{"id":7781,"date":"2022-04-25T05:22:30","date_gmt":"2022-04-25T05:22:30","guid":{"rendered":"https:\/\/wahdatemasalik.com\/u\/?page_id=7781"},"modified":"2023-03-11T15:43:46","modified_gmt":"2023-03-11T15:43:46","slug":"diagnosis","status":"publish","type":"page","link":"https:\/\/wahdatemasalik.com\/u\/diagnosis\/","title":{"rendered":"\u062a\u0634\u062e\u06cc\u0635 \u0641\u0627\u0631\u0645  diagnosis form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7781\" class=\"elementor elementor-7781\">\r\n\t\t\t\t\t\t\t        <section class=\"elementor-section elementor-top-section elementor-element elementor-element-23ae6d01 elementor-section-boxed elementor-section-height-default elementor-section-height-default ct-header-fixed-none ct-row-max-none\" data-id=\"23ae6d01\" data-element_type=\"section\">\n            \n                        <div class=\"elementor-container elementor-column-gap-default \">\n                    <div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5ddb32c6\" data-id=\"5ddb32c6\" data-element_type=\"column\">\n            <div class=\"elementor-widget-wrap elementor-element-populated\">\n                        \t\t<div class=\"elementor-element elementor-element-13e6c4f elementor-widget elementor-widget-ct_about_us\" data-id=\"13e6c4f\" data-element_type=\"widget\" data-widget_type=\"ct_about_us.default\">\r\n\t\t\t\t<div class=\"elementor-widget-container\">\r\n\t\t\t<div class=\"ct-about-us\">\r\n\t<div class=\"ct-about-left\">\r\n\t\t\t\t\t<div class=\"ct-about-imge\"><img decoding=\"async\" class=\"\" src=\"https:\/\/wahdatemasalik.com\/u\/wp-content\/uploads\/2022\/01\/bg-page-title-306x306.png\" width=\"306\" height=\"306\" alt=\"bg-page-title\" title=\"bg-page-title\" \/><\/div>\r\n\t\t\t<\/div>\r\n\t<div class=\"ct-about-right\">\r\n\t\t<div class=\"ct-about-holder\">\r\n\t        <div class=\"ct-about-subtitle\"><span><\/span><\/div>\r\n\t        <h3 class=\"ct-about-title\">&quot;\u062c\u0633\u0645\u0627\u0646\u06cc \u060c \u0646\u0641\u0633\u06cc\u0627\u062a\u06cc \u0627\u0648\u0631 \u0631\u0648\u062d\u0627\u0646\u06cc \u0627\u0645\u0631\u0627\u0636 \u06a9\u06cc \u062a\u0634\u062e\u06cc\u0635 \u06a9\u0627 \u0627\u0628\u062a\u062f\u0627\u0626\u06cc \u0641\u0627\u0631\u0645&quot;   Initial diagnosis form for All kind of diseases (Pysical,Mental,Spiritual)<\/h3>\r\n\t        <div class=\"ct-about-desc\"><\/div>\r\n\t        \t    <\/div>\r\n\t<\/div>\r\n<\/div>\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"elementor-element elementor-element-3840f66f elementor-widget elementor-widget-text-editor\" data-id=\"3840f66f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\r\n\t\t\t\t<div class=\"elementor-widget-container\">\r\n\t\t\t<style>\/*! elementor - v3.15.0 - 09-08-2023 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:right;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"elementor-element elementor-element-26d8ec9 elementor-widget elementor-widget-text-editor\" data-id=\"26d8ec9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\r\n\t\t\t\t<div class=\"elementor-widget-container\">\r\n\t\t\t\t\t\t\t<p style=\"text-align: center;\">\ufdfd<\/p><p style=\"text-align: center;\"><span style=\"color: #800000;\">\u0642\u0631\u0622\u0646 \u06a9\u0631\u06cc\u0645 \u0627\u0648\u0631 \u0637\u0628 \u0646\u0628\u0648\u06cc \u0622\u0646 \u0644\u0627\u0626\u0646 \u067e\u0627\u06a9\u0633\u062a\u0627\u0646 &#8212; <\/span><br \/><span style=\"color: #800000;\">Holy Quran and Prophetic Medicine Online Pakistan &#8212;<\/span><\/p><h3 style=\"text-align: center;\">\u0632\u06cc\u0631\u0646\u06af\u0631\u0627\u0646\u06cc : \u0645\u0627\u06c1\u0631 \u0635\u062d\u062a \u062a\u06be\u0631\u0627\u067e\u0633\u0679 \u062d\u06a9\u06cc\u0645 \u0688\u0627\u06a9\u0679\u0631 \u062d\u0627\u0641\u0638 \u0645\u062d\u0645\u062f \u0635\u0627\u0644\u062d \u0627\u062d\u0645\u062f<\/h3><h3 style=\"text-align: center;\">Supervised by: Healer Therapist Hakeem Dr Hafiz Saleh Ahmad<\/h3><h3>\u00a0<\/h3><h3 style=\"text-align: center;\"><a href=\"https:\/\/wahdatemasalik.com\/u\/wp-content\/uploads\/2023\/03\/web-heder.png\" target=\"_blank\" rel=\"attachment noopener wp-att-8663\"><img decoding=\"async\" class=\"aligncenter size-full wp-image-8663\" src=\"https:\/\/wahdatemasalik.com\/u\/wp-content\/uploads\/2023\/03\/web-heder.png\" alt=\"\" width=\"1240\" height=\"452\" srcset=\"https:\/\/wahdatemasalik.com\/u\/wp-content\/uploads\/2023\/03\/web-heder.png 1240w, https:\/\/wahdatemasalik.com\/u\/wp-content\/uploads\/2023\/03\/web-heder-300x109.png 300w, https:\/\/wahdatemasalik.com\/u\/wp-content\/uploads\/2023\/03\/web-heder-1024x373.png 1024w, https:\/\/wahdatemasalik.com\/u\/wp-content\/uploads\/2023\/03\/web-heder-768x280.png 768w, https:\/\/wahdatemasalik.com\/u\/wp-content\/uploads\/2023\/03\/web-heder-600x219.png 600w\" sizes=\"(max-width: 1240px) 100vw, 1240px\" \/><\/a><\/h3><h3 style=\"text-align: center;\"><span style=\"color: #008080;\">&#8220;\u062c\u0633\u0645\u0627\u0646\u06cc \u060c \u0646\u0641\u0633\u06cc\u0627\u062a\u06cc \u0627\u0648\u0631 \u0631\u0648\u062d\u0627\u0646\u06cc \u0627\u0645\u0631\u0627\u0636 \u06a9\u06cc \u062a\u0634\u062e\u06cc\u0635 \u06a9\u0627 \u0627\u0628\u062a\u062f\u0627\u0626\u06cc \u0641\u0627\u0631\u0645&#8221;<\/span><br \/><span style=\"color: #008080;\">Initial diagnosis form for All kind of diseases (Pysical,Mental,Spiritual)<\/span><\/h3><p style=\"text-align: center;\"><span style=\"color: #ff0000;\">\u0627\u06af\u0631 \u0622\u067e \u0635\u062d\u06cc\u062d \u062a\u0634\u062e\u06cc\u0635 \u0627\u0648\u0631 \u0639\u0644\u0627\u062c \u0686\u0627\u06c1\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u06cc\u06c1 \u0641\u0627\u0631\u0645 \u0641\u0644 \u06a9\u0631\u06a9\u06d2 \u06c1\u0645\u06cc\u06ba \u0627\u0633 \u0646\u0645\u0628\u0631 \u067e\u0631 \u0648\u0627\u0679\u0633 \u0627\u06cc\u067e +923334103401 \u06cc\u0627 \u06c1\u0645\u0627\u0631\u06d2 \u0627\u06cc \u0645\u06cc\u0644 info@wahdatemasalik.com \u067e\u0631 \u0628\u06be\u062c\u0648\u0627\u062f\u06cc\u06ba \u06d4<\/span><\/p><p style=\"text-align: center;\"><span style=\"color: #ff0000;\">If you want complete diagnosis and treatment for your diseases please fil out this form and send us on WhatsApp 03334103401 or e-mail info@wahdatemasalik.com<\/span><\/p><p style=\"text-align: center;\"><span style=\"color: #0000ff;\">\u0622\u067e \u06a9\u06d2 \u062c\u0648\u0627\u0628\u0627\u062a \u0627\u0648\u0631 \u0622\u067e \u06a9\u06cc \u0645\u06cc\u0688\u06cc\u06a9\u0644 \u0631\u067e\u0648\u0631\u0679\u0633 \u062f\u06cc\u06a9\u06be\u0646\u06d2 \u06a9\u06d2 \u0628\u0639\u062f \u06cc\u06c1 \u0637\u06d2 \u06a9\u06cc\u0627 \u062c\u0627\u0626\u06d2 \u06af\u0627 \u06a9\u06c1 \u06cc\u06c1 \u0628\u06cc\u0645\u0627\u0631\u06cc \u0622\u067e \u06a9\u0648 \u0633\u062d\u0631 \u0648\u062c\u0627\u062f\u0648 \u06cc\u0627 \u062c\u0646\u0627\u062a \u06cc\u0627 \u062d\u0633\u062f \u06cc\u0627 \u0646\u0638\u0631 \u06cc\u0627 \u0646\u0641\u0633\u06cc\u0627\u062a\u06cc \u06cc\u0627 \u062c\u0633\u0645\u0627\u0646\u06cc \u0645\u0633\u0627\u0626\u0644 \u0645\u06cc\u06ba \u0633\u06d2 \u06a9\u0646 \u0648\u062c\u0648\u06c1\u0627\u062a \u06a9\u06cc \u0648\u062c\u06c1 \u0633\u06d2 \u0644\u06af\u06cc \u06c1\u06d2 \u06d4 <\/span><br \/><span style=\"color: #0000ff;\">\u067e\u06be\u0631 \u0622\u067e \u06a9\u0627 \u0639\u0644\u0627\u062c \u0642\u0631\u0622\u0646 \u06a9\u0631\u06cc\u0645 \u0627\u0648\u0631 \u0637\u0628 \u0646\u0628\u0648\u06cc \u06a9\u06cc \u0631\u0648\u0634\u0646\u06cc \u0645\u06cc\u06ba \u06a9\u06cc\u0627 \u062c\u0627\u0626\u06d2 \u06af\u0627\u06d4<\/span><\/p><p style=\"text-align: center;\"><span style=\"color: #0000ff;\">After examining your answers and complete analysis of your medical reports,ot will be determined which are the root causes for you have for this disease(Magic,Evil Eye,Psychological or other Medical conditions etc)<\/span><br \/><span style=\"color: #0000ff;\">Our treatment methods starts in the light of Holy Quran and medicines are derived from Tibb E Nabwi.<\/span><\/p><p style=\"text-align: center;\"><span style=\"color: #008000;\">\u0646\u0648\u0679: \u062a\u0645\u0627\u0645 \u0633\u0648\u0627\u0644\u0627\u062a \u06a9\u06d2 \u062c\u0648\u0627\u0628\u0627\u062a \u0635\u06cc\u063a\u06c1 \u0631\u0627\u0632 \u0645\u06cc\u06ba \u0631\u06a9\u06be\u06d2 \u062c\u0627\u0626\u06cc\u06ba \u06af\u06d2 \u0627\u0648\u0631 \u06cc\u06c1 \u0633\u0648\u0627\u0644\u0627\u062a \u0635\u0631\u0641 \u0635\u062d\u06cc\u062d \u062a\u0634\u062e\u06cc\u0635 \u06a9\u06d2 \u0644\u06cc\u06d2 \u06c1\u06d2\u06d4 \u0627\u0633 \u0644\u06cc\u06d2 \u06c1\u0631 \u0633\u0648\u0627\u0644 \u06a9\u0627 \u0628\u0627\u0644\u06a9\u0644 \u0635\u062d\u06cc\u062d \u062c\u0648\u0627\u0628 \u062f\u06cc\u06ba\u06d4<\/span><\/p><p style=\"text-align: center;\"><span style=\"color: #008000;\">Note:Your answers to all questions will be kept confidential as we know this is a matter of high secrecy so plz answer correctly so that it will will be easy for us to find the correct solution.<\/span><\/p>\t\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t            <\/div>\n        <\/div>\n                            <\/div>\n        <\/section>\n                <section class=\"elementor-section elementor-top-section elementor-element elementor-element-ea9f2db elementor-section-boxed elementor-section-height-default elementor-section-height-default ct-header-fixed-none ct-row-max-none\" data-id=\"ea9f2db\" data-element_type=\"section\">\n            \n                        <div class=\"elementor-container elementor-column-gap-default \">\n                    <div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-bc756e0\" data-id=\"bc756e0\" data-element_type=\"column\">\n            <div class=\"elementor-widget-wrap elementor-element-populated\">\n                        \t\t<div class=\"elementor-element elementor-element-066ba8a elementor-widget__width-inherit elementor-invisible elementor-widget elementor-widget-wp-widget-wpforms-widget\" data-id=\"066ba8a\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;bounceInUp&quot;}\" data-widget_type=\"wp-widget-wpforms-widget.default\">\r\n\t\t\t\t<div class=\"elementor-widget-container\">\r\n\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-7780\"><form id=\"wpforms-form-7780\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"7780\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/u\/wp-json\/wp\/v2\/pages\/7781\" data-token=\"2d5f0794ca8186418a475170a521c196\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-7780-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_0\">\u0646\u0627\u0645 Name <\/label><input type=\"text\" id=\"wpforms-7780-field_0\" class=\"wpforms-field-medium\" name=\"wpforms[fields][0]\" ><\/div><div id=\"wpforms-7780-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_6\">\u0639\u0645\u0631 Age<\/label><input type=\"text\" id=\"wpforms-7780-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" ><\/div><div id=\"wpforms-7780-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_3\">\u0648\u0627\u0679\u0633 \u0627\u06cc\u067e \u0646\u0645\u0628\u0631 WhatsApp Numbers <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-7780-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-7780-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_7\">\u0635\u0646\u0641 Gender <\/label><ul id=\"wpforms-7780-field_7\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_7_1\" name=\"wpforms[fields][7]\" value=\"\u0645\u0631\u062f  Male\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_7_1\">\u0645\u0631\u062f  Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_7_2\" name=\"wpforms[fields][7]\" value=\"\u0639\u0648\u0631\u062a Female\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_7_2\">\u0639\u0648\u0631\u062a Female<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_7_3\" name=\"wpforms[fields][7]\" value=\"\u062f\u06cc\u06af\u0631 other\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_7_3\">\u062f\u06cc\u06af\u0631 other<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_26\">\u0634\u06c1\u0631 City<\/label><input type=\"text\" id=\"wpforms-7780-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" ><\/div><div id=\"wpforms-7780-field_9-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_9\">\u0627\u06cc\u0688\u0631\u06cc\u0633 Address<\/label><textarea id=\"wpforms-7780-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_10\">\u0648\u0632\u0646 Weight<\/label><input type=\"text\" id=\"wpforms-7780-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-7780-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_25\">\u0627\u0632\u062f\u0648\u0627\u062c\u06cc \u062d\u06cc\u062b\u06cc\u062a : Marital status<\/label><input type=\"text\" id=\"wpforms-7780-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\" ><div class=\"wpforms-field-description\">\u0634\u0627\u062f\u06cc \u0634\u062f\u06c1 \u06cc\u0627 \u063a\u06cc\u0631 \u0634\u0627\u062f\u06cc \u0634\u0627\u062f\u06c1 <\/div><\/div><div id=\"wpforms-7780-field_8-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_8\">\u0627\u06cc \u0645\u06cc\u0644 Email<\/label><input type=\"email\" id=\"wpforms-7780-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" ><\/div><div id=\"wpforms-7780-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_2\"> 1.  \u0622\u067e \u06a9\u0648 \u062c\u0648 \u0645\u0631\u0636 \u0644\u0627\u062d\u0642 \u06c1\u06d2 \u0648\u06c1 \u06a9\u0628 \u0633\u06d2 \u0634\u0631\u0648\u0639 \u06c1\u0648\u0627\u061f    When did the disease you are suffering from was started?<\/label><textarea id=\"wpforms-7780-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_183-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"183\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_183\"> 1.  \u0622\u067e \u06a9\u0648 \u062c\u0648 \u0645\u0631\u0636 \u0644\u0627\u062d\u0642 \u06c1\u06d2 \u0648\u06c1 \u06a9\u0628 \u0633\u06d2 \u0634\u0631\u0648\u0639 \u06c1\u0648\u0627\u061f    When did the disease you are suffering from was started?<\/label><ul id=\"wpforms-7780-field_183\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_183_1\" name=\"wpforms[fields][183]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_183_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_183_2\" name=\"wpforms[fields][183]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_183_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_183_4\" name=\"wpforms[fields][183]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_183_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_27-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_27\"> 2.  \u0627\u067e\u0646\u06d2 \u0645\u0631\u0636 \u06a9\u06cc \u062a\u0641\u0635\u06cc\u0644 \u0628\u06cc\u0627\u0646 \u06a9\u0631\u06cc\u06ba :    Please completely describe your disease <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-7780-field_27\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][27]\" required><\/textarea><\/div><div id=\"wpforms-7780-field_200-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"200\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_200\"> 2.  \u0627\u067e\u0646\u06d2 \u0645\u0631\u0636 \u06a9\u06cc \u062a\u0641\u0635\u06cc\u0644 \u0628\u06cc\u0627\u0646 \u06a9\u0631\u06cc\u06ba :    Please completely describe your disease<\/label><ul id=\"wpforms-7780-field_200\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_200_1\" name=\"wpforms[fields][200]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_200_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_200_2\" name=\"wpforms[fields][200]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_200_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_200_4\" name=\"wpforms[fields][200]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_200_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_28-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_28\"> 3.  \u06a9\u06cc\u0627 \u0622\u067e \u0631\u0648\u0632\u0627\u0646\u06c1 \u0628\u0627\u0642\u0627\u0639\u062f\u06af\u06cc \u0633\u06d2  \u067e\u0627\u0646\u0686\u0648\u06ba \u0646\u0645\u0627\u0632\u0648\u06ba \u06a9\u0648 \u0627\u062f\u0627 \u06a9\u0631\u0646\u06d2 \u06a9\u06cc \u067e\u0627\u0628\u0646\u062f\u06cc \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f    Do you offer payers five time a day?<\/label><textarea id=\"wpforms-7780-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_199-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"199\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_199\"> 3.  \u06a9\u06cc\u0627 \u0622\u067e \u0631\u0648\u0632\u0627\u0646\u06c1 \u0628\u0627\u0642\u0627\u0639\u062f\u06af\u06cc \u0633\u06d2  \u067e\u0627\u0646\u0686\u0648\u06ba \u0646\u0645\u0627\u0632\u0648\u06ba \u06a9\u0648 \u0627\u062f\u0627 \u06a9\u0631\u0646\u06d2 \u06a9\u06cc \u067e\u0627\u0628\u0646\u062f\u06cc \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f    Do you offer payers five time a day?<\/label><ul id=\"wpforms-7780-field_199\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_199_1\" name=\"wpforms[fields][199]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_199_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_199_2\" name=\"wpforms[fields][199]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_199_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_199_4\" name=\"wpforms[fields][199]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_199_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_30-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_30\"> 4.\u06a9\u06cc\u0627 \u0622\u067e \u0642\u0631\u0622\u0646 \u06a9\u0631\u06cc\u0645 \u06a9\u06cc \u062a\u0644\u0627\u0648\u062a \u0628\u0627\u0642\u0627\u0639\u062f\u06af\u06cc \u0633\u06d2 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba (\u0631\u0648\u0632\u0627\u0646\u06c1\u060c \u06c1\u0641\u062a\u06c1 \u0648\u0627\u0631\u060c \u0645\u0627\u06c1\u0627\u0646\u06c1) \u061f  Do you recite Holy Quran (Daily,Weekly,Monthly)<\/label><textarea id=\"wpforms-7780-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_198-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"198\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_198\"> 4.