{"id":1519,"date":"2023-09-10T12:58:39","date_gmt":"2023-09-10T12:58:39","guid":{"rendered":"https:\/\/www.childgardens.com\/?page_id=1519"},"modified":"2023-09-10T13:00:01","modified_gmt":"2023-09-10T13:00:01","slug":"elementor-1519","status":"publish","type":"page","link":"https:\/\/www.childgardens.com\/index.php\/elementor-1519\/","title":{"rendered":"PARENT INTERVIEW"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1519\" class=\"elementor elementor-1519\">\n\t\t\t\t\t\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-f206f71 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f206f71\" 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=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-72af4e4\" data-id=\"72af4e4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a519931 elementor-widget elementor-widget-shortcode\" data-id=\"a519931\" 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\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1518 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1518\" data-uid=\"6a13da475ac0e\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1518\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1518 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1518\"\n\t\t\t\t\n\t\t\t\tdata-design=\"default\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"6a13da475ac0e\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-1518--page-0\" class=\"forminator-pagination forminator-pagination-start\" aria-labelledby=\"forminator-custom-form-1518--page-0-label\" data-step=\"0\" data-label=\"Finish\" data-name=\"page-break-1\"><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-date-1-picker_6a13da475ac0e-label\">TODAY\u00b4S DATE<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-1-picker_6a13da475ac0e\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-1-picker_6a13da475ac0e\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1900\" data-end-year=\"3000\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"Jan 1 1900\" data-end-date=\"Dec 31 3000\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-name-1_6a13da475ac0e-label\">CLIENT\u00b4S NAME<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a13da475ac0e\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"date-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-date-2-picker_6a13da475ac0e-label\">DOB<\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-2-picker_6a13da475ac0e\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-2-picker_6a13da475ac0e\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1900\" data-end-year=\"3000\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"Jan 1 1900\" data-end-date=\"Dec 31 3000\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-address-1-street_address_6a13da475ac0e-label\">Street Address<\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-1-street_address_6a13da475ac0e\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-address-1-city_6a13da475ac0e-label\">City<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"E.g. Sydney\" id=\"forminator-field-address-1-city_6a13da475ac0e\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><div id=\"address-1-state\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-state_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-address-1-state_6a13da475ac0e-label\">State\/Province<\/label><input type=\"text\" name=\"address-1-state\" placeholder=\"E.g. New South Wales\" id=\"forminator-field-address-1-state_6a13da475ac0e\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-address-1-zip_6a13da475ac0e-label\">ZIP \/ Postal Code<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"E.g. 2000\" id=\"forminator-field-address-1-zip_6a13da475ac0e\" class=\"forminator-input\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-1518--page-1\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-1518--page-1-label\" aria-hidden=\"true\" data-step=\"1\" data-label=\"Page  1\" data-name=\"page-break-2\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-name-2_6a13da475ac0e-label\">PARENT\/GUARDIAN<\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-2_6a13da475ac0e\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-3-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-3-street_address_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-address-3-street_address_6a13da475ac0e-label\">Street Address (If Different)<\/label><input type=\"text\" name=\"address-3-street_address\" placeholder=\"E.g. 42 Wallaby Way\" id=\"forminator-field-address-3-street_address_6a13da475ac0e\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-3-city\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-3-city_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-address-3-city_6a13da475ac0e-label\">City (If Different)<\/label><input type=\"text\" name=\"address-3-city\" placeholder=\"E.g. Sydney\" id=\"forminator-field-address-3-city_6a13da475ac0e\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><div id=\"address-3-state\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-3-state_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-address-3-state_6a13da475ac0e-label\">State\/Province (If Different)<\/label><input type=\"text\" name=\"address-3-state\" placeholder=\"E.g. New South Wales\" id=\"forminator-field-address-3-state_6a13da475ac0e\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-3-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-3-zip_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-address-3-zip_6a13da475ac0e-label\">ZIP \/ Postal Code (If Different)<\/label><input type=\"text\" name=\"address-3-zip\" placeholder=\"E.g. 2000\" id=\"forminator-field-address-3-zip_6a13da475ac0e\" class=\"forminator-input\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-phone-1_6a13da475ac0e-label\">Phone<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. +1 300 400 5000\" id=\"forminator-field-phone-1_6a13da475ac0e\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-1518--page-2\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-1518--page-2-label\" aria-hidden=\"true\" data-step=\"2\" data-label=\"Page  2\" data-name=\"page-break-3\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">1) HOW DID YOU FIND US?<\/h4><label id=\"forminator-field-checkbox-1-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-1-1-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Internet\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-1-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Internet<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-1-2-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Social Media\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-1-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Social Media<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a13da475ac0e-label\" for=\"forminator-field-checkbox-1-3-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Doctor Referral\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Doctor-Referral\" id=\"forminator-field-checkbox-1-3-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-1-3-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Doctor Referral<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a13da475ac0e-label\" for=\"forminator-field-checkbox-1-4-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Others\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Others\" id=\"forminator-field-checkbox-1-4-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-1-4-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-1-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Others<\/span><\/label><\/div><\/div><div id=\"textarea-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a13da475ac0e\" id=\"forminator-field-textarea-1_6a13da475ac0e-label\" class=\"forminator-label\">SPECIFY OTHERS:<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a13da475ac0e\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:100px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">2) WHO GAVE THE REFERRAL?