{"id":51,"date":"2022-11-18T16:31:44","date_gmt":"2022-11-18T16:31:44","guid":{"rendered":"https:\/\/www.indianatech.edu\/campuslife\/?page_id=51"},"modified":"2023-01-24T14:48:50","modified_gmt":"2023-01-24T14:48:50","slug":"phq-9","status":"publish","type":"page","link":"https:\/\/www.indianatech.edu\/wellness-clinic\/additional-mental-health-resources\/phq-9\/","title":{"rendered":"PHQ-9"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' ><div id='gf_3' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/wellness-clinic\/wp-json\/wp\/v2\/pages\/51\/#gf_3' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_3_1\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_1\" ><p>Over the last 2 weeks, how often have you been bothered by any of the following problems?<\/p><\/div><fieldset id=\"field_3_3\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_3\" ><legend class='gfield_label gform-field-label' >Little interest or pleasure in doing things<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_3'>\n\t\t\t<div class='gchoice gchoice_3_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='0'  id='choice_3_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_3_0' id='label_3_3_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='1'  id='choice_3_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_3_1' id='label_3_3_1' class='gform-field-label gform-field-label--type-inline'>Several days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_3_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='2'  id='choice_3_3_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_3_2' id='label_3_3_2' class='gform-field-label gform-field-label--type-inline'>More than half the days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_3_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='3'  id='choice_3_3_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_3_3' id='label_3_3_3' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_11\" ><legend class='gfield_label gform-field-label' >Feeling down, depressed, or hopeless<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_11'>\n\t\t\t<div class='gchoice gchoice_3_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='0'  id='choice_3_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_0' id='label_3_11_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='1'  id='choice_3_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_1' id='label_3_11_1' class='gform-field-label gform-field-label--type-inline'>Several days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='2'  id='choice_3_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_2' id='label_3_11_2' class='gform-field-label gform-field-label--type-inline'>More than half the days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='3'  id='choice_3_11_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_3' id='label_3_11_3' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_10\" ><legend class='gfield_label gform-field-label' >Trouble falling or staying asleep, or sleeping too much<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_10'>\n\t\t\t<div class='gchoice gchoice_3_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='0'  id='choice_3_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_10_0' id='label_3_10_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='1'  id='choice_3_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_10_1' id='label_3_10_1' class='gform-field-label gform-field-label--type-inline'>Several days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='2'  id='choice_3_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_10_2' id='label_3_10_2' class='gform-field-label gform-field-label--type-inline'>More than half the days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='3'  id='choice_3_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_10_3' id='label_3_10_3' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_9\" ><legend class='gfield_label gform-field-label' >Feeling tired or having little energy<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_9'>\n\t\t\t<div class='gchoice gchoice_3_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='0'  id='choice_3_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_9_0' id='label_3_9_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='1'  id='choice_3_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_9_1' id='label_3_9_1' class='gform-field-label gform-field-label--type-inline'>Several days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='2'  id='choice_3_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_9_2' id='label_3_9_2' class='gform-field-label gform-field-label--type-inline'>More than half the days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='3'  id='choice_3_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_9_3' id='label_3_9_3' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_8\" ><legend class='gfield_label gform-field-label' >Poor appetite or overeating<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_8'>\n\t\t\t<div class='gchoice gchoice_3_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='0'  id='choice_3_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_8_0' id='label_3_8_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='1'  id='choice_3_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_8_1' id='label_3_8_1' class='gform-field-label gform-field-label--type-inline'>Several days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='2'  id='choice_3_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_8_2' id='label_3_8_2' class='gform-field-label gform-field-label--type-inline'>More than half the days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='3'  id='choice_3_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_8_3' id='label_3_8_3' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_7\" ><legend class='gfield_label gform-field-label' >Feeling bad about yourself \u2013 or that you are a failure or have let yourself or your family down<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_7'>\n\t\t\t<div class='gchoice gchoice_3_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='0'  id='choice_3_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_7_0' id='label_3_7_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='1'  id='choice_3_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_7_1' id='label_3_7_1' class='gform-field-label gform-field-label--type-inline'>Several days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='2'  id='choice_3_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_7_2' id='label_3_7_2' class='gform-field-label gform-field-label--type-inline'>More than half the days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='3'  id='choice_3_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_7_3' id='label_3_7_3' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_6\" ><legend class='gfield_label gform-field-label' >Trouble concentrating on things, such as reading the newspaper or watching television<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_6'>\n\t\t\t<div class='gchoice gchoice_3_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='0'  id='choice_3_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_6_0' id='label_3_6_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='1'  id='choice_3_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_6_1' id='label_3_6_1' class='gform-field-label gform-field-label--type-inline'>Several days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_6_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='2'  id='choice_3_6_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_6_2' id='label_3_6_2' class='gform-field-label