\u06a9\u06cc\u0627 \u0622\u067e \u0642\u0631\u0622\u0646 \u06a9\u0631\u06cc\u0645 \u06a9\u06cc \u062a\u0644\u0627\u0648\u062a \u0628\u0627\u0642\u0627\u0639\u062f\u06af\u06cc \u0633\u06d2 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba (\u0631\u0648\u0632\u0627\u0646\u06c1\u060c \u06c1\u0641\u062a\u06c1 \u0648\u0627\u0631\u060c \u0645\u0627\u06c1\u0627\u0646\u06c1) \u061f  Do you recite Holy Quran (Daily,Weekly,Monthly)<\/label><ul id=\"wpforms-7780-field_198\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_198_1\" name=\"wpforms[fields][198]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_198_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_198_2\" name=\"wpforms[fields][198]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_198_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_198_4\" name=\"wpforms[fields][198]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_198_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_31-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_31\"> 5. \u06a9\u06cc\u0627 \u0622\u067e \u0635\u0628\u062d \u0648 \u0634\u0627\u0645 \u06a9\u06d2 \u0627\u0630\u06a9\u0627\u0631 \u0627\u0648\u0631 \u0633\u0648\u0646\u06d2 \u06a9\u06d2 \u0627\u0630\u06a9\u0627\u0631 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you have Morning and evening azkaar in your routine?<\/label><textarea id=\"wpforms-7780-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_197-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"197\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_197\"> 5. \u06a9\u06cc\u0627 \u0622\u067e \u0635\u0628\u062d \u0648 \u0634\u0627\u0645 \u06a9\u06d2 \u0627\u0630\u06a9\u0627\u0631 \u0627\u0648\u0631 \u0633\u0648\u0646\u06d2 \u06a9\u06d2 \u0627\u0630\u06a9\u0627\u0631 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you have Morning and evening azkaar in your routine?<\/label><ul id=\"wpforms-7780-field_197\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_197_1\" name=\"wpforms[fields][197]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_197_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_197_2\" name=\"wpforms[fields][197]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_197_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_197_4\" name=\"wpforms[fields][197]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_197_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_32-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_32\"> 6. \u06a9\u06cc\u0627 \u0622\u067e \u062c\u0628 \u062f\u06cc\u0646\u06cc \u0639\u0628\u0627\u062f\u062a \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u0622\u067e \u06a9\u0627 \u0630\u06c1\u0646 \u0645\u0646\u062a\u0634\u0631 \u0627\u0648\u0631 \u0622\u067e \u062a\u0646\u06af\u06cc \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you feel it difficult to offer religious worships?<\/label><textarea id=\"wpforms-7780-field_32\" class=\"wpforms-field-medium\" name=\"wpforms[fields][32]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_196-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"196\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_196\"> 6. \u06a9\u06cc\u0627 \u0622\u067e \u062c\u0628 \u062f\u06cc\u0646\u06cc \u0639\u0628\u0627\u062f\u062a \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u0622\u067e \u06a9\u0627 \u0630\u06c1\u0646 \u0645\u0646\u062a\u0634\u0631 \u0627\u0648\u0631 \u0622\u067e \u062a\u0646\u06af\u06cc \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you feel it difficult to offer religious worships?<\/label><ul id=\"wpforms-7780-field_196\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_196_1\" name=\"wpforms[fields][196]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_196_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_196_2\" name=\"wpforms[fields][196]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_196_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_196_4\" name=\"wpforms[fields][196]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_196_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_33-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_33\"> 7. \u06a9\u06cc\u0627 \u0622\u067e \u0648\u0642\u062a\u0627 \u0641\u0648\u0642\u062a\u0627 \u0627\u067e\u0646\u06d2 \u062c\u0633\u0645 \u0645\u06cc\u06ba \u06a9\u067e\u06a9\u067e\u06cc \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel your body trembling or shivering from time to time?<\/label><textarea id=\"wpforms-7780-field_33\" class=\"wpforms-field-medium\" name=\"wpforms[fields][33]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_195-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"195\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_195\"> 7. \u06a9\u06cc\u0627 \u0622\u067e \u0648\u0642\u062a\u0627 \u0641\u0648\u0642\u062a\u0627 \u0627\u067e\u0646\u06d2 \u062c\u0633\u0645 \u0645\u06cc\u06ba \u06a9\u067e\u06a9\u067e\u06cc \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel your body trembling or shivering from time to time?<\/label><ul id=\"wpforms-7780-field_195\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_195_1\" name=\"wpforms[fields][195]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_195_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_195_2\" name=\"wpforms[fields][195]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_195_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_195_4\" name=\"wpforms[fields][195]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_195_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_34-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_34\"> 8. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0633\u0631 \u06a9\u0627 \u067e\u0686\u06be\u0644\u06d2 \u062d\u0635\u06c1 \u0628\u06be\u0627\u0631\u06cc \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u061f Do you find your back of the head heavy?<\/label><textarea id=\"wpforms-7780-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_194-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"194\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_194\"> 8. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0633\u0631 \u06a9\u0627 \u067e\u0686\u06be\u0644\u06d2 \u062d\u0635\u06c1 \u0628\u06be\u0627\u0631\u06cc \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u061f Do you find your back of the head heavy?<\/label><ul id=\"wpforms-7780-field_194\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_194_1\" name=\"wpforms[fields][194]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_194_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_194_2\" name=\"wpforms[fields][194]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_194_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_194_4\" name=\"wpforms[fields][194]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_194_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_35-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_35\"> 9. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0628\u06c1\u062a \u0632\u06cc\u0627\u062f\u06c1 \u0688\u06a9\u0627\u0631 \u062c\u06cc\u0633\u06d2 \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you have excessive burps and bad breath?<\/label><textarea id=\"wpforms-7780-field_35\" class=\"wpforms-field-medium\" name=\"wpforms[fields][35]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_193-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"193\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_193\"> 9. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0628\u06c1\u062a \u0632\u06cc\u0627\u062f\u06c1 \u0688\u06a9\u0627\u0631 \u062c\u06cc\u0633\u06d2 \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you have excessive burps and bad breath?<\/label><ul id=\"wpforms-7780-field_193\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_193_1\" name=\"wpforms[fields][193]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_193_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_193_2\" name=\"wpforms[fields][193]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_193_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_193_4\" name=\"wpforms[fields][193]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_193_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_36-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_36\"> 10. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u067e\u06cc\u0679 \u0645\u06cc\u06ba \u062f\u0631\u062f \u0627\u0648\u0631 \u0645\u0631\u0648\u0691 \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f Do you feel abdominal pain and cramps?<\/label><textarea id=\"wpforms-7780-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_192-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"192\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_192\"> 10. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u067e\u06cc\u0679 \u0645\u06cc\u06ba \u062f\u0631\u062f \u0627\u0648\u0631 \u0645\u0631\u0648\u0691 \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f Do you feel abdominal pain and cramps?<\/label><ul id=\"wpforms-7780-field_192\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_192_1\" name=\"wpforms[fields][192]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_192_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_192_2\" name=\"wpforms[fields][192]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_192_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_192_4\" name=\"wpforms[fields][192]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_192_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_37-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_37\"> 11. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0627 \u067e\u06cc\u0679 \u067e\u06be\u0648\u0644\u0627 \u06c1\u0648\u0627 \u06c1\u06d2 \u061f Is your stomach bloated ?<\/label><textarea id=\"wpforms-7780-field_37\" class=\"wpforms-field-medium\" name=\"wpforms[fields][37]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_191-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"191\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_191\"> 11. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0627 \u067e\u06cc\u0679 \u067e\u06be\u0648\u0644\u0627 \u06c1\u0648\u0627 \u06c1\u06d2 \u061f Is your stomach bloated ?<\/label><ul id=\"wpforms-7780-field_191\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_191_1\" name=\"wpforms[fields][191]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_191_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_191_2\" name=\"wpforms[fields][191]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_191_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_191_4\" name=\"wpforms[fields][191]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_191_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_38-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_38\"> 12. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0645\u0639\u062f\u06d2 \u0645\u06cc\u06ba \u062a\u06cc\u0632\u0627\u0628\u06cc\u062a  \u06c1\u06d2: Do you feel acidity in your stomach?<\/label><textarea id=\"wpforms-7780-field_38\" class=\"wpforms-field-medium\" name=\"wpforms[fields][38]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_190-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"190\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_190\"> 12. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0645\u0639\u062f\u06d2 \u0645\u06cc\u06ba \u062a\u06cc\u0632\u0627\u0628\u06cc\u062a  \u06c1\u06d2: Do you feel acidity in your stomach?<\/label><ul id=\"wpforms-7780-field_190\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_190_1\" name=\"wpforms[fields][190]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_190_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_190_2\" name=\"wpforms[fields][190]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_190_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_190_4\" name=\"wpforms[fields][190]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_190_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_39-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_39\"> 13. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u06af\u0644\u06d2 \u0645\u06cc\u06ba \u0646\u06cc\u0646\u062f \u0633\u06d2 \u0627\u0679\u06be\u062a\u06d2 \u0648\u0642\u062a \u06a9\u0691\u0648\u0627\u06c1\u0679 \u0627\u0648\u0631 \u0633\u0648\u0632\u0634 \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u061f Do you have soar throat when you wake up?<\/label><textarea id=\"wpforms-7780-field_39\" class=\"wpforms-field-medium\" name=\"wpforms[fields][39]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_189-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"189\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_189\"> 13. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u06af\u0644\u06d2 \u0645\u06cc\u06ba \u0646\u06cc\u0646\u062f \u0633\u06d2 \u0627\u0679\u06be\u062a\u06d2 \u0648\u0642\u062a \u06a9\u0691\u0648\u0627\u06c1\u0679 \u0627\u0648\u0631 \u0633\u0648\u0632\u0634 \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u061f Do you have soar throat when you wake up?<\/label><ul id=\"wpforms-7780-field_189\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_189_1\" name=\"wpforms[fields][189]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_189_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_189_2\" name=\"wpforms[fields][189]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_189_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_189_4\" name=\"wpforms[fields][189]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_189_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_40-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_40\"> 14. \u062c\u0628 \u0622\u067e \u0646\u06cc\u0646\u062f \u0633\u06d2 \u0627\u0679\u06be\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u0622\u067e \u06a9\u0648 \u06a9\u06be\u0627\u0646\u06d2 \u06a9\u06cc \u0628\u06be\u0648\u06a9 \u0645\u0631\u06cc \u06c1\u0648\u0626\u06cc \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u061f Do you feel hungry when you wake up?<\/label><textarea id=\"wpforms-7780-field_40\" class=\"wpforms-field-medium\" name=\"wpforms[fields][40]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_188-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"188\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_188\"> 14. \u062c\u0628 \u0622\u067e \u0646\u06cc\u0646\u062f \u0633\u06d2 \u0627\u0679\u06be\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u0622\u067e \u06a9\u0648 \u06a9\u06be\u0627\u0646\u06d2 \u06a9\u06cc \u0628\u06be\u0648\u06a9 \u0645\u0631\u06cc \u06c1\u0648\u0626\u06cc \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u061f Do you feel hungry when you wake up?<\/label><ul id=\"wpforms-7780-field_188\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_188_1\" name=\"wpforms[fields][188]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_188_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_188_2\" name=\"wpforms[fields][188]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_188_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_188_4\" name=\"wpforms[fields][188]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_188_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_41-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_41\"> 15. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0642\u0628\u0636 \u06a9\u0627 \u0633\u0627\u0645\u0646\u0627 \u0631\u06c1\u062a\u0627 \u06c1\u06d2 (\u0627\u06a9\u062b\u0631 \u06cc\u0627 \u062f\u0627\u0626\u0645\u06cc)\u061f Do you suffer from constipation (Acute or Chronic)<\/label><textarea id=\"wpforms-7780-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_187-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"187\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_187\"> 15. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0642\u0628\u0636 \u06a9\u0627 \u0633\u0627\u0645\u0646\u0627 \u0631\u06c1\u062a\u0627 \u06c1\u06d2 (\u0627\u06a9\u062b\u0631 \u06cc\u0627 \u062f\u0627\u0626\u0645\u06cc)\u061f Do you suffer from constipation (Acute or Chronic)<\/label><ul id=\"wpforms-7780-field_187\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_187_1\" name=\"wpforms[fields][187]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_187_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_187_2\" name=\"wpforms[fields][187]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_187_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_187_4\" name=\"wpforms[fields][187]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_187_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_42-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_42\"> 16. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0645\u0646\u06c1 (\u0645\u0639\u062f\u06c1) \u0633\u06d2 \u0627\u06cc\u06a9 \u0646\u0627\u06af\u0648\u0627\u0631 \u0628\u062f\u0628\u0648 \u0622\u062a\u06cc \u06c1\u06d2\u061f Does your mouth (stomach) give off an unpleasant smell?<\/label><textarea id=\"wpforms-7780-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_186-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"186\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_186\"> 16. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0645\u0646\u06c1 (\u0645\u0639\u062f\u06c1) \u0633\u06d2 \u0627\u06cc\u06a9 \u0646\u0627\u06af\u0648\u0627\u0631 \u0628\u062f\u0628\u0648 \u0622\u062a\u06cc \u06c1\u06d2\u061f Does your mouth (stomach) give off an unpleasant smell?<\/label><ul id=\"wpforms-7780-field_186\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_186_1\" name=\"wpforms[fields][186]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_186_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_186_2\" name=\"wpforms[fields][186]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_186_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_186_4\" name=\"wpforms[fields][186]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_186_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_43-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_43\"> 17.\u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u067e\u06cc\u0679\u06be \u06a9\u06d2 \u0646\u0686\u0644\u06d2 \u062d\u0635\u06d2 \u0645\u06cc\u06ba \u062f\u0631\u062f \u06c1\u06d2\u061f Do you feel back pain in back bone?<\/label><textarea id=\"wpforms-7780-field_43\" class=\"wpforms-field-medium\" name=\"wpforms[fields][43]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_185-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"185\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_185\"> 17.\u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u067e\u06cc\u0679\u06be \u06a9\u06d2 \u0646\u0686\u0644\u06d2 \u062d\u0635\u06d2 \u0645\u06cc\u06ba \u062f\u0631\u062f \u06c1\u06d2\u061f Do you feel back pain in back bone?