    <script type="text/javascript">
        jQuery(document).on('gform_page_loaded', function(){
            /* apply only to a input with a class of gf_readonly */
            jQuery(".gf_readonly input").attr("readonly","readonly");
        });
    </script>
    {"id":578,"date":"2026-08-22T12:17:50","date_gmt":"2026-08-22T11:17:50","guid":{"rendered":"https:\/\/surgerywebtemp.org.uk\/m91021\/?page_id=578"},"modified":"2026-08-22T12:17:50","modified_gmt":"2026-08-22T11:17:50","slug":"asthma-review","status":"publish","type":"page","link":"https:\/\/surgerywebtemp.org.uk\/m91021\/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_19' style='display:none'><div id='gf_19' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_19' id='gform_19'  action='\/m91021\/wp-json\/wp\/v2\/pages\/578#gf_19' data-formid='19' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_19' class='c-form-list gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_19_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_19_37'><span class='gform-field-label__text'>LinkedIn<\/span>&nbsp;&nbsp;<span class=\"nhsuk-tag\">Optional<\/span><\/label><div class='ginput_container'><input name='input_37' id='input_19_37' type='text' value='' autocomplete='new-password'\/><\/div><span class='nhsuk-hint' id='gfield_description_19_37'>This field is for validation purposes and should be left unchanged.<\/span><\/div><div id=\"field_19_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_19_1'><span class='gform-field-label__text'>Full Name<\/span>&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_19_1' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_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' ><span class='gform-field-label__text'>Date of Birth<\/span>&nbsp;&nbsp;<span class=\"nhsuk-tag nhsuk-tag--grey\">Required<\/span><\/legend><div id='input_19_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_19_3_2_container'><label for='input_19_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_19_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_19_3_1_container'><label for='input_19_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_19_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_19_3_3_container'><label for='input_19_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_19_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_19_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_19_4'><span class='gform-field-label__text'>Email<\/span>&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_19_4' type='email' value='' class='large nhsuk-input '    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_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_19_5'><span class='gform-field-label__text'>Phone Number<\/span>&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_19_5' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>How often does your asthma cause symptoms during the day?<\/span>&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_19_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_19_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_7_0' id='label_19_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_19_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_19_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_7_1' id='label_19_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_19_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_19_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_7_2' id='label_19_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_19_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_19_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_7_3' id='label_19_7_3' class='gform-field-label gform-field-label--type-inline'>Most days<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>How often does your asthma cause symptoms at night?<\/span>&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_19_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_19_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_8_0' id='label_19_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_19_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_19_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_8_1' id='label_19_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_19_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_19_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_8_2' id='label_19_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_19_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_19_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_8_3' id='label_19_8_3' class='gform-field-label gform-field-label--type-inline'>Most days<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>How often does your asthma limit your activities?<\/span>&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_19_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_19_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_9_0' id='label_19_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_19_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_19_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_9_1' id='label_19_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_19_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_19_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_9_2' id='label_19_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_19_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_19_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_9_3' id='label_19_9_3' class='gform-field-label gform-field-label--type-inline'>Most days<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_19_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_19_10'><span class='gform-field-label__text'>How many asthma exacerbations (attacked) have you had in the past year?<\/span>&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_19_10' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_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_19_11'><span class='gform-field-label__text'>How many times have you attended Accident and Emergency Department since your last asthma review?<\/span>&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_19_11' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label nhsuk-label_before_complex' ><span class='gform-field-label__text'>Please select the types of inhalers that you use<\/span>&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_19_13'><div class='gchoice nhsuk-checkboxes__item gchoice_19_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_19_13_1'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_19_13_1' id='label_19_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_19_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_19_13_2'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_19_13_2' id='label_19_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_19_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_19_13_3'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_19_13_3' id='label_19_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_19_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_19_13_4'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_19_13_4' id='label_19_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_19_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_19_13_5'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_19_13_5' id='label_19_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_19_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_19_13_6'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_19_13_6' id='label_19_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_19_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_19_13_7'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_19_13_7' id='label_19_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_19_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_19_13_8'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_19_13_8' id='label_19_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_19_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_19_13_9'   \/>\n\t\t\t\t\t\t\t\t<label class=\"nhsuk-label nhsuk-checkboxes__label\" for='choice_19_13_9' id='label_19_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_19_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_19_14'><span class='gform-field-label__text'>Please specify your inhaler<\/span>&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_19_14' type='text' value='' class='large nhsuk-input '     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>How often do you have a drink containing alcohol?