{"id":471,"date":"2023-01-06T08:00:53","date_gmt":"2023-01-06T08:00:53","guid":{"rendered":"https:\/\/drbahraminejad.com\/en\/?page_id=471"},"modified":"2023-01-06T08:28:49","modified_gmt":"2023-01-06T08:28:49","slug":"elderly","status":"publish","type":"page","link":"https:\/\/drbahraminejad.com\/en\/elderly\/","title":{"rendered":""},"content":{"rendered":"\n<p class=\"has-text-align-center wp-block-paragraph\">Please be patient and fill in the required information carefully<\/p>\n\n\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme' id='gform_wrapper_13' style='display:none'><div id='gf_13' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Elderly<\/h2>\n                            <span class='gform_description'><\/span>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_13'  action='\/en\/wp-json\/wp\/v2\/pages\/471#gf_13' >\n        <div id='gf_progressbar_wrapper_13' class='gf_progressbar_wrapper'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>7<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_14' style='width:14%;'><span>14%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform_body gform-body'><div id='gform_page_13_1' class='gform_page' >\n                                    <div class='gform_page_fields'><div id='gform_fields_13' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_13_3\"  class=\"gfield gfield_contains_required field_sublabel_above field_description_above gfield_visibility_visible\"  data-js-reload=\"field_13_3\"><legend class='gfield_label screen-reader-text gfield_label_before_complex'  ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_13_3'>\n                            \n                            <span id='input_13_3_3_container' class='name_first' >\n                                                    <label for='input_13_3_3' >First Name<\/label>\n                                                    <input type='text' name='input_3.3' id='input_13_3_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_13_3_6_container' class='name_last' >\n   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 ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date' id='input_13_134_2_container'><select name='input_134[]' id='input_13_134_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date' id='input_13_134_3_container'><select name='input_134[]' id='input_13_134_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_13_92\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_92\"><label class='gfield_label' for='input_13_92' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_92' id='input_13_92' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_8\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_8\"><label class='gfield_label' for='input_13_8' >Level of education<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_13_8' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Diploma' >Diploma<\/option><option value='Bachelor' >Bachelor<\/option><option value='Master' >Master<\/option><option value='PHD' >PHD<\/option><\/select><\/div><\/div><div id=\"field_13_186\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_186\"><label class='gfield_label' for='input_13_186' >Field of Study<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_186' id='input_13_186' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_187\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_187\"><label class='gfield_label' for='input_13_187' >Employment status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_187' id='input_13_187' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='employed' >employed<\/option><option value='retired' >retired<\/option><\/select><\/div><\/div><div id=\"field_13_188\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_188\"><label class='gfield_label' for='input_13_188' >Job<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_188' id='input_13_188' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_93\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_93\"><label class='gfield_label' for='input_13_93' >Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_93' id='input_13_93' type='text' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_13_85\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_85\"><label class='gfield_label' for='input_13_85' >Email (Result are sentvia email)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_85' id='input_13_85' type='text' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_13_18\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_18\"><h3 class=\"gsection_title\">Payment (50$ )<\/h3><div class='gsection_description' id='gfield_description_13_18'>Please email transfer to: Dr.Bahrami@gmail.com\nor Paypal to: Dr.Bahraminejad@yahoo.com<\/div><\/div><div id=\"field_13_19\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_19\"><label class='gfield_label' for='input_13_19' >The name of the payer:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_13_19' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_13_20\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_20\"><legend class='gfield_label'  >Date of payment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_13_20' class='ginput_container ginput_complex'><div class='gfield_date_dropdown_month ginput_container ginput_container_date' id='input_13_20_1_container'><select name='input_20[]' id='input_13_20_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date' id='input_13_20_2_container'><select name='input_20[]' id='input_13_20_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date' id='input_13_20_3_container'><select name='input_20[]' id='input_13_20_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_13_21\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_21\"><label class='gfield_label' for='input_13_21' >Payment receipt<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='2097152' \/><input name='input_21' id='input_13_21' type='file' class='large' aria-describedby=\"gfield_upload_rules_13_21\" onchange='javascript:gformValidateFileSize( this, 2097152 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_13_21'>Max. file size: 2 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_13_21'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_13_22' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"2\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"2\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_13_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_13_2' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_13_139\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_139\"><label class='gfield_label' for='input_13_139' >Height (cm)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_139' id='input_13_139' type='text'    value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_13_140\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_140\"><label class='gfield_label' for='input_13_140' >Current weight (measure your weight in the morning with underwear after toilet<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_140' id='input_13_140' type='text'    value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_13_141\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_141\"><label