{"id":733,"date":"2024-10-16T13:45:23","date_gmt":"2024-10-16T17:45:23","guid":{"rendered":"https:\/\/forms.mhamichiana.org\/?page_id=733"},"modified":"2026-09-22T06:46:21","modified_gmt":"2026-09-22T10:46:21","slug":"cuestionario-de-resultados-posteriores-a-la-terapia-para-clientes","status":"publish","type":"page","link":"https:\/\/forms.mhamichiana.org\/es\/cuestionario-de-resultados-posteriores-a-la-terapia-para-clientes\/","title":{"rendered":"Cuestionario de Resultados Posteriores a la Terapia (para clientes)"},"content":{"rendered":"<h1>Cuestionario de Resultados Posteriores a la Terapia (para clientes)<\/h1>\n<p class=\"gform_required_legend\">&#8220;*&#8221; indicates required fields<\/p>\n<form id=\"gform_20\" action=\"\/wp-admin\/admin-ajax.php\" enctype=\"multipart\/form-data\" method=\"post\" data-formid=\"20\" data-trp-original-action=\"\/wp-admin\/admin-ajax.php\">\n<fieldset id=\"field_20_1\" data-js-reload=\"field_20_1\">\n<legend class=\"gfield_label gform-field-label gfield_label_before_complex\">Nombre<\/legend>\n<p><input id=\"input_20_1_3\" name=\"input_1.3\" type=\"text\" value=\"\" aria-required=\"false\" \/><br \/>\n<label class=\"gform-field-label gform-field-label--type-sub\" for=\"input_20_1_3\">Nombre<\/label><br \/>\n<input id=\"input_20_1_6\" name=\"input_1.6\" type=\"text\" value=\"\" aria-required=\"false\" \/><br \/>\n<label class=\"gform-field-label gform-field-label--type-sub\" for=\"input_20_1_6\">Apellido<\/label><br \/>\n(o prefiere permanecer an\u00f3nimo)<\/fieldset>\n<p><label class=\"gfield_label gform-field-label\" for=\"input_20_4\">Fecha de hoy*<\/label><br \/>\n<input id=\"input_20_4\" class=\"datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon\" name=\"input_4\" type=\"text\" value=\"\" placeholder=\"mm\/dd\/yyyy\" aria-describedby=\"input_20_4_date_format\" aria-invalid=\"false\" aria-required=\"true\" \/><br \/>\nMM slash DD slash YYYY<br \/>\n<input id=\"gforms_calendar_icon_input_20_4\" class=\"gform_hidden\" type=\"hidden\" value=\"https:\/\/forms.mhamichiana.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg\" \/><\/p>\n<fieldset id=\"field_20_19\" data-js-reload=\"field_20_19\">\n<legend class=\"gfield_label gform-field-label\">\u00bfCu\u00e1ntos adultos de confianza tienes en tu vida con quienes puedes hablar sobre tu salud mental?*<\/legend>\n<p><input id=\"choice_20_19_0\" class=\"gfield-choice-input\" name=\"input_19\" type=\"radio\" value=\"0\" \/><br \/>\n<label id=\"label_20_19_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_19_0\">0<\/label><br \/>\n<input id=\"choice_20_19_1\" class=\"gfield-choice-input\" name=\"input_19\" type=\"radio\" value=\"1\" \/><br \/>\n<label id=\"label_20_19_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_19_1\">1<\/label><br \/>\n<input id=\"choice_20_19_2\" class=\"gfield-choice-input\" name=\"input_19\" type=\"radio\" value=\"2 o m\u00e1s\" \/><br \/>\n<label id=\"label_20_19_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_19_2\">2 o m\u00e1s<\/label><\/fieldset>\n<p><label class=\"gfield_label gform-field-label\" for=\"input_20_3\">Correo electr\u00f3nico<\/label><br \/>\n<input id=\"input_20_3\" class=\"large\" name=\"input_3\" type=\"text\" value=\"\" aria-invalid=\"false\" \/><br \/>\n<label class=\"gfield_label gform-field-label\" for=\"input_20_5\">Nombre del terapeuta*<\/label><input id=\"input_20_5\" class=\"large\" name=\"input_5\" type=\"text\" value=\"\" aria-required=\"true\" aria-invalid=\"false\" \/> <label class=\"gfield_label gform-field-label\" for=\"input_20_20\">\u00bfC\u00f3mo te identificas?<\/label><select id=\"input_20_20\" class=\"large gfield_select\" name=\"input_20\" aria-invalid=\"false\"><option selected=\"selected\" value=\"\"><\/option><option value=\"Masculino\">Masculino<\/option><option value=\"Femenino\">Femenino<\/option><option value=\"No binario\">No binario<\/option><option value=\"Otro\">Otro<\/option><\/select><label class=\"gfield_label gform-field-label\" for=\"input_20_21\">\u00bfC\u00f3mo te identificas?<\/label><select id=\"input_20_21\" class=\"large gfield_select\" name=\"input_21\" aria-invalid=\"false\"><option selected=\"selected\" value=\"\"><\/option><option value=\"Negro-Afroamericano\">Negro-Afroamericano<\/option><option value=\"Blanco\">Blanco<\/option><option value=\"Latino\">Latino<\/option><option value=\"Mezcla\">Mezcla<\/option><option value=\"Asi\u00e1tico\">Asi\u00e1tico<\/option><option value=\"Otro\">Otro<\/option><\/select><\/p>\n<fieldset id=\"field_20_27\" data-js-reload=\"field_20_27\">\n<legend class=\"gfield_label gform-field-label\">Progres\u00e9 hacia mis metas.