<\/h4><label id=\"forminator-field-checkbox-2-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-2-1-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Pediatrician\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-2-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-2-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Pediatrician<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-2-2-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Neurologist\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-2-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-2-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Neurologist<\/span><\/label><label id=\"forminator-field-checkbox-2-3-6a13da475ac0e-label\" for=\"forminator-field-checkbox-2-3-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"ABA Referral\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Doctor-Referral\" id=\"forminator-field-checkbox-2-3-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-2-3-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-2-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">ABA Referral<\/span><\/label><label id=\"forminator-field-checkbox-2-4-6a13da475ac0e-label\" for=\"forminator-field-checkbox-2-4-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Other Referrals\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Others\" id=\"forminator-field-checkbox-2-4-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-2-4-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-2-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other Referrals<\/span><\/label><\/div><\/div><div id=\"textarea-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a13da475ac0e\" id=\"forminator-field-textarea-2_6a13da475ac0e-label\" class=\"forminator-label\">WHAT WAS THE DIAGNOSIS?<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a13da475ac0e\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:100px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">3) SOCIAL RELATIONSHIPS (Mark all that apply)<\/h4><label id=\"forminator-field-checkbox-3-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-3-1-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Mom\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-3-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-3-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mom<\/span><\/label><label id=\"forminator-field-checkbox-3-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-3-2-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Dad\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-3-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-3-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dad<\/span><\/label><label id=\"forminator-field-checkbox-3-3-6a13da475ac0e-label\" for=\"forminator-field-checkbox-3-3-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Siblings\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Doctor-Referral\" id=\"forminator-field-checkbox-3-3-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-3-3-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-3-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Siblings<\/span><\/label><label id=\"forminator-field-checkbox-3-4-6a13da475ac0e-label\" for=\"forminator-field-checkbox-3-4-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Grand parents\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Others\" id=\"forminator-field-checkbox-3-4-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-3-4-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-3-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Grand parents<\/span><\/label><label id=\"forminator-field-checkbox-3-5-6a13da475ac0e-label\" for=\"forminator-field-checkbox-3-5-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Friends\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Friends\" id=\"forminator-field-checkbox-3-5-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-3-5-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-3-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Friends<\/span><\/label><label id=\"forminator-field-checkbox-3-6-6a13da475ac0e-label\" for=\"forminator-field-checkbox-3-6-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Others\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Others\" id=\"forminator-field-checkbox-3-6-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-3-6-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-3-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Others<\/span><\/label><\/div><\/div><div id=\"textarea-3\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a13da475ac0e\" id=\"forminator-field-textarea-3_6a13da475ac0e-label\" class=\"forminator-label\">SPECIFY OTHERS:<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a13da475ac0e\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:100px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">WHO DOES THE LIVES WITH:<\/h4><label id=\"forminator-field-checkbox-4-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-4-1-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Mom\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"one\" id=\"forminator-field-checkbox-4-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-4-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-4-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mom<\/span><\/label><label id=\"forminator-field-checkbox-4-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-4-2-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Dad\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"two\" id=\"forminator-field-checkbox-4-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-4-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-4-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dad<\/span><\/label><label id=\"forminator-field-checkbox-4-3-6a13da475ac0e-label\" for=\"forminator-field-checkbox-4-3-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Siblings\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Doctor-Referral\" id=\"forminator-field-checkbox-4-3-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-4-3-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-4-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Siblings<\/span><\/label><label id=\"forminator-field-checkbox-4-4-6a13da475ac0e-label\" for=\"forminator-field-checkbox-4-4-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Grand parents\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Others\" id=\"forminator-field-checkbox-4-4-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-4-4-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-4-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Grand parents<\/span><\/label><label id=\"forminator-field-checkbox-4-5-6a13da475ac0e-label\" for=\"forminator-field-checkbox-4-5-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Friends\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Friends\" id=\"forminator-field-checkbox-4-5-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-4-5-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-4-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Friends<\/span><\/label><label