{"id":21488,"date":"2025-07-14T20:04:25","date_gmt":"2025-07-14T16:34:25","guid":{"rendered":"https:\/\/aqdasiyeh.dm2.ir\/?page_id=21488"},"modified":"2025-12-17T13:40:56","modified_gmt":"2025-12-17T10:10:56","slug":"survey-form","status":"publish","type":"page","link":"https:\/\/aqdasiyeh.nikan.hospital\/fa\/survey-form\/","title":{"rendered":"Survey Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"21488\" class=\"elementor elementor-21488\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a6785db elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a6785db\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0a617e8\" data-id=\"0a617e8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ea7bc08 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"ea7bc08\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Questionnaire of hospitalized patients and their companions\nin Nikan Hospital<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dd30247 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"dd30247\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Dear patient, In the hope of good health, please plan your comments for more appropriate medical treatment and improve the conditions of the hospital after completing the following section. Specify your comments in the column beside the questions with the\u00a0<\/strong><strong>\u00fc<\/strong><strong>mark. (This form of information is considered confidential and will not have any negative effect on the services provided to you).<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bb2ebd1 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"bb2ebd1\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\" aria-label=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"21488\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"bb2ebd1\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Survey Form - \u0646\u06cc\u06a9\u0627\u0646 \u0627\u0642\u062f\u0633\u06cc\u0647\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"21488\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_014f011 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Measuring the satisfaction of international hospitalized patients survey\n<br>\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_3adab63 elementor-col-50\">\n\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_3adab63]\" id=\"form-field-field_3adab63\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Form completion date:\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_cba0f05 elementor-col-50\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Medical center\/hospital: NIKAN \n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Ward Name:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_964404b elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_964404b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you ever been hospitalized in this hospital?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"yes\" id=\"form-field-field_964404b-0\" name=\"form_fields[field_964404b]\"> <label for=\"form-field-field_964404b-0\">yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"no\" id=\"form-field-field_964404b-1\" name=\"form_fields[field_964404b]\"> <label for=\"form-field-field_964404b-1\">no<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5184a1f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_5184a1f]\" id=\"form-field-field_5184a1f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Adress:Vliage\/City\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-email elementor-col-50\">\n\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Age:\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-message elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tsex:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Male \" id=\"form-field-message-0\" name=\"form_fields[message]\" required=\"required\"> <label for=\"form-field-message-0\">Male <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"famale\" id=\"form-field-message-1\" name=\"form_fields[message]\" required=\"required\"> <label for=\"form-field-message-1\">famale<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_009def2 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_009def2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDepartment\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_009def2]\" id=\"form-field-field_009def2\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name of admission department:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_466ea21 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_466ea21\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDays\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_466ea21]\" id=\"form-field-field_466ea21\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Length of hospitalization:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_a054db6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a054db6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEducation Level\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Illiterate\" id=\"form-field-field_a054db6-0\" name=\"form_fields[field_a054db6]\"> <label for=\"form-field-field_a054db6-0\">Illiterate<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"High school\" id=\"form-field-field_a054db6-1\" name=\"form_fields[field_a054db6]\"> <label for=\"form-field-field_a054db6-1\">High school<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"diploma\" id=\"form-field-field_a054db6-2\" name=\"form_fields[field_a054db6]\"> <label