{"id":9386,"date":"2025-11-21T01:45:16","date_gmt":"2025-11-21T01:45:16","guid":{"rendered":"https:\/\/dreugenelipov.com\/?page_id=9386"},"modified":"2026-02-10T19:12:53","modified_gmt":"2026-02-10T19:12:53","slug":"pcl-5-ptsd-assessment-form","status":"publish","type":"page","link":"https:\/\/dreugenelipov.com\/es\/pcl-5-ptsd-assessment-form\/","title":{"rendered":"Formulario de evaluaci\u00f3n de TEPT PCL-5"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"9386\" class=\"elementor elementor-9386\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1698a6b e-flex e-con-boxed e-con e-parent\" data-id=\"1698a6b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4ab2543 elementor-widget elementor-widget-heading\" data-id=\"4ab2543\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">PCL-5 PTSD Assessment Form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e27fa84 e-con-full e-flex e-con e-parent\" data-id=\"e27fa84\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-af2ec1b e-con-full e-flex e-con e-parent\" data-id=\"af2ec1b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-5c96001 e-flex e-con-boxed e-con e-child\" data-id=\"5c96001\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4557a97 elementor-widget-mobile__width-initial elementor-widget__width-inherit elementor-widget elementor-widget-shortcode\" data-id=\"4557a97\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\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 InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return 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<\/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_2' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">PCL-5 PTSD Assessment Form<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/es\/wp-json\/wp\/v2\/pages\/9386' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_4\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Basic Information<\/h3><\/div><fieldset id=\"field_2_29\" class=\"gfield gfield--type-name gfield--input-type-name 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' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_29'>\n                            \n                            <span id='input_2_29_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.3' id='input_2_29_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_29_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_29_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.6' id='input_2_29_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_29_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_31\" class=\"gfield gfield--type-email gfield--input-type-email 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_2_31'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_31' id='input_2_31' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_32\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_32'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_32' id='input_2_32' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_35\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_2_5\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><strong>Instructions: Below is a list of problems that people sometimes have in response to a very stressful experience. Please\nread each problem carefully and then circle one of the numbers to the right to indicate how much you have been\nbothered by that problem in the past month.  <\/strong><\/div><fieldset id=\"field_2_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >1. Repeated, disturbing, and unwanted memories of the stressful experience?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_1'>\n\t\t\t<div class='gchoice gchoice_2_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='0'  id='choice_2_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_1_0' id='label_2_1_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='1'  id='choice_2_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_1_1' id='label_2_1_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_1_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='2'  id='choice_2_1_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_1_2' id='label_2_1_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_1_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='3'  id='choice_2_1_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_1_3' id='label_2_1_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_1_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='4'  id='choice_2_1_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_1_4' id='label_2_1_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >2. Repeated, disturbing dreams of the stressful experience?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_18'>\n\t\t\t<div class='gchoice gchoice_2_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='0'  id='choice_2_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_18_0' id='label_2_18_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='1'  id='choice_2_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_18_1' id='label_2_18_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_18_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='2'  id='choice_2_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_18_2' id='label_2_18_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_18_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='3'  id='choice_2_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_18_3' id='label_2_18_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_18_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='4'  id='choice_2_18_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_18_4' id='label_2_18_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_19'>\n\t\t\t<div class='gchoice gchoice_2_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='0'  id='choice_2_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_19_0' id='label_2_19_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='1'  id='choice_2_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_19_1' id='label_2_19_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_19_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='2'  id='choice_2_19_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_19_2' id='label_2_19_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_19_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='3'  id='choice_2_19_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_19_3' id='label_2_19_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_19_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='4'  id='choice_2_19_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_19_4' id='label_2_19_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >4. Feeling very upset when something reminded you of the stressful experience?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_17'>\n\t\t\t<div class='gchoice gchoice_2_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='0'  id='choice_2_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_0' id='label_2_17_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='1'  id='choice_2_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_1' id='label_2_17_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='2'  id='choice_2_17_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_2' id='label_2_17_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='3'  id='choice_2_17_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_3' id='label_2_17_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='4'  id='choice_2_17_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_17_4' id='label_2_17_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_16'>\n\t\t\t<div class='gchoice gchoice_2_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='0'  id='choice_2_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_0' id='label_2_16_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='1'  id='choice_2_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_1' id='label_2_16_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='2'  id='choice_2_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_2' id='label_2_16_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_16_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='3'  id='choice_2_16_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_3' id='label_2_16_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_16_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='4'  id='choice_2_16_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_16_4' id='label_2_16_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >6. Avoiding memories, thoughts, or feelings related to the stressful experience?