<\/label><ul id=\"wpforms-7780-field_185\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_185_1\" name=\"wpforms[fields][185]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_185_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_185_2\" name=\"wpforms[fields][185]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_185_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_185_4\" name=\"wpforms[fields][185]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_185_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_44-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_44\"> 18. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0633\u06cc\u0646\u06d2 \u0645\u06cc\u06ba \u06af\u06be\u0679\u0646 \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u061f Do you feel chest tighteness?<\/label><textarea id=\"wpforms-7780-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_184-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"184\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_184\"> 18. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0633\u06cc\u0646\u06d2 \u0645\u06cc\u06ba \u06af\u06be\u0679\u0646 \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u061f Do you feel chest tighteness?<\/label><ul id=\"wpforms-7780-field_184\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_184_1\" name=\"wpforms[fields][184]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_184_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_184_2\" name=\"wpforms[fields][184]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_184_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_184_4\" name=\"wpforms[fields][184]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_184_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_45-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_45\"> 19. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0645\u06a9\u0645\u0644 \u0633\u0631 \u062f\u0631\u062f \u0631\u06c1\u062a\u0627 \u06c1\u06d2 \u06cc\u0627 \u0628\u0639\u0636 \u062d\u0635\u06d2 \u0645\u06cc\u06ba (\u0646\u0634\u0627\u0646\u062f\u06c1\u06cc \u06a9\u0631\u06cc\u06ba)\u061f Do you have headache or Migrane(Please mention in which part of head)<\/label><textarea id=\"wpforms-7780-field_45\" class=\"wpforms-field-medium\" name=\"wpforms[fields][45]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_177-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"177\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_177\"> 19. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0645\u06a9\u0645\u0644 \u0633\u0631 \u062f\u0631\u062f \u0631\u06c1\u062a\u0627 \u06c1\u06d2 \u06cc\u0627 \u0628\u0639\u0636 \u062d\u0635\u06d2 \u0645\u06cc\u06ba (\u0646\u0634\u0627\u0646\u062f\u06c1\u06cc \u06a9\u0631\u06cc\u06ba)\u061f Do you have headache or Migrane(Please mention in which part of head)<\/label><ul id=\"wpforms-7780-field_177\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_177_1\" name=\"wpforms[fields][177]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_177_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_177_2\" name=\"wpforms[fields][177]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_177_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_177_4\" name=\"wpforms[fields][177]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_177_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_46-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_46\"> 20. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0686\u06c1\u0631\u06c1 \u06a9\u0627 \u0631\u0646\u06af  ( \u0633\u06cc\u0627\u06c1 \u060c \u0644\u0627\u0644 \u06cc\u0627 \u067e\u06cc\u0644\u06d2 \u067e\u0646) \u0645\u06cc\u06ba \u062a\u0628\u062f\u06cc\u0644 \u06c1\u0648\u062a\u0627 \u06c1\u06d2 \u061f \u0627\u0648\u0631 \u0632\u06cc\u0627\u062f\u06c1 \u062a\u0631 \u06a9\u0633 \u0648\u0642\u062a \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f Does the color of your face (black, red or yellow) change? And what happens most of the time?<\/label><textarea id=\"wpforms-7780-field_46\" class=\"wpforms-field-medium\" name=\"wpforms[fields][46]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_182-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"182\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_182\"> 20. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0686\u06c1\u0631\u06c1 \u06a9\u0627 \u0631\u0646\u06af  ( \u0633\u06cc\u0627\u06c1 \u060c \u0644\u0627\u0644 \u06cc\u0627 \u067e\u06cc\u0644\u06d2 \u067e\u0646) \u0645\u06cc\u06ba \u062a\u0628\u062f\u06cc\u0644 \u06c1\u0648\u062a\u0627 \u06c1\u06d2 \u061f \u0627\u0648\u0631 \u0632\u06cc\u0627\u062f\u06c1 \u062a\u0631 \u06a9\u0633 \u0648\u0642\u062a \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f Does the color of your face (black, red or yellow) change? And what happens most of the time?<\/label><ul id=\"wpforms-7780-field_182\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_182_1\" name=\"wpforms[fields][182]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_182_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_182_2\" name=\"wpforms[fields][182]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_182_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_182_4\" name=\"wpforms[fields][182]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_182_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_47-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_47\"> 21. \u06a9\u06cc\u0627 \u0622\u067e \u0627\u067e\u0646\u06d2 \u062c\u0633\u0645 \u0645\u06cc\u06ba \u06a9\u0633\u06cc \u062d\u0635\u06d2 \u06a9\u0648 \u0633\u0646 \u067e\u0627\u062a\u06d2 \u06c1\u06cc\u06ba \u061f  \u0627\u06af\u0631 \u062c\u0648\u0627\u0628 \u06c1\u0627\u06ba \u0645\u06cc\u06ba \u06c1\u06d2 \u062a\u0648 \u062c\u0633\u0645 \u06a9\u06d2 \u0627\u0646 \u062d\u0635\u0648\u06ba \u06a9\u06cc \u0646\u0634\u0627\u0646\u062f\u06c1\u06cc \u06a9\u0631\u06cc\u06ba \u062c\u0648 \u0633\u0646 \u06c1\u0648\u062a\u06d2 \u06c1\u06cc\u06ba\u061f\u061f Do you feel Numbness and Tingling in any part of your body? If the answer is yes, then identify the parts of the body that are audible ?<\/label><textarea id=\"wpforms-7780-field_47\" class=\"wpforms-field-medium\" name=\"wpforms[fields][47]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_181-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"181\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_181\"> 21. \u06a9\u06cc\u0627 \u0622\u067e \u0627\u067e\u0646\u06d2 \u062c\u0633\u0645 \u0645\u06cc\u06ba \u06a9\u0633\u06cc \u062d\u0635\u06d2 \u06a9\u0648 \u0633\u0646 \u067e\u0627\u062a\u06d2 \u06c1\u06cc\u06ba \u061f  \u0627\u06af\u0631 \u062c\u0648\u0627\u0628 \u06c1\u0627\u06ba \u0645\u06cc\u06ba \u06c1\u06d2 \u062a\u0648 \u062c\u0633\u0645 \u06a9\u06d2 \u0627\u0646 \u062d\u0635\u0648\u06ba \u06a9\u06cc \u0646\u0634\u0627\u0646\u062f\u06c1\u06cc \u06a9\u0631\u06cc\u06ba \u062c\u0648 \u0633\u0646 \u06c1\u0648\u062a\u06d2 \u06c1\u06cc\u06ba\u061f\u061f Do you feel Numbness and Tingling in any part of your body? If the answer is yes, then identify the parts of the body that are audible ?<\/label><ul id=\"wpforms-7780-field_181\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_181_1\" name=\"wpforms[fields][181]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_181_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_181_2\" name=\"wpforms[fields][181]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_181_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_181_4\" name=\"wpforms[fields][181]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_181_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_48-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_48\"> 22. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06d2 \u062c\u0633\u0645 \u06a9\u06d2 \u067e\u06c1\u0644\u0648\u0648\u0654\u06ba  \u0645\u06cc\u06ba \u0634\u062f\u06cc\u062f \u0633\u0631\u062f\u06cc \u06cc\u0627 \u06af\u0631\u0645\u06cc \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u06cc \u06c1\u06d2\u061f Do you feel extreme cold or heat in all aspects of your body?<\/label><textarea id=\"wpforms-7780-field_48\" class=\"wpforms-field-medium\" name=\"wpforms[fields][48]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_180-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"180\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_180\"> 22. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06d2 \u062c\u0633\u0645 \u06a9\u06d2 \u067e\u06c1\u0644\u0648\u0648\u0654\u06ba  \u0645\u06cc\u06ba \u0634\u062f\u06cc\u062f \u0633\u0631\u062f\u06cc \u06cc\u0627 \u06af\u0631\u0645\u06cc \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u06cc \u06c1\u06d2\u061f Do you feel extreme cold or heat in all aspects of your body?<\/label><ul id=\"wpforms-7780-field_180\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_180_1\" name=\"wpforms[fields][180]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_180_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_180_2\" name=\"wpforms[fields][180]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_180_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_180_4\" name=\"wpforms[fields][180]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_180_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_49-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_49\"> 23.  \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06a9\u0646\u062f\u06be\u0648\u06ba \u0627\u0648\u0631 \u067e\u06cc\u0631\u0648\u06ba \u0645\u06cc\u06ba \u0628\u0648\u062c\u06be \u0627\u0648\u0631 \u0628\u06be\u0627\u0631\u06cc \u067e\u0646 \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f Do you feel heaviness and heaviness in your shoulders and legs?<\/label><textarea id=\"wpforms-7780-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_179-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"179\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_179\"> 23.  \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06a9\u0646\u062f\u06be\u0648\u06ba \u0627\u0648\u0631 \u067e\u06cc\u0631\u0648\u06ba \u0645\u06cc\u06ba \u0628\u0648\u062c\u06be \u0627\u0648\u0631 \u0628\u06be\u0627\u0631\u06cc \u067e\u0646 \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f Do you feel heaviness and heaviness in your shoulders and legs?<\/label><ul id=\"wpforms-7780-field_179\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_179_1\" name=\"wpforms[fields][179]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_179_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_179_2\" name=\"wpforms[fields][179]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_179_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_179_4\" name=\"wpforms[fields][179]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_179_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_50-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_50\"> 24. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0648\u0642\u062a\u0627 \u0641\u0648\u0642\u062a\u0627 \u062f\u0648\u0631\u06d2 \u067e\u0691\u062a\u06d2 \u06c1\u06cc\u06ba \u0627\u0648\u0631 \u0686\u06a9\u0631 \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you have occasional seizures and dizziness? <\/label><textarea id=\"wpforms-7780-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_178-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"178\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_178\"> 24. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0648\u0642\u062a\u0627 \u0641\u0648\u0642\u062a\u0627 \u062f\u0648\u0631\u06d2 \u067e\u0691\u062a\u06d2 \u06c1\u06cc\u06ba \u0627\u0648\u0631 \u0686\u06a9\u0631 \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you have occasional seizures and dizziness? <\/label><ul id=\"wpforms-7780-field_178\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_178_1\" name=\"wpforms[fields][178]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_178_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_178_2\" name=\"wpforms[fields][178]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_178_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_178_4\" name=\"wpforms[fields][178]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_178_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_51-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_51\"> 25. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06cc \u0622\u0646\u06a9\u06be\u0648\u06ba \u06a9\u06d2 \u0633\u0627\u0645\u0646\u06d2 \u062f\u06be\u0646\u062f\u0644\u0627 \u067e\u0646 \u062f\u06a9\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u0627 \u06c1\u06d2 \u060c \u0628\u0627\u0644\u062e\u0635\u0648\u0635 \u0639\u0635\u0631 \u06a9\u06d2 \u0628\u0639\u062f \u06cc\u0627 \u0645\u063a\u0631\u0628 \u0633\u06d2 \u06a9\u0686\u06be \u062f\u06cc\u0631 \u067e\u06c1\u0644\u06d2 \u061f Do you notice blurred vision before your eyes, especially after noon or shortly before sunset?<\/label><textarea id=\"wpforms-7780-field_51\" class=\"wpforms-field-medium\" name=\"wpforms[fields][51]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_164-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"164\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_164\"> 25. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06cc \u0622\u0646\u06a9\u06be\u0648\u06ba \u06a9\u06d2 \u0633\u0627\u0645\u0646\u06d2 \u062f\u06be\u0646\u062f\u0644\u0627 \u067e\u0646 \u062f\u06a9\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u0627 \u06c1\u06d2 \u060c \u0628\u0627\u0644\u062e\u0635\u0648\u0635 \u0639\u0635\u0631 \u06a9\u06d2 \u0628\u0639\u062f \u06cc\u0627 \u0645\u063a\u0631\u0628 \u0633\u06d2 \u06a9\u0686\u06be \u062f\u06cc\u0631 \u067e\u06c1\u0644\u06d2 \u061f Do you notice blurred vision before your eyes, especially after noon or shortly before sunset?<\/label><ul id=\"wpforms-7780-field_164\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_164_1\" name=\"wpforms[fields][164]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_164_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_164_2\" name=\"wpforms[fields][164]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_164_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_164_4\" name=\"wpforms[fields][164]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_164_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_52-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_52\"> 26. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06cc \u0622\u0646\u06a9\u06be\u0648\u06ba \u06a9\u06d2 \u0633\u0627\u0645\u0646\u06d2 \u0688\u0648\u0631\u06d2 \u0628\u0646\u062f\u06be\u06cc \u06c1\u0648\u0626\u06cc \u0646\u0638\u0631 \u0622\u062a\u06cc \u06c1\u06cc\u06ba\u061f Do you see the strings tied in front of your eyes?<\/label><textarea id=\"wpforms-7780-field_52\" class=\"wpforms-field-medium\" name=\"wpforms[fields][52]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_176-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"176\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_176\"> 26. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06cc \u0622\u0646\u06a9\u06be\u0648\u06ba \u06a9\u06d2 \u0633\u0627\u0645\u0646\u06d2 \u0688\u0648\u0631\u06d2 \u0628\u0646\u062f\u06be\u06cc \u06c1\u0648\u0626\u06cc \u0646\u0638\u0631 \u0622\u062a\u06cc \u06c1\u06cc\u06ba\u061f Do you see the strings tied in front of your eyes?<\/label><ul id=\"wpforms-7780-field_176\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_176_1\" name=\"wpforms[fields][176]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_176_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_176_2\" name=\"wpforms[fields][176]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_176_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_176_4\" name=\"wpforms[fields][176]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_176_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_53-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_53\"> 27. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0627 \u062f\u0644 \u0628\u06d2 \u0686\u06cc\u0646 \u0627\u0648\u0631 \u06af\u06be\u0628\u0631\u0627\u062a\u0627 \u0631\u06c1\u062a\u0627 \u06c1\u06d2 \u061f Is your heart panic and heart palpitations ?<\/label><textarea id=\"wpforms-7780-field_53\" class=\"wpforms-field-medium\" name=\"wpforms[fields][53]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_175-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"175\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_175\"> 27. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0627 \u062f\u0644 \u0628\u06d2 \u0686\u06cc\u0646 \u0627\u0648\u0631 \u06af\u06be\u0628\u0631\u0627\u062a\u0627 \u0631\u06c1\u062a\u0627 \u06c1\u06d2 \u061f Is your heart panic and heart palpitations??<\/label><ul id=\"wpforms-7780-field_175\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_175_1\" name=\"wpforms[fields][175]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_175_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_175_2\" name=\"wpforms[fields][175]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_175_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_175_4\" name=\"wpforms[fields][175]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_175_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_54-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_54\"> 28. \u06a9\u06cc\u0627 \u0622\u067e \u067e\u0631 \u06a9\u0648\u0626\u06cc \u062e\u0648\u0641 \u0637\u0627\u0631\u06cc \u0631\u06c1\u062a\u0627 \u06c1\u06d2 \u061f  Do you have any fear?<\/label><textarea id=\"wpforms-7780-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_174-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"174\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_174\"> 28. \u06a9\u06cc\u0627 \u0622\u067e \u067e\u0631 \u06a9\u0648\u0626\u06cc \u062e\u0648\u0641 \u0637\u0627\u0631\u06cc \u0631\u06c1\u062a\u0627 \u06c1\u06d2 \u061f  Do you have any fear?<\/label><ul id=\"wpforms-7780-field_174\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_174_1\" name=\"wpforms[fields][174]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_174_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_174_2\" name=\"wpforms[fields][174]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_174_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_174_4\" name=\"wpforms[fields][174]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_174_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_55-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_55\"> 29. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0639\u062c\u06cc\u0628 \u0633\u06cc \u062e\u0648\u0634\u0628\u0648\u0626\u06cc\u06ba \u0633\u0646\u06af\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u06cc \u06c1\u06cc\u06ba \u06cc\u0627 \u0622\u0648\u0627\u0632\u06cc\u06ba \u0633\u0646\u0627\u0626\u06cc \u062f\u06cc\u062a\u06cc \u06c1\u06cc\u06ba\u061fDo you hear strange sounds or smell strange smells?<\/label><textarea id=\"wpforms-7780-field_55\" class=\"wpforms-field-medium\" name=\"wpforms[fields][55]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_173-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"173\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_173\"> 29. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0639\u062c\u06cc\u0628 \u0633\u06cc \u062e\u0648\u0634\u0628\u0648\u0626\u06cc\u06ba \u0633\u0646\u06af\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u06cc \u06c1\u06cc\u06ba \u06cc\u0627 \u0622\u0648\u0627\u0632\u06cc\u06ba \u0633\u0646\u0627\u0626\u06cc \u062f\u06cc\u062a\u06cc \u06c1\u06cc\u06ba\u061fDo you hear strange sounds or smell strange smells?<\/label><ul id=\"wpforms-7780-field_173\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_173_1\" name=\"wpforms[fields][173]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_173_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_173_2\" name=\"wpforms[fields][173]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_173_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_173_4\" name=\"wpforms[fields][173]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_173_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_56-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_56\"> 30. \u06a9\u06cc\u0627 \u0622\u067e \u0628\u0644\u0627 \u0648\u062c\u06c1 \u062a\u06be\u06a9\u0627\u0648\u0679 \u0627\u0648\u0631 \u0633\u0633\u062a\u06cc \u06a9\u0627 \u0634\u06a9\u0627\u0631 \u0631\u06c1\u062a\u06d2 \u06c1\u06cc\u06ba\u061f  Do you feel tired and lazy all the time?<\/label><textarea id=\"wpforms-7780-field_56\" class=\"wpforms-field-medium\" name=\"wpforms[fields][56]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_172-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"172\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_172\"> 30. \u06a9\u06cc\u0627 \u0622\u067e \u0628\u0644\u0627 \u0648\u062c\u06c1 \u062a\u06be\u06a9\u0627\u0648\u0679 \u0627\u0648\u0631 \u0633\u0633\u062a\u06cc \u06a9\u0627 \u0634\u06a9\u0627\u0631 \u0631\u06c1\u062a\u06d2 \u06c1\u06cc\u06ba\u061f  Do you feel tired and lazy all the time?<\/label><ul id=\"wpforms-7780-field_172\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_172_1\" name=\"wpforms[fields][172]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_172_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_172_2\" name=\"wpforms[fields][172]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_172_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_172_4\" name=\"wpforms[fields][172]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_172_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_57-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_57\"> 31. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u062c\u0633\u0645 \u067e\u0631 \u0646\u06cc\u0644\u06d2 \u06cc\u0627 \u0633\u0631\u062e \u0631\u0646\u06af \u06a9\u06d2 \u06c1\u0644\u06a9\u06d2 \u062f\u06be\u0628\u06d2 \u0646\u06a9\u0644\u062a\u06d2 \u06c1\u06cc\u06ba \u0627\u0648\u0631  \u062c\u0633\u0645 \u06a9\u06d2 \u06a9\u0633 \u062d\u0635\u06d2 \u0645\u06cc\u06ba \u0646\u06a9\u0644\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you have any type or colour of spots on your body,plz state which part?<\/label><textarea id=\"wpforms-7780-field_57\" class=\"wpforms-field-medium\" name=\"wpforms[fields][57]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_171-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"171\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_171\"> 31. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u062c\u0633\u0645 \u067e\u0631 \u0646\u06cc\u0644\u06d2 \u06cc\u0627 \u0633\u0631\u062e \u0631\u0646\u06af \u06a9\u06d2 \u06c1\u0644\u06a9\u06d2 \u062f\u06be\u0628\u06d2 \u0646\u06a9\u0644\u062a\u06d2 \u06c1\u06cc\u06ba \u0627\u0648\u0631  \u062c\u0633\u0645 \u06a9\u06d2 \u06a9\u0633 \u062d\u0635\u06d2 \u0645\u06cc\u06ba \u0646\u06a9\u0644\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you have any type or colour of spots on your body,plz state which part?<\/label><ul id=\"wpforms-7780-field_171\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_171_1\" name=\"wpforms[fields][171]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_171_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_171_2\" name=\"wpforms[fields][171]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_171_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_171_4\" name=\"wpforms[fields][171]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_171_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_59-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_59\"> 32. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06cc \u0622\u0646\u062a\u0648\u06ba \u0645\u06cc\u06ba \u062f\u0631\u062f \u06c1\u0648\u062a\u0627 \u06c1\u06d2 \u061f Do you have pain in your intestines? <\/label><textarea id=\"wpforms-7780-field_59\" class=\"wpforms-field-medium\" name=\"wpforms[fields][59]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_170-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"170\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_170\"> 32. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06cc \u0622\u0646\u062a\u0648\u06ba \u0645\u06cc\u06ba \u062f\u0631\u062f \u06c1\u0648\u062a\u0627 \u06c1\u06d2 \u061f Do you have pain in your intestines? <\/label><ul id=\"wpforms-7780-field_170\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_170_1\" name=\"wpforms[fields][170]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_170_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_170_2\" name=\"wpforms[fields][170]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_170_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_170_4\" name=\"wpforms[fields][170]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_170_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_60-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_60\"> 33. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06d2 \u062c\u0633\u0645 \u06a9\u06d2 \u06a9\u0633\u06cc \u0628\u06be\u06cc \u062d\u0635\u06d2 \u0645\u06cc\u06ba \u062f\u0631\u062f \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f \u0627\u0648\u0631 \u06a9\u0648\u0646 \u0633\u06d2 \u062d\u0635\u06d2 \u0645\u06cc\u06ba \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f Do you feel pain in any part of your body? Please mention.<\/label><textarea id=\"wpforms-7780-field_60\" class=\"wpforms-field-medium\" name=\"wpforms[fields][60]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_169-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"169\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_169\"> 33. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06d2 \u062c\u0633\u0645 \u06a9\u06d2 \u06a9\u0633\u06cc \u0628\u06be\u06cc \u062d\u0635\u06d2 \u0645\u06cc\u06ba \u062f\u0631\u062f \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f \u0627\u0648\u0631 \u06a9\u0648\u0646 \u0633\u06d2 \u062d\u0635\u06d2 \u0645\u06cc\u06ba \u06c1\u0648\u062a\u0627 \u06c1\u06d2\u061f Do you feel pain in any part of your body? Please mention.<\/label><ul id=\"wpforms-7780-field_169\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_169_1\" name=\"wpforms[fields][169]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_169_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_169_2\" name=\"wpforms[fields][169]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_169_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_169_4\" name=\"wpforms[fields][169]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_169_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_61-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_61\"> 34. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0633\u06cc \u0639\u0636\u0648\u06cc \u0628\u06cc\u0645\u0627\u0631\u06cc\u0648\u06ba \u0645\u06cc\u06ba \u0645\u0628\u062a\u0644\u0627 \u06c1\u06cc\u06ba \u060c \u0627\u0648\u0631 \u0648\u06c1 \u06a9\u0648\u0646\u0633\u06cc \u06c1\u06cc\u06ba\u061f Do you have any disease particular in any organ? Please mention<\/label><textarea id=\"wpforms-7780-field_61\" class=\"wpforms-field-medium\" name=\"wpforms[fields][61]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_167-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"167\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_167\"> 34. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0633\u06cc \u0639\u0636\u0648\u06cc \u0628\u06cc\u0645\u0627\u0631\u06cc\u0648\u06ba \u0645\u06cc\u06ba \u0645\u0628\u062a\u0644\u0627 \u06c1\u06cc\u06ba \u060c \u0627\u0648\u0631 \u0648\u06c1 \u06a9\u0648\u0646\u0633\u06cc \u06c1\u06cc\u06ba\u061f Do you have any disease particular in any organ? Please mention<\/label><ul id=\"wpforms-7780-field_167\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_167_1\" name=\"wpforms[fields][167]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_167_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_167_2\" name=\"wpforms[fields][167]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_167_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_167_4\" name=\"wpforms[fields][167]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_167_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_62-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"62\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_62\"> 35. \u06a9\u06cc\u0627 \u0622\u067e \u0646\u06d2 \u0688\u0627\u06a9\u0679\u0631\u0648\u06ba \u06a9\u06d2 \u0633\u0627\u062a\u06be \u0627\u0633 \u06a9\u0627 \u0639\u0644\u0627\u062c \u06a9\u06cc\u0627\u061f \u0688\u0627\u06a9\u0679\u0631\u0648\u06ba \u0646\u06d2 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u06cc \u06a9\u06cc\u0627 \u062a\u0634\u062e\u06cc\u0635 \u06a9\u06cc \u062a\u06be\u06cc\u061f Did you get any treatment from doctor or any source? What is previous diagnosis of your disease?<\/label><textarea id=\"wpforms-7780-field_62\" class=\"wpforms-field-medium\" name=\"wpforms[fields][62]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_166-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"166\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_166\"> 35. \u06a9\u06cc\u0627 \u0622\u067e \u0646\u06d2 \u0688\u0627\u06a9\u0679\u0631\u0648\u06ba \u06a9\u06d2 \u0633\u0627\u062a\u06be \u0627\u0633 \u06a9\u0627 \u0639\u0644\u0627\u062c \u06a9\u06cc\u0627\u061f \u0688\u0627\u06a9\u0679\u0631\u0648\u06ba \u0646\u06d2 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u06cc \u06a9\u06cc\u0627 \u062a\u0634\u062e\u06cc\u0635 \u06a9\u06cc \u062a\u06be\u06cc\u061f Did you get any treatment from doctor or any source? What is previous diagnosis of your disease?<\/label><ul id=\"wpforms-7780-field_166\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_166_1\" name=\"wpforms[fields][166]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_166_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_166_2\" name=\"wpforms[fields][166]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_166_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_166_4\" name=\"wpforms[fields][166]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_166_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_63-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"63\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_63\"> 36. \u06a9\u06cc\u0627 \u06cc\u06c1 \u0628\u06cc\u0645\u0627\u0631\u06cc \u0627\u0686\u0627\u0646\u06a9 \u06c1\u0648\u0626\u06cc \u06cc\u0627 \u0628\u062a\u062f\u0631\u06cc\u062c \u061f  Did the disease occur suddenly or gradual?<\/label><textarea id=\"wpforms-7780-field_63\" class=\"wpforms-field-medium\" name=\"wpforms[fields][63]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_153-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"153\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_153\">\u0645\u062e\u062a\u0635\u0631 \u062c\u0648\u0627\u0628 \u06a9\u06d2 \u0644\u06cc\u06d2 \u06a9 36. \u06a9\u06cc\u0627 \u06cc\u06c1 \u0628\u06cc\u0645\u0627\u0631\u06cc \u0627\u0686\u0627\u0646\u06a9 \u06c1\u0648\u0626\u06cc \u06cc\u0627 \u0628\u062a\u062f\u0631\u06cc\u062c \u061f  Did the disease occur suddenly or gradual?\u0648\u0626\u06cc \u0627\u06cc\u06a9 \u0633\u0644\u06cc\u06a9\u0679 \u06a9\u0631\u06cc\u06ba :  Multiple Choice <\/label><ul id=\"wpforms-7780-field_153\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_153_1\" name=\"wpforms[fields][153]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_153_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_153_2\" name=\"wpforms[fields][153]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_153_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_153_4\" name=\"wpforms[fields][153]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_153_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_64-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"64\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_64\"> 37. \u06a9\u06cc\u0627 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u0627 \u0622\u063a\u0627\u0632 \u0634\u0627\u062f\u06cc \u0633\u06d2 \u067e\u06c1\u0644\u06d2 \u06c1\u0648\u0627 \u062a\u06be\u0627  \u06cc\u0627 ..... \u061f Did this disease start before marriage (For married persons)<\/label><textarea id=\"wpforms-7780-field_64\" class=\"wpforms-field-medium\" name=\"wpforms[fields][64]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_165-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"165\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_165\"> 37. \u06a9\u06cc\u0627 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u0627 \u0622\u063a\u0627\u0632 \u0634\u0627\u062f\u06cc \u0633\u06d2 \u067e\u06c1\u0644\u06d2 \u06c1\u0648\u0627 \u062a\u06be\u0627  \u06cc\u0627 ..... \u061f Did this disease start before marriage (For married persons)<\/label><ul id=\"wpforms-7780-field_165\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_165_1\" name=\"wpforms[fields][165]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_165_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_165_2\" name=\"wpforms[fields][165]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_165_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_165_4\" name=\"wpforms[fields][165]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_165_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_65-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_65\"> 38. \u06a9\u06cc\u0627 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u0627 \u0622\u063a\u0627\u0632 \u06a9\u0633\u06cc \u062a\u0642\u0631\u06cc\u0628 \u06cc\u0627 \u067e\u0631\u0648\u06af\u0631\u0627\u0645 \u0633\u06d2 \u0648\u0627\u067e\u0633 \u0622\u0646\u06d2 \u06a9\u06d2 \u0628\u0639\u062f \u06c1\u0648\u0627 \u061f  Did the disease start after returning from an event or program? Or any accident?<\/label><textarea id=\"wpforms-7780-field_65\" class=\"wpforms-field-medium\" name=\"wpforms[fields][65]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_163-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"163\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_163\"> 38. \u06a9\u06cc\u0627 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u0627 \u0622\u063a\u0627\u0632 \u06a9\u0633\u06cc \u062a\u0642\u0631\u06cc\u0628 \u06cc\u0627 \u067e\u0631\u0648\u06af\u0631\u0627\u0645 \u0633\u06d2 \u0648\u0627\u067e\u0633 \u0622\u0646\u06d2 \u06a9\u06d2 \u0628\u0639\u062f \u06c1\u0648\u0627 \u061f  Did the disease start after returning from an event or program? Or any accident?<\/label><ul id=\"wpforms-7780-field_163\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_163_1\" name=\"wpforms[fields][163]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_163_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_163_2\" name=\"wpforms[fields][163]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_163_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_163_4\" name=\"wpforms[fields][163]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_163_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_66-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_66\"> 39. \u06a9\u06cc\u0627 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u0627 \u0622\u063a\u0627\u0632 \u063a\u0635\u06d2 \u06cc\u0627 \u0644\u0691\u0627\u0626\u06cc \u062c\u06be\u06af\u0691\u06d2 \u06a9\u06d2 \u0628\u0639\u062f \u06c1\u0648\u0627 \u061f  Did the disease start after anger or fighting?<\/label><textarea id=\"wpforms-7780-field_66\" class=\"wpforms-field-medium\" name=\"wpforms[fields][66]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_161-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"161\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_161\"> 39. \u06a9\u06cc\u0627 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u0627 \u0622\u063a\u0627\u0632 \u063a\u0635\u06d2 \u06cc\u0627 \u0644\u0691\u0627\u0626\u06cc \u062c\u06be\u06af\u0691\u06d2 \u06a9\u06d2 \u0628\u0639\u062f \u06c1\u0648\u0627 \u061f  Did the disease start after anger or fighting?<\/label><ul id=\"wpforms-7780-field_161\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_161_1\" name=\"wpforms[fields][161]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_161_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_161_2\" name=\"wpforms[fields][161]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_161_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_161_4\" name=\"wpforms[fields][161]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_161_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_67-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_67\"> 40. \u06a9\u06cc\u0627 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u0627 \u0622\u063a\u0627\u0632 \u062e\u0648\u0641 \u06cc\u0627 \u06af\u0628\u06be\u0631\u0627\u06c1\u0679 \u0633\u06d2 \u062f\u0648\u0686\u0627\u0631 \u06c1\u0648\u0646\u06d2 \u06a9\u06d2 \u0628\u0639\u062f \u06c1\u0648\u0627 \u061f  Did the disease start after suffering from fear or panic?