sleeping_too_much_copy_104">Trouble falling or staying asleep, or sleeping too much <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="trouble_falling_or_staying_asleep__or_sleeping_too_much_copy" class="wpuf_trouble_falling_or_staying_asleep__or_sleeping_too_much_copy_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="trouble_falling_or_staying_asleep__or_sleeping_too_much_copy" class="wpuf_trouble_falling_or_staying_asleep__or_sleeping_too_much_copy_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="trouble_falling_or_staying_asleep__or_sleeping_too_much_copy" class="wpuf_trouble_falling_or_staying_asleep__or_sleeping_too_much_copy_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="trouble_falling_or_staying_asleep__or_sleeping_too_much_copy" class="wpuf_trouble_falling_or_staying_asleep__or_sleeping_too_much_copy_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el feeling_tired_or_having_little_energy field-size-large" data-label="Feeling tired or having little energy">
<div class="wpuf-label"><label for="feeling_tired_or_having_little_energy_104">Feeling tired or having little energy <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="feeling_tired_or_having_little_energy" class="wpuf_feeling_tired_or_having_little_energy_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="feeling_tired_or_having_little_energy" class="wpuf_feeling_tired_or_having_little_energy_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="feeling_tired_or_having_little_energy" class="wpuf_feeling_tired_or_having_little_energy_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="feeling_tired_or_having_little_energy" class="wpuf_feeling_tired_or_having_little_energy_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el poor_appetite_or_overeating field-size-large" data-label="Poor appetite or overeating">
<div class="wpuf-label"><label for="poor_appetite_or_overeating_104">Poor appetite or overeating <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="poor_appetite_or_overeating" class="wpuf_poor_appetite_or_overeating_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="poor_appetite_or_overeating" class="wpuf_poor_appetite_or_overeating_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="poor_appetite_or_overeating" class="wpuf_poor_appetite_or_overeating_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="poor_appetite_or_overeating" class="wpuf_poor_appetite_or_overeating_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down field-size-large" data-label="Feeling bad about yourself - or that you are a failure or have let yourself or your family down">
<div class="wpuf-label"><label for="feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down_104">Feeling bad about yourself - or that you are a failure or have let yourself or your family down <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down" class="wpuf_feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down" class="wpuf_feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down" class="wpuf_feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down" class="wpuf_feeling_bad_about_yourself___or_that_you_are_a_failure_or_have_let_yourself_or_your_family_down_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television field-size-large" data-label="Trouble concentrating on things, such as reading the newspaper or watching television">
<div class="wpuf-label"><label for="trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television_104">Trouble concentrating on things, such as reading the newspaper or watching television <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television" class="wpuf_trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television" class="wpuf_trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television" class="wpuf_trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television" class="wpuf_trouble_concentrating_on_things__such_as_reading_the_newspaper_or_watching_television_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el moving_or_speaking_so_slowly_that_other_people_could_have_noticed field-size-large" data-label="Moving or speaking so slowly that other people could have noticed">
<div class="wpuf-label"><label for="moving_or_speaking_so_slowly_that_other_people_could_have_noticed_104">Moving or speaking so slowly that other people could have noticed <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="moving_or_speaking_so_slowly_that_other_people_could_have_noticed" class="wpuf_moving_or_speaking_so_slowly_that_other_people_could_have_noticed_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="moving_or_speaking_so_slowly_that_other_people_could_have_noticed" class="wpuf_moving_or_speaking_so_slowly_that_other_people_could_have_noticed_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="moving_or_speaking_so_slowly_that_other_people_could_have_noticed" class="wpuf_moving_or_speaking_so_slowly_that_other_people_could_have_noticed_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="moving_or_speaking_so_slowly_that_other_people_could_have_noticed" class="wpuf_moving_or_speaking_so_slowly_that_other_people_could_have_noticed_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself field-size-large" data-label="Thoughts that you would be better off dead, or of hurting yourself">
<div class="wpuf-label"><label for="thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself_104">Thoughts that you would be better off dead, or of hurting yourself <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself" class="wpuf_thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself" class="wpuf_thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself" class="wpuf_thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself" class="wpuf_thoughts_that_you_would_be_better_off_dead__or_of_hurting_yourself_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el custom_html_1" data-label="Custom HTML">