id=\"forminator-field-checkbox-4-6-6a13da475ac0e-label\" for=\"forminator-field-checkbox-4-6-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Others\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Others\" id=\"forminator-field-checkbox-4-6-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-4-6-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-4-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Others<\/span><\/label><\/div><\/div><div id=\"textarea-4\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a13da475ac0e\" id=\"forminator-field-textarea-4_6a13da475ac0e-label\" class=\"forminator-label\">SPECIFY OTHERS:<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_6a13da475ac0e\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:100px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-1518--page-3\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-1518--page-3-label\" aria-hidden=\"true\" data-step=\"3\" data-label=\"Page  3\" data-name=\"page-break-4\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6a13da475ac0e\" id=\"forminator-field-textarea-5_6a13da475ac0e-label\" class=\"forminator-label\">4) MEDICATIONS<\/label><textarea name=\"textarea-5\" placeholder=\"Dose, Frequency, Reason, Impact on behavior\" id=\"forminator-field-textarea-5_6a13da475ac0e\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><span id=\"forminator-field-textarea-5_6a13da475ac0e-description\" class=\"forminator-description\"><span data-limit=\"1000\" data-type=\"words\">0 \/ 1000<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">5) SCHOOL<\/h4><label id=\"forminator-field-checkbox-5-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-5-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"one\" id=\"forminator-field-checkbox-5-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-5-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-5-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-5-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-5-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"two\" id=\"forminator-field-checkbox-5-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-5-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-5-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-text-3_6a13da475ac0e-label\">If Yes, School Name:<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a13da475ac0e\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-form-1518__field--select-1_6a13da475ac0e\" id=\"forminator-form-1518__field--select-1_6a13da475ac0e-label\" class=\"forminator-label\">GRADE<\/label><select id=\"forminator-form-1518__field--select-1_6a13da475ac0e\" class=\"forminator-select--field forminator-select2\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"true\" aria-labelledby=\"forminator-form-1518__field--select-1_6a13da475ac0e-label\" aria-describedby=\"forminator-form-1518__field--select-1_6a13da475ac0e-description\"><option value=\"one\"  data-calculation=\"0\">1st<\/option><option value=\"two\"  data-calculation=\"0\">2nd<\/option><option value=\"3rd\"  data-calculation=\"0\">3rd<\/option><option value=\"4th\"  data-calculation=\"0\">4th<\/option><option value=\"5th\"  data-calculation=\"0\">5th<\/option><option value=\"6th\"  data-calculation=\"0\">6th<\/option><option value=\"7th\"  data-calculation=\"0\">7th<\/option><option value=\"8th\"  data-calculation=\"0\">8th<\/option><option value=\"Other\"  data-calculation=\"0\">Other<\/option><\/select><\/div><\/div><div id=\"text-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-text-2_6a13da475ac0e-label\">SPECIFY OTHER:<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a13da475ac0e\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_6a13da475ac0e\" id=\"forminator-field-textarea-6_6a13da475ac0e-label\" class=\"forminator-label\">COMPLAINTS FROM THE TEACHER (If Any):<\/label><textarea name=\"textarea-6\" placeholder=\"\" id=\"forminator-field-textarea-6_6a13da475ac0e\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">6) ABA THERAPY PREVIOUSLY<\/h4><label id=\"forminator-field-checkbox-6-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-6-1-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"one\" id=\"forminator-field-checkbox-6-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-6-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-6-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-6-2-6a13da475ac0e\" class=\"forminator-checkbox\" title=\"No\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"two\" id=\"forminator-field-checkbox-6-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-6-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-6-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">No<\/span><\/label><\/div><\/div><div id=\"text-4\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-text-4_6a13da475ac0e-label\">AT WHAT AGE:<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"Years old:\" id=\"forminator-field-text-4_6a13da475ac0e\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-1518--page-4\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-1518--page-4-label\" aria-hidden=\"true\" data-step=\"4\" data-label=\"Page  4\" data-name=\"\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"section-1\" class=\"forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h2 class=\"forminator-title\">7) BEHAVIORS<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">AGRESSION<\/h4><label id=\"forminator-field-checkbox-7-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-7-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"one\" id=\"forminator-field-checkbox-7-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-7-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-7-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-7-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-7-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"two\" id=\"forminator-field-checkbox-7-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-7-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-7-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-1\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-1_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-1\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-1_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-8\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">AVOIDANCE: (Avoids something he\/she shouldn\u00b4t)<\/h4><label id=\"forminator-field-checkbox-8-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-8-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"one\" id=\"forminator-field-checkbox-8-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-8-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-8-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-8-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-8-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"two\" id=\"forminator-field-checkbox-8-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-8-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-8-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-2\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-2_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-2\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-2_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">BOLTING: (Run or Walk Away Within a Safe Area)<\/h4><label id=\"forminator-field-checkbox-9-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-9-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"one\" id=\"forminator-field-checkbox-9-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-9-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-9-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-9-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-9-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"two\" id=\"forminator-field-checkbox-9-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-9-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-9-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-3\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-3_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-3\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-3_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-10\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">CLIMBING:<\/h4><label id=\"forminator-field-checkbox-10-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-10-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"one\" id=\"forminator-field-checkbox-10-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-10-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-10-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-10-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-10-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"two\" id=\"forminator-field-checkbox-10-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-10-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-10-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-4\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-4_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-4_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-4\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-4_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-11\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">DEFIANT BEHAVIOR: Refuses to obey rules, continually challenges authority<\/h4><label id=\"forminator-field-checkbox-11-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-11-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"one\" id=\"forminator-field-checkbox-11-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-11-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-11-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-11-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-11-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"two\" id=\"forminator-field-checkbox-11-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-11-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-11-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-5\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-5_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-5_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-5\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-5_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-12\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">DIFFICULTY COMMUNICATING WANTS\/NEEDS<\/h4><label id=\"forminator-field-checkbox-12-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-12-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"one\" id=\"forminator-field-checkbox-12-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-12-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-12-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-12-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-12-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"two\" id=\"forminator-field-checkbox-12-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-12-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-12-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-6\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-6_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-6_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-6\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-6_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-13\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">DIFFICULTY INITIATING AND SUSTAINING SOCIAL INTERACTIONS<\/h4><label id=\"forminator-field-checkbox-13-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-13-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"one\" id=\"forminator-field-checkbox-13-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-13-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-13-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-13-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-13-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"two\" id=\"forminator-field-checkbox-13-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-13-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-13-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-7\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-7_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-7_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-7\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-7_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-14\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">ECHOLALIA(Word repeated that is not used for information)<\/h4><label id=\"forminator-field-checkbox-14-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-14-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"one\" id=\"forminator-field-checkbox-14-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-14-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-14-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-14-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-14-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"two\" id=\"forminator-field-checkbox-14-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-14-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-14-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-8\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-8_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-8_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-8\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-8_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-15\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">ELOPEMENT(Run or Walk Away to An Unsafe Place)<\/h4><label id=\"forminator-field-checkbox-15-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-15-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"one\" id=\"forminator-field-checkbox-15-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-15-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-15-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-15-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-15-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"two\" id=\"forminator-field-checkbox-15-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-15-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-15-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-9\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-9_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-9_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-9\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-9_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-16\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">EXCESSIVE DRINK(Polydipsia)<\/h4><label