{"id":1503,"date":"2026-03-10T12:32:58","date_gmt":"2026-03-10T09:32:58","guid":{"rendered":"https:\/\/staging.balantia.app\/forms\/history\/"},"modified":"2026-04-21T23:28:39","modified_gmt":"2026-04-21T20:28:39","slug":"history","status":"publish","type":"page","link":"https:\/\/staging.balantia.app\/en\/forms\/history\/","title":{"rendered":"HISTORY"},"content":{"rendered":"<div>\n<div class=\"frm_forms  with_frm_style frm_style_balantia\" id=\"frm_form_25_container\" data-token=\"953eae66061be29b02f727d1ece7a053\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form  frm_logic_form \" id=\"form_balantia-questionnaire-el\" data-token=\"953eae66061be29b02f727d1ece7a053\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Balantia Health &amp; Nutrition History Form<\/legend>\r\n<h3 class=\"frm_form_title\">Balantia Health &amp; Nutrition History Form<\/h3>\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"25\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_25\" id=\"frm_hide_fields_25\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"balantia-questionnaire-el\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_25\" name=\"frm_submit_entry_25\" value=\"40d9be55bb\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/1503\" \/><div id=\"frm_field_540_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Contact details<\/h3>\r\n\r\n\r\n<div id=\"frm_field_541_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_capitalize\">\r\n\t<div id=\"field_fprs1_label\" class=\"frm_primary_label\">What is your full name?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_fprs1_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tWhat is your full name?\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_541\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_541-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_fprs1_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_fprs1_first\" value=\"\" name=\"item_meta[541][first]\" autocomplete=\"given-name\" data-sectionid=\"540\"  data-reqmsg=\"What is your full name? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your full name? is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_541_first_desc\">First name<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_541-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_fprs1_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_fprs1_last\" value=\"\" name=\"item_meta[541][last]\" autocomplete=\"family-name\" data-sectionid=\"540\"  data-reqmsg=\"What is your full name? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your full name? is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_541_last_desc\">Last name<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_542_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n\t<label for=\"field_winse\" id=\"field_winse_label\" class=\"frm_primary_label\">What is your email address?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_winse\" name=\"item_meta[542]\" value=\"\"  data-sectionid=\"540\"  autocomplete=\"email\"  placeholder=\"myemail@gmail.com\" data-reqmsg=\"What is your email address? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your email address? is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_conf_542_container\" class=\"frm_form_field frm_hidden_container frm_conf_field form-field  frm_required_field frm_top_container frm_half\">\r\n\t<label for=\"field_conf_winse\" id=\"field_conf_winse_label\" class=\"frm_conf_label frm_primary_label\">Confirm What is your email address?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_conf_winse\" name=\"item_meta[conf_542]\" value=\"\"  data-sectionid=\"540\"  autocomplete=\"email\"  placeholder=\"\u03a0\u03bb\u03b7\u03ba\u03c4\u03c1\u03bf\u03bb\u03bf\u03b3\u03ae\u03c3\u03c4\u03b5 \u03be\u03b1\u03bd\u03ac \u03c4\u03bf e-mail\" data-reqmsg=\"Confirm What is your email address? cannot be blank.\" aria-required=\"true\" data-confmsg=\"The entered values do not match\" data-invmsg=\"Confirm What is your email address? is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_543_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_half\">\r\n\t<label for=\"field_z8gqi\" id=\"field_z8gqi_label\" class=\"frm_primary_label\">What is your occupation?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_z8gqi\" name=\"item_meta[543]\" value=\"\"  data-sectionid=\"540\"  data-invmsg=\"What is your occupation? is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_544_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n\t<label for=\"field_n51ij2\" id=\"field_n51ij2_label\" class=\"frm_primary_label\">Which city do you live in?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t\t\t<select  name=\"item_meta[544]\" id=\"field_n51ij2\"  data-sectionid=\"540\"  data-reqmsg=\"Which city do you live in? cannot be blank.\" aria-required=\"true\" data-invmsg=\"Which city do you live in? is invalid\" aria-invalid=\"false\"  >\n\t\t\t\t\t\t\t<option  value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\t\t \t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Afghanistan\">\n\t\t\t\t\tAfghanistan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Aland\">\n\t\t\t\t\tAland\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Albania\">\n\t\t\t\t\tAlbania\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Algeria\">\n\t\t\t\t\tAlgeria\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"American Samoa\">\n\t\t\t\t\tAmerican Samoa\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Andorra\">\n\t\t\t\t\tAndorra\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Angola\">\n\t\t\t\t\tAngola\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Anguilla\">\n\t\t\t\t\tAnguilla\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Antarctica\">\n\t\t\t\t\tAntarctica\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Antigua and Barbuda\">\n\t\t\t\t\tAntigua and Barbuda\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Argentina\">\n\t\t\t\t\tArgentina\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Armenia\">\n\t\t\t\t\tArmenia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Aruba\">\n\t\t\t\t\tAruba\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Ascension\">\n\t\t\t\t\tAscension\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Australia\">\n\t\t\t\t\tAustralia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Austria\">\n\t\t\t\t\tAustria\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Azerbaijan\">\n\t\t\t\t\tAzerbaijan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Bahamas\">\n\t\t\t\t\tBahamas\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Bahrain\">\n\t\t\t\t\tBahrain\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Bangladesh\">\n\t\t\t\t\tBangladesh\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Barbados\">\n\t\t\t\t\tBarbados\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Belarus\">\n\t\t\t\t\tBelarus\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Belgium\">\n\t\t\t\t\tBelgium\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Belize\">\n\t\t\t\t\tBelize\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Benin\">\n\t\t\t\t\tBenin\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Bermuda\">\n\t\t\t\t\tBermuda\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Bhutan\">\n\t\t\t\t\tBhutan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Bolivia\">\n\t\t\t\t\tBolivia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Bosnia and Herzegovina\">\n\t\t\t\t\tBosnia and Herzegovina\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Botswana\">\n\t\t\t\t\tBotswana\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Bouvet Island\">\n\t\t\t\t\tBouvet Island\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Brazil\">\n\t\t\t\t\tBrazil\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"British Indian Ocean Territory\">\n\t\t\t\t\tBritish Indian Ocean Territory\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"British Virgin Islands\">\n\t\t\t\t\tBritish Virgin Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Brunei\">\n\t\t\t\t\tBrunei\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Bulgaria\">\n\t\t\t\t\tBulgaria\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Burkina Faso\">\n\t\t\t\t\tBurkina Faso\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Burundi\">\n\t\t\t\t\tBurundi\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Cambodia\">\n\t\t\t\t\tCambodia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Cameroon\">\n\t\t\t\t\tCameroon\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Canada\">\n\t\t\t\t\tCanada\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Cape Verde\">\n\t\t\t\t\tCape Verde\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Cayman Islands\">\n\t\t\t\t\tCayman Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Central African Republic\">\n\t\t\t\t\tCentral African Republic\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Chad\">\n\t\t\t\t\tChad\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Chile\">\n\t\t\t\t\tChile\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"China\">\n\t\t\t\t\tChina\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Christmas Island\">\n\t\t\t\t\tChristmas Island\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Cocos (Keeling) Islands\">\n\t\t\t\t\tCocos (Keeling) Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Colombia\">\n\t\t\t\t\tColombia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Comoros\">\n\t\t\t\t\tComoros\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Congo\">\n\t\t\t\t\tCongo\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Congo (DRC)\">\n\t\t\t\t\tCongo (DRC)\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Cook Islands\">\n\t\t\t\t\tCook Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Costa Rica\">\n\t\t\t\t\tCosta Rica\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Cote d&#039;Ivoire\">\n\t\t\t\t\tCote d&#039;Ivoire\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Croatia\">\n\t\t\t\t\tCroatia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Cuba\">\n\t\t\t\t\tCuba\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Cyprus\">\n\t\t\t\t\tCyprus\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Czech Republic\">\n\t\t\t\t\tCzech Republic\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Denmark\">\n\t\t\t\t\tDenmark\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Djibouti\">\n\t\t\t\t\tDjibouti\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Dominica\">\n\t\t\t\t\tDominica\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Dominican Republic\">\n\t\t\t\t\tDominican Republic\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Ecuador\">\n\t\t\t\t\tEcuador\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Egypt\">\n\t\t\t\t\tEgypt\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"El Salvador\">\n\t\t\t\t\tEl Salvador\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Equatorial Guinea\">\n\t\t\t\t\tEquatorial Guinea\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Eritrea\">\n\t\t\t\t\tEritrea\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Estonia\">\n\t\t\t\t\tEstonia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Ethiopia\">\n\t\t\t\t\tEthiopia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Falkland Islands (Islas Malvinas)\">\n\t\t\t\t\tFalkland Islands (Islas Malvinas)\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Faroe Islands\">\n\t\t\t\t\tFaroe Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Fiji\">\n\t\t\t\t\tFiji\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Finland\">\n\t\t\t\t\tFinland\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"France\">\n\t\t\t\t\tFrance\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"French Guiana\">\n\t\t\t\t\tFrench Guiana\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"French Polynesia\">\n\t\t\t\t\tFrench Polynesia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"French Southern and Antarctic Lands\">\n\t\t\t\t\tFrench Southern and Antarctic Lands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Gabon\">\n\t\t\t\t\tGabon\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Gambia\">\n\t\t\t\t\tGambia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Georgia\">\n\t\t\t\t\tGeorgia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Germany\">\n\t\t\t\t\tGermany\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Ghana\">\n\t\t\t\t\tGhana\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Gibraltar\">\n\t\t\t\t\tGibraltar\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Greece\">\n\t\t\t\t\tGreece\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Greenland\">\n\t\t\t\t\tGreenland\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Grenada\">\n\t\t\t\t\tGrenada\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Guadeloupe\">\n\t\t\t\t\tGuadeloupe\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Guam\">\n\t\t\t\t\tGuam\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Guatemala\">\n\t\t\t\t\tGuatemala\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Guernsey\">\n\t\t\t\t\tGuernsey\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Guinea\">\n\t\t\t\t\tGuinea\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Guinea-Bissau\">\n\t\t\t\t\tGuinea-Bissau\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Guyana\">\n\t\t\t\t\tGuyana\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Haiti\">\n\t\t\t\t\tHaiti\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Heard Island and McDonald Islands\">\n\t\t\t\t\tHeard Island and McDonald Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Honduras\">\n\t\t\t\t\tHonduras\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Hong Kong\">\n\t\t\t\t\tHong Kong\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Hungary\">\n\t\t\t\t\tHungary\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Iceland\">\n\t\t\t\t\tIceland\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"India\">\n\t\t\t\t\tIndia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Indonesia\">\n\t\t\t\t\tIndonesia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Iran\">\n\t\t\t\t\tIran\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Iraq\">\n\t\t\t\t\tIraq\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Ireland\">\n\t\t\t\t\tIreland\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Isle of Man\">\n\t\t\t\t\tIsle of Man\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Israel\">\n\t\t\t\t\tIsrael\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Italy\">\n\t\t\t\t\tItaly\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Jamaica\">\n\t\t\t\t\tJamaica\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Japan\">\n\t\t\t\t\tJapan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Jersey\">\n\t\t\t\t\tJersey\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Jordan\">\n\t\t\t\t\tJordan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Kazakhstan\">\n\t\t\t\t\tKazakhstan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Kenya\">\n\t\t\t\t\tKenya\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Kiribati\">\n\t\t\t\t\tKiribati\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Korea (North Korea)\">\n\t\t\t\t\tKorea (North Korea)\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Korea (South Korea)\">\n\t\t\t\t\tKorea (South Korea)\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Kosovo\">\n\t\t\t\t\tKosovo\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Kuwait\">\n\t\t\t\t\tKuwait\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Kyrgyzstan\">\n\t\t\t\t\tKyrgyzstan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Laos\">\n\t\t\t\t\tLaos\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Latvia\">\n\t\t\t\t\tLatvia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Lebanon\">\n\t\t\t\t\tLebanon\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Lesotho\">\n\t\t\t\t\tLesotho\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Liberia\">\n\t\t\t\t\tLiberia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Libya\">\n\t\t\t\t\tLibya\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Liechtenstein\">\n\t\t\t\t\tLiechtenstein\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Lithuania\">\n\t\t\t\t\tLithuania\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Luxembourg\">\n\t\t\t\t\tLuxembourg\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Macau\">\n\t\t\t\t\tMacau\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Macedonia\">\n\t\t\t\t\tMacedonia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Madagascar\">\n\t\t\t\t\tMadagascar\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Malawi\">\n\t\t\t\t\tMalawi\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Malaysia\">\n\t\t\t\t\tMalaysia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Maldives\">\n\t\t\t\t\tMaldives\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Mali\">\n\t\t\t\t\tMali\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Malta\">\n\t\t\t\t\tMalta\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Marshall Islands\">\n\t\t\t\t\tMarshall Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Martinique\">\n\t\t\t\t\tMartinique\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Mauritania\">\n\t\t\t\t\tMauritania\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Mauritius\">\n\t\t\t\t\tMauritius\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Mayotte\">\n\t\t\t\t\tMayotte\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Mexico\">\n\t\t\t\t\tMexico\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Micronesia\">\n\t\t\t\t\tMicronesia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Moldova\">\n\t\t\t\t\tMoldova\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Monaco\">\n\t\t\t\t\tMonaco\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Mongolia\">\n\t\t\t\t\tMongolia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Montenegro\">\n\t\t\t\t\tMontenegro\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Montserrat\">\n\t\t\t\t\tMontserrat\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Morocco\">\n\t\t\t\t\tMorocco\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Mozambique\">\n\t\t\t\t\tMozambique\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Myanmar (Burma)\">\n\t\t\t\t\tMyanmar (Burma)\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Namibia\">\n\t\t\t\t\tNamibia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Nauru\">\n\t\t\t\t\tNauru\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Nepal\">\n\t\t\t\t\tNepal\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Netherlands\">\n\t\t\t\t\tNetherlands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Netherlands Antilles\">\n\t\t\t\t\tNetherlands Antilles\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"New Caledonia\">\n\t\t\t\t\tNew Caledonia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"New Zealand\">\n\t\t\t\t\tNew Zealand\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Nicaragua\">\n\t\t\t\t\tNicaragua\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Niger\">\n\t\t\t\t\tNiger\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Nigeria\">\n\t\t\t\t\tNigeria\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Niue\">\n\t\t\t\t\tNiue\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Northern Mariana Islands\">\n\t\t\t\t\tNorthern Mariana Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Norway\">\n\t\t\t\t\tNorway\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Oman\">\n\t\t\t\t\tOman\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Pakistan\">\n\t\t\t\t\tPakistan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Palau\">\n\t\t\t\t\tPalau\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Palestinian Territories (Gaza Strip and West Bank)\">\n\t\t\t\t\tPalestinian Territories (Gaza Strip and West Bank)\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Panama\">\n\t\t\t\t\tPanama\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Papua New Guinea\">\n\t\t\t\t\tPapua New Guinea\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Paraguay\">\n\t\t\t\t\tParaguay\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Peru\">\n\t\t\t\t\tPeru\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Philippines\">\n\t\t\t\t\tPhilippines\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Pitcairn Islands\">\n\t\t\t\t\tPitcairn Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Poland\">\n\t\t\t\t\tPoland\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Portugal\">\n\t\t\t\t\tPortugal\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Puerto Rico\">\n\t\t\t\t\tPuerto Rico\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Qatar\">\n\t\t\t\t\tQatar\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Reunion\">\n\t\t\t\t\tReunion\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Romania\">\n\t\t\t\t\tRomania\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Russia\">\n\t\t\t\t\tRussia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Rwanda\">\n\t\t\t\t\tRwanda\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Saint Helena\">\n\t\t\t\t\tSaint Helena\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Saint Kitts and Nevis\">\n\t\t\t\t\tSaint Kitts and Nevis\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Saint Lucia\">\n\t\t\t\t\tSaint Lucia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Saint Pierre and Miquelon\">\n\t\t\t\t\tSaint Pierre and Miquelon\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Saint Vincent and the Grenadines\">\n\t\t\t\t\tSaint Vincent and the Grenadines\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Samoa\">\n\t\t\t\t\tSamoa\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"San Marino\">\n\t\t\t\t\tSan Marino\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Sao Tome and Principe\">\n\t\t\t\t\tSao Tome and Principe\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Saudi Arabia\">\n\t\t\t\t\tSaudi Arabia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Senegal\">\n\t\t\t\t\tSenegal\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Serbia\">\n\t\t\t\t\tSerbia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Seychelles\">\n\t\t\t\t\tSeychelles\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Sierra Leone\">\n\t\t\t\t\tSierra Leone\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Singapore\">\n\t\t\t\t\tSingapore\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Slovakia\">\n\t\t\t\t\tSlovakia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Slovenia\">\n\t\t\t\t\tSlovenia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Solomon Islands\">\n\t\t\t\t\tSolomon Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Somalia\">\n\t\t\t\t\tSomalia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"South Africa\">\n\t\t\t\t\tSouth Africa\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"South Georgia and the South Sandwich Islands\">\n\t\t\t\t\tSouth Georgia and the South Sandwich Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Spain\">\n\t\t\t\t\tSpain\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Sri Lanka\">\n\t\t\t\t\tSri Lanka\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Sudan\">\n\t\t\t\t\tSudan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Suriname\">\n\t\t\t\t\tSuriname\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Svalbard\">\n\t\t\t\t\tSvalbard\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Swaziland\">\n\t\t\t\t\tSwaziland\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Sweden\">\n\t\t\t\t\tSweden\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Switzerland\">\n\t\t\t\t\tSwitzerland\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Syria\">\n\t\t\t\t\tSyria\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Taiwan\">\n\t\t\t\t\tTaiwan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Tajikistan\">\n\t\t\t\t\tTajikistan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Tanzania\">\n\t\t\t\t\tTanzania\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Thailand\">\n\t\t\t\t\tThailand\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Timor-Leste (East Timor)\">\n\t\t\t\t\tTimor-Leste (East Timor)\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Togo\">\n\t\t\t\t\tTogo\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Tokelau\">\n\t\t\t\t\tTokelau\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Tonga\">\n\t\t\t\t\tTonga\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Trinidad and Tobago\">\n\t\t\t\t\tTrinidad and Tobago\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Tristan da Cunha\">\n\t\t\t\t\tTristan da Cunha\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Tunisia\">\n\t\t\t\t\tTunisia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Turkey\">\n\t\t\t\t\tTurkey\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Turkmenistan\">\n\t\t\t\t\tTurkmenistan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Turks and Caicos Islands\">\n\t\t\t\t\tTurks and Caicos Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Tuvalu\">\n\t\t\t\t\tTuvalu\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"U.S. Virgin Islands\">\n\t\t\t\t\tU.S. Virgin Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uganda\">\n\t\t\t\t\tUganda\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Ukraine\">\n\t\t\t\t\tUkraine\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"United Arab Emirates\">\n\t\t\t\t\tUnited Arab Emirates\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"United Kingdom\">\n\t\t\t\t\tUnited Kingdom\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"United States\">\n\t\t\t\t\tUnited States\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"United States Minor Outlying Islands\">\n\t\t\t\t\tUnited States Minor Outlying Islands\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uruguay\">\n\t\t\t\t\tUruguay\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Uzbekistan\">\n\t\t\t\t\tUzbekistan\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Vanuatu\">\n\t\t\t\t\tVanuatu\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Vatican City\">\n\t\t\t\t\tVatican City\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Venezuela\">\n\t\t\t\t\tVenezuela\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Vietnam\">\n\t\t\t\t\tVietnam\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Wallis and Futuna\">\n\t\t\t\t\tWallis and Futuna\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Western Sahara\">\n\t\t\t\t\tWestern Sahara\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Yemen\">\n\t\t\t\t\tYemen\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Zambia\">\n\t\t\t\t\tZambia\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Zimbabwe\">\n\t\t\t\t\tZimbabwe\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_545_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\">\r\n\t<label for=\"field_709jk2\" id=\"field_709jk2_label\" class=\"frm_primary_label\">State\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t\t\t<select  name=\"item_meta[545]\" id=\"field_709jk2\"  data-sectionid=\"540\"  data-reqmsg=\"State cannot be blank.