{"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":"2024-11-07T05:59:21","modified_gmt":"2024-11-07T10:59:21","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":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"733\" class=\"elementor elementor-733\" 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 Posteriores 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_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_20' >\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\"<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\" indica \u00e1reas requeridas<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_20'  action='\/es\/cuestionario-de-resultados-posteriores-a-la-terapia-para-clientes\/' data-formid='20' novalidate data-trp-original-action=\"\/cuestionario-de-resultados-posteriores-a-la-terapia-para-clientes\/\">\n                        <div class='gform-body gform_body'><div id='gform_fields_20' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_20_46\" class=\"gfield gfield--type-text gfield--width-half hipaa_forms_first_name field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_20_46'>Nombre<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_20_46' type='text' value='' class='large'  aria-describedby=\"gfield_description_20_46\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_20_46'>(o prefiere permanecer an\u00f3nimo)<\/div><\/div><div id=\"field_20_47\" class=\"gfield gfield--type-text gfield--width-half hipaa_forms_last_name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_20_47'>Apellido<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_20_47' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_20_4\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon 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_20_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_20_4' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_20_4_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_20_4_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_20_4' class='gform_hidden' value='https:\/\/forms.mhamichiana.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_20_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' >\u00bfCu\u00e1ntos adultos de confianza tienes en tu vida con quienes puedes hablar sobre tu 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_20_19'>\n\t\t\t<div class='gchoice gchoice_20_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='0'  id='choice_20_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_19_0' id='label_20_19_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='1'  id='choice_20_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_19_1' id='label_20_19_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_19_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='2 o m\u00e1s'  id='choice_20_19_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_19_2' id='label_20_19_2' class='gform-field-label gform-field-label--type-inline'>2 o m\u00e1s<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_20_3\" class=\"gfield gfield--type-email gfield--width-half hipaa_forms_email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_20_3'>Correo electr\u00f3nico<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_20_3' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_20_5\" class=\"gfield gfield--type-text gfield--width-half 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_20_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_20_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_20_20\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_20_20'>\u00bfC\u00f3mo te identificas?<\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_20_20' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='Masculino' >Masculino<\/option><option value='Femenino' >Femenino<\/option><option value='No binario' >No binario<\/option><option value='Otro' >Otro<\/option><\/select><\/div><\/div><div id=\"field_20_21\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_20_21'>\u00bfC\u00f3mo te identificas?<\/label><div class='ginput_container ginput_container_select'><select name='input_21' id='input_20_21' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected'><\/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><\/div><\/div><fieldset id=\"field_20_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' >Progres\u00e9 hacia mis metas.<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_20_27'>\n\t\t\t<div class='gchoice gchoice_20_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_20_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_27_0' id='label_20_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_20_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='De acuerdo (4)'  id='choice_20_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_27_1' id='label_20_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_20_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Neutro (3)'  id='choice_20_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_27_2' id='label_20_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_20_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='En desacuerdo (2)'  id='choice_20_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_27_3' id='label_20_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_20_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_20_27_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_27_4' id='label_20_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_20_27_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='No aplica'  id='choice_20_27_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_27_5' id='label_20_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_20_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 el progreso que hice.<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_20_28'>\n\t\t\t<div class='gchoice gchoice_20_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_20_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_28_0' id='label_20_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_20_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='De acuerdo (4)'  id='choice_20_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_28_1' id='label_20_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_20_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Neutro (3)'  id='choice_20_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_28_2' id='label_20_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_20_28_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='En desacuerdo (2)'  id='choice_20_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_28_3' id='label_20_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_20_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_20_28_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_28_4' id='label_20_28_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_20_28_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='No aplica'  id='choice_20_28_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_28_5' id='label_20_28_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_29\" 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_20_29'>\n\t\t\t<div class='gchoice gchoice_20_29_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_29_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_29_0' id='label_20_29_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_20_29_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='De acuerdo (4)'  id='choice_20_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_29_1' id='label_20_29_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_20_29_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Neutro (3)'  id='choice_20_29_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_29_2' id='label_20_29_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_20_29_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='En desacuerdo (2)'  id='choice_20_29_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_29_3' id='label_20_29_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_20_29_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_29_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_29_4' id='label_20_29_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_20_29_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='No aplica'  id='choice_20_29_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_29_5' id='label_20_29_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_30\" 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' >Mi salud mental mejor\u00f3 gracias a la terapia.