{"id":20,"date":"2025-04-03T12:45:34","date_gmt":"2025-04-03T12:45:34","guid":{"rendered":"https:\/\/ksrht.org\/portal\/?page_id=20"},"modified":"2025-04-03T14:06:45","modified_gmt":"2025-04-03T14:06:45","slug":"ksrht-form","status":"publish","type":"page","link":"https:\/\/ksrht.org\/portal\/","title":{"rendered":"KSRHT Form"},"content":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_3_container\" data-token=\"1d63274aca475b2e039575fcd60c3e5b\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_iz5fx\" data-token=\"1d63274aca475b2e039575fcd60c3e5b\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">KSRHT Form<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"3\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_3\" id=\"frm_hide_fields_3\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"iz5fx\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_3\" name=\"frm_submit_entry_3\" value=\"643022c0d4\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/portal\/wp-json\/wp\/v2\/pages\/20\" \/><div id=\"frm_field_180_container\" class=\"frm_form_field frm_section_heading form-field \">\n<h3 class=\"frm_pos_top frm_section_spacing\">Select a Therapy<\/h3>\n\n\n<div id=\"frm_field_182_container\" class=\"frm_form_field form-field  frm_top_container frm_two_col frm_display_format_buttons frm_text_align_left\">\n\t<div  id=\"field_kjjeu_label\" class=\"frm_primary_label\">Choose from the following (click on a service to find out more)\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/div>\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_kjjeu_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_182-180-0\">\t\t\t<label  for=\"field_kjjeu-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[182]\" id=\"field_kjjeu-0\" value=\"PC or CBT Therapy \u00a345 for qualified therapist per session or Trainee therapist at \u00a315 a session\"\n\t\t   data-sectionid=\"180\"  data-invmsg=\"Choose from the following (click on a service to find out more) is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">PC or CBT Therapy \u00a345 for qualified therapist per session or Trainee therapist at \u00a315 a session<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_182-180-1\">\t\t\t<label  for=\"field_kjjeu-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[182]\" id=\"field_kjjeu-1\" value=\"EMDR therapy at \u00a360 a session\"\n\t\t   data-sectionid=\"180\"  data-invmsg=\"Choose from the following (click on a service to find out more) is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">EMDR therapy at \u00a360 a session<\/div><\/label><\/div>\n<\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_183_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div class=\"advise\">\n<div><b>What is PC?<\/b><\/div>\n<p>Person Centred counselling is an effective and popular treatment for a variety of issues such as:<\/p>\n<ul>\n<li>Grief<\/li>\n<li>Relationship Issues<\/li>\n<li>Loneliness<\/li>\n<li>Transitions Through Life<\/li>\n<li>Anger<\/li>\n<\/ul>\n<div><b>What is CBT?<\/b><\/div>\n<p>Cognitive-behaviour therapy can assist with:<\/p>\n<ul>\n<li>Generalised Anxiety Disorder (GAD)<\/li>\n<li>Obsessive Compulsive Disorder (OCD)<\/li>\n<li>Panic Disorder<\/li>\n<li>Phobia<\/li>\n<li>Social Anxiety<\/li>\n<li>Low Mood\/Depression<\/li>\n<li>Low Self Esteem<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div id=\"frm_field_184_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div class=\"advise\">\n<div><b>What is EMDR?<\/b><\/div>\n<p>EMDR (Eye Movement Desensitisation and Reprocessing) is an evidence\u2010based psychological therapy that helps the brain process distressing experiences.<\/p>\n<ul>\n<li>Unprocessed memories can stay \u201cstuck\u201d and affect current thoughts and reactions<\/li>\n<li>EMDR helps these memories become less distressing and more integrated<\/li>\n<\/ul>\n<p><b>Benefits of EMDR<\/b><br \/>\nReduces emotional distress from past experiences<\/p>\n<ul>\n<li>Helps shift unhelpful self\u2011beliefs<\/li>\n<li>Doesn\u2019t require going into lots of verbal detail<\/li>\n<li>Often feels less overwhelming than traditional talk therapy<\/li>\n<li>Supports long\u2011term emotional healing and resilience<\/li>\n<\/ul>\n<p><b>Important to Know<\/b><br \/>\nEMDR is always delivered at a pace that feels manageable for you. Preparation and safety are key part of the process, and you remain in control throughout therapy. If you have any questions or would like to know whether EMDR might be right for you, please feel free to ask.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"frm_field_187_container\" class=\"frm_form_field frm_section_heading form-field \">\n<h3 class=\"frm_pos_top frm_section_spacing\">If you selected PC or CBT Please Complete<\/h3>\n\n\n<div id=\"frm_field_37_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first vertical_radio\">\r\n\t<div  id=\"field_i3f2x_label\" class=\"frm_primary_label\">The main issue I am looking for help with is: \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_i3f2x_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-0\">\t\t\t<label  for=\"field_i3f2x-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-0\" value=\"Low Mood\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> Low Mood<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-1\">\t\t\t<label  for=\"field_i3f2x-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-1\" value=\"Anxiety\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> Anxiety<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-2\">\t\t\t<label  for=\"field_i3f2x-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-2\" value=\"Social Anxiety\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> Social Anxiety<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-3\">\t\t\t<label  for=\"field_i3f2x-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-3\" value=\"Panic Attacks\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> Panic Attacks<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-4\">\t\t\t<label  for=\"field_i3f2x-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-4\" value=\"Relationship Issues\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> Relationship Issues<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-5\">\t\t\t<label  for=\"field_i3f2x-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-5\" value=\"Anger\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> Anger<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-6\">\t\t\t<label  for=\"field_i3f2x-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-6\" value=\"Self Esteem\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> Self Esteem<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-7\">\t\t\t<label  for=\"field_i3f2x-7\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-7\" value=\"OCD\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> OCD<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-8\">\t\t\t<label  for=\"field_i3f2x-8\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-8\" value=\"Phobia\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> Phobia<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-9\">\t\t\t<label  for=\"field_i3f2x-9\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-9\" value=\"PTSD\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> PTSD<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_37-187-10\">\t\t\t<label  