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_15'>\n\t\t\t<div class='gchoice gchoice_2_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='0'  id='choice_2_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_0' id='label_2_15_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='1'  id='choice_2_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_1' id='label_2_15_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='2'  id='choice_2_15_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_2' id='label_2_15_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='3'  id='choice_2_15_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_3' id='label_2_15_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='4'  id='choice_2_15_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_15_4' id='label_2_15_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_13'>\n\t\t\t<div class='gchoice gchoice_2_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='0'  id='choice_2_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_13_0' id='label_2_13_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='1'  id='choice_2_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_13_1' id='label_2_13_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='2'  id='choice_2_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_13_2' id='label_2_13_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='3'  id='choice_2_13_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_13_3' id='label_2_13_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_13_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='4'  id='choice_2_13_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_13_4' id='label_2_13_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >8. Trouble remembering important parts of the stressful experience?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_14'>\n\t\t\t<div class='gchoice gchoice_2_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='0'  id='choice_2_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_0' id='label_2_14_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='1'  id='choice_2_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_1' id='label_2_14_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='2'  id='choice_2_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_2' id='label_2_14_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='3'  id='choice_2_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_3' id='label_2_14_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='4'  id='choice_2_14_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_4' id='label_2_14_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_12'>\n\t\t\t<div class='gchoice gchoice_2_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='0'  id='choice_2_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_12_0' id='label_2_12_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='1'  id='choice_2_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_12_1' id='label_2_12_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='2'  id='choice_2_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_12_2' id='label_2_12_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='3'  id='choice_2_12_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_12_3' id='label_2_12_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='4'  id='choice_2_12_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_12_4' id='label_2_12_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >10. Blaming yourself or someone else for the stressful experience or what happened after it?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_11'>\n\t\t\t<div class='gchoice gchoice_2_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='0'  id='choice_2_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_11_0' id='label_2_11_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='1'  id='choice_2_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_11_1' id='label_2_11_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='2'  id='choice_2_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_11_2' id='label_2_11_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='3'  id='choice_2_11_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_11_3' id='label_2_11_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_11_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='4'  id='choice_2_11_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_11_4' id='label_2_11_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_10'>\n\t\t\t<div class='gchoice gchoice_2_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='0'  id='choice_2_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_10_0' id='label_2_10_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='1'  id='choice_2_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_10_1' id='label_2_10_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='2'  id='choice_2_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_10_2' id='label_2_10_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='3'  id='choice_2_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_10_3' id='label_2_10_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_10_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='4'  id='choice_2_10_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_10_4' id='label_2_10_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >12. Loss of interest in activities that you used to enjoy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_9'>\n\t\t\t<div class='gchoice gchoice_2_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='0'  id='choice_2_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_0' id='label_2_9_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='1'  id='choice_2_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_1' id='label_2_9_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='2'  id='choice_2_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_2' id='label_2_9_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='3'  id='choice_2_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_3' id='label_2_9_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='4'  id='choice_2_9_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_9_4' id='label_2_9_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >13. Feeling distant or cut off from other people?