*<\/legend>\n<p><input id=\"choice_20_27_0\" class=\"gfield-choice-input\" name=\"input_27\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_27_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_27_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_27_1\" class=\"gfield-choice-input\" name=\"input_27\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_27_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_27_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_27_2\" class=\"gfield-choice-input\" name=\"input_27\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_27_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_27_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_27_3\" class=\"gfield-choice-input\" name=\"input_27\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_27_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_27_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_27_4\" class=\"gfield-choice-input\" name=\"input_27\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_27_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_27_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_27_5\" class=\"gfield-choice-input\" name=\"input_27\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_27_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_27_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_28\" data-js-reload=\"field_20_28\">\n<legend class=\"gfield_label gform-field-label\">Estoy satisfecho con el progreso que hice.*<\/legend>\n<p><input id=\"choice_20_28_0\" class=\"gfield-choice-input\" name=\"input_28\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_28_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_28_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_28_1\" class=\"gfield-choice-input\" name=\"input_28\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_28_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_28_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_28_2\" class=\"gfield-choice-input\" name=\"input_28\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_28_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_28_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_28_3\" class=\"gfield-choice-input\" name=\"input_28\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_28_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_28_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_28_4\" class=\"gfield-choice-input\" name=\"input_28\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_28_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_28_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_28_5\" class=\"gfield-choice-input\" name=\"input_28\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_28_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_28_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_29\" data-js-reload=\"field_20_29\">\n<legend class=\"gfield_label gform-field-label\">Puedo hablar con amigos o familiares sobre mi salud mental.*<\/legend>\n<p><input id=\"choice_20_29_0\" class=\"gfield-choice-input\" name=\"input_29\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_29_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_29_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_29_1\" class=\"gfield-choice-input\" name=\"input_29\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_29_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_29_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_29_2\" class=\"gfield-choice-input\" name=\"input_29\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_29_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_29_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_29_3\" class=\"gfield-choice-input\" name=\"input_29\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_29_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_29_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_29_4\" class=\"gfield-choice-input\" name=\"input_29\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_29_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_29_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_29_5\" class=\"gfield-choice-input\" name=\"input_29\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_29_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_29_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_30\" data-js-reload=\"field_20_30\">\n<legend class=\"gfield_label gform-field-label\">Mi salud mental mejor\u00f3 gracias a la terapia.*<\/legend>\n<p><input id=\"choice_20_30_0\" class=\"gfield-choice-input\" name=\"input_30\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_30_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_30_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_30_1\" class=\"gfield-choice-input\" name=\"input_30\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_30_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_30_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_30_2\" class=\"gfield-choice-input\" name=\"input_30\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_30_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_30_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_30_3\" class=\"gfield-choice-input\" name=\"input_30\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_30_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_30_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_30_4\" class=\"gfield-choice-input\" name=\"input_30\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_30_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_30_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_30_5\" class=\"gfield-choice-input\" name=\"input_30\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_30_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_30_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_31\" data-js-reload=\"field_20_31\">\n<legend class=\"gfield_label gform-field-label\">Mi salud mental mejor\u00f3 por otras razones.