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    {"id":482,"date":"2026-01-13T17:06:46","date_gmt":"2026-01-13T17:06:46","guid":{"rendered":"https:\/\/surgerywebtemp.org.uk\/c82009\/?page_id=482"},"modified":"2026-01-13T17:06:46","modified_gmt":"2026-01-13T17:06:46","slug":"sleep-apnoea-questionnaire","status":"publish","type":"page","link":"https:\/\/surgerywebtemp.org.uk\/c82009\/sleep-apnoea-questionnaire\/","title":{"rendered":"Sleep apnoea questionnaire"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_16' ><div id='gf_16' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_16' id='gform_16'  action='\/c82009\/wp-json\/wp\/v2\/pages\/482#gf_16' data-formid='16' novalidate>\n        <div id='gf_progressbar_wrapper_16' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_16_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_16' class='c-form-list gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_16_1\" class=\"gfield nhsuk-form-group gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_1'>Please select your practice:&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_16_1' class='large gfield_select nhsuk-select '    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select...<\/option><option value='Market Harborough Medical Centre' >Market Harborough Medical Centre<\/option><option value='St Lukes Treatment Centre' >St Lukes Treatment Centre<\/option><option value='Husbands Bosworth Medical Centre' >Husbands Bosworth Medical Centre<\/option><\/select><\/div><\/div><fieldset id=\"field_16_3\" class=\"gfield nhsuk-form-group gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label nhsuk-label_before_complex' >What is your name?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_16_3'>\n                            \n                            <span id='input_16_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' class='nhsuk-input '  name='input_3.3' id='input_16_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_16_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_16_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' class='nhsuk-input '  name='input_3.6' id='input_16_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_16_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_16_4\" class=\"gfield nhsuk-form-group gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >What is your date of birth?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div id='input_16_4' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_16_4_2_container'><label for='input_16_4_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select class=\"nhsuk-select\" name='input_4[]' id='input_16_4_2'   aria-required='true'  ><option value=''>Day<\/option><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><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_16_4_1_container'><label for='input_16_4_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select class=\"nhsuk-select\" name='input_4[]' id='input_16_4_1'   aria-required='true'  ><option value=''>Month<\/option><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><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_16_4_3_container'><label for='input_16_4_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select class=\"nhsuk-select\" name='input_4[]' id='input_16_4_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><fieldset id=\"field_16_5\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >What is your sex?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_5' type='radio' value='Male'  id='choice_16_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_5_0' id='label_16_5_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_5' type='radio' value='Female'  id='choice_16_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_5_1' id='label_16_5_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_5' type='radio' value='gf_other_choice'  id='choice_16_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_5_2' id='label_16_5_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_16_5_other' class='gchoice_other_control' name='input_5_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_16_6\" class=\"gfield nhsuk-form-group gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_6'>What is your postcode?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_16_6' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_16_7\" class=\"gfield nhsuk-form-group gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_7'>What is your phone number?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_16_7' type='tel' value='' class='large nhsuk-input '   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_16_8\" class=\"gfield nhsuk-form-group gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_8'>What is your email address?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_8' id='input_16_8' type='email' value='' class='large nhsuk-input '    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_16_9\" class=\"gfield nhsuk-form-group gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Epworth Sleepiness Scale<\/h2><div class='gsection_description' id='gfield_description_16_9'>Please select your chance of dozing in the following situations:<\/div><\/div><fieldset id=\"field_16_10\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Sitting and Reading:&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_10' type='radio' value='Would never doze'  id='choice_16_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_10_0' id='label_16_10_0' class='gform-field-label gform-field-label--type-inline'>Would never doze<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_10' type='radio' value='Slight chance of dozing'  id='choice_16_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_10_1' id='label_16_10_1' class='gform-field-label gform-field-label--type-inline'>Slight chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_10' type='radio' value='Moderate chance of dozing'  id='choice_16_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_10_2' id='label_16_10_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_10' type='radio' value='High chance of dozing'  id='choice_16_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_10_3' id='label_16_10_3' class='gform-field-label gform-field-label--type-inline'>High chance of dozing<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_11\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Watching TV:&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_11' type='radio' value='Would never doze'  id='choice_16_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_11_0' id='label_16_11_0' class='gform-field-label gform-field-label--type-inline'>Would never doze<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_11' type='radio' value='Slight chance of dozing'  