{"id":1317,"date":"2026-08-20T18:01:59","date_gmt":"2026-08-20T18:01:59","guid":{"rendered":"https:\/\/chipolahealthystart.org\/?page_id=1317"},"modified":"2026-08-20T18:02:44","modified_gmt":"2026-08-20T18:02:44","slug":"satisfaction-survey","status":"publish","type":"page","link":"https:\/\/chipolahealthystart.org\/index.php\/satisfaction-survey\/","title":{"rendered":"Satisfaction Survey"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1317\" class=\"elementor elementor-1317\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f6d0b20 e-flex e-con-boxed e-con e-parent\" data-id=\"f6d0b20\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8a7b38c fluent-form-widget-step-header-yes fluent-form-widget-step-progressbar-yes fluentform-widget-submit-button-custom elementor-widget elementor-widget-fluent-form-widget\" data-id=\"8a7b38c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"fluent-form-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n            <div class=\"fluentform-widget-wrapper fluentform-widget-align-default\">\n\n            \n            <div class='fluentform ff-default fluentform_wrapper_7 ffs_default_wrap'><form data-form_id=\"7\" id=\"fluentform_7\" class=\"frm-fluent-form fluent_form_7 ff-el-form-top ff_form_instance_7_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_7_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Satisfaction Survey<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='1317' \/><input type=\"hidden\" id=\"_fluentform_7_fluentformnonce\" name=\"_fluentform_7_fluentformnonce\" value=\"2e45dbdd7c\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1317\" \/><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-7_1\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p>Please score the following questions 1-5, 1 being <strong>Strongly disagree<\/strong> and 5 being\u00a0<strong>Strongly agree.<\/strong><strong><br \/><\/strong><\/p><\/div><hr \/><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >You were offered an appointment time convenient for you.<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_625097d562b79f37625a453b504b0d8b'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"1\"  id='checkbox_625097d562b79f37625a453b504b0d8b' aria-label='1' aria-invalid='false' aria-required=true> <span>1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_33e73128d19e938bb3d4be4388e812ae'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"2\"  id='checkbox_33e73128d19e938bb3d4be4388e812ae' aria-label='2' aria-invalid='false' aria-required=true> <span>2<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_c159fdb1fc5b2a5e30766881a93ec9fe'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"3\"  id='checkbox_c159fdb1fc5b2a5e30766881a93ec9fe' aria-label='3' aria-invalid='false' aria-required=true> <span>3<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_8ba9d2b9adfc726474bff931591a53f3'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"4\"  id='checkbox_8ba9d2b9adfc726474bff931591a53f3' aria-label='4' aria-invalid='false' aria-required=true> <span>4<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6cf7ea624cc69fa9437bb4e8f1204dd2'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"5\"  id='checkbox_6cf7ea624cc69fa9437bb4e8f1204dd2' aria-label='5' aria-invalid='false' aria-required=true> <span>5<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >The Heathy Start Care Coordinator provided me helpful information.<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_385a386a6838fde68d65826436d9bd36'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"1\"  id='checkbox_1_385a386a6838fde68d65826436d9bd36' aria-label='1' aria-invalid='false' aria-required=true> <span>1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_e1da64c965ab2d9cb9364e5f2ced5b81'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"2\"  id='checkbox_1_e1da64c965ab2d9cb9364e5f2ced5b81' aria-label='2' aria-invalid='false' aria-required=true> <span>2<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_a14047ad87a5c9ca111ebccadf7c6c0d'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"3\"  id='checkbox_1_a14047ad87a5c9ca111ebccadf7c6c0d' aria-label='3' aria-invalid='false' aria-required=true> <span>3<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_15f928eaf4e9c67f8eaf0d419ff1556c'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"4\"  id='checkbox_1_15f928eaf4e9c67f8eaf0d419ff1556c' aria-label='4' aria-invalid='false' aria-required=true> <span>4<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_ee6df188474bd794958d293dce5fbdbd'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"5\"  id='checkbox_1_ee6df188474bd794958d293dce5fbdbd' aria-label='5' aria-invalid='false' aria-required=true> <span>5<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >I felt comfortable sharing my concerns with the Healthy Start Care  Coordinator.