<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_20_30'>\n\t\t\t<div class='gchoice gchoice_20_30_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_30_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_30_0' id='label_20_30_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_20_30_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='De acuerdo (4)'  id='choice_20_30_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_30_1' id='label_20_30_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_20_30_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Neutro (3)'  id='choice_20_30_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_30_2' id='label_20_30_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_20_30_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='En desacuerdo (2)'  id='choice_20_30_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_30_3' id='label_20_30_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_20_30_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_30_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_30_4' id='label_20_30_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_20_30_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='No aplica'  id='choice_20_30_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_30_5' id='label_20_30_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_31\" 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' >Mi salud mental mejor\u00f3 por otras razones.<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_20_31'>\n\t\t\t<div class='gchoice gchoice_20_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_31_0' id='label_20_31_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_20_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='De acuerdo (4)'  id='choice_20_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_31_1' id='label_20_31_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_20_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Neutro (3)'  id='choice_20_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_31_2' id='label_20_31_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_20_31_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='En desacuerdo (2)'  id='choice_20_31_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_31_3' id='label_20_31_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_20_31_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_31_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_31_4' id='label_20_31_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_20_31_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No aplica'  id='choice_20_31_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_31_5' id='label_20_31_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_32\" 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' >Mi situaci\u00f3n laboral mejor\u00f3 (nuevo trabajo, mejor trabajo, mejores horarios, mejores salarios o beneficios, mejor asistencia)<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_20_32'>\n\t\t\t<div class='gchoice gchoice_20_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_32_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_32_0' id='label_20_32_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_20_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='De acuerdo (4)'  id='choice_20_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_32_1' id='label_20_32_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_20_32_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Neutro (3)'  id='choice_20_32_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_32_2' id='label_20_32_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_20_32_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='En desacuerdo (2)'  id='choice_20_32_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_32_3' id='label_20_32_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_20_32_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_32_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_32_4' id='label_20_32_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_20_32_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='No aplica'  id='choice_20_32_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_32_5' id='label_20_32_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_33\" 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' >Mi educaci\u00f3n mejor\u00f3 (regres\u00e9 a la escuela, permanec\u00ed en la escuela, mejor asistencia)<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_20_33'>\n\t\t\t<div class='gchoice gchoice_20_33_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_33_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_33_0' id='label_20_33_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_20_33_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='De acuerdo (4)'  id='choice_20_33_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_33_1' id='label_20_33_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_20_33_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Neutro (3)'  id='choice_20_33_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_33_2' id='label_20_33_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_20_33_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='En desacuerdo (2)'  id='choice_20_33_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_33_3' id='label_20_33_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_20_33_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_33_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_33_4' id='label_20_33_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_20_33_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='No aplica'  id='choice_20_33_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_33_5' id='label_20_33_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_34\" 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' >Mi bienestar general mejor\u00f3 (bienestar general, 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_20_34'>\n\t\t\t<div class='gchoice gchoice_20_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_34_0' id='label_20_34_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_20_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='De acuerdo (4)'  id='choice_20_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_34_1' id='label_20_34_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_20_34_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Neutro (3)'  id='choice_20_34_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_34_2' id='label_20_34_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_20_34_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='En desacuerdo (2)'  id='choice_20_34_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_34_3' id='label_20_34_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_20_34_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_34_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_34_4' id='label_20_34_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_20_34_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='No aplica'  id='choice_20_34_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_34_5' id='label_20_34_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_35\" 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 mejoraron (mejor comunicaci\u00f3n, menos conflictos).