for=\"field_i3f2x-10\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[37]\" id=\"field_i3f2x-10\" value=\"Grief\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"The main issue I am looking for help with is:  is invalid\" aria-invalid=\"false\"  \/> Grief<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_38_container\" class=\"frm_form_field form-field  frm_top_container frm6 vertical_radio\">\r\n\t<div  id=\"field_krbks_label\" class=\"frm_primary_label\">Secondary issue\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_krbks_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-0\">\t\t\t<label  for=\"field_krbks-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-0\" value=\"Low Mood\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> Low Mood<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-1\">\t\t\t<label  for=\"field_krbks-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-1\" value=\"Anxiety\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> Anxiety<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-2\">\t\t\t<label  for=\"field_krbks-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-2\" value=\"Social Anxiety\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> Social Anxiety<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-3\">\t\t\t<label  for=\"field_krbks-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-3\" value=\"Panic Attacks\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> Panic Attacks<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-4\">\t\t\t<label  for=\"field_krbks-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-4\" value=\"Relationship Issues\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> Relationship Issues<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-5\">\t\t\t<label  for=\"field_krbks-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-5\" value=\"Anger\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> Anger<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-6\">\t\t\t<label  for=\"field_krbks-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-6\" value=\"Self Esteem\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> Self Esteem<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-7\">\t\t\t<label  for=\"field_krbks-7\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-7\" value=\"OCD\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> OCD<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-8\">\t\t\t<label  for=\"field_krbks-8\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-8\" value=\"Phobia\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> Phobia<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-9\">\t\t\t<label  for=\"field_krbks-9\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-9\" value=\"PTSD\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> PTSD<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_38-187-10\">\t\t\t<label  for=\"field_krbks-10\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[38]\" id=\"field_krbks-10\" value=\"Grief\"\n\t\t   data-sectionid=\"187\"  data-invmsg=\"Secondary issue is invalid\" aria-invalid=\"false\"  \/> Grief<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_113_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div class=\"advise\">Based on your selection we would advise CBT<\/div>\n<\/div>\n<div id=\"frm_field_114_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div class=\"advise\">Based on your selection we would advise Person Centred Therapy<\/div>\n<\/div>\n<div id=\"frm_field_24_container\" class=\"frm_form_field form-field  frm_top_container frm_two_col frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_zntox_label\" class=\"frm_primary_label\">What type of therapy are you looking for? \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_zntox_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_24-187-0\">\t\t\t<label  for=\"field_zntox-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[24][]\" id=\"field_zntox-0\" value=\"Person Centred\"  data-sectionid=\"187\"  data-frmlimit=\"3\"  data-invmsg=\"What type of therapy are you looking for?  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Person Centred<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_24-187-1\">\t\t\t<label  for=\"field_zntox-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[24][]\" id=\"field_zntox-1\" value=\"CBT\"  data-sectionid=\"187\"  data-frmlimit=\"3\"  data-invmsg=\"What type of therapy are you looking for?  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">CBT<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_19_container\" class=\"frm_form_field form-field  frm_top_container frm_three_col frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_6ffql_label\" class=\"frm_primary_label\">What option are you looking for? (PC or CBT only)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_6ffql_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_19-187-0\">\t\t\t<label  for=\"field_6ffql-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[19][]\" id=\"field_6ffql-0\" value=\"Trainee therapist @ \u00a315.00 per session\"  data-sectionid=\"187\"  data-frmlimit=\"3\"  data-invmsg=\"What option are you looking for? (PC or CBT only) is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Trainee therapist @ \u00a315.00 per session<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_19-187-1\">\t\t\t<label  for=\"field_6ffql-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[19][]\" id=\"field_6ffql-1\" value=\"Qualified therapist @ \u00a345.00 per session\"  data-sectionid=\"187\"  data-frmlimit=\"3\"  data-invmsg=\"What option are you looking for? (PC or CBT only) is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Qualified therapist @ \u00a345.00 per session<\/div><\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_6ffql\">It&#8217;s not possible for a trainee therapist to work with higher risk conditions such as PTSD or for people who are at risk of suicide.<\/div>\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_189_container\" class=\"frm_form_field frm_section_heading form-field \">\n<h3 class=\"frm_pos_top frm_section_spacing\">If you selected EMDR Please Complete<\/h3>\n\n\n<div id=\"frm_field_185_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\n\t<div  id=\"field_d1rwf_label\" class=\"frm_primary_label\">Main Issue (EMDR)\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/div>\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_d1rwf_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_185-189-0\">\t\t\t<label  for=\"field_d1rwf-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[185]\" id=\"field_d1rwf-0\" value=\"Single event trauma e.g accidents,medical procedures,assaults\"\n\t\t   data-sectionid=\"189\"  data-invmsg=\"Main Issue (EMDR) is invalid\" aria-invalid=\"false\"  \/> Single event trauma e.g accidents,medical procedures,assaults<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_185-189-1\">\t\t\t<label  for=\"field_d1rwf-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[185]\" id=\"field_d1rwf-1\" value=\"Phobias and fears\"\n\t\t   data-sectionid=\"189\"  data-invmsg=\"Main Issue (EMDR) is invalid\" aria-invalid=\"false\"  \/> Phobias and fears<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_185-189-2\">\t\t\t<label  for=\"field_d1rwf-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[185]\" id=\"field_d1rwf-2\" value=\"PTSD and trauma related symptoms\"\n\t\t   data-sectionid=\"189\"  data-invmsg=\"Main Issue (EMDR) is invalid\" aria-invalid=\"false\"  \/> PTSD and trauma related symptoms<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_185-189-3\">\t\t\t<label  for=\"field_d1rwf-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[185]\" id=\"field_d1rwf-3\" value=\"Limiting self beliefs  e.g. &quot;Im not worthy&quot;\"\n\t\t   data-sectionid=\"189\"  data-invmsg=\"Main Issue (EMDR) is invalid\" aria-invalid=\"false\"  \/> Limiting self beliefs  e.g. &#8220;Im not worthy&#8221;<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_185-189-4\">\t\t\t<label  for=\"field_d1rwf-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[185]\" id=\"field_d1rwf-4\" value=\"Anxiety linked to past experiences\"\n\t\t   data-sectionid=\"189\"  data-invmsg=\"Main Issue (EMDR) is invalid\" aria-invalid=\"false\"  \/> Anxiety linked to past experiences<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_185-189-5\">\t\t\t<label  for=\"field_d1rwf-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[185]\" id=\"field_d1rwf-5\" value=\"Distressing memories that still affect daily life\"\n\t\t   data-sectionid=\"189\"  data-invmsg=\"Main Issue (EMDR) is invalid\" aria-invalid=\"false\"  \/> Distressing memories that still affect daily life<\/label><\/div>\n<\/div>\n\t\n\t\n<\/div>\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">All to Complete<\/h3>\r\n\r\n\r\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first vertical_radio\">\r\n\t<div  id=\"field_ihf2l_label\" class=\"frm_primary_label\">Are you on medication related to the issue you are seeking help for?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ihf2l_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_42-0\">\t\t\t<label  for=\"field_ihf2l-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[42]\" id=\"field_ihf2l-0\" value=\"Yes\"\n\t\t   data-invmsg=\"Are you on medication related to the issue you are seeking help for? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_42-1\">\t\t\t<label  for=\"field_ihf2l-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[42]\" id=\"field_ihf2l-1\" value=\"No\"\n\t\t   data-invmsg=\"Are you on medication related to the issue you are seeking help for? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_43_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_3hoo9\" id=\"field_3hoo9_label\" class=\"frm_primary_label\">If you answered yes to the previous questions please provide the name and current dosage\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[43]\" id=\"field_3hoo9\" rows=\"2\"  data-invmsg=\"If you answered yes to the previous questions please provide the name and current dosage is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_3vf2z_label\" class=\"frm_primary_label\">Do you have any contact with psychological\/psychiatric services (eg CPN, psychologist or psychiatrist) or have you had in the past?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_3vf2z_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_44-0\">\t\t\t<label  for=\"field_3vf2z-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_3vf2z-0\" value=\"Yes currently\"\n\t\t   data-invmsg=\"Do you have any contact with psychological\/psychiatric services (eg CPN, psychologist or psychiatrist) or have you had in the past? is invalid\" aria-invalid=\"false\"  \/> Yes currently<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_44-1\">\t\t\t<label  for=\"field_3vf2z-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_3vf2z-1\" value=\"Yes recent past (within past 2 years)\"\n\t\t   data-invmsg=\"Do you have any contact with psychological\/psychiatric services (eg CPN, psychologist or psychiatrist) or have you had in the past? is invalid\" aria-invalid=\"false\"  \/> Yes recent past (within past 2 years)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_44-2\">\t\t\t<label  for=\"field_3vf2z-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_3vf2z-2\" value=\"Yes not recent\"\n\t\t   data-invmsg=\"Do you have any contact with psychological\/psychiatric services (eg CPN, psychologist or psychiatrist) or have you had in the past? is invalid\" aria-invalid=\"false\"  \/> Yes not recent<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_44-3\">\t\t\t<label  for=\"field_3vf2z-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_3vf2z-3\" value=\"No\"\n\t\t   data-invmsg=\"Do you have any contact with psychological\/psychiatric services (eg CPN, psychologist or psychiatrist) or have you had in the past? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_45_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_th27e\" id=\"field_th27e_label\" class=\"frm_primary_label\">If you answered yes could please provide brief details\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[45]\" id=\"field_th27e\" rows=\"2\"  data-invmsg=\"If you answered yes could please provide brief details is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_46_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first vertical_radio\">\r\n\t<div  id=\"field_21t6b_label\" class=\"frm_primary_label\">Sorry to ask an intrusive question but do you consider yourself to be a risk either to yourself or others at the current time?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_21t6b_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_46-0\">\t\t\t<label  for=\"field_21t6b-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[46]\" id=\"field_21t6b-0\" value=\"Yes\"\n\t\t   data-reqmsg=\"Sorry to ask an intrusive question but do you consider yourself to be a risk either to yourself or others at the current time? cannot be blank.\" data-invmsg=\"Sorry to ask an intrusive question but do you consider yourself to be a risk either to yourself or others at the current time? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_46-1\">\t\t\t<label  for=\"field_21t6b-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[46]\" id=\"field_21t6b-1\" value=\"No\"\n\t\t   data-reqmsg=\"Sorry to ask an intrusive question but do you consider yourself to be a risk either to yourself or others at the current time? cannot be blank.\" data-invmsg=\"Sorry to ask an intrusive question but do you consider yourself to be a risk either to yourself or others at the current time? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_2294q\" id=\"field_2294q_label\" class=\"frm_primary_label\">Name of your GP Surgery\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_2294q\" name=\"item_meta[26]\" value=\"\"  data-invmsg=\"Name of your GP Surgery is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_27_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_86th_label\" class=\"frm_primary_label\">Do we have your permission to contact GP surgery in an emergency?