id='choice_16_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_11_1' id='label_16_11_1' class='gform-field-label gform-field-label--type-inline'>Slight chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_11' type='radio' value='Moderate chance of dozing'  id='choice_16_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_11_2' id='label_16_11_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_11_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_11' type='radio' value='High chance of dozing'  id='choice_16_11_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_11_3' id='label_16_11_3' class='gform-field-label gform-field-label--type-inline'>High chance of dozing<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_12\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Sitting, inactive in a public place (e.g. a theatre or a meeting):&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_12' type='radio' value='Would never doze'  id='choice_16_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_12_0' id='label_16_12_0' class='gform-field-label gform-field-label--type-inline'>Would never doze<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_12' type='radio' value='Slight chance of dozing'  id='choice_16_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_12_1' id='label_16_12_1' class='gform-field-label gform-field-label--type-inline'>Slight chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_12' type='radio' value='Moderate chance of dozing'  id='choice_16_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_12_2' id='label_16_12_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_12' type='radio' value='High chance of dozing'  id='choice_16_12_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_12_3' id='label_16_12_3' class='gform-field-label gform-field-label--type-inline'>High chance of dozing<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_13\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >As a passenger in a car for an hour without a break:&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_13' type='radio' value='Would never doze'  id='choice_16_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_13_0' id='label_16_13_0' class='gform-field-label gform-field-label--type-inline'>Would never doze<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_13' type='radio' value='Slight chance of dozing'  id='choice_16_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_13_1' id='label_16_13_1' class='gform-field-label gform-field-label--type-inline'>Slight chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_13' type='radio' value='Moderate chance of dozing'  id='choice_16_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_13_2' id='label_16_13_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_13_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_13' type='radio' value='High chance of dozing'  id='choice_16_13_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_13_3' id='label_16_13_3' class='gform-field-label gform-field-label--type-inline'>High chance of dozing<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_14\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Lying down to rest in the afternoon when circumstances permit:&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_14' type='radio' value='Would never doze'  id='choice_16_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_14_0' id='label_16_14_0' class='gform-field-label gform-field-label--type-inline'>Would never doze<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_14' type='radio' value='Slight chance of dozing'  id='choice_16_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_14_1' id='label_16_14_1' class='gform-field-label gform-field-label--type-inline'>Slight chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_14' type='radio' value='Moderate chance of dozing'  id='choice_16_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_14_2' id='label_16_14_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_14' type='radio' value='High chance of dozing'  id='choice_16_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_14_3' id='label_16_14_3' class='gform-field-label gform-field-label--type-inline'>High chance of dozing<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_15\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Sitting and talking to someone:&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_15' type='radio' value='Would never doze'  id='choice_16_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_15_0' id='label_16_15_0' class='gform-field-label gform-field-label--type-inline'>Would never doze<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_15' type='radio' value='Slight chance of dozing'  id='choice_16_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_15_1' id='label_16_15_1' class='gform-field-label gform-field-label--type-inline'>Slight chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_15_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_15' type='radio' value='Moderate chance of dozing'  id='choice_16_15_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_15_2' id='label_16_15_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_15_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_15' type='radio' value='High chance of dozing'  id='choice_16_15_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_15_3' id='label_16_15_3' class='gform-field-label gform-field-label--type-inline'>High chance of dozing<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_16\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Sitting quietly after lunch without alcohol:&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='Would never doze'  id='choice_16_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_16_0' id='label_16_16_0' class='gform-field-label gform-field-label--type-inline'>Would never doze<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='Slight chance of dozing'  id='choice_16_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_16_1' id='label_16_16_1' class='gform-field-label gform-field-label--type-inline'>Slight chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='Moderate chance of dozing'  id='choice_16_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_16_2' id='label_16_16_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_16_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='High chance of dozing'  id='choice_16_16_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_16_3' id='label_16_16_3' class='gform-field-label gform-field-label--type-inline'>High chance of dozing<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_17\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >In a car, while stopped for a few minutes in