\" aria-required=\"true\" data-invmsg=\"State is invalid\" aria-invalid=\"false\"  >\n\t\t\t\t\t\t\t<option  value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\t\t \t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_546_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n\t<label for=\"field_ios3p\" id=\"field_ios3p_label\" class=\"frm_primary_label\">Which city do you live in?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_ios3p\" name=\"item_meta[546]\" value=\"\"  data-sectionid=\"540\"  data-invmsg=\"Which city do you live in? is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_547_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_half\">\r\n\t<label for=\"field_abf5g\" id=\"field_abf5g_label\" class=\"frm_primary_label\">What is your phone number?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_abf5g\" name=\"item_meta[547]\" value=\"\"  data-sectionid=\"540\"  data-invmsg=\"What is your phone number? is invalid\" class=\"frm-intl-tel-input\" aria-invalid=\"false\" pattern=\"\\+?\\d{1,4}[\\s\\-]?(?:\\(\\d{1,3}\\)[\\s\\-]?)?\\d{1,4}[\\s\\-]?\\d{1,4}[\\s\\-]?\\d{1,4}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_548_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_uf2302_label\" class=\"frm_primary_label\">How did you hear about balantia?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_uf2302_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_548-540-0\">\t\t\t<label  for=\"field_uf2302-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[548]\" id=\"field_uf2302-0\" value=\"Facebook\"\n\t\t data-sectionid=\"540\"  data-invmsg=\"How did you hear about balantia? is invalid\"   \/> <div class=\"frm_label_button_container\">Facebook<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_548-540-1\">\t\t\t<label  for=\"field_uf2302-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[548]\" id=\"field_uf2302-1\" value=\"Instagram\"\n\t\t data-sectionid=\"540\"  data-invmsg=\"How did you hear about balantia? is invalid\"   \/> <div class=\"frm_label_button_container\">Instagram<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_548-540-2\">\t\t\t<label  for=\"field_uf2302-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[548]\" id=\"field_uf2302-2\" value=\"TikTok\"\n\t\t data-sectionid=\"540\"  data-invmsg=\"How did you hear about balantia? is invalid\"   \/> <div class=\"frm_label_button_container\">TikTok<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_548-540-3\">\t\t\t<label  for=\"field_uf2302-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[548]\" id=\"field_uf2302-3\" value=\"Google\"\n\t\t data-sectionid=\"540\"  data-invmsg=\"How did you hear about balantia? is invalid\"   \/> <div class=\"frm_label_button_container\">Google<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_548-540-4\">\t\t\t<label  for=\"field_uf2302-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[548]\" id=\"field_uf2302-4\" value=\"\u03a6\u03af\u03bb\u03bf\u03c2\"\n\t\t data-sectionid=\"540\"  data-invmsg=\"How did you hear about balantia? is invalid\"   \/> <div class=\"frm_label_button_container\">Friend<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_548-540-5\">\t\t\t<label  for=\"field_uf2302-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[548]\" id=\"field_uf2302-5\" value=\"\u0399\u03b1\u03c4\u03c1\u03cc\u03c2\"\n\t\t data-sectionid=\"540\"  data-invmsg=\"How did you hear about balantia? is invalid\"   \/> <div class=\"frm_label_button_container\">Doctor<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_548-540-6\">\t\t\t<label  for=\"field_uf2302-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[548]\" id=\"field_uf2302-6\" value=\"\u0386\u03bb\u03bb\u03bf\"\n\t\t data-sectionid=\"540\"  data-invmsg=\"How did you hear about balantia? is invalid\"   \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_549_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_ezqpx2\" id=\"field_ezqpx2_label\" class=\"frm_primary_label\">Specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_ezqpx2\" name=\"item_meta[549]\" value=\"\"  data-sectionid=\"540\"  data-invmsg=\"Specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_550_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half frm_two_col frm_display_format_buttons frm_text_align_center\">\r\n\t<div  id=\"field_j1fli_label\" class=\"frm_primary_label\">Are you currently using the balantia app?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_j1fli_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_550-540-0\">\t\t\t<label  for=\"field_j1fli-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[550]\" id=\"field_j1fli-0\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"540\"  data-reqmsg=\"Are you currently using the balantia app? cannot be blank.\" data-invmsg=\"Are you currently using the balantia app? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_550-540-1\">\t\t\t<label  for=\"field_j1fli-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[550]\" id=\"field_j1fli-1\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"540\"  data-reqmsg=\"Are you currently using the balantia app? cannot be blank.\" data-invmsg=\"Are you currently using the balantia app? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_552_container\" class=\"frm_form_field frm_section_heading form-field  frm12\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Profile<\/h3>\r\n\r\n\r\n<div id=\"frm_field_553_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first f frm_half frm_two_col frm_display_format_buttons frm_text_align_center\">\r\n\t<div id=\"field_xpdr6_label\" class=\"frm_primary_label\">Preferred units\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_553-552-1\">\t\t\t<label  for=\"field_xpdr6-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[553]\" id=\"field_xpdr6-1\" value=\"kg, cm\"\n\t\t data-sectionid=\"552\"  data-frmval=\"Metric (kg, cm)\" data-reqmsg=\"Preferred units cannot be blank.\" data-invmsg=\"Preferred units is invalid\"   \/> <div class=\"frm_label_button_container\">Metric (kg, cm)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_553-552-0\">\t\t\t<label  for=\"field_xpdr6-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[553]\" id=\"field_xpdr6-0\" value=\"lb, ft\"\n\t\t data-sectionid=\"552\"  data-frmval=\"Metric (kg, cm)\" data-reqmsg=\"Preferred units cannot be blank.\" data-invmsg=\"Preferred units is invalid\"   \/> <div class=\"frm_label_button_container\">Imperial (lb, ft)<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_554_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_iply\" id=\"field_iply_label\" class=\"frm_primary_label\">What is your height?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<div class=\"frm_input_group frm_with_box frm_with_post\">\t\t<select name=\"item_meta[554]\" id=\"field_iply\"  data-sectionid=\"552\"  data-frmval=\"6ft\" data-reqmsg=\"What is your height? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your height? is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"4ft\">4ft<\/option><option  value=\"4ft 1in\">4ft 1in<\/option><option  value=\"4ft 2in\">4ft 2in<\/option><option  value=\"4ft 3in\">4ft 3in<\/option><option  value=\"4ft 4in\">4ft 4in<\/option><option  value=\"4ft 5in\">4ft 5in<\/option><option  value=\"4ft 6in\">4ft 6in<\/option><option  value=\"4ft 7in\">4ft 7in<\/option><option  value=\"4ft 8in\">4ft 8in<\/option><option  value=\"4ft 9in\">4ft 9in<\/option><option  value=\"4ft 10in\">4ft 10in<\/option><option  value=\"4ft 11in\">4ft 11in<\/option><option  value=\"5ft\">5ft<\/option><option  value=\"5ft 1in\">5ft 1in<\/option><option  value=\"5ft 2in\">5ft 2in<\/option><option  value=\"5ft 3in\">5ft 3in<\/option><option  value=\"5ft 4in\">5ft 4in<\/option><option  value=\"5ft 5in\">5ft 5in<\/option><option  value=\"5ft 6in\">5ft 6in<\/option><option  value=\"5ft 7in\">5ft 7in<\/option><option  value=\"5ft 8in\">5ft 8in<\/option><option  value=\"5ft 9in\">5ft 9in<\/option><option  value=\"5ft 10in\">5ft 10in<\/option><option  value=\"5ft 11in\">5ft 11in<\/option><option  value=\"6ft\" selected='selected'>6ft<\/option><option  value=\"6ft 1in\">6ft 1in<\/option><option  value=\"6ft 2in\">6ft 2in<\/option><option  value=\"6ft 3in\">6ft 3in<\/option><option  value=\"6ft 4in\">6ft 4in<\/option><option  value=\"6ft 5in\">6ft 5in<\/option><option  value=\"6ft 6in\">6ft 6in<\/option><option  value=\"6ft 7in\">6ft 7in<\/option><option  value=\"6ft 8in\">6ft 8in<\/option><option  value=\"6ft 9in\">6ft 9in<\/option><option  value=\"6ft 10in\">6ft 10in<\/option><option  value=\"6ft 11in\">6ft 11in<\/option><option  value=\"7ft\">7ft<\/option><option  value=\"7ft 1in\">7ft 1in<\/option><option  value=\"7ft 2in\">7ft 2in<\/option><option  value=\"7ft 3in\">7ft 3in<\/option><option  value=\"7ft 4in\">7ft 4in<\/option><option  value=\"7ft 5in\">7ft 5in<\/option><option  value=\"7ft 6in\">7ft 6in<\/option><option  value=\"7ft 7in\">7ft 7in<\/option><option  value=\"7ft 8in\">7ft 8in<\/option><option  value=\"7ft 9in\">7ft 9in<\/option><option  value=\"7ft 10in\">7ft 10in<\/option><option  value=\"7ft 11in\">7ft 11in<\/option>\t<\/select>\n\t<span class=\"frm_inline_box\">ft in<\/span><\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_555_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n\t<label for=\"field_5nths2\" id=\"field_5nths2_label\" class=\"frm_primary_label\">What is your current weight?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"number\" id=\"field_5nths2\" name=\"item_meta[555]\" value=\"\" data-sectionid=\"552\"  data-reqmsg=\"What is your current weight? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your current weight? is invalid\" aria-invalid=\"false\"   min=\"60\" max=\"1000\" step=\"any\" \/><span class=\"frm_inline_box\">lbs<\/span><\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_556_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_n8x6l2\" id=\"field_n8x6l2_label\" class=\"frm_primary_label\">What is your height?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<div class=\"frm_input_group frm_with_box frm_with_post\">\t\t<select name=\"item_meta[556]\" id=\"field_n8x6l2\"  data-sectionid=\"552\"  data-frmval=\"160\" data-reqmsg=\"What is your height? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your height? is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"40\">40<\/option><option  value=\"41\">41<\/option><option  value=\"42\">42<\/option><option  value=\"43\">43<\/option><option  value=\"44\">44<\/option><option  value=\"45\">45<\/option><option  value=\"46\">46<\/option><option  value=\"47\">47<\/option><option  value=\"48\">48<\/option><option  value=\"49\">49<\/option><option  value=\"50\">50<\/option><option  value=\"51\">51<\/option><option  value=\"52\">52<\/option><option  value=\"53\">53<\/option><option  value=\"54\">54<\/option><option  value=\"55\">55<\/option><option  value=\"56\">56<\/option><option  value=\"57\">57<\/option><option  value=\"58\">58<\/option><option  value=\"59\">59<\/option><option  value=\"60\">60<\/option><option  value=\"61\">61<\/option><option  value=\"62\">62<\/option><option  value=\"63\">63<\/option><option  value=\"64\">64<\/option><option  value=\"65\">65<\/option><option  value=\"66\">66<\/option><option  value=\"67\">67<\/option><option  value=\"68\">68<\/option><option  value=\"69\">69<\/option><option  value=\"70\">70<\/option><option  value=\"71\">71<\/option><option  value=\"72\">72<\/option><option  value=\"73\">73<\/option><option  value=\"74\">74<\/option><option  value=\"75\">75<\/option><option  value=\"76\">76<\/option><option  value=\"77\">77<\/option><option  value=\"78\">78<\/option><option  value=\"79\">79<\/option><option  value=\"80\">80<\/option><option  value=\"81\">81<\/option><option  value=\"82\">82<\/option><option  value=\"83\">83<\/option><option  value=\"84\">84<\/option><option  value=\"85\">85<\/option><option  value=\"86\">86<\/option><option  value=\"87\">87<\/option><option  value=\"88\">88<\/option><option  value=\"89\">89<\/option><option  value=\"90\">90<\/option><option  value=\"91\">91<\/option><option  value=\"92\">92<\/option><option  value=\"93\">93<\/option><option  value=\"94\">94<\/option><option  value=\"95\">95<\/option><option  value=\"96\">96<\/option><option  value=\"97\">97<\/option><option  value=\"98\">98<\/option><option  value=\"99\">99<\/option><option  value=\"100\">100<\/option><option  value=\"101\">101<\/option><option  value=\"102\">102<\/option><option  value=\"103\">103<\/option><option  value=\"104\">104<\/option><option  value=\"105\">105<\/option><option  value=\"106\">106<\/option><option  value=\"107\">107<\/option><option  value=\"108\">108<\/option><option  value=\"109\">109<\/option><option  value=\"110\">110<\/option><option  value=\"111\">111<\/option><option  value=\"112\">112<\/option><option  value=\"113\">113<\/option><option  value=\"114\">114<\/option><option  value=\"115\">115<\/option><option  value=\"116\">116<\/option><option  value=\"117\">117<\/option><option  value=\"118\">118<\/option><option  value=\"119\">119<\/option><option  value=\"120\">120<\/option><option  value=\"121\">121<\/option><option  value=\"122\">122<\/option><option  value=\"123\">123<\/option><option  value=\"124\">124<\/option><option  value=\"125\">125<\/option><option  value=\"126\">126<\/option><option  value=\"127\">127<\/option><option  value=\"128\">128<\/option><option  value=\"129\">129<\/option><option  value=\"130\">130<\/option><option  value=\"131\">131<\/option><option  value=\"132\">132<\/option><option  value=\"133\">133<\/option><option  value=\"134\">134<\/option><option  value=\"135\">135<\/option><option  value=\"136\">136<\/option><option  value=\"137\">137<\/option><option  value=\"138\">138<\/option><option  value=\"139\">139<\/option><option  value=\"140\">140<\/option><option  value=\"141\">141<\/option><option  value=\"142\">142<\/option><option  value=\"143\">143<\/option><option  value=\"144\">144<\/option><option  value=\"145\">145<\/option><option  value=\"146\">146<\/option><option  value=\"147\">147<\/option><option  value=\"148\">148<\/option><option  value=\"149\">149<\/option><option  value=\"150\">150<\/option><option  value=\"151\">151<\/option><option  value=\"152\">152<\/option><option  value=\"153\">153<\/option><option  value=\"154\">154<\/option><option  value=\"155\">155<\/option><option  value=\"156\">156<\/option><option  value=\"157\">157<\/option><option  value=\"158\">158<\/option><option  value=\"159\">159<\/option><option  value=\"160\" selected='selected'>160<\/option><option  value=\"161\">161<\/option><option  value=\"162\">162<\/option><option  value=\"163\">163<\/option><option  value=\"164\">164<\/option><option  value=\"165\">165<\/option><option  value=\"166\">166<\/option><option  value=\"167\">167<\/option><option  value=\"168\">168<\/option><option  value=\"169\">169<\/option><option  value=\"170\">170<\/option><option  value=\"171\">171<\/option><option  value=\"172\">172<\/option><option  value=\"173\">173<\/option><option  value=\"174\">174<\/option><option  value=\"175\">175<\/option><option  value=\"176\">176<\/option><option  value=\"177\">177<\/option><option  value=\"178\">178<\/option><option  value=\"179\">179<\/option><option  value=\"180\">180<\/option><option  value=\"181\">181<\/option><option  value=\"182\">182<\/option><option  value=\"183\">183<\/option><option  value=\"184\">184<\/option><option  value=\"185\">185<\/option><option  value=\"186\">186<\/option><option  value=\"187\">187<\/option><option  value=\"188\">188<\/option><option  value=\"189\">189<\/option><option  value=\"190\">190<\/option><option  value=\"191\">191<\/option><option  value=\"192\">192<\/option><option  value=\"193\">193<\/option><option  value=\"194\">194<\/option><option  value=\"195\">195<\/option><option  value=\"196\">196<\/option><option  value=\"197\">197<\/option><option  value=\"198\">198<\/option><option  value=\"199\">199<\/option><option  value=\"200\">200<\/option><option  value=\"201\">201<\/option><option  value=\"202\">202<\/option><option  value=\"203\">203<\/option><option  value=\"204\">204<\/option><option  value=\"205\">205<\/option><option  value=\"206\">206<\/option><option  value=\"207\">207<\/option><option  value=\"208\">208<\/option><option  value=\"209\">209<\/option><option  value=\"210\">210<\/option><option  value=\"211\">211<\/option><option  value=\"212\">212<\/option><option  value=\"213\">213<\/option><option  value=\"214\">214<\/option><option  value=\"215\">215<\/option><option  value=\"216\">216<\/option><option  value=\"217\">217<\/option><option  value=\"218\">218<\/option><option  value=\"219\">219<\/option><option  value=\"220\">220<\/option><option  value=\"221\">221<\/option><option  value=\"222\">222<\/option><option  value=\"223\">223<\/option><option  value=\"224\">224<\/option><option  value=\"225\">225<\/option><option  value=\"226\">226<\/option><option  value=\"227\">227<\/option><option  value=\"228\">228<\/option><option  value=\"229\">229<\/option><option  value=\"230\">230<\/option><option  value=\"231\">231<\/option><option  value=\"232\">232<\/option><option  value=\"233\">233<\/option><option  value=\"234\">234<\/option><option  value=\"235\">235<\/option><option  value=\"236\">236<\/option><option  value=\"237\">237<\/option><option  value=\"238\">238<\/option><option  value=\"239\">239<\/option><option  value=\"240\">240<\/option><option  value=\"241\">241<\/option><option  value=\"242\">242<\/option><option  value=\"243\">243<\/option><option  value=\"244\">244<\/option><option  value=\"245\">245<\/option><option  value=\"246\">246<\/option><option  value=\"247\">247<\/option><option  value=\"248\">248<\/option><option  value=\"249\">249<\/option><option  value=\"250\">250<\/option>\t<\/select>\n\t<span class=\"frm_inline_box\">cm<\/span><\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_557_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n\t<label for=\"field_721tg2\" id=\"field_721tg2_label\" class=\"frm_primary_label\">What is your current weight?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"number\" id=\"field_721tg2\" name=\"item_meta[557]\" value=\"\" data-sectionid=\"552\"  data-reqmsg=\"What is your current weight? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your current weight? is invalid\" aria-invalid=\"false\"   min=\"30\" max=\"500\" step=\"any\" \/><span class=\"frm_inline_box\">kg<\/span><\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_558_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_two_thirds frm_two_col frm_display_format_buttons frm_text_align_center\">\r\n\t<div  id=\"field_cj8sn_label\" class=\"frm_primary_label\">What is your sex?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_cj8sn_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_558-552-0\">\t\t\t<label  for=\"field_cj8sn-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[558]\" id=\"field_cj8sn-0\" value=\"\u2642\ufe0f \u0386\u03bd\u03b4\u03c1\u03b1\u03c2\"\n\t\t data-sectionid=\"552\"  data-reqmsg=\"What is your sex? cannot be blank.\" data-invmsg=\"What is your sex? is invalid\"   \/> <div class=\"frm_label_button_container\">\u2642\ufe0f Male<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_558-552-1\">\t\t\t<label  for=\"field_cj8sn-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[558]\" id=\"field_cj8sn-1\" value=\"\u2640\ufe0f \u0393\u03c5\u03bd\u03b1\u03af\u03ba\u03b1\"\n\t\t data-sectionid=\"552\"  data-reqmsg=\"What is your sex? cannot be blank.\" data-invmsg=\"What is your sex? is invalid\"   \/> <div class=\"frm_label_button_container\">\u2640\ufe0f Female<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_559_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_g0ft9\" id=\"field_g0ft9_label\" class=\"frm_primary_label\">What is your date of birth?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_g0ft9\" name=\"item_meta[559]\" value=\"\"  data-sectionid=\"552\"  maxlength=\"10\" data-reqmsg=\"What is your date of birth? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your date of birth? is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_560_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n\t<label for=\"field_v4hpw\" id=\"field_v4hpw_label\" class=\"frm_primary_label\">Do you know your body fat percentage?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\t\t<select name=\"item_meta[560]\" id=\"field_v4hpw\"  data-sectionid=\"552\"  data-invmsg=\"Do you know your body fat percentage? is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"\u0394\u03b5\u03bd \u03b3\u03bd\u03c9\u03c1\u03af\u03b6\u03c9\">I don&#039;t know<\/option><option  value=\"&lt;18%\">&lt;18%<\/option><option  value=\"19\u201325%\">19\u201325%<\/option><option  value=\"26\u201330%\">26\u201330%<\/option><option  value=\"31\u201339%\">31\u201339%<\/option><option  value=\"\u226540%\">\u226540%<\/option>\t<\/select>\n\t\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_562_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Goals<\/h3>\r\n\r\n\r\n<div id=\"frm_field_563_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_su0vv_label\" class=\"frm_primary_label\">What are your nutrition goals?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-0\">\t\t\t<label  for=\"field_su0vv-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-0\" value=\"\u03a5\u03b3\u03b9\u03b5\u03b9\u03bd\u03ae \u03b4\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   aria-required=\"true\"  \/> <div class=\"frm_label_button_container\">Healthy eating<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-1\">\t\t\t<label  for=\"field_su0vv-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-1\" value=\"\u0394\u03b9\u03b1\u03c7\u03b5\u03af\u03c1\u03b9\u03c3\u03b7 \u03b2\u03ac\u03c1\u03bf\u03c5\u03c2\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Weight management<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-2\">\t\t\t<label  for=\"field_su0vv-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-2\" value=\"\u0392\u03b5\u03bb\u03c4\u03af\u03c9\u03c3\u03b7 \u03b5\u03c1\u03b3\u03b1\u03c3\u03c4\u03b7\u03c1\u03b9\u03b1\u03ba\u03ce\u03bd \u03b4\u03b5\u03b9\u03ba\u03c4\u03ce\u03bd (\u03c0.\u03c7. \u03c7\u03bf\u03bb\u03b7\u03c3\u03c4\u03b5\u03c1\u03cc\u03bb\u03b7)\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Improve laboratory markers (eg cholesterol)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-3\">\t\t\t<label  for=\"field_su0vv-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-3\" value=\"\u0399\u03b1\u03c4\u03c1\u03b9\u03ba\u03ae \u03b4\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03b9\u03ba\u03ae \u03b8\u03b5\u03c1\u03b1\u03c0\u03b5\u03af\u03b1\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Medical nutrition therapy<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-4\">\t\t\t<label  for=\"field_su0vv-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-4\" value=\"\u03a5\u03c0\u03bf\u03c3\u03c4\u03ae\u03c1\u03b9\u03be\u03b7 \u03ba\u03b1\u03c4\u03ac \u03c4\u03b7 \u03b4\u03b9\u03ac\u03c1\u03ba\u03b5\u03b9\u03b1 \u03c4\u03b7\u03c2 \u03b8\u03b5\u03c1\u03b1\u03c0\u03b5\u03af\u03b1\u03c2 \u03bc\u03b5 GLP-1\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Support during GLP-1 therapy<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-5\">\t\t\t<label  for=\"field_su0vv-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-5\" value=\"\u0391\u03b8\u03bb\u03b7\u03c4\u03b9\u03ba\u03ae \u03b4\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Sports nutrition<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-6\">\t\t\t<label  for=\"field_su0vv-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-6\" value=\"\u0394\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae \u03b5\u03b3\u03ba\u03c5\u03bc\u03bf\u03c3\u03cd\u03bd\u03b7\u03c2\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Pregnancy nutrition<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-7\">\t\t\t<label  for=\"field_su0vv-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-7\" value=\"\u0394\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae \u03b8\u03b7\u03bb\u03b1\u03c3\u03bc\u03bf\u03cd\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Breastfeeding nutrition<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-8\">\t\t\t<label  for=\"field_su0vv-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-8\" value=\"\u0394\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae \u03c3\u03c4\u03b7\u03bd \u03b5\u03bc\u03bc\u03b7\u03bd\u03cc\u03c0\u03b1\u03c5\u03c3\u03b7\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Menopause nutrition<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-9\">\t\t\t<label  for=\"field_su0vv-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-9\" value=\"\u0394\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae \u03c0\u03b1\u03b9\u03b4\u03b9\u03ce\u03bd \u03ae \u03b5\u03c6\u03ae\u03b2\u03c9\u03bd\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Child or adolescent nutrition<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-10\">\t\t\t<label  for=\"field_su0vv-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-10\" value=\"\u03a5\u03c0\u03bf\u03c3\u03c4\u03ae\u03c1\u03b9\u03be\u03b7 \u03b3\u03bf\u03bd\u03b9\u03bc\u03cc\u03c4\u03b7\u03c4\u03b1\u03c2\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Fertility support<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-11\">\t\t\t<label  for=\"field_su0vv-11\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-11\" value=\"\u0394\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03b9\u03ba\u03ad\u03c2 \u03b4\u03b9\u03b1\u03c4\u03b1\u03c1\u03b1\u03c7\u03ad\u03c2 (\u03b1\u03bd\u03bf\u03c1\u03b5\u03be\u03af\u03b1 \/ \u03b2\u03bf\u03c5\u03bb\u03b9\u03bc\u03af\u03b1)\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Eating disorders (anorexia \/ bulimia)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-12\">\t\t\t<label  for=\"field_su0vv-12\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-12\" value=\"\u0395\u03bd\u03c4\u03b5\u03c1\u03b9\u03ba\u03ae \u03ae \u03c0\u03b1\u03c1\u03b5\u03bd\u03c4\u03b5\u03c1\u03b9\u03ba\u03ae \u03b4\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Enteral or parenteral nutrition<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_563-562-13\">\t\t\t<label  for=\"field_su0vv-13\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[563][]\" id=\"field_su0vv-13\" value=\"\u0386\u03bb\u03bb\u03bf\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_564_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_three_col frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_krefx_label\" class=\"frm_primary_label\">What are your nutrition goals?