for=\"form-field-field_a054db6-2\">diploma<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Associate degree \" id=\"form-field-field_a054db6-3\" name=\"form_fields[field_a054db6]\"> <label for=\"form-field-field_a054db6-3\">Associate degree <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Academic Degree \" id=\"form-field-field_a054db6-4\" name=\"form_fields[field_a054db6]\"> <label for=\"form-field-field_a054db6-4\">Academic Degree <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Etc\" id=\"form-field-field_a054db6-5\" name=\"form_fields[field_a054db6]\"> <label for=\"form-field-field_a054db6-5\">Etc<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_8f749c1 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8f749c1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow to be hospitalized\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Etc\" id=\"form-field-field_8f749c1-0\" name=\"form_fields[field_8f749c1]\"> <label for=\"form-field-field_8f749c1-0\">Etc<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"physician&#039;s recommendation\" id=\"form-field-field_8f749c1-1\" name=\"form_fields[field_8f749c1]\"> <label for=\"form-field-field_8f749c1-1\">physician's recommendation<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"company\" id=\"form-field-field_8f749c1-2\" name=\"form_fields[field_8f749c1]\"> <label for=\"form-field-field_8f749c1-2\">company<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Academic Degree \" id=\"form-field-field_8f749c1-3\" name=\"form_fields[field_8f749c1]\"> <label for=\"form-field-field_8f749c1-3\">Academic Degree <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"hospital website\" id=\"form-field-field_8f749c1-4\" name=\"form_fields[field_8f749c1]\"> <label for=\"form-field-field_8f749c1-4\">hospital website<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bda9f5f elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bda9f5f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMode of admission:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Doctor&#039;s appointment order \" id=\"form-field-field_bda9f5f-0\" name=\"form_fields[field_bda9f5f]\" required=\"required\"> <label for=\"form-field-field_bda9f5f-0\">Doctor's appointment order <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Emergency\" id=\"form-field-field_bda9f5f-1\" name=\"form_fields[field_bda9f5f]\" required=\"required\"> <label for=\"form-field-field_bda9f5f-1\">Emergency<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_7a52324 elementor-col-100\">\n\t\t\t\t\tEvaluation items\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ccbaa25 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Security \n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d20e495 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d20e495\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t1-Are you satisfied with the signboards in different parts of the hospital?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_d20e495-0\" name=\"form_fields[field_d20e495]\"> <label for=\"form-field-field_d20e495-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_d20e495-1\" name=\"form_fields[field_d20e495]\"> <label for=\"form-field-field_d20e495-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_d20e495-2\" name=\"form_fields[field_d20e495]\"> <label for=\"form-field-field_d20e495-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_d20e495-3\" name=\"form_fields[field_d20e495]\"> <label for=\"form-field-field_d20e495-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_daa295d elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Information \n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f8b8d4a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f8b8d4a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t2-Are you satisfied with the necessary guidance from the intelligence unit on arrival at the hospital?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_f8b8d4a-0\" name=\"form_fields[field_f8b8d4a]\"> <label for=\"form-field-field_f8b8d4a-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_f8b8d4a-1\" name=\"form_fields[field_f8b8d4a]\"> <label for=\"form-field-field_f8b8d4a-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_f8b8d4a-2\" name=\"form_fields[field_f8b8d4a]\"> <label for=\"form-field-field_f8b8d4a-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_f8b8d4a-3\" name=\"form_fields[field_f8b8d4a]\"> <label for=\"form-field-field_f8b8d4a-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_8a6cc14 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8a6cc14\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t3-Are you satisfied with the signboards in different parts of the hospital?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_8a6cc14-0\" name=\"form_fields[field_8a6cc14]\"> <label for=\"form-field-field_8a6cc14-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_8a6cc14-1\" name=\"form_fields[field_8a6cc14]\"> <label for=\"form-field-field_8a6cc14-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_8a6cc14-2\" name=\"form_fields[field_8a6cc14]\"> <label for=\"form-field-field_8a6cc14-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_8a6cc14-3\" name=\"form_fields[field_8a6cc14]\"> <label for=\"form-field-field_8a6cc14-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_6a5f135 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Reception \n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_3b5ca94 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3b5ca94\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t4-Are you satisfied with the way IPD employees behave you?