traffic:&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_17' type='radio' value='Would never doze'  id='choice_16_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_17_0' id='label_16_17_0' class='gform-field-label gform-field-label--type-inline'>Would never doze<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_17' type='radio' value='Slight chance of dozing'  id='choice_16_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_17_1' id='label_16_17_1' class='gform-field-label gform-field-label--type-inline'>Slight chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_17_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_17' type='radio' value='Moderate chance of dozing'  id='choice_16_17_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_17_2' id='label_16_17_2' class='gform-field-label gform-field-label--type-inline'>Moderate chance of dozing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_17_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_17' type='radio' value='High chance of dozing'  id='choice_16_17_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_17_3' id='label_16_17_3' class='gform-field-label gform-field-label--type-inline'>High chance of dozing<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_16_18\" class=\"gfield nhsuk-form-group gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Berlin Questionnaire<\/h2><\/div><fieldset id=\"field_16_19\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Your snoring is:&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_19' type='radio' value='Slightly louder than breathing'  id='choice_16_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_19_0' id='label_16_19_0' class='gform-field-label gform-field-label--type-inline'>Slightly louder than breathing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_19' type='radio' value='As loud as talking'  id='choice_16_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_19_1' id='label_16_19_1' class='gform-field-label gform-field-label--type-inline'>As loud as talking<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_19_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_19' type='radio' value='Louder than talking'  id='choice_16_19_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_19_2' id='label_16_19_2' class='gform-field-label gform-field-label--type-inline'>Louder than talking<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_19_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_19' type='radio' value='Very loud: can be heard in adjacent rooms'  id='choice_16_19_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_19_3' id='label_16_19_3' class='gform-field-label gform-field-label--type-inline'>Very loud: can be heard in adjacent rooms<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_20\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Has your snoring ever bothered other people?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='Yes'  id='choice_16_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_20_0' id='label_16_20_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='No'  id='choice_16_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_20_1' id='label_16_20_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='Don&#039;t know'  id='choice_16_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_20_2' id='label_16_20_2' class='gform-field-label gform-field-label--type-inline'>Don't know<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_21\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >How often do you snore?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_21' type='radio' value='Nearly every day'  id='choice_16_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_21_0' id='label_16_21_0' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_21' type='radio' value='3-4 times a week'  id='choice_16_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_21_1' id='label_16_21_1' class='gform-field-label gform-field-label--type-inline'>3-4 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_21_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_21' type='radio' value='1-2 times a week'  id='choice_16_21_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_21_2' id='label_16_21_2' class='gform-field-label gform-field-label--type-inline'>1-2 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_21_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_21' type='radio' value='1-2 times a month'  id='choice_16_21_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_21_3' id='label_16_21_3' class='gform-field-label gform-field-label--type-inline'>1-2 times a month<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_21_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_21' type='radio' value='Never or nearly never'  id='choice_16_21_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_21_4' id='label_16_21_4' class='gform-field-label gform-field-label--type-inline'>Never or nearly never<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_22\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Has anyone noticed that you quit breathing during your sleep?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_22' type='radio' value='Nearly every day'  id='choice_16_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_22_0' id='label_16_22_0' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_22' type='radio' value='3-4 times a week'  id='choice_16_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_22_1' id='label_16_22_1' class='gform-field-label gform-field-label--type-inline'>3-4 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_22' type='radio' value='1-2 times a week'  id='choice_16_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_22_2' id='label_16_22_2' class='gform-field-label gform-field-label--type-inline'>1-2 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_22_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_22' type='radio' value='1-2 times a month'  id='choice_16_22_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_22_3' id='label_16_22_3' class='gform-field-label gform-field-label--type-inline'>1-2 times a month<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_22_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_22' type='radio' value='Never or nearly never'  id='choice_16_22_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_22_4' id='label_16_22_4' class='gform-field-label gform-field-label--type-inline'>Never or nearly never<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_23\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >How often do you feel tired or fatigued after your sleep?