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-0\">\t\t\t<label  for=\"field_krefx-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-0\" value=\"\u03a5\u03b3\u03b9\u03b5\u03b9\u03bd\u03ae \u03b4\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   aria-required=\"true\"  \/> <div class=\"frm_label_button_container\">Healthy eating<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-1\">\t\t\t<label  for=\"field_krefx-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-1\" value=\"\u0394\u03b9\u03b1\u03c7\u03b5\u03af\u03c1\u03b9\u03c3\u03b7 \u03b2\u03ac\u03c1\u03bf\u03c5\u03c2\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Weight management<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-2\">\t\t\t<label  for=\"field_krefx-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-2\" value=\"\u0392\u03b5\u03bb\u03c4\u03af\u03c9\u03c3\u03b7 \u03b5\u03c1\u03b3\u03b1\u03c3\u03c4\u03b7\u03c1\u03b9\u03b1\u03ba\u03ce\u03bd \u03b4\u03b5\u03b9\u03ba\u03c4\u03ce\u03bd (\u03c0.\u03c7. \u03c7\u03bf\u03bb\u03b7\u03c3\u03c4\u03b5\u03c1\u03cc\u03bb\u03b7)\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Improve laboratory markers (eg cholesterol)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-3\">\t\t\t<label  for=\"field_krefx-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-3\" value=\"\u0399\u03b1\u03c4\u03c1\u03b9\u03ba\u03ae \u03b4\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03b9\u03ba\u03ae \u03b8\u03b5\u03c1\u03b1\u03c0\u03b5\u03af\u03b1\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Medical nutrition therapy<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-4\">\t\t\t<label  for=\"field_krefx-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-4\" value=\"\u03a5\u03c0\u03bf\u03c3\u03c4\u03ae\u03c1\u03b9\u03be\u03b7 \u03ba\u03b1\u03c4\u03ac \u03c4\u03b7 \u03b4\u03b9\u03ac\u03c1\u03ba\u03b5\u03b9\u03b1 \u03c4\u03b7\u03c2 \u03b8\u03b5\u03c1\u03b1\u03c0\u03b5\u03af\u03b1\u03c2 \u03bc\u03b5 GLP-1\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Support during GLP-1 therapy<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-5\">\t\t\t<label  for=\"field_krefx-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-5\" value=\"\u0391\u03b8\u03bb\u03b7\u03c4\u03b9\u03ba\u03ae \u03b4\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Sports nutrition<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-9\">\t\t\t<label  for=\"field_krefx-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-9\" value=\"\u0394\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae \u03c0\u03b1\u03b9\u03b4\u03b9\u03ce\u03bd \u03ae \u03b5\u03c6\u03ae\u03b2\u03c9\u03bd\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Child or adolescent nutrition<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-10\">\t\t\t<label  for=\"field_krefx-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-10\" value=\"\u03a5\u03c0\u03bf\u03c3\u03c4\u03ae\u03c1\u03b9\u03be\u03b7 \u03b3\u03bf\u03bd\u03b9\u03bc\u03cc\u03c4\u03b7\u03c4\u03b1\u03c2\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Fertility support<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-11\">\t\t\t<label  for=\"field_krefx-11\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-11\" value=\"\u0394\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03b9\u03ba\u03ad\u03c2 \u03b4\u03b9\u03b1\u03c4\u03b1\u03c1\u03b1\u03c7\u03ad\u03c2 (\u03b1\u03bd\u03bf\u03c1\u03b5\u03be\u03af\u03b1 \/ \u03b2\u03bf\u03c5\u03bb\u03b9\u03bc\u03af\u03b1)\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Eating disorders (anorexia \/ bulimia)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-12\">\t\t\t<label  for=\"field_krefx-12\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-12\" value=\"\u0395\u03bd\u03c4\u03b5\u03c1\u03b9\u03ba\u03ae \u03ae \u03c0\u03b1\u03c1\u03b5\u03bd\u03c4\u03b5\u03c1\u03b9\u03ba\u03ae \u03b4\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03ae\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Enteral or parenteral nutrition<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_564-562-13\">\t\t\t<label  for=\"field_krefx-13\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[564][]\" id=\"field_krefx-13\" value=\"\u0386\u03bb\u03bb\u03bf\"  data-sectionid=\"562\"  data-reqmsg=\"What are your nutrition goals? cannot be blank.\" data-invmsg=\"What are your nutrition goals? is invalid\"   \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_565_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_ur0q32\" id=\"field_ur0q32_label\" class=\"frm_primary_label\">Specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_ur0q32\" name=\"item_meta[565]\" value=\"\"  data-sectionid=\"562\"  data-invmsg=\"Specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_566_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_wqw0i2\" id=\"field_wqw0i2_label\" class=\"frm_primary_label\">Specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_wqw0i2\" name=\"item_meta[566]\" value=\"\"  data-sectionid=\"562\"  data-invmsg=\"Specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_567_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_3zpzi2_label\" class=\"frm_primary_label\">Is breastfeeding exclusive?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_3zpzi2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_567-562-4\">\t\t\t<label  for=\"field_3zpzi2-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[567]\" id=\"field_3zpzi2-4\" value=\"\ud83d\udc4e \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"Is breastfeeding exclusive? cannot be blank.\" data-invmsg=\"Is breastfeeding exclusive? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_567-562-5\">\t\t\t<label  for=\"field_3zpzi2-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[567]\" id=\"field_3zpzi2-5\" value=\"\ud83d\udc4d \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"Is breastfeeding exclusive? cannot be blank.\" data-invmsg=\"Is breastfeeding exclusive? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4eNo<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_568_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n\t<label for=\"field_ltcuu2\" id=\"field_ltcuu2_label\" class=\"frm_primary_label\">Which week of pregnancy are you currently in?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t\t\t<select name=\"item_meta[568]\" id=\"field_ltcuu2\"  data-sectionid=\"562\"  data-reqmsg=\"Which week of pregnancy are you currently in? cannot be blank.\" aria-required=\"true\" data-invmsg=\"Which week of pregnancy are you currently in? is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"1\">1<\/option><option  value=\"2\">2<\/option><option  value=\"3\">3<\/option><option  value=\"4\">4<\/option><option  value=\"5\">5<\/option><option  value=\"6\">6<\/option><option  value=\"7\">7<\/option><option  value=\"8\">8<\/option><option  value=\"9\">9<\/option><option  value=\"10\">10<\/option><option  value=\"11\">11<\/option><option  value=\"12\">12<\/option><option  value=\"13\">13<\/option><option  value=\"14\">14<\/option><option  value=\"15\">15<\/option><option  value=\"16\">16<\/option><option  value=\"17\">17<\/option><option  value=\"18\">18<\/option><option  value=\"19\">19<\/option><option  value=\"20\">20<\/option><option  value=\"21\">21<\/option><option  value=\"22\">22<\/option><option  value=\"23\">23<\/option><option  value=\"24\">24<\/option><option  value=\"25\">25<\/option><option  value=\"26\">26<\/option><option  value=\"27\">27<\/option><option  value=\"28\">28<\/option><option  value=\"29\">29<\/option><option  value=\"30\">30<\/option><option  value=\"31\">31<\/option><option  value=\"32\">32<\/option><option  value=\"33\">33<\/option><option  value=\"34\">34<\/option><option  value=\"35\">35<\/option><option  value=\"36\">36<\/option><option  value=\"37\">37<\/option><option  value=\"38\">38<\/option><option  value=\"39\">39<\/option><option  value=\"40\">40<\/option><option  value=\"41\">41<\/option><option  value=\"42\">42<\/option>\t<\/select>\n\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_569_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_two_thirds frm_three_col frm_display_format_buttons frm_text_align_center\">\r\n\t<div  id=\"field_xmc1v_label\" class=\"frm_primary_label\">What is your weight goal?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_xmc1v_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_569-562-0\">\t\t\t<label  for=\"field_xmc1v-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[569]\" id=\"field_xmc1v-0\" value=\"\u2198\ufe0f \u0391\u03c0\u03ce\u03bb\u03b5\u03b9\u03b1 \u03b2\u03ac\u03c1\u03bf\u03c5\u03c2\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"What is your weight goal? cannot be blank.\" data-invmsg=\"What is your weight goal? is invalid\"   \/> <div class=\"frm_label_button_container\">\u2198\ufe0f Weight loss<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_569-562-1\">\t\t\t<label  for=\"field_xmc1v-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[569]\" id=\"field_xmc1v-1\" value=\"\u27a1\ufe0f \u0394\u03b9\u03b1\u03c4\u03ae\u03c1\u03b7\u03c3\u03b7 \u03b2\u03ac\u03c1\u03bf\u03c5\u03c2\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"What is your weight goal? cannot be blank.\" data-invmsg=\"What is your weight goal? is invalid\"   \/> <div class=\"frm_label_button_container\">\u27a1\ufe0f Weight maintenance<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_569-562-2\">\t\t\t<label  for=\"field_xmc1v-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[569]\" id=\"field_xmc1v-2\" value=\"\u2197\ufe0f \u0391\u03cd\u03be\u03b7\u03c3\u03b7 \u03b2\u03ac\u03c1\u03bf\u03c5\u03c2\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"What is your weight goal? cannot be blank.\" data-invmsg=\"What is your weight goal? is invalid\"   \/> <div class=\"frm_label_button_container\">\u2197\ufe0f Weight gain<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_570_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_19hia\" id=\"field_19hia_label\" class=\"frm_primary_label\">What is your desired weight?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_19hia\" name=\"item_meta[570]\" value=\"\" data-sectionid=\"562\"  autocomplete=\"off\"  placeholder=\"ex 77.2\" data-reqmsg=\"What is your desired weight? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your desired weight? is invalid\" aria-invalid=\"false\"   min=\"40\" max=\"500\" step=\"0.5\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_571_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_j1d5o2\" id=\"field_j1d5o2_label\" class=\"frm_primary_label\">What is your desired weight?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_j1d5o2\" name=\"item_meta[571]\" value=\"\" data-sectionid=\"562\"  autocomplete=\"off\"  placeholder=\"ex 77.2\" data-reqmsg=\"What is your desired weight? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your desired weight? is invalid\" aria-invalid=\"false\"   min=\"40\" max=\"500\" step=\"0.5\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_572_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_l86212\" id=\"field_l86212_label\" class=\"frm_primary_label\">What is your desired weight?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_l86212\" name=\"item_meta[572]\" value=\"\" data-sectionid=\"562\"  autocomplete=\"off\"  placeholder=\"ex 170.2\" data-reqmsg=\"What is your desired weight? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your desired weight? is invalid\" aria-invalid=\"false\"   min=\"60\" max=\"1000\" step=\"0.5\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_573_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_cxqyr2\" id=\"field_cxqyr2_label\" class=\"frm_primary_label\">What is your desired weight?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_cxqyr2\" name=\"item_meta[573]\" value=\"\" data-sectionid=\"562\"  autocomplete=\"off\"  placeholder=\"ex 170.2\" data-reqmsg=\"What is your desired weight? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What is your desired weight? is invalid\" aria-invalid=\"false\"   min=\"60\" max=\"1000\" step=\"0.5\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_574_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first frm_three_col frm_display_format_buttons frm_text_align_center\">\r\n\t<div  id=\"field_nqhfx_label\" class=\"frm_primary_label\">How quickly would you like your weight to change?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_nqhfx_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_574-562-0\">\t\t\t<label  for=\"field_nqhfx-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[574]\" id=\"field_nqhfx-0\" value=\"\u0391\u03c1\u03b3\u03ac (~0,3 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Slow (~0.3 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_574-562-1\">\t\t\t<label  for=\"field_nqhfx-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[574]\" id=\"field_nqhfx-1\" value=\"\u039c\u03ad\u03c4\u03c1\u03b9\u03b1 (~0,5 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Moderate (~0.5 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_574-562-2\">\t\t\t<label  for=\"field_nqhfx-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[574]\" id=\"field_nqhfx-2\" value=\"\u03a4\u03c5\u03c0\u03b9\u03ba\u03ac (~0,75 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Standard (~0.75 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_574-562-3\">\t\t\t<label  for=\"field_nqhfx-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[574]\" id=\"field_nqhfx-3\" value=\"\u0393\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 (~1 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Fast (~1 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_574-562-4\">\t\t\t<label  for=\"field_nqhfx-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[574]\" id=\"field_nqhfx-4\" value=\"\u03a0\u03bf\u03bb\u03cd \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1(~1,3 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Very fast (~1.3 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_574-562-5\">\t\t\t<label  for=\"field_nqhfx-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[574]\" id=\"field_nqhfx-5\" value=\"\u0394\u03b5\u03bd \u03b5\u03af\u03bc\u03b1\u03b9 \u03c3\u03af\u03b3\u03bf\u03c5\u03c1\u03bf\u03c2\/\u03b7\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Not sure<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_575_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first frm_three_col frm_display_format_buttons frm_text_align_center\">\r\n\t<div  id=\"field_o0uvm2_label\" class=\"frm_primary_label\">\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2;\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_o0uvm2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_575-562-0\">\t\t\t<label  for=\"field_o0uvm2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[575]\" id=\"field_o0uvm2-0\" value=\"\u0391\u03c1\u03b3\u03ac (~0,3 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; cannot be blank.\" data-invmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; is invalid\"   \/> <div class=\"frm_label_button_container\">Slow (~0.3 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_575-562-1\">\t\t\t<label  for=\"field_o0uvm2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[575]\" id=\"field_o0uvm2-1\" value=\"\u039c\u03ad\u03c4\u03c1\u03b9\u03b1 (~0,5 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; cannot be blank.\" data-invmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; is invalid\"   \/> <div class=\"frm_label_button_container\">Moderate (~0.5 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_575-562-2\">\t\t\t<label  for=\"field_o0uvm2-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[575]\" id=\"field_o0uvm2-2\" value=\"\u03a4\u03c5\u03c0\u03b9\u03ba\u03ac (~0,75 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; cannot be blank.\" data-invmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; is invalid\"   \/> <div class=\"frm_label_button_container\">Standard (~0.75 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_575-562-3\">\t\t\t<label  for=\"field_o0uvm2-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[575]\" id=\"field_o0uvm2-3\" value=\"\u0393\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 (~1 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; cannot be blank.\" data-invmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; is invalid\"   \/> <div class=\"frm_label_button_container\">Fast (~1 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_575-562-4\">\t\t\t<label  for=\"field_o0uvm2-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[575]\" id=\"field_o0uvm2-4\" value=\"\u03a0\u03bf\u03bb\u03cd \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1(~1,3 kg\/\u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; cannot be blank.\" data-invmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; is invalid\"   \/> <div class=\"frm_label_button_container\">Very fast (~1.3 kg\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_575-562-5\">\t\t\t<label  for=\"field_o0uvm2-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[575]\" id=\"field_o0uvm2-5\" value=\"\u0394\u03b5\u03bd \u03b5\u03af\u03bc\u03b1\u03b9 \u03c3\u03af\u03b3\u03bf\u03c5\u03c1\u03bf\u03c2\/\u03b7\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; cannot be blank.\" data-invmsg=\"\u03a0\u03cc\u03c3\u03bf \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 \u03b8\u03b1 \u03b8\u03ad\u03bb\u03b1\u03c4\u03b5 \u03bd\u03b1 \u03b1\u03bb\u03bb\u03ac\u03be\u03b5\u03b9 \u03c4\u03bf \u03b2\u03ac\u03c1\u03bf\u03c2 \u03c3\u03b1\u03c2; is invalid\"   \/> <div class=\"frm_label_button_container\">Not sure<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_576_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first frm_three_col frm_display_format_buttons frm_text_align_center\">\r\n\t<div  id=\"field_tdir42_label\" class=\"frm_primary_label\">How quickly would you like your weight to change?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_tdir42_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_576-562-0\">\t\t\t<label  for=\"field_tdir42-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[576]\" id=\"field_tdir42-0\" value=\"\u0391\u03c1\u03b3\u03ac (~0.7 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Slow (~0.7 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_576-562-1\">\t\t\t<label  for=\"field_tdir42-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[576]\" id=\"field_tdir42-1\" value=\"\u039c\u03ad\u03c4\u03c1\u03b9\u03b1 (~1.1 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Moderate (~1.1 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_576-562-2\">\t\t\t<label  for=\"field_tdir42-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[576]\" id=\"field_tdir42-2\" value=\"\u03a4\u03c5\u03c0\u03b9\u03ba\u03ac (~1.7 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Standard (~1.7 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_576-562-3\">\t\t\t<label  for=\"field_tdir42-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[576]\" id=\"field_tdir42-3\" value=\"\u0393\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 (~2.2 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Fast (~2.2 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_576-562-4\">\t\t\t<label  for=\"field_tdir42-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[576]\" id=\"field_tdir42-4\" value=\"\u03a0\u03bf\u03bb\u03cd \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 (~2.9 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Very fast (~2.9 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_576-562-5\">\t\t\t<label  for=\"field_tdir42-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[576]\" id=\"field_tdir42-5\" value=\"\u0394\u03b5\u03bd \u03b5\u03af\u03bc\u03b1\u03b9 \u03c3\u03af\u03b3\u03bf\u03c5\u03c1\u03bf\u03c2\/\u03b7\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Not sure<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_577_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first frm_three_col frm_display_format_buttons frm_text_align_center\">\r\n\t<div  id=\"field_ydt472_label\" class=\"frm_primary_label\">How quickly would you like your weight to change?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ydt472_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_577-562-0\">\t\t\t<label  for=\"field_ydt472-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[577]\" id=\"field_ydt472-0\" value=\"\u0391\u03c1\u03b3\u03ac (~0.7 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Slow (~0.7 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_577-562-1\">\t\t\t<label  for=\"field_ydt472-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[577]\" id=\"field_ydt472-1\" value=\"\u039c\u03ad\u03c4\u03c1\u03b9\u03b1 (~1.1 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Moderate (~1.1 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_577-562-2\">\t\t\t<label  for=\"field_ydt472-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[577]\" id=\"field_ydt472-2\" value=\"\u03a4\u03c5\u03c0\u03b9\u03ba\u03ac (~1.7 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Standard (~1.7 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_577-562-3\">\t\t\t<label  for=\"field_ydt472-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[577]\" id=\"field_ydt472-3\" value=\"\u0393\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 (~2.2 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Fast (~2.2 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_577-562-4\">\t\t\t<label  for=\"field_ydt472-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[577]\" id=\"field_ydt472-4\" value=\"\u03a0\u03bf\u03bb\u03cd \u03b3\u03c1\u03ae\u03b3\u03bf\u03c1\u03b1 (~2.9 lbs\/ \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Very fast (~2.9 lbs\/week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_577-562-5\">\t\t\t<label  for=\"field_ydt472-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[577]\" id=\"field_ydt472-5\" value=\"\u0394\u03b5\u03bd \u03b5\u03af\u03bc\u03b1\u03b9 \u03c3\u03af\u03b3\u03bf\u03c5\u03c1\u03bf\u03c2\/\u03b7\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"How quickly would you like your weight to change? cannot be blank.\" data-invmsg=\"How quickly would you like your weight to change? is invalid\"   \/> <div class=\"frm_label_button_container\">Not sure<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_578_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_ulgu9_label\" class=\"frm_primary_label\">Have you followed a diet before?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ulgu9_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_578-562-5\">\t\t\t<label  for=\"field_ulgu9-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[578]\" id=\"field_ulgu9-5\" value=\"\ud83d\udc4d \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"Have you followed a diet before? cannot be blank.\" data-invmsg=\"Have you followed a diet before? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_578-562-4\">\t\t\t<label  for=\"field_ulgu9-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[578]\" id=\"field_ulgu9-4\" value=\"\ud83d\udc4e \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"Have you followed a diet before? cannot be blank.\" data-invmsg=\"Have you followed a diet before? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_579_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_6w2px\" id=\"field_6w2px_label\" class=\"frm_primary_label\">How many kg did you lose?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_6w2px\" name=\"item_meta[579]\" value=\"\" data-sectionid=\"562\"  autocomplete=\"off\"  placeholder=\"ex 10\" data-reqmsg=\"How many kg did you lose? cannot be blank.\" aria-required=\"true\" data-invmsg=\"How many kg did you lose? is invalid\" aria-invalid=\"false\"   min=\"0.5\" max=\"500\" step=\"0.5\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_580_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_28h8e\" id=\"field_28h8e_label\" class=\"frm_primary_label\">How many lbs did you lose?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_28h8e\" name=\"item_meta[580]\" value=\"\" data-sectionid=\"562\"  autocomplete=\"off\"  placeholder=\"ex 10\" data-reqmsg=\"How many lbs did you lose? cannot be blank.\" aria-required=\"true\" data-invmsg=\"How many lbs did you lose? is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"1100\" step=\"1\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_581_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_1yy3y_label\" class=\"frm_primary_label\">Did you regain weight afterwards?