{"id":831,"date":"2014-10-27T10:34:14","date_gmt":"2014-10-27T20:34:14","guid":{"rendered":"http:mauimedical.com\/?page_id=831"},"modified":"2020-08-21T10:08:36","modified_gmt":"2020-08-21T20:08:36","slug":"survey","status":"publish","type":"page","link":"https:\/\/www.mauimedical.com\/?page_id=831","title":{"rendered":"Survey"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; _builder_version=&#8221;3.0.47&#8243;][et_pb_row admin_label=&#8221;row&#8221; _builder_version=&#8221;3.0.47&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221;][et_pb_column type=&#8221;3_4&#8243; _builder_version=&#8221;3.0.47&#8243; parallax=&#8221;off&#8221; parallax_method=&#8221;on&#8221;][et_pb_text admin_label=&#8221;Survey Text and Form&#8221; _builder_version=&#8221;3.5.1&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; use_border_color=&#8221;off&#8221;]<\/p>\n<h2>We Want to Hear From You!<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-835 size-full\" src=\"https:\/\/mauimedical.com\/wp-content\/uploads\/2014\/10\/Survey-Image.jpg\" alt=\"Survey-Image\" width=\"1202\" height=\"400\" srcset=\"https:\/\/www.mauimedical.com\/wp-content\/uploads\/2014\/10\/Survey-Image.jpg 1202w, https:\/\/www.mauimedical.com\/wp-content\/uploads\/2014\/10\/Survey-Image-300x99.jpg 300w, https:\/\/www.mauimedical.com\/wp-content\/uploads\/2014\/10\/Survey-Image-1024x340.jpg 1024w, https:\/\/www.mauimedical.com\/wp-content\/uploads\/2014\/10\/Survey-Image-1080x359.jpg 1080w\" sizes=\"auto, (max-width: 1202px) 100vw, 1202px\" \/><\/p>\n<p>Please take a moment to fill out our physician&#8217;s survey so we can better serve you and your family&#8217;s health care needs.<\/p>\n<p><em>***Before submitting please be sure to double check you&#8217;ve selected the correct physician you want to survey.***<\/em><\/p>\n<p>&nbsp;<\/p>\n<div data-test='contact-form'\n\t\t\tid='contact-form-831'\n\t\t\tclass='jetpack-contact-form-container '\n\t\t\tdata-wp-interactive='jetpack\/form' data-wp-context='{\"formId\":\"831\",\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\",\"showErrors\":false,\"errors\":[],\"fields\":[],\"isMultiStep\":false,\"useAjax\":true,\"submissionData\":null,\"formattedSubmissionData\":[],\"submissionSuccess\":false,\"submissionError\":null,\"elementId\":\"jp-form-710c99b5e74a09a51a0d8c55e7873b922e85e73b\",\"isSingleInputForm\":false,\"isForcedHorizontal\":false,\"conditionalLogic\":[]}'\n\t\t\tdata-wp-on--focusin=\"actions.trackFirstInteraction\"\n\t\t\tdata-wp-watch--scroll-to-wrapper=\"callbacks.scrollToWrapper\"\n\t\t>\n<div class=\"contact-form-submission contact-form-ajax-submission\" data-wp-bind--aria-hidden=\"state.isSuccessMessageAriaHidden\" data-wp-class--submission-success=\"context.submissionSuccess\" 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11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-patientsname-text-error-message\"><\/span>\n\t\t\t<\/div> \n\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-email\",\"fieldType\":\"email\",\"fieldLabel\":\"Email\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-email-wrap grunion-field-wrap'  data-jp-field-id='g831-email' data-jp-visibility-root='g831-email' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<label\n\t\t\t\tfor='g831-email' class=\"grunion-field-label email\" >Email<span class=\"grunion-label-required\" aria-hidden=\"true\">(required)<\/span><\/label>\n<input\n\t\t\t\t\ttype='email'\n\t\t\t\t\tname='g831-email'\n\t\t\t\t\tid='g831-email'\n\t\t\t\t\tvalue=''\n\n\t\t\t\t\tdata-wp-bind--aria-invalid='state.fieldAriaInvalid'\n\t\t\t\t\tdata-wp-bind--value='state.getFieldValue'\n\t\t\t\t\taria-describedby='g831-email-email-error-message'\n\t\t\t\t\tdata-wp-on--input='actions.onFieldChange'\n\t\t\t\t\tdata-wp-on--blur='actions.onFieldBlur'\n\t\t\t\t\tdata-wp-class--has-value='state.hasFieldValue'\n\n\t\t\t\t\tclass='email  grunion-field' \n\t\t\t\t\trequired='true' aria-required='true'  \/>\n \n\t\t\t<div id=\"g831-email-email-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-email-email-error-message\"><\/span>\n\t\t\t<\/div> \n\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-nameofphysiciantosurvey\",\"fieldType\":\"text\",\"fieldLabel\":\"Name of Physician to survey\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-text-wrap grunion-field-wrap'  data-jp-field-id='g831-nameofphysiciantosurvey' data-jp-visibility-root='g831-nameofphysiciantosurvey' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<label\n\t\t\t\tfor='g831-nameofphysiciantosurvey' class=\"grunion-field-label text\" >Name of Physician to survey<span class=\"grunion-label-required\" aria-hidden=\"true\">(required)<\/span><\/label>\n<input\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='g831-nameofphysiciantosurvey'\n\t\t\t\t\tid='g831-nameofphysiciantosurvey'\n\t\t\t\t\tvalue=''\n\n\t\t\t\t\tdata-wp-bind--aria-invalid='state.fieldAriaInvalid'\n\t\t\t\t\tdata-wp-bind--value='state.getFieldValue'\n\t\t\t\t\taria-describedby='g831-nameofphysiciantosurvey-text-error-message'\n\t\t\t\t\tdata-wp-on--input='actions.onFieldChange'\n\t\t\t\t\tdata-wp-on--blur='actions.onFieldBlur'\n\t\t\t\t\tdata-wp-class--has-value='state.hasFieldValue'\n\n\t\t\t\t\tclass='text  grunion-field' \n\t\t\t\t\trequired='true' aria-required='true'  \/>\n \n\t\t\t<div id=\"g831-nameofphysiciantosurvey-text-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-nameofphysiciantosurvey-text-error-message\"><\/span>\n\t\t\t<\/div> \n\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-daytimephone\",\"fieldType\":\"text\",\"fieldLabel\":\"Daytime Phone\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-text-wrap grunion-field-wrap'  