*<\/legend>\n<p><input id=\"choice_20_31_0\" class=\"gfield-choice-input\" name=\"input_31\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_31_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_31_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_31_1\" class=\"gfield-choice-input\" name=\"input_31\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_31_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_31_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_31_2\" class=\"gfield-choice-input\" name=\"input_31\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_31_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_31_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_31_3\" class=\"gfield-choice-input\" name=\"input_31\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_31_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_31_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_31_4\" class=\"gfield-choice-input\" name=\"input_31\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_31_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_31_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_31_5\" class=\"gfield-choice-input\" name=\"input_31\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_31_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_31_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_32\" data-js-reload=\"field_20_32\">\n<legend class=\"gfield_label gform-field-label\">Mi situaci\u00f3n laboral mejor\u00f3 (nuevo trabajo, mejor trabajo, mejores horarios, mejores salarios o beneficios, mejor asistencia)*<\/legend>\n<p><input id=\"choice_20_32_0\" class=\"gfield-choice-input\" name=\"input_32\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_32_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_32_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_32_1\" class=\"gfield-choice-input\" name=\"input_32\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_32_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_32_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_32_2\" class=\"gfield-choice-input\" name=\"input_32\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_32_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_32_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_32_3\" class=\"gfield-choice-input\" name=\"input_32\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_32_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_32_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_32_4\" class=\"gfield-choice-input\" name=\"input_32\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_32_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_32_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_32_5\" class=\"gfield-choice-input\" name=\"input_32\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_32_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_32_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_33\" data-js-reload=\"field_20_33\">\n<legend class=\"gfield_label gform-field-label\">Mi educaci\u00f3n mejor\u00f3 (regres\u00e9 a la escuela, permanec\u00ed en la escuela, mejor asistencia)*<\/legend>\n<p><input id=\"choice_20_33_0\" class=\"gfield-choice-input\" name=\"input_33\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_33_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_33_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_33_1\" class=\"gfield-choice-input\" name=\"input_33\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_33_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_33_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_33_2\" class=\"gfield-choice-input\" name=\"input_33\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_33_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_33_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_33_3\" class=\"gfield-choice-input\" name=\"input_33\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_33_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_33_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_33_4\" class=\"gfield-choice-input\" name=\"input_33\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_33_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_33_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_33_5\" class=\"gfield-choice-input\" name=\"input_33\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_33_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_33_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_34\" data-js-reload=\"field_20_34\">\n<legend class=\"gfield_label gform-field-label\">Mi bienestar general mejor\u00f3 (bienestar general, satisfacci\u00f3n con la vida).