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_3b5ca94-0\" name=\"form_fields[field_3b5ca94]\"> <label for=\"form-field-field_3b5ca94-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_3b5ca94-1\" name=\"form_fields[field_3b5ca94]\"> <label for=\"form-field-field_3b5ca94-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_3b5ca94-2\" name=\"form_fields[field_3b5ca94]\"> <label for=\"form-field-field_3b5ca94-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_3b5ca94-3\" name=\"form_fields[field_3b5ca94]\"> <label for=\"form-field-field_3b5ca94-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_ba9c4d2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ba9c4d2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t5-Are you satisfied with the waiting length from the time of filing the case to the transfer to the department?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_ba9c4d2-0\" name=\"form_fields[field_ba9c4d2]\"> <label for=\"form-field-field_ba9c4d2-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_ba9c4d2-1\" name=\"form_fields[field_ba9c4d2]\"> <label for=\"form-field-field_ba9c4d2-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_ba9c4d2-2\" name=\"form_fields[field_ba9c4d2]\"> <label for=\"form-field-field_ba9c4d2-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_ba9c4d2-3\" name=\"form_fields[field_ba9c4d2]\"> <label for=\"form-field-field_ba9c4d2-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_3c99f0a elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Physician(s) \n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_9cd1523 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9cd1523\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t6-Are you satisfied with the way doctors treat you?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_9cd1523-0\" name=\"form_fields[field_9cd1523]\"> <label for=\"form-field-field_9cd1523-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_9cd1523-1\" name=\"form_fields[field_9cd1523]\"> <label for=\"form-field-field_9cd1523-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_9cd1523-2\" name=\"form_fields[field_9cd1523]\"> <label for=\"form-field-field_9cd1523-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_9cd1523-3\" name=\"form_fields[field_9cd1523]\"> <label for=\"form-field-field_9cd1523-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_c3164bc elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c3164bc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t7-Are you satisfied with the presence of doctors when needed?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_c3164bc-0\" name=\"form_fields[field_c3164bc]\"> <label for=\"form-field-field_c3164bc-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_c3164bc-1\" name=\"form_fields[field_c3164bc]\"> <label for=\"form-field-field_c3164bc-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_c3164bc-2\" name=\"form_fields[field_c3164bc]\"> <label for=\"form-field-field_c3164bc-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_c3164bc-3\" name=\"form_fields[field_c3164bc]\"> <label for=\"form-field-field_c3164bc-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_2a7e46e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2a7e46e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t8-Are you satisfied with the training provided by the doctors (during the treatment and discharge)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_2a7e46e-0\" name=\"form_fields[field_2a7e46e]\"> <label for=\"form-field-field_2a7e46e-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_2a7e46e-1\" name=\"form_fields[field_2a7e46e]\"> <label for=\"form-field-field_2a7e46e-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_2a7e46e-2\" name=\"form_fields[field_2a7e46e]\"> <label for=\"form-field-field_2a7e46e-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_2a7e46e-3\" name=\"form_fields[field_2a7e46e]\"> <label for=\"form-field-field_2a7e46e-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_2bc6218 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2bc6218\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t9-Are you satisfied with the doctors' answers to your questions?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_2bc6218-0\" name=\"form_fields[field_2bc6218]\"> <label for=\"form-field-field_2bc6218-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_2bc6218-1\" name=\"form_fields[field_2bc6218]\"> <label for=\"form-field-field_2bc6218-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_2bc6218-2\" name=\"form_fields[field_2bc6218]\"> <label for=\"form-field-field_2bc6218-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_2bc6218-3\" name=\"form_fields[field_2bc6218]\"> <label for=\"form-field-field_2bc6218-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b15a656 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b15a656\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t10-Are you satisfied with drawing the curtain and respecting your privacy while performing medical procedures?