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_23' type='radio' value='Nearly every day'  id='choice_16_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_23_0' id='label_16_23_0' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_23' type='radio' value='3-4 times a week'  id='choice_16_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_23_1' id='label_16_23_1' class='gform-field-label gform-field-label--type-inline'>3-4 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_23_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_23' type='radio' value='1-2 times a week'  id='choice_16_23_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_23_2' id='label_16_23_2' class='gform-field-label gform-field-label--type-inline'>1-2 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_23_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_23' type='radio' value='1-2 times a month'  id='choice_16_23_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_23_3' id='label_16_23_3' class='gform-field-label gform-field-label--type-inline'>1-2 times a month<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_23_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_23' type='radio' value='Never or nearly never'  id='choice_16_23_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_23_4' id='label_16_23_4' class='gform-field-label gform-field-label--type-inline'>Never or nearly never<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_24\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >During your waking time, do you feel tired, fatigued or not \u2018up to par\u2019?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_24' type='radio' value='Nearly every day'  id='choice_16_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_24_0' id='label_16_24_0' class='gform-field-label gform-field-label--type-inline'>Nearly every day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_24' type='radio' value='3-4 times a week'  id='choice_16_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_24_1' id='label_16_24_1' class='gform-field-label gform-field-label--type-inline'>3-4 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_24' type='radio' value='1-2 times a week'  id='choice_16_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_24_2' id='label_16_24_2' class='gform-field-label gform-field-label--type-inline'>1-2 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_24' type='radio' value='1-2 times a month'  id='choice_16_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_24_3' id='label_16_24_3' class='gform-field-label gform-field-label--type-inline'>1-2 times a month<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_24_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_24' type='radio' value='Never or nearly never'  id='choice_16_24_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_24_4' id='label_16_24_4' class='gform-field-label gform-field-label--type-inline'>Never or nearly never<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_16_25\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Have you ever nodded of or fallen asleep while driving a vehicle?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_25' type='radio' value='Yes'  id='choice_16_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_25_0' id='label_16_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_25' type='radio' value='No'  id='choice_16_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_25_1' id='label_16_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_16_26\" class=\"gfield nhsuk-form-group gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Other Risk Factors<\/h2><\/div><fieldset id=\"field_16_27\" class=\"gfield nhsuk-form-group gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='nhsuk-label gform-field-label' >Do you have high blood pressure (includes all people on treatment for blood pressure)?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_radio nhsuk-radios'>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_27' type='radio' value='Yes'  id='choice_16_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_27_0' id='label_16_27_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_27' type='radio' value='No'  id='choice_16_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_27_1' id='label_16_27_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_16_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_27' type='radio' value='Don&#039;t know'  id='choice_16_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_16_27_2' id='label_16_27_2' class='gform-field-label gform-field-label--type-inline'>Don't know<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_16_28\" class=\"gfield nhsuk-form-group gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_28'>Height (in metres):&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_16_28' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_16_29\" class=\"gfield nhsuk-form-group gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_16_29'>Weight (in KG):&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_16_29' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_16_30\" class=\"gfield nhsuk-form-group gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"nhsuk_checkboxes\"><legend class='nhsuk-label gform-field-label nhsuk-label_before_complex' >Confirmation&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_consent nhsuk-checkboxes__item'><input name='input_30.1' id='input_16_30_1' type='checkbox' class='nhsuk-checkboxes__input' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label nhsuk-label nhsuk-checkboxes__label\" for='input_16_30_1' >I confirm that the information provided is accurate to the best of my knowledge.<\/label><input type='hidden' name='input_30.2' value='I confirm that the information provided is accurate to the best of my knowledge.' class='gform_hidden' \/><input type='hidden' name='input_30.3' value='2' class='gform_hidden' \/><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_16_31' class='nhsuk-button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_16_2' class='gform_page' data-js='page-field-id-31' style='display:none;'>\n       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data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=16&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;styles=[]&amp;hash=8c5772b34936fae6c31e93978517291a' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_16' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_16' id='gform_theme_16' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_16' id='gform_style_settings_16' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_16' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='16' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='GBP' value='VDsinVxA3DbgDuV+FzXQwb\/Z2WZEJMwC7UgxcjWL6moAqoHYtHTJVbc1LzriMg7qLuN\/zBrY\/ucznMv\/JQqw0WaUrJPzVbdgtJydDFmCQCuR9Tc=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_16' 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