class='gfield_label' for='input_13_141' >What is your normal weight? (kg)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_141' id='input_13_141' type='text'    value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_13_142\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_142\"><label class='gfield_label' for='input_13_142' >Waist circumference (Measure the smallest circumference with a tape<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_142' id='input_13_142' type='text'    value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_13_143\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_143\"><label class='gfield_label' for='input_13_143' >Hip circumference (Measure the biggest circumference with a tape)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_143' id='input_13_143' type='text'    value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_13_94\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_94\"><label class='gfield_label' for='input_13_94' >3 points priorities of body fat distribution (Priority 1)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_94' id='input_13_94' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='None' >None<\/option><option value='front of abdomen' >front of abdomen<\/option><option value='the sides' >the sides<\/option><option value='hip' >hip<\/option><option value='thigh' >thigh<\/option><option value='chest' >chest<\/option><option value='the arms' >the arms<\/option><\/select><\/div><\/div><div id=\"field_13_146\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_146\"><label class='gfield_label' for='input_13_146' >Priority 2<\/label><div class='ginput_container ginput_container_select'><select name='input_146' id='input_13_146' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='front of abdomen' >front of abdomen<\/option><option value='the sides' >the sides<\/option><option value='hip' >hip<\/option><option value='thigh' >thigh<\/option><option value='chest' >chest<\/option><option value='the arms' >the arms<\/option><\/select><\/div><\/div><div id=\"field_13_147\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_147\"><label class='gfield_label' for='input_13_147' >Priority 3<\/label><div class='ginput_container ginput_container_select'><select name='input_147' id='input_13_147' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='front of abdomen' >front of abdomen<\/option><option value='the sides' >the sides<\/option><option value='hip' >hip<\/option><option value='thigh' >thigh<\/option><option value='chest' >chest<\/option><option value='the arms' >the arms<\/option><\/select><\/div><\/div><div id=\"field_13_224\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_224\"><label class='gfield_label' for='input_13_224' >Fat percentage (with caliper or body composition analysis device)<\/label><div class='ginput_container ginput_container_number'><input name='input_224' id='input_13_224' type='text'    value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_13_150\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_150\"><label class='gfield_label' for='input_13_150' >Send body composition file<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='2097152' \/><input name='input_150' id='input_13_150' type='file' class='large' aria-describedby=\"gfield_upload_rules_13_150\" onchange='javascript:gformValidateFileSize( this, 2097152 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_13_150'>Max. file size: 2 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_13_150'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_13_49' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"1\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"1\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_13_49' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"3\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"3\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_13_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_13_3' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_13_151\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_151\"><label class='gfield_label' for='input_13_151' >Do you currently have a specific illness?<\/label><div class='ginput_container ginput_container_select'><select name='input_151' id='input_13_151' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_152\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_152\"><label class='gfield_label' for='input_13_152' >Please mention the type and duration of the disease<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_152' id='input_13_152' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_106\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_106\"><label class='gfield_label' for='input_13_106' >Have you ever been hospitalized?<\/label><div class='ginput_container ginput_container_select'><select name='input_106' id='input_13_106' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_105\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_105\"><label class='gfield_label' for='input_13_105' >Please state the reason for hospitalization and its time in full<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_105' id='input_13_105' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_153\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_153\"><label class='gfield_label' for='input_13_153' >Do you have a special injury or limited mobility?<\/label><div class='ginput_container ginput_container_select'><select name='input_153' id='input_13_153' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_154\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_154\"><label class='gfield_label' for='input_13_154' >Mention the type of injury or movement restriction<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_154' id='input_13_154' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_190\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_190\"><label class='gfield_label' for='input_13_190' >At what times and with what factor does the pain intensify and subside?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_190' id='input_13_190' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_155\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_155\"><label class='gfield_label' for='input_13_155' >Have you ever experienced heart palpitations or shortness of breath?<\/label><div class='ginput_container ginput_container_select'><select name='input_155' id='input_13_155' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_156\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_156\"><label class='gfield_label' for='input_13_156' >Please describe the process of palpitations or shortness of breath<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_156' id='input_13_156' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_191\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_191\"><label class='gfield_label' for='input_13_191' >Do you get dizzy and headache?