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_1yy3y_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_581-562-5\">\t\t\t<label  for=\"field_1yy3y-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[581]\" id=\"field_1yy3y-5\" value=\"\ud83d\udc4d \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"Did you regain weight afterwards? cannot be blank.\" data-invmsg=\"Did you regain weight afterwards? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_581-562-4\">\t\t\t<label  for=\"field_1yy3y-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[581]\" id=\"field_1yy3y-4\" value=\"\ud83d\udc4e \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"562\"  data-reqmsg=\"Did you regain weight afterwards? cannot be blank.\" data-invmsg=\"Did you regain weight afterwards? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d \u039d\u03b1\u03b9<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_583_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Health information<\/h3>\r\n\r\n\r\n<div id=\"frm_field_584_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_is0jl2_label\" class=\"frm_primary_label\">Do you have any diagnosed medical conditions?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_is0jl2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_584-583-1\">\t\t\t<label  for=\"field_is0jl2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[584]\" id=\"field_is0jl2-1\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Do you have any diagnosed medical conditions? cannot be blank.\" data-invmsg=\"Do you have any diagnosed medical conditions? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_584-583-0\">\t\t\t<label  for=\"field_is0jl2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[584]\" id=\"field_is0jl2-0\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Do you have any diagnosed medical conditions? cannot be blank.\" data-invmsg=\"Do you have any diagnosed medical conditions? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_585_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_qkz3\" id=\"field_qkz3_label\" class=\"frm_primary_label\">Specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_qkz3\" name=\"item_meta[585]\" value=\"\"  data-sectionid=\"583\"  data-invmsg=\"Specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_586_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_13lvi2_label\" class=\"frm_primary_label\">Have you had any surgeries?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_13lvi2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_586-583-0\">\t\t\t<label  for=\"field_13lvi2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[586]\" id=\"field_13lvi2-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Have you had any surgeries? cannot be blank.\" data-invmsg=\"Have you had any surgeries? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_586-583-1\">\t\t\t<label  for=\"field_13lvi2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[586]\" id=\"field_13lvi2-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Have you had any surgeries? cannot be blank.\" data-invmsg=\"Have you had any surgeries? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_587_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_gur0q2\" id=\"field_gur0q2_label\" class=\"frm_primary_label\">Specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_gur0q2\" name=\"item_meta[587]\" value=\"\"  data-sectionid=\"583\"  data-invmsg=\"Specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_588_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_1crks2_label\" class=\"frm_primary_label\">Do you have any allergies?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_1crks2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_588-583-0\">\t\t\t<label  for=\"field_1crks2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[588]\" id=\"field_1crks2-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Do you have any allergies? cannot be blank.\" data-invmsg=\"Do you have any allergies? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_588-583-1\">\t\t\t<label  for=\"field_1crks2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[588]\" id=\"field_1crks2-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Do you have any allergies? cannot be blank.\" data-invmsg=\"Do you have any allergies? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_589_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_5jj372\" id=\"field_5jj372_label\" class=\"frm_primary_label\">Specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_5jj372\" name=\"item_meta[589]\" value=\"\"  data-sectionid=\"583\"  data-invmsg=\"Specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_590_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_7kpf02_label\" class=\"frm_primary_label\">Do you have any food intolerances? \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_7kpf02_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_590-583-0\">\t\t\t<label  for=\"field_7kpf02-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[590]\" id=\"field_7kpf02-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Do you have any food intolerances?  cannot be blank.\" data-invmsg=\"Do you have any food intolerances?  is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_590-583-1\">\t\t\t<label  for=\"field_7kpf02-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[590]\" id=\"field_7kpf02-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Do you have any food intolerances?  cannot be blank.\" data-invmsg=\"Do you have any food intolerances?  is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_591_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_i6i652\" id=\"field_i6i652_label\" class=\"frm_primary_label\">Specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_i6i652\" name=\"item_meta[591]\" value=\"\"  data-sectionid=\"583\"  data-invmsg=\"Specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_592_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_yz6vs2_label\" class=\"frm_primary_label\">Do you have recent medical test results?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_yz6vs2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_592-583-0\">\t\t\t<label  for=\"field_yz6vs2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[592]\" id=\"field_yz6vs2-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Do you have recent medical test results? cannot be blank.\" data-invmsg=\"Do you have recent medical test results? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_592-583-1\">\t\t\t<label  for=\"field_yz6vs2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[592]\" id=\"field_yz6vs2-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"583\"  data-reqmsg=\"Do you have recent medical test results? cannot be blank.\" data-invmsg=\"Do you have recent medical test results? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_593_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_61wf42\" id=\"field_61wf42_label\" class=\"frm_primary_label\">File upload\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"hidden\"  data-sectionid=\"583\"  data-invmsg=\"File upload is invalid\" aria-invalid=\"false\"   name=\"item_meta[593][]\"  value=\"\" data-frmfile=\"593\" \/>\n\n<div class=\"frm_dropzone frm_multi_upload frm_clearfix\" id=\"file593_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file593[]\" id=\"field_61wf42\"\n\t\t\t data-frmfile=\"593\" multiple=\"multiple\"  data-sectionid=\"583\"  data-invmsg=\"File upload is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"File upload. Drop a file here or click to upload. Maximum file size: 134.22MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"File upload. Choose File. Maximum file size: 134.22MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 134.22MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_595_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_7zwn1_label\" class=\"frm_primary_label\">Are you currently taking any medications?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_595-1\">\t\t\t<label  for=\"field_7zwn1-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[595]\" id=\"field_7zwn1-1\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-reqmsg=\"Are you currently taking any medications? cannot be blank.\" data-invmsg=\"Are you currently taking any medications? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_595-0\">\t\t\t<label  for=\"field_7zwn1-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[595]\" id=\"field_7zwn1-0\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-reqmsg=\"Are you currently taking any medications? cannot be blank.\" data-invmsg=\"Are you currently taking any medications? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_596_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Medication<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[596][form]\" value=\"26\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_596-0\" class=\"frm_repeat_sec frm_repeat_596 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[596][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[596][0][0]\" value=\"\" \/><div id=\"frm_field_597-596-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_first frm_field_597_container\">\r\n\t<label for=\"field_mm3g6-0\" id=\"field_mm3g6-0_label\" class=\"frm_primary_label\">Medication name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_mm3g6-0\" name=\"item_meta[596][0][597]\" value=\"\"  data-sectionid=\"596\"  data-reqmsg=\"Medication name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Medication name is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_598-596-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm4 frm_field_598_container\">\r\n\t<label for=\"field_txys92-0\" id=\"field_txys92-0_label\" class=\"frm_primary_label\">Reason\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_txys92-0\" name=\"item_meta[596][0][598]\" value=\"\"  data-sectionid=\"596\"  data-reqmsg=\"Reason cannot be blank.\" aria-required=\"true\" data-invmsg=\"Reason is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_599-596-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_field_599_container\">\r\n\t<label for=\"field_cjx302-0\" id=\"field_cjx302-0_label\" class=\"frm_primary_label\">Dosage\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_cjx302-0\" name=\"item_meta[596][0][599]\" value=\"\"  data-sectionid=\"596\"  data-reqmsg=\"Dosage cannot be blank.\" aria-required=\"true\" data-invmsg=\"Dosage is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_600-596-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_field_600_container\">\r\n\t<label for=\"field_p29832-0\" id=\"field_p29832-0_label\" class=\"frm_primary_label\">Frequency of use\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_p29832-0\" name=\"item_meta[596][0][600]\" value=\"\"  data-sectionid=\"596\"  data-reqmsg=\"Frequency of use cannot be blank.\" aria-required=\"true\" data-invmsg=\"Frequency of use is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"596\" aria-label=\"Add\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>plus1<\/title>\n\t<path d=\"M11 5H9v4H5v2h4v4h2v-4h4V9h-4V5zm-1-5a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> Add Medication<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"596\" aria-label=\"Remove\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>minus1<\/title>\n\t<path d=\"M5 9v2h10V9H5zm5-9a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> Remove Medication<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_602_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_rmqbv_label\" class=\"frm_primary_label\">Are you using GLP-1 therapy (eg Ozempic, Wegovy, Mounjaro)?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_602-1\">\t\t\t<label  for=\"field_rmqbv-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[602]\" id=\"field_rmqbv-1\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-reqmsg=\"Are you using GLP-1 therapy (eg Ozempic, Wegovy, Mounjaro)? cannot be blank.\" data-invmsg=\"Are you using GLP-1 therapy (eg Ozempic, Wegovy, Mounjaro)? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_602-0\">\t\t\t<label  for=\"field_rmqbv-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[602]\" id=\"field_rmqbv-0\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-reqmsg=\"Are you using GLP-1 therapy (eg Ozempic, Wegovy, Mounjaro)? cannot be blank.\" data-invmsg=\"Are you using GLP-1 therapy (eg Ozempic, Wegovy, Mounjaro)? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_603_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">GLP-1<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[603][form]\" value=\"27\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_603-0\" class=\"frm_repeat_sec frm_repeat_603 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[603][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[603][0][0]\" value=\"\" \/><div id=\"frm_field_604-603-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_first frm_field_604_container\">\r\n\t<label for=\"field_ktmnh-0\" id=\"field_ktmnh-0_label\" class=\"frm_primary_label\">Medication name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_ktmnh-0\" name=\"item_meta[603][0][604]\" value=\"\"  data-sectionid=\"603\"  data-reqmsg=\"Medication name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Medication name is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_605-603-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_field_605_container\">\r\n\t<label for=\"field_wghhw-0\" id=\"field_wghhw-0_label\" class=\"frm_primary_label\">Dosage\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_wghhw-0\" name=\"item_meta[603][0][605]\" value=\"\"  data-sectionid=\"603\"  data-reqmsg=\"Dosage cannot be blank.\" aria-required=\"true\" data-invmsg=\"Dosage is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_606-603-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_field_606_container\">\r\n\t<label for=\"field_3h2mq-0\" id=\"field_3h2mq-0_label\" class=\"frm_primary_label\">Duration of use\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_3h2mq-0\" name=\"item_meta[603][0][606]\" value=\"\"  data-sectionid=\"603\"  placeholder=\"ex 3 months\" data-reqmsg=\"Duration of use cannot be blank.\" aria-required=\"true\" data-invmsg=\"Duration of use is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_607-603-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm4 frm_field_607_container\">\r\n\t<label for=\"field_c6wjx-0\" id=\"field_c6wjx-0_label\" class=\"frm_primary_label\">Your results so far?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_c6wjx-0\" name=\"item_meta[603][0][607]\" value=\"\"  data-sectionid=\"603\"  data-reqmsg=\"Your results so far? cannot be blank.\" aria-required=\"true\" data-invmsg=\"Your results so far? is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"603\" aria-label=\"Add\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>plus1<\/title>\n\t<path d=\"M11 5H9v4H5v2h4v4h2v-4h4V9h-4V5zm-1-5a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> Add Medication<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"603\" aria-label=\"Remove\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>minus1<\/title>\n\t<path d=\"M5 9v2h10V9H5zm5-9a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> Remove Medication<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_609_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_pd7n6_label\" class=\"frm_primary_label\">Have you previously used medication for weight loss?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_609-1\">\t\t\t<label  for=\"field_pd7n6-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[609]\" id=\"field_pd7n6-1\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-reqmsg=\"Have you previously used medication for weight loss? cannot be blank.\" data-invmsg=\"Have you previously used medication for weight loss? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_609-0\">\t\t\t<label  for=\"field_pd7n6-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[609]\" id=\"field_pd7n6-0\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-reqmsg=\"Have you previously used medication for weight loss? cannot be blank.\" data-invmsg=\"Have you previously used medication for weight loss? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_610_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Medication<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[610][form]\" value=\"28\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_610-0\" class=\"frm_repeat_sec frm_repeat_610 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[610][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[610][0][0]\" value=\"\" \/><div id=\"frm_field_611-610-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_first frm_field_611_container\">\r\n\t<label for=\"field_apvae-0\" id=\"field_apvae-0_label\" class=\"frm_primary_label\">Medication name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_apvae-0\" name=\"item_meta[610][0][611]\" value=\"\"  data-sectionid=\"610\"  data-reqmsg=\"Medication name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Medication name is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_612-610-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_field_612_container\">\r\n\t<label for=\"field_wbvk2-0\" id=\"field_wbvk2-0_label\" class=\"frm_primary_label\">Dosage\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_wbvk2-0\" name=\"item_meta[610][0][612]\" value=\"\"  data-sectionid=\"610\"  data-reqmsg=\"Dosage cannot be blank.\" aria-required=\"true\" data-invmsg=\"Dosage is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_613-610-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_field_613_container\">\r\n\t<label for=\"field_kklr3-0\" id=\"field_kklr3-0_label\" class=\"frm_primary_label\">How long ago?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_kklr3-0\" name=\"item_meta[610][0][613]\" value=\"\"  data-sectionid=\"610\"  placeholder=\"ex 1 year\" data-reqmsg=\"How long ago? cannot be blank.\" aria-required=\"true\" data-invmsg=\"How long ago? is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_614-610-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm4 frm_field_614_container\">\r\n\t<label for=\"field_xyste-0\" id=\"field_xyste-0_label\" class=\"frm_primary_label\">Your results?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_xyste-0\" name=\"item_meta[610][0][614]\" value=\"\"  data-sectionid=\"610\"  data-reqmsg=\"Your results? cannot be blank.\" aria-required=\"true\" data-invmsg=\"Your results? is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"610\" aria-label=\"Add\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>plus1<\/title>\n\t<path d=\"M11 5H9v4H5v2h4v4h2v-4h4V9h-4V5zm-1-5a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> Add Medication<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"610\" aria-label=\"Remove\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>minus1<\/title>\n\t<path d=\"M5 9v2h10V9H5zm5-9a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> Remove Medication<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_616_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_oemch_label\" class=\"frm_primary_label\">Do you take dietary supplements? (eg protein powder, creatine, omega-3, vitamin D)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_616-1\">\t\t\t<label  for=\"field_oemch-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[616]\" id=\"field_oemch-1\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-reqmsg=\"Do you take dietary supplements? (eg protein powder, creatine, omega-3, vitamin D) cannot be blank.\" data-invmsg=\"Do you take dietary supplements? (eg protein powder, creatine, omega-3, vitamin D) is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_616-0\">\t\t\t<label  for=\"field_oemch-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[616]\" id=\"field_oemch-0\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-reqmsg=\"Do you take dietary supplements? (eg protein powder, creatine, omega-3, vitamin D) cannot be blank.\" data-invmsg=\"Do you take dietary supplements? (eg protein powder, creatine, omega-3, vitamin D) is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_617_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Dietary supplements<\/h3>\r\n\r\n<input type=\"hidden\" name=\"item_meta[617][form]\" value=\"29\" class=\"frm_dnc\" \/>\n\t\t\t<div id=\"frm_section_617-0\" class=\"frm_repeat_sec frm_repeat_617 frm_first_repeat frm_grid_container\">\n<input type=\"hidden\" name=\"item_meta[617][row_ids][]\" value=\"0\" \/><input type=\"hidden\" name=\"item_meta[617][0][0]\" value=\"\" \/><div id=\"frm_field_618-617-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_first frm_field_618_container\">\r\n\t<label for=\"field_9x0b5-0\" id=\"field_9x0b5-0_label\" class=\"frm_primary_label\">Supplement Name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_9x0b5-0\" name=\"item_meta[617][0][618]\" value=\"\"  data-sectionid=\"617\"  data-reqmsg=\"Supplement Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Supplement Name is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_619-617-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_field_619_container\">\r\n\t<label for=\"field_zupna-0\" id=\"field_zupna-0_label\" class=\"frm_primary_label\">Reason\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_zupna-0\" name=\"item_meta[617][0][619]\" value=\"\"  data-sectionid=\"617\"  data-reqmsg=\"Reason cannot be blank.\" aria-required=\"true\" data-invmsg=\"Reason is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_620-617-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_field_620_container\">\r\n\t<label for=\"field_wmz2r2-0\" id=\"field_wmz2r2-0_label\" class=\"frm_primary_label\">Dosage\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_wmz2r2-0\" name=\"item_meta[617][0][620]\" value=\"\"  data-sectionid=\"617\"  data-reqmsg=\"Dosage cannot be blank.\" aria-required=\"true\" data-invmsg=\"Dosage is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_621-617-0_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm3 frm_field_621_container\">\r\n\t<label for=\"field_m64o12-0\" id=\"field_m64o12-0_label\" class=\"frm_primary_label\">Frequency of use\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_m64o12-0\" name=\"item_meta[617][0][621]\" value=\"\"  data-sectionid=\"617\"  data-reqmsg=\"Frequency of use cannot be blank.\" aria-required=\"true\" data-invmsg=\"Frequency of use is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div class=\"frm_form_field frm_hidden_container frm_repeat_buttons \"><a href=\"#\" class=\"frm_add_form_row frm_button\" data-parent=\"617\" aria-label=\"Add\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>plus1<\/title>\n\t<path d=\"M11 5H9v4H5v2h4v4h2v-4h4V9h-4V5zm-1-5a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> Add Medication<\/a>\n<a href=\"#\" class=\"frm_remove_form_row frm_button\" data-key=\"0\" data-parent=\"617\" aria-label=\"Remove\"><svg  viewBox=\"0 0 20 20\" width=\"1em\" height=\"1em\" class=\"frmsvg frm-svg-icon\">\n\t<title>minus1<\/title>\n\t<path d=\"M5 9v2h10V9H5zm5-9a10 10 0 1 0 0 20 10 10 0 0 0 0-20zm0 18a8 8 0 1 1 0-16 8 8 0 0 1 0 16z\"><\/path>\n\n<\/svg> Remove Medication<\/a> <\/div><\/div>\n\r\n<\/div>\n<div id=\"frm_field_623_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Dietary habits<\/h3>\r\n\r\n\r\n<div id=\"frm_field_624_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_54s1m_label\" class=\"frm_primary_label\">Do you follow a specific dietary pattern?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_624-623-0\">\t\t\t<label  for=\"field_54s1m-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[624]\" id=\"field_54s1m-0\" value=\"\u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you follow a specific dietary pattern? cannot be blank.\" data-invmsg=\"Do you follow a specific dietary pattern? is invalid\"   \/> <div class=\"frm_label_button_container\">No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_624-623-1\">\t\t\t<label  for=\"field_54s1m-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[624]\" id=\"field_54s1m-1\" value=\"\u03a7\u03bf\u03c1\u03c4\u03bf\u03c6\u03ac\u03b3\u03bf\u03c2\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you follow a specific dietary pattern? cannot be blank.\" data-invmsg=\"Do you follow a specific dietary pattern? is invalid\"   \/> <div class=\"frm_label_button_container\">Vegetarian<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_624-623-2\">\t\t\t<label  for=\"field_54s1m-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[624]\" id=\"field_54s1m-2\" value=\"\u0392\u03af\u03b3\u03ba\u03b1\u03bd\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you follow a specific dietary pattern? cannot be blank.\" data-invmsg=\"Do you follow a specific dietary pattern? is invalid\"   \/> <div class=\"frm_label_button_container\">Vegan<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_624-623-3\">\t\t\t<label  for=\"field_54s1m-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[624]\" id=\"field_54s1m-3\" value=\"\u03a0\u03b5\u03c3\u03ba\u03b1\u03c4\u03b1\u03c1\u03b9\u03b1\u03bd\u03cc\u03c2\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you follow a specific dietary pattern? cannot be blank.\" data-invmsg=\"Do you follow a specific dietary pattern? is invalid\"   \/> <div class=\"frm_label_button_container\">Pescatarian<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_624-623-4\">\t\t\t<label  for=\"field_54s1m-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[624]\" id=\"field_54s1m-4\" value=\"\u03a9\u03bc\u03bf\u03c6\u03b1\u03b3\u03af\u03b1\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you follow a specific dietary pattern? cannot be blank.