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    {"id":516,"date":"2026-07-21T19:31:29","date_gmt":"2026-07-21T18:31:29","guid":{"rendered":"https:\/\/surgerywebtemp.org.uk\/f81089\/?page_id=516"},"modified":"2026-07-21T19:31:29","modified_gmt":"2026-07-21T18:31:29","slug":"asthma-review","status":"publish","type":"page","link":"https:\/\/surgerywebtemp.org.uk\/f81089\/asthma-review\/","title":{"rendered":"Asthma Review"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_14' style='display:none'><div id='gf_14' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_14' id='gform_14'  action='\/f81089\/wp-json\/wp\/v2\/pages\/516#gf_14' data-formid='14' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_14' class='c-form-list gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_14_37\" class=\"gfield nhsuk-form-group gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_14_37'>X\/Twitter&nbsp;&nbsp;<span class=\"nhsuk-tag\">Optional<\/span><\/label><div class='ginput_container'><input name='input_37' id='input_14_37' type='text' value='' autocomplete='new-password'\/><\/div><span class='nhsuk-hint' id='gfield_description_14_37'>This field is for validation purposes and should be left unchanged.<\/span><\/div><div id=\"field_14_1\" class=\"gfield nhsuk-form-group gfield--type-text gfield--input-type-text gfield--width-full 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_14_1'>Full Name&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_14_1' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_14_3\" class=\"gfield nhsuk-form-group gfield--type-date gfield--input-type-date gfield--input-type-datedropdown 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' >Date of Birth&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div id='input_14_3' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_14_3_2_container'><label for='input_14_3_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>DD<\/label><select class=\"nhsuk-select\" name='input_3[]' id='input_14_3_2'   aria-required='true'  ><option value=''>DD<\/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_14_3_1_container'><label for='input_14_3_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>MM<\/label><select class=\"nhsuk-select\" name='input_3[]' id='input_14_3_1'   aria-required='true'  ><option value=''>MM<\/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_14_3_3_container'><label for='input_14_3_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>YYYY<\/label><select class=\"nhsuk-select\" name='input_3[]' id='input_14_3_3'   aria-required='true'  ><option value=''>YYYY<\/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><div id=\"field_14_4\" class=\"gfield nhsuk-form-group gfield--type-email gfield--input-type-email gfield--width-full 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_14_4'>Email&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_14_4' type='email' value='' class='large nhsuk-input '    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_14_5\" class=\"gfield nhsuk-form-group gfield--type-text gfield--input-type-text gfield--width-full 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_14_5'>Phone Number&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_14_5' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_14_6\" 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\">Please complete the following questions to allow your health care professional to assess your asthma.<\/h2><\/div><fieldset id=\"field_14_7\" 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' >How often does your asthma cause symptoms during the day?&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_14_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_7' type='radio' value='Never'  id='choice_14_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_7_0' id='label_14_7_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_7' type='radio' value='1 to 2 times per month'  id='choice_14_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_7_1' id='label_14_7_1' class='gform-field-label gform-field-label--type-inline'>1 to 2 times per month<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_7' type='radio' value='1 to 2 times per week'  id='choice_14_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_7_2' id='label_14_7_2' class='gform-field-label gform-field-label--type-inline'>1 to 2 times per week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_7' type='radio' value='Most days'  id='choice_14_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_7_3' id='label_14_7_3' class='gform-field-label gform-field-label--type-inline'>Most days<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_8\" 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' >How often does your asthma cause symptoms at night?&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_14_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_8' type='radio' value='Never'  id='choice_14_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_8_0' id='label_14_8_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_8' type='radio' value='1 to 2 times per month'  id='choice_14_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_8_1' id='label_14_8_1' class='gform-field-label gform-field-label--type-inline'>1 to 2 times per month<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_8' type='radio' value='1 to 2 times per week'  id='choice_14_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_8_2' id='label_14_8_2' class='gform-field-label gform-field-label--type-inline'>1 to 2 times per week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_8' type='radio' value='Most days'  id='choice_14_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_8_3' id='label_14_8_3' class='gform-field-label gform-field-label--type-inline'>Most days<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_9\" 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' >How often does your asthma limit your activities?