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_8'>\n\t\t\t<div class='gchoice gchoice_2_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='0'  id='choice_2_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_0' id='label_2_8_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='1'  id='choice_2_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_1' id='label_2_8_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='2'  id='choice_2_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_2' id='label_2_8_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='3'  id='choice_2_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_3' id='label_2_8_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='4'  id='choice_2_8_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_8_4' id='label_2_8_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_20'>\n\t\t\t<div class='gchoice gchoice_2_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='0'  id='choice_2_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_0' id='label_2_20_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='1'  id='choice_2_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_1' id='label_2_20_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='2'  id='choice_2_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_2' id='label_2_20_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='3'  id='choice_2_20_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_3' id='label_2_20_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='4'  id='choice_2_20_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_4' id='label_2_20_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >15. Irritable behavior, angry outbursts, or acting aggressively?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_7'>\n\t\t\t<div class='gchoice gchoice_2_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='0'  id='choice_2_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_0' id='label_2_7_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='1'  id='choice_2_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_1' id='label_2_7_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='2'  id='choice_2_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_2' id='label_2_7_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='3'  id='choice_2_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_3' id='label_2_7_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_7_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='4'  id='choice_2_7_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_4' id='label_2_7_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >16. Taking too many risks or doing things that could cause you harm?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_23'>\n\t\t\t<div class='gchoice gchoice_2_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='0'  id='choice_2_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_0' id='label_2_23_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='1'  id='choice_2_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_1' id='label_2_23_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_23_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='2'  id='choice_2_23_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_2' id='label_2_23_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_23_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='3'  id='choice_2_23_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_3' id='label_2_23_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_23_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='4'  id='choice_2_23_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_23_4' id='label_2_23_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >17. Being \u201csuperalert\u201d or watchful or on guard?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_24'>\n\t\t\t<div class='gchoice gchoice_2_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='0'  id='choice_2_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_0' id='label_2_24_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='1'  id='choice_2_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_1' id='label_2_24_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='2'  id='choice_2_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_2' id='label_2_24_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='3'  id='choice_2_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_3' id='label_2_24_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='4'  id='choice_2_24_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_4' id='label_2_24_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >18. Feeling jumpy or easily startled?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_27'>\n\t\t\t<div class='gchoice gchoice_2_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='0'  id='choice_2_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_0' id='label_2_27_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='1'  id='choice_2_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_1' id='label_2_27_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='2'  id='choice_2_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_2' id='label_2_27_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='3'  id='choice_2_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_3' id='label_2_27_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_27_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='4'  id='choice_2_27_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_27_4' id='label_2_27_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >19. Having difficulty concentrating?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_26'>\n\t\t\t<div class='gchoice gchoice_2_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='0'  id='choice_2_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_0' id='label_2_26_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='1'  id='choice_2_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_1' id='label_2_26_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='2'  id='choice_2_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_2' id='label_2_26_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='3'  id='choice_2_26_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_3' id='label_2_26_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='4'  id='choice_2_26_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_4' id='label_2_26_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_5col 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' >20. Trouble falling or staying asleep?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_25'>\n\t\t\t<div class='gchoice gchoice_2_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='0'  id='choice_2_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_0' id='label_2_25_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='1'  id='choice_2_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_1' id='label_2_25_1' class='gform-field-label gform-field-label--type-inline'>A little bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_25_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='2'  id='choice_2_25_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_2' id='label_2_25_2' class='gform-field-label gform-field-label--type-inline'>Moderately<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_25_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='3'  id='choice_2_25_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_3' id='label_2_25_3' class='gform-field-label gform-field-label--type-inline'>Quite a bit<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_25_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='4'  id='choice_2_25_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_4' id='label_2_25_4' class='gform-field-label gform-field-label--type-inline'>Extremely<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_28\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Este campo est\u00e1 oculto cuando se visualiza el formulario\"><\/i><span>Este campo est\u00e1 oculto cuando se visualiza el formulario<\/span><\/div><label class='gfield_label gform-field-label' for='input_2_28'>Total Score<\/label><div class='ginput_container ginput_container_number'><input name='input_28' id='input_2_28' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Enviar'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='WA9jboQbyHaeJaKMByR+GKTaTePukQULEej0IRWRLxJhmwtR+ZqYnob7nOj85aLyp1BecInLbv7mR5Igk0lmLhuliKME5lkWSDN6wuHMofR5oiw=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' 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