\" data-invmsg=\"Do you follow a specific dietary pattern? is invalid\"   \/> <div class=\"frm_label_button_container\">Raw foodist<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_624-623-5\">\t\t\t<label  for=\"field_54s1m-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[624]\" id=\"field_54s1m-5\" value=\"\u0386\u03bb\u03bb\u03bf\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you follow a specific dietary pattern? cannot be blank.\" data-invmsg=\"Do you follow a specific dietary pattern? is invalid\"   \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_625_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_n3oz5\" id=\"field_n3oz5_label\" class=\"frm_primary_label\">Specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_n3oz5\" name=\"item_meta[625]\" value=\"\"  data-sectionid=\"623\"  data-reqmsg=\"Specify cannot be blank.\" aria-required=\"true\" data-invmsg=\"Specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_626_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_f7f1w_label\" class=\"frm_primary_label\">Do you follow intermittent fasting?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_626-623-0\">\t\t\t<label  for=\"field_f7f1w-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[626]\" id=\"field_f7f1w-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you follow intermittent fasting? cannot be blank.\" data-invmsg=\"Do you follow intermittent fasting? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_626-623-1\">\t\t\t<label  for=\"field_f7f1w-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[626]\" id=\"field_f7f1w-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you follow intermittent fasting? cannot be blank.\" data-invmsg=\"Do you follow intermittent fasting? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_627_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\">\r\n\t<div  id=\"field_xlasu_label\" class=\"frm_primary_label\">Start time\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<select aria-labelledby=\"field_xlasu_label\" name=\"item_meta[627]\" id=\"field_xlasu\"  data-sectionid=\"623\"  data-invmsg=\"Start time is invalid\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"00:00\" >00:00<\/option><option value=\"00:30\" >00:30<\/option><option value=\"01:00\" >01:00<\/option><option value=\"01:30\" >01:30<\/option><option value=\"02:00\" >02:00<\/option><option value=\"02:30\" >02:30<\/option><option value=\"03:00\" >03:00<\/option><option value=\"03:30\" >03:30<\/option><option value=\"04:00\" >04:00<\/option><option value=\"04:30\" >04:30<\/option><option value=\"05:00\" >05:00<\/option><option value=\"05:30\" >05:30<\/option><option value=\"06:00\" >06:00<\/option><option value=\"06:30\" >06:30<\/option><option value=\"07:00\" >07:00<\/option><option value=\"07:30\" >07:30<\/option><option value=\"08:00\" >08:00<\/option><option value=\"08:30\" >08:30<\/option><option value=\"09:00\" >09:00<\/option><option value=\"09:30\" >09:30<\/option><option value=\"10:00\" >10:00<\/option><option value=\"10:30\" >10:30<\/option><option value=\"11:00\" >11:00<\/option><option value=\"11:30\" >11:30<\/option><option value=\"12:00\" >12:00<\/option><option value=\"12:30\" >12:30<\/option><option value=\"13:00\" >13:00<\/option><option value=\"13:30\" >13:30<\/option><option value=\"14:00\" >14:00<\/option><option value=\"14:30\" >14:30<\/option><option value=\"15:00\" >15:00<\/option><option value=\"15:30\" >15:30<\/option><option value=\"16:00\" >16:00<\/option><option value=\"16:30\" >16:30<\/option><option value=\"17:00\" >17:00<\/option><option value=\"17:30\" >17:30<\/option><option value=\"18:00\" >18:00<\/option><option value=\"18:30\" >18:30<\/option><option value=\"19:00\" >19:00<\/option><option value=\"19:30\" >19:30<\/option><option value=\"20:00\" >20:00<\/option><option value=\"20:30\" >20:30<\/option><option value=\"21:00\" >21:00<\/option><option value=\"21:30\" >21:30<\/option><option value=\"22:00\" >22:00<\/option><option value=\"22:30\" >22:30<\/option><option value=\"23:00\" >23:00<\/option><option value=\"23:30\" >23:30<\/option><\/select>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_628_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n\t<div  id=\"field_oqv72_label\" class=\"frm_primary_label\">End time\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<select aria-labelledby=\"field_oqv72_label\" name=\"item_meta[628]\" id=\"field_oqv72\"  data-sectionid=\"623\"  data-invmsg=\"End time is invalid\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"00:00\" >00:00<\/option><option value=\"00:30\" >00:30<\/option><option value=\"01:00\" >01:00<\/option><option value=\"01:30\" >01:30<\/option><option value=\"02:00\" >02:00<\/option><option value=\"02:30\" >02:30<\/option><option value=\"03:00\" >03:00<\/option><option value=\"03:30\" >03:30<\/option><option value=\"04:00\" >04:00<\/option><option value=\"04:30\" >04:30<\/option><option value=\"05:00\" >05:00<\/option><option value=\"05:30\" >05:30<\/option><option value=\"06:00\" >06:00<\/option><option value=\"06:30\" >06:30<\/option><option value=\"07:00\" >07:00<\/option><option value=\"07:30\" >07:30<\/option><option value=\"08:00\" >08:00<\/option><option value=\"08:30\" >08:30<\/option><option value=\"09:00\" >09:00<\/option><option value=\"09:30\" >09:30<\/option><option value=\"10:00\" >10:00<\/option><option value=\"10:30\" >10:30<\/option><option value=\"11:00\" >11:00<\/option><option value=\"11:30\" >11:30<\/option><option value=\"12:00\" >12:00<\/option><option value=\"12:30\" >12:30<\/option><option value=\"13:00\" >13:00<\/option><option value=\"13:30\" >13:30<\/option><option value=\"14:00\" >14:00<\/option><option value=\"14:30\" >14:30<\/option><option value=\"15:00\" >15:00<\/option><option value=\"15:30\" >15:30<\/option><option value=\"16:00\" >16:00<\/option><option value=\"16:30\" >16:30<\/option><option value=\"17:00\" >17:00<\/option><option value=\"17:30\" >17:30<\/option><option value=\"18:00\" >18:00<\/option><option value=\"18:30\" >18:30<\/option><option value=\"19:00\" >19:00<\/option><option value=\"19:30\" >19:30<\/option><option value=\"20:00\" >20:00<\/option><option value=\"20:30\" >20:30<\/option><option value=\"21:00\" >21:00<\/option><option value=\"21:30\" >21:30<\/option><option value=\"22:00\" >22:00<\/option><option value=\"22:30\" >22:30<\/option><option value=\"23:00\" >23:00<\/option><option value=\"23:30\" >23:30<\/option><\/select>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_629_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_lfsmz2_label\" class=\"frm_primary_label\">Do you have any dislikes?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_629-623-0\">\t\t\t<label  for=\"field_lfsmz2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[629]\" id=\"field_lfsmz2-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you have any dislikes? cannot be blank.\" data-invmsg=\"Do you have any dislikes? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_629-623-1\">\t\t\t<label  for=\"field_lfsmz2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[629]\" id=\"field_lfsmz2-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you have any dislikes? cannot be blank.\" data-invmsg=\"Do you have any dislikes? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_630_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_5dh2a\" id=\"field_5dh2a_label\" class=\"frm_primary_label\">List foods you do not consume\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_5dh2a\" name=\"item_meta[630]\" value=\"\"  data-sectionid=\"623\"  placeholder=\"eg cheese, mushrooms\" data-reqmsg=\"List foods you do not consume cannot be blank.\" aria-required=\"true\" data-invmsg=\"List foods you do not consume is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_631_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_wwdca2_label\" class=\"frm_primary_label\">Are there foods you especially like?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_631-623-0\">\t\t\t<label  for=\"field_wwdca2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[631]\" id=\"field_wwdca2-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Are there foods you especially like? cannot be blank.\" data-invmsg=\"Are there foods you especially like? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_631-623-1\">\t\t\t<label  for=\"field_wwdca2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[631]\" id=\"field_wwdca2-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Are there foods you especially like? cannot be blank.\" data-invmsg=\"Are there foods you especially like? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_632_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_cegzu\" id=\"field_cegzu_label\" class=\"frm_primary_label\">List foods you especially like\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_cegzu\" name=\"item_meta[632]\" value=\"\"  data-sectionid=\"623\"  placeholder=\"eg potato, eggs\" data-reqmsg=\"List foods you especially like cannot be blank.\" aria-required=\"true\" data-invmsg=\"List foods you especially like is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_633_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_cug4s_label\" class=\"frm_primary_label\">Do you prefer seasonal foods?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_633-623-0\">\t\t\t<label  for=\"field_cug4s-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[633]\" id=\"field_cug4s-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you prefer seasonal foods? cannot be blank.\" data-invmsg=\"Do you prefer seasonal foods? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_633-623-1\">\t\t\t<label  for=\"field_cug4s-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[633]\" id=\"field_cug4s-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"623\"  data-reqmsg=\"Do you prefer seasonal foods? cannot be blank.\" data-invmsg=\"Do you prefer seasonal foods? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_635_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Describe your typical breakfast<\/h3>\r\n\r\n\r\n<div id=\"frm_field_636_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_ggkno_label\" class=\"frm_primary_label\">Do you usually eat breakfast?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_636-635-0\">\t\t\t<label  for=\"field_ggkno-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[636]\" id=\"field_ggkno-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"635\"  data-reqmsg=\"Do you usually eat breakfast? cannot be blank.\" data-invmsg=\"Do you usually eat breakfast? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_636-635-1\">\t\t\t<label  for=\"field_ggkno-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[636]\" id=\"field_ggkno-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"635\"  data-reqmsg=\"Do you usually eat breakfast? cannot be blank.\" data-invmsg=\"Do you usually eat breakfast? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_637_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_lt98u_label\" class=\"frm_primary_label\">Breakfast preferences\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_637-635-0\">\t\t\t<label  for=\"field_lt98u-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[637][]\" id=\"field_lt98u-0\" value=\"\u03a3\u03c0\u03b9\u03c4\u03b9\u03ba\u03cc (\u03c0.\u03c7. \u03b1\u03c5\u03b3\u03ac, \u03c4\u03bf\u03c3\u03c4, \u03b2\u03c1\u03ce\u03bc\u03b7, \u03b3\u03b9\u03b1\u03bf\u03cd\u03c1\u03c4\u03b9 \u03bc\u03b5 \u03c6\u03c1\u03bf\u03cd\u03c4\u03b1)\"  data-sectionid=\"635\"  data-reqmsg=\"Breakfast preferences cannot be blank.\" data-invmsg=\"Breakfast preferences is invalid\"   aria-required=\"true\"  \/> <div class=\"frm_label_button_container\">Homemade (eg eggs, toast, oatmeal, yogurt with fruit)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_637-635-1\">\t\t\t<label  for=\"field_lt98u-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[637][]\" id=\"field_lt98u-1\" value=\"\u0395\u03bd \u03ba\u03b9\u03bd\u03ae\u03c3\u03b5\u03b9 (\u03c0.\u03c7. \u03b5\u03af\u03b4\u03b7 \u03b1\u03c1\u03c4\u03bf\u03c0\u03bf\u03b9\u03af\u03b1\u03c2, \u03b5\u03c0\u03b9\u03bb\u03bf\u03b3\u03ad\u03c2 \u03ba\u03b1\u03c6\u03b5\u03c4\u03ad\u03c1\u03b9\u03b1\u03c2)\"  data-sectionid=\"635\"  data-reqmsg=\"Breakfast preferences cannot be blank.\" data-invmsg=\"Breakfast preferences is invalid\"   \/> <div class=\"frm_label_button_container\">On the go (eg bakery items, coffee shop options)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_637-635-2\">\t\t\t<label  for=\"field_lt98u-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[637][]\" id=\"field_lt98u-2\" value=\"\u0388\u03c4\u03bf\u03b9\u03bc\u03bf \u03b3\u03b5\u03cd\u03bc\u03b1 (\u03c0.\u03c7. \u03c5\u03c0\u03b7\u03c1\u03b5\u03c3\u03af\u03b5\u03c2 \u03c0\u03b1\u03c1\u03ac\u03b4\u03bf\u03c3\u03b7\u03c2 \u03b3\u03b5\u03c5\u03bc\u03ac\u03c4\u03c9\u03bd, \u03b3\u03b5\u03cd\u03bc\u03b1\u03c4\u03b1 \u03bc\u03b5 \u03b5\u03c4\u03b9\u03ba\u03ad\u03c4\u03b5\u03c2)\"  data-sectionid=\"635\"  data-reqmsg=\"Breakfast preferences cannot be blank.\" data-invmsg=\"Breakfast preferences is invalid\"   \/> <div class=\"frm_label_button_container\">Ready made meal (eg meal delivery services, labeled meals)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_637-635-3\">\t\t\t<label  for=\"field_lt98u-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[637][]\" id=\"field_lt98u-3\" value=\"\u0386\u03bb\u03bb\u03bf\"  data-sectionid=\"635\"  data-reqmsg=\"Breakfast preferences cannot be blank.\" data-invmsg=\"Breakfast preferences is invalid\"   \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_638_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_lpfhj\" id=\"field_lpfhj_label\" class=\"frm_primary_label\">Describe your typical breakfast\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_lpfhj\" name=\"item_meta[638]\" value=\"\"  data-sectionid=\"635\"  data-reqmsg=\"Describe your typical breakfast cannot be blank.\" aria-required=\"true\" data-invmsg=\"Describe your typical breakfast is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_639_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_g8tm1_label\" class=\"frm_primary_label\">\u0395\u03af\u03bd\u03b1\u03b9 \u03c4\u03bf \u03c0\u03c1\u03c9\u03b9\u03bd\u03cc \u03c3\u03b1\u03c2 \u03c0\u03b1\u03c1\u03cc\u03bc\u03bf\u03b9\u03bf \u03c4\u03b1 \u03a3\u03b1\u03b2\u03b2\u03b1\u03c4\u03bf\u03ba\u03cd\u03c1\u03b9\u03b1\u03ba\u03b1;\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_g8tm1_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_639-635-0\">\t\t\t<label  for=\"field_g8tm1-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[639]\" id=\"field_g8tm1-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9, \u03b5\u03af\u03bd\u03b1\u03b9 \u03b4\u03b9\u03b1\u03c6\u03bf\u03c1\u03b5\u03c4\u03b9\u03ba\u03cc\"\n\t\t data-sectionid=\"635\"  data-reqmsg=\"\u0395\u03af\u03bd\u03b1\u03b9 \u03c4\u03bf \u03c0\u03c1\u03c9\u03b9\u03bd\u03cc \u03c3\u03b1\u03c2 \u03c0\u03b1\u03c1\u03cc\u03bc\u03bf\u03b9\u03bf \u03c4\u03b1 \u03a3\u03b1\u03b2\u03b2\u03b1\u03c4\u03bf\u03ba\u03cd\u03c1\u03b9\u03b1\u03ba\u03b1; cannot be blank.\" data-invmsg=\"\u0395\u03af\u03bd\u03b1\u03b9 \u03c4\u03bf \u03c0\u03c1\u03c9\u03b9\u03bd\u03cc \u03c3\u03b1\u03c2 \u03c0\u03b1\u03c1\u03cc\u03bc\u03bf\u03b9\u03bf \u03c4\u03b1 \u03a3\u03b1\u03b2\u03b2\u03b1\u03c4\u03bf\u03ba\u03cd\u03c1\u03b9\u03b1\u03ba\u03b1; is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No, it is different<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_639-635-1\">\t\t\t<label  for=\"field_g8tm1-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[639]\" id=\"field_g8tm1-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9, \u03b5\u03af\u03bd\u03b1\u03b9 \u03c0\u03b1\u03c1\u03cc\u03bc\u03bf\u03b9\u03bf\"\n\t\t data-sectionid=\"635\"  data-reqmsg=\"\u0395\u03af\u03bd\u03b1\u03b9 \u03c4\u03bf \u03c0\u03c1\u03c9\u03b9\u03bd\u03cc \u03c3\u03b1\u03c2 \u03c0\u03b1\u03c1\u03cc\u03bc\u03bf\u03b9\u03bf \u03c4\u03b1 \u03a3\u03b1\u03b2\u03b2\u03b1\u03c4\u03bf\u03ba\u03cd\u03c1\u03b9\u03b1\u03ba\u03b1; cannot be blank.\" data-invmsg=\"\u0395\u03af\u03bd\u03b1\u03b9 \u03c4\u03bf \u03c0\u03c1\u03c9\u03b9\u03bd\u03cc \u03c3\u03b1\u03c2 \u03c0\u03b1\u03c1\u03cc\u03bc\u03bf\u03b9\u03bf \u03c4\u03b1 \u03a3\u03b1\u03b2\u03b2\u03b1\u03c4\u03bf\u03ba\u03cd\u03c1\u03b9\u03b1\u03ba\u03b1; is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes, it is similar<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_640_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_1kkj3\" id=\"field_1kkj3_label\" class=\"frm_primary_label\">Please describe:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_1kkj3\" name=\"item_meta[640]\" value=\"\"  data-sectionid=\"635\"  data-reqmsg=\"Please describe: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please describe: is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_642_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Describe your typical lunch<\/h3>\r\n\r\n\r\n<div id=\"frm_field_643_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_7j1gp2_label\" class=\"frm_primary_label\">Do you usually eat lunch?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_643-642-0\">\t\t\t<label  for=\"field_7j1gp2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[643]\" id=\"field_7j1gp2-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"642\"  data-reqmsg=\"Do you usually eat lunch? cannot be blank.\" data-invmsg=\"Do you usually eat lunch? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_643-642-1\">\t\t\t<label  for=\"field_7j1gp2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[643]\" id=\"field_7j1gp2-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"642\"  data-reqmsg=\"Do you usually eat lunch? cannot be blank.\" data-invmsg=\"Do you usually eat lunch? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_644_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_brkc82_label\" class=\"frm_primary_label\">Lunch preferences\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_644-642-0\">\t\t\t<label  for=\"field_brkc82-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[644][]\" id=\"field_brkc82-0\" value=\"\u03a3\u03c0\u03b9\u03c4\u03b9\u03ba\u03cc (\u03c0.\u03c7. \u03c8\u03b7\u03c4\u03cc \u03ba\u03bf\u03c4\u03cc\u03c0\u03bf\u03c5\u03bb\u03bf \u03bc\u03b5 \u03c1\u03cd\u03b6\u03b9, \u03b6\u03c5\u03bc\u03b1\u03c1\u03b9\u03ba\u03ac, \u03bc\u03b1\u03b3\u03b5\u03b9\u03c1\u03b5\u03c5\u03c4\u03ac \u03c6\u03b1\u03b3\u03b7\u03c4\u03ac)\"  data-sectionid=\"642\"  data-reqmsg=\"Lunch preferences cannot be blank.\" data-invmsg=\"Lunch preferences is invalid\"   aria-required=\"true\"  \/> <div class=\"frm_label_button_container\">Homemade (eg grilled chicken with rice, pasta, cooked meals)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_644-642-1\">\t\t\t<label  for=\"field_brkc82-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[644][]\" id=\"field_brkc82-1\" value=\"\u0395\u03c3\u03c4\u03b9\u03b1\u03c4\u03cc\u03c1\u03b9\u03bf (\u03c0.\u03c7. \u03b5\u03c0\u03b1\u03b3\u03b3\u03b5\u03bb\u03bc\u03b1\u03c4\u03b9\u03ba\u03cc \u03b3\u03b5\u03cd\u03bc\u03b1, \u03bc\u03c0\u03ad\u03c1\u03b3\u03ba\u03b5\u03c1 \u03bc\u03b5 \u03c0\u03b1\u03c4\u03ac\u03c4\u03b5\u03c2, \u03c0\u03b9\u03ac\u03c4\u03bf \u03b6\u03c5\u03bc\u03b1\u03c1\u03b9\u03ba\u03ce\u03bd, \u03c3\u03c5\u03bd\u03b4\u03c5\u03b1\u03c3\u03bc\u03cc\u03c2 \u03c3\u03bf\u03cd\u03c3\u03b9)\"  data-sectionid=\"642\"  data-reqmsg=\"Lunch preferences cannot be blank.\" data-invmsg=\"Lunch preferences is invalid\"   \/> <div class=\"frm_label_button_container\">Restaurant (eg business lunch, burger &amp; fries, pasta dish, sushi combo)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_644-642-2\">\t\t\t<label  for=\"field_brkc82-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[644][]\" id=\"field_brkc82-2\" value=\"\u0393\u03c1\u03ae\u03b3\u03bf\u03c1\u03bf \u03b3\u03b5\u03cd\u03bc\u03b1 (\u03c0.\u03c7. \u03b2\u03c1\u03b1\u03c3\u03c4\u03ac \u03b1\u03c5\u03b3\u03ac, \u03c3\u03ac\u03bd\u03c4\u03bf\u03c5\u03b9\u03c4\u03c2, \u03c4\u03c5\u03bb\u03b9\u03c7\u03c4\u03cc \u03c8\u03c9\u03bc\u03af, \u03c4\u03bf\u03c3\u03c4, instant noodles, \u03c3\u03b1\u03bb\u03ac\u03c4\u03b1 \u03c4\u03cc\u03bd\u03bf\u03c5)\"  data-sectionid=\"642\"  data-reqmsg=\"Lunch preferences cannot be blank.\" data-invmsg=\"Lunch preferences is invalid\"   \/> <div class=\"frm_label_button_container\">Quick meal (eg boiled eggs, sandwich, wrap, toast, instant noodles, tuna salad)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_644-642-4\">\t\t\t<label  for=\"field_brkc82-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[644][]\" id=\"field_brkc82-4\" value=\"\u0388\u03c4\u03bf\u03b9\u03bc\u03bf \u03b3\u03b5\u03cd\u03bc\u03b1 (\u03c0.\u03c7. \u03c5\u03c0\u03b7\u03c1\u03b5\u03c3\u03af\u03b5\u03c2 \u03c0\u03b1\u03c1\u03ac\u03b4\u03bf\u03c3\u03b7\u03c2 \u03b3\u03b5\u03c5\u03bc\u03ac\u03c4\u03c9\u03bd, \u03b3\u03b5\u03cd\u03bc\u03b1\u03c4\u03b1 \u03bc\u03b5 \u03b5\u03c4\u03b9\u03ba\u03ad\u03c4\u03b5\u03c2)\"  data-sectionid=\"642\"  data-reqmsg=\"Lunch preferences cannot be blank.\" data-invmsg=\"Lunch preferences is invalid\"   \/> <div class=\"frm_label_button_container\">\u0388\u03c4\u03bf\u03b9\u03bc\u03bf \u03b3\u03b5\u03cd\u03bc\u03b1 (\u03c0.\u03c7. \u03c5\u03c0\u03b7\u03c1\u03b5\u03c3\u03af\u03b5\u03c2 \u03c0\u03b1\u03c1\u03ac\u03b4\u03bf\u03c3\u03b7\u03c2 \u03b3\u03b5\u03c5\u03bc\u03ac\u03c4\u03c9\u03bd, \u03b3\u03b5\u03cd\u03bc\u03b1\u03c4\u03b1 \u03bc\u03b5 \u03b5\u03c4\u03b9\u03ba\u03ad\u03c4\u03b5\u03c2)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_644-642-3\">\t\t\t<label  for=\"field_brkc82-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[644][]\" id=\"field_brkc82-3\" value=\"\u0386\u03bb\u03bb\u03bf\"  data-sectionid=\"642\"  data-reqmsg=\"Lunch preferences cannot be blank.\" data-invmsg=\"Lunch preferences is invalid\"   \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_645_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_9bftm2\" id=\"field_9bftm2_label\" class=\"frm_primary_label\">Describe your typical lunch\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_9bftm2\" name=\"item_meta[645]\" value=\"\"  data-sectionid=\"642\"  data-reqmsg=\"Describe your typical lunch cannot be blank.\" aria-required=\"true\" data-invmsg=\"Describe your typical lunch is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_646_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_1u7jz2_label\" class=\"frm_primary_label\">Is your lunch the same on weekends?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_1u7jz2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_646-642-0\">\t\t\t<label  for=\"field_1u7jz2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[646]\" id=\"field_1u7jz2-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9, \u03b5\u03af\u03bd\u03b1\u03b9 \u03b4\u03b9\u03b1\u03c6\u03bf\u03c1\u03b5\u03c4\u03b9\u03ba\u03cc\"\n\t\t data-sectionid=\"642\"  data-reqmsg=\"Is your lunch the same on weekends? cannot be blank.\" data-invmsg=\"Is your lunch the same on weekends? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No, it is different<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_646-642-1\">\t\t\t<label  for=\"field_1u7jz2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[646]\" id=\"field_1u7jz2-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9, \u03b5\u03af\u03bd\u03b1\u03b9 \u03c0\u03b1\u03c1\u03cc\u03bc\u03bf\u03b9\u03bf\"\n\t\t data-sectionid=\"642\"  data-reqmsg=\"Is your lunch the same on weekends? cannot be blank.\" data-invmsg=\"Is your lunch the same on weekends? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes, it is similar<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_647_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_8jb932\" id=\"field_8jb932_label\" class=\"frm_primary_label\">Please describe:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_8jb932\" name=\"item_meta[647]\" value=\"\"  data-sectionid=\"642\"  data-reqmsg=\"Please describe: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please describe: is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_649_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Describe your typical dinner<\/h3>\r\n\r\n\r\n<div id=\"frm_field_650_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_l8fz62_label\" class=\"frm_primary_label\">Do you usually eat dinner?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_650-649-0\">\t\t\t<label  for=\"field_l8fz62-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[650]\" id=\"field_l8fz62-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"649\"  data-reqmsg=\"Do you usually eat dinner? cannot be blank.\" data-invmsg=\"Do you usually eat dinner? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_650-649-1\">\t\t\t<label  for=\"field_l8fz62-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[650]\" id=\"field_l8fz62-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"649\"  data-reqmsg=\"Do you usually eat dinner? cannot be blank.\" data-invmsg=\"Do you usually eat dinner? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_651_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_eydbh2_label\" class=\"frm_primary_label\">Dinner preferences\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_651-649-0\">\t\t\t<label  for=\"field_eydbh2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[651][]\" id=\"field_eydbh2-0\" value=\"\u03a3\u03c0\u03b9\u03c4\u03b9\u03ba\u03cc (\u03c0.\u03c7. \u03bc\u03c0\u03c1\u03b9\u03b6\u03cc\u03bb\u03b1 \u03bc\u03b5 \u03bb\u03b1\u03c7\u03b1\u03bd\u03b9\u03ba\u03ac, \u03c8\u03ac\u03c1\u03b9 \u03c3\u03c4\u03bf \u03c6\u03bf\u03cd\u03c1\u03bd\u03bf, \u03bc\u03b1\u03b3\u03b5\u03b9\u03c1\u03b5\u03c5\u03c4\u03ac \u03c6\u03b1\u03b3\u03b7\u03c4\u03ac)\"  data-sectionid=\"649\"  data-reqmsg=\"Dinner preferences cannot be blank.\" data-invmsg=\"Dinner preferences is invalid\"   aria-required=\"true\"  \/> <div class=\"frm_label_button_container\">Homemade (eg steak with vegetables, baked fish, cooked meals)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_651-649-1\">\t\t\t<label  for=\"field_eydbh2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[651][]\" id=\"field_eydbh2-1\" value=\"\u0395\u03c3\u03c4\u03b9\u03b1\u03c4\u03cc\u03c1\u03b9\u03bf (\u03c0.