{"id":728,"date":"2024-10-16T13:41:58","date_gmt":"2024-10-16T17:41:58","guid":{"rendered":"https:\/\/forms.mhamichiana.org\/?page_id=728"},"modified":"2024-10-16T13:43:24","modified_gmt":"2024-10-16T17:43:24","slug":"cuestionario-de-resultados-previos-a-la-terapia-para-clientes","status":"publish","type":"page","link":"https:\/\/forms.mhamichiana.org\/es\/cuestionario-de-resultados-previos-a-la-terapia-para-clientes\/","title":{"rendered":"Cuestionario de Resultados Previos a la Terapia (para clientes)"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"728\" class=\"elementor elementor-728\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a99b317 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a99b317\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-a6df548\" data-id=\"a6df548\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-409c0c9 elementor-widget elementor-widget-heading\" data-id=\"409c0c9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">\nCuestionario de Resultados Previos a la Terapia (para clientes)\n\n<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-665c110 pp-gravity-form-button-custom pp-gravity-form-pagination-buttons-auto elementor-widget elementor-widget-pp-gravity-forms\" data-id=\"665c110\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"pp-gravity-forms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"pp-contact-form pp-gravity-form\">\n\t\t\t\t\t\t\t\t\t\t<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_safari gf_browser_iphone gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_19' >\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend' data-no-translation=\"\" data-trp-gettext=\"\">\"<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\" indica \u00e1reas requeridas<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_19'  action='\/es\/cuestionario-de-resultados-previos-a-la-terapia-para-clientes\/' data-formid='19' novalidate data-trp-original-action=\"\/es\/cuestionario-de-resultados-previos-a-la-terapia-para-clientes\/\">\n                        <div class='gform-body gform_body'><div id='gform_fields_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_31\" class=\"gfield gfield--type-text gfield--width-half hipaa_forms_first_name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_31'>Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_19_31' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_32\" class=\"gfield gfield--type-text gfield--width-half hipaa_forms_last_name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_32'>Apellido<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_19_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_3\" class=\"gfield gfield--type-email gfield--width-two-thirds hipaa_forms_email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_3'>Correo electr\u00f3nico<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_19_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_4\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_4'>Fecha de hoy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_4' id='input_19_4' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_19_4_date_format\" aria-invalid=\"false\" aria-required=\"true\" data-no-translation-placeholder=\"\"\/>\n                            <span id='input_19_4_date_format' class='screen-reader-text' data-no-translation=\"\" data-trp-gettext=\"\">MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_4' class='gform_hidden' value='https:\/\/forms.mhamichiana.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_19_5\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_5'>Nombre del terapeuta<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_19_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >S\u00e9 en qu\u00e9 objetivos quiero trabajar con mi terapeuta.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_19'>\n\t\t\t<div class='gchoice gchoice_19_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_19_0' id='label_19_19_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='De acuerdo (4)'  id='choice_19_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_19_1' id='label_19_19_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_19_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Neutro (3)'  id='choice_19_19_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_19_2' id='label_19_19_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_19_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='En desacuerdo (2)'  id='choice_19_19_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_19_3' id='label_19_19_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_19_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_19_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_19_4' id='label_19_19_4' class='gform-field-label gform-field-label--type-inline'>Totalmente en desacuerdo (1)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_19_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No aplica'  id='choice_19_19_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_19_5' id='label_19_19_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >En las \u00faltimas dos semanas, falt\u00e9 al trabajo o llegu\u00e9 tarde al trabajo debido a mi salud mental.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_20'>\n\t\t\t<div class='gchoice gchoice_19_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_0' id='label_19_20_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='De acuerdo (4)'  id='choice_19_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_1' id='label_19_20_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Neutro (3)'  id='choice_19_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_2' id='label_19_20_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_20_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='En desacuerdo (2)'  id='choice_19_20_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_3' id='label_19_20_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_20_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_20_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_4' id='label_19_20_4' class='gform-field-label gform-field-label--type-inline'>Totalmente en desacuerdo (1)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_20_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='No aplica'  id='choice_19_20_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_20_5' id='label_19_20_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Estoy satisfecho con mi trabajo (es decir, tipo de trabajo, salario, beneficios, horario).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_21'>\n\t\t\t<div class='gchoice gchoice_19_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_21_0' id='label_19_21_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='De acuerdo (4)'  id='choice_19_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_21_1' id='label_19_21_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_21_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Neutro (3)'  id='choice_19_21_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_21_2' id='label_19_21_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_21_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='En desacuerdo (2)'  id='choice_19_21_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_21_3' id='label_19_21_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_21_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_21_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_21_4' id='label_19_21_4' class='gform-field-label gform-field-label--type-inline'>Totalmente en desacuerdo (1)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_21_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='No aplica'  id='choice_19_21_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_21_5' id='label_19_21_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Estoy satisfecho con mi nivel educativo actual o mis habilidades laborales.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_22'>\n\t\t\t<div class='gchoice gchoice_19_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_22_0' id='label_19_22_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='De acuerdo (4)'  id='choice_19_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_22_1' id='label_19_22_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Neutro (3)'  id='choice_19_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_22_2' id='label_19_22_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_22_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='En desacuerdo (2)'  id='choice_19_22_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_22_3' id='label_19_22_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_22_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_22_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_22_4' id='label_19_22_4' class='gform-field-label gform-field-label--type-inline'>Totalmente en desacuerdo (1)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_22_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='No aplica'  id='choice_19_22_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_22_5' id='label_19_22_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >En las \u00faltimas dos semanas, falt\u00e9 a la escuela o llegu\u00e9 tarde a clases debido a mi salud mental.