<\/span>&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_19_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_19_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_16_0' id='label_19_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_19_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_19_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_16_1' id='label_19_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_19_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_19_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_16_2' id='label_19_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_19_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_19_16_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_16_3' id='label_19_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_19_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_19_16_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_16_4' id='label_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>How many units of alcohol do you drink on a typical day drinking?<\/span>&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_19_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_19_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_17_0' id='label_19_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_19_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_19_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_17_1' id='label_19_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_19_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_19_17_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_17_2' id='label_19_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_19_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_19_17_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_17_3' id='label_19_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_19_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_19_17_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_17_4' id='label_19_17_4' class='gform-field-label gform-field-label--type-inline'>10+<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>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?<\/span>&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_19_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_19_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_18_0' id='label_19_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_19_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_19_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_18_1' id='label_19_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_19_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_19_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_18_2' id='label_19_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_19_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_19_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_18_3' id='label_19_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_19_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_19_18_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_18_4' id='label_19_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_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>Do you smoke?<\/span>&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_19_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_19_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_20_0' id='label_19_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_19_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_19_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_20_1' id='label_19_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_19_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_19_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_20_2' id='label_19_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_19_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_19_20_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_20_3' id='label_19_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_19_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_19_20_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_20_4' id='label_19_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_19_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_19_20_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_20_5' id='label_19_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_19_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_19_20_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_20_6' id='label_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>Do you use an e-cigarette?<\/span>&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_19_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_19_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_21_0' id='label_19_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_19_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_19_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_21_1' id='label_19_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_19_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_19_21_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_21_2' id='label_19_21_2' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div><\/div><\/fieldset><fieldset id=\"field_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>Would you like help to quit smoking?<\/span>&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_19_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_19_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_22_0' id='label_19_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_19_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_19_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_22_1' id='label_19_22_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_19_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_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>During the past 4 weeks, how often did your asthma prevent you from getting as much done at work, school or home?<\/span>&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_19_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_19_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_25_0' id='label_19_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_19_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_19_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_25_1' id='label_19_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_19_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_19_25_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_25_2' id='label_19_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_19_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_19_25_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_25_3' id='label_19_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_19_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_19_25_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_25_4' id='label_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>How often have you had shortness of breath?<\/span>&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_19_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_19_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_28_0' id='label_19_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_19_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_19_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_28_1' id='label_19_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_19_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_19_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_28_2' id='label_19_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_19_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_19_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_28_3' id='label_19_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_19_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_19_28_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_28_4' id='label_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>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?