&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_14_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_9' type='radio' value='Never'  id='choice_14_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_9_0' id='label_14_9_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_9' type='radio' value='1 to 2 times per month'  id='choice_14_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_9_1' id='label_14_9_1' class='gform-field-label gform-field-label--type-inline'>1 to 2 times per month<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_9' type='radio' value='1 to 2 times per week'  id='choice_14_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_9_2' id='label_14_9_2' class='gform-field-label gform-field-label--type-inline'>1 to 2 times per week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_9' type='radio' value='Most days'  id='choice_14_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_9_3' id='label_14_9_3' class='gform-field-label gform-field-label--type-inline'>Most days<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_14_10\" 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_14_10'>How many asthma exacerbations (attacked) have you had in the past year?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_14_10' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_14_11\" 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_14_11'>How many times have you attended Accident and Emergency Department since your last asthma review?&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_14_11' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_14_12\" 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\">Inhaler Technique<\/h2><\/div><fieldset id=\"field_14_13\" class=\"gfield nhsuk-form-group gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_inline 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' >Please select the types of inhalers that you use&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox nhsuk_checkbox ' id='input_14_13'><div class='gchoice nhsuk-checkboxes__item gchoice_14_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_13.1' type='checkbox'  value='Metered Dose Inhaler'  id='choice_14_13_1'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_14_13_1' id='label_14_13_1' class='gform-field-label gform-field-label--type-inline'>Metered Dose Inhaler<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_14_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_13.2' type='checkbox'  value='Autohaler'  id='choice_14_13_2'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_14_13_2' id='label_14_13_2' class='gform-field-label gform-field-label--type-inline'>Autohaler<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_14_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_13.3' type='checkbox'  value='Accuhaler'  id='choice_14_13_3'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_14_13_3' id='label_14_13_3' class='gform-field-label gform-field-label--type-inline'>Accuhaler<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_14_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_13.4' type='checkbox'  value='EasiBreathe Inhaler'  id='choice_14_13_4'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_14_13_4' id='label_14_13_4' class='gform-field-label gform-field-label--type-inline'>EasiBreathe Inhaler<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_14_13_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_13.5' type='checkbox'  value='Easyhaler'  id='choice_14_13_5'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_14_13_5' id='label_14_13_5' class='gform-field-label gform-field-label--type-inline'>Easyhaler<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_14_13_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_13.6' type='checkbox'  value='Turbohaler'  id='choice_14_13_6'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_14_13_6' id='label_14_13_6' class='gform-field-label gform-field-label--type-inline'>Turbohaler<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_14_13_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_13.7' type='checkbox'  value='Small Volume Spacer'  id='choice_14_13_7'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_14_13_7' id='label_14_13_7' class='gform-field-label gform-field-label--type-inline'>Small Volume Spacer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_14_13_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_13.8' type='checkbox'  value='Large Volume Spacer'  id='choice_14_13_8'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_14_13_8' id='label_14_13_8' class='gform-field-label gform-field-label--type-inline'>Large Volume Spacer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice nhsuk-checkboxes__item gchoice_14_13_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input nhsuk-checkboxes__input' name='input_13.9' type='checkbox'  value='My inhaler is not listed here'  id='choice_14_13_9'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_14_13_9' id='label_14_13_9' class='gform-field-label gform-field-label--type-inline'>My inhaler is not listed here<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_14\" 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_14_14'>Please specify your inhaler&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_14_14' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_14_15\" 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\">Lifestyle - Alcohol<\/h2><\/div><fieldset id=\"field_14_16\" 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' >How often do you have a drink containing 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_14_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='Never'  id='choice_14_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_16_0' id='label_14_16_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='Monthly or less'  id='choice_14_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_16_1' id='label_14_16_1' class='gform-field-label gform-field-label--type-inline'>Monthly or less<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='2-4 times a month'  id='choice_14_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_16_2' id='label_14_16_2' class='gform-field-label gform-field-label--type-inline'>2-4 times a month<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_16_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='2-3 times a week'  id='choice_14_16_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_16_3' id='label_14_16_3' class='gform-field-label gform-field-label--type-inline'>2-3 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_16_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_16' type='radio' value='4 times or more a week'  id='choice_14_16_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_16_4' id='label_14_16_4' class='gform-field-label gform-field-label--type-inline'>4 times or more a week<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_17\" 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' >How many units of alcohol do you drink on a typical day drinking?