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_23'>\n\t\t\t<div class='gchoice gchoice_19_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_23_0' id='label_19_23_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='De acuerdo (4)'  id='choice_19_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_23_1' id='label_19_23_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_23_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Neutro (3)'  id='choice_19_23_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_23_2' id='label_19_23_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_23_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='En desacuerdo (2)'  id='choice_19_23_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_23_3' id='label_19_23_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_23_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_23_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_23_4' id='label_19_23_4' class='gform-field-label gform-field-label--type-inline'>Totalmente en desacuerdo (1)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_23_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No aplica'  id='choice_19_23_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_23_5' id='label_19_23_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Puedo hablar con amigos o familiares sobre mi salud mental.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_24'>\n\t\t\t<div class='gchoice gchoice_19_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_24_0' id='label_19_24_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='De acuerdo (4)'  id='choice_19_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_24_1' id='label_19_24_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Neutro (3)'  id='choice_19_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_24_2' id='label_19_24_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='En desacuerdo (2)'  id='choice_19_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_24_3' id='label_19_24_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_24_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_24_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_24_4' id='label_19_24_4' class='gform-field-label gform-field-label--type-inline'>Totalmente en desacuerdo (1)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_24_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='No aplica'  id='choice_19_24_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_24_5' id='label_19_24_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Estoy satisfecho con mi bienestar general (sensaci\u00f3n general de bienestar, satisfacci\u00f3n con la vida).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_25'>\n\t\t\t<div class='gchoice gchoice_19_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_25_0' id='label_19_25_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='De acuerdo (4)'  id='choice_19_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_25_1' id='label_19_25_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_25_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Neutro (3)'  id='choice_19_25_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_25_2' id='label_19_25_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_25_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='En desacuerdo (2)'  id='choice_19_25_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_25_3' id='label_19_25_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_25_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_25_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_25_4' id='label_19_25_4' class='gform-field-label gform-field-label--type-inline'>Totalmente en desacuerdo (1)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_25_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No aplica'  id='choice_19_25_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_25_5' id='label_19_25_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Mis relaciones cercanas van bien (buena comunicaci\u00f3n, poco conflicto).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_26'>\n\t\t\t<div class='gchoice gchoice_19_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_26_0' id='label_19_26_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='De acuerdo (4)'  id='choice_19_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_26_1' id='label_19_26_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Neutro (3)'  id='choice_19_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_26_2' id='label_19_26_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_26_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='En desacuerdo (2)'  id='choice_19_26_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_26_3' id='label_19_26_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_26_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_26_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_26_4' id='label_19_26_4' class='gform-field-label gform-field-label--type-inline'>Totalmente en desacuerdo (1)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_26_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='No aplica'  id='choice_19_26_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_26_5' id='label_19_26_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Mis otras relaciones van bien (trabajo, escuela, amigos).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_27'>\n\t\t\t<div class='gchoice gchoice_19_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_27_0' id='label_19_27_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='De acuerdo (4)'  id='choice_19_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_27_1' id='label_19_27_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Neutro (3)'  id='choice_19_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_27_2' id='label_19_27_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='En desacuerdo (2)'  id='choice_19_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_27_3' id='label_19_27_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_27_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_27_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_27_4' id='label_19_27_4' class='gform-field-label gform-field-label--type-inline'>Totalmente en desacuerdo (1)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_27_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='No aplica'  id='choice_19_27_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_27_5' id='label_19_27_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Estoy satisfecho con mis finanzas (ingresos estables, buena toma de decisiones).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_28'>\n\t\t\t<div class='gchoice gchoice_19_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Totalmente de acuerdo (5)'  id='choice_19_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_28_0' id='label_19_28_0' class='gform-field-label gform-field-label--type-inline'>Totalmente de acuerdo (5)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='De acuerdo (4)'  id='choice_19_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_28_1' id='label_19_28_1' class='gform-field-label gform-field-label--type-inline'>De acuerdo (4)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Neutro (3)'  id='choice_19_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_28_2' id='label_19_28_2' class='gform-field-label gform-field-label--type-inline'>Neutro (3)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_28_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='En desacuerdo (2)'  id='choice_19_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_28_3' id='label_19_28_3' class='gform-field-label gform-field-label--type-inline'>En desacuerdo (2)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_28_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_19_28_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_28_4' 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