<\/label><div class='ginput_container ginput_container_select'><select name='input_191' id='input_13_191' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_192\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_192\"><label class='gfield_label' for='input_13_192' >Explain its type and amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_192' id='input_13_192' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_193\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_193\"><label class='gfield_label' for='input_13_193' >Do you have digestive problems?<\/label><div class='ginput_container ginput_container_select'><select name='input_193' id='input_13_193' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_194\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_194\"><label class='gfield_label' for='input_13_194' >Explain its type and amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_194' id='input_13_194' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_195\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_195\"><label class='gfield_label' for='input_13_195' >If there is a particular disease in the first degree relatives, mention it<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_195' id='input_13_195' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_198\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_198\"><label class='gfield_label' for='input_13_198' >Assess the stresses of your life and work environment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_198' id='input_13_198' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='low' >low<\/option><option value='medium' >medium<\/option><option value='high' >high<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_13_197' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"2\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"2\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_13_197' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"4\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"4\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_13_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_13_4' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_13_157\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_157\"><label class='gfield_label' for='input_13_157' >Do you take any special medication?<\/label><div class='ginput_container ginput_container_select'><select name='input_157' id='input_13_157' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_114\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_114\"><label class='gfield_label' for='input_13_114' >Please specify the type and amount of medicine<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_13_114' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_199\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_199\"><label class='gfield_label' for='input_13_199' >Do you take supplements or vitamins?<\/label><div class='ginput_container ginput_container_select'><select name='input_199' id='input_13_199' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_200\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_200\"><label class='gfield_label' for='input_13_200' >Please specify the type and amount of medicine<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_200' id='input_13_200' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_158\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_158\"><label class='gfield_label' for='input_13_158' >Do you use cigarettes, alcohol or drugs?<\/label><div class='ginput_container ginput_container_select'><select name='input_158' id='input_13_158' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_159\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_159\"><label class='gfield_label' for='input_13_159' >Explain its type and amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_159' id='input_13_159' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_163\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_163\"><label class='gfield_label' for='input_13_163' >Are you allergic to a certain substance?<\/label><div class='ginput_container ginput_container_select'><select name='input_163' id='input_13_163' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_203\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_203\"><label class='gfield_label' for='input_13_203' >Explain the type of sensitivity and its symptoms<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_203' id='input_13_203' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_13_164' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"3\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"3\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_13_164' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"5\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"5\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_13_5' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_13_5' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_13_204\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_204\"><label class='gfield_label' for='input_13_204' >Can you raise both your hands above your head without pain?<\/label><div class='ginput_container ginput_container_select'><select name='input_204' id='input_13_204' class='large gfield_select'     aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_13_205\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_205\"><label class='gfield_label' for='input_13_205' >In case of pain and disability, explain the conditions<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_205' id='input_13_205' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_206\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_206\"><label class='gfield_label' for='input_13_206' >Can you easily rub the back of your shoulder from below with each hand?<\/label><div class='ginput_container ginput_container_select'><select name='input_206' id='input_13_206' class='large gfield_select'     aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_13_207\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_207\"><label class='gfield_label' for='input_13_207' >If unable, explain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_207' id='input_13_207' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_208\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_208\"><label class='gfield_label' for='input_13_208' >Can you squat without knee and hip pain?<\/label><div class='ginput_container ginput_container_select'><select name='input_208' id='input_13_208' class='large gfield_select'     aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_13_209\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_209\"><label class='gfield_label' for='input_13_209' >In case of pain and disability, explain the situation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_209' id='input_13_209' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_210\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_210\"><label class='gfield_label' for='input_13_210' >Can you touch your toes while sitting flat on the floor?