{"id":3344,"date":"2022-12-06T00:33:30","date_gmt":"2022-12-06T05:33:30","guid":{"rendered":"https:\/\/www.visualstress.app\/contact-us-2\/"},"modified":"2023-05-10T01:23:15","modified_gmt":"2023-05-10T06:23:15","slug":"patient-satisfaction-survey","status":"publish","type":"page","link":"https:\/\/www.visualstress.app\/fr\/patient-satisfaction-survey\/","title":{"rendered":"Patient satisfaction survey"},"content":{"rendered":"\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-8f761849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\"><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-e5628486-df20-4721-a8d7-b85b96738f8a\" id=\"wpforms-3335\"><form id=\"wpforms-form-3335\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3335\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/3344\" data-token=\"8ec354838fed2d4b2e3dad4a6d0b0d63\" data-token-time=\"1785038851\"><div class=\"wpforms-head-container\"><div class=\"wpforms-description\">Your responses will help us improve the tools, services and care we provide.\r\n\r\nThank you in advance for your feedback!<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-3335-field_26-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"26\"><label class=\"wpforms-field-label\">Are you completing this survey for yourself or for another person?<\/label><ul id=\"wpforms-3335-field_26\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3335-field_26_1\" name=\"wpforms[fields][26]\" value=\"I am completing this survey for myself \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_26_1\">I am completing this survey for myself<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3335-field_26_2\" name=\"wpforms[fields][26]\" value=\"I am completing this survey for another person\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_26_2\">I am completing this survey for another person<\/label><\/li><\/ul><\/div><div id=\"wpforms-3335-field_27-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"27\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3335-field_27\">Your name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3335-field_27\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][27][first]\" placeholder=\"First name\" required><label for=\"wpforms-3335-field_27\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3335-field_27-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][27][last]\" placeholder=\"Last name\" required><label for=\"wpforms-3335-field_27-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-3335-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-3335-field_6\">Patient&#039;s name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3335-field_6\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][6][first]\" placeholder=\"Patient&#039;s fist name\" required><label for=\"wpforms-3335-field_6\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3335-field_6-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][6][last]\" placeholder=\"Patient&#039;s last name\" required><label for=\"wpforms-3335-field_6-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-3335-field_7-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-3335-field_7\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3335-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" placeholder=\"Email of person completing this survey\" spellcheck=\"false\" required><\/div><div id=\"wpforms-3335-field_8-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-3335-field_8\">Phone<\/label><input type=\"tel\" id=\"wpforms-3335-field_8\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][8]\" placeholder=\"Phone of person completing this survey\" aria-label=\"Phone\" ><\/div><div id=\"wpforms-3335-field_11-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"11\"><label class=\"wpforms-field-label\">About your Assessment Specialist (select all that apply)? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3335-field_11\" class=\"wpforms-field-required\"><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-3335-field_11_6\" name=\"wpforms[fields][11][]\" value=\"They treated you with dignity and respect\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_11_6\">They treated you with dignity and respect<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-3335-field_11_5\" name=\"wpforms[fields][11][]\" value=\"They were sensitive to your needs and preferences\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_11_5\">They were sensitive to your needs and preferences<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3335-field_11_1\" name=\"wpforms[fields][11][]\" value=\"They reviewed your medical history\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_11_1\">They reviewed your medical history<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3335-field_11_2\" name=\"wpforms[fields][11][]\" value=\"They listened to your concerns \" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_11_2\">They listened to your concerns<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-3335-field_11_3\" name=\"wpforms[fields][11][]\" value=\"They spoke using a language you could understand \" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_11_3\">They spoke using a language you could understand<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-3335-field_11_4\" name=\"wpforms[fields][11][]\" value=\"They provided good explanations\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_11_4\">They provided good explanations<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-3335-field_11_7\" name=\"wpforms[fields][11][]\" value=\"They gave you clear instructions about next steps\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_11_7\">They gave you clear instructions about next steps<\/label><\/li><\/ul><\/div><div id=\"wpforms-3335-field_23-container\" class=\"wpforms-field wpforms-field-rating\" data-field-type=\"rating\" data-field-id=\"23\"><label class=\"wpforms-field-label\">How would you rate your Assessment Specialist? <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-rating-wrapper wpforms-field-rating-labels-position-below\"><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-3335-field_23_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_23_1\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][23]\" value=\"1\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-3335-field_23_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_23_2\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][23]\" value=\"2\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-3335-field_23_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_23_3\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][23]\" value=\"3\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-3335-field_23_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_23_4\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][23]\" value=\"4\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-3335-field_23_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_23_5\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][23]\" value=\"5\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><\/div><\/div><\/div><div id=\"wpforms-3335-field_24-container\" class=\"wpforms-field wpforms-field-rating\" data-field-type=\"rating\" data-field-id=\"24\"><label class=\"wpforms-field-label\">How would you rate our office (reception, cleanliness, your physical comfort)? <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-rating-wrapper wpforms-field-rating-labels-position-below\"><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-3335-field_24_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_24_1\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][24]\" value=\"1\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-3335-field_24_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_24_2\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][24]\" value=\"2\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-3335-field_24_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_24_3\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][24]\" value=\"3\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-3335-field_24_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_24_4\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][24]\" value=\"4\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-3335-field_24_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_24_5\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][24]\" value=\"5\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><\/div><\/div><\/div><div id=\"wpforms-3335-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"28\"><label class=\"wpforms-field-label\">Did you use the Visual Stress and Colorimetry Assessment Tool (VSCAT)?<\/label><ul id=\"wpforms-3335-field_28\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3335-field_28_1\" name=\"wpforms[fields][28]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_28_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3335-field_28_2\" name=\"wpforms[fields][28]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_28_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3335-field_28_3\" name=\"wpforms[fields][28]\" value=\"Don&#039;t know\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_28_3\">Don&#8217;t know<\/label><\/li><\/ul><\/div><div id=\"wpforms-3335-field_25-container\" class=\"wpforms-field wpforms-field-rating wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"rating\" data-field-id=\"25\" style=\"display:none;\"><label class=\"wpforms-field-label\">How would you rate the VSCAT system? <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-rating-wrapper wpforms-field-rating-labels-position-below\"><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-3335-field_25_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_25_1\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"1\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-3335-field_25_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_25_2\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"2\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-3335-field_25_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_25_3\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"3\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-3335-field_25_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_25_4\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"4\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-3335-field_25_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_25_5\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"5\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><\/div><\/div><\/div><div id=\"wpforms-3335-field_15-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"15\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3335-field_15\">Comments or recommendations about the VSCAT:<\/label><textarea id=\"wpforms-3335-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" ><\/textarea><\/div><div id=\"wpforms-3335-field_22-container\" class=\"wpforms-field wpforms-field-rating\" data-field-type=\"rating\" data-field-id=\"22\"><label class=\"wpforms-field-label\">How would you rate your overall experience? <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-rating-wrapper wpforms-field-rating-labels-position-below\"><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-3335-field_22_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_22_1\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][22]\" value=\"1\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-3335-field_22_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_22_2\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][22]\" value=\"2\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-3335-field_22_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_22_3\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][22]\" value=\"3\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-3335-field_22_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_22_4\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][22]\" value=\"4\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-3335-field_22_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-3335-field_22_5\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][22]\" value=\"5\" required><svg width=\"28\" height=\"28\" style=\"height:28px;width:28px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><\/div><\/div><\/div><div id=\"wpforms-3335-field_21-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"21\"><label class=\"wpforms-field-label\">Are you willing to provide a testimonial? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3335-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3335-field_21_1\" name=\"wpforms[fields][21]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3335-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3335-field_21_2\" 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