data-jp-field-id='g831-daytimephone' data-jp-visibility-root='g831-daytimephone' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<label\n\t\t\t\tfor='g831-daytimephone' class=\"grunion-field-label text\" >Daytime Phone<span class=\"grunion-label-required\" aria-hidden=\"true\">(required)<\/span><\/label>\n<input\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='g831-daytimephone'\n\t\t\t\t\tid='g831-daytimephone'\n\t\t\t\t\tvalue=''\n\n\t\t\t\t\tdata-wp-bind--aria-invalid='state.fieldAriaInvalid'\n\t\t\t\t\tdata-wp-bind--value='state.getFieldValue'\n\t\t\t\t\taria-describedby='g831-daytimephone-text-error-message'\n\t\t\t\t\tdata-wp-on--input='actions.onFieldChange'\n\t\t\t\t\tdata-wp-on--blur='actions.onFieldBlur'\n\t\t\t\t\tdata-wp-class--has-value='state.hasFieldValue'\n\n\t\t\t\t\tclass='text  grunion-field' \n\t\t\t\t\trequired='true' aria-required='true'  \/>\n \n\t\t\t<div id=\"g831-daytimephone-text-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-daytimephone-text-error-message\"><\/span>\n\t\t\t<\/div> \n\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-lengthoftimeittookforanappointment\",\"fieldType\":\"radio\",\"fieldLabel\":\"Length of time it took for an appointment\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-lengthoftimeittookforanappointment' data-jp-visibility-root='g831-lengthoftimeittookforanappointment' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-lengthoftimeittookforanappointment-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Length of time it took for an appointment<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthoftimeittookforanappointment-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthoftimeittookforanappointment'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthoftimeittookforanappointment-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthoftimeittookforanappointment-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthoftimeittookforanappointment'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthoftimeittookforanappointment-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthoftimeittookforanappointment-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthoftimeittookforanappointment'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthoftimeittookforanappointment-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthoftimeittookforanappointment-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthoftimeittookforanappointment'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthoftimeittookforanappointment-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthoftimeittookforanappointment-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthoftimeittookforanappointment'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthoftimeittookforanappointment-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-lengthoftimeittookforanappointment-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-lengthoftimeittookforanappointment-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-convenienceofofficelocation\",\"fieldType\":\"radio\",\"fieldLabel\":\"Convenience of office location\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-convenienceofofficelocation' data-jp-visibility-root='g831-convenienceofofficelocation' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-convenienceofofficelocation-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Convenience of office location<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-convenienceofofficelocation-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-convenienceofofficelocation'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-convenienceofofficelocation-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-convenienceofofficelocation-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-convenienceofofficelocation'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-convenienceofofficelocation-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-convenienceofofficelocation-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-convenienceofofficelocation'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-convenienceofofficelocation-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-convenienceofofficelocation-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-convenienceofofficelocation'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-convenienceofofficelocation-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-convenienceofofficelocation-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-convenienceofofficelocation'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-convenienceofofficelocation-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-convenienceofofficelocation-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-convenienceofofficelocation-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-lengthofwaitatoffice\",\"fieldType\":\"radio\",\"fieldLabel\":\"Length of wait at office\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-lengthofwaitatoffice' data-jp-visibility-root='g831-lengthofwaitatoffice' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-lengthofwaitatoffice-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Length of wait at