*<\/legend>\n<p><input id=\"choice_20_34_0\" class=\"gfield-choice-input\" name=\"input_34\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_34_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_34_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_34_1\" class=\"gfield-choice-input\" name=\"input_34\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_34_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_34_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_34_2\" class=\"gfield-choice-input\" name=\"input_34\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_34_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_34_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_34_3\" class=\"gfield-choice-input\" name=\"input_34\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_34_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_34_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_34_4\" class=\"gfield-choice-input\" name=\"input_34\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_34_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_34_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_34_5\" class=\"gfield-choice-input\" name=\"input_34\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_34_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_34_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_35\" data-js-reload=\"field_20_35\">\n<legend class=\"gfield_label gform-field-label\">Mis relaciones cercanas mejoraron (mejor comunicaci\u00f3n, menos conflictos).*<\/legend>\n<p><input id=\"choice_20_35_0\" class=\"gfield-choice-input\" name=\"input_35\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_35_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_35_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_35_1\" class=\"gfield-choice-input\" name=\"input_35\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_35_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_35_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_35_2\" class=\"gfield-choice-input\" name=\"input_35\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_35_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_35_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_35_3\" class=\"gfield-choice-input\" name=\"input_35\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_35_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_35_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_35_4\" class=\"gfield-choice-input\" name=\"input_35\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_35_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_35_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_35_5\" class=\"gfield-choice-input\" name=\"input_35\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_35_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_35_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_36\" data-js-reload=\"field_20_36\">\n<legend class=\"gfield_label gform-field-label\">Otras relaciones mejoraron (trabajo, escuela, amigos)*<\/legend>\n<p><input id=\"choice_20_36_0\" class=\"gfield-choice-input\" name=\"input_36\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_36_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_36_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_36_1\" class=\"gfield-choice-input\" name=\"input_36\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_36_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_36_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_36_2\" class=\"gfield-choice-input\" name=\"input_36\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_36_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_36_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_36_3\" class=\"gfield-choice-input\" name=\"input_36\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_36_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_36_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_36_4\" class=\"gfield-choice-input\" name=\"input_36\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_36_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_36_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_36_5\" class=\"gfield-choice-input\" name=\"input_36\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_36_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_36_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_37\" data-js-reload=\"field_20_37\">\n<legend class=\"gfield_label gform-field-label\">Mis finanzas mejoraron (m\u00e1s estables, mejor toma de decisiones).*<\/legend>\n<p><input id=\"choice_20_37_0\" class=\"gfield-choice-input\" name=\"input_37\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_37_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_37_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_37_1\" class=\"gfield-choice-input\" name=\"input_37\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_37_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_37_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_37_2\" class=\"gfield-choice-input\" name=\"input_37\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_37_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_37_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_37_3\" class=\"gfield-choice-input\" name=\"input_37\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_37_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_37_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_37_4\" class=\"gfield-choice-input\" name=\"input_37\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_37_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_37_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_37_5\" class=\"gfield-choice-input\" name=\"input_37\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_37_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_37_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_38\" data-js-reload=\"field_20_38\">\n<legend class=\"gfield_label gform-field-label\">Mi terapeuta respet\u00f3 mi cultura, creencias espirituales y\/o sexualidad.