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_b15a656-0\" name=\"form_fields[field_b15a656]\"> <label for=\"form-field-field_b15a656-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_b15a656-1\" name=\"form_fields[field_b15a656]\"> <label for=\"form-field-field_b15a656-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_b15a656-2\" name=\"form_fields[field_b15a656]\"> <label for=\"form-field-field_b15a656-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_b15a656-3\" name=\"form_fields[field_b15a656]\"> <label for=\"form-field-field_b15a656-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_7fa8473 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Nursing staff\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b7313e5 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b7313e5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t11-Are you satisfied with the way nurses behave you?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_b7313e5-0\" name=\"form_fields[field_b7313e5]\"> <label for=\"form-field-field_b7313e5-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_b7313e5-1\" name=\"form_fields[field_b7313e5]\"> <label for=\"form-field-field_b7313e5-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_b7313e5-2\" name=\"form_fields[field_b7313e5]\"> <label for=\"form-field-field_b7313e5-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_b7313e5-3\" name=\"form_fields[field_b7313e5]\"> <label for=\"form-field-field_b7313e5-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_89c27c2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_89c27c2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t12-Are you satisfied with the response time of the nurses to the alarm bell?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_89c27c2-0\" name=\"form_fields[field_89c27c2]\"> <label for=\"form-field-field_89c27c2-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_89c27c2-1\" name=\"form_fields[field_89c27c2]\"> <label for=\"form-field-field_89c27c2-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_89c27c2-2\" name=\"form_fields[field_89c27c2]\"> <label for=\"form-field-field_89c27c2-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_89c27c2-3\" name=\"form_fields[field_89c27c2]\"> <label for=\"form-field-field_89c27c2-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_239ebf0 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_239ebf0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t13-Are you satisfied with the training provided by the nurses (upon arrival, during treatment and discharge)?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_239ebf0-0\" name=\"form_fields[field_239ebf0]\"> <label for=\"form-field-field_239ebf0-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_239ebf0-1\" name=\"form_fields[field_239ebf0]\"> <label for=\"form-field-field_239ebf0-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_239ebf0-2\" name=\"form_fields[field_239ebf0]\"> <label for=\"form-field-field_239ebf0-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_239ebf0-3\" name=\"form_fields[field_239ebf0]\"> <label for=\"form-field-field_239ebf0-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_a3b9dc1 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a3b9dc1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t14-Are you satisfied with drawing the curtain and observing privacy while performing nursing activities?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_a3b9dc1-0\" name=\"form_fields[field_a3b9dc1]\"> <label for=\"form-field-field_a3b9dc1-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_a3b9dc1-1\" name=\"form_fields[field_a3b9dc1]\"> <label for=\"form-field-field_a3b9dc1-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_a3b9dc1-2\" name=\"form_fields[field_a3b9dc1]\"> <label for=\"form-field-field_a3b9dc1-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_a3b9dc1-3\" name=\"form_fields[field_a3b9dc1]\"> <label for=\"form-field-field_a3b9dc1-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_c81dbd1 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Diagnostic services\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_83fc080 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_83fc080\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t15-If you need diagnostic methods such as radiology, ultrasound, CT scan, etc., are you satisfied with how it is done?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_83fc080-0\" name=\"form_fields[field_83fc080]\"> <label for=\"form-field-field_83fc080-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_83fc080-1\" name=\"form_fields[field_83fc080]\"> <label for=\"form-field-field_83fc080-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_83fc080-2\" name=\"form_fields[field_83fc080]\"> <label for=\"form-field-field_83fc080-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_83fc080-3\" name=\"form_fields[field_83fc080]\"> <label for=\"form-field-field_83fc080-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_fbcda1b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fbcda1b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t16-Are you satisfied with the laboratory's diagnostic methods if you need them?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_fbcda1b-0\" name=\"form_fields[field_fbcda1b]\"> <label for=\"form-field-field_fbcda1b-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_fbcda1b-1\" name=\"form_fields[field_fbcda1b]\"> <label for=\"form-field-field_fbcda1b-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_fbcda1b-2\" name=\"form_fields[field_fbcda1b]\"> <label for=\"form-field-field_fbcda1b-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_fbcda1b-3\" name=\"form_fields[field_fbcda1b]\"> <label for=\"form-field-field_fbcda1b-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_39b64a8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_39b64a8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t17-Are you satisfied with the way the staff behaves in the diagnostic units?