&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_14_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_17' type='radio' value='1 - 2'  id='choice_14_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_17_0' id='label_14_17_0' class='gform-field-label gform-field-label--type-inline'>1 - 2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_17' type='radio' value='3 - 4'  id='choice_14_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_17_1' id='label_14_17_1' class='gform-field-label gform-field-label--type-inline'>3 - 4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_17_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_17' type='radio' value='5 - 6'  id='choice_14_17_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_17_2' id='label_14_17_2' class='gform-field-label gform-field-label--type-inline'>5 - 6<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_17_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_17' type='radio' value='7 - 9'  id='choice_14_17_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_17_3' id='label_14_17_3' class='gform-field-label gform-field-label--type-inline'>7 - 9<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_17_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_17' type='radio' value='10+'  id='choice_14_17_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_17_4' id='label_14_17_4' class='gform-field-label gform-field-label--type-inline'>10+<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_18\" 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' >How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?&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_14_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_18' type='radio' value='Never'  id='choice_14_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_18_0' id='label_14_18_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_18' type='radio' value='Less than monthly'  id='choice_14_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_18_1' id='label_14_18_1' class='gform-field-label gform-field-label--type-inline'>Less than monthly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_18_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_18' type='radio' value='Monthly'  id='choice_14_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_18_2' id='label_14_18_2' class='gform-field-label gform-field-label--type-inline'>Monthly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_18_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_18' type='radio' value='Weekly'  id='choice_14_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_18_3' id='label_14_18_3' class='gform-field-label gform-field-label--type-inline'>Weekly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_18_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_18' type='radio' value='Daily or almost daily'  id='choice_14_18_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_18_4' id='label_14_18_4' class='gform-field-label gform-field-label--type-inline'>Daily or almost daily<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_14_19\" 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\">Lifestyle - Smoking<\/h2><\/div><fieldset id=\"field_14_20\" 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 smoke?&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_14_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='Never smoked'  id='choice_14_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_20_0' id='label_14_20_0' class='gform-field-label gform-field-label--type-inline'>Never smoked<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='Ex-smoker'  id='choice_14_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_20_1' id='label_14_20_1' class='gform-field-label gform-field-label--type-inline'>Ex-smoker<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='Trivial smoker (less than 1 cigarette per day)'  id='choice_14_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_20_2' id='label_14_20_2' class='gform-field-label gform-field-label--type-inline'>Trivial smoker (less than 1 cigarette per day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_20_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='Light Smoker (1-9 cigarettes per day)'  id='choice_14_20_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_20_3' id='label_14_20_3' class='gform-field-label gform-field-label--type-inline'>Light Smoker (1-9 cigarettes per day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_20_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='Moderate smoker (10-19 cigarettes per day)'  id='choice_14_20_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_20_4' id='label_14_20_4' class='gform-field-label gform-field-label--type-inline'>Moderate smoker (10-19 cigarettes per day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_20_5'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='Heavy smoker (20-39 cigarettes per day)'  id='choice_14_20_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_20_5' id='label_14_20_5' class='gform-field-label gform-field-label--type-inline'>Heavy smoker (20-39 cigarettes per day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_20_6'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_20' type='radio' value='Very heavy smoker (40 or more cigarettes per day)'  id='choice_14_20_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_20_6' id='label_14_20_6' class='gform-field-label gform-field-label--type-inline'>Very heavy smoker (40 or more cigarettes per day)<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_21\" 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 use an e-cigarette?