\u03c7. \u03b3\u03b5\u03cd\u03bc\u03b1 \u03bc\u03b5 steakhouse, \u03b4\u03b5\u03af\u03c0\u03bd\u03bf \u03bc\u03b5 \u03c3\u03bf\u03cd\u03c3\u03b9, \u03c0\u03b9\u03ac\u03c4\u03bf \u03b6\u03c5\u03bc\u03b1\u03c1\u03b9\u03ba\u03ce\u03bd, \u03c0\u03b1\u03ba\u03ad\u03c4\u03bf)\"  data-sectionid=\"649\"  data-reqmsg=\"Dinner preferences cannot be blank.\" data-invmsg=\"Dinner preferences is invalid\"   \/> <div class=\"frm_label_button_container\">Restaurant (eg steakhouse meal, sushi dinner, pasta dish, takeaway)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_651-649-4\">\t\t\t<label  for=\"field_eydbh2-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[651][]\" id=\"field_eydbh2-4\" value=\"\u0393\u03c1\u03ae\u03b3\u03bf\u03c1\u03bf \u03b3\u03b5\u03cd\u03bc\u03b1 (\u03c0.\u03c7. \u03b2\u03c1\u03b1\u03c3\u03c4\u03ac \u03b1\u03c5\u03b3\u03ac, \u03bf\u03bc\u03b5\u03bb\u03ad\u03c4\u03b1, \u03c4\u03bf\u03c3\u03c4, \u03c3\u03c4\u03b9\u03b3\u03bc\u03b9\u03b1\u03af\u03b1 noodles, \u03c3\u03b1\u03bb\u03ac\u03c4\u03b1 \u03c4\u03cc\u03bd\u03bf\u03c5)\"  data-sectionid=\"649\"  data-reqmsg=\"Dinner preferences cannot be blank.\" data-invmsg=\"Dinner preferences is invalid\"   \/> <div class=\"frm_label_button_container\">Quick meal (eg boiled eggs, omelette, toast, instant noodles, tuna salad)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_651-649-5\">\t\t\t<label  for=\"field_eydbh2-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[651][]\" id=\"field_eydbh2-5\" value=\"\u0388\u03c4\u03bf\u03b9\u03bc\u03bf \u03b3\u03b5\u03cd\u03bc\u03b1 (\u03c0.\u03c7. \u03c5\u03c0\u03b7\u03c1\u03b5\u03c3\u03af\u03b5\u03c2 \u03c0\u03b1\u03c1\u03ac\u03b4\u03bf\u03c3\u03b7\u03c2 \u03b3\u03b5\u03c5\u03bc\u03ac\u03c4\u03c9\u03bd, \u03b3\u03b5\u03cd\u03bc\u03b1\u03c4\u03b1 \u03bc\u03b5 \u03b5\u03c4\u03b9\u03ba\u03ad\u03c4\u03b5\u03c2)\"  data-sectionid=\"649\"  data-reqmsg=\"Dinner preferences cannot be blank.\" data-invmsg=\"Dinner preferences is invalid\"   \/> <div class=\"frm_label_button_container\">Ready made meal (eg meal delivery services, labeled meals)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_651-649-3\">\t\t\t<label  for=\"field_eydbh2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[651][]\" id=\"field_eydbh2-3\" value=\"\u0386\u03bb\u03bb\u03bf\"  data-sectionid=\"649\"  data-reqmsg=\"Dinner preferences cannot be blank.\" data-invmsg=\"Dinner preferences is invalid\"   \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_652_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_tbv7s2\" id=\"field_tbv7s2_label\" class=\"frm_primary_label\">Describe your typical dinner\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_tbv7s2\" name=\"item_meta[652]\" value=\"\"  data-sectionid=\"649\"  data-reqmsg=\"Describe your typical dinner cannot be blank.\" aria-required=\"true\" data-invmsg=\"Describe your typical dinner is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_653_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_wuqpl2_label\" class=\"frm_primary_label\">Is your dinner the same on weekends?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_wuqpl2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_653-649-0\">\t\t\t<label  for=\"field_wuqpl2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[653]\" id=\"field_wuqpl2-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9, \u03b5\u03af\u03bd\u03b1\u03b9 \u03b4\u03b9\u03b1\u03c6\u03bf\u03c1\u03b5\u03c4\u03b9\u03ba\u03cc\"\n\t\t data-sectionid=\"649\"  data-reqmsg=\"Is your dinner the same on weekends? cannot be blank.\" data-invmsg=\"Is your dinner the same on weekends? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No, it is different<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_653-649-1\">\t\t\t<label  for=\"field_wuqpl2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[653]\" id=\"field_wuqpl2-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9, \u03b5\u03af\u03bd\u03b1\u03b9 \u03c0\u03b1\u03c1\u03cc\u03bc\u03bf\u03b9\u03bf\"\n\t\t data-sectionid=\"649\"  data-reqmsg=\"Is your dinner the same on weekends? cannot be blank.\" data-invmsg=\"Is your dinner the same on weekends? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes, it is similar<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_654_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_fspd32\" id=\"field_fspd32_label\" class=\"frm_primary_label\">Please describe:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_fspd32\" name=\"item_meta[654]\" value=\"\"  data-sectionid=\"649\"  data-reqmsg=\"Please describe: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please describe: is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_656_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Describe the snacks you usually eat. <\/h3>\r\n\r\n\r\n<div id=\"frm_field_657_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_z2lif_label\" class=\"frm_primary_label\">Do you usually eat snacks between meals?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_657-656-0\">\t\t\t<label  for=\"field_z2lif-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[657]\" id=\"field_z2lif-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"Do you usually eat snacks between meals? cannot be blank.\" data-invmsg=\"Do you usually eat snacks between meals? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_657-656-1\">\t\t\t<label  for=\"field_z2lif-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[657]\" id=\"field_z2lif-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"Do you usually eat snacks between meals? cannot be blank.\" data-invmsg=\"Do you usually eat snacks between meals? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_658_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 horizontal_radio frm_display_format_buttons frm_text_align_center\">\r\n\t<div  id=\"field_jb4uu2_label\" class=\"frm_primary_label\">How many snacks do you usually have per day?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_jb4uu2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-0\">\t\t\t<label  for=\"field_jb4uu2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-0\" value=\"1\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">1<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-1\">\t\t\t<label  for=\"field_jb4uu2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-1\" value=\"2\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">2<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-2\">\t\t\t<label  for=\"field_jb4uu2-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-2\" value=\"3\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">3<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-3\">\t\t\t<label  for=\"field_jb4uu2-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-3\" value=\"4\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">4<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-4\">\t\t\t<label  for=\"field_jb4uu2-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-4\" value=\"5\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">5<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-5\">\t\t\t<label  for=\"field_jb4uu2-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-5\" value=\"6\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">6<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-6\">\t\t\t<label  for=\"field_jb4uu2-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-6\" value=\"7\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">7<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-7\">\t\t\t<label  for=\"field_jb4uu2-7\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-7\" value=\"8\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">8<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-8\">\t\t\t<label  for=\"field_jb4uu2-8\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-8\" value=\"9\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">9<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_658-656-9\">\t\t\t<label  for=\"field_jb4uu2-9\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[658]\" id=\"field_jb4uu2-9\" value=\"10\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"How many snacks do you usually have per day? cannot be blank.\" data-invmsg=\"How many snacks do you usually have per day? is invalid\"   \/> <div class=\"frm_label_button_container\">10<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_659_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_y0trt\" id=\"field_y0trt_label\" class=\"frm_primary_label\">Describe the snacks you usually eat.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_y0trt\" name=\"item_meta[659]\" value=\"\"  data-sectionid=\"656\"  data-reqmsg=\"Describe the snacks you usually eat. cannot be blank.\" aria-required=\"true\" data-invmsg=\"Describe the snacks you usually eat. is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_660_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_np18p_label\" class=\"frm_primary_label\">Are your snacks the same on weekends?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_np18p_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_660-656-0\">\t\t\t<label  for=\"field_np18p-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[660]\" id=\"field_np18p-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9, \u03b5\u03af\u03bd\u03b1\u03b9 \u03b4\u03b9\u03b1\u03c6\u03bf\u03c1\u03b5\u03c4\u03b9\u03ba\u03ac\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"Are your snacks the same on weekends? cannot be blank.\" data-invmsg=\"Are your snacks the same on weekends? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No, it is different<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_660-656-1\">\t\t\t<label  for=\"field_np18p-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[660]\" id=\"field_np18p-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9, \u03b5\u03af\u03bd\u03b1\u03b9 \u03c0\u03b1\u03c1\u03cc\u03bc\u03bf\u03b9\u03b1\"\n\t\t data-sectionid=\"656\"  data-reqmsg=\"Are your snacks the same on weekends? cannot be blank.\" data-invmsg=\"Are your snacks the same on weekends? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes, it is similar<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_661_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_d0mk5\" id=\"field_d0mk5_label\" class=\"frm_primary_label\">Please describe:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_d0mk5\" name=\"item_meta[661]\" value=\"\"  data-sectionid=\"656\"  data-reqmsg=\"Please describe: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please describe: is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_663_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_v5osu_label\" class=\"frm_primary_label\">Do you add salt to your food?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_v5osu_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_663-1\">\t\t\t<label  for=\"field_v5osu-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[663]\" id=\"field_v5osu-1\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-reqmsg=\"Do you add salt to your food? cannot be blank.\" data-invmsg=\"Do you add salt to your food? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_663-0\">\t\t\t<label  for=\"field_v5osu-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[663]\" id=\"field_v5osu-0\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-reqmsg=\"Do you add salt to your food? cannot be blank.\" data-invmsg=\"Do you add salt to your food? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_663-2\">\t\t\t<label  for=\"field_v5osu-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[663]\" id=\"field_v5osu-2\" value=\"\u03a7\u03c9\u03c1\u03af\u03c2 \u03c0\u03c1\u03bf\u03c4\u03af\u03bc\u03b7\u03c3\u03b7\"\n\t\t data-reqmsg=\"Do you add salt to your food? cannot be blank.\" data-invmsg=\"Do you add salt to your food? is invalid\"   \/> <div class=\"frm_label_button_container\">No preference<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_664_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_jdqf2_label\" class=\"frm_primary_label\">What portion size do you usually eat?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_jdqf2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_664-0\">\t\t\t<label  for=\"field_jdqf2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[664]\" id=\"field_jdqf2-0\" value=\"\u039c\u03b9\u03ba\u03c1\u03ad\u03c2 \u03bc\u03b5\u03c1\u03af\u03b4\u03b5\u03c2\"\n\t\t data-reqmsg=\"What portion size do you usually eat? cannot be blank.\" data-invmsg=\"What portion size do you usually eat? is invalid\"   \/> <div class=\"frm_label_button_container\">Small portions<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_664-1\">\t\t\t<label  for=\"field_jdqf2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[664]\" id=\"field_jdqf2-1\" value=\"\u03a4\u03c5\u03c0\u03b9\u03ba\u03ad\u03c2 \u03bc\u03b5\u03c1\u03af\u03b4\u03b5\u03c2\"\n\t\t data-reqmsg=\"What portion size do you usually eat? cannot be blank.\" data-invmsg=\"What portion size do you usually eat? is invalid\"   \/> <div class=\"frm_label_button_container\">Standard portions<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_664-2\">\t\t\t<label  for=\"field_jdqf2-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[664]\" id=\"field_jdqf2-2\" value=\"\u039c\u03b5\u03b3\u03ac\u03bb\u03b5\u03c2 \u03bc\u03b5\u03c1\u03af\u03b4\u03b5\u03c2\"\n\t\t data-reqmsg=\"What portion size do you usually eat? cannot be blank.\" data-invmsg=\"What portion size do you usually eat? is invalid\"   \/> <div class=\"frm_label_button_container\">Large portions<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_665_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">How often do you eat sweets?<\/h3>\r\n\r\n\r\n<div id=\"frm_field_666_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_krryb_label\" class=\"frm_primary_label\">How often do you eat sweets?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_krryb_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_666-665-0\">\t\t\t<label  for=\"field_krryb-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[666]\" id=\"field_krryb-0\" value=\"\u03a0\u03bf\u03c4\u03ad\"\n\t\t data-sectionid=\"665\"  data-reqmsg=\"How often do you eat sweets? cannot be blank.\" data-invmsg=\"How often do you eat sweets? is invalid\"   \/> <div class=\"frm_label_button_container\">Never<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_666-665-1\">\t\t\t<label  for=\"field_krryb-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[666]\" id=\"field_krryb-1\" value=\"\u0395\u03bd\u03af\u03bf\u03c4\u03b5\"\n\t\t data-sectionid=\"665\"  data-reqmsg=\"How often do you eat sweets? cannot be blank.\" data-invmsg=\"How often do you eat sweets? is invalid\"   \/> <div class=\"frm_label_button_container\">Occasionally<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_666-665-2\">\t\t\t<label  for=\"field_krryb-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[666]\" id=\"field_krryb-2\" value=\"1-2 \u03c6\u03bf\u03c1\u03ad\u03c2 \u03c4\u03b7\u03bd \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1\"\n\t\t data-sectionid=\"665\"  data-reqmsg=\"How often do you eat sweets? cannot be blank.\" data-invmsg=\"How often do you eat sweets? is invalid\"   \/> <div class=\"frm_label_button_container\">1-2 times per week<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_666-665-3\">\t\t\t<label  for=\"field_krryb-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[666]\" id=\"field_krryb-3\" value=\"3-4 \u03c6\u03bf\u03c1\u03ad\u03c2 \u03c4\u03b7\u03bd \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1\"\n\t\t data-sectionid=\"665\"  data-reqmsg=\"How often do you eat sweets? cannot be blank.\" data-invmsg=\"How often do you eat sweets? is invalid\"   \/> <div class=\"frm_label_button_container\">3-4 times per week<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_666-665-4\">\t\t\t<label  for=\"field_krryb-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[666]\" id=\"field_krryb-4\" value=\"5-6 \u03c6\u03bf\u03c1\u03ad\u03c2 \u03c4\u03b7\u03bd \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1\"\n\t\t data-sectionid=\"665\"  data-reqmsg=\"How often do you eat sweets? cannot be blank.\" data-invmsg=\"How often do you eat sweets? is invalid\"   \/> <div class=\"frm_label_button_container\">5-6 times per week<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_666-665-5\">\t\t\t<label  for=\"field_krryb-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[666]\" id=\"field_krryb-5\" value=\"\u039a\u03b1\u03b8\u03b7\u03bc\u03b5\u03c1\u03b9\u03bd\u03ac\"\n\t\t data-sectionid=\"665\"  data-reqmsg=\"How often do you eat sweets? cannot be blank.\" data-invmsg=\"How often do you eat sweets? is invalid\"   \/> <div class=\"frm_label_button_container\">Daily<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_667_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_xtayv_label\" class=\"frm_primary_label\">What types of sweets do you usually choose?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_xtayv_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_667-665-0\">\t\t\t<label  for=\"field_xtayv-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[667][]\" id=\"field_xtayv-0\" value=\"\u03a0\u03b1\u03b3\u03c9\u03c4\u03cc\"  data-sectionid=\"665\"  data-reqmsg=\"What types of sweets do you usually choose? cannot be blank.\" data-invmsg=\"What types of sweets do you usually choose? is invalid\"   aria-required=\"true\"  \/> Ice cream<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_667-665-1\">\t\t\t<label  for=\"field_xtayv-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[667][]\" id=\"field_xtayv-1\" value=\"\u039c\u03b9\u03ba\u03c1\u03ac \u03b5\u03c0\u03b9\u03b4\u03cc\u03c1\u03c0\u03b9\u03b1 (\u03c0.\u03c7. \u03bc\u03c0\u03b9\u03c3\u03ba\u03cc\u03c4\u03b1, \u03ba\u03b1\u03c1\u03b1\u03bc\u03ad\u03bb\u03b5\u03c2)\"  data-sectionid=\"665\"  data-reqmsg=\"What types of sweets do you usually choose? cannot be blank.\" data-invmsg=\"What types of sweets do you usually choose? is invalid\"   \/> Small desserts (eg cookies, candies)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_667-665-2\">\t\t\t<label  for=\"field_xtayv-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[667][]\" id=\"field_xtayv-2\" value=\"\u0395\u03c0\u03b9\u03b4\u03cc\u03c1\u03c0\u03b9\u03b1 \u03c8\u03b7\u03bc\u03ad\u03bd\u03b1 \u03c3\u03b5 \u03c4\u03b1\u03c8\u03af\"  data-sectionid=\"665\"  data-reqmsg=\"What types of sweets do you usually choose? cannot be blank.\" data-invmsg=\"What types of sweets do you usually choose? is invalid\"   \/> Tray-baked desserts<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_667-665-3\">\t\t\t<label  for=\"field_xtayv-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[667][]\" id=\"field_xtayv-3\" value=\"\u03a3\u03bf\u03ba\u03bf\u03bb\u03ac\u03c4\u03b1\"  data-sectionid=\"665\"  data-reqmsg=\"What types of sweets do you usually choose? cannot be blank.\" data-invmsg=\"What types of sweets do you usually choose? is invalid\"   \/> Chocolate<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_667-665-4\">\t\t\t<label  for=\"field_xtayv-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[667][]\" id=\"field_xtayv-4\" value=\"\u039a\u03ad\u03b9\u03ba\"  data-sectionid=\"665\"  data-reqmsg=\"What types of sweets do you usually choose? cannot be blank.\" data-invmsg=\"What types of sweets do you usually choose? is invalid\"   \/> Cakes<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_667-665-5\">\t\t\t<label  for=\"field_xtayv-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[667][]\" id=\"field_xtayv-5\" value=\"\u0393\u03bb\u03c5\u03ba\u03ac \u03c4\u03bf\u03c5 \u03ba\u03bf\u03c5\u03c4\u03b1\u03bb\u03b9\u03bf\u03cd\"  data-sectionid=\"665\"  data-reqmsg=\"What types of sweets do you usually choose? cannot be blank.\" data-invmsg=\"What types of sweets do you usually choose? is invalid\"   \/> Spoon sweets<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_667-665-other_6\">\t\t\t<label  for=\"field_xtayv-other_6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[667][other_6]\" id=\"field_xtayv-other_6\" value=\"\u0386\u03bb\u03bb\u03bf\"  data-sectionid=\"665\"  data-reqmsg=\"What types of sweets do you usually choose? cannot be blank.\" data-invmsg=\"What types of sweets do you usually choose? is invalid\"   \/> Other<\/label><label for=\"field_xtayv-other_6-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_xtayv-other_6-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][667][other_6]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_668_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_yitn5_label\" class=\"frm_primary_label\">How many sweets do you usually consume?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_yitn5_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_668-665-0\">\t\t\t<label  for=\"field_yitn5-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[668]\" id=\"field_yitn5-0\" value=\"\u039b\u03af\u03b3\u03b1\"\n\t\t data-sectionid=\"665\"  data-reqmsg=\"How many sweets do you usually consume? cannot be blank.\" data-invmsg=\"How many sweets do you usually consume? is invalid\"   \/> <div class=\"frm_label_button_container\">Few<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_668-665-1\">\t\t\t<label  for=\"field_yitn5-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[668]\" id=\"field_yitn5-1\" value=\"\u039c\u03b5\u03c1\u03b9\u03ba\u03ac\"\n\t\t data-sectionid=\"665\"  data-reqmsg=\"How many sweets do you usually consume? cannot be blank.\" data-invmsg=\"How many sweets do you usually consume? is invalid\"   \/> <div class=\"frm_label_button_container\">Some<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_668-665-2\">\t\t\t<label  for=\"field_yitn5-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[668]\" id=\"field_yitn5-2\" value=\"\u03a0\u03bf\u03bb\u03bb\u03ac\"\n\t\t data-sectionid=\"665\"  data-reqmsg=\"How many sweets do you usually consume? cannot be blank.\" data-invmsg=\"How many sweets do you usually consume? is invalid\"   \/> <div class=\"frm_label_button_container\">Many<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_670_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Water<\/h3>\r\n\r\n\r\n<div id=\"frm_field_671_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_ka5wz_label\" class=\"frm_primary_label\">How much water do you drink per day?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ka5wz_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_671-670-0\">\t\t\t<label  for=\"field_ka5wz-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[671]\" id=\"field_ka5wz-0\" value=\"\u039a\u03b1\u03b8\u03cc\u03bb\u03bf\u03c5\"\n\t\t data-sectionid=\"670\"  data-reqmsg=\"How much water do you drink per day? cannot be blank.\" data-invmsg=\"How much water do you drink per day? is invalid\"   \/> <div class=\"frm_label_button_container\">None<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_671-670-1\">\t\t\t<label  for=\"field_ka5wz-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[671]\" id=\"field_ka5wz-1\" value=\"1\u20132 \u03c0\u03bf\u03c4\u03ae\u03c1\u03b9\u03b1\"\n\t\t data-sectionid=\"670\"  data-reqmsg=\"How much water do you drink per day? cannot be blank.\" data-invmsg=\"How much water do you drink per day? is invalid\"   \/> <div class=\"frm_label_button_container\">1\u20132 glasses<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_671-670-2\">\t\t\t<label  for=\"field_ka5wz-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[671]\" id=\"field_ka5wz-2\" value=\"3\u20134 \u03c0\u03bf\u03c4\u03ae\u03c1\u03b9\u03b1\"\n\t\t data-sectionid=\"670\"  data-reqmsg=\"How much water do you drink per day? cannot be blank.\" data-invmsg=\"How much water do you drink per day? is invalid\"   \/> <div class=\"frm_label_button_container\">3\u20134 glasses<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_671-670-3\">\t\t\t<label  for=\"field_ka5wz-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[671]\" id=\"field_ka5wz-3\" value=\"5\u20136 \u03c0\u03bf\u03c4\u03ae\u03c1\u03b9\u03b1\"\n\t\t data-sectionid=\"670\"  data-reqmsg=\"How much water do you drink per day? cannot be blank.\" data-invmsg=\"How much water do you drink per day? is invalid\"   \/> <div class=\"frm_label_button_container\">5\u20136 glasses<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_671-670-4\">\t\t\t<label  for=\"field_ka5wz-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[671]\" id=\"field_ka5wz-4\" value=\"7\u20138 \u03c0\u03bf\u03c4\u03ae\u03c1\u03b9\u03b1\"\n\t\t data-sectionid=\"670\"  data-reqmsg=\"How much water do you drink per day? cannot be blank.\" data-invmsg=\"How much water do you drink per day? is invalid\"   \/> <div class=\"frm_label_button_container\">7\u20138 glasses<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_671-670-5\">\t\t\t<label  for=\"field_ka5wz-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[671]\" id=\"field_ka5wz-5\" value=\"\u03a0\u03b5\u03c1\u03b9\u03c3\u03c3\u03cc\u03c4\u03b5\u03c1\u03b1 \u03b1\u03c0\u03cc 8 \u03c0\u03bf\u03c4\u03ae\u03c1\u03b9\u03b1\"\n\t\t data-sectionid=\"670\"  data-reqmsg=\"How much water do you drink per day? cannot be blank.\" data-invmsg=\"How much water do you drink per day? is invalid\"   \/> <div class=\"frm_label_button_container\">More than 8 glasses<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_673_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Caffeine<\/h3>\r\n\r\n\r\n<div id=\"frm_field_674_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_mmzzq_label\" class=\"frm_primary_label\">Do you drink coffee during the day?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_674-673-0\">\t\t\t<label  for=\"field_mmzzq-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[674]\" id=\"field_mmzzq-0\" value=\"\ud83d\udc4e \u039f\u03c7\u03b9\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you drink coffee during the day? cannot be blank.