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_86th_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_27-0\">\t\t\t<label  for=\"field_86th-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_86th-0\" value=\"Yes\"\n\t\t   data-invmsg=\"Do we have your permission to contact GP surgery in an emergency? is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_27-1\">\t\t\t<label  for=\"field_86th-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_86th-1\" value=\"No\"\n\t\t   data-invmsg=\"Do we have your permission to contact GP surgery in an emergency? is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_39_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_ti955\" id=\"field_ti955_label\" class=\"frm_primary_label\">Any other issue that you are looking for help with?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[39]\" id=\"field_ti955\" rows=\"2\"  data-invmsg=\"Any other issue that you are looking for help with? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_eselo_label\" class=\"frm_primary_label\">Have you had support through counselling before? \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_eselo_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_40-0\">\t\t\t<label  for=\"field_eselo-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[40]\" id=\"field_eselo-0\" value=\"Yes\"\n\t\t   data-invmsg=\"Have you had support through counselling before?  is invalid\" aria-invalid=\"false\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_40-1\">\t\t\t<label  for=\"field_eselo-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[40]\" id=\"field_eselo-1\" value=\"No\"\n\t\t   data-invmsg=\"Have you had support through counselling before?  is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_186_container\" class=\"frm_form_field  frm_html_container form-field\">\n<div class=\"advise\">\n<b>Just a reminder that the cost for an EMDR session is \u00a360<\/b>\n<\/div>\n<\/div>\n<div id=\"frm_field_81_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Contact Details<\/h3>\r\n\r\n\r\n<div id=\"frm_field_28_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_3bhsk\" id=\"field_3bhsk_label\" class=\"frm_primary_label\">First Name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_3bhsk\" name=\"item_meta[28]\" value=\"\"  data-sectionid=\"81\"  placeholder=\"J\" data-reqmsg=\"First Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"First Name is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_80_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n\t<label for=\"field_eev7e\" id=\"field_eev7e_label\" class=\"frm_primary_label\">Surname\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_eev7e\" name=\"item_meta[80]\" value=\"\"  placeholder=\"Smith\" data-reqmsg=\"Surname cannot be blank.\" aria-required=\"true\" data-invmsg=\"Surname is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_29_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_vko50\" id=\"field_vko50_label\" class=\"frm_primary_label\">Address\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[29]\" id=\"field_vko50\" rows=\"2\"  data-sectionid=\"81\"  data-invmsg=\"Address is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_30_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_4n2hj\" id=\"field_4n2hj_label\" class=\"frm_primary_label\">Postcode\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_4n2hj\" name=\"item_meta[30]\" value=\"\"  data-sectionid=\"81\"  data-invmsg=\"Postcode is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_31_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_x4nmr\" id=\"field_x4nmr_label\" class=\"frm_primary_label\">Contact Telephone Number\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_x4nmr\" name=\"item_meta[31]\" value=\"\"  data-sectionid=\"81\"  data-invmsg=\"Contact Telephone Number is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_32_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_3aapv\" id=\"field_3aapv_label\" class=\"frm_primary_label\">Email address\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_3aapv\" name=\"item_meta[32]\" value=\"\"  autocomplete=\"email\"  data-invmsg=\"Email address is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_33_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_wx0r2\" id=\"field_wx0r2_label\" class=\"frm_primary_label\">Date of birth\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_wx0r2\" name=\"item_meta[33]\" value=\"\"  data-sectionid=\"81\"  maxlength=\"10\" data-invmsg=\"Date of birth is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_34_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_a8y33\" id=\"field_a8y33_label\" class=\"frm_primary_label\">Occupation\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_a8y33\" name=\"item_meta[34]\" value=\"\"  data-invmsg=\"Occupation is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_47_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\"><\/h3>\r\n<div id=\"frm_desc_field_tr1gn\" class=\"frm_description frm_section_spacing\"> If you have answered yes to the previous question please answer the following question. Please read each statement below and think how often you have felt like that way in the last week, then mark the box which is closest to this.<\/div>\r\n\r\n<div id=\"frm_field_49_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_ue8sq_label\" class=\"frm_primary_label\">I have thought of hurting myself\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ue8sq_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_49-47-0\">\t\t\t<label  for=\"field_ue8sq-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[49]\" id=\"field_ue8sq-0\" value=\"Not at all\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought of hurting myself is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Not at all<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_49-47-1\">\t\t\t<label  for=\"field_ue8sq-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[49]\" id=\"field_ue8sq-1\" value=\"Only occasionally\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought of hurting myself is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Only occasionally<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_49-47-2\">\t\t\t<label  for=\"field_ue8sq-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[49]\" id=\"field_ue8sq-2\" value=\"Sometimes\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought of hurting myself is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Sometimes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_49-47-3\">\t\t\t<label  for=\"field_ue8sq-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[49]\" id=\"field_ue8sq-3\" value=\"Often\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought of hurting myself is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Often<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_49-47-4\">\t\t\t<label  for=\"field_ue8sq-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[49]\" id=\"field_ue8sq-4\" value=\"Most or all of the time\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought of hurting myself is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Most or all of the time<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_51_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_7tm30_label\" class=\"frm_primary_label\">I have made plans to end my life \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_7tm30_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_51-47-0\">\t\t\t<label  for=\"field_7tm30-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[51]\" id=\"field_7tm30-0\" value=\"Not