&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_14_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_21' type='radio' value='No'  id='choice_14_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_21_0' id='label_14_21_0' 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_14_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_21' type='radio' value='Ex-user'  id='choice_14_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_21_1' id='label_14_21_1' class='gform-field-label gform-field-label--type-inline'>Ex-user<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_21_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_21' type='radio' value='Yes'  id='choice_14_21_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_21_2' id='label_14_21_2' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_22\" 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' >Would you like help to quit smoking?&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_14_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_22' type='radio' value='Yes'  id='choice_14_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_22_0' id='label_14_22_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_14_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_22' type='radio' value='No'  id='choice_14_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_22_1' id='label_14_22_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_14_23\" class=\"gfield nhsuk-form-group gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>For further information, please see: <a href=\"https:\/\/www.nhs.uk\/better-health\/quit-smoking\/\" target=\"_blank\">nhs.uk\/quit-smoking<\/a><\/p><\/div><div id=\"field_14_24\" 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\">Asthma Control Test Score<\/h2><\/div><fieldset id=\"field_14_25\" 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' >During the past 4 weeks, how often did your asthma prevent you from getting as much done at work, school or home?&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_14_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_25' type='radio' value='1'  id='choice_14_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_25_0' id='label_14_25_0' class='gform-field-label gform-field-label--type-inline'>All of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_25' type='radio' value='2'  id='choice_14_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_25_1' id='label_14_25_1' class='gform-field-label gform-field-label--type-inline'>Most of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_25_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_25' type='radio' value='3'  id='choice_14_25_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_25_2' id='label_14_25_2' class='gform-field-label gform-field-label--type-inline'>Some of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_25_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_25' type='radio' value='4'  id='choice_14_25_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_25_3' id='label_14_25_3' class='gform-field-label gform-field-label--type-inline'>A little of the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_25_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_25' type='radio' value='5'  id='choice_14_25_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_25_4' id='label_14_25_4' class='gform-field-label gform-field-label--type-inline'>None of the time<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_28\" 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 have you had shortness of breath?&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_14_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_28' type='radio' value='1'  id='choice_14_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_28_0' id='label_14_28_0' class='gform-field-label gform-field-label--type-inline'>More than once a day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_28' type='radio' value='2'  id='choice_14_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_28_1' id='label_14_28_1' class='gform-field-label gform-field-label--type-inline'>Once a day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_28' type='radio' value='3'  id='choice_14_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_28_2' id='label_14_28_2' class='gform-field-label gform-field-label--type-inline'>3-6 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_28_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_28' type='radio' value='4'  id='choice_14_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_28_3' id='label_14_28_3' 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_14_28_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_28' type='radio' value='5'  id='choice_14_28_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_28_4' id='label_14_28_4' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_29\" 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 did your asthma symptoms (wheezing, coughing, chest tightness, shortness of breath) wake you up at night or earlier than usual in the morning?