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_39b64a8-0\" name=\"form_fields[field_39b64a8]\"> <label for=\"form-field-field_39b64a8-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_39b64a8-1\" name=\"form_fields[field_39b64a8]\"> <label for=\"form-field-field_39b64a8-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_39b64a8-2\" name=\"form_fields[field_39b64a8]\"> <label for=\"form-field-field_39b64a8-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_39b64a8-3\" name=\"form_fields[field_39b64a8]\"> <label for=\"form-field-field_39b64a8-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_c51cf80 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c51cf80\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t18-Are you satisfied with privacy when carrying out diagnostic measures?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_c51cf80-0\" name=\"form_fields[field_c51cf80]\"> <label for=\"form-field-field_c51cf80-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_c51cf80-1\" name=\"form_fields[field_c51cf80]\"> <label for=\"form-field-field_c51cf80-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_c51cf80-2\" name=\"form_fields[field_c51cf80]\"> <label for=\"form-field-field_c51cf80-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_c51cf80-3\" name=\"form_fields[field_c51cf80]\"> <label for=\"form-field-field_c51cf80-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_1d61df5 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Environment and services of the ward\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bac0c48 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bac0c48\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t19-Are you satisfied with the way the service staff behaves and treated you?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_bac0c48-0\" name=\"form_fields[field_bac0c48]\"> <label for=\"form-field-field_bac0c48-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_bac0c48-1\" name=\"form_fields[field_bac0c48]\"> <label for=\"form-field-field_bac0c48-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_bac0c48-2\" name=\"form_fields[field_bac0c48]\"> <label for=\"form-field-field_bac0c48-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_bac0c48-3\" name=\"form_fields[field_bac0c48]\"> <label for=\"form-field-field_bac0c48-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f50ef11 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f50ef11\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t20-How satisfied are you with the way you are transferred to the ward or the transfer between different wards of the hospital?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_f50ef11-0\" name=\"form_fields[field_f50ef11]\"> <label for=\"form-field-field_f50ef11-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_f50ef11-1\" name=\"form_fields[field_f50ef11]\"> <label for=\"form-field-field_f50ef11-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_f50ef11-2\" name=\"form_fields[field_f50ef11]\"> <label for=\"form-field-field_f50ef11-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_f50ef11-3\" name=\"form_fields[field_f50ef11]\"> <label for=\"form-field-field_f50ef11-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_0179a69 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0179a69\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t21-Are you satisfied with the cleanliness of the ward?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_0179a69-0\" name=\"form_fields[field_0179a69]\"> <label for=\"form-field-field_0179a69-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_0179a69-1\" name=\"form_fields[field_0179a69]\"> <label for=\"form-field-field_0179a69-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_0179a69-2\" name=\"form_fields[field_0179a69]\"> <label for=\"form-field-field_0179a69-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_0179a69-3\" name=\"form_fields[field_0179a69]\"> <label for=\"form-field-field_0179a69-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_60ca332 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_60ca332\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t22-Are you satisfied with the quality and replacement of bedding, blankets and clothes?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_60ca332-0\" name=\"form_fields[field_60ca332]\"> <label for=\"form-field-field_60ca332-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_60ca332-1\" name=\"form_fields[field_60ca332]\"> <label for=\"form-field-field_60ca332-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_60ca332-2\" name=\"form_fields[field_60ca332]\"> <label for=\"form-field-field_60ca332-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_60ca332-3\" name=\"form_fields[field_60ca332]\"> <label for=\"form-field-field_60ca332-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_7564d42 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7564d42\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t23-Are you satisfied with the amenities (TV, chair, water cooler, telephone, lighting, bed, telephone and prayer hall, cooling status, heating and rooms ventilation)?