office<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthofwaitatoffice-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthofwaitatoffice'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthofwaitatoffice-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthofwaitatoffice-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthofwaitatoffice'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthofwaitatoffice-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthofwaitatoffice-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthofwaitatoffice'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthofwaitatoffice-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthofwaitatoffice-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthofwaitatoffice'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthofwaitatoffice-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-lengthofwaitatoffice-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-lengthofwaitatoffice'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-lengthofwaitatoffice-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-lengthofwaitatoffice-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-lengthofwaitatoffice-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw\",\"fieldType\":\"radio\",\"fieldLabel\":\"Amount of time you spent with the physician\\\/health care professional you saw\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw' data-jp-visibility-root='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Amount of time you spent with the physician\/health care professional you saw<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-amountoftimeyouspentwiththephysicianhealthcareprofessionalyousaw-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-explanationofwhatwasdoneforyoubyphysician\",\"fieldType\":\"radio\",\"fieldLabel\":\"Explanation of what was done for you by physician\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-explanationofwhatwasdoneforyoubyphysician' data-jp-visibility-root='g831-explanationofwhatwasdoneforyoubyphysician' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-explanationofwhatwasdoneforyoubyphysician-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Explanation of what was done for you by physician<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-explanationofwhatwasdoneforyoubyphysician-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-explanationofwhatwasdoneforyoubyphysician'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-explanationofwhatwasdoneforyoubyphysician-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-explanationofwhatwasdoneforyoubyphysician-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-explanationofwhatwasdoneforyoubyphysician'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-explanationofwhatwasdoneforyoubyphysician-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-explanationofwhatwasdoneforyoubyphysician-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-explanationofwhatwasdoneforyoubyphysician'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-explanationofwhatwasdoneforyoubyphysician-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-explanationofwhatwasdoneforyoubyphysician-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-explanationofwhatwasdoneforyoubyphysician'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-explanationofwhatwasdoneforyoubyphysician-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-explanationofwhatwasdoneforyoubyphysician-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-explanationofwhatwasdoneforyoubyphysician'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-explanationofwhatwasdoneforyoubyphysician-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-explanationofwhatwasdoneforyoubyphysician-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-explanationofwhatwasdoneforyoubyphysician-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence\",\"fieldType\":\"radio\",\"fieldLabel\":\"Technical skills of physician\\\/health care professional (thoroughness, carefulness, competence)\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence' data-jp-visibility-root='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Technical skills of physician\/health care professional (thoroughness, carefulness, competence)<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-technicalskillsofphysicianhealthcareprofessionalthoroughnesscarefulnesscompetence-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw\",\"fieldType\":\"radio\",\"fieldLabel\":\"Personal manner (courtesy, respect, sensitivity, friendliness) The physician\\\/health care professional you saw\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw' data-jp-visibility-root='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Personal manner (courtesy, respect, sensitivity, friendliness) The physician\/health care professional you saw<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-personalmannercourtesyrespectsensitivityfriendlinessthephysicianhealthcareprofessionalyousaw-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-nursingstaff\",\"fieldType\":\"radio\",\"fieldLabel\":\"Nursing staff\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-nursingstaff' data-jp-visibility-root='g831-nursingstaff' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-nursingstaff-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Nursing staff<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-nursingstaff-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-nursingstaff'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-nursingstaff-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-nursingstaff-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-nursingstaff'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-nursingstaff-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-nursingstaff-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-nursingstaff'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-nursingstaff-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-nursingstaff-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-nursingstaff'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-nursingstaff-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-nursingstaff-Exellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-nursingstaff'\n\t\t\t\t\t\t\t\t\tvalue='Exellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-nursingstaff-Exellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Exellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-nursingstaff-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-nursingstaff-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-receptionstaff\",\"fieldType\":\"radio\",\"fieldLabel\":\"Reception