&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_14_29_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_29' type='radio' value='1'  id='choice_14_29_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_29_0' id='label_14_29_0' class='gform-field-label gform-field-label--type-inline'>4 or more times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_29_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_29' type='radio' value='2'  id='choice_14_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_29_1' id='label_14_29_1' class='gform-field-label gform-field-label--type-inline'>2-3 nights a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_29_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_29' type='radio' value='3'  id='choice_14_29_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_29_2' id='label_14_29_2' class='gform-field-label gform-field-label--type-inline'>Once a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_29_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_29' type='radio' value='4'  id='choice_14_29_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_29_3' id='label_14_29_3' class='gform-field-label gform-field-label--type-inline'>Once or twice<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_29_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_29' type='radio' value='5'  id='choice_14_29_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_29_4' id='label_14_29_4' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_30\" 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 have you used your reliever inhaler (usually blue)?&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_14_30_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_30' type='radio' value='1'  id='choice_14_30_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_30_0' id='label_14_30_0' class='gform-field-label gform-field-label--type-inline'>3 or more times a day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_30_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_30' type='radio' value='2'  id='choice_14_30_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_30_1' id='label_14_30_1' class='gform-field-label gform-field-label--type-inline'>1-2 times a day<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_30_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_30' type='radio' value='3'  id='choice_14_30_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_30_2' id='label_14_30_2' class='gform-field-label gform-field-label--type-inline'>2-3 times a week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_30_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_30' type='radio' value='4'  id='choice_14_30_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_30_3' id='label_14_30_3' class='gform-field-label gform-field-label--type-inline'>Once a week or less<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_30_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_30' type='radio' value='5'  id='choice_14_30_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_30_4' id='label_14_30_4' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_14_31\" 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 would you rate your asthma control?&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_14_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_31' type='radio' value='1'  id='choice_14_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_31_0' id='label_14_31_0' class='gform-field-label gform-field-label--type-inline'>Not controlled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_31' type='radio' value='2'  id='choice_14_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_31_1' id='label_14_31_1' class='gform-field-label gform-field-label--type-inline'>Poorly controlled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_31' type='radio' value='3'  id='choice_14_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_31_2' id='label_14_31_2' class='gform-field-label gform-field-label--type-inline'>Somewhat controlled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_31_3'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_31' type='radio' value='4'  id='choice_14_31_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_31_3' id='label_14_31_3' class='gform-field-label gform-field-label--type-inline'>Well controlled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice nhsuk-radios__item gchoice_14_31_4'>\n\t\t\t\t\t<input class='gfield-choice-input nhsuk-radios__input' name='input_31' type='radio' value='5'  id='choice_14_31_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_14_31_4' id='label_14_31_4' class='gform-field-label gform-field-label--type-inline'>Completely controlled<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_14_27\" class=\"gfield nhsuk-form-group gfield--type-number gfield--input-type-number gfield_contains_required gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_14_27'>Your Calculated Asthma score&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_27' id='input_14_27' type='text' step='any'   value='' class='large nhsuk-input  gform-text-input-reset'  readonly=\"readonly\"   aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_14_32\" class=\"gfield nhsuk-form-group gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style=\"background: red; padding: 30px; color: #fff;\">\n<p>Your score is less than 20.<\/p>\n<p>Your asthma may not have been controlled during the past 4 weeks.<\/p>\n<p>Your doctor or nurse can recommend an asthma action plan to help improve your asthma control.<\/p>\n<\/div><\/div><div id=\"field_14_33\" class=\"gfield nhsuk-form-group gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style=\"background: orange; padding: 30px; color: #000;\">\n<p>Your score is between 20 and 24.<\/p>\n<p>Your asthma appears to have been reasonably well controlled during the past 4 weeks.<\/p>\n<p>However, if you are experiencing symptoms your doctor or nurse may be able to help you.<\/p>\n<\/div><\/div><div id=\"field_14_34\" class=\"gfield nhsuk-form-group gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div style=\"background: green; padding: 30px; color: #fff;\">\n<p>Your score is 25, well done!<\/p>\n<p>Your asthma appears to have been under control over the last 4 weeks.<\/p>\n<p>However, if you are experiencing any problems with your asthma, you should see your doctor or nurse.<\/p>\n<\/div><\/div><div id=\"field_14_35\" 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\">Further Questions<\/h2><\/div><div id=\"field_14_36\" class=\"gfield nhsuk-form-group gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='nhsuk-label gform-field-label' for='input_14_36'>I have the 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