{"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=\"bf165c275e\" \/><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   aria-label=\"You were offered an appointment time convenient for you.\">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_6cba3cc0d3852484d3439b72f92bfafa'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"1\"  id='checkbox_6cba3cc0d3852484d3439b72f92bfafa' 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_fa822bfe433199ea6fcc3588c6feef29'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"2\"  id='checkbox_fa822bfe433199ea6fcc3588c6feef29' 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_71e427638d65ab364f331e08d5d270ae'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"3\"  id='checkbox_71e427638d65ab364f331e08d5d270ae' 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_4f467c3d3d9adfc87ab91b64bad295f6'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"4\"  id='checkbox_4f467c3d3d9adfc87ab91b64bad295f6' 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_2a24e9d7630659478507d3491ef1f2a2'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"5\"  id='checkbox_2a24e9d7630659478507d3491ef1f2a2' 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   aria-label=\"The Heathy Start Care Coordinator provided me helpful information.\">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_27b6ec07e4e6c5bde3786c2a45e5445c'><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_27b6ec07e4e6c5bde3786c2a45e5445c' 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_71e633573dc799ca33df111f491864dc'><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_71e633573dc799ca33df111f491864dc' 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_6361e054c031262efb53b70f68c78611'><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_6361e054c031262efb53b70f68c78611' 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_27415b9d3bca0dbcb87e66df3c7231a9'><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_27415b9d3bca0dbcb87e66df3c7231a9' 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_b00037f275aab24c3cf0077a047475ec'><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_b00037f275aab24c3cf0077a047475ec' 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   aria-label=\"I felt comfortable sharing my concerns with the Healthy Start Care  Coordinator.\">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_66f340732120d29b13869d1b94cd4604'><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_66f340732120d29b13869d1b94cd4604' 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_3fc36b03237382047d54c70ffcb23971'><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_3fc36b03237382047d54c70ffcb23971' 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_bfd22d3761669306dd26fe6fae73329e'><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_bfd22d3761669306dd26fe6fae73329e' 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_cbe742884acd9aa3a88d3fe07bacc3f1'><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_cbe742884acd9aa3a88d3fe07bacc3f1' 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_2aabc6b05e53fc94dce8af8c58a22084'><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_2aabc6b05e53fc94dce8af8c58a22084' 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   aria-label=\"The Care Coordinator was friendly and supportive.\">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_61e5875a7c0d4f318839f7f51a5e2ff1'><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_61e5875a7c0d4f318839f7f51a5e2ff1' 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_4ce9c2ce09aa459f1f3020d29752ee34'><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_4ce9c2ce09aa459f1f3020d29752ee34' 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_e3690278120099e0eebf6ee5156e2bad'><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_e3690278120099e0eebf6ee5156e2bad' 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_931885fcad6d40945f9d23e159d5c4da'><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_931885fcad6d40945f9d23e159d5c4da' 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_497e09a462442615c2e4ea64c77122f6'><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_497e09a462442615c2e4ea64c77122f6' 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   aria-label=\"The Care Coordinator explained the Healthy Start program in a way  that I could understand.\">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_65f1a517691eaa12fd52e8232205b2c7'><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_65f1a517691eaa12fd52e8232205b2c7' 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_b76a161da4450462d2527a4dd30606c8'><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_b76a161da4450462d2527a4dd30606c8' 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_86407d8dd0d300ab02d6fcb1fe69cae3'><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_86407d8dd0d300ab02d6fcb1fe69cae3' 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_db70224dc2a03a8352a24d22f0c4e5e2'><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_db70224dc2a03a8352a24d22f0c4e5e2' 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_e90188d572367fceafa4923b75fed685'><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_e90188d572367fceafa4923b75fed685' 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   aria-label=\"While in the Healthy Start Program, I received information about  how to take care of myself and my baby.\">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_309cda7b4e1598823446f882ee98c639'><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_309cda7b4e1598823446f882ee98c639' 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_b426f4d41b19c12632cebebc3ac34418'><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_b426f4d41b19c12632cebebc3ac34418' 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_3c12d1c940a63c2a74b2093aab6d0920'><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_3c12d1c940a63c2a74b2093aab6d0920' 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_7168c8fe56832ee2affe178d281c9cd0'><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_7168c8fe56832ee2affe178d281c9cd0' 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_bf96963e1981269d3b6c37a265ee9052'><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_bf96963e1981269d3b6c37a265ee9052' 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   aria-label=\"Was the Healthy Start Program useful to you?\">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_576da23c7f9687424f0d20b796b65d5f'><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_576da23c7f9687424f0d20b796b65d5f' 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_21bb85e189487fe9c86c22eb792df38e'><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_21bb85e189487fe9c86c22eb792df38e' 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_3103e61066168619d638a17fbd4089c7'><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_3103e61066168619d638a17fbd4089c7' 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_553f298279e8c044be5c43f93bb90804'><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_553f298279e8c044be5c43f93bb90804' 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_47b76ae20f2d5dd56920b10c2aa04573'><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_47b76ae20f2d5dd56920b10c2aa04573' 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   aria-label=\"The Healthy Start Care Coordinator directed me to other agencies  in the community to assist me.\">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_df1f23fd3dce36bdf2afe018d7d84d75'><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_df1f23fd3dce36bdf2afe018d7d84d75' 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_70d22368e2adf04e091218478903a672'><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_70d22368e2adf04e091218478903a672' 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_0ba5d64203d49531c6815a95a44110da'><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_0ba5d64203d49531c6815a95a44110da' 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   aria-label=\"My visit time\/duration was\">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_0a926877ce6ce9dcd1e4a06b737dd99c'><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_0a926877ce6ce9dcd1e4a06b737dd99c' 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_25aca41350b3db8a25290c625cd4c118'><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_25aca41350b3db8a25290c625cd4c118' 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_de07557ec959e1d65f49a22d1be359f1'><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_de07557ec959e1d65f49a22d1be359f1' 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   aria-label=\"Would you recommend our services to a friend?\">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_998f5032cbd99d28412f26cbae38a3f5'><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_998f5032cbd99d28412f26cbae38a3f5' 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_9d3628f08ffe39f58ea05a5772081db3'><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_9d3628f08ffe39f58ea05a5772081db3' 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' aria-label=\"Why, or why not?\">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' aria-label=\"Would you like to share anything else?\">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   aria-label=\"Race\">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_9e24cf1e981fe4d91dae06154818a7ad'><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_9e24cf1e981fe4d91dae06154818a7ad' 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_f20a0e440e906971004118744486557f'><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_f20a0e440e906971004118744486557f' 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_059addf743862ec6dad374772f1851ba'><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_059addf743862ec6dad374772f1851ba' 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_28e69b8eab09c4cd71f80df2f2dd8d27'><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_28e69b8eab09c4cd71f80df2f2dd8d27' 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_e2b9e83ccf92fe9ea59bda67d2fb6594'><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_e2b9e83ccf92fe9ea59bda67d2fb6594' 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_63d284e1fc7ed74a17c93a3d58b01e9b'><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_63d284e1fc7ed74a17c93a3d58b01e9b' 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_e735066af49ece100bbffbe929362208'><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_e735066af49ece100bbffbe929362208' 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   aria-label=\"Ethnicity\">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_135d3d0d28f0abcd2e13c53c82fdd346'><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_135d3d0d28f0abcd2e13c53c82fdd346' 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_ff38177fc33183fcfcb9a0bcbc97586e'><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_ff38177fc33183fcfcb9a0bcbc97586e' 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_b7686e6268026e77c495a327bca3076e'><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_b7686e6268026e77c495a327bca3076e' 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 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