<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_721510bd1b790dd7f8abca5f6da93dde'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"1\"  id='checkbox_2_721510bd1b790dd7f8abca5f6da93dde' aria-label='1' aria-invalid='false' aria-required=true> <span>1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_a48cc0c98fbbedb63a03bba210788c9e'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"2\"  id='checkbox_2_a48cc0c98fbbedb63a03bba210788c9e' aria-label='2' aria-invalid='false' aria-required=true> <span>2<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_d5ccf68fe81c01d9179e96f90b764f7b'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"3\"  id='checkbox_2_d5ccf68fe81c01d9179e96f90b764f7b' aria-label='3' aria-invalid='false' aria-required=true> <span>3<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_5a4dba969e83a8e05333120baf46f342'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"4\"  id='checkbox_2_5a4dba969e83a8e05333120baf46f342' aria-label='4' aria-invalid='false' aria-required=true> <span>4<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_23933b92a75a082cef0af147af3ffed9'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"5\"  id='checkbox_2_23933b92a75a082cef0af147af3ffed9' aria-label='5' aria-invalid='false' aria-required=true> <span>5<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >The Care Coordinator was friendly and supportive.<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_74aeefff37fb09f93e38cf1da864e71d'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"1\"  id='checkbox_3_74aeefff37fb09f93e38cf1da864e71d' aria-label='1' aria-invalid='false' aria-required=true> <span>1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_ea3affbb6167d4a8235c74bb3f087e66'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"2\"  id='checkbox_3_ea3affbb6167d4a8235c74bb3f087e66' aria-label='2' aria-invalid='false' aria-required=true> <span>2<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_d16141d4d73d1133bb06e8997e4854ff'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"3\"  id='checkbox_3_d16141d4d73d1133bb06e8997e4854ff' aria-label='3' aria-invalid='false' aria-required=true> <span>3<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_a1e394a72289ac29ad320bc9f2ef1ed0'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"4\"  id='checkbox_3_a1e394a72289ac29ad320bc9f2ef1ed0' aria-label='4' aria-invalid='false' aria-required=true> <span>4<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_2cb4366188ae403b4f86cae03c4b111d'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"5\"  id='checkbox_3_2cb4366188ae403b4f86cae03c4b111d' aria-label='5' aria-invalid='false' aria-required=true> <span>5<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >The Care Coordinator explained the Healthy Start program in a way  that I could understand.<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_65237f89f186685e93be8258ea18e002'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"1\"  id='checkbox_4_65237f89f186685e93be8258ea18e002' aria-label='1' aria-invalid='false' aria-required=true> <span>1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_41226b4690c99c70ad89e84df3eb202f'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"2\"  id='checkbox_4_41226b4690c99c70ad89e84df3eb202f' aria-label='2' aria-invalid='false' aria-required=true> <span>2<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_18f10e836c1307c3bc7e5f5b98eaeb37'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"3\"  id='checkbox_4_18f10e836c1307c3bc7e5f5b98eaeb37' aria-label='3' aria-invalid='false' aria-required=true> <span>3<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_ffc6834d6e92a0e087c1249021988c29'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"4\"  id='checkbox_4_ffc6834d6e92a0e087c1249021988c29' aria-label='4' aria-invalid='false' aria-required=true> <span>4<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_3cd732e32e0e56ef38aadf1cc81dbec3'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"5\"  id='checkbox_4_3cd732e32e0e56ef38aadf1cc81dbec3' aria-label='5' aria-invalid='false' aria-required=true> <span>5<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >While in the Healthy Start Program, I received information about  how to take care of myself and my baby.<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6_7458f3a7f1baebaf0f392b8e2d527c38'><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"1\"  id='checkbox_6_7458f3a7f1baebaf0f392b8e2d527c38' aria-label='1' aria-invalid='false' aria-required=true> <span>1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6_66a00de1544bcb1287c0ee634ae7e88a'><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"2\"  id='checkbox_6_66a00de1544bcb1287c0ee634ae7e88a' aria-label='2' aria-invalid='false' aria-required=true> <span>2<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6_4fab9d54ab1903d576c74caedc080b61'><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"3\"  id='checkbox_6_4fab9d54ab1903d576c74caedc080b61' aria-label='3' aria-invalid='false' aria-required=true> <span>3<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6_81559dec42dbac53b85e12b3785545a5'><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"4\"  id='checkbox_6_81559dec42dbac53b85e12b3785545a5' aria-label='4' aria-invalid='false' aria-required=true> <span>4<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6_a7673b17e78d8bfd207470e27fb4b215'><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"5\"  id='checkbox_6_a7673b17e78d8bfd207470e27fb4b215' aria-label='5' aria-invalid='false' aria-required=true> <span>5<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Was the Healthy Start Program useful to you?