{"id":665,"date":"2022-12-26T16:02:14","date_gmt":"2022-12-26T16:02:14","guid":{"rendered":"https:\/\/alcon-deq5.com\/?page_id=665"},"modified":"2024-05-23T15:20:23","modified_gmt":"2024-05-23T13:20:23","slug":"deq","status":"publish","type":"page","link":"https:\/\/staging.systane-deq5.com\/ar_uae\/deq\/","title":{"rendered":"Questionnaire"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"665\" class=\"elementor elementor-665\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2e30c221 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"2e30c221\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-53bcbb16\" data-id=\"53bcbb16\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-731b75e2 elementor-widget elementor-widget-shortcode\" data-id=\"731b75e2\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">deq5 (1)<\/h2>\n                            <p class='gform_description'>deq<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/ar_uae\/wp-json\/wp\/v2\/pages\/665#gf_2' data-formid='2' novalidate data-trp-original-action=\"\/ar_uae\/wp-json\/wp\/v2\/pages\/665#gf_2\"><div id='gf_page_steps_2' class='gf_page_steps'><div id='gf_step_2_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>\u062a\u0631\u0637\u064a\u0628 \u0627\u0644\u0639\u064a\u0646<\/span><\/div><div id='gf_step_2_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>\u0631\u0627\u062d\u0629 \u0627\u0644\u0639\u064a\u0646<\/span><\/div><div id='gf_step_2_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>\u062c\u0641\u0627\u0641 \u0627\u0644\u0639\u064a\u0646<\/span><\/div><div id='gf_step_2_4' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>\u062f\u0645\u0648\u0639 \u0627\u0644\u0639\u064a\u0646<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page tabs_heading' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_1\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field\"  data-field-class=\"gquiz-field\" data-js-reload=\"field_2_1\" ><legend class='gfield_label gform-field-label' >\u0647\u0644 \u062a\u0642\u0648\u0645 \u0628\u0627\u0633\u062a\u062e\u062f\u0627\u0645 \u0645\u0631\u0637\u0628\u0627\u062a \u0644\u0644\u0639\u064a\u0646 \u062d\u0627\u0644\u064a\u064b\u0627 \u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_1'>\n\t\t\t<div class='gchoice gchoice_2_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='NEVER'  id='choice_2_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_1_0' id='label_2_1_0' class='gform-field-label gform-field-label--type-inline'>\u0646\u0639\u0645<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='RARELY'  id='choice_2_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_1_1' id='label_2_1_1' class='gform-field-label gform-field-label--type-inline'>\u0644\u0627<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_16' class='gform_next_button gform-theme-button button' value='\u0627\u0644\u062a\u0627\u0644\u064a'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-16' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_14\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field\"  data-field-class=\"gquiz-field\" data-js-reload=\"field_2_14\" ><legend class='gfield_label gform-field-label' >\u062e\u0644\u0627\u0644 \u064a\u0648\u0645 \u0639\u0627\u062f\u064a \u0627\u0644\u0634\u0647\u0631 \u0627\u0644\u0645\u0627\u0636\u064a\u060c \u0643\u0645 \u0645\u0631\u0629 \u0634\u0639\u0631\u062a \u0628\u0639\u062f\u0645 \u0627\u0644\u0631\u0627\u062d\u0629 \u0641\u064a \u0627\u0644\u0639\u064a\u0646 \u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_14'>\n\t\t\t<div class='gchoice gchoice_2_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='NEVER'  id='choice_2_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_0' id='label_2_14_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='RARELY'  id='choice_2_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_1' id='label_2_14_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='SOMETIMES'  id='choice_2_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_2' id='label_2_14_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='FREQUENTLY'  id='choice_2_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_3' id='label_2_14_3' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0643\u062b\u064a\u0631 \u0645\u0646 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='CONSTANTLY'  id='choice_2_14_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_4' id='label_2_14_4' class='gform-field-label gform-field-label--type-inline'>\u0628\u0625\u0633\u062a\u0645\u0631\u0627\u0631<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_9\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field\"  data-field-class=\"gquiz-field\" data-js-reload=\"field_2_9\" ><legend class='gfield_label gform-field-label' >\u0639\u0646\u062f\u0645\u0627 \u0634\u0639\u0631\u062a \u0628\u0639\u062f\u0645 \u0627\u0644\u0631\u0627\u062d\u0629 \u0641\u064a \u0639\u064a\u0646\u064a\u0643, \u0645\u0627 \u0645\u062f\u064a \u0634\u062f\u0629 \u0647\u0630\u0627 \u0627\u0644\u0634\u0639\u0648\u0631 \u0628\u0639\u062f\u0645 \u0627\u0644\u0631\u0627\u062d\u0629 \u0641\u064a \u0646\u0647\u0627\u064a\u0629 \u0627\u0644\u064a\u0648\u0645\u060c \u0641\u064a \u063a\u0636\u0648\u0646 \u0633\u0627\u0639\u062a\u064a\u0646 \u0645\u0646 \u0627\u0644\u0630\u0647\u0627\u0628 \u0625\u0644\u064a \u0627\u0644\u0641\u0631\u0627\u0634 \u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_9'>\n\t\t\t<div class='gchoice gchoice_2_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9f912c424'  id='choice_2_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_0' id='label_2_9_0' class='gform-field-label gform-field-label--type-inline'>\u0644\u0645 \u064a\u0643\u0646 \u0644\u062f\u064a\u0643<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9b39b706c'  id='choice_2_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_1' id='label_2_9_1' class='gform-field-label gform-field-label--type-inline'>\u0644\u064a\u0633 \u0634\u062f\u064a\u062f\u0627\u064b \u0639\u0644\u0649 \u0627\u0644\u0625\u0637\u0644\u0627\u0642<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9fd01cbd0'  id='choice_2_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_2' id='label_2_9_2' class='gform-field-label gform-field-label--type-inline'>\u064a\u0645\u0643\u0646 \u0627\u062d\u062a\u0645\u0627\u0644\u0647<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9c90b3d4a'  id='choice_2_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_3' id='label_2_9_3' class='gform-field-label gform-field-label--type-inline'>\u0645\u062a\u0648\u0633\u0637 \u0627\u0644\u0634\u062f\u0629<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9b814fd8b'  id='choice_2_9_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_4' id='label_2_9_4' class='gform-field-label gform-field-label--type-inline'>\u0634\u062f\u064a\u062f<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9faf3b818'  id='choice_2_9_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_5' id='label_2_9_5' class='gform-field-label gform-field-label--type-inline'>\u0634\u062f\u064a\u062f \u062c\u062f\u0627\u064b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_17' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u0627\u0644\u0633\u0627\u0628\u0642'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_17' class='gform_next_button gform-theme-button button' value='\u0627\u0644\u062a\u0627\u0644\u064a'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-17' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_7\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field\"  data-field-class=\"gquiz-field\" data-js-reload=\"field_2_7\" ><legend class='gfield_label gform-field-label' >\u062e\u0644\u0627\u0644 \u064a\u0648\u0645 \u0639\u0627\u062f\u064a \u0645\u0646 \u0627\u0644\u0634\u0647\u0631 \u0627\u0644\u0645\u0627\u0636\u064a\u060c \u0643\u0645 \u0645\u0631\u0629 \u0634\u0639\u0631\u062a \u0628\u062c\u0641\u0627\u0641 \u0627\u0644\u0639\u064a\u0646 \u061f<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_7'>\n\t\t\t<div class='gchoice gchoice_2_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz171afa494'  id='choice_2_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_0' id='label_2_7_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz19884f99c'  id='choice_2_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_1' id='label_2_7_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz18c39f93e'  id='choice_2_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_2' id='label_2_7_2' class='gform-field-label gform-field-label--type-inline'>\u0623\u062d\u064a\u0627\u0646\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz769be5665'  id='choice_2_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_3' id='label_2_7_3' class='gform-field-label gform-field-label--type-inline'>\u0641\u064a \u0643\u062b\u064a\u0631 \u0645\u0646 \u0627\u0644\u0623\u062d\u064a\u0627\u0646<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_7_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz79747f707'  id='choice_2_7_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_4' id='label_2_7_4' class='gform-field-label gform-field-label--type-inline'>\u0628\u0625\u0633\u062a\u0645\u0631\u0627\u0631<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_11\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field\"  data-field-class=\"gquiz-field\" data-js-reload=\"field_2_11\" ><legend class='gfield_label gform-field-label' >\u0639\u0646\u062f\u0645\u0627 \u0634\u0639\u0631\u062a \u0628\u062c\u0641\u0627\u0641 \u0639\u064a\u0646\u064a\u0643, \u0645\u0627 \u0645\u062f\u064a \u0634\u062f\u0629 \u0647\u0630\u0627 \u0627\u0644\u0634\u0639\u0648\u0631 \u0628\u0627\u0644\u062c\u0641\u0627\u0641 \u0641\u064a \u0646\u0647\u0627\u064a\u0629 \u0627\u0644\u064a\u0648\u0645\u060c \u0641\u064a \u063a\u0636\u0648\u0646 \u0633\u0627\u0639\u062a\u064a\u0646 \u0645\u0646 \u0627\u0644\u0630\u0647\u0627\u0628 \u0625\u0644\u064a \u0627\u0644\u0641\u0631\u0627\u0634 \u061f<span class=\"gfield_required\"><span class=\"gfield_required 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\u0627\u0644\u0625\u0637\u0644\u0627\u0642<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9fd01cbd0'  id='choice_2_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_11_2' id='label_2_11_2' class='gform-field-label gform-field-label--type-inline'>\u064a\u0645\u0643\u0646 \u0627\u062d\u062a\u0645\u0627\u0644\u0647<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9c90b3d4a'  id='choice_2_11_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_11_3' id='label_2_11_3' class='gform-field-label gform-field-label--type-inline'>\u0645\u062a\u0648\u0633\u0637 \u0627\u0644\u0634\u062f\u0629<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9b814fd8b'  id='choice_2_11_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_11_4' id='label_2_11_4' class='gform-field-label gform-field-label--type-inline'>\u0634\u062f\u064a\u062f<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9faf3b818'  id='choice_2_11_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_11_5' id='label_2_11_5' class='gform-field-label gform-field-label--type-inline'>\u0634\u062f\u064a\u062f \u062c\u062f\u0627\u064b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_6' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='\u0627\u0644\u0633\u0627\u0628\u0642'  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class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_8'>\n\t\t\t<div class='gchoice gchoice_2_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='gquiz171afa494'  id='choice_2_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_0' id='label_2_8_0' class='gform-field-label gform-field-label--type-inline'>\u0623\u0628\u062f\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='gquiz19884f99c'  id='choice_2_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_1' id='label_2_8_1' class='gform-field-label gform-field-label--type-inline'>\u0646\u0627\u062f\u0631\u0627<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='gquiz18c39f93e'  id='choice_2_8_2' 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