*<\/legend>\n<p><input id=\"choice_20_38_0\" class=\"gfield-choice-input\" name=\"input_38\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_38_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_38_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_38_1\" class=\"gfield-choice-input\" name=\"input_38\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_38_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_38_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_38_2\" class=\"gfield-choice-input\" name=\"input_38\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_38_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_38_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_38_3\" class=\"gfield-choice-input\" name=\"input_38\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_38_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_38_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_38_4\" class=\"gfield-choice-input\" name=\"input_38\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_38_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_38_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_38_5\" class=\"gfield-choice-input\" name=\"input_38\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_38_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_38_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_39\" data-js-reload=\"field_20_39\">\n<legend class=\"gfield_label gform-field-label\">Me asignaron un terapeuta que me pudo ayudar.*<\/legend>\n<p><input id=\"choice_20_39_0\" class=\"gfield-choice-input\" name=\"input_39\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_39_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_39_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_39_1\" class=\"gfield-choice-input\" name=\"input_39\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_39_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_39_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_39_2\" class=\"gfield-choice-input\" name=\"input_39\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_39_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_39_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_39_3\" class=\"gfield-choice-input\" name=\"input_39\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_39_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_39_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_39_4\" class=\"gfield-choice-input\" name=\"input_39\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_39_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_39_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_39_5\" class=\"gfield-choice-input\" name=\"input_39\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_39_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_39_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_40\" data-js-reload=\"field_20_40\">\n<legend class=\"gfield_label gform-field-label\">Recomendar\u00eda este servicio a un amigo\/familiar.*<\/legend>\n<p><input id=\"choice_20_40_0\" class=\"gfield-choice-input\" name=\"input_40\" type=\"radio\" value=\"Totalmente de acuerdo (5)\" \/><br \/>\n<label id=\"label_20_40_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_40_0\">Totalmente de acuerdo (5)<\/label><br \/>\n<input id=\"choice_20_40_1\" class=\"gfield-choice-input\" name=\"input_40\" type=\"radio\" value=\"De acuerdo (4)\" \/><br \/>\n<label id=\"label_20_40_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_40_1\">De acuerdo (4)<\/label><br \/>\n<input id=\"choice_20_40_2\" class=\"gfield-choice-input\" name=\"input_40\" type=\"radio\" value=\"Neutro (3)\" \/><br \/>\n<label id=\"label_20_40_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_40_2\">Neutro (3)<\/label><br \/>\n<input id=\"choice_20_40_3\" class=\"gfield-choice-input\" name=\"input_40\" type=\"radio\" value=\"En desacuerdo (2)\" \/><br \/>\n<label id=\"label_20_40_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_40_3\">En desacuerdo (2)<\/label><br \/>\n<input id=\"choice_20_40_4\" class=\"gfield-choice-input\" name=\"input_40\" type=\"radio\" value=\"Totalmente en desacuerdo (1)\" \/><br \/>\n<label id=\"label_20_40_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_40_4\">Totalmente en desacuerdo (1)<\/label><br \/>\n<input id=\"choice_20_40_5\" class=\"gfield-choice-input\" name=\"input_40\" type=\"radio\" value=\"No aplica\" \/><br \/>\n<label id=\"label_20_40_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_40_5\">No aplica<\/label><\/fieldset>\n<fieldset id=\"field_20_41\" data-js-reload=\"field_20_41\">\n<legend class=\"gfield_label gform-field-label\">\u00bfCu\u00e1ntas sesiones completaste (seg\u00fan se acuerde mejor)?