<\/label><div class='ginput_container ginput_container_select'><select name='input_210' id='input_13_210' class='large gfield_select'     aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_13_211\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_211\"><label class='gfield_label' for='input_13_211' >If unable, explain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_211' id='input_13_211' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_212\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_212\"><label class='gfield_label' for='input_13_212' >Can you run?<\/label><div class='ginput_container ginput_container_select'><select name='input_212' id='input_13_212' class='large gfield_select'     aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_13_213\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_213\"><label class='gfield_label' for='input_13_213' >If unable, explain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_213' id='input_13_213' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_217\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_217\"><label class='gfield_label' for='input_13_217' >blood pressure (minimum)<\/label><div class='ginput_container ginput_container_number'><input name='input_217' id='input_13_217' type='text'    value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_13_216\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_216\"><label class='gfield_label' for='input_13_216' >blood pressure (maximum)<\/label><div class='ginput_container ginput_container_number'><input name='input_216' id='input_13_216' type='text'    value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_13_219\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_219\"><label class='gfield_label' for='input_13_219' >If possible, send a radiology picture of the knee<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='2097152' \/><input name='input_219' id='input_13_219' type='file' class='large' aria-describedby=\"gfield_upload_rules_13_219\" onchange='javascript:gformValidateFileSize( this, 2097152 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_13_219'>Max. file size: 2 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_13_219'><\/div><\/div><\/div><div id=\"field_13_218\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_218\"><label class='gfield_label' for='input_13_218' >If possible, send a radiology picture of the lumbar vertebrae<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='2097152' \/><input name='input_218' id='input_13_218' type='file' class='large' aria-describedby=\"gfield_upload_rules_13_218\" onchange='javascript:gformValidateFileSize( this, 2097152 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_13_218'>Max. file size: 2 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_13_218'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_13_220' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"4\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"4\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_13_220' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"6\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"6\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_13_6' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_13_6' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_13_160\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_160\"><label class='gfield_label' for='input_13_160' >Purpose of training program<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_160' id='input_13_160' class='large gfield_select'  aria-describedby=\"gfield_description_13_160\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Increase vitality and health' >Increase vitality and health<\/option><option value='Fitness without weight change' >Fitness without weight change<\/option><option value='Fitness with weight loss' >Fitness with weight loss<\/option><option value='Fitness with weight gain' >Fitness with weight gain<\/option><option value='Cure specific disease' >Cure specific disease<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_13_160'>If you need to change your weight, complete the food plan questionnaire<\/div><\/div><div id=\"field_13_161\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_161\"><label class='gfield_label' for='input_13_161' >Fully explain your mobility limitation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_161' id='input_13_161' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_162\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_162\"><label class='gfield_label' for='input_13_162' >Do you have a special desire to shrink a part of your body?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_162' id='input_13_162' class='large gfield_select'  aria-describedby=\"gfield_description_13_162\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_13_162'>If you need to change your weight, complete the food plan questionnaire<\/div><\/div><div id=\"field_13_165\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_165\"><label class='gfield_label' for='input_13_165' >Please name the desired parts<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_165' id='input_13_165' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_166\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_166\"><label class='gfield_label' for='input_13_166' >Do you have a special desire to become muscular and bulky in a part of your body?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_166' id='input_13_166' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_167\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_167\"><label class='gfield_label' for='input_13_167' >Please name the desired parts<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_13_167' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_168\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_168\"><label class='gfield_label' for='input_13_168' >Do you have any special restrictions for going to sports places?<\/label><div class='ginput_container ginput_container_select'><select name='input_168' id='input_13_168' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_169\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_169\"><label class='gfield_label' for='input_13_169' >Mention the training location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_169' id='input_13_169' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_170\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_170\"><label class='gfield_label' for='input_13_170' >What training tools do you have?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_170' id='input_13_170' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_13_221\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_221\"><label class='gfield_label' for='input_13_221' >Do you have a desire to take supplements and vitamins?<\/label><div class='ginput_container ginput_container_select'><select name='input_221' id='input_13_221' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_79\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_79\"><label class='gfield_label' for='input_13_79' >Please send photos of your training equipment<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='2097152' \/><input name='input_79' id='input_13_79' type='file' class='large' aria-describedby=\"gfield_upload_rules_13_79\" onchange='javascript:gformValidateFileSize( this, 2097152 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_13_79'>Max. file size: 2 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_13_79'><\/div><\/div><\/div><div id=\"field_13_171\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_171\"><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_13_171'>Please specify only the days and times you want to do exercises (required).