<\/label><textarea id=\"wpforms-7780-field_67\" class=\"wpforms-field-medium\" name=\"wpforms[fields][67]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_160-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"160\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_160\"> 40. \u06a9\u06cc\u0627 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u0627 \u0622\u063a\u0627\u0632 \u062e\u0648\u0641 \u06cc\u0627 \u06af\u0628\u06be\u0631\u0627\u06c1\u0679 \u0633\u06d2 \u062f\u0648\u0686\u0627\u0631 \u06c1\u0648\u0646\u06d2 \u06a9\u06d2 \u0628\u0639\u062f \u06c1\u0648\u0627 \u061f  Did the disease start after suffering from fear or panic?<\/label><ul id=\"wpforms-7780-field_160\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_160_1\" name=\"wpforms[fields][160]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_160_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_160_2\" name=\"wpforms[fields][160]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_160_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_160_4\" name=\"wpforms[fields][160]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_160_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_68-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_68\"> 41. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06d2 \u0628\u06cc\u0688 \u067e\u0631 \u0644\u06cc\u0679\u062a\u06d2 \u0648\u0642\u062a \u06a9\u0648\u0626\u06cc \u062e\u0648\u0634\u0628\u0648 \u0633\u0648\u0646\u06af\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u06cc \u06c1\u06d2 \u06cc\u0627 \u06a9\u0648\u0626\u06cc \u06c1\u0648\u0627 \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u061f  Do you smell any smell or sense of wind around you while you&#039;re lying in your bed?<\/label><textarea id=\"wpforms-7780-field_68\" class=\"wpforms-field-medium\" name=\"wpforms[fields][68]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_159-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"159\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_159\"> 41. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06d2 \u0628\u06cc\u0688 \u067e\u0631 \u0644\u06cc\u0679\u062a\u06d2 \u0648\u0642\u062a \u06a9\u0648\u0626\u06cc \u062e\u0648\u0634\u0628\u0648 \u0633\u0648\u0646\u06af\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u06cc \u06c1\u06d2 \u06cc\u0627 \u06a9\u0648\u0626\u06cc \u06c1\u0648\u0627 \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u061f  Do you smell any smell or sense of wind around you while you&#039;re lying in your bed?<\/label><ul id=\"wpforms-7780-field_159\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_159_1\" name=\"wpforms[fields][159]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_159_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_159_2\" name=\"wpforms[fields][159]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_159_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_159_4\" name=\"wpforms[fields][159]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_159_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_69-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_69\"> 42.  \u06a9\u06cc\u0627 \u0622\u067e \u0646\u06cc\u0646\u062f \u06a9\u06d2 \u0648\u0642\u062a \u0627\u0686\u0627\u0646\u06a9 \u06a9\u0627\u0646\u067e\u062a\u06d2 \u0627\u0648\u0631 \u0644\u0631\u0632 \u0627\u0679\u06be\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you shiver and shake when sleeping?<\/label><textarea id=\"wpforms-7780-field_69\" class=\"wpforms-field-medium\" name=\"wpforms[fields][69]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_158-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"158\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_158\"> 42.  \u06a9\u06cc\u0627 \u0622\u067e \u0646\u06cc\u0646\u062f \u06a9\u06d2 \u0648\u0642\u062a \u0627\u0686\u0627\u0646\u06a9 \u06a9\u0627\u0646\u067e\u062a\u06d2 \u0627\u0648\u0631 \u0644\u0631\u0632 \u0627\u0679\u06be\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you shiver and shake when sleeping?<\/label><ul id=\"wpforms-7780-field_158\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_158_1\" name=\"wpforms[fields][158]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_158_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_158_2\" name=\"wpforms[fields][158]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_158_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_158_4\" name=\"wpforms[fields][158]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_158_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_70-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_70\"> 43.  \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u06cc\u0633\u0627 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u062c\u06cc\u0633\u06d2 \u0622\u067e \u06a9\u0633\u06cc \u0627\u0648\u0646\u0686\u06cc \u062c\u06af\u06c1 \u0633\u06d2 \u06af\u0631 \u0631\u06c1\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel like you are falling from a high place?<\/label><textarea id=\"wpforms-7780-field_70\" class=\"wpforms-field-medium\" name=\"wpforms[fields][70]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_157-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"157\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_157\"> 43.  \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u06cc\u0633\u0627 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u062c\u06cc\u0633\u06d2 \u0622\u067e \u06a9\u0633\u06cc \u0627\u0648\u0646\u0686\u06cc \u062c\u06af\u06c1 \u0633\u06d2 \u06af\u0631 \u0631\u06c1\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel like you are falling from a high place?<\/label><ul id=\"wpforms-7780-field_157\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_157_1\" name=\"wpforms[fields][157]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_157_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_157_2\" name=\"wpforms[fields][157]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_157_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_157_4\" name=\"wpforms[fields][157]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_157_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_71-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_71\"> 44. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u06cc\u0633\u0627 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u062c\u06cc\u0633\u06d2 \u06a9\u0648\u0626\u06cc \u0622\u067e \u06a9\u0648 \u0648\u0642\u062a\u0627 \u0641\u0648\u0642\u062a\u0627 \u0646\u06cc\u0646\u062f \u0633\u06d2 \u062c\u06af\u0627 \u0631\u06c1\u0627 \u06c1\u0648\u061f Do you feel like someone is waking you up from time to time?<\/label><textarea id=\"wpforms-7780-field_71\" class=\"wpforms-field-medium\" name=\"wpforms[fields][71]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_156-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"156\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_156\"> 44. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u06cc\u0633\u0627 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u062c\u06cc\u0633\u06d2 \u06a9\u0648\u0626\u06cc \u0622\u067e \u06a9\u0648 \u0648\u0642\u062a\u0627 \u0641\u0648\u0642\u062a\u0627 \u0646\u06cc\u0646\u062f \u0633\u06d2 \u062c\u06af\u0627 \u0631\u06c1\u0627 \u06c1\u0648\u061f Do you feel like someone is waking you up from time to time?<\/label><ul id=\"wpforms-7780-field_156\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_156_1\" name=\"wpforms[fields][156]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_156_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_156_2\" name=\"wpforms[fields][156]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_156_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_156_4\" name=\"wpforms[fields][156]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_156_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_72-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"72\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_72\"> 45. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u062e\u0648\u0627\u0628 \u0645\u06cc\u06ba \u062c\u0646\u0633\u06cc \u0686\u06be\u06cc\u0691\u062e\u0627\u0646\u06cc\u0648\u06ba \u06a9\u0627 \u0634\u06a9\u0627\u0631 \u0628\u0646\u0627\u06cc\u0627 \u062c\u0627\u0631\u06c1\u0627 \u06c1\u06d2 \u061f  Do you think you are being sexually harassed in a dream?<\/label><textarea id=\"wpforms-7780-field_72\" class=\"wpforms-field-medium\" name=\"wpforms[fields][72]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_155-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"155\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_155\"> 45. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u062e\u0648\u0627\u0628 \u0645\u06cc\u06ba \u062c\u0646\u0633\u06cc \u0686\u06be\u06cc\u0691\u062e\u0627\u0646\u06cc\u0648\u06ba \u06a9\u0627 \u0634\u06a9\u0627\u0631 \u0628\u0646\u0627\u06cc\u0627 \u062c\u0627\u0631\u06c1\u0627 \u06c1\u06d2 \u061f  Do you think you are being sexually harassed in a dream?<\/label><ul id=\"wpforms-7780-field_155\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_155_1\" name=\"wpforms[fields][155]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_155_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_155_2\" name=\"wpforms[fields][155]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_155_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_155_4\" name=\"wpforms[fields][155]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_155_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_73-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_73\"> 46. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u062e\u0648\u0627\u0628 \u0645\u06cc\u06ba \u0627\u06cc\u0633\u06d2 \u062c\u0627\u0646\u0648\u0631 \u0646\u0638\u0631 \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u062c\u0648 \u0622\u067e \u06a9\u0627 \u067e\u06cc\u0686\u06be\u0627 \u06a9\u0631\u0631\u06c1\u06d2 \u06c1\u0648 \u061f\u06cc\u06c1 \u06a9\u0633 \u0642\u0633\u0645 \u06a9\u06d2 \u062c\u0627\u0646\u0648\u0631 \u06c1\u06cc\u06ba: (\u0628\u0644\u06cc\u0627\u06ba - \u06a9\u062a\u06d2 - \u0633\u0627\u0646\u067e - \u06a9\u06cc\u0691\u06d2 ...) \u061f Do you see animals chasing you in your dreams? Please mention name of animal.<\/label><textarea id=\"wpforms-7780-field_73\" class=\"wpforms-field-medium\" name=\"wpforms[fields][73]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_154-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"154\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_154\"> 46. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u062e\u0648\u0627\u0628 \u0645\u06cc\u06ba \u0627\u06cc\u0633\u06d2 \u062c\u0627\u0646\u0648\u0631 \u0646\u0638\u0631 \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u062c\u0648 \u0622\u067e \u06a9\u0627 \u067e\u06cc\u0686\u06be\u0627 \u06a9\u0631\u0631\u06c1\u06d2 \u06c1\u0648 \u061f\u06cc\u06c1 \u06a9\u0633 \u0642\u0633\u0645 \u06a9\u06d2 \u062c\u0627\u0646\u0648\u0631 \u06c1\u06cc\u06ba: (\u0628\u0644\u06cc\u0627\u06ba - \u06a9\u062a\u06d2 - \u0633\u0627\u0646\u067e - \u06a9\u06cc\u0691\u06d2 ...) \u061f Do you see animals chasing you in your dreams? Please mention name of animal.<\/label><ul id=\"wpforms-7780-field_154\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_154_1\" name=\"wpforms[fields][154]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_154_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_154_2\" name=\"wpforms[fields][154]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_154_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_154_4\" name=\"wpforms[fields][154]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_154_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_74-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_74\">47. \u062c\u0628 \u0622\u067e \u0628\u06cc\u062f\u0627\u0631 \u06c1\u0648\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u06a9\u06cc\u0627 \u0622\u067e \u0628\u06c1\u062a \u062a\u0646\u06af\u06cc \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel tightmess of body when you wake up?<\/label><textarea id=\"wpforms-7780-field_74\" class=\"wpforms-field-medium\" name=\"wpforms[fields][74]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_152-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"152\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_152\">47. \u062c\u0628 \u0622\u067e \u0628\u06cc\u062f\u0627\u0631 \u06c1\u0648\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u06a9\u06cc\u0627 \u0622\u067e \u0628\u06c1\u062a \u062a\u0646\u06af\u06cc \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel tightmess of body when you wake up?<\/label><ul id=\"wpforms-7780-field_152\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_152_1\" name=\"wpforms[fields][152]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_152_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_152_2\" name=\"wpforms[fields][152]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_152_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_152_4\" name=\"wpforms[fields][152]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_152_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_75-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_75\"> 48. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0646\u06cc\u0646\u062f \u0633\u06d2 \u0628\u06cc\u062f\u0627\u0631 \u06c1\u0648\u0646\u06d2 \u0645\u06cc\u06ba \u0628\u06c1\u062a \u0645\u0634\u06a9\u0644 \u06a9\u0627 \u0633\u0627\u0645\u0646\u0627 \u06a9\u0631\u0646\u0627 \u067e\u0691\u062a\u0627 \u06c1\u06d2 \u061f  Do you find it very difficult to wale up?<\/label><textarea id=\"wpforms-7780-field_75\" class=\"wpforms-field-medium\" name=\"wpforms[fields][75]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_145-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"145\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_145\"> 48. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0646\u06cc\u0646\u062f \u0633\u06d2 \u0628\u06cc\u062f\u0627\u0631 \u06c1\u0648\u0646\u06d2 \u0645\u06cc\u06ba \u0628\u06c1\u062a \u0645\u0634\u06a9\u0644 \u06a9\u0627 \u0633\u0627\u0645\u0646\u0627 \u06a9\u0631\u0646\u0627 \u067e\u0691\u062a\u0627 \u06c1\u06d2 \u061f  Do you find it very difficult to wale up?<\/label><ul id=\"wpforms-7780-field_145\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_145_1\" name=\"wpforms[fields][145]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_145_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_145_2\" name=\"wpforms[fields][145]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_145_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_145_4\" name=\"wpforms[fields][145]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_145_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_76-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_76\"> 49. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06d2 \u062e\u0648\u0627\u0628\u0648\u06ba \u0645\u06cc\u06ba \u0628\u064f\u0631\u06d2 \u062e\u0648\u0627\u0628  (\u0688\u0631\u0627\u0624\u0646\u06d2 \u062e\u0648\u0627\u0628) \u0646\u0638\u0631 \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you have nightmares?<\/label><textarea id=\"wpforms-7780-field_76\" class=\"wpforms-field-medium\" name=\"wpforms[fields][76]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_151-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"151\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_151\"> 49. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0627\u067e\u0646\u06d2 \u062e\u0648\u0627\u0628\u0648\u06ba \u0645\u06cc\u06ba \u0628\u064f\u0631\u06d2 \u062e\u0648\u0627\u0628  (\u0688\u0631\u0627\u0624\u0646\u06d2 \u062e\u0648\u0627\u0628) \u0646\u0638\u0631 \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you have nightmares?<\/label><ul id=\"wpforms-7780-field_151\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_151_1\" name=\"wpforms[fields][151]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_151_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_151_2\" name=\"wpforms[fields][151]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_151_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_151_4\" name=\"wpforms[fields][151]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_151_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_77-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_77\"> 50. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0644\u06cc\u0679\u0646\u06d2 \u06a9\u06d2 \u0628\u0639\u062f \u0646\u06cc\u0646\u062f \u0646\u06c1\u06cc\u06ba \u0622\u062a\u06cc \u0627\u0648\u0631 \u0622\u067e \u0628\u06d2 \u0686\u06cc\u0646\u06cc  \u0633\u06d2 \u062f\u0648\u0686\u0627\u0631 \u0631\u06c1\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel sleepy and restless after you wake up?<\/label><textarea id=\"wpforms-7780-field_77\" class=\"wpforms-field-medium\" name=\"wpforms[fields][77]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_150-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"150\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_150\"> 50. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0644\u06cc\u0679\u0646\u06d2 \u06a9\u06d2 \u0628\u0639\u062f \u0646\u06cc\u0646\u062f \u0646\u06c1\u06cc\u06ba \u0622\u062a\u06cc \u0627\u0648\u0631 \u0622\u067e \u0628\u06d2 \u0686\u06cc\u0646\u06cc  \u0633\u06d2 \u062f\u0648\u0686\u0627\u0631 \u0631\u06c1\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel sleepy and restless after you wake up?