<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_20_35'>\n\t\t\t<div class='gchoice gchoice_20_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_35_0' id='label_20_35_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_20_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='De acuerdo (4)'  id='choice_20_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_35_1' id='label_20_35_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_20_35_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Neutro (3)'  id='choice_20_35_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_35_2' id='label_20_35_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_20_35_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='En desacuerdo (2)'  id='choice_20_35_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_35_3' id='label_20_35_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_20_35_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_35_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_35_4' id='label_20_35_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_20_35_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='No aplica'  id='choice_20_35_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_35_5' id='label_20_35_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_36\" 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' >Otras relaciones mejoraron (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_20_36'>\n\t\t\t<div class='gchoice gchoice_20_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_36_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_36_0' id='label_20_36_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_20_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='De acuerdo (4)'  id='choice_20_36_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_36_1' id='label_20_36_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_20_36_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Neutro (3)'  id='choice_20_36_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_36_2' id='label_20_36_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_20_36_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='En desacuerdo (2)'  id='choice_20_36_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_36_3' id='label_20_36_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_20_36_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_36_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_36_4' id='label_20_36_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_20_36_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='No aplica'  id='choice_20_36_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_36_5' id='label_20_36_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_37\" 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 finanzas mejoraron (m\u00e1s estables, mejor 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_20_37'>\n\t\t\t<div class='gchoice gchoice_20_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_37_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_37_0' id='label_20_37_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_20_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='De acuerdo (4)'  id='choice_20_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_37_1' id='label_20_37_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_20_37_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Neutro (3)'  id='choice_20_37_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_37_2' id='label_20_37_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_20_37_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='En desacuerdo (2)'  id='choice_20_37_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_37_3' id='label_20_37_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_20_37_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_37_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_37_4' id='label_20_37_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_20_37_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='No aplica'  id='choice_20_37_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_37_5' id='label_20_37_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_38\" 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' >Mi terapeuta respet\u00f3 mi cultura, creencias espirituales y\/o sexualidad.<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_20_38'>\n\t\t\t<div class='gchoice gchoice_20_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_38_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_38_0' id='label_20_38_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_20_38_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='De acuerdo (4)'  id='choice_20_38_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_38_1' id='label_20_38_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_20_38_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Neutro (3)'  id='choice_20_38_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_38_2' id='label_20_38_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_20_38_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='En desacuerdo (2)'  id='choice_20_38_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_38_3' id='label_20_38_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_20_38_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_38_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_38_4' id='label_20_38_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_20_38_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='No aplica'  id='choice_20_38_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_38_5' id='label_20_38_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_39\" 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' >Me asignaron un terapeuta que me pudo ayudar.<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_20_39'>\n\t\t\t<div class='gchoice gchoice_20_39_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_39_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_39_0' id='label_20_39_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_20_39_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='De acuerdo (4)'  id='choice_20_39_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_39_1' id='label_20_39_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_20_39_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Neutro (3)'  id='choice_20_39_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_39_2' id='label_20_39_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_20_39_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='En desacuerdo (2)'  id='choice_20_39_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_39_3' id='label_20_39_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_20_39_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_39_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_39_4' id='label_20_39_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_20_39_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='No aplica'  id='choice_20_39_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_39_5' id='label_20_39_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_40\" 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' >Recomendar\u00eda este servicio a un amigo\/familiar.