id=\"forminator-field-checkbox-16-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-16-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"one\" id=\"forminator-field-checkbox-16-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-16-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-16-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-16-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-16-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-16[]\" value=\"two\" id=\"forminator-field-checkbox-16-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-16-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-16-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-10\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-10_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-10_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-10\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-10_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-17\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">EXCESSIVE EATING<\/h4><label id=\"forminator-field-checkbox-17-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-17-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"one\" id=\"forminator-field-checkbox-17-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-17-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-17-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-17-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-17-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-17[]\" value=\"two\" id=\"forminator-field-checkbox-17-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-17-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-17-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-11\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-11_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-11_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-11\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-11_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-18\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">EYE POKING<\/h4><label id=\"forminator-field-checkbox-18-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-18-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"one\" id=\"forminator-field-checkbox-18-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-18-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-18-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-18-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-18-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-18[]\" value=\"two\" id=\"forminator-field-checkbox-18-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-18-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-18-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-12\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-12_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-12_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-12\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-12_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-19\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">FOOD REFUSAL<\/h4><label id=\"forminator-field-checkbox-19-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-19-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"one\" id=\"forminator-field-checkbox-19-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-19-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-19-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-19-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-19-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-19[]\" value=\"two\" id=\"forminator-field-checkbox-19-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-19-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-19-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-13\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-13_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-13_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-13\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-13_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-20\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">HEAD BANGING<\/h4><label id=\"forminator-field-checkbox-20-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-20-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"one\" id=\"forminator-field-checkbox-20-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-20-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-20-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-20-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-20-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-20[]\" value=\"two\" id=\"forminator-field-checkbox-20-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-20-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-20-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-14\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-14_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-14_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-14\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-14_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-21\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">HYPERACTIVE<\/h4><label id=\"forminator-field-checkbox-21-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-21-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"one\" id=\"forminator-field-checkbox-21-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-21-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-21-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-21-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-21-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-21[]\" value=\"two\" id=\"forminator-field-checkbox-21-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-21-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-21-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-15\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-15_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-15_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-15\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-15_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-22\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">INAPPROPIATE SEXUAL BEHAVIOR TOWARD SELF<\/h4><label id=\"forminator-field-checkbox-22-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-22-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"one\" id=\"forminator-field-checkbox-22-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-22-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-22-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-22-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-22-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-22[]\" value=\"two\" id=\"forminator-field-checkbox-22-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-22-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-22-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-16\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-16_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-16_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-16\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-16_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-23\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">INAPPROPIATE SEXUAL BEHAVIOR TOWARD OTHER<\/h4><label