<div class="wpuf-fields html_104 wpuf_custom_html_1_104"><hr /></div>
</li>
<li class="wpuf-el if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people_ field-size-large" data-label="If you've had any days with issues above, how difficult have these problems made it for you at work, home, school, or with other people?">
<div class="wpuf-label"><label for="if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people__104">If you've had any days with issues above, how difficult have these problems made it for you at work, home, school, or with other people? <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people_" class="wpuf_if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people__104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people_" class="wpuf_if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people__104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people_" class="wpuf_if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people__104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people_" class="wpuf_if_you_ve_had_any_days_with_issues_above__how_difficult_have_these_problems_made_it_for_you_at_work__home__school__or_with_other_people__104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them field-size-large" data-label="Thoughts that you would be better off without family or parent or friends or feel like  hurting them">
<div class="wpuf-label"><label for="thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them_104">Thoughts that you would be better off without family or parent or friends or feel like hurting them <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them" class="wpuf_thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them" class="wpuf_thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them" class="wpuf_thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them" class="wpuf_thoughts_that_you_would_be_better_off_without_family_or_parent_or_friends_or_feel_like__hurting_them_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el do_you_feel_like_talking_to_people_or_express_your_feeling_with_other field-size-large" data-label="Do you feel like talking to people or express your feeling with other">
<div class="wpuf-label"><label for="do_you_feel_like_talking_to_people_or_express_your_feeling_with_other_104">Do you feel like talking to people or express your feeling with other <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="do_you_feel_like_talking_to_people_or_express_your_feeling_with_other" class="wpuf_do_you_feel_like_talking_to_people_or_express_your_feeling_with_other_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="do_you_feel_like_talking_to_people_or_express_your_feeling_with_other" class="wpuf_do_you_feel_like_talking_to_people_or_express_your_feeling_with_other_104" type="radio" value="several_days" /> Several days </label> <label class="wpuf-radio-block"> <input name="do_you_feel_like_talking_to_people_or_express_your_feeling_with_other" class="wpuf_do_you_feel_like_talking_to_people_or_express_your_feeling_with_other_104" type="radio" value="more_than_half_the_days" /> More than half the days </label> <label class="wpuf-radio-block"> <input name="do_you_feel_like_talking_to_people_or_express_your_feeling_with_other" class="wpuf_do_you_feel_like_talking_to_people_or_express_your_feeling_with_other_104" type="radio" value="nearly_every_day" /> Nearly every day </label></div>
</li>
<li class="wpuf-el how_strong_you_believe_that_this_will_help_you field-size-large" data-label="How strong you believe that this will help you">
<div class="wpuf-label"><label for="how_strong_you_believe_that_this_will_help_you_104">How strong you believe that this will help you <span class="required">*</span></label></div>
<div class="wpuf-fields" data-required="yes" data-type="radio"><label class="wpuf-radio-block"> <input name="how_strong_you_believe_that_this_will_help_you" class="wpuf_how_strong_you_believe_that_this_will_help_you_104" type="radio" value="not_at_all" /> Not at all </label> <label class="wpuf-radio-block"> <input name="how_strong_you_believe_that_this_will_help_you" class="wpuf_how_strong_you_believe_that_this_will_help_you_104" type="radio" value="somewhat" /> somewhat </label> <label class="wpuf-radio-block"> <input name="how_strong_you_believe_that_this_will_help_you" class="wpuf_how_strong_you_believe_that_this_will_help_you_104" type="radio" value="not_sure" /> not sure </label> <label class="wpuf-radio-block"> <input name="how_strong_you_believe_that_this_will_help_you" class="wpuf_how_strong_you_believe_that_this_will_help_you_104" type="radio" value="strongly_believe" /> strongly believe </label></div>
</li>
<li class="wpuf-el custom_html" data-label="Custom HTML">
<div class="wpuf-fields html_104 wpuf_custom_html_104"></div>
</li>
<li class="wpuf-submit">
<div class="wpuf-label"> </div>
<input type="hidden" id="_wpnonce" name="_wpnonce" value="230c04962e" /><input type="hidden" name="_wp_http_referer" value="/?et_pb_preview=true&amp;et_pb_preview_nonce=c2d84a241a&amp;iframe_id=et-fb-preview-1537943413254-209" /> <input type="hidden" name="form_id" value="104" /> <input type="hidden" name="page_id" value="" /> <input type="hidden" name="action" value="weforms_frontend_submit" /> <input type="hidden" name="weforms-front-report" value="no" /> <input type="submit" class="weforms_submit_btn" name="submit" value="Submit Query" /></li>
</ul>
</form>
<h5><code></code></h5>
</td>
</tr>
</tbody>
</table>[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]