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_7_9cd8fcb7311c2cd15e8d08490a7bb72c'><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"1\"  id='checkbox_7_9cd8fcb7311c2cd15e8d08490a7bb72c' aria-label='1' aria-invalid='false' aria-required=true> <span>1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_7_812fb945d275a799924c7921bd67f30c'><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"2\"  id='checkbox_7_812fb945d275a799924c7921bd67f30c' aria-label='2' aria-invalid='false' aria-required=true> <span>2<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_7_8e27e5a48118bc04867d9084aa21435d'><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"3\"  id='checkbox_7_8e27e5a48118bc04867d9084aa21435d' aria-label='3' aria-invalid='false' aria-required=true> <span>3<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_7_bcd57ba7996468ad0a98d8fb7618103c'><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"4\"  id='checkbox_7_bcd57ba7996468ad0a98d8fb7618103c' aria-label='4' aria-invalid='false' aria-required=true> <span>4<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_7_74b431b858c2e0cf05249546609fd8be'><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"5\"  id='checkbox_7_74b431b858c2e0cf05249546609fd8be' aria-label='5' aria-invalid='false' aria-required=true> <span>5<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-7_2\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >The Healthy Start Care Coordinator directed me to other agencies  in the community to assist me. <\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_d3140a18b53677909a35c21328abd9d1'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Yes\"  id='checkbox_5_d3140a18b53677909a35c21328abd9d1' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_1e2c58510a56c202c4a8c8b8cb1e2abd'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"No\"  id='checkbox_5_1e2c58510a56c202c4a8c8b8cb1e2abd' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_97d36529f680f74014646ca2f177f09a'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"N\/A\"  id='checkbox_5_97d36529f680f74014646ca2f177f09a' aria-label='N\/A' aria-invalid='false' aria-required=true> <span>N\/A<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >My visit time\/duration was <\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_8_34b877c14a2cf5b889b19330b6279080'><input  type=\"checkbox\" name=\"checkbox_8[]\" data-name=\"checkbox_8\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Longer than I expected\"  id='checkbox_8_34b877c14a2cf5b889b19330b6279080' aria-label='Longer than I expected' aria-invalid='false' aria-required=true> <span>Longer than I expected<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_8_58f0386a4caa101242b3669e24234336'><input  type=\"checkbox\" name=\"checkbox_8[]\" data-name=\"checkbox_8\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Duration that I expected\"  id='checkbox_8_58f0386a4caa101242b3669e24234336' aria-label='Duration that I expected' aria-invalid='false' aria-required=true> <span>Duration that I expected<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_8_bfd8e82837491507f7c89e14af3963bb'><input  type=\"checkbox\" name=\"checkbox_8[]\" data-name=\"checkbox_8\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Shorter than I expected\"  id='checkbox_8_bfd8e82837491507f7c89e14af3963bb' aria-label='Shorter than I expected' aria-invalid='false' aria-required=true> <span>Shorter than I expected<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Would you recommend our services to a friend?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_9_0becba2b30e583395a9ab13e48067807'><input  type=\"checkbox\" name=\"checkbox_9[]\" data-name=\"checkbox_9\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Yes\"  id='checkbox_9_0becba2b30e583395a9ab13e48067807' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_9_54c2f8f35a0824f0e43981b467c606e1'><input  type=\"checkbox\" name=\"checkbox_9[]\" data-name=\"checkbox_9\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"No\"  id='checkbox_9_54c2f8f35a0824f0e43981b467c606e1' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_7_input_text' id='label_ff_7_input_text'>Why, or why not?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" maxlength=\"200\" data-name=\"input_text\" id=\"ff_7_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_7_input_text_1' id='label_ff_7_input_text_1'>Would you like to share anything else?