at all\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have made plans to end my life  is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Not at all<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_51-47-1\">\t\t\t<label  for=\"field_7tm30-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[51]\" id=\"field_7tm30-1\" value=\"Only occasionally\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have made plans to end my life  is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Only occasionally<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_51-47-2\">\t\t\t<label  for=\"field_7tm30-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[51]\" id=\"field_7tm30-2\" value=\"Sometimes\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have made plans to end my life  is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Sometimes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_51-47-3\">\t\t\t<label  for=\"field_7tm30-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[51]\" id=\"field_7tm30-3\" value=\"Often\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have made plans to end my life  is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Often<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_51-47-4\">\t\t\t<label  for=\"field_7tm30-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[51]\" id=\"field_7tm30-4\" value=\"Most or all of the time\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have made plans to end my life  is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Most or all of the time<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_52_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_7iprn_label\" class=\"frm_primary_label\">I have thought it would be better if i were dead\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_7iprn_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_52-47-0\">\t\t\t<label  for=\"field_7iprn-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[52]\" id=\"field_7iprn-0\" value=\"Not at all\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought it would be better if i were dead is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Not at all<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_52-47-1\">\t\t\t<label  for=\"field_7iprn-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[52]\" id=\"field_7iprn-1\" value=\"Only occasionally\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought it would be better if i were dead is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Only occasionally<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_52-47-2\">\t\t\t<label  for=\"field_7iprn-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[52]\" id=\"field_7iprn-2\" value=\"Sometimes\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought it would be better if i were dead is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Sometimes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_52-47-3\">\t\t\t<label  for=\"field_7iprn-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[52]\" id=\"field_7iprn-3\" value=\"Often\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought it would be better if i were dead is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Often<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_52-47-4\">\t\t\t<label  for=\"field_7iprn-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[52]\" id=\"field_7iprn-4\" value=\"Most or all of the time\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have thought it would be better if i were dead is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Most or all of the time<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_53_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_8z4fr_label\" class=\"frm_primary_label\">I have been physically violent to others\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_8z4fr_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_53-47-0\">\t\t\t<label  for=\"field_8z4fr-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[53]\" id=\"field_8z4fr-0\" value=\"Not at all\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have been physically violent to others is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Not at all<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_53-47-1\">\t\t\t<label  for=\"field_8z4fr-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[53]\" id=\"field_8z4fr-1\" value=\"Only occasionally\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have been physically violent to others is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Only occasionally<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_53-47-2\">\t\t\t<label  for=\"field_8z4fr-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[53]\" id=\"field_8z4fr-2\" value=\"Sometimes\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have been physically violent to others is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Sometimes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_53-47-3\">\t\t\t<label  for=\"field_8z4fr-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[53]\" id=\"field_8z4fr-3\" value=\"Often\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have been physically violent to others is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Often<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_53-47-4\">\t\t\t<label  for=\"field_8z4fr-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[53]\" id=\"field_8z4fr-4\" value=\"Most or all of the time\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have been physically violent to others is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Most or all of the time<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_54_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_nwyma_label\" class=\"frm_primary_label\">I have threatened or intimidated another person\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_nwyma_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_54-47-0\">\t\t\t<label  for=\"field_nwyma-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[54]\" id=\"field_nwyma-0\" value=\"Not at all\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have threatened or intimidated another person is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Not at all<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_54-47-1\">\t\t\t<label  for=\"field_nwyma-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[54]\" id=\"field_nwyma-1\" value=\"Only occasionally\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have threatened or intimidated another person is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Only occasionally<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_54-47-2\">\t\t\t<label  for=\"field_nwyma-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[54]\" id=\"field_nwyma-2\" value=\"Sometimes\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have threatened or intimidated another person is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Sometimes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_54-47-3\">\t\t\t<label  for=\"field_nwyma-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[54]\" id=\"field_nwyma-3\" value=\"Often\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have threatened or intimidated another