\" data-invmsg=\"Do you drink coffee during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_674-673-1\">\t\t\t<label  for=\"field_mmzzq-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[674]\" id=\"field_mmzzq-1\" value=\"\u0395\u03bd\u03af\u03bf\u03c4\u03b5\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you drink coffee during the day? cannot be blank.\" data-invmsg=\"Do you drink coffee during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">\u0395\u03bd\u03af\u03bf\u03c4\u03b5<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_674-673-2\">\t\t\t<label  for=\"field_mmzzq-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[674]\" id=\"field_mmzzq-2\" value=\"1 \u03b1\u03bd\u03ac \u03b7\u03bc\u03ad\u03c1\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you drink coffee during the day? cannot be blank.\" data-invmsg=\"Do you drink coffee during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">1 per day<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_674-673-3\">\t\t\t<label  for=\"field_mmzzq-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[674]\" id=\"field_mmzzq-3\" value=\"2 \u03b1\u03bd\u03ac \u03b7\u03bc\u03ad\u03c1\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you drink coffee during the day? cannot be blank.\" data-invmsg=\"Do you drink coffee during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">2 per day<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_674-673-4\">\t\t\t<label  for=\"field_mmzzq-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[674]\" id=\"field_mmzzq-4\" value=\"3 \u03b1\u03bd\u03ac \u03b7\u03bc\u03ad\u03c1\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you drink coffee during the day? cannot be blank.\" data-invmsg=\"Do you drink coffee during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">3 per day<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_674-673-5\">\t\t\t<label  for=\"field_mmzzq-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[674]\" id=\"field_mmzzq-5\" value=\"\u03a0\u03ac\u03bd\u03c9 \u03b1\u03c0\u03cc 3 \u03c4\u03b7\u03bd \u03b7\u03bc\u03ad\u03c1\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you drink coffee during the day? cannot be blank.\" data-invmsg=\"Do you drink coffee during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">More than 3 per day<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_675_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_e7znw_label\" class=\"frm_primary_label\">What type of coffee do you usually drink?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-0\">\t\t\t<label  for=\"field_e7znw-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-0\" value=\"\u0395\u03bb\u03bb\u03b7\u03bd\u03b9\u03ba\u03cc\u03c2\/\u03a4\u03bf\u03cd\u03c1\u03ba\u03b9\u03ba\u03bf\u03c2 \u03ba\u03b1\u03c6\u03ad\u03c2\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Greek\/ Turkish coffee<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-1\">\t\t\t<label  for=\"field_e7znw-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-1\" value=\"\u039a\u03b1\u03c6\u03ad\u03c2 \u03c6\u03af\u03bb\u03c4\u03c1\u03bf\u03c5\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Filter coffee<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-2\">\t\t\t<label  for=\"field_e7znw-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-2\" value=\"\u03a6\u03c1\u03b1\u03c0\u03ad\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Frappe coffee<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-3\">\t\t\t<label  for=\"field_e7znw-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-3\" value=\"\u0396\u03b5\u03c3\u03c4\u03cc\u03c2 \u03c3\u03c4\u03b9\u03b3\u03bc\u03b9\u03b1\u03af\u03bf\u03c2 \u03ba\u03b1\u03c6\u03ad\u03c2\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Hot instant coffee<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-4\">\t\t\t<label  for=\"field_e7znw-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-4\" value=\"Freddo espresso\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Iced espresso<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-5\">\t\t\t<label  for=\"field_e7znw-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-5\" value=\"Espresso\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Espresso<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-6\">\t\t\t<label  for=\"field_e7znw-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-6\" value=\"\u03a3\u03c4\u03b9\u03b3\u03bc\u03b9\u03b1\u03af\u03bf\u03c2 espresso\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Hot instant espresso<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-7\">\t\t\t<label  for=\"field_e7znw-7\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-7\" value=\"\u03a3\u03c4\u03b9\u03b3\u03bc\u03b9\u03b1\u03af\u03bf\u03c2 \u03c0\u03b1\u03b3\u03c9\u03bc\u03ad\u03bd\u03bf\u03c2 espresso\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Iced instant espresso<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-8\">\t\t\t<label  for=\"field_e7znw-8\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-8\" value=\"Cappuccino\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Cappuccino<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-9\">\t\t\t<label  for=\"field_e7znw-9\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-9\" value=\"\u03a0\u03b1\u03b3\u03c9\u03bc\u03ad\u03bd\u03bf cappuccino\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Iced cappuccino<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-10\">\t\t\t<label  for=\"field_e7znw-10\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-10\" value=\"Latte\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Latte<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-11\">\t\t\t<label  for=\"field_e7znw-11\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-11\" value=\"\u03a0\u03b1\u03b3\u03c9\u03bc\u03ad\u03bd\u03bf latte\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Iced latte<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-12\">\t\t\t<label  for=\"field_e7znw-12\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-12\" value=\"Flat white\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Flat white<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-13\">\t\t\t<label  for=\"field_e7znw-13\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-13\" value=\"Espresso macchiato\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Espresso macchiato<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-14\">\t\t\t<label  for=\"field_e7znw-14\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-14\" value=\"Iced espresso macchiato\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Iced espresso macchiato<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-15\">\t\t\t<label  for=\"field_e7znw-15\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-15\" value=\"Latte macchiato\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Latte macchiato<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-16\">\t\t\t<label  for=\"field_e7znw-16\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-16\" value=\"Iced latte macchiato\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Iced latte macchiato<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-17\">\t\t\t<label  for=\"field_e7znw-17\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-17\" value=\"Hot Americano\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Hot Americano<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-18\">\t\t\t<label  for=\"field_e7znw-18\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-18\" value=\"Iced Americano\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Iced Americano<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-19\">\t\t\t<label  for=\"field_e7znw-19\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-19\" value=\"Cold brew coffee\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Cold brew coffee<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-673-20\">\t\t\t<label  for=\"field_e7znw-20\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_e7znw-20\" value=\"\u0386\u03bb\u03bb\u03bf\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of coffee do you usually drink? cannot be blank.\" data-invmsg=\"What type of coffee do you usually drink? is invalid\"   \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_676_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_1hoi52\" id=\"field_1hoi52_label\" class=\"frm_primary_label\">Please specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_1hoi52\" name=\"item_meta[676]\" value=\"\"  data-sectionid=\"673\"  data-invmsg=\"Please specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_677_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_yrhpi_label\" class=\"frm_primary_label\">Does your coffee contain caffeine? \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_677-673-0\">\t\t\t<label  for=\"field_yrhpi-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[677]\" id=\"field_yrhpi-0\" value=\"\u039c\u03b5 \u03ba\u03b1\u03c6\u03b5\u0390\u03bd\u03b7\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Does your coffee contain caffeine?  cannot be blank.\" data-invmsg=\"Does your coffee contain caffeine?  is invalid\"   \/> <div class=\"frm_label_button_container\">With caffeine<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_677-673-1\">\t\t\t<label  for=\"field_yrhpi-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[677]\" id=\"field_yrhpi-1\" value=\"\u03a7\u03c9\u03c1\u03af\u03c2 \u03ba\u03b1\u03c6\u03b5\u0390\u03bd\u03b7 (\u03bd\u03c4\u03b5\u03ba\u03b1\u03c6\u03b5\u03ca\u03bd\u03ad)\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Does your coffee contain caffeine?  cannot be blank.\" data-invmsg=\"Does your coffee contain caffeine?  is invalid\"   \/> <div class=\"frm_label_button_container\">Without caffeine (decaf)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_677-673-2\">\t\t\t<label  for=\"field_yrhpi-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[677]\" id=\"field_yrhpi-2\" value=\"\u039a\u03b1\u03b9 \u03bf\u03b9 \u03b4\u03cd\u03bf\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Does your coffee contain caffeine?  cannot be blank.\" data-invmsg=\"Does your coffee contain caffeine?  is invalid\"   \/> <div class=\"frm_label_button_container\">Both<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_678_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_1rklu2_label\" class=\"frm_primary_label\">Do you add sugar \/ sweeteners to your coffee?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_678-673-0\">\t\t\t<label  for=\"field_1rklu2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[678]\" id=\"field_1rklu2-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you add sugar \/ sweeteners to your coffee? cannot be blank.\" data-invmsg=\"Do you add sugar \/ sweeteners to your coffee? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_678-673-1\">\t\t\t<label  for=\"field_1rklu2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[678]\" id=\"field_1rklu2-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you add sugar \/ sweeteners to your coffee? cannot be blank.\" data-invmsg=\"Do you add sugar \/ sweeteners to your coffee? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_679_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_other_container\">\r\n\t<div id=\"field_ihtn3_label\" class=\"frm_primary_label\">\u03a4\u03cd\u03c0\u03bf\u03c2 \u03b3\u03bb\u03c5\u03ba\u03b1\u03bd\u03c4\u03b9\u03ba\u03bf\u03cd:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_679-673-0\">\t\t\t<label  for=\"field_ihtn3-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[679]\" id=\"field_ihtn3-0\" value=\"\u0396\u03ac\u03c7\u03b1\u03c1\u03b7\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"\u03a4\u03cd\u03c0\u03bf\u03c2 \u03b3\u03bb\u03c5\u03ba\u03b1\u03bd\u03c4\u03b9\u03ba\u03bf\u03cd: cannot be blank.\" data-invmsg=\"\u03a4\u03cd\u03c0\u03bf\u03c2 \u03b3\u03bb\u03c5\u03ba\u03b1\u03bd\u03c4\u03b9\u03ba\u03bf\u03cd: is invalid\"   \/> Sugar<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_679-673-1\">\t\t\t<label  for=\"field_ihtn3-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[679]\" id=\"field_ihtn3-1\" value=\"\u03a3\u03b1\u03ba\u03c7\u03b1\u03c1\u03af\u03bd\u03b7\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"\u03a4\u03cd\u03c0\u03bf\u03c2 \u03b3\u03bb\u03c5\u03ba\u03b1\u03bd\u03c4\u03b9\u03ba\u03bf\u03cd: cannot be blank.\" data-invmsg=\"\u03a4\u03cd\u03c0\u03bf\u03c2 \u03b3\u03bb\u03c5\u03ba\u03b1\u03bd\u03c4\u03b9\u03ba\u03bf\u03cd: is invalid\"   \/> Saccharin<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_679-673-2\">\t\t\t<label  for=\"field_ihtn3-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[679]\" id=\"field_ihtn3-2\" value=\"\u03a3\u03c4\u03ad\u03b2\u03b9\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"\u03a4\u03cd\u03c0\u03bf\u03c2 \u03b3\u03bb\u03c5\u03ba\u03b1\u03bd\u03c4\u03b9\u03ba\u03bf\u03cd: cannot be blank.\" data-invmsg=\"\u03a4\u03cd\u03c0\u03bf\u03c2 \u03b3\u03bb\u03c5\u03ba\u03b1\u03bd\u03c4\u03b9\u03ba\u03bf\u03cd: is invalid\"   \/> Stevia<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_679-673-other_4\">\t\t\t<label  for=\"field_ihtn3-other_4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[679]\" id=\"field_ihtn3-other_4\" value=\"\u0386\u03bb\u03bb\u03bf\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"\u03a4\u03cd\u03c0\u03bf\u03c2 \u03b3\u03bb\u03c5\u03ba\u03b1\u03bd\u03c4\u03b9\u03ba\u03bf\u03cd: cannot be blank.\" data-invmsg=\"\u03a4\u03cd\u03c0\u03bf\u03c2 \u03b3\u03bb\u03c5\u03ba\u03b1\u03bd\u03c4\u03b9\u03ba\u03bf\u03cd: is invalid\"   \/> OtherOther<\/label><label for=\"field_ihtn3-other_4-otext\" class=\"frm_screen_reader frm_hidden\">OtherOther<\/label><input type=\"text\" id=\"field_ihtn3-other_4-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][679]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_680_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_ftty62\" id=\"field_ftty62_label\" class=\"frm_primary_label\">Quantity:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_ftty62\" name=\"item_meta[680]\" value=\"\"  data-sectionid=\"673\"  data-invmsg=\"Quantity: is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_681_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_center\">\r\n\t<div id=\"field_uhvpp_label\" class=\"frm_primary_label\">Do you add milk to your coffee?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_681-673-0\">\t\t\t<label  for=\"field_uhvpp-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[681]\" id=\"field_uhvpp-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you add milk to your coffee? cannot be blank.\" data-invmsg=\"Do you add milk to your coffee? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_681-673-1\">\t\t\t<label  for=\"field_uhvpp-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[681]\" id=\"field_uhvpp-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Do you add milk to your coffee? cannot be blank.\" data-invmsg=\"Do you add milk to your coffee? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_682_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_other_container\">\r\n\t<div id=\"field_c7rw0_label\" class=\"frm_primary_label\">Type of milk:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_682-673-0\">\t\t\t<label  for=\"field_c7rw0-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[682]\" id=\"field_c7rw0-0\" value=\"\u0393\u03ac\u03bb\u03b1 \u03bc\u03b7 \u03b1\u03c0\u03bf\u03b2\u03bf\u03c5\u03c4\u03c5\u03c1\u03c9\u03bc\u03ad\u03bd\u03bf\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Type of milk: cannot be blank.\" data-invmsg=\"Type of milk: is invalid\"   \/> Whole milk<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_682-673-1\">\t\t\t<label  for=\"field_c7rw0-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[682]\" id=\"field_c7rw0-1\" value=\"\u0397\u03bc\u03b9\u03b1\u03c0\u03bf\u03b2\u03bf\u03c5\u03c4\u03c5\u03c1\u03c9\u03bc\u03ad\u03bd\u03bf \u03b3\u03ac\u03bb\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Type of milk: cannot be blank.\" data-invmsg=\"Type of milk: is invalid\"   \/> Semi-skimmed milk<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_682-673-2\">\t\t\t<label  for=\"field_c7rw0-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[682]\" id=\"field_c7rw0-2\" value=\"\u0391\u03c0\u03bf\u03b2\u03bf\u03c5\u03c4\u03c5\u03c1\u03c9\u03bc\u03ad\u03bd\u03bf \u03b3\u03ac\u03bb\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Type of milk: cannot be blank.\" data-invmsg=\"Type of milk: is invalid\"   \/> Skimmed milk<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_682-673-3\">\t\t\t<label  for=\"field_c7rw0-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[682]\" id=\"field_c7rw0-3\" value=\"\u03a3\u03c5\u03bc\u03c0\u03c5\u03ba\u03bd\u03c9\u03bc\u03ad\u03bd\u03bf \u03b3\u03ac\u03bb\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Type of milk: cannot be blank.\" data-invmsg=\"Type of milk: is invalid\"   \/> Evaporated milk<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_682-673-4\">\t\t\t<label  for=\"field_c7rw0-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[682]\" id=\"field_c7rw0-4\" value=\"\u0393\u03ac\u03bb\u03b1 \u03c6\u03c5\u03c4\u03b9\u03ba\u03ae\u03c2 \u03c0\u03c1\u03bf\u03ad\u03bb\u03b5\u03c5\u03c3\u03b7\u03c2 (\u03c0.\u03c7. \u03b1\u03bc\u03c5\u03b3\u03b4\u03ac\u03bb\u03bf\u03c5, \u03c3\u03cc\u03b3\u03b9\u03b1\u03c2, \u03b2\u03c1\u03ce\u03bc\u03b7\u03c2)\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Type of milk: cannot be blank.\" data-invmsg=\"Type of milk: is invalid\"   \/> Plant-based milk (eg almond, soy, oat)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_682-673-5\">\t\t\t<label  for=\"field_c7rw0-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[682]\" id=\"field_c7rw0-5\" value=\"\u0394\u03b5\u03bd \u03b3\u03bd\u03c9\u03c1\u03af\u03b6\u03c9\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Type of milk: cannot be blank.\" data-invmsg=\"Type of milk: is invalid\"   \/> I don\u2019t know<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_682-673-other_6\">\t\t\t<label  for=\"field_c7rw0-other_6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[682]\" id=\"field_c7rw0-other_6\" value=\"\u0386\u03bb\u03bb\u03bf\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Type of milk: cannot be blank.\" data-invmsg=\"Type of milk: is invalid\"   \/> Other<\/label><label for=\"field_c7rw0-other_6-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_c7rw0-other_6-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][682]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_683_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_other_container\">\r\n\t<div id=\"field_vno89_label\" class=\"frm_primary_label\">Amount of milk:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_683-673-0\">\t\t\t<label  for=\"field_vno89-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[683]\" id=\"field_vno89-0\" value=\"\u039c\u03b9\u03ba\u03c1\u03ae \u03c0\u03bf\u03c3\u03cc\u03c4\u03b7\u03c4\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Amount of milk: cannot be blank.\" data-invmsg=\"Amount of milk: is invalid\"   \/> Small amount<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_683-673-1\">\t\t\t<label  for=\"field_vno89-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[683]\" id=\"field_vno89-1\" value=\"\u039c\u03ad\u03c4\u03c1\u03b9\u03b1 \u03c0\u03bf\u03c3\u03cc\u03c4\u03b7\u03c4\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Amount of milk: cannot be blank.\" data-invmsg=\"Amount of milk: is invalid\"   \/> Moderate amount<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_683-673-2\">\t\t\t<label  for=\"field_vno89-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[683]\" id=\"field_vno89-2\" value=\"\u039c\u03b5\u03b3\u03ac\u03bb\u03b7 \u03c0\u03bf\u03c3\u03cc\u03c4\u03b7\u03c4\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Amount of milk: cannot be blank.\" data-invmsg=\"Amount of milk: is invalid\"   \/> Large amount<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_683-673-3\">\t\t\t<label  for=\"field_vno89-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[683]\" id=\"field_vno89-3\" value=\"\u0394\u03b5\u03bd \u03b3\u03bd\u03c9\u03c1\u03af\u03b6\u03c9\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Amount of milk: cannot be blank.\" data-invmsg=\"Amount of milk: is invalid\"   \/> I don\u2019t know<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_683-673-other_6\">\t\t\t<label  for=\"field_vno89-other_6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[683]\" id=\"field_vno89-other_6\" value=\"\u0386\u03bb\u03bb\u03bf\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"Amount of milk: cannot be blank.\" data-invmsg=\"Amount of milk: is invalid\"   \/> OtherOther<\/label><label for=\"field_vno89-other_6-otext\" class=\"frm_screen_reader frm_hidden\">OtherOther<\/label><input type=\"text\" id=\"field_vno89-other_6-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][683]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_684_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_other_container\">\r\n\t<div id=\"field_gph9k_label\" class=\"frm_primary_label\">What type of milk does it usually contain? \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_684-673-0\">\t\t\t<label  for=\"field_gph9k-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[684]\" id=\"field_gph9k-0\" value=\"\u0393\u03ac\u03bb\u03b1 \u03bc\u03b7 \u03b1\u03c0\u03bf\u03b2\u03bf\u03c5\u03c4\u03c5\u03c1\u03c9\u03bc\u03ad\u03bd\u03bf\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of milk does it usually contain?  cannot be blank.\" data-invmsg=\"What type of milk does it usually contain?  is invalid\"   \/> Whole milk<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_684-673-1\">\t\t\t<label  for=\"field_gph9k-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[684]\" id=\"field_gph9k-1\" value=\"\u0397\u03bc\u03b9\u03b1\u03c0\u03bf\u03b2\u03bf\u03c5\u03c4\u03c5\u03c1\u03c9\u03bc\u03ad\u03bd\u03bf \u03b3\u03ac\u03bb\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of milk does it usually contain?  cannot be blank.\" data-invmsg=\"What type of milk does it usually contain?  is invalid\"   \/> Semi-skimmed milk<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_684-673-2\">\t\t\t<label  for=\"field_gph9k-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[684]\" id=\"field_gph9k-2\" value=\"\u0391\u03c0\u03bf\u03b2\u03bf\u03c5\u03c4\u03c5\u03c1\u03c9\u03bc\u03ad\u03bd\u03bf \u03b3\u03ac\u03bb\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of milk does it usually contain?  cannot be blank.\" data-invmsg=\"What type of milk does it usually contain?  is invalid\"   \/> Skimmed milk<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_684-673-3\">\t\t\t<label  for=\"field_gph9k-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[684]\" id=\"field_gph9k-3\" value=\"\u03a3\u03c5\u03bc\u03c0\u03c5\u03ba\u03bd\u03c9\u03bc\u03ad\u03bd\u03bf \u03b3\u03ac\u03bb\u03b1\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of milk does it usually contain?  cannot be blank.\" data-invmsg=\"What type of milk does it usually contain?  is invalid\"   \/> Evaporated milk<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_684-673-4\">\t\t\t<label  for=\"field_gph9k-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[684]\" id=\"field_gph9k-4\" value=\"\u0393\u03ac\u03bb\u03b1 \u03c6\u03c5\u03c4\u03b9\u03ba\u03ae\u03c2 \u03c0\u03c1\u03bf\u03ad\u03bb\u03b5\u03c5\u03c3\u03b7\u03c2 (\u03c0.\u03c7. \u03b1\u03bc\u03c5\u03b3\u03b4\u03ac\u03bb\u03bf\u03c5, \u03c3\u03cc\u03b3\u03b9\u03b1\u03c2, \u03b2\u03c1\u03ce\u03bc\u03b7\u03c2)\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of milk does it usually contain?  cannot be blank.\" data-invmsg=\"What type of milk does it usually contain?  is invalid\"   \/> \u0393\u03ac\u03bb\u03b1 \u03c6\u03c5\u03c4\u03b9\u03ba\u03ae\u03c2 \u03c0\u03c1\u03bf\u03ad\u03bb\u03b5\u03c5\u03c3\u03b7\u03c2 (\u03c0.\u03c7. \u03b1\u03bc\u03c5\u03b3\u03b4\u03ac\u03bb\u03bf\u03c5, \u03c3\u03cc\u03b3\u03b9\u03b1\u03c2, \u03b2\u03c1\u03ce\u03bc\u03b7\u03c2)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_684-673-5\">\t\t\t<label  for=\"field_gph9k-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[684]\" id=\"field_gph9k-5\" value=\"\u0394\u03b5\u03bd \u03b3\u03bd\u03c9\u03c1\u03af\u03b6\u03c9\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of milk does it usually contain?  cannot be blank.\" data-invmsg=\"What type of milk does it usually contain?  is invalid\"   \/> I don\u2019t know<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_684-673-other_6\">\t\t\t<label  for=\"field_gph9k-other_6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[684]\" id=\"field_gph9k-other_6\" value=\"\u0386\u03bb\u03bb\u03bf\"\n\t\t data-sectionid=\"673\"  data-reqmsg=\"What type of milk does it usually contain?  cannot be blank.\" data-invmsg=\"What type of milk does it usually contain?  is invalid\"   \/> Other<\/label><label for=\"field_gph9k-other_6-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_gph9k-other_6-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][684]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_686_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Beverages<\/h3>\r\n\r\n\r\n<div id=\"frm_field_687_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_750k9_label\" class=\"frm_primary_label\">Do you drink any other beverages?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_687-686-0\">\t\t\t<label  for=\"field_750k9-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[687]\" id=\"field_750k9-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"686\"  data-reqmsg=\"Do you drink any other beverages? cannot be blank.\" data-invmsg=\"Do you drink any other beverages? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_687-686-1\">\t\t\t<label  for=\"field_750k9-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[687]\" id=\"field_750k9-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"686\"  data-reqmsg=\"Do you drink any other beverages? cannot be blank.