<\/div><\/div><fieldset id=\"field_13_172\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_172\"><legend class='gfield_label gfield_label_before_complex'  >Morning<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_13_172'><div class='gchoice gchoice_13_172_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_172.1' type='checkbox'  value='Saturday morning'  id='choice_13_172_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_172_1' id='label_13_172_1'>Saturday morning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_172_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_172.2' type='checkbox'  value='Sunday morning'  id='choice_13_172_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_172_2' id='label_13_172_2'>Sunday morning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_172_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_172.3' type='checkbox'  value='Monday morning'  id='choice_13_172_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_172_3' id='label_13_172_3'>Monday morning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_172_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_172.4' type='checkbox'  value='Tuesday morning'  id='choice_13_172_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_172_4' id='label_13_172_4'>Tuesday morning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_172_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_172.5' type='checkbox'  value='Wednesday morning'  id='choice_13_172_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_172_5' id='label_13_172_5'>Wednesday morning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_172_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_172.6' type='checkbox'  value='Thursday morning'  id='choice_13_172_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_172_6' id='label_13_172_6'>Thursday morning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_172_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_172.7' type='checkbox'  value='Friday morning'  id='choice_13_172_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_172_7' id='label_13_172_7'>Friday morning<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_13_173\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_173\"><legend class='gfield_label gfield_label_before_complex'  >Evening<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_13_173'><div class='gchoice gchoice_13_173_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_173.1' type='checkbox'  value='Saturday evening'  id='choice_13_173_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_173_1' id='label_13_173_1'>Saturday evening<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_173_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_173.2' type='checkbox'  value='Sunday evening'  id='choice_13_173_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_173_2' id='label_13_173_2'>Sunday evening<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_173_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_173.3' type='checkbox'  value='Monday evening'  id='choice_13_173_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_173_3' id='label_13_173_3'>Monday evening<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_173_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_173.4' type='checkbox'  value='Tuesday evening'  id='choice_13_173_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_173_4' id='label_13_173_4'>Tuesday evening<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_173_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_173.5' type='checkbox'  value='Wednesday evening'  id='choice_13_173_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_173_5' id='label_13_173_5'>Wednesday evening<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_173_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_173.6' type='checkbox'  value='Thursday evening'  id='choice_13_173_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_173_6' id='label_13_173_6'>Thursday evening<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_173_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_173.7' type='checkbox'  value='Friday evening'  id='choice_13_173_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_173_7' id='label_13_173_7'>Friday evening<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_13_223\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_223\"><legend class='gfield_label gfield_label_before_complex'  >Which of the following methods do you prefer for endurance training?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_13_223'><div class='gchoice gchoice_13_223_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_223.1' type='checkbox'  value='Free at the discretion of the coach'  id='choice_13_223_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_223_1' id='label_13_223_1'>Free at the discretion of the coach<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_223_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_223.2' type='checkbox'  value='Running in open space'  id='choice_13_223_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_223_2' id='label_13_223_2'>Running in open space<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_223_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_223.3' type='checkbox'  value='Running on a treadmill'  id='choice_13_223_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_223_3' id='label_13_223_3'>Running on a treadmill<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_223_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_223.4' type='checkbox'  value='Outdoor cycling'  id='choice_13_223_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_223_4' id='label_13_223_4'>Outdoor cycling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_223_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_223.5' type='checkbox'  value='Stationary bike'  id='choice_13_223_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_223_5' id='label_13_223_5'>Stationary bike<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_223_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_223.6' type='checkbox'  value='elliptical'  id='choice_13_223_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_223_6' id='label_13_223_6'>elliptical<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_223_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_223.7' type='checkbox'  value='Swimming'  id='choice_13_223_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_223_7' id='label_13_223_7'>Swimming<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_223_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_223.8' type='checkbox'  value='Mountain climbing'  id='choice_13_223_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_223_8' id='label_13_223_8'>Mountain climbing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_223_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_223.9' type='checkbox'  value='Roping'  id='choice_13_223_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_223_9' id='label_13_223_9'>Roping<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_13_185\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_185\"><legend class='gfield_label gfield_label_before_complex'  >Which of the following methods do you prefer for strength training?