{"id":2194,"date":"2022-04-14T11:22:56","date_gmt":"2022-04-14T18:22:56","guid":{"rendered":"http:\/\/www.risemedical.com\/join\/?page_id=2194"},"modified":"2022-04-14T11:25:03","modified_gmt":"2022-04-14T18:25:03","slug":"questionnaire","status":"publish","type":"page","link":"https:\/\/www.risemedical.com\/join\/questionnaire\/","title":{"rendered":"Questionnaire"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-4\">\n<div class=\"wp-block-column is-layout-flow\" style=\"flex-basis:25%\"><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow\" style=\"flex-basis:50%\"><div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_30_container\" data-token=\"748831e65e01c4b2a7ee2d851349e57e\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form  frm_slidein \" id=\"form_decisiontree2\"  data-token=\"748831e65e01c4b2a7ee2d851349e57e\">\n<div class=\"frm_form_fields  frm_page_num_1\">\n<fieldset>\n<legend class=\"frm_screen_reader\">Tele-Rise Decision Tree<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"30\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_30\" id=\"frm_hide_fields_30\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"decisiontree2\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_30\" name=\"frm_submit_entry_30\" value=\"9d14e59230\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/join\/wp-json\/wp\/v2\/pages\/2194\" \/><div id=\"frm_field_586_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_two_col frm_display_format_buttons frm_text_align_center\">\n    <div  id=\"field_r11vt_label\" class=\"frm_primary_label\">Are you over the age of 18?\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n    <\/div>\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_r11vt_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_586-0\"><label for=\"field_r11vt-0\">\t\t<input type=\"radio\" name=\"item_meta[586]\" id=\"field_r11vt-0\" value=\"Yes\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Are you over the age of 18? is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Yes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_586-1\"><label for=\"field_r11vt-1\">\t\t<input type=\"radio\" name=\"item_meta[586]\" id=\"field_r11vt-1\" value=\"No\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Are you over the age of 18? is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">No<\/div><\/label><\/div>\n<\/div>\n    \n    \n<\/div>\n<input type=\"hidden\" name=\"frm_page_order_30\" id=\"frm_page_order_30\" value=\"6\" \/><input type=\"hidden\" name=\"item_meta[502]\" id=\"field_59iby2\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What state do you currently live in? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[503]\" id=\"field_34xse2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[504]\" id=\"field_b02rm2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Status is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[505]\" id=\"field_fepgr2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[506]\" id=\"field_kki6r2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"To begin, tell us why you thought about getting support from a specialist. (select all that apply) is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[507]\" id=\"field_mj5dt2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[508]\" id=\"field_o37232-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Have you and your partner worked with a couples specialist before? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[509]\" id=\"field_pj3ql2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[510]\" id=\"field_ru97q2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What type of relationship do you have? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[511]\" id=\"field_j49592\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[512]\" id=\"field_1vbyl2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What gender do you identify with? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[513]\" id=\"field_12mwc2-0\" value=\"\"  data-invmsg=\"Gender-other is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[514]\" id=\"field_6l81j2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[515]\" id=\"field_pq35e2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"How do you identify? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[516]\" id=\"field_8afx82-0\" value=\"\"  data-invmsg=\" is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[517]\" id=\"field_c7dx82\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[518]\" id=\"field_lthla2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Would you prefer to be matched with an LGBTQ specialist? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[519]\" id=\"field_dc6f32\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[520]\" id=\"field_2g5132-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What gender do you identify with? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[521]\" id=\"field_aq1fu2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[522]\" id=\"field_7oi652-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What are your pronouns? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[523]\" id=\"field_clqb32\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[524]\" id=\"field_dgdee2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your relationship status? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[525]\" id=\"field_x7sim2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[526]\" id=\"field_dj8v2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Are you seeking improvements in your relationship or as an individual? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[527]\" id=\"field_omcqw2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[528]\" id=\"field_i5f8k2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Are you interested in being matched with a dating coach? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[529]\" id=\"field_mlcdr2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[530]\" id=\"field_dmaix2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"How long has it been since you&#039;ve been in relationship? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[531]\" id=\"field_n95ad2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[532]\" id=\"field_qicy02-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What are the main obstacles holding you back from a relationship\/dating? (Select all that apply) is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[533]\" id=\"field_ujzsu2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[534]\" id=\"field_m7j0d2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is a result you would like to create from enrolling in one of our coaching programs? You can choose more than one option. is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[535]\" id=\"field_7gkg52\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[536]\" id=\"field_2kp7z2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Have you worked with a counselor or therapist before? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[537]\" id=\"field_ok1mo2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[538]\" id=\"field_m7ph52-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What led you to us today? (select all that apply) is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[539]\" id=\"field_2wlli2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[540]\" id=\"field_wa78x2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"On a scale of 1-10 (10 being the highest), how committed are you to seeing positive results in your life? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[541]\" id=\"field_ufi7z2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[542]\" id=\"field_vxv152-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"On a scale of 1-10 (10 being the highest), how committed are you to seeing positive results in your life? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[543]\" id=\"field_cyysb2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[544]\" id=\"field_vf4682-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"On a scale of 1-10 (10 being the highest), how committed are you to seeing positive results in your life? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[545]\" id=\"field_9q4t52\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[546]\" id=\"field_jqe0g2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Do you have a preference for the gender of your counselor\/therapist? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[547]\" id=\"field_bhsbr2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[548]\" id=\"field_j88cf2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Do you consider yourself is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[549]\" id=\"field_vabqx2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[550]\" id=\"field_ih3862-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Do you consider yourself is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[551]\" id=\"field_y3vfn2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[552]\" id=\"field_6b0fm2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Does religion play a factor in your relationship? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[553]\" id=\"field_gybla2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[554]\" id=\"field_gqhez2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Would you prefer a specialist who shares your faith? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[555]\" id=\"field_7ypkl2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[556]\" id=\"field_5pyhh2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Would you prefer a specialist who shares your faith? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[557]\" id=\"field_lka7a2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[558]\" id=\"field_wolzu2\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please select your faith is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[559]\" id=\"field_6dtc02\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[560]\" id=\"field_hs9z3-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Have you worked with a counselor or therapist before? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[561]\" id=\"field_m8i9r2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[562]\" id=\"field_stnpu2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"What led you to us today? (select all that apply) is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[563]\" id=\"field_y18032\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[564]\" id=\"field_qaxgp2-0\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Do you have a preference for the gender of your counselor\/therapist? is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[565]\" id=\"field_ygtvl2\" value=\"\"  data-invmsg=\"Next is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[567]\" id=\"field_u7xa52\" value=\"\"  data-invmsg=\"Thanks is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[569]\" id=\"field_s74sq2\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[570]\" id=\"field_htfs92\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[571]\" id=\"field_qmbww2\" value=\"\"  data-invmsg=\"Submit is invalid\"   \/>\n<input type=\"hidden\" name=\"item_meta[582]\" id=\"field_ah5ad2\" value=\"\" data-frmval=\"\"\/>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm_verify\" aria-hidden=\"true\">\n\t\t\t\t<label for=\"frm_email_30\">\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input type=\"text\" class=\"frm_verify\" id=\"frm_email_30\" name=\"frm_verify\" value=\"\"  \/>\n\t\t\t<\/div>\n\t\t<input type=\"hidden\" name=\"frm_register[email]\" value=\"574\"\/><input type=\"hidden\" name=\"frm_register[username]\" value=\"-1\"\/><input type=\"hidden\" name=\"frm_register[password]\" value=\"575\"\/><input type=\"hidden\" name=\"frm_register[subsite_title]\" value=\"username\"\/><input type=\"hidden\" name=\"frm_register[subsite_domain]\" value=\"blog_title\"\/><input name=\"frm_state\" type=\"hidden\" value=\"VsnygUL08Da5kNVUKlERz6eAWtlDXXbvZw5bwfLtmVk=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Next<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow\" style=\"flex-basis:25%\"><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.risemedical.com\/join\/wp-json\/wp\/v2\/pages\/2194"}],"collection":[{"href":"https:\/\/www.risemedical.com\/join\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.risemedical.com\/join\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.risemedical.com\/join\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.risemedical.com\/join\/wp-json\/wp\/v2\/comments?post=2194"}],"version-history":[{"count":2,"href":"https:\/\/www.risemedical.com\/join\/wp-json\/wp\/v2\/pages\/2194\/revisions"}],"predecessor-version":[{"id":2198,"href":"https:\/\/www.risemedical.com\/join\/wp-json\/wp\/v2\/pages\/2194\/revisions\/2198"}],"wp:attachment":[{"href":"https:\/\/www.risemedical.com\/join\/wp-json\/wp\/v2\/media?parent=2194"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}