id=\"forminator-field-checkbox-23-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-23-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"one\" id=\"forminator-field-checkbox-23-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-23-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-23-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-23-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-23-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-23[]\" value=\"two\" id=\"forminator-field-checkbox-23-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-23-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-23-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-17\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-17_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-17_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-17\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-17_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-24\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">INATTENTION<\/h4><label id=\"forminator-field-checkbox-24-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-24-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"one\" id=\"forminator-field-checkbox-24-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-24-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-24-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-24-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-24-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-24[]\" value=\"two\" id=\"forminator-field-checkbox-24-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-24-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-24-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-18\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-18_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-18_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-18\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-18_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-25\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">INDUCE VOMITING<\/h4><label id=\"forminator-field-checkbox-25-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-25-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"one\" id=\"forminator-field-checkbox-25-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-25-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-25-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-25-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-25-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-25[]\" value=\"two\" id=\"forminator-field-checkbox-25-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-25-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-25-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-19\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-19_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-19_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-19\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-19_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Field Group<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:true,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Add item&quot;,&quot;remove_text&quot;:&quot;Remove item&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-27\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">LYING<\/h4><label id=\"forminator-field-checkbox-27-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-27-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"one\" id=\"forminator-field-checkbox-27-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-27-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-27-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-27-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-27-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-27[]\" value=\"two\" id=\"forminator-field-checkbox-27-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-27-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-27-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-20\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-20_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-20_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-20\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-20_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-26\" class=\"forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a13da475ac0e-label\"><h4 id=\"forminator-checkbox-group-6a13da475ac0e-label\" class=\"forminator-label\">ISOLATION<\/h4><label id=\"forminator-field-checkbox-26-1-6a13da475ac0e-label\" for=\"forminator-field-checkbox-26-1-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"YES\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"one\" id=\"forminator-field-checkbox-26-1-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-26-1-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-26-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">YES<\/span><\/label><label id=\"forminator-field-checkbox-26-2-6a13da475ac0e-label\" for=\"forminator-field-checkbox-26-2-6a13da475ac0e\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"NO\"><input type=\"checkbox\" name=\"checkbox-26[]\" value=\"two\" id=\"forminator-field-checkbox-26-2-6a13da475ac0e\" aria-labelledby=\"forminator-field-checkbox-26-2-6a13da475ac0e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-26-6a13da475ac0e-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">NO<\/span><\/label><\/div><\/div><div id=\"number-21\" class=\"forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-21_6a13da475ac0e\" class=\"forminator-label\" id=\"forminator-field-number-21_6a13da475ac0e-label\">iF YES, FREQUENCY AT WEEK:<\/label><input name=\"number-21\" value=\"\" placeholder=\"E.g. 10\" id=\"forminator-field-number-21_6a13da475ac0e\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"999\" \/><\/div><\/div><\/div><div class=\"forminator-row forminator-action-buttons\"><div class=\"forminator-col forminator-col-12\"><input type=\"button\" value=\"Add item\" class=\"forminator-repeater-action-button forminator-repeater-add\" \/><input type=\"button\" value=\"Remove item\" class=\"forminator-repeater-action-button forminator-repeater-remove\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Send Message<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"8e1cd216b1\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1519\" \/><input type=\"hidden\" name=\"form_id\" value=\"1518\"><input type=\"hidden\" name=\"page_id\" value=\"1519\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.childgardens.com\/index.php\/elementor-1519\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1519","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.childgardens.com\/index.php\/wp-json\/wp\/v2\/pages\/1519","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.childgardens.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.childgardens.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.childgardens.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.childgardens.com\/index.php\/wp-json\/wp\/v2\/comments?post=1519"}],"version-history":[{"count":5,"href":"https:\/\/www.childgardens.com\/index.php\/wp-json\/wp\/v2\/pages\/1519\/revisions"}],"predecessor-version":[{"id":1525,"href":"https:\/\/www.childgardens.com\/index.php\/wp-json\/wp\/v2\/pages\/1519\/revisions\/1525"}],"wp:attachment":[{"href":"https:\/\/www.childgardens.com\/index.php\/wp-json\/wp\/v2\/media?parent=1519"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}