<\/label><ul id=\"wpforms-7780-field_150\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_150_1\" name=\"wpforms[fields][150]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_150_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_150_2\" name=\"wpforms[fields][150]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_150_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_150_4\" name=\"wpforms[fields][150]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_150_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_78-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_78\"> 51. \u06a9\u06cc\u0627 \u0622\u067e \u0628\u06c1\u062a \u0632\u06cc\u0627\u062f\u06c1 \u0633\u0648\u062a\u06d2 \u06c1\u06cc\u06ba \u061f  \u0627\u0648\u0631 \u0627\u06cc\u06a9 \u062f\u0646 \u0645\u06cc\u06ba \u06a9\u062a\u0646\u06d2 \u06af\u06be\u0646\u0679\u06d2 \u0633\u0648\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you sleep too much (How many hours)<\/label><textarea id=\"wpforms-7780-field_78\" class=\"wpforms-field-medium\" name=\"wpforms[fields][78]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_149-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"149\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_149\"> 51. \u06a9\u06cc\u0627 \u0622\u067e \u0628\u06c1\u062a \u0632\u06cc\u0627\u062f\u06c1 \u0633\u0648\u062a\u06d2 \u06c1\u06cc\u06ba \u061f  \u0627\u0648\u0631 \u0627\u06cc\u06a9 \u062f\u0646 \u0645\u06cc\u06ba \u06a9\u062a\u0646\u06d2 \u06af\u06be\u0646\u0679\u06d2 \u0633\u0648\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you sleep too much (How many hours)<\/label><ul id=\"wpforms-7780-field_149\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_149_1\" name=\"wpforms[fields][149]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_149_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_149_2\" name=\"wpforms[fields][149]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_149_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_149_4\" name=\"wpforms[fields][149]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_149_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_79-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_79\"> 52. \u06a9\u06cc\u0627 \u0622\u067e \u0628\u0633\u062a\u0631 \u0633\u06d2 \u0627\u0679\u06be\u062a\u06d2 \u06c1\u06cc\u06ba \u0627\u0648\u0631 \u0627\u0648\u0631 \u0628\u063a\u06cc\u0631 \u0634\u0639\u0648\u0631 \u06a9\u06d2 \u0646\u06cc\u0646\u062f \u0645\u06cc\u06ba \u0686\u0644\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you get out of bed and go to sleep unconscious?<\/label><textarea id=\"wpforms-7780-field_79\" class=\"wpforms-field-medium\" name=\"wpforms[fields][79]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_148-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"148\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_148\"> 52. \u06a9\u06cc\u0627 \u0622\u067e \u0628\u0633\u062a\u0631 \u0633\u06d2 \u0627\u0679\u06be\u062a\u06d2 \u06c1\u06cc\u06ba \u0627\u0648\u0631 \u0627\u0648\u0631 \u0628\u063a\u06cc\u0631 \u0634\u0639\u0648\u0631 \u06a9\u06d2 \u0646\u06cc\u0646\u062f \u0645\u06cc\u06ba \u0686\u0644\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you get out of bed and go to sleep unconscious?<\/label><ul id=\"wpforms-7780-field_148\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_148_1\" name=\"wpforms[fields][148]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_148_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_148_2\" name=\"wpforms[fields][148]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_148_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_148_4\" name=\"wpforms[fields][148]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_148_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_80-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_80\"> 53.  \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648  \u062e\u0648\u0627\u0628\u0648\u06ba \u0645\u06cc\u06ba \u0627\u06cc\u0633\u06d2 \u0644\u0648\u06af \u062f\u06a9\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u06d2 \u06c1\u06cc\u06ba \u062c\u0648 \u0622\u067e \u06a9\u0627 \u0645\u0630\u0627\u0642 \u0627\u0691\u0627\u062a\u06d2 \u06c1\u0648 \u0627\u0648\u0631 \u0622\u067e \u06a9\u06cc \u0637\u0631\u0641 \u0637\u0646\u0632\u06cc\u06c1 \u0646\u06af\u0627\u06c1\u0648\u06ba \u0633\u06d2 \u062f\u06cc\u06a9\u06be \u0631\u06c1\u06d2 \u06c1\u0648\u061f Do you see in your dreams people who are making fun of you and looking at you with sarcastic eyes?<\/label><textarea id=\"wpforms-7780-field_80\" class=\"wpforms-field-medium\" name=\"wpforms[fields][80]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_147-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"147\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_147\"> 53.  \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648  \u062e\u0648\u0627\u0628\u0648\u06ba \u0645\u06cc\u06ba \u0627\u06cc\u0633\u06d2 \u0644\u0648\u06af \u062f\u06a9\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u06d2 \u06c1\u06cc\u06ba \u062c\u0648 \u0622\u067e \u06a9\u0627 \u0645\u0630\u0627\u0642 \u0627\u0691\u0627\u062a\u06d2 \u06c1\u0648 \u0627\u0648\u0631 \u0622\u067e \u06a9\u06cc \u0637\u0631\u0641 \u0637\u0646\u0632\u06cc\u06c1 \u0646\u06af\u0627\u06c1\u0648\u06ba \u0633\u06d2 \u062f\u06cc\u06a9\u06be \u0631\u06c1\u06d2 \u06c1\u0648\u061f Do you see in your dreams people who are making fun of you and looking at you with sarcastic eyes?<\/label><ul id=\"wpforms-7780-field_147\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_147_1\" name=\"wpforms[fields][147]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_147_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_147_2\" name=\"wpforms[fields][147]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_147_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_147_4\" name=\"wpforms[fields][147]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_147_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_81-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"81\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_81\"> 54. \u06a9\u06cc\u0627 \u0622\u067e \u0627\u06cc\u0633\u0627 \u062e\u0648\u0627\u0628 \u062f\u06cc\u06a9\u06be\u062a\u06d2 \u06c1\u06cc\u06ba \u06a9\u06c1 \u0622\u067e \u062c\u06cc\u0633\u06d2 \u0622\u0633\u0645\u0627\u0646 \u0645\u06cc\u06ba \u0627\u0691 \u0631\u06c1\u06d2 \u06c1\u0648\u061f Do you dream like you are flying in the sky?<\/label><textarea id=\"wpforms-7780-field_81\" class=\"wpforms-field-medium\" name=\"wpforms[fields][81]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_146-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"146\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_146\"> 54. \u06a9\u06cc\u0627 \u0622\u067e \u0627\u06cc\u0633\u0627 \u062e\u0648\u0627\u0628 \u062f\u06cc\u06a9\u06be\u062a\u06d2 \u06c1\u06cc\u06ba \u06a9\u06c1 \u0622\u067e \u062c\u06cc\u0633\u06d2 \u0622\u0633\u0645\u0627\u0646 \u0645\u06cc\u06ba \u0627\u0691 \u0631\u06c1\u06d2 \u06c1\u0648\u061f Do you dream like you are flying in the sky?<\/label><ul id=\"wpforms-7780-field_146\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_146_1\" name=\"wpforms[fields][146]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_146_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_146_2\" name=\"wpforms[fields][146]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_146_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_146_4\" name=\"wpforms[fields][146]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_146_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_82-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"82\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_82\"> 55. \u06a9\u06cc\u0627 \u0622\u067e \u062e\u0648\u0627\u0628 \u0645\u06cc\u06ba \u0645\u0679\u06cc \u0633\u06d2 \u062c\u0691\u06cc \u06c1\u0648\u0626\u06cc \u0686\u06cc\u0632\u06cc\u06ba \u062f\u06cc\u06a9\u06be\u062a\u06d2 \u06c1\u06cc\u06ba: (\u0642\u0628\u0631\u0633\u062a\u0627\u0646 - \u06af\u06be\u0627\u0679\u06cc\u0627\u06ba - \u0648\u063a\u06cc\u0631\u06c1 ...)\u061f\u0627\u06af\u0631 \u062c\u0648\u0627\u0628 \u06c1\u0627\u06ba \u0645\u06cc\u06ba \u06c1\u06d2 \u062a\u0648 \u0627\u0646 \u0686\u06cc\u0632\u0648\u06ba \u06a9\u06cc \u0646\u0634\u0627\u0646\u062f\u06c1\u06cc \u06a9\u0631\u06cc\u06ba\u061f\u061f  Do you see in the dream things connected with mud: (graveyard - ghats - etc ...)?<\/label><textarea id=\"wpforms-7780-field_82\" class=\"wpforms-field-medium\" name=\"wpforms[fields][82]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_131-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"131\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_131\">\u0645\u062e\u062a\u0635\u0631 \u062c\u0648\u0627\u0628 \u06a9\u06d2 \u0644\u06cc\u06d2 \u06a9\u0648\u0626\u06cc \u0627\u06cc\u06a9 \u0633\u0644\u06cc\u06a9\u0679 \u06a9\u0631\u06cc\u06ba :  Multiple Choice <\/label><ul id=\"wpforms-7780-field_131\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_131_1\" name=\"wpforms[fields][131]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_131_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_131_2\" name=\"wpforms[fields][131]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_131_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_131_4\" name=\"wpforms[fields][131]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_131_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_83-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"83\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_83\"> 56. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u062e\u0648\u0627\u0628 \u0645\u06cc\u06ba \u062f\u06a9\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u0633\u0645\u0646\u062f\u0631\u06cc \u0644\u06c1\u0631\u06cc\u06ba \u0622\u06a9\u0631 \u0622\u067e \u0633\u06d2 \u0679\u06a9\u0631\u0627\u0631\u06c1\u06cc \u06c1\u0648\u061f  Do you dream that the waves are coming and hitting you?<\/label><textarea id=\"wpforms-7780-field_83\" class=\"wpforms-field-medium\" name=\"wpforms[fields][83]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_143-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"143\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_143\"> 56. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u062e\u0648\u0627\u0628 \u0645\u06cc\u06ba \u062f\u06a9\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u0633\u0645\u0646\u062f\u0631\u06cc \u0644\u06c1\u0631\u06cc\u06ba \u0622\u06a9\u0631 \u0622\u067e \u0633\u06d2 \u0679\u06a9\u0631\u0627\u0631\u06c1\u06cc \u06c1\u0648\u061f  Do you dream that the waves are coming and hitting you?<\/label><ul id=\"wpforms-7780-field_143\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_143_1\" name=\"wpforms[fields][143]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_143_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_143_2\" name=\"wpforms[fields][143]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_143_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_143_4\" name=\"wpforms[fields][143]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_143_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_84-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_84\"> 57.\u0627\u06af\u0631 \u0622\u067e \u0634\u0627\u062f\u06cc \u0634\u062f\u06c1 \u06c1\u06cc\u06ba \u062a\u0648 \u06a9\u06cc\u0627 \u0622\u067e \u062e\u0648\u0627\u0628 \u0645\u06cc\u06ba \u0634\u0631\u06cc\u06a9 \u062d\u06cc\u0627\u062a \u06a9\u0648 \u0628\u0631\u06cc \u0635\u0648\u0631\u062a \u0645\u06cc\u06ba \u062f\u06cc\u06a9\u06be\u062a\u06cc \u06c1\u06cc\u06ba \u061f  Of you&#039;re married then you see your spouse in bad way?<\/label><textarea id=\"wpforms-7780-field_84\" class=\"wpforms-field-medium\" name=\"wpforms[fields][84]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_144-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"144\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_144\"> 57.\u0627\u06af\u0631 \u0622\u067e \u0634\u0627\u062f\u06cc \u0634\u062f\u06c1 \u06c1\u06cc\u06ba \u062a\u0648 \u06a9\u06cc\u0627 \u0622\u067e \u062e\u0648\u0627\u0628 \u0645\u06cc\u06ba \u0634\u0631\u06cc\u06a9 \u062d\u06cc\u0627\u062a \u06a9\u0648 \u0628\u0631\u06cc \u0635\u0648\u0631\u062a \u0645\u06cc\u06ba \u062f\u06cc\u06a9\u06be\u062a\u06cc \u06c1\u06cc\u06ba \u061f  Of you&#039;re married then you see your spouse in bad way?<\/label><ul id=\"wpforms-7780-field_144\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_144_1\" name=\"wpforms[fields][144]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_144_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_144_2\" name=\"wpforms[fields][144]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_144_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_144_4\" name=\"wpforms[fields][144]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_144_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_85-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_85\"> 58. \u06a9\u06cc\u0627 \u0622\u067e \u0646\u06cc\u0646\u062f \u0645\u06cc\u06ba \u0627\u067e\u0646\u06d2 \u0622\u067e \u06a9\u0648 \u062f\u0627\u0646\u062a\u0648\u06ba \u0633\u06d2 \u06a9\u0627\u0679\u062a\u06d2 \u0627\u0648\u0631 \u0646\u0648\u0686\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you bite yourself in your sleep?<\/label><textarea id=\"wpforms-7780-field_85\" class=\"wpforms-field-medium\" name=\"wpforms[fields][85]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_142-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"142\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_142\"> 58. \u06a9\u06cc\u0627 \u0622\u067e \u0646\u06cc\u0646\u062f \u0645\u06cc\u06ba \u0627\u067e\u0646\u06d2 \u0622\u067e \u06a9\u0648 \u062f\u0627\u0646\u062a\u0648\u06ba \u0633\u06d2 \u06a9\u0627\u0679\u062a\u06d2 \u0627\u0648\u0631 \u0646\u0648\u0686\u062a\u06d2 \u06c1\u06cc\u06ba \u061f Do you bite yourself in your sleep?<\/label><ul id=\"wpforms-7780-field_142\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_142_1\" name=\"wpforms[fields][142]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_142_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_142_2\" name=\"wpforms[fields][142]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_142_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_142_4\" name=\"wpforms[fields][142]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_142_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_86-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_86\"> 59. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0628\u063a\u06cc\u0631 \u06a9\u0633\u06cc \u0633\u0628\u0628 \u06a9\u06d2 \u0631\u0648\u0646\u0627 \u0622\u062a\u0627 \u06c1\u06d2 \u061f  Do you cry for no reason?<\/label><textarea id=\"wpforms-7780-field_86\" class=\"wpforms-field-medium\" name=\"wpforms[fields][86]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_141-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"141\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_141\"> 59. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0628\u063a\u06cc\u0631 \u06a9\u0633\u06cc \u0633\u0628\u0628 \u06a9\u06d2 \u0631\u0648\u0646\u0627 \u0622\u062a\u0627 \u06c1\u06d2 \u061f  Do you cry for no reason?<\/label><ul id=\"wpforms-7780-field_141\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_141_1\" name=\"wpforms[fields][141]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_141_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_141_2\" name=\"wpforms[fields][141]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_141_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_141_4\" name=\"wpforms[fields][141]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_141_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_87-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_87\"> 60. \u06a9\u06cc\u0627 \u063a\u0635\u06d2 \u0645\u06cc\u06ba \u0622\u067e \u06a9\u06cc \u06cc\u06c1 \u062d\u0627\u0644\u062a \u0634\u062f\u062a \u0627\u062e\u062a\u06cc\u0627\u0631 \u06a9\u0631\u062c\u0627\u062a\u06cc \u06c1\u06d2 \u061f  Does your condition worsen in anger?<\/label><textarea id=\"wpforms-7780-field_87\" class=\"wpforms-field-medium\" name=\"wpforms[fields][87]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_140-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"140\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_140\"> 60. \u06a9\u06cc\u0627 \u063a\u0635\u06d2 \u0645\u06cc\u06ba \u0622\u067e \u06a9\u06cc \u06cc\u06c1 \u062d\u0627\u0644\u062a \u0634\u062f\u062a \u0627\u062e\u062a\u06cc\u0627\u0631 \u06a9\u0631\u062c\u0627\u062a\u06cc \u06c1\u06d2 \u061f  Does your condition worsen in anger?<\/label><ul id=\"wpforms-7780-field_140\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_140_1\" name=\"wpforms[fields][140]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_140_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_140_2\" name=\"wpforms[fields][140]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_140_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_140_4\" name=\"wpforms[fields][140]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_140_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_88-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"88\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_88\"> 61. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u062a\u0646\u06c1\u0627\u0626\u06cc \u0627\u0648\u0631 \u0627\u0644\u06af \u0631\u06c1\u0646\u0627 \u067e\u0633\u0646\u062f \u06c1\u06d2 \u061f  Do you like to be alone?<\/label><textarea id=\"wpforms-7780-field_88\" class=\"wpforms-field-medium\" name=\"wpforms[fields][88]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_139-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"139\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_139\"> 61. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u062a\u0646\u06c1\u0627\u0626\u06cc \u0627\u0648\u0631 \u0627\u0644\u06af \u0631\u06c1\u0646\u0627 \u067e\u0633\u0646\u062f \u06c1\u06d2 \u061f  Do you like to be alone?<\/label><ul id=\"wpforms-7780-field_139\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_139_1\" name=\"wpforms[fields][139]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_139_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_139_2\" name=\"wpforms[fields][139]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_139_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_139_4\" name=\"wpforms[fields][139]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_139_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_89-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"89\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_89\"> 62. \u06a9\u06cc\u0627 \u0622\u067e \u067e\u0631 \u062c\u0646\u0633\u06cc \u062e\u06cc\u0627\u0644\u0627\u062a \u062d\u0627\u0648\u06cc \u0631\u06c1\u062a\u06d2 \u06c1\u06cc\u06ba\u061f  Do have sexual thoughts?<\/label><textarea id=\"wpforms-7780-field_89\" class=\"wpforms-field-medium\" name=\"wpforms[fields][89]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_138-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"138\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_138\"> 62. \u06a9\u06cc\u0627 \u0622\u067e \u067e\u0631 \u062c\u0646\u0633\u06cc \u062e\u06cc\u0627\u0644\u0627\u062a \u062d\u0627\u0648\u06cc \u0631\u06c1\u062a\u06d2 \u06c1\u06cc\u06ba\u061f  Do have sexual thoughts?<\/label><ul id=\"wpforms-7780-field_138\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_138_1\" name=\"wpforms[fields][138]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_138_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_138_2\" name=\"wpforms[fields][138]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_138_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_138_4\" name=\"wpforms[fields][138]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_138_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_90-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_90\"> 63. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06a9\u0633\u06cc \u0642\u0633\u0645 \u06a9\u06cc \u062d\u062f \u0633\u06d2 \u0632\u06cc\u0627\u062f\u06c1 \u062c\u0646\u0633\u06cc \u0634\u06c1\u0648\u062a \u062d\u0627\u0648\u06cc \u0631\u06c1\u062a\u06cc \u06c1\u06d2 \u061f  Do you have excessive sexual thoughts?<\/label><textarea id=\"wpforms-7780-field_90\" class=\"wpforms-field-medium\" name=\"wpforms[fields][90]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_136-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"136\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_136\"> 63. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06a9\u0633\u06cc \u0642\u0633\u0645 \u06a9\u06cc \u062d\u062f \u0633\u06d2 \u0632\u06cc\u0627\u062f\u06c1 \u062c\u0646\u0633\u06cc \u0634\u06c1\u0648\u062a \u062d\u0627\u0648\u06cc \u0631\u06c1\u062a\u06cc \u06c1\u06d2 \u061f  Do you have excessive sexual thoughts?<\/label><ul id=\"wpforms-7780-field_136\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_136_1\" name=\"wpforms[fields][136]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_136_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_136_2\" name=\"wpforms[fields][136]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_136_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_136_4\" name=\"wpforms[fields][136]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_136_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_91-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_91\">  64. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0633\u06cc\u0646\u06d2 \u0645\u06cc\u06ba \u06af\u06be\u0679\u0646 \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u062e\u0627\u0635 \u06a9\u0631 \u0634\u0627\u0645 \u0645\u06cc\u06ba \u0639\u0635\u0631 \u06a9\u06d2 \u0628\u0639\u062f \u061f  Do you have chest tightness, especially after Asr in the evening?<\/label><textarea id=\"wpforms-7780-field_91\" class=\"wpforms-field-medium\" name=\"wpforms[fields][91]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_137-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"137\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_137\">  64. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u06d2 \u0633\u06cc\u0646\u06d2 \u0645\u06cc\u06ba \u06af\u06be\u0679\u0646 \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u062e\u0627\u0635 \u06a9\u0631 \u0634\u0627\u0645 \u0645\u06cc\u06ba \u0639\u0635\u0631 \u06a9\u06d2 \u0628\u0639\u062f \u061f  Do you have chest tightness, especially after Asr in the evening?<\/label><ul id=\"wpforms-7780-field_137\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_137_1\" name=\"wpforms[fields][137]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_137_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_137_2\" name=\"wpforms[fields][137]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_137_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_137_4\" name=\"wpforms[fields][137]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_137_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_92-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_92\"> 65. \u06a9\u06cc\u0627 \u0622\u067e \u0686\u0691\u0686\u0691\u0627\u067e\u0646 \u060c \u062c\u0630\u0628\u0627\u062a\u06cc \u067e\u0646 \u0627\u0648\u0631 \u0646\u0631\u0648\u0633 \u0645\u0632\u0627\u062c \u06a9\u06d2 \u062d\u0627\u0645\u0644 \u06c1\u06cc\u06ba \u061f  Do you have irritability, emotion and nervousness?<\/label><textarea id=\"wpforms-7780-field_92\" class=\"wpforms-field-medium\" name=\"wpforms[fields][92]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_135-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"135\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_135\"> 65. \u06a9\u06cc\u0627 \u0622\u067e \u0686\u0691\u0686\u0691\u0627\u067e\u0646 \u060c \u062c\u0630\u0628\u0627\u062a\u06cc \u067e\u0646 \u0627\u0648\u0631 \u0646\u0631\u0648\u0633 \u0645\u0632\u0627\u062c \u06a9\u06d2 \u062d\u0627\u0645\u0644 \u06c1\u06cc\u06ba \u061f  Do you have irritability, emotion and nervousness?<\/label><ul id=\"wpforms-7780-field_135\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_135_1\" name=\"wpforms[fields][135]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_135_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_135_2\" name=\"wpforms[fields][135]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_135_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_135_4\" name=\"wpforms[fields][135]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_135_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_93-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"93\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_93\"> 66. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0628\u06be\u06cc \u06a9\u0686\u06be \u0627\u06cc\u0633\u0627 \u06a9\u0631\u062c\u0627\u062a\u06d2 \u06c1\u06cc\u06ba \u06a9\u06c1 \u062c\u0633 \u067e\u0631 \u0622\u067e \u06a9\u0648 \u0628\u0639\u062f \u0645\u06cc\u06ba \u0646\u062f\u0627\u0645\u062a \u06c1\u0648\u062a\u06cc \u06c1\u0648\u061f  What do you do that you later regret ?  <\/label><textarea id=\"wpforms-7780-field_93\" class=\"wpforms-field-medium\" name=\"wpforms[fields][93]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_134-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"134\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_134\"> 66. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0628\u06be\u06cc \u06a9\u0686\u06be \u0627\u06cc\u0633\u0627 \u06a9\u0631\u062c\u0627\u062a\u06d2 \u06c1\u06cc\u06ba \u06a9\u06c1 \u062c\u0633 \u067e\u0631 \u0622\u067e \u06a9\u0648 \u0628\u0639\u062f \u0645\u06cc\u06ba \u0646\u062f\u0627\u0645\u062a \u06c1\u0648\u062a\u06cc \u06c1\u0648\u061f  What do you do that you later regret ?  <\/label><ul id=\"wpforms-7780-field_134\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_134_1\" name=\"wpforms[fields][134]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_134_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_134_2\" name=\"wpforms[fields][134]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_134_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_134_4\" name=\"wpforms[fields][134]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_134_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_94-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"94\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_94\"> 67. \u06a9\u06cc\u0627 \u06a9\u0628\u06be\u06cc \u0627\u06cc\u0633\u0627 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u0622\u067e \u06a9\u06d2 \u062f\u0645\u0627\u063a \u067e\u0631 \u06a9\u0633\u06cc \u0627\u0648\u0631 \u0646\u06d2 \u0642\u0627\u0628\u0648 \u067e\u0627\u06cc\u0627 \u06c1\u0648\u0627 \u06c1\u06d2\u061f Does it ever seem like your brain is controlled by someone else?<\/label><textarea id=\"wpforms-7780-field_94\" class=\"wpforms-field-medium\" name=\"wpforms[fields][94]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_133-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"133\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_133\"> 67. \u06a9\u06cc\u0627 \u06a9\u0628\u06be\u06cc \u0627\u06cc\u0633\u0627 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u0622\u067e \u06a9\u06d2 \u062f\u0645\u0627\u063a \u067e\u0631 \u06a9\u0633\u06cc \u0627\u0648\u0631 \u0646\u06d2 \u0642\u0627\u0628\u0648 \u067e\u0627\u06cc\u0627 \u06c1\u0648\u0627 \u06c1\u06d2\u061f Does it ever seem like your brain is controlled by someone else?<\/label><ul id=\"wpforms-7780-field_133\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_133_1\" name=\"wpforms[fields][133]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_133_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_133_2\" name=\"wpforms[fields][133]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_133_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_133_4\" name=\"wpforms[fields][133]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_133_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_95-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"95\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_95\"> 68. \u06a9\u06cc\u0627 \u0622\u067e \u0627\u067e\u0646\u06cc \u0645\u0631\u0636\u06cc \u06a9\u06d2 \u0628\u063a\u06cc\u0631 \u06a9\u0628\u06be\u06cc \u06a9\u0628\u06be\u06cc \u0628\u0648\u0644\u062a\u06d2 \u06cc\u0627 \u06a9\u0686\u06be \u06a9\u0627\u0645 \u06a9\u0631\u062c\u0627\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you sometimes speak or do things involuntarily?<\/label><textarea id=\"wpforms-7780-field_95\" class=\"wpforms-field-medium\" name=\"wpforms[fields][95]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_132-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"132\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_132\"> 68. \u06a9\u06cc\u0627 \u0622\u067e \u0627\u067e\u0646\u06cc \u0645\u0631\u0636\u06cc \u06a9\u06d2 \u0628\u063a\u06cc\u0631 \u06a9\u0628\u06be\u06cc \u06a9\u0628\u06be\u06cc \u0628\u0648\u0644\u062a\u06d2 \u06cc\u0627 \u06a9\u0686\u06be \u06a9\u0627\u0645 \u06a9\u0631\u062c\u0627\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you sometimes speak or do things involuntarily?<\/label><ul id=\"wpforms-7780-field_132\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_132_1\" name=\"wpforms[fields][132]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_132_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_132_2\" name=\"wpforms[fields][132]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_132_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_132_4\" name=\"wpforms[fields][132]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_132_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_96-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"96\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_96\"> 69. \u06a9\u06cc\u0627 \u0633\u0648\u0686\u0646\u0627 \u0627\u0648\u0631 \u062e\u06cc\u0627\u0644\u0627\u062a \u0648 \u0648\u0633\u0648\u0633\u06d2 \u0622\u067e \u06a9\u0648 \u062a\u06be\u06a9\u0627\u062f\u06cc\u062a\u06d2 \u06c1\u06cc\u06ba \u061f  thoughts and thoughts tire you out?<\/label><textarea id=\"wpforms-7780-field_96\" class=\"wpforms-field-medium\" name=\"wpforms[fields][96]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_130-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"130\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_130\"> 69. \u06a9\u06cc\u0627 \u0633\u0648\u0686\u0646\u0627 \u0627\u0648\u0631 \u062e\u06cc\u0627\u0644\u0627\u062a \u0648 \u0648\u0633\u0648\u0633\u06d2 \u0622\u067e \u06a9\u0648 \u062a\u06be\u06a9\u0627\u062f\u06cc\u062a\u06d2 \u06c1\u06cc\u06ba \u061f  thoughts and thoughts tire you out?<\/label><ul id=\"wpforms-7780-field_130\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_130_1\" name=\"wpforms[fields][130]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_130_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_130_2\" name=\"wpforms[fields][130]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_130_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_130_4\" name=\"wpforms[fields][130]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_130_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_97-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"97\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_97\"> 70. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0628\u063a\u06cc\u0631 \u06a9\u0633\u06cc \u0633\u0628\u0628 \u06a9\u06d2 \u062e\u0648\u0641 \u0644\u0627\u062d\u0642 \u0631\u06c1\u062a\u0627 \u06c1\u06d2 \u061f  Are you afraid for no reason?<\/label><textarea id=\"wpforms-7780-field_97\" class=\"wpforms-field-medium\" name=\"wpforms[fields][97]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_129-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"129\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_129\"> 70. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0628\u063a\u06cc\u0631 \u06a9\u0633\u06cc \u0633\u0628\u0628 \u06a9\u06d2 \u062e\u0648\u0641 \u0644\u0627\u062d\u0642 \u0631\u06c1\u062a\u0627 \u06c1\u06d2 \u061f  Are you afraid for no reason?<\/label><ul id=\"wpforms-7780-field_129\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_129_1\" name=\"wpforms[fields][129]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_129_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_129_2\" name=\"wpforms[fields][129]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_129_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_129_4\" name=\"wpforms[fields][129]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_129_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_98-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"98\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_98\"> 71. \u06a9\u06cc\u0627 \u062c\u0628 \u0622\u067e \u0622\u0646\u06a9\u06be\u06cc\u06ba \u0628\u0646\u062f \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u0633\u0627\u0645\u0646\u06d2 \u06a9\u0648\u0626\u06cc \u0634\u062e\u0635 \u062f\u06a9\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u0627 \u06c1\u06d2 \u061f  Is there anyone in front of you when you close your eyes?<\/label><textarea id=\"wpforms-7780-field_98\" class=\"wpforms-field-medium\" name=\"wpforms[fields][98]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_126-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"126\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_126\"> 71. \u06a9\u06cc\u0627 \u062c\u0628 \u0622\u067e \u0622\u0646\u06a9\u06be\u06cc\u06ba \u0628\u0646\u062f \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u0633\u0627\u0645\u0646\u06d2 \u06a9\u0648\u0626\u06cc \u0634\u062e\u0635 \u062f\u06a9\u06be\u0627\u0626\u06cc \u062f\u06cc\u062a\u0627 \u06c1\u06d2 \u061f  Is there anyone in front of you when you close your eyes?<\/label><ul id=\"wpforms-7780-field_126\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_126_1\" name=\"wpforms[fields][126]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_126_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_126_2\" name=\"wpforms[fields][126]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_126_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_126_4\" name=\"wpforms[fields][126]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_126_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_99-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"99\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_99\"> 72. \u06a9\u06cc\u0627 \u0627\u0633 \u0634\u062e\u0635 \u06a9\u0648 \u0622\u067e \u0646\u06d2  \u06c1\u0645\u06cc\u0634\u06c1 \u0644\u0648\u06af\u0648\u06ba \u06a9\u06d2 \u0628\u06cc\u0686 \u0645\u06cc\u06ba \u0622\u067e \u06a9\u06cc \u062a\u0639\u0631\u06cc\u0641 \u06a9\u0631\u062a\u06d2 \u06c1\u0648\u0627 \u067e\u0627\u06cc\u0627 \u061f  Did you always find this person praising you in public?<\/label><textarea id=\"wpforms-7780-field_99\" class=\"wpforms-field-medium\" name=\"wpforms[fields][99]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_128-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"128\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_128\"> 72. \u06a9\u06cc\u0627 \u0627\u0633 \u0634\u062e\u0635 \u06a9\u0648 \u0622\u067e \u0646\u06d2  \u06c1\u0645\u06cc\u0634\u06c1 \u0644\u0648\u06af\u0648\u06ba \u06a9\u06d2 \u0628\u06cc\u0686 \u0645\u06cc\u06ba \u0622\u067e \u06a9\u06cc \u062a\u0639\u0631\u06cc\u0641 \u06a9\u0631\u062a\u06d2 \u06c1\u0648\u0627 \u067e\u0627\u06cc\u0627 \u061f  Did you always find this person praising you in public?<\/label><ul id=\"wpforms-7780-field_128\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_128_1\" name=\"wpforms[fields][128]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_128_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_128_2\" name=\"wpforms[fields][128]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_128_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_128_4\" name=\"wpforms[fields][128]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_128_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_100-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"100\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_100\"> 73. \u06a9\u06cc\u0627 \u062c\u0628 \u0622\u067e \u0627\u0633 \u0633\u06d2 \u0645\u0644\u0627\u0642\u0627\u062a \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u0622\u067e \u06a9\u0648\u0626\u06cc \u062a\u0646\u06af\u06cc \u0627\u0648\u0631 \u062a\u06a9\u0644\u06cc\u0641 \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you eel any discomfort when you meet him?<\/label><textarea id=\"wpforms-7780-field_100\" class=\"wpforms-field-medium\" name=\"wpforms[fields][100]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_127-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"127\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_127\"> 73. \u06a9\u06cc\u0627 \u062c\u0628 \u0622\u067e \u0627\u0633 \u0633\u06d2 \u0645\u0644\u0627\u0642\u0627\u062a \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba \u062a\u0648 \u0622\u067e \u06a9\u0648\u0626\u06cc \u062a\u0646\u06af\u06cc \u0627\u0648\u0631 \u062a\u06a9\u0644\u06cc\u0641 \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you eel any discomfort when you meet him?<\/label><ul id=\"wpforms-7780-field_127\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_127_1\" name=\"wpforms[fields][127]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_127_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_127_2\" name=\"wpforms[fields][127]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_127_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_127_4\" name=\"wpforms[fields][127]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_127_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_101-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"101\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_101\">  74. \u06a9\u06cc\u0627 \u0622\u067e \u0644\u0648\u06af\u0648\u06ba \u0633\u06d2 \u0628\u06be\u0631\u06cc \u06c1\u0648\u0626\u06cc \u0631\u0634 \u0648\u0627\u0644\u06cc \u062c\u06af\u06c1\u0648\u06ba \u06a9\u0648 \u0646\u0627\u067e\u0633\u0646\u062f \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you dislike crowded places?