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_13_185'><div class='gchoice gchoice_13_185_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_185.1' type='checkbox'  value='Free at the discretion of the coach'  id='choice_13_185_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_185_1' id='label_13_185_1'>Free at the discretion of the coach<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_185_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_185.2' type='checkbox'  value='Strength machines'  id='choice_13_185_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_185_2' id='label_13_185_2'>Strength machines<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_185_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_185.3' type='checkbox'  value='free weights'  id='choice_13_185_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_185_3' id='label_13_185_3'>free weights<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_185_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_185.4' type='checkbox'  value='Body weight training'  id='choice_13_185_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_185_4' id='label_13_185_4'>Body weight training<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_13_185_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_185.5' type='checkbox'  value='rubber band'  id='choice_13_185_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_13_185_5' id='label_13_185_5'>rubber band<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_13_222' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"5\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"5\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_13_222' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_13\").val(\"7\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_13\").val(\"7\");  jQuery(\"#gform_13\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_13_7' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_13_7' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_13_181\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_181\"><label class='gfield_label' for='input_13_181' >Please provide a summary of your training record for the past 2 months<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_181' id='input_13_181' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_13_180\"  class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_180\"><label class='gfield_label' for='input_13_180' >Have you already received the training program from the site?<\/label><div class='ginput_container ginput_container_select'><select name='input_180' id='input_13_180' class='large gfield_select'     aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_13_225\"  class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_225\"><label class='gfield_label' for='input_13_225' >In what language would you like to receive your training plan?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_225' id='input_13_225' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='English' >English<\/option><option value='Persion' >Persion<\/option><\/select><\/div><\/div><div id=\"field_13_182\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_182\"><label class='gfield_label' for='input_13_182' >Please, in addition to criticisms and suggestions, if you think there is something special, write it in the form below.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_182' id='input_13_182' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_13_183\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_183\"><label class='gfield_label' for='input_13_183' >If you want, you can send a photo of your body<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='2097152' \/><input name='input_183' id='input_13_183' type='file' class='large' aria-describedby=\"gfield_upload_rules_13_183\" onchange='javascript:gformValidateFileSize( this, 2097152 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_13_183'>Max. file size: 2 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_13_183'><\/div><\/div><\/div><fieldset id=\"field_13_133\"  class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_13_133\"><legend class='gfield_label screen-reader-text gfield_label_before_complex'  ><\/legend><div class='ginput_container ginput_container_consent'><input name='input_133.1' id='input_13_133_1' type='checkbox' value='1'    aria-invalid=\"false\"   \/> <label class=\"gfield_consent_label\" for='input_13_133_1' >While accepting the accuracy of the above information, I request the annual training program (required).<\/label><input type='hidden' name='input_133.2' value='While accepting the accuracy of the above information, I request the annual training program (required).' class='gform_hidden' \/><input type='hidden' name='input_133.3' value='4' class='gform_hidden' \/><\/div><\/fieldset><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_13' class='gform_previous_button button' value='Previous'  onclick='if(window[\"gf_submitting_13\"]){return false;}  window[\"gf_submitting_13\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_13\"]){return false;} window[\"gf_submitting_13\"]=true;  jQuery(\"#gform_13\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_13' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_13\"]){return false;}  window[\"gf_submitting_13\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_13\"]){return false;} window[\"gf_submitting_13\"]=true;  jQuery(\"#gform_13\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_13' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='13' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_13' 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carefully<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-471","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/drbahraminejad.com\/en\/wp-json\/wp\/v2\/pages\/471","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drbahraminejad.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/drbahraminejad.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/drbahraminejad.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/drbahraminejad.com\/en\/wp-json\/wp\/v2\/comments?post=471"}],"version-history":[{"count":4,"href":"https:\/\/drbahraminejad.com\/en\/wp-json\/wp\/v2\/pages\/471\/revisions"}],"predecessor-version":[{"id":561,"href":"https:\/\/drbahraminejad.com\/en\/wp-json\/wp\/v2\/pages\/471\/revisions\/561"}],"wp:attachment":[{"href":"https:\/\/drbahraminejad.com\/en\/wp-json\/wp\/v2\/media?parent=471"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}