<\/span>&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_19_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_19_29_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_29_0' id='label_19_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_19_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_19_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_29_1' id='label_19_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_19_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_19_29_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_29_2' id='label_19_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_19_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_19_29_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_29_3' id='label_19_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_19_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_19_29_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_29_4' id='label_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>How often have you used your reliever inhaler (usually blue)?<\/span>&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_19_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_19_30_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_30_0' id='label_19_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_19_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_19_30_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_30_1' id='label_19_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_19_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_19_30_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_30_2' id='label_19_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_19_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_19_30_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_30_3' id='label_19_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_19_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_19_30_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_30_4' id='label_19_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_19_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 gfield--choice-align-vertical\"  ><legend class='nhsuk-label gform-field-label' ><span class='gform-field-label__text'>How would you rate your asthma control?<\/span>&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_19_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_19_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_31_0' id='label_19_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_19_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_19_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_31_1' id='label_19_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_19_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_19_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_31_2' id='label_19_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_19_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_19_31_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_31_3' id='label_19_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_19_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_19_31_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label class=\"nhsuk-label nhsuk-radios__label\" for='choice_19_31_4' id='label_19_31_4' class='gform-field-label gform-field-label--type-inline'>Completely controlled<\/label>\n\t\t\t<\/div><\/div><\/fieldset><div id=\"field_19_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_19_27'><span class='gform-field-label__text'>Your Calculated Asthma score<\/span>&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_19_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_19_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_19_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_19_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_19_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_19_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_19_36'><span class='gform-field-label__text'>I have the following information, questions or concerns that I would like to raise with my Asthma Nurse or Doctor<\/span>&nbsp;&nbsp;<span class=\"nhsuk-tag\">Optional<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_36' id='input_19_36' class='textarea nhsuk-textarea  small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_19' class='nhsuk-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> <input type='hidden' name='gform_ajax' value='form_id=19&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;styles=[]&amp;hash=9457ecf9de01b7522e25ddb3c3d8baa5' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_19' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_19' id='gform_theme_19' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_19' id='gform_style_settings_19' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_19' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='19' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='GBP' value='iGaEMuUCpO5vRJCmPoSboNymmn88s4x77Vz5lhBVg1pOWbXH+eB\/J9gPx1Lgqh78HhzMDdkQsJ\/9Y+dv8+1OlK3NttKD7AzBszNdt9hWwUHn9k4=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_19' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_19' id='gform_target_page_number_19' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_19' id='gform_source_page_number_19' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <input type=\"hidden\" id=\"ct_checkjs_b1eec33c726a60554bc78518d5f9b32c\" name=\"ct_checkjs\" value=\"0\" \/><script >setTimeout(function(){var ct_input_name = \"ct_checkjs_b1eec33c726a60554bc78518d5f9b32c\";if (document.getElementById(ct_input_name) !== null) {var ct_input_value = document.getElementById(ct_input_name).value;document.getElementById(ct_input_name).value = document.getElementById(ct_input_name).value.replace(ct_input_value, '649836719');}}, 1000);<\/script><input\n                    class=\"apbct_special_field apbct_email_id__gravity_form\"\n                    name=\"apbct__email_id__gravity_form\"\n                    aria-label=\"apbct__label_id__gravity_form\"\n                    type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n                    value=\"\"\n                \/><\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_19' id='gform_ajax_frame_19' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script>\ngform.initializeOnLoaded( function() {jQuery('#gform_ajax_frame_19').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_19');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_19').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_19').html(form_content.html());if(form_content.hasClass('gform_nhsuk-error-message is-error')){jQuery('#gform_wrapper_19').addClass('gform_nhsuk-error-message is-error');} else {jQuery('#gform_wrapper_19').removeClass('gform_nhsuk-error-message is-error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_19').offset().top - mt); }, 50 );var current_page = jQuery('#gform_source_page_number_19').val();jQuery(document).trigger('gform_page_loaded', [19, current_page]);window['gf_submitting_19'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_19').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_19').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [19]);window['gf_submitting_19'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_19').text());}else{jQuery('#gform_19').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"19\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_19\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_19\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_19\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 19, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-578","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/surgerywebtemp.org.uk\/m91021\/wp-json\/wp\/v2\/pages\/578","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/surgerywebtemp.org.uk\/m91021\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/surgerywebtemp.org.uk\/m91021\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/surgerywebtemp.org.uk\/m91021\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/surgerywebtemp.org.uk\/m91021\/wp-json\/wp\/v2\/comments?post=578"}],"version-history":[{"count":0,"href":"https:\/\/surgerywebtemp.org.uk\/m91021\/wp-json\/wp\/v2\/pages\/578\/revisions"}],"wp:attachment":[{"href":"https:\/\/surgerywebtemp.org.uk\/m91021\/wp-json\/wp\/v2\/media?parent=578"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}