<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_20_40'>\n\t\t\t<div class='gchoice gchoice_20_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Totalmente de acuerdo (5)'  id='choice_20_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_40_0' id='label_20_40_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_20_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='De acuerdo (4)'  id='choice_20_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_40_1' id='label_20_40_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_20_40_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Neutro (3)'  id='choice_20_40_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_40_2' id='label_20_40_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_20_40_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='En desacuerdo (2)'  id='choice_20_40_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_40_3' id='label_20_40_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_20_40_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Totalmente en desacuerdo (1)'  id='choice_20_40_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_40_4' id='label_20_40_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_20_40_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='No aplica'  id='choice_20_40_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_40_5' id='label_20_40_5' class='gform-field-label gform-field-label--type-inline'>No aplica<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_20_41\" 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' >\u00bfCu\u00e1ntas sesiones completaste (seg\u00fan se acuerde mejor)?<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_20_41'>\n\t\t\t<div class='gchoice gchoice_20_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='0'  id='choice_20_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_0' id='label_20_41_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='1'  id='choice_20_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_1' id='label_20_41_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='2'  id='choice_20_41_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_2' id='label_20_41_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='3'  id='choice_20_41_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_3' id='label_20_41_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='4'  id='choice_20_41_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_4' id='label_20_41_4' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='5'  id='choice_20_41_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_5' id='label_20_41_5' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='6'  id='choice_20_41_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_6' id='label_20_41_6' class='gform-field-label gform-field-label--type-inline'>6<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='7'  id='choice_20_41_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_7' id='label_20_41_7' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='8'  id='choice_20_41_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_8' id='label_20_41_8' class='gform-field-label gform-field-label--type-inline'>8<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='9'  id='choice_20_41_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_9' id='label_20_41_9' class='gform-field-label gform-field-label--type-inline'>9<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='10'  id='choice_20_41_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_10' id='label_20_41_10' class='gform-field-label gform-field-label--type-inline'>10<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='11'  id='choice_20_41_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_11' id='label_20_41_11' class='gform-field-label gform-field-label--type-inline'>11<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='12'  id='choice_20_41_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_12' id='label_20_41_12' class='gform-field-label gform-field-label--type-inline'>12<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_20_41_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='m\u00e1s de 12'  id='choice_20_41_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_20_41_13' id='label_20_41_13' class='gform-field-label gform-field-label--type-inline'>m\u00e1s de 12<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_20_45\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_20_45'>\u00bfCu\u00e1ntos d\u00edas del mes pasado dir\u00eda que su salud mental no fue buena (dificultad para afrontar situaciones)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_45' id='input_20_45' type='number' step='any' min='0' max='30' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_20_45 gfield_description_20_45\" \/><div class='gfield_description instruction' id='gfield_instruction_20_45'>Please enter a number from <strong>0<\/strong> to <strong>30<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_20_45'>Por favor indique un n\u00famero del 0 al 30.<\/div><\/div><fieldset id=\"field_20_43\" class=\"gfield gfield--type-checkbox 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 gfield_label_before_complex' >Motivo por el que finaliz\u00f3 la terapia (marque todos los que correspondan):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_20_43'><div class='gchoice gchoice_20_43_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.1' type='checkbox'  value='Cumpl\u00ed mis objetivos'  id='choice_20_43_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_20_43_1' id='label_20_43_1' class='gform-field-label gform-field-label--type-inline'>Cumpl\u00ed mis objetivos<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_20_43_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.2' type='checkbox'  value='N\u00famero de sesiones asignadas finalizadas.'  id='choice_20_43_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_20_43_2' id='label_20_43_2' class='gform-field-label gform-field-label--type-inline'>N\u00famero de sesiones asignadas finalizadas.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_20_43_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.3' type='checkbox'  value='Mal ajuste con el terapeuta'  id='choice_20_43_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_20_43_3' id='label_20_43_3' class='gform-field-label gform-field-label--type-inline'>Mal ajuste con el terapeuta<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_20_43_4'>\n\t\t\t\t\t\t\t\t<input 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)'  id='choice_20_43_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_20_43_4' id='label_20_43_4' class='gform-field-label gform-field-label--type-inline'>No puede continuar la terapia debido a circunstancias de la vida (transporte, horario, otras)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_20_43_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.5' type='checkbox'  value='Seguro de salud obtenido (nuevo beneficio)'  id='choice_20_43_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_20_43_5' id='label_20_43_5' class='gform-field-label gform-field-label--type-inline'>Seguro de salud obtenido (nuevo beneficio)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_20_43_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.6' type='checkbox'  value='Estoy buscando servicios en otro lugar'  id='choice_20_43_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_20_43_6' id='label_20_43_6' class='gform-field-label gform-field-label--type-inline'>Estoy buscando servicios en otro lugar<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_20_43_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.7' type='checkbox'  value='Otro:'  id='choice_20_43_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_20_43_7' id='label_20_43_7' class='gform-field-label gform-field-label--type-inline'>Otro:<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_20_26\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_20_26'>Agradecemos cualquier otro comentario o sugerencia sobre su experiencia<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_20_26' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'>  \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_20' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_20' id='gform_theme_20' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_20' id='gform_style_settings_20' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_20' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='20' \/>\n            \n            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