person is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Often<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_54-47-4\">\t\t\t<label  for=\"field_nwyma-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[54]\" id=\"field_nwyma-4\" value=\"Most or all of the time\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have threatened or intimidated another person is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Most or all of the time<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_55_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_utpfj_label\" class=\"frm_primary_label\">I have hurt myself or taken dangerous risks with my life\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_utpfj_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_55-47-0\">\t\t\t<label  for=\"field_utpfj-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[55]\" id=\"field_utpfj-0\" value=\"Not at all\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have hurt myself or taken dangerous risks with my life is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Not at all<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_55-47-1\">\t\t\t<label  for=\"field_utpfj-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[55]\" id=\"field_utpfj-1\" value=\"Only occasionally\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have hurt myself or taken dangerous risks with my life is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Only occasionally<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_55-47-2\">\t\t\t<label  for=\"field_utpfj-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[55]\" id=\"field_utpfj-2\" value=\"Sometimes\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have hurt myself or taken dangerous risks with my life is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Sometimes<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_55-47-3\">\t\t\t<label  for=\"field_utpfj-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[55]\" id=\"field_utpfj-3\" value=\"Often\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have hurt myself or taken dangerous risks with my life is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Often<\/div><\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_55-47-4\">\t\t\t<label  for=\"field_utpfj-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[55]\" id=\"field_utpfj-4\" value=\"Most or all of the time\"\n\t\t   data-sectionid=\"47\"  data-invmsg=\"I have hurt myself or taken dangerous risks with my life is invalid\" aria-invalid=\"false\"  \/> <div class=\"frm_label_button_container\">Most or all of the time<\/div><\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_56_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio frm_display_format_buttons frm_text_align_left\">\r\n\t<div  id=\"field_vna39_label\" class=\"frm_primary_label\">Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply. \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_vna39_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-10\">\t\t\t<label  for=\"field_vna39-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-10\" value=\"Any Day\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Any Day<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-0\">\t\t\t<label  for=\"field_vna39-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-0\" value=\"Monday Morning\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Monday Morning<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-1\">\t\t\t<label  for=\"field_vna39-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-1\" value=\"Monday Afternoon\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Monday Afternoon<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-2\">\t\t\t<label  for=\"field_vna39-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-2\" value=\"Tuesday Morning\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Tuesday Morning<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-3\">\t\t\t<label  for=\"field_vna39-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-3\" value=\"Tuesday Afternoon\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Tuesday Afternoon<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-4\">\t\t\t<label  for=\"field_vna39-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-4\" value=\"Wednesday Morning\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Wednesday Morning<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-5\">\t\t\t<label  for=\"field_vna39-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-5\" value=\"Wednesday Afternoon\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Wednesday Afternoon<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-6\">\t\t\t<label  for=\"field_vna39-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-6\" value=\"Thursday Morning\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Thursday Morning<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-7\">\t\t\t<label  for=\"field_vna39-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-7\" value=\"Thursday Afternoon\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Thursday Afternoon<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-8\">\t\t\t<label  for=\"field_vna39-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-8\" value=\"Friday Morning\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Friday Morning<\/div><\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_56-9\">\t\t\t<label  for=\"field_vna39-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[56][]\" id=\"field_vna39-9\" value=\"Friday Afternoon\"  data-invmsg=\"Can you tell us what slots you might be available for your chosen therapy? The wider your availability the more timely we will be able to allocate you a counsellor. Please tick all that apply.  is invalid\" aria-invalid=\"false\"   \/> <div class=\"frm_label_button_container\">Friday Afternoon<\/div><\/label><\/div>\n<\/div>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_vna39\">Mornings are 9am \u2013 12pm, Afternoons are 12pm \u2013 5pm (last appointment time is 4pm) <\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_57_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_1e3qa\" id=\"field_1e3qa_label\" class=\"frm_primary_label\">We can only hold appointments for 24 hours after we have contacted you as we are extremely busy. Please check your voicemail\/email regularly. \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t\n<div >\n    <label class=\"frm_switch_block\">\n\t\t\t\t\t<span class=\"frm_off_label frm_switch_opt\">I understand that appointments cannot be held<\/span>\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[57][]\" id=\"field_1e3qa\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t\tdata-off=\"I understand that appointments cannot be held\"\n\t\t\t\t\t\t data-reqmsg=\"We can only hold appointments for 24 hours after we have contacted you as we are extremely busy. Please check your voicemail\/email regularly.  cannot be blank.\" aria-required=\"true\" data-invmsg=\"We can only hold appointments for 24 hours after we have contacted you as we are extremely busy. Please check your voicemail\/email regularly.  