<\/label><textarea id=\"wpforms-7780-field_101\" class=\"wpforms-field-medium\" name=\"wpforms[fields][101]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_119-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"119\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_119\">  74. \u06a9\u06cc\u0627 \u0622\u067e \u0644\u0648\u06af\u0648\u06ba \u0633\u06d2 \u0628\u06be\u0631\u06cc \u06c1\u0648\u0626\u06cc \u0631\u0634 \u0648\u0627\u0644\u06cc \u062c\u06af\u06c1\u0648\u06ba \u06a9\u0648 \u0646\u0627\u067e\u0633\u0646\u062f \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you dislike crowded places?<\/label><ul id=\"wpforms-7780-field_119\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_119_1\" name=\"wpforms[fields][119]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_119_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_119_2\" name=\"wpforms[fields][119]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_119_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_119_4\" name=\"wpforms[fields][119]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_119_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_102-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"102\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_102\"> 75. \u06a9\u06cc\u0627 \u0622\u067e \u0642\u0648\u0644 \u0648\u0641\u0639\u0644 \u0645\u06cc\u06ba \u06a9\u0645\u06cc \u0627\u0648\u0631 \u062a\u0636\u0627\u062f \u06a9\u0648 \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel a lack of words and actions and contradictions?<\/label><textarea id=\"wpforms-7780-field_102\" class=\"wpforms-field-medium\" name=\"wpforms[fields][102]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_125-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"125\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_125\"> 75. \u06a9\u06cc\u0627 \u0622\u067e \u0642\u0648\u0644 \u0648\u0641\u0639\u0644 \u0645\u06cc\u06ba \u06a9\u0645\u06cc \u0627\u0648\u0631 \u062a\u0636\u0627\u062f \u06a9\u0648 \u0645\u062d\u0633\u0648\u0633 \u06a9\u0631\u062a\u06d2 \u06c1\u06cc\u06ba\u061f Do you feel a lack of words and actions and contradictions?<\/label><ul id=\"wpforms-7780-field_125\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_125_1\" name=\"wpforms[fields][125]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_125_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_125_2\" name=\"wpforms[fields][125]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_125_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_125_4\" name=\"wpforms[fields][125]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_125_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_103-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_103\"> 76. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0628\u06c1\u062a \u0628\u0631\u0627 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u062c\u0628 \u06a9\u0648\u0626\u06cc \u0622\u067e \u06a9\u0648 \u0686\u06be\u0648\u0626\u06d2\u061f  Do you feel bad when someone touches you?<\/label><textarea id=\"wpforms-7780-field_103\" class=\"wpforms-field-medium\" name=\"wpforms[fields][103]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_124-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"124\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_124\"> 76. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0628\u06c1\u062a \u0628\u0631\u0627 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u062c\u0628 \u06a9\u0648\u0626\u06cc \u0622\u067e \u06a9\u0648 \u0686\u06be\u0648\u0626\u06d2\u061f  Do you feel bad when someone touches you?<\/label><ul id=\"wpforms-7780-field_124\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_124_1\" name=\"wpforms[fields][124]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_124_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_124_2\" name=\"wpforms[fields][124]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_124_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_124_4\" name=\"wpforms[fields][124]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_124_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_104-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"104\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_104\"> 77. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06a9\u0628\u06be\u06cc \u062e\u0648\u062f\u06a9\u0634\u06cc \u06a9\u0631\u0646\u06d2 \u062c\u06cc\u0633\u06d2 \u0628\u0631\u06d2 \u062e\u06cc\u0627\u0644\u0627\u062a \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u061f  Do you ever have bad thoughts like committing suicide?<\/label><textarea id=\"wpforms-7780-field_104\" class=\"wpforms-field-medium\" name=\"wpforms[fields][104]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_123-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"123\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_123\"> 77. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06a9\u0628\u06be\u06cc \u062e\u0648\u062f\u06a9\u0634\u06cc \u06a9\u0631\u0646\u06d2 \u062c\u06cc\u0633\u06d2 \u0628\u0631\u06d2 \u062e\u06cc\u0627\u0644\u0627\u062a \u0622\u062a\u06d2 \u06c1\u06cc\u06ba \u061f  Do you ever have bad thoughts like committing suicide?<\/label><ul id=\"wpforms-7780-field_123\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_123_1\" name=\"wpforms[fields][123]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_123_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_123_2\" name=\"wpforms[fields][123]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_123_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_123_4\" name=\"wpforms[fields][123]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_123_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_105-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"105\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_105\"> 78. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u0622\u067e \u06a9\u06d2 \u0627\u0631\u062f\u06af\u0631\u062f \u062c\u0648 \u0631\u06c1\u062a\u06d2 \u06c1\u06cc\u06ba \u0648\u06c1 \u0633\u0628 \u06a9\u06d2 \u0633\u0628 \u06cc\u0627 \u0627\u0646 \u0645\u06cc\u06ba \u0633\u06d2 \u06a9\u0686\u06be \u0622\u067e \u06a9\u0648 \u0646\u0642\u0635\u0627\u0646 \u067e\u06c1\u0646\u0686\u0627\u0646\u06d2 \u06a9\u06d2 \u062f\u0631\u067e\u06d2 \u06c1\u06cc\u06ba \u061f Do you think that all or some of the people around you are trying to harm you?<\/label><textarea id=\"wpforms-7780-field_105\" class=\"wpforms-field-medium\" name=\"wpforms[fields][105]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_122-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"122\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_122\"> 78. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0644\u06af\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u0622\u067e \u06a9\u06d2 \u0627\u0631\u062f\u06af\u0631\u062f \u062c\u0648 \u0631\u06c1\u062a\u06d2 \u06c1\u06cc\u06ba \u0648\u06c1 \u0633\u0628 \u06a9\u06d2 \u0633\u0628 \u06cc\u0627 \u0627\u0646 \u0645\u06cc\u06ba \u0633\u06d2 \u06a9\u0686\u06be \u0622\u067e \u06a9\u0648 \u0646\u0642\u0635\u0627\u0646 \u067e\u06c1\u0646\u0686\u0627\u0646\u06d2 \u06a9\u06d2 \u062f\u0631\u067e\u06d2 \u06c1\u06cc\u06ba \u061f Do you think that all or some of the people around you are trying to harm you?<\/label><ul id=\"wpforms-7780-field_122\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_122_1\" name=\"wpforms[fields][122]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_122_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_122_2\" name=\"wpforms[fields][122]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_122_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_122_4\" name=\"wpforms[fields][122]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_122_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_106-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"106\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_106\"> 79. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06a9\u0686\u06be \u0644\u0648\u06af\u0648\u06ba \u0633\u06d2 \u0628\u0644\u0627\u0648\u062c\u06c1 \u0646\u0641\u0631\u062a \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u0627\u0648\u0631 \u0622\u067e \u06a9\u0648 \u0627\u0646 \u0633\u06d2 \u062f\u0648\u0631 \u0631\u06c1\u0646\u0627 \u067e\u0633\u0646\u062f \u06c1\u06d2 \u061f Do you hate some people for no reason and do you like to stay away from them?<\/label><textarea id=\"wpforms-7780-field_106\" class=\"wpforms-field-medium\" name=\"wpforms[fields][106]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_121-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"121\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_121\"> 79. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06a9\u0686\u06be \u0644\u0648\u06af\u0648\u06ba \u0633\u06d2 \u0628\u0644\u0627\u0648\u062c\u06c1 \u0646\u0641\u0631\u062a \u06c1\u0648\u062a\u06cc \u06c1\u06d2 \u0627\u0648\u0631 \u0622\u067e \u06a9\u0648 \u0627\u0646 \u0633\u06d2 \u062f\u0648\u0631 \u0631\u06c1\u0646\u0627 \u067e\u0633\u0646\u062f \u06c1\u06d2 \u061f Do you hate some people for no reason and do you like to stay away from them?<\/label><ul id=\"wpforms-7780-field_121\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_121_1\" name=\"wpforms[fields][121]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_121_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_121_2\" name=\"wpforms[fields][121]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_121_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_121_4\" name=\"wpforms[fields][121]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_121_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_107-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"107\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_107\"> 80. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06af\u06be\u0631 \u06cc\u0627 \u062c\u0627\u0628 \u06cc\u0627 \u067e\u0691\u06be\u0627\u0626\u06cc \u0633\u06d2 \u0646\u0641\u0631\u062a \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u06cc \u06c1\u06d2\u061f  Do you hate home or job or study?<\/label><textarea id=\"wpforms-7780-field_107\" class=\"wpforms-field-medium\" name=\"wpforms[fields][107]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_120-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"120\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_120\"> 80. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u06af\u06be\u0631 \u06cc\u0627 \u062c\u0627\u0628 \u06cc\u0627 \u067e\u0691\u06be\u0627\u0626\u06cc \u0633\u06d2 \u0646\u0641\u0631\u062a \u0645\u062d\u0633\u0648\u0633 \u06c1\u0648\u062a\u06cc \u06c1\u06d2\u061f  Do you hate home or job or study?<\/label><ul id=\"wpforms-7780-field_120\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_120_1\" name=\"wpforms[fields][120]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_120_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_120_2\" name=\"wpforms[fields][120]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_120_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_120_4\" name=\"wpforms[fields][120]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_120_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_108-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"108\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_108\"> 81. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0633\u0646\u0627\u0626\u06cc \u062f\u06cc\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u06a9\u0648\u0626\u06cc \u0622\u067e \u06a9\u0648 \u067e\u06a9\u0627\u0631\u0631\u06c1\u0627 \u06c1\u06d2 \u061f  Do you hear someone calling you?<\/label><textarea id=\"wpforms-7780-field_108\" class=\"wpforms-field-medium\" name=\"wpforms[fields][108]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_118-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"118\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-7780-field_118\"> 81. \u06a9\u06cc\u0627 \u0622\u067e \u06a9\u0648 \u0633\u0646\u0627\u0626\u06cc \u062f\u06cc\u062a\u0627 \u06c1\u06d2 \u06a9\u06c1 \u06a9\u0648\u0626\u06cc \u0622\u067e \u06a9\u0648 \u067e\u06a9\u0627\u0631\u0631\u06c1\u0627 \u06c1\u06d2 \u061f  Do you hear someone calling you?<\/label><ul id=\"wpforms-7780-field_118\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_118_1\" name=\"wpforms[fields][118]\" value=\"\u062c\u06cc \u06c1\u0627\u06ba (Yes)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_118_1\">\u062c\u06cc \u06c1\u0627\u06ba (Yes)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_118_2\" name=\"wpforms[fields][118]\" value=\"\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_118_2\">\u062c\u06cc \u0646\u06c1\u06cc\u06ba (No)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-7780-field_118_4\" name=\"wpforms[fields][118]\" value=\"\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don&#039;t know)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-7780-field_118_4\">\u0645\u0639\u0644\u0648\u0645 \u0646\u06c1\u06cc\u06ba (don't know)<\/label><\/li><\/ul><\/div><div id=\"wpforms-7780-field_109-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"109\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_109\"> 82. \u0622\u067e \u0646\u06d2 \u0627\u067e\u0646\u06d2 \u062c\u0648 \u0622\u062e\u0631\u06cc \u0645\u06cc\u0688\u06cc\u06a9\u0644 \u0679\u06cc\u0633\u0679 \u06a9\u0631\u0648\u0627\u0626\u06d2 \u06c1\u06cc\u06ba \u060c \u0627\u0646 \u06a9\u06cc \u0631\u067e\u0648\u0631\u0679\u0633 \u06a9\u06cc \u062a\u0635\u0627\u0648\u06cc\u0631 \u06c1\u0645\u06cc\u06ba \u0628\u06be\u062c\u0648\u0627\u062f\u06cc\u06ba\u06d4  Send us photos of the reports of your last medical test <\/label><textarea id=\"wpforms-7780-field_109\" class=\"wpforms-field-medium\" name=\"wpforms[fields][109]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_116-container\" class=\"wpforms-field wpforms-field-drop-uploader\" data-field-id=\"116\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_116\">\u0627\u067e\u0646\u06cc \u0631\u067e\u0648\u0631\u0679\u0633 \u0627\u067e\u0644\u0648\u0688 \u06a9\u0631\u06cc\u06ba Attach your reports<\/label><input type=\"file\" id=\"wpforms-7780-field_116\" class=\"wpf-drop-uploader\" name=\"wpforms[fields][116]\"    multiple  data-method=\"ajax\"><\/div><div id=\"wpforms-7780-field_110-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_110\"> 83. \u0622\u067e \u0646\u06d2 \u0627\u0633 \u0633\u06d2 \u067e\u06c1\u0644\u06d2 \u0627\u0633 \u0628\u06cc\u0645\u0627\u0631\u06cc \u06a9\u06d2 \u0639\u0644\u0627\u062c \u06a9\u06d2 \u0644\u06cc\u06d2 \u06a9\u0648\u0646 \u06a9\u0648\u0646 \u0633\u06cc \u0627\u062f\u0648\u06cc\u0627\u062a \u06a9\u06be\u0627\u0626\u06cc\u061f What medications have you taken before to treat this disease?<\/label><textarea id=\"wpforms-7780-field_110\" class=\"wpforms-field-medium\" name=\"wpforms[fields][110]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_111-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"111\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_111\"> 84. \u0627\u0633 \u0648\u0642\u062a \u06a9\u0648\u0646 \u0633\u06cc \u0627\u062f\u0648\u06cc\u0627\u062a \u0622\u067e \u06a9\u06be\u0627\u0631\u06c1\u06d2 \u06c1\u06cc\u06ba\u060c \u0627\u0646 \u06a9\u06d2 \u0646\u0627\u0645 \u0627\u0648\u0631 \u062a\u0635\u0627\u0648\u06cc\u0631 \u06c1\u0645\u06cc\u06ba \u0628\u06be\u062c\u0648\u0627\u062f\u06cc\u06ba \u061f  What medicines are you taking at the moment, send us their names and pictures?<\/label><textarea id=\"wpforms-7780-field_111\" class=\"wpforms-field-medium\" name=\"wpforms[fields][111]\" ><\/textarea><\/div><div id=\"wpforms-7780-field_201-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"201\"><label class=\"wpforms-field-label\" for=\"wpforms-7780-field_201\">\u0627\u067e\u0646\u06cc \u0627\u062f\u0648\u06cc\u0627\u062a \u06a9\u06cc \u062a\u0635\u0627\u0648\u06cc\u0631 \u0628\u06be\u062c\u0648\u0627\u0626\u06cc\u06ba Send pictures of your medicines<\/label><input type=\"tel\" id=\"wpforms-7780-field_201\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][201]\" ><div class=\"wpforms-field-description\">WhatsApp : +923334103401<\/div><\/div><\/div><div class=\"wpforms-submit-container\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"7780\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-7780\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/wahdatemasalik.com\/u\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t            <\/div>\n        <\/div>\n                            <\/div>\n        <\/section>\n        \t\t\t\t\t<\/div>\r\n\t\t","protected":false},"excerpt":{"rendered":"<p>&quot;\u062c\u0633\u0645\u0627\u0646\u06cc \u060c \u0646\u0641\u0633\u06cc\u0627\u062a\u06cc \u0627\u0648\u0631 \u0631\u0648\u062d\u0627\u0646\u06cc \u0627\u0645\u0631\u0627\u0636 \u06a9\u06cc \u062a\u0634\u062e\u06cc\u0635 \u06a9\u0627 \u0627\u0628\u062a\u062f\u0627\u0626\u06cc \u0641\u0627\u0631\u0645&quot; Initial diagnosis form for All kind of diseases (Pysical,Mental,Spiritual) \u0637\u0628 \u0627\u0644\u06c1\u06cc \u0627\u0648\u0631 \u0633\u06cc\u0644\u0641 \u0679\u0631\u06cc\u0679\u0645\u0646\u0679 \u0644\u06cc\u0632\u0631 \u062a\u06be\u0631\u0627\u067e\u06cc \u06a9\u0644\u06cc\u0646\u06a9 -\u0644\u0627\u06c1\u0648\u0631\u060c \u067e\u0627\u06a9\u0633\u062a\u0627\u0646 Complementary health care &#038; self treatment laser therapy clinic, Lahore, Pakistan \ufdfd \u0642\u0631\u0622\u0646 \u06a9\u0631\u06cc\u0645 \u0627\u0648\u0631 \u0637\u0628 \u0646\u0628\u0648\u06cc \u0622\u0646 \u0644\u0627\u0626\u0646 \u067e\u0627\u06a9\u0633\u062a\u0627\u0646 &#8212; Holy Quran and Prophetic [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mi_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-7781","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/wahdatemasalik.com\/u\/wp-json\/wp\/v2\/pages\/7781","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wahdatemasalik.com\/u\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wahdatemasalik.com\/u\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wahdatemasalik.com\/u\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wahdatemasalik.com\/u\/wp-json\/wp\/v2\/comments?post=7781"}],"version-history":[{"count":49,"href":"https:\/\/wahdatemasalik.com\/u\/wp-json\/wp\/v2\/pages\/7781\/revisions"}],"predecessor-version":[{"id":8670,"href":"https:\/\/wahdatemasalik.com\/u\/wp-json\/wp\/v2\/pages\/7781\/revisions\/8670"}],"wp:attachment":[{"href":"https:\/\/wahdatemasalik.com\/u\/wp-json\/wp\/v2\/media?parent=7781"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}