staff\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-receptionstaff' data-jp-visibility-root='g831-receptionstaff' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-receptionstaff-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Reception staff<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-receptionstaff-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-receptionstaff'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-receptionstaff-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-receptionstaff-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-receptionstaff'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-receptionstaff-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-receptionstaff-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-receptionstaff'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-receptionstaff-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-receptionstaff-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-receptionstaff'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-receptionstaff-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-receptionstaff-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-receptionstaff'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-receptionstaff-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-receptionstaff-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-receptionstaff-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-overallvisit\",\"fieldType\":\"radio\",\"fieldLabel\":\"Overall visit\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-overallvisit' data-jp-visibility-root='g831-overallvisit' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-overallvisit-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Overall visit<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-overallvisit-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-overallvisit'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-overallvisit-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-overallvisit-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-overallvisit'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-overallvisit-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-overallvisit-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-overallvisit'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-overallvisit-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-overallvisit-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-overallvisit'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-overallvisit-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-overallvisit-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-overallvisit'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-overallvisit-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-overallvisit-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-overallvisit-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-ingeneralwouldyousayyourhealthis\",\"fieldType\":\"radio\",\"fieldLabel\":\"In general, would you say your health is\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-ingeneralwouldyousayyourhealthis' data-jp-visibility-root='g831-ingeneralwouldyousayyourhealthis' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-ingeneralwouldyousayyourhealthis-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">In general, would you say your health is<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-ingeneralwouldyousayyourhealthis-Poor'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-ingeneralwouldyousayyourhealthis'\n\t\t\t\t\t\t\t\t\tvalue='Poor'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-ingeneralwouldyousayyourhealthis-Poor' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Poor<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-ingeneralwouldyousayyourhealthis-Fair'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-ingeneralwouldyousayyourhealthis'\n\t\t\t\t\t\t\t\t\tvalue='Fair'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-ingeneralwouldyousayyourhealthis-Fair' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Fair<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-ingeneralwouldyousayyourhealthis-Good'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-ingeneralwouldyousayyourhealthis'\n\t\t\t\t\t\t\t\t\tvalue='Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-ingeneralwouldyousayyourhealthis-Good' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-ingeneralwouldyousayyourhealthis-VeryGood'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-ingeneralwouldyousayyourhealthis'\n\t\t\t\t\t\t\t\t\tvalue='Very Good'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-ingeneralwouldyousayyourhealthis-VeryGood' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Very Good<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-ingeneralwouldyousayyourhealthis-Excellent'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-ingeneralwouldyousayyourhealthis'\n\t\t\t\t\t\t\t\t\tvalue='Excellent'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-ingeneralwouldyousayyourhealthis-Excellent' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Excellent<\/span><\/label><\/p><\/div>\n\t\t\t<div id=\"g831-ingeneralwouldyousayyourhealthis-radio-error\" class=\"contact-form__input-error\" data-wp-class--has-errors=\"state.fieldHasErrors\">\n\t\t\t\t<span class=\"contact-form__warning-icon\" aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-ingeneralwouldyousayyourhealthis-radio-error-message\"><\/span>\n\t\t\t<\/div><\/fieldset>\t<\/div>\n\n<div style=\"\"  data-wp-interactive=\"jetpack\/form\" data-wp-context='{\"fieldId\":\"g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends\",\"fieldType\":\"radio\",\"fieldLabel\":\"Would you recommend the physician\\\/health care professional you saw to your family or friends?