is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_1e3qa_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t<span class=\"frm_on_label frm_switch_opt\">Yes<\/span>\n\t\t\t<\/label>\n<\/div>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_58_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n\t<label for=\"field_wriyp\" id=\"field_wriyp_label\" class=\"frm_primary_label\">Is there anything else you think we should be aware of in relation to your enquiry for support?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[58]\" id=\"field_wriyp\" rows=\"2\"  data-invmsg=\"Is there anything else you think we should be aware of in relation to your enquiry for support? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_59_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_tntgg_label\" class=\"frm_primary_label\">Where did you hear about our services? \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_tntgg_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-0\">\t\t\t<label  for=\"field_tntgg-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_tntgg-0\" value=\"Website\"  data-invmsg=\"Where did you hear about our services?  is invalid\" aria-invalid=\"false\"   \/> Website<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-1\">\t\t\t<label  for=\"field_tntgg-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_tntgg-1\" value=\"Facebook\"  data-invmsg=\"Where did you hear about our services?  is invalid\" aria-invalid=\"false\"   \/> Facebook<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-2\">\t\t\t<label  for=\"field_tntgg-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_tntgg-2\" value=\"Recommendation\"  data-invmsg=\"Where did you hear about our services?  is invalid\" aria-invalid=\"false\"   \/> Recommendation<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-3\">\t\t\t<label  for=\"field_tntgg-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_tntgg-3\" value=\"Referral from NHS\"  data-invmsg=\"Where did you hear about our services?  is invalid\" aria-invalid=\"false\"   \/> Referral from NHS<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-4\">\t\t\t<label  for=\"field_tntgg-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_tntgg-4\" value=\"X (Twitter)\"  data-invmsg=\"Where did you hear about our services?  is invalid\" aria-invalid=\"false\"   \/> X (Twitter)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-5\">\t\t\t<label  for=\"field_tntgg-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_tntgg-5\" value=\"Radio Advert\"  data-invmsg=\"Where did you hear about our services?  is invalid\" aria-invalid=\"false\"   \/> Radio Advert<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_59-6\">\t\t\t<label  for=\"field_tntgg-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[59][]\" id=\"field_tntgg-6\" value=\"Other\"  data-invmsg=\"Where did you hear about our services?  is invalid\" aria-invalid=\"false\"   \/> Other<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_17_container\" class=\"frm_form_field frm_section_heading frm_hidden frm_invisible_section form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">More Info<\/h3>\r\n\r\n\r\n<div id=\"frm_field_11_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_2xmyr\" id=\"field_2xmyr_label\" class=\"frm_primary_label\">Status\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\t\t<select name=\"item_meta[11]\" id=\"field_2xmyr\"  data-sectionid=\"17\"  data-frmval=\"Pending\" data-invmsg=\"Status is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Pending\" selected='selected'>Pending<\/option><option  value=\"Called to book in, left message to call back\">Called to book in, left message to call back<\/option><option  value=\"Booked In\">Booked In<\/option><option  value=\"Sessions ongoing\">Sessions ongoing<\/option><option  value=\"Completed\">Completed<\/option><option  value=\"Discharged\/could not contact\">Discharged\/could not contact<\/option><option  value=\"Discharged\/DNA\">Discharged\/DNA<\/option>\t<\/select>\n\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_83_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_mk7ea\" id=\"field_mk7ea_label\" class=\"frm_primary_label\">First session date\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_mk7ea\" name=\"item_meta[83]\" value=\"\"  data-sectionid=\"17\"  maxlength=\"10\" data-invmsg=\"First session date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_84_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<div  id=\"field_9fd7v_label\" class=\"frm_primary_label\">First session time\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_time_wrap\"><span dir=\"ltr\">\r\n<select aria-label=\"First session time ... hour\" name=\"item_meta[84][H]\" id=\"field_9fd7v_H\"  data-sectionid=\"17\"  data-frmval=\"{&quot;H&quot;:&quot;&quot;,&quot;m&quot;:&quot;&quot;,&quot;A&quot;:&quot;&quot;,&quot;s&quot;:&quot;&quot;,&quot;ms&quot;:&quot;&quot;}\" data-invmsg=\"First session time is invalid\" class=\"auto_width frm_time_select\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"12\" >12<\/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><\/select>\r\n<span class=\"frm_time_sep\" aria-hidden=\"true\">:<\/span>\r\n<select aria-label=\"First session time ... minute\" name=\"item_meta[84][m]\" id=\"field_9fd7v_m\"  data-sectionid=\"17\"  data-frmval=\"{&quot;H&quot;:&quot;&quot;,&quot;m&quot;:&quot;&quot;,&quot;A&quot;:&quot;&quot;,&quot;s&quot;:&quot;&quot;,&quot;ms&quot;:&quot;&quot;}\" data-invmsg=\"First session time is invalid\" class=\"auto_width frm_time_select auto_width frm_time_select\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"00\" >00<\/option><option value=\"15\" >15<\/option><option value=\"30\" >30<\/option><option value=\"45\" >45<\/option><\/select>\r\n<\/span>\r\n<select aria-label=\"First session time\" name=\"item_meta[84][A]\" id=\"field_9fd7v_A\"  data-sectionid=\"17\"  data-frmval=\"{&quot;H&quot;:&quot;&quot;,&quot;m&quot;:&quot;&quot;,&quot;A&quot;:&quot;&quot;,&quot;s&quot;:&quot;&quot;,&quot;ms&quot;:&quot;&quot;}\" data-invmsg=\"First session time is invalid\" class=\"auto_width frm_time_select auto_width frm_time_select auto_width frm_time_select\" aria-invalid=\"false\"  ><option value=\"AM\" >AM<\/option><option value=\"PM\" >PM<\/option><\/select>\r\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_79_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_4s3ua\" id=\"field_4s3ua_label\" class=\"frm_primary_label\">Number of Sessions Completed So Far\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_4s3ua\" name=\"item_meta[79]\" value=\"\" data-sectionid=\"17\"  style=\"width:70px\" data-invmsg=\"Number of Sessions Completed So Far is invalid\" class=\"auto_width\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_4s3ua\" min=\"0\" max=\"9999999\" step=\"any\" \/>\r\n\t<div class=\"frm_description\" id=\"frm_desc_field_4s3ua\">Keep up to date<\/div>\r\n\t\r\n<\/div>\n<div id=\"frm_field_12_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_33sa4\" id=\"field_33sa4_label\" class=\"frm_primary_label\">Assign Staff (Please Select)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\t\t<select  name=\"item_meta[12][]\" id=\"field_33sa4\"  data-sectionid=\"17\"  multiple=\"multiple\"  data-placeholder=\"Select options\"  data-placeholder=\" \" data-invmsg=\"Assign Staff (Please Select) is invalid\" class=\"frm_slimselect\" aria-invalid=\"false\"  >\n\t\t\t\t\t\t\t<option  data-placeholder=\"true\" value=\"\" class=\"frm-select-placeholder\">\n\t\t\t\t\t \t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"20403752@myclyde.ac.uk\">\n\t\t\t\t\t20403752@myclyde.ac.