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_7564d42-0\" name=\"form_fields[field_7564d42]\"> <label for=\"form-field-field_7564d42-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_7564d42-1\" name=\"form_fields[field_7564d42]\"> <label for=\"form-field-field_7564d42-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_7564d42-2\" name=\"form_fields[field_7564d42]\"> <label for=\"form-field-field_7564d42-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_7564d42-3\" name=\"form_fields[field_7564d42]\"> <label for=\"form-field-field_7564d42-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_0e39aa3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0e39aa3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t24-Are you satisfied with the quality of the food?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_0e39aa3-0\" name=\"form_fields[field_0e39aa3]\"> <label for=\"form-field-field_0e39aa3-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_0e39aa3-1\" name=\"form_fields[field_0e39aa3]\"> <label for=\"form-field-field_0e39aa3-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_0e39aa3-2\" name=\"form_fields[field_0e39aa3]\"> <label for=\"form-field-field_0e39aa3-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_0e39aa3-3\" name=\"form_fields[field_0e39aa3]\"> <label for=\"form-field-field_0e39aa3-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_24c4acb elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_24c4acb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t25-Are you happy with the distribution time of food?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_24c4acb-0\" name=\"form_fields[field_24c4acb]\"> <label for=\"form-field-field_24c4acb-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_24c4acb-1\" name=\"form_fields[field_24c4acb]\"> <label for=\"form-field-field_24c4acb-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_24c4acb-2\" name=\"form_fields[field_24c4acb]\"> <label for=\"form-field-field_24c4acb-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_24c4acb-3\" name=\"form_fields[field_24c4acb]\"> <label for=\"form-field-field_24c4acb-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_92c8917 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_92c8917\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t26-Have you had surgery? Yes... No.. (If yes, answer the following questions.)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"yes\" id=\"form-field-field_92c8917-0\" name=\"form_fields[field_92c8917]\"> <label for=\"form-field-field_92c8917-0\">yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"no\" id=\"form-field-field_92c8917-1\" name=\"form_fields[field_92c8917]\"> <label for=\"form-field-field_92c8917-1\">no<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ad7e623 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Operation room ward\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_129230f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_129230f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t27-Are you satistied with the way the surgery room personnel behave?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_129230f-0\" name=\"form_fields[field_129230f]\"> <label for=\"form-field-field_129230f-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_129230f-1\" name=\"form_fields[field_129230f]\"> <label for=\"form-field-field_129230f-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_129230f-2\" name=\"form_fields[field_129230f]\"> <label for=\"form-field-field_129230f-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_129230f-3\" name=\"form_fields[field_129230f]\"> <label for=\"form-field-field_129230f-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b2e65d6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b2e65d6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t28-Are you satisfied with the surgery at the appointed time?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_b2e65d6-0\" name=\"form_fields[field_b2e65d6]\"> <label for=\"form-field-field_b2e65d6-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_b2e65d6-1\" name=\"form_fields[field_b2e65d6]\"> <label for=\"form-field-field_b2e65d6-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_b2e65d6-2\" name=\"form_fields[field_b2e65d6]\"> <label for=\"form-field-field_b2e65d6-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_b2e65d6-3\" name=\"form_fields[field_b2e65d6]\"> <label for=\"form-field-field_b2e65d6-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_6ee3979 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6ee3979\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t29-Are you satisfied with the necessary information before the surgery?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_6ee3979-0\" name=\"form_fields[field_6ee3979]\"> <label for=\"form-field-field_6ee3979-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_6ee3979-1\" name=\"form_fields[field_6ee3979]\"> <label for=\"form-field-field_6ee3979-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_6ee3979-2\" name=\"form_fields[field_6ee3979]\"> <label for=\"form-field-field_6ee3979-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_6ee3979-3\" name=\"form_fields[field_6ee3979]\"> <label for=\"form-field-field_6ee3979-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_890eb8a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_890eb8a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t30-Are you satisfied with the care after the surgery room?