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" maxlength=\"200\" data-name=\"input_text_1\" id=\"ff_7_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-7_3\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Race<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_11_017f4980f15b506ab73f636af074db39'><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"White\"  id='checkbox_11_017f4980f15b506ab73f636af074db39' aria-label='White' aria-invalid='false' aria-required=true> <span>White<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_11_2e1302bc8f8c50196a7244ed34d5c319'><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Black\/African American\"  id='checkbox_11_2e1302bc8f8c50196a7244ed34d5c319' aria-label='Black\/African American' aria-invalid='false' aria-required=true> <span>Black\/African American<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_11_293c2c4222a5db158ec51e7b4570ba02'><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Asian\"  id='checkbox_11_293c2c4222a5db158ec51e7b4570ba02' aria-label='Asian' aria-invalid='false' aria-required=true> <span>Asian<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_11_7ad3183a7b7c9d2f55a9796edc8ab860'><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Pacific Islander\"  id='checkbox_11_7ad3183a7b7c9d2f55a9796edc8ab860' aria-label='Pacific Islander' aria-invalid='false' aria-required=true> <span>Pacific Islander<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_11_ebe9824905f546738140791c19432340'><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Native American\/American Indian\"  id='checkbox_11_ebe9824905f546738140791c19432340' aria-label='Native American\/American Indian' aria-invalid='false' aria-required=true> <span>Native American\/American Indian<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_11_bf67dac4767b9a0a2780d5d8a27744a2'><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Multiracial\"  id='checkbox_11_bf67dac4767b9a0a2780d5d8a27744a2' aria-label='Multiracial' aria-invalid='false' aria-required=true> <span>Multiracial<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_11_1a1d1de15f934f81e4ee4b8bea551c09'><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Prefer not to share\"  id='checkbox_11_1a1d1de15f934f81e4ee4b8bea551c09' aria-label='Prefer not to share' aria-invalid='false' aria-required=true> <span>Prefer not to share<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Ethnicity<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_12_3f635a0ea608bf2683f80b7ee8bf9be4'><input  type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Hispanic\/Latino\/Spanish origin\"  id='checkbox_12_3f635a0ea608bf2683f80b7ee8bf9be4' aria-label='Hispanic\/Latino\/Spanish origin' aria-invalid='false' aria-required=true> <span>Hispanic\/Latino\/Spanish origin<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_12_309ff579b60589a199a3a221c9f5820e'><input  type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Haitian origin\"  id='checkbox_12_309ff579b60589a199a3a221c9f5820e' aria-label='Haitian origin' aria-invalid='false' aria-required=true> <span>Haitian origin<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_12_522f4c6475f82220cac3dcd8a1e08787'><input  type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Not Hispanic\/Hatian origin\"  id='checkbox_12_522f4c6475f82220cac3dcd8a1e08787' aria-label='Not Hispanic\/Hatian origin' aria-invalid='false' aria-required=true> <span>Not Hispanic\/Hatian origin<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_12_ca6c60b8682d495c112caff2828d3a23'><input  type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Prefer not to share\"  id='checkbox_12_ca6c60b8682d495c112caff2828d3a23' aria-label='Prefer not to share' aria-invalid='false' aria-required=true> <span>Prefer not to share<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_7_dropdown' id='label_ff_7_dropdown'>Please select the county you live in. <\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_7_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_7_dropdown\"><option value=\"\">- Select -<\/option><option value=\"Calhoun\"  >Calhoun<\/option><option value=\"Holmes\"  >Holmes<\/option><option value=\"Jackson\"  >Jackson<\/option><option value=\"Liberty\"  >Liberty<\/option><option value=\"Washington\"  >Washington<\/option><\/select><\/div><\/div><div class='ff-form-inline-style' hidden><style>form.fluent_form_7 .ff-btn-submit:not(.ff_btn_no_style) { background-color: var(--fluentform-primary); color: #ffffff; }<\/style><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\"  aria-label=\"Submit Form\">Submit Form<\/button><\/div><\/fieldset><\/form><div id='fluentform_7_errors' class='ff-errors-in-stack ff_form_instance_7_1 ff-form-loading_errors ff_form_instance_7_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_7_1 = 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questions 1-5, 1 being Strongly disagree and 5 being\u00a0Strongly agree. 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