gform-field-label--type-inline'>More than half the days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_6_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='3'  id='choice_3_6_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_6_3' id='label_3_6_3' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_5\" ><legend class='gfield_label gform-field-label' >Moving or speaking so slowly that other people could have noticed? Or the opposite \u2013\u00a0being so fidgety or restless that you have been moving around a lot more than usual<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_5'>\n\t\t\t<div class='gchoice gchoice_3_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='0'  id='choice_3_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_5_0' id='label_3_5_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='1'  id='choice_3_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_5_1' id='label_3_5_1' class='gform-field-label gform-field-label--type-inline'>Several days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='2'  id='choice_3_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_5_2' id='label_3_5_2' class='gform-field-label gform-field-label--type-inline'>More than half the days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_5_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='3'  id='choice_3_5_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_5_3' id='label_3_5_3' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_4\" ><legend class='gfield_label gform-field-label' >Thoughts that you would be better off dead or of hurting yourself in some way<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_4'>\n\t\t\t<div class='gchoice gchoice_3_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='0'  id='choice_3_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_4_0' id='label_3_4_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='1'  id='choice_3_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_4_1' id='label_3_4_1' class='gform-field-label gform-field-label--type-inline'>Several days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_4_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='2'  id='choice_3_4_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_4_2' id='label_3_4_2' class='gform-field-label gform-field-label--type-inline'>More than half the days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_4_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='3'  id='choice_3_4_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_4_3' id='label_3_4_3' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible immaterial\"  data-field-class=\"immaterial\" data-js-reload=\"field_3_24\" ><legend class='gfield_label gform-field-label' >If you checked any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_24'>\n\t\t\t<div class='gchoice gchoice_3_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Not difficult at all'  id='choice_3_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_24_0' id='label_3_24_0' class='gform-field-label gform-field-label--type-inline'>Not difficult at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Somewhat difficult'  id='choice_3_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_24_1' id='label_3_24_1' class='gform-field-label gform-field-label--type-inline'>Somewhat difficult<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Very difficult'  id='choice_3_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_24_2' id='label_3_24_2' class='gform-field-label gform-field-label--type-inline'>Very difficult<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Extremely difficult'  id='choice_3_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_24_3' id='label_3_24_3' class='gform-field-label gform-field-label--type-inline'>Extremely difficult<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_13\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_13\" ><label class='gfield_label gform-field-label' for='input_3_13'>Q1 2+<\/label><div class='ginput_container ginput_container_number'><input name='input_13' id='input_3_13' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_14\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_14\" ><label class='gfield_label gform-field-label' for='input_3_14'>Q2 2+<\/label><div class='ginput_container ginput_container_number'><input name='input_14' id='input_3_14' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_15\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_15\" ><label class='gfield_label gform-field-label' for='input_3_15'>Q3 2+<\/label><div class='ginput_container ginput_container_number'><input name='input_15' id='input_3_15' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_16\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_16\" ><label class='gfield_label gform-field-label' for='input_3_16'>Q4 2+<\/label><div class='ginput_container ginput_container_number'><input name='input_16' id='input_3_16' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_17\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_17\" ><label class='gfield_label gform-field-label' for='input_3_17'>Q5 2+<\/label><div class='ginput_container ginput_container_number'><input name='input_17' id='input_3_17' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_18\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_18\" ><label class='gfield_label gform-field-label' for='input_3_18'>Q6 2+<\/label><div class='ginput_container ginput_container_number'><input name='input_18' id='input_3_18' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_19\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_19\" ><label class='gfield_label gform-field-label' for='input_3_19'>Q7 2+<\/label><div class='ginput_container ginput_container_number'><input name='input_19' id='input_3_19' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_20\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_20\" ><label class='gfield_label gform-field-label' for='input_3_20'>Q8 2+<\/label><div class='ginput_container ginput_container_number'><input name='input_20' id='input_3_20' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_21\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_21\" ><label class='gfield_label gform-field-label' for='input_3_21'>Q9 2+<\/label><div class='ginput_container ginput_container_number'><input name='input_21' id='input_3_21' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_22\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_22\" ><label class='gfield_label gform-field-label' for='input_3_22'>Evaluation 1<\/label><div class='ginput_container ginput_container_number'><input name='input_22' id='input_3_22' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_23\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_23\" ><label class='gfield_label gform-field-label' for='input_3_23'>Evaluation 2<\/label><div class='ginput_container ginput_container_number'><input name='input_23' id='input_3_23' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_3_12\" class=\"gfield gfield--type-number gfield--width-full gf_hidden gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible material-simple\"  data-field-class=\"material-simple\" data-js-reload=\"field_3_12\" ><label class='gfield_label gform-field-label' for='input_3_12'>Total<\/label><div class='ginput_container ginput_container_number'><input name='input_12' id='input_3_12' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='{\"formId\":\"3\",\"title\":false,\"description\":false}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='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' 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