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Albrown@KSRHT.org\">\n\t\t\t\t\tAlbrown@KSRHT.org\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"andrea@ksrht.org\">\n\t\t\t\t\tandrea@ksrht.org\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"angelafisk@hotmail.co.uk\">\n\t\t\t\t\tangelafisk@hotmail.co.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"beranova.dasa@gmail.com\">\n\t\t\t\t\tberanova.dasa@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"cailin.murray.2020@uni.strath.ac.uk\">\n\t\t\t\t\tcailin.murray.2020@uni.strath.ac.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"carolinecbt1@gmail.com\">\n\t\t\t\t\tcarolinecbt1@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"counsellingwithpaul@outlook.com\">\n\t\t\t\t\tcounsellingwithpaul@outlook.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"emma.katie.oregan@hotmail.co.uk\">\n\t\t\t\t\temma.katie.oregan@hotmail.co.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"fionag505@gmail.com\">\n\t\t\t\t\tfionag505@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"fionatweedlie@gmail.com\">\n\t\t\t\t\tfionatweedlie@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"garystephenmason.gm@googlemail.com\">\n\t\t\t\t\tgarystephenmason.gm@googlemail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"herriot2125@outlook.com\">\n\t\t\t\t\therriot2125@outlook.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"jemmakenny71@outlook.com\">\n\t\t\t\t\tjemmakenny71@outlook.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"jonohgrant@gmail.com\">\n\t\t\t\t\tjonohgrant@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"julie2202@googlemail.com\">\n\t\t\t\t\tjulie2202@googlemail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"katrinaacarr@hotmail.com\">\n\t\t\t\t\tkatrinaacarr@hotmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"KCOX300@caledonian.ac.uk\">\n\t\t\t\t\tKCOX300@caledonian.ac.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"laura.mcpheators@hotmail.co.uk\">\n\t\t\t\t\tlaura.mcpheators@hotmail.co.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"laurajoyjoyjoy79@gmail.com\">\n\t\t\t\t\tlaurajoyjoyjoy79@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"louisecampbell4c@hotmail.co.uk\">\n\t\t\t\t\tlouisecampbell4c@hotmail.co.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"lucybarge@hotmail.com\">\n\t\t\t\t\tlucybarge@hotmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"lyetton@ksrht.org\">\n\t\t\t\t\tlyetton@ksrht.org\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"lynsey.bennett@ymail.com\">\n\t\t\t\t\tlynsey.bennett@ymail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"mcfaddenctb@gmail.com\">\n\t\t\t\t\tmcfaddenctb@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Nickycrofts4@outlook.com\">\n\t\t\t\t\tNickycrofts4@outlook.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"pamela_higton@hotmail.co.uk\">\n\t\t\t\t\tpamela_higton@hotmail.co.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"paul.burns21881@gmail.com\">\n\t\t\t\t\tpaul.burns21881@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"philpilot@hotmail.co.uk\">\n\t\t\t\t\tphilpilot@hotmail.co.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"rachelbrewster2010@yahoo.com\">\n\t\t\t\t\trachelbrewster2010@yahoo.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"reclaimyourlifetherapies@gmail.com\">\n\t\t\t\t\treclaimyourlifetherapies@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"rowantk@gmail.com\">\n\t\t\t\t\trowantk@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"sarah@ksrht.org\">\n\t\t\t\t\tsarah@ksrht.org\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"saraherobertson90@gmail.com\">\n\t\t\t\t\tsaraherobertson90@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"sean0301tb@gmail.com\">\n\t\t\t\t\tsean0301tb@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"severinkachi@yahoo.com\">\n\t\t\t\t\tseverinkachi@yahoo.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"Shannon_Malone2017@hotmail.com\">\n\t\t\t\t\tShannon_Malone2017@hotmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"shonasteele5@icloud.com\">\n\t\t\t\t\tshonasteele5@icloud.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"skyeborthwick@gmail.com\">\n\t\t\t\t\tskyeborthwick@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"sophiemclar23@gmail.com\">\n\t\t\t\t\tsophiemclar23@gmail.com\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"TMJELV300@caledonian.ac.uk\">\n\t\t\t\t\tTMJELV300@caledonian.ac.uk\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option  value=\"TracyHepburn24@outlook.com\">\n\t\t\t\t\tTracyHepburn24@outlook.com\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_97_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_fv0jk\" id=\"field_fv0jk_label\" class=\"frm_primary_label\">Staff Name (Read Only)\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input  type=\"text\" id=\"field_fv0jk\" name=\"item_meta[97]\" value=\"\"  readonly=\"readonly\"  data-sectionid=\"17\"  data-invmsg=\"Staff Name (Read Only) is invalid\" aria-invalid=\"false\"   \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_77_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_r9cf4\" id=\"field_r9cf4_label\" class=\"frm_primary_label\">Notes\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea data-auto-grow=\"1\"  name=\"item_meta[77]\" id=\"field_r9cf4\" rows=\"5\"  data-sectionid=\"17\"  data-invmsg=\"Notes is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<input type=\"hidden\" name=\"item_meta[66]\" id=\"field_axzb\" value=\"\" data-frmval=\"\"\/>\n<div id=\"frm_field_178_container\" class=\"frm_form_field frm_section_heading form-field \">\n<h3 class=\"frm_pos_top frm_section_spacing\">Section<\/h3>\n\n\n<\/div>\n<div id=\"frm_field_10_container\" class=\"frm_form_field form-field \">\r\n\t<div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__67ee68d1c90f9\">\n\t\t\t\t<label for=\"frm_email_3\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_3\" type=\"text\" class=\"frm_verify\" name=\"frm__67ee68d1c90f9\" value=\"\" autocomplete=\"off\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"K2B8PDjhKKE+Lkq2boXmGvUjtfL6FWsdAz120fywTSk=\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n\n\n<p><\/p>\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":{"footnotes":""},"class_list":["post-20","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/ksrht.org\/portal\/wp-json\/wp\/v2\/pages\/20","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ksrht.org\/portal\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ksrht.org\/portal\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ksrht.org\/portal\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ksrht.org\/portal\/wp-json\/wp\/v2\/comments?post=20"}],"version-history":[{"count":3,"href":"https:\/\/ksrht.org\/portal\/wp-json\/wp\/v2\/pages\/20\/revisions"}],"predecessor-version":[{"id":32,"href":"https:\/\/ksrht.org\/portal\/wp-json\/wp\/v2\/pages\/20\/revisions\/32"}],"wp:attachment":[{"href":"https:\/\/ksrht.org\/portal\/wp-json\/wp\/v2\/media?parent=20"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}