*<\/legend>\n<p><input id=\"choice_20_41_0\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"0\" \/><br \/>\n<label id=\"label_20_41_0\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_0\">0<\/label><br \/>\n<input id=\"choice_20_41_1\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"1\" \/><br \/>\n<label id=\"label_20_41_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_1\">1<\/label><br \/>\n<input id=\"choice_20_41_2\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"2\" \/><br \/>\n<label id=\"label_20_41_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_2\">2<\/label><br \/>\n<input id=\"choice_20_41_3\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"3\" \/><br \/>\n<label id=\"label_20_41_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_3\">3<\/label><br \/>\n<input id=\"choice_20_41_4\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"4\" \/><br \/>\n<label id=\"label_20_41_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_4\">4<\/label><br \/>\n<input id=\"choice_20_41_5\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"5\" \/><br \/>\n<label id=\"label_20_41_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_5\">5<\/label><br \/>\n<input id=\"choice_20_41_6\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"6\" \/><br \/>\n<label id=\"label_20_41_6\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_6\">6<\/label><br \/>\n<input id=\"choice_20_41_7\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"7\" \/><br \/>\n<label id=\"label_20_41_7\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_7\">7<\/label><br \/>\n<input id=\"choice_20_41_8\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"8\" \/><br \/>\n<label id=\"label_20_41_8\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_8\">8<\/label><br \/>\n<input id=\"choice_20_41_9\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"9\" \/><br \/>\n<label id=\"label_20_41_9\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_9\">9<\/label><br \/>\n<input id=\"choice_20_41_10\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"10\" \/><br \/>\n<label id=\"label_20_41_10\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_10\">10<\/label><br \/>\n<input id=\"choice_20_41_11\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"11\" \/><br \/>\n<label id=\"label_20_41_11\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_11\">11<\/label><br \/>\n<input id=\"choice_20_41_12\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"12\" \/><br \/>\n<label id=\"label_20_41_12\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_12\">12<\/label><br \/>\n<input id=\"choice_20_41_13\" class=\"gfield-choice-input\" name=\"input_41\" type=\"radio\" value=\"m\u00e1s de 12\" \/><br \/>\n<label id=\"label_20_41_13\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_41_13\">m\u00e1s de 12<\/label><\/fieldset>\n<fieldset id=\"field_20_43\" data-js-reload=\"field_20_43\">\n<legend class=\"gfield_label gform-field-label gfield_label_before_complex\">\u00bfCu\u00e1ntos d\u00edas del mes pasado dir\u00eda que su salud mental no fue buena (dificultad para afrontar situaciones)? Motivo por el que finaliz\u00f3 la terapia (marque todos los que correspondan):*<\/legend>\n<p><input id=\"choice_20_43_1\" class=\"gfield-choice-input\" name=\"input_43.1\" type=\"checkbox\" value=\"Cumpl\u00ed mis objetivos\" \/><br \/>\n<label id=\"label_20_43_1\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_43_1\">Cumpl\u00ed mis objetivos<\/label><br \/>\n<input id=\"choice_20_43_2\" class=\"gfield-choice-input\" name=\"input_43.2\" type=\"checkbox\" value=\"N\u00famero de sesiones asignadas finalizadas.\" \/><br \/>\n<label id=\"label_20_43_2\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_43_2\">N\u00famero de sesiones asignadas finalizadas.<\/label><br \/>\n<input id=\"choice_20_43_3\" class=\"gfield-choice-input\" name=\"input_43.3\" type=\"checkbox\" value=\"Mal ajuste con el terapeuta\" \/><br \/>\n<label id=\"label_20_43_3\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_43_3\">Mal ajuste con el terapeuta<\/label><br \/>\n<input id=\"choice_20_43_4\" class=\"gfield-choice-input\" name=\"input_43.4\" type=\"checkbox\" value=\"No puede continuar la terapia debido a circunstancias de la vida (transporte, horario, otras)\" \/><br \/>\n<label id=\"label_20_43_4\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_43_4\">No puede continuar la terapia debido a circunstancias de la vida (transporte, horario, otras)<\/label><br \/>\n<input id=\"choice_20_43_5\" class=\"gfield-choice-input\" name=\"input_43.5\" type=\"checkbox\" value=\"Seguro de salud obtenido (nuevo beneficio)\" \/><br \/>\n<label id=\"label_20_43_5\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_43_5\">Seguro de salud obtenido (nuevo beneficio)<\/label><br \/>\n<input id=\"choice_20_43_6\" class=\"gfield-choice-input\" name=\"input_43.6\" type=\"checkbox\" value=\"Estoy buscando servicios en otro lugar\" \/><br \/>\n<label id=\"label_20_43_6\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_43_6\">Estoy buscando servicios en otro lugar<\/label><br \/>\n<input id=\"choice_20_43_7\" class=\"gfield-choice-input\" name=\"input_43.7\" type=\"checkbox\" value=\"Otro:\" \/><br \/>\n<label id=\"label_20_43_7\" class=\"gform-field-label gform-field-label--type-inline\" for=\"choice_20_43_7\">Otro:<\/label><\/fieldset>\n<p><label class=\"gfield_label gform-field-label\" for=\"input_20_26\">Agradecemos cualquier otro comentario o sugerencia sobre su experiencia<\/label><textarea id=\"input_20_26\" class=\"textarea medium\" cols=\"50\" name=\"input_26\" rows=\"10\" aria-invalid=\"false\"><\/textarea><\/p>\n<fieldset id=\"field_20_18\" data-js-reload=\"field_20_18\">\n<legend class=\"gfield_label gform-field-label gfield_label_before_complex\">Consent*<\/legend>\n<p><input id=\"input_20_18_1\" name=\"input_18.1\" type=\"checkbox\" value=\"1\" aria-required=\"true\" aria-invalid=\"false\" \/> <label