\",\"fieldValue\":\"\",\"fieldPlaceholder\":\"\",\"fieldIsRequired\":\"1\",\"fieldErrorMessage\":\"\",\"fieldExtra\":[],\"formHash\":\"710c99b5e74a09a51a0d8c55e7873b922e85e73b\"}'  class='grunion-field-radio-wrap grunion-field-wrap'  data-jp-field-id='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends' data-jp-visibility-root='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends' data-wp-class--jetpack-field--conditionally-hidden=\"state.isFieldHidden\" data-wp-watch--conditional-focus=\"callbacks.manageConditionalFocus\" data-wp-init='callbacks.initializeField' data-wp-on--jetpack-form-reset='callbacks.initializeField' >\n<fieldset id='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends-label' class='jetpack-field-multiple__fieldset' data-wp-bind--aria-invalid='state.fieldAriaInvalid' ><legend class=\"grunion-field-label\" ><span class=\"grunion-label-text\">Would you recommend the physician\/health care professional you saw to your family or friends?<\/span><span class=\"grunion-label-required\">(required)<\/span><\/legend>\n<div class='grunion-radio-options ' style=''><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends-DefinitelyYes'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends'\n\t\t\t\t\t\t\t\t\tvalue='Definitely Yes'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends-DefinitelyYes' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Definitely Yes<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends-ProbablyYes'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends'\n\t\t\t\t\t\t\t\t\tvalue='Probably Yes'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends-ProbablyYes' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Probably Yes<\/span><\/label><\/p><p class='contact-form-field'><input\n\t\t\t\t\t\t\t\t\tid='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends-ProbablyNot'\n\t\t\t\t\t\t\t\t\ttype='radio'\n\t\t\t\t\t\t\t\t\tname='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends'\n\t\t\t\t\t\t\t\t\tvalue='Probably Not'\n\t\t\t\t\t\t\t\t\tdata-wp-on--change='actions.onFieldChange' class='radio  grunion-field'  required aria-required='true'\/> <label for='g831-wouldyourecommendthephysicianhealthcareprofessionalyousawtoyourfamilyorfriends-ProbablyNot' style=\"\" class='grunion-radio-label radio'><span class='grunion-field-text'>Probably Not<\/span><\/label><\/p><p 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aria-hidden=\"true\">\n\t\t\t\t\t<svg width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t\t\t\t<path d=\"M8.50015 11.6402H7.50015V10.6402H8.50015V11.6402Z\" \/>\n\t\t\t\t\t\t<path d=\"M7.50015 9.64018H8.50015V6.30684H7.50015V9.64018Z\" \/>\n\t\t\t\t\t\t<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M6.98331 3.0947C7.42933 2.30177 8.57096 2.30177 9.01698 3.09469L13.8771 11.7349C14.3145 12.5126 13.7525 13.4735 12.8602 13.4735H3.14004C2.24774 13.4735 1.68575 12.5126 2.12321 11.7349L6.98331 3.0947ZM8.14541 3.58496C8.08169 3.47168 7.9186 3.47168 7.85488 3.58496L2.99478 12.2251C2.93229 12.3362 3.01257 12.4735 3.14004 12.4735H12.8602C12.9877 12.4735 13.068 12.3362 13.0055 12.2251L8.14541 3.58496Z\" \/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/span>\n\t\t\t\t<span data-wp-text=\"state.errorMessage\" id=\"g831-personalcommentsoptional-textarea-error-message\"><\/span>\n\t\t\t<\/div>\n\t<\/div>\n\t<p class='contact-submit'>\n<div 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fb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; _builder_version=&#8221;3.0.47&#8243;][et_pb_row admin_label=&#8221;row&#8221; _builder_version=&#8221;3.0.47&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221;][et_pb_column type=&#8221;3_4&#8243; _builder_version=&#8221;3.0.47&#8243; parallax=&#8221;off&#8221; parallax_method=&#8221;on&#8221;][et_pb_text admin_label=&#8221;Survey Text and Form&#8221; _builder_version=&#8221;3.5.1&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; use_border_color=&#8221;off&#8221;] We Want to Hear From You! Please take a moment to fill out our physician&#8217;s survey so we can better serve you and your family&#8217;s health care needs. ***Before submitting please be sure [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-831","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/P6nCk4-dp","_links":{"self":[{"href":"https:\/\/www.mauimedical.com\/index.php?rest_route=\/wp\/v2\/pages\/831","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.mauimedical.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.mauimedical.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.mauimedical.com\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.mauimedical.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=831"}],"version-history":[{"count":25,"href":"https:\/\/www.mauimedical.com\/index.php?rest_route=\/wp\/v2\/pages\/831\/revisions"}],"predecessor-version":[{"id":10318,"href":"https:\/\/www.mauimedical.com\/index.php?rest_route=\/wp\/v2\/pages\/831\/revisions\/10318"}],"wp:attachment":[{"href":"https:\/\/www.mauimedical.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=831"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}