\" data-invmsg=\"Do you drink any other beverages? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yed<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_688_container\" class=\"frm_form_field form-field  frm_required_field frm_none_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_l36p7_label\" class=\"frm_primary_label\">\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_l36p7_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_688-686-0\">\t\t\t<label  for=\"field_l36p7-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[688][]\" id=\"field_l36p7-0\" value=\"\u0396\u03b1\u03c7\u03b1\u03c1\u03bf\u03cd\u03c7\u03b1 \u03b1\u03bd\u03b1\u03c8\u03c5\u03ba\u03c4\u03b9\u03ba\u03ac\"  data-sectionid=\"686\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This field is invalid\"   aria-required=\"true\"  \/> <div class=\"frm_label_button_container\">Sugary soft drinks<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_688-686-1\">\t\t\t<label  for=\"field_l36p7-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[688][]\" id=\"field_l36p7-1\" value=\"\u0391\u03bd\u03b1\u03c8\u03c5\u03ba\u03c4\u03b9\u03ba\u03ac \u03b4\u03b9\u03b1\u03af\u03c4\u03b7\u03c2\"  data-sectionid=\"686\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This field is invalid\"   \/> <div class=\"frm_label_button_container\">Diet soft drinks<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_688-686-2\">\t\t\t<label  for=\"field_l36p7-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[688][]\" id=\"field_l36p7-2\" value=\"\u03a6\u03c5\u03c4\u03b9\u03ba\u03ac \u03b1\u03c6\u03b5\u03c8\u03ae\u03bc\u03b1\u03c4\u03b1 (\u03c0.\u03c7. \u03c4\u03c3\u03ac\u03b9)\"  data-sectionid=\"686\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This field is invalid\"   \/> <div class=\"frm_label_button_container\">Herbal infusions (eg tea)<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_688-686-3\">\t\t\t<label  for=\"field_l36p7-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[688][]\" id=\"field_l36p7-3\" value=\"\u03a3\u03c5\u03c3\u03ba\u03b5\u03c5\u03b1\u03c3\u03bc\u03ad\u03bd\u03bf\u03b9 \u03c7\u03c5\u03bc\u03bf\u03af\"  data-sectionid=\"686\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This field is invalid\"   \/> <div class=\"frm_label_button_container\">Packaged juices<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_688-686-4\">\t\t\t<label  for=\"field_l36p7-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[688][]\" id=\"field_l36p7-4\" value=\"\u03a6\u03c1\u03ad\u03c3\u03ba\u03bf\u03b9 \u03c7\u03c5\u03bc\u03bf\u03af\"  data-sectionid=\"686\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This field is invalid\"   \/> <div class=\"frm_label_button_container\">Fresh juices<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_688-686-5\">\t\t\t<label  for=\"field_l36p7-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[688][]\" id=\"field_l36p7-5\" value=\"\u0386\u03bb\u03bb\u03bf\"  data-sectionid=\"686\"  data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"This field is invalid\"   \/> <div class=\"frm_label_button_container\">Other<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_689_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_t8xsc\" id=\"field_t8xsc_label\" class=\"frm_primary_label\">Please specify\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_t8xsc\" name=\"item_meta[689]\" value=\"\"  data-sectionid=\"686\"  data-invmsg=\"Please specify is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_691_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\">Alcohol<\/h3>\r\n\r\n\r\n<div id=\"frm_field_692_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_pq773_label\" class=\"frm_primary_label\">Do you consume alcohol?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_692-691-0\">\t\t\t<label  for=\"field_pq773-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[692]\" id=\"field_pq773-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"691\"  data-reqmsg=\"Do you consume alcohol? cannot be blank.\" data-invmsg=\"Do you consume alcohol? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_692-691-1\">\t\t\t<label  for=\"field_pq773-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[692]\" id=\"field_pq773-1\" value=\"\u0395\u03bd\u03af\u03bf\u03c4\u03b5\"\n\t\t data-sectionid=\"691\"  data-reqmsg=\"Do you consume alcohol? cannot be blank.\" data-invmsg=\"Do you consume alcohol? is invalid\"   \/> <div class=\"frm_label_button_container\">Occasionally<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_692-691-2\">\t\t\t<label  for=\"field_pq773-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[692]\" id=\"field_pq773-2\" value=\"1\u20132 \u03c6\u03bf\u03c1\u03ad\u03c2 \u03c4\u03b7\u03bd \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1\"\n\t\t data-sectionid=\"691\"  data-reqmsg=\"Do you consume alcohol? cannot be blank.\" data-invmsg=\"Do you consume alcohol? is invalid\"   \/> <div class=\"frm_label_button_container\">1\u20132 times per week<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_692-691-3\">\t\t\t<label  for=\"field_pq773-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[692]\" id=\"field_pq773-3\" value=\"3\u20134 \u03c6\u03bf\u03c1\u03ad\u03c2 \u03c4\u03b7\u03bd \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1\"\n\t\t data-sectionid=\"691\"  data-reqmsg=\"Do you consume alcohol? cannot be blank.\" data-invmsg=\"Do you consume alcohol? is invalid\"   \/> <div class=\"frm_label_button_container\">3\u20134 times per week<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_692-691-4\">\t\t\t<label  for=\"field_pq773-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[692]\" id=\"field_pq773-4\" value=\"\u039a\u03b1\u03b8\u03b7\u03bc\u03b5\u03c1\u03b9\u03bd\u03ac\"\n\t\t data-sectionid=\"691\"  data-reqmsg=\"Do you consume alcohol? cannot be blank.\" data-invmsg=\"Do you consume alcohol? is invalid\"   \/> <div class=\"frm_label_button_container\">Daily<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_693_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_43ydu_label\" class=\"frm_primary_label\">How much do you usually consume?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_693-691-0\">\t\t\t<label  for=\"field_43ydu-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[693]\" id=\"field_43ydu-0\" value=\"1 \u03c0\u03bf\u03c4\u03cc\"\n\t\t data-sectionid=\"691\"  data-reqmsg=\"How much do you usually consume? cannot be blank.\" data-invmsg=\"How much do you usually consume? is invalid\"   \/> <div class=\"frm_label_button_container\">1 drink<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_693-691-1\">\t\t\t<label  for=\"field_43ydu-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[693]\" id=\"field_43ydu-1\" value=\"2\u20133 \u03c0\u03bf\u03c4\u03ac\"\n\t\t data-sectionid=\"691\"  data-reqmsg=\"How much do you usually consume? cannot be blank.\" data-invmsg=\"How much do you usually consume? is invalid\"   \/> <div class=\"frm_label_button_container\">2\u20133 drinks<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_693-691-2\">\t\t\t<label  for=\"field_43ydu-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[693]\" id=\"field_43ydu-2\" value=\"4\u20136 \u03c0\u03bf\u03c4\u03ac\"\n\t\t data-sectionid=\"691\"  data-reqmsg=\"How much do you usually consume? cannot be blank.\" data-invmsg=\"How much do you usually consume? is invalid\"   \/> <div class=\"frm_label_button_container\">4\u20136 drinks<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_693-691-3\">\t\t\t<label  for=\"field_43ydu-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[693]\" id=\"field_43ydu-3\" value=\"\u03a0\u03b5\u03c1\u03b9\u03c3\u03c3\u03cc\u03c4\u03b5\u03c1\u03b1 \u03b1\u03c0\u03cc 6 \u03c0\u03bf\u03c4\u03ac\"\n\t\t data-sectionid=\"691\"  data-reqmsg=\"How much do you usually consume? cannot be blank.\" data-invmsg=\"How much do you usually consume? is invalid\"   \/> <div class=\"frm_label_button_container\">More than 6 drinks<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_694_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_a7y7n2\" id=\"field_a7y7n2_label\" class=\"frm_primary_label\">Type of alcohol you usually prefer (ex. wine, beer, vodka)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_a7y7n2\" name=\"item_meta[694]\" value=\"\"  data-sectionid=\"691\"  data-invmsg=\"Type of alcohol you usually prefer (ex. wine, beer, vodka) is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_696_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Physical activity &amp; lifestyle<\/h3>\r\n\r\n\r\n<div id=\"frm_field_697_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_v7kpz_label\" class=\"frm_primary_label\"> \u0397\u03bfw often do you exercise?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_697-696-0\">\t\t\t<label  for=\"field_v7kpz-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[697]\" id=\"field_v7kpz-0\" value=\"\u039a\u03b1\u03b8\u03b9\u03c3\u03c4\u03b9\u03ba\u03cc\u03c2 \u03c4\u03c1\u03cc\u03c0\u03bf\u03c2 \u03b6\u03c9\u03ae\u03c2 (\u03c7\u03c9\u03c1\u03af\u03c2 \u03b4\u03bf\u03bc\u03b7\u03bc\u03ad\u03bd\u03b7 \u03ac\u03c3\u03ba\u03b7\u03c3\u03b7)\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\" \u0397\u03bfw often do you exercise? cannot be blank.\" data-invmsg=\" \u0397\u03bfw often do you exercise? is invalid\"   \/> <div class=\"frm_label_button_container\">Sedentary lifestyle (no structured exercise)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_697-696-1\">\t\t\t<label  for=\"field_v7kpz-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[697]\" id=\"field_v7kpz-1\" value=\"\u0395\u03bb\u03b1\u03c6\u03c1\u03ce\u03c2 \u03b5\u03bd\u03b5\u03c1\u03b3\u03cc\u03c2\/\u03b7 (1-2 \u03c0\u03c1\u03bf\u03c0\u03bf\u03bd\u03ae\u03c3\u03b5\u03b9\u03c2 \u03c4\u03b7\u03bd \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\" \u0397\u03bfw often do you exercise? cannot be blank.\" data-invmsg=\" \u0397\u03bfw often do you exercise? is invalid\"   \/> <div class=\"frm_label_button_container\">Lightly active(1\u20132 workouts per week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_697-696-2\">\t\t\t<label  for=\"field_v7kpz-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[697]\" id=\"field_v7kpz-2\" value=\"\u039c\u03ad\u03c4\u03c1\u03b9\u03b1 \u03b4\u03c1\u03b1\u03c3\u03c4\u03b7\u03c1\u03b9\u03cc\u03c4\u03b7\u03c4\u03b1 (3-4 \u03c0\u03c1\u03bf\u03c0\u03bf\u03bd\u03ae\u03c3\u03b5\u03b9\u03c2 \u03c4\u03b7\u03bd \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\" \u0397\u03bfw often do you exercise? cannot be blank.\" data-invmsg=\" \u0397\u03bfw often do you exercise? is invalid\"   \/> <div class=\"frm_label_button_container\">Moderately active (3\u20134 workouts per week)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_697-696-3\">\t\t\t<label  for=\"field_v7kpz-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[697]\" id=\"field_v7kpz-3\" value=\"\u03a0\u03bf\u03bb\u03cd \u03b4\u03c1\u03b1\u03c3\u03c4\u03ae\u03c1\u03b9\u03bf\u03c2\/\u03b1 (5+ \u03c0\u03c1\u03bf\u03c0\u03bf\u03bd\u03ae\u03c3\u03b5\u03b9\u03c2 \u03c4\u03b7\u03bd \u03b5\u03b2\u03b4\u03bf\u03bc\u03ac\u03b4\u03b1)\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\" \u0397\u03bfw often do you exercise? cannot be blank.\" data-invmsg=\" \u0397\u03bfw often do you exercise? is invalid\"   \/> <div class=\"frm_label_button_container\">Very active (5+ workouts per week)<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_698_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_usg2k_label\" class=\"frm_primary_label\">How active are you during the day?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_698-696-0\">\t\t\t<label  for=\"field_usg2k-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[698]\" id=\"field_usg2k-0\" value=\"\u039a\u03c5\u03c1\u03af\u03c9\u03c2 \u03ba\u03b1\u03b8\u03b9\u03c3\u03c4\u03ae (\u03b5\u03c1\u03b3\u03b1\u03c3\u03af\u03b1 \u03b3\u03c1\u03b1\u03c6\u03b5\u03af\u03bf\u03c5, \u03b5\u03bb\u03ac\u03c7\u03b9\u03c3\u03c4\u03b7 \u03ba\u03af\u03bd\u03b7\u03c3\u03b7)\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How active are you during the day? cannot be blank.\" data-invmsg=\"How active are you during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">Mostly sitting (desk work, minimal movement)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_698-696-1\">\t\t\t<label  for=\"field_usg2k-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[698]\" id=\"field_usg2k-1\" value=\"\u0395\u03bb\u03b1\u03c6\u03c1\u03b9\u03ac \u03ba\u03af\u03bd\u03b7\u03c3\u03b7 (\u03bb\u03af\u03b3\u03bf \u03c0\u03b5\u03c1\u03c0\u03ac\u03c4\u03b7\u03bc\u03b1 \u03ae \u03bf\u03c1\u03b8\u03bf\u03c3\u03c4\u03b1\u03c3\u03af\u03b1 \u03ba\u03b1\u03c4\u03ac \u03c4\u03b7 \u03b4\u03b9\u03ac\u03c1\u03ba\u03b5\u03b9\u03b1 \u03c4\u03b7\u03c2 \u03b7\u03bc\u03ad\u03c1\u03b1\u03c2)\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How active are you during the day? cannot be blank.\" data-invmsg=\"How active are you during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">Light movement (some walking or standing during the day)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_698-696-2\">\t\t\t<label  for=\"field_usg2k-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[698]\" id=\"field_usg2k-2\" value=\"\u0395\u03bd\u03b5\u03c1\u03b3\u03ae \u03b5\u03c1\u03b3\u03b1\u03c3\u03af\u03b1 (\u03cc\u03c1\u03b8\u03b9\u03b1 \u03c3\u03c4\u03ac\u03c3\u03b7 \u03ae \u03c0\u03b5\u03c1\u03c0\u03ac\u03c4\u03b7\u03bc\u03b1 \u03c4\u03bf \u03bc\u03b5\u03b3\u03b1\u03bb\u03cd\u03c4\u03b5\u03c1\u03bf \u03bc\u03ad\u03c1\u03bf\u03c2 \u03c4\u03b7\u03c2 \u03b7\u03bc\u03ad\u03c1\u03b1\u03c2)\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How active are you during the day? cannot be blank.\" data-invmsg=\"How active are you during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">Active job (standing or walking most of the day)<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_698-696-3\">\t\t\t<label  for=\"field_usg2k-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[698]\" id=\"field_usg2k-3\" value=\"\u03a3\u03c9\u03bc\u03b1\u03c4\u03b9\u03ba\u03ac \u03b1\u03c0\u03b1\u03b9\u03c4\u03b7\u03c4\u03b9\u03ba\u03ae \u03b5\u03c1\u03b3\u03b1\u03c3\u03af\u03b1 (\u03c7\u03b5\u03b9\u03c1\u03c9\u03bd\u03b1\u03ba\u03c4\u03b9\u03ba\u03ae \u03b5\u03c1\u03b3\u03b1\u03c3\u03af\u03b1, \u03ba\u03b1\u03c4\u03b1\u03c3\u03ba\u03b5\u03c5\u03ad\u03c2, \u03b1\u03bd\u03cd\u03c8\u03c9\u03c3\u03b7 \u03b2\u03b1\u03c1\u03ad\u03c9\u03bd \u03b1\u03bd\u03c4\u03b9\u03ba\u03b5\u03b9\u03bc\u03ad\u03bd\u03c9\u03bd)\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How active are you during the day? cannot be blank.\" data-invmsg=\"How active are you during the day? is invalid\"   \/> <div class=\"frm_label_button_container\">Physically demanding (manual labor, construction, heavy lifting)<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_699_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_d4xdw_label\" class=\"frm_primary_label\">Do You Smoke?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_699-696-0\">\t\t\t<label  for=\"field_d4xdw-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[699]\" id=\"field_d4xdw-0\" value=\"\ud83d\udc4e \u038c\u03c7\u03b9\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"Do You Smoke? cannot be blank.\" data-invmsg=\"Do You Smoke? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4e No<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_699-696-1\">\t\t\t<label  for=\"field_d4xdw-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[699]\" id=\"field_d4xdw-1\" value=\"\ud83d\udc4d \u039d\u03b1\u03b9\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"Do You Smoke? cannot be blank.\" data-invmsg=\"Do You Smoke? is invalid\"   \/> <div class=\"frm_label_button_container\">\ud83d\udc4d Yes<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_700_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_c4o2h\" id=\"field_c4o2h_label\" class=\"frm_primary_label\">How many years have you been smoking?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_c4o2h\" name=\"item_meta[700]\" value=\"\" data-sectionid=\"696\"  data-reqmsg=\"How many years have you been smoking? cannot be blank.\" aria-required=\"true\" data-invmsg=\"How many years have you been smoking? is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"100\" step=\"1\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_701_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n\t<label for=\"field_6dh2o\" id=\"field_6dh2o_label\" class=\"frm_primary_label\">Number of cigarettes per day:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_6dh2o\" name=\"item_meta[701]\" value=\"\" data-sectionid=\"696\"  data-reqmsg=\"Number of cigarettes per day: cannot be blank.\" aria-required=\"true\" data-invmsg=\"Number of cigarettes per day: is invalid\" aria-invalid=\"false\"   min=\"1\" max=\"100\" step=\"1\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_702_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_cvo6o_label\" class=\"frm_primary_label\">How many hours do you usually sleep per night?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_702-696-0\">\t\t\t<label  for=\"field_cvo6o-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[702]\" id=\"field_cvo6o-0\" value=\"\u039b\u03b9\u03b3\u03cc\u03c4\u03b5\u03c1\u03bf \u03b1\u03c0\u03cc 6 \u03ce\u03c1\u03b5\u03c2\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How many hours do you usually sleep per night? cannot be blank.\" data-invmsg=\"How many hours do you usually sleep per night? is invalid\"   \/> <div class=\"frm_label_button_container\">Less than 6 hours<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_702-696-1\">\t\t\t<label  for=\"field_cvo6o-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[702]\" id=\"field_cvo6o-1\" value=\"6\u20138 \u03ce\u03c1\u03b5\u03c2\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How many hours do you usually sleep per night? cannot be blank.\" data-invmsg=\"How many hours do you usually sleep per night? is invalid\"   \/> <div class=\"frm_label_button_container\">6\u20138 hours<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_702-696-2\">\t\t\t<label  for=\"field_cvo6o-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[702]\" id=\"field_cvo6o-2\" value=\"\u03a0\u03ac\u03bd\u03c9 \u03b1\u03c0\u03cc 8 \u03ce\u03c1\u03b5\u03c2\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How many hours do you usually sleep per night? cannot be blank.\" data-invmsg=\"How many hours do you usually sleep per night? is invalid\"   \/> <div class=\"frm_label_button_container\">More than 8 hours<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_702-696-3\">\t\t\t<label  for=\"field_cvo6o-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[702]\" id=\"field_cvo6o-3\" value=\"\u0394\u03b5\u03bd \u03b3\u03bd\u03c9\u03c1\u03af\u03b6\u03c9\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How many hours do you usually sleep per night? cannot be blank.\" data-invmsg=\"How many hours do you usually sleep per night? is invalid\"   \/> <div class=\"frm_label_button_container\">I don\u2019t know<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_703_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div id=\"field_430qu_label\" class=\"frm_primary_label\">How would you rate your sleep quality?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_703-696-0\">\t\t\t<label  for=\"field_430qu-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[703]\" id=\"field_430qu-0\" value=\"\u039a\u03b1\u03bb\u03ae\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How would you rate your sleep quality? cannot be blank.\" data-invmsg=\"How would you rate your sleep quality? is invalid\"   \/> <div class=\"frm_label_button_container\">Good<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_703-696-1\">\t\t\t<label  for=\"field_430qu-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[703]\" id=\"field_430qu-1\" value=\"\u039c\u03ad\u03c4\u03c1\u03b9\u03b1\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How would you rate your sleep quality? cannot be blank.\" data-invmsg=\"How would you rate your sleep quality? is invalid\"   \/> <div class=\"frm_label_button_container\">Fair<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_703-696-2\">\t\t\t<label  for=\"field_430qu-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[703]\" id=\"field_430qu-2\" value=\"\u039a\u03b1\u03ba\u03ae\"\n\t\t data-sectionid=\"696\"  data-reqmsg=\"How would you rate your sleep quality? cannot be blank.\" data-invmsg=\"How would you rate your sleep quality? is invalid\"   \/> <div class=\"frm_label_button_container\">Poor<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_705_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Submit questionnaire<\/h3>\r\n\r\n\r\n<div id=\"frm_field_706_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_62d6y\" id=\"field_62d6y_label\" class=\"frm_primary_label\">Is there anything else you would like your dietitian to know?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[706]\" id=\"field_62d6y\" rows=\"5\"  data-sectionid=\"705\"  data-invmsg=\"Is there anything else you would like your dietitian to know? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_707_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_ckhhn2_label\" class=\"frm_primary_label\">Consent &amp; Declaration\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ckhhn2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_707-705-3\">\t\t\t<label  for=\"field_ckhhn2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[707][]\" id=\"field_ckhhn2-3\" value=\"\u0395\u03c0\u03b9\u03b2\u03b5\u03b2\u03b1\u03b9\u03ce\u03bd\u03c9 \u03cc\u03c4\u03b9 \u03bf\u03b9 \u03c0\u03bb\u03b7\u03c1\u03bf\u03c6\u03bf\u03c1\u03af\u03b5\u03c2 \u03c0\u03bf\u03c5 \u03ad\u03c7\u03c9 \u03c0\u03b1\u03c1\u03ac\u03c3\u03c7\u03b5\u03b9 \u03b5\u03af\u03bd\u03b1\u03b9 \u03b1\u03bb\u03b7\u03b8\u03b5\u03af\u03c2, \u03c0\u03bb\u03ae\u03c1\u03b5\u03b9\u03c2 \u03ba\u03b1\u03b9 \u03b1\u03ba\u03c1\u03b9\u03b2\u03b5\u03af\u03c2.\"  data-sectionid=\"705\"  data-reqmsg=\"Consent &amp; Declaration cannot be blank.\" data-invmsg=\"Consent &amp; Declaration is invalid\"   aria-required=\"true\"  \/> I confirm that the information I have provided is true, complete and accurate.<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_707-705-1\">\t\t\t<label  for=\"field_ckhhn2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[707][]\" id=\"field_ckhhn2-1\" value=\"\u0395\u03c0\u03b9\u03b2\u03b5\u03b2\u03b1\u03b9\u03ce\u03bd\u03c9 \u03cc\u03c4\u03b9 \u03ad\u03c7\u03c9 \u03b4\u03b9\u03b1\u03b2\u03ac\u03c3\u03b5\u03b9 \u03ba\u03b1\u03b9 \u03c3\u03c5\u03bc\u03c6\u03c9\u03bd\u03ce \u03bc\u03b5 \u03c4\u03b7\u03bd \u03a0\u03bf\u03bb\u03b9\u03c4\u03b9\u03ba\u03ae \u0391\u03c0\u03bf\u03c1\u03c1\u03ae\u03c4\u03bf\u03c5 \u03ba\u03b1\u03b9 \u03c4\u03bf\u03c5\u03c2 \u038c\u03c1\u03bf\u03c5\u03c2 \u03a7\u03c1\u03ae\u03c3\u03b7\u03c2.\"  data-sectionid=\"705\"  data-reqmsg=\"Consent &amp; Declaration cannot be blank.\" data-invmsg=\"Consent &amp; Declaration is invalid\"   \/> I confirm that I have read and agree to the Privacy Policy and Terms of Use.<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_707-705-2\">\t\t\t<label  for=\"field_ckhhn2-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[707][]\" id=\"field_ckhhn2-2\" value=\"\u03a3\u03c5\u03bd\u03b1\u03b9\u03bd\u03ce \u03c3\u03c4\u03b7 \u03c3\u03c5\u03bb\u03bb\u03bf\u03b3\u03ae, \u03c4\u03b7\u03bd \u03b1\u03bd\u03b1\u03b8\u03b5\u03ce\u03c1\u03b7\u03c3\u03b7 \u03ba\u03b1\u03b9 \u03c4\u03b7\u03bd \u03b5\u03c0\u03b5\u03be\u03b5\u03c1\u03b3\u03b1\u03c3\u03af\u03b1 \u03c4\u03c9\u03bd \u03c0\u03bb\u03b7\u03c1\u03bf\u03c6\u03bf\u03c1\u03b9\u03ce\u03bd \u03c5\u03b3\u03b5\u03af\u03b1\u03c2 \u03ba\u03b1\u03b9 \u03c4\u03c9\u03bd \u03c0\u03c1\u03bf\u03c3\u03c9\u03c0\u03b9\u03ba\u03ce\u03bd \u03c0\u03bb\u03b7\u03c1\u03bf\u03c6\u03bf\u03c1\u03b9\u03ce\u03bd \u03c0\u03bf\u03c5 \u03c0\u03b1\u03c1\u03ad\u03c7\u03c9 \u03b3\u03b9\u03b1 \u03c4\u03bf\u03bd \u03c3\u03ba\u03bf\u03c0\u03cc \u03c4\u03b7\u03c2 \u03b4\u03b9\u03b1\u03c4\u03c1\u03bf\u03c6\u03b9\u03ba\u03ae\u03c2 \u03b1\u03be\u03b9\u03bf\u03bb\u03cc\u03b3\u03b7\u03c3\u03b7\u03c2, \u03c4\u03b7\u03c2 \u03c0\u03b1\u03c1\u03bf\u03c7\u03ae\u03c2 \u03c5\u03c0\u03b7\u03c1\u03b5\u03c3\u03b9\u03ce\u03bd \u03ba\u03b1\u03b9 \u03c4\u03b7\u03c2 \u03c3\u03c5\u03bd\u03b5\u03c7\u03bf\u03cd\u03c2 \u03c5\u03c0\u03bf\u03c3\u03c4\u03ae\u03c1\u03b9\u03be\u03b7\u03c2, \u03c3\u03cd\u03bc\u03c6\u03c9\u03bd\u03b1 \u03bc\u03b5 \u03c4\u03b7\u03bd \u03a0\u03bf\u03bb\u03b9\u03c4\u03b9\u03ba\u03ae \u0391\u03c0\u03bf\u03c1\u03c1\u03ae\u03c4\u03bf\u03c5 \u03ba\u03b1\u03b9 \u03c4\u03bf\u03c5\u03c2 \u03b9\u03c3\u03c7\u03cd\u03bf\u03bd\u03c4\u03b5\u03c2 \u03bd\u03cc\u03bc\u03bf\u03c5\u03c2 \u03c0\u03b5\u03c1\u03af \u03c0\u03c1\u03bf\u03c3\u03c4\u03b1\u03c3\u03af\u03b1\u03c2 \u03b4\u03b5\u03b4\u03bf\u03bc\u03ad\u03bd\u03c9\u03bd.\"  data-sectionid=\"705\"  data-reqmsg=\"Consent &amp; Declaration cannot be blank.\" data-invmsg=\"Consent &amp; Declaration is invalid\"   \/> I consent to the collection, review, and processing of the health and personal information I provide for the purpose of nutritional evaluation, service delivery, and ongoing support, in accordance with the Privacy Policy and applicable data protection laws.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_709_container\" class=\"frm_form_field form-field  frm12 frm_first\">\r\n\t<div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_733_container\">\n\t\t\t<label for=\"field_10ghy\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_10ghy\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[733]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"3O1qGQZ\/mWS+YHpt3jwzh0dms2Uu67F0JrgCCq\/x8+mbIjB4igzraIrbdODujfkL\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n<\/div>\n<p><!--more--><br \/>\n<!-- 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