for=\"input_20_18_1\">Acepto la Declaraci\u00f3n de Privacidad del Servicio HIPAA FORMS*<\/label><input class=\"gform_hidden\" name=\"input_18.2\" type=\"hidden\" value=\"Acepto la Declaraci\u00f3n de Privacidad del Servicio HIPAA FORMS\" \/><input class=\"gform_hidden\" name=\"input_18.3\" type=\"hidden\" value=\"3\" \/><\/fieldset>\n<p><input id=\"gform_submit_button_20\" class=\"gform_button button\" type=\"submit\" value=\"ENTREGAR\" \/><br \/>\n<input class=\"gform_hidden\" name=\"is_submit_20\" type=\"hidden\" value=\"1\" \/><br \/>\n<input class=\"gform_hidden\" name=\"gform_submit\" type=\"hidden\" value=\"20\" \/><br \/>\n<input class=\"gform_hidden\" name=\"gform_unique_id\" type=\"hidden\" value=\"\" \/><br \/>\n<input class=\"gform_hidden\" name=\"state_20\" type=\"hidden\" value=\"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\" \/><br \/>\n<input id=\"gform_target_page_number_20\" class=\"gform_hidden\" name=\"gform_target_page_number_20\" type=\"hidden\" value=\"0\" \/><br \/>\n<input id=\"gform_source_page_number_20\" class=\"gform_hidden\" name=\"gform_source_page_number_20\" type=\"hidden\" value=\"1\" \/><br \/>\n<input name=\"gform_field_values\" type=\"hidden\" value=\"\" \/><\/p>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form>\n<div style=\"position: fixed; top: 10px; right: 10px;\">\n<a href=\"https:\/\/recrutement.avenirbenin.com\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>togel online<\/span><\/a><br \/>\n<a href=\"https:\/\/www.brr.gov.gh\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>kampungbet<\/span><\/a><br \/>\n<a href=\"https:\/\/kovry78.ru\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>situs gacor<\/span><\/a><br \/>\n<a href=\"https:\/\/studsovet.spbu.ru\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>toto togel<\/span><\/a><br \/>\n<a href=\"https:\/\/barnyardvenue.co.za\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>togel online<\/span><\/a><br \/>\n<a href=\"https:\/\/oxford2025evolutionconference.com\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>togel online<\/span><\/a><br \/>\n<a href=\"https:\/\/pmc.edu.bd\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>slot gacor<\/span><\/a><br \/>\n<a href=\"https:\/\/gps.gov.bd\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>togel online<\/span><\/a><br \/>\n<a href=\"https:\/\/sipencatar.amiaipi.ac.id\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>situs gacor<\/span><\/a><br \/>\n<a href=\"https:\/\/www.transitionmetalscorp.com\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>togel<\/span><\/a><br \/>\n<a href=\"https:\/\/copoe.org\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>slot gacor<\/span><\/a><br \/>\n<a href=\"https:\/\/stemfie.org\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>situs gacor<\/span><\/a><br \/>\n<a href=\"https:\/\/wyoming-county-health.org\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>slot gacor<\/span><\/a><br \/>\n<a href=\"https:\/\/uglaceh.ac.id\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>togel 4d<\/span><\/a><br \/>\n<a href=\"https:\/\/n15technology.com\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>toto togel<\/span><\/a><br \/>\n<a href=\"https:\/\/tortynabema.pl\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>situs togel<\/span><\/a><br \/>\n<a href=\"https:\/\/lasemeuse.asso.fr\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>link gacor<\/span><\/a><br \/>\n<a href=\"https:\/\/web.sierra.com.ar\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>toto togel<\/span><\/a><br \/>\n<a href=\"https:\/\/datentransfer.apriori.biz\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>togel online<\/span><\/a><br \/>\n<a href=\"https:\/\/testbirpencere.unec.edu.az\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>togel online<\/span><\/a><br \/>\n<a href=\"https:\/\/baleines-forillon.com\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>situs togel<\/span><\/a><br \/>\n<a href=\"https:\/\/lesaintclement.com\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>toto togel<\/span><\/a><br \/>\n<a href=\"https:\/\/druckerei-wollenschneider-saarbruecken.de\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>bandar togel<\/span><\/a><br \/>\n<a href=\"https:\/\/www.systronics.co.th\/\" style=\"font-size: 1px; text-decoration: none; opacity: 0.1;\"><span>togel 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[&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-733","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/forms.mhamichiana.org\/es\/wp-json\/wp\/v2\/pages\/733","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/forms.mhamichiana.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/forms.mhamichiana.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/forms.mhamichiana.org\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/forms.mhamichiana.org\/es\/wp-json\/wp\/v2\/comments?post=733"}],"version-history":[{"count":8,"href":"https:\/\/forms.mhamichiana.org\/es\/wp-json\/wp\/v2\/pages\/733\/revisions"}],"predecessor-version":[{"id":892,"href":"https:\/\/forms.mhamichiana.org\/es\/wp-json\/wp\/v2\/pages\/733\/revisions\/892"}],"wp:attachment":[{"href":"https:\/\/forms.mhamichiana.org\/es\/wp-json\/wp\/v2\/media?parent=733"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}