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_890eb8a-0\" name=\"form_fields[field_890eb8a]\"> <label for=\"form-field-field_890eb8a-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_890eb8a-1\" name=\"form_fields[field_890eb8a]\"> <label for=\"form-field-field_890eb8a-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_890eb8a-2\" name=\"form_fields[field_890eb8a]\"> <label for=\"form-field-field_890eb8a-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_890eb8a-3\" name=\"form_fields[field_890eb8a]\"> <label for=\"form-field-field_890eb8a-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_4be3c55 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>Hospital managerment\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_ef56c45 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ef56c45\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t31-Are you satisfied with the performance of the hospital's IPD ward?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_ef56c45-0\" name=\"form_fields[field_ef56c45]\"> <label for=\"form-field-field_ef56c45-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_ef56c45-1\" name=\"form_fields[field_ef56c45]\"> <label for=\"form-field-field_ef56c45-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_ef56c45-2\" name=\"form_fields[field_ef56c45]\"> <label for=\"form-field-field_ef56c45-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_ef56c45-3\" name=\"form_fields[field_ef56c45]\"> <label for=\"form-field-field_ef56c45-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_a9b8d21 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a9b8d21\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t32-Are you satisfied with the availability of prescribed drugs?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_a9b8d21-0\" name=\"form_fields[field_a9b8d21]\"> <label for=\"form-field-field_a9b8d21-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_a9b8d21-1\" name=\"form_fields[field_a9b8d21]\"> <label for=\"form-field-field_a9b8d21-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_a9b8d21-2\" name=\"form_fields[field_a9b8d21]\"> <label for=\"form-field-field_a9b8d21-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_a9b8d21-3\" name=\"form_fields[field_a9b8d21]\"> <label for=\"form-field-field_a9b8d21-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b0c171e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b0c171e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t33-Are you satisfied with the complaints and criticisms of the patients in this hospital?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_b0c171e-0\" name=\"form_fields[field_b0c171e]\"> <label for=\"form-field-field_b0c171e-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_b0c171e-1\" name=\"form_fields[field_b0c171e]\"> <label for=\"form-field-field_b0c171e-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_b0c171e-2\" name=\"form_fields[field_b0c171e]\"> <label for=\"form-field-field_b0c171e-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_b0c171e-3\" name=\"form_fields[field_b0c171e]\"> <label for=\"form-field-field_b0c171e-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_a4845d7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a4845d7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t34-Are you satisfied with amenities such as buffet, internet, etc. in this hospital?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_a4845d7-0\" name=\"form_fields[field_a4845d7]\"> <label for=\"form-field-field_a4845d7-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_a4845d7-1\" name=\"form_fields[field_a4845d7]\"> <label for=\"form-field-field_a4845d7-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_a4845d7-2\" name=\"form_fields[field_a4845d7]\"> <label for=\"form-field-field_a4845d7-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_a4845d7-3\" name=\"form_fields[field_a4845d7]\"> <label for=\"form-field-field_a4845d7-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_79983cd elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_79983cd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t35-Are you satisfied with amenities such as buffet, internet, etc. in this hospital?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Excellent\ud83d\ude00\" id=\"form-field-field_79983cd-0\" name=\"form_fields[field_79983cd]\"> <label for=\"form-field-field_79983cd-0\">Excellent\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Good\ud83d\ude42\" id=\"form-field-field_79983cd-1\" name=\"form_fields[field_79983cd]\"> <label for=\"form-field-field_79983cd-1\">Good\ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Suitable\ud83d\ude15\" id=\"form-field-field_79983cd-2\" name=\"form_fields[field_79983cd]\"> <label for=\"form-field-field_79983cd-2\">Suitable\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Inappropriate\ud83d\ude20\" id=\"form-field-field_79983cd-3\" name=\"form_fields[field_79983cd]\"> <label for=\"form-field-field_79983cd-3\">Inappropriate\ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_a1c52cf elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a1c52cf\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t36-. In general, at what level do you evaluate your satisfaction with hospital services? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"High\" id=\"form-field-field_a1c52cf-0\" name=\"form_fields[field_a1c52cf]\"> <label for=\"form-field-field_a1c52cf-0\">High<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"medium\" id=\"form-field-field_a1c52cf-1\" name=\"form_fields[field_a1c52cf]\"> <label for=\"form-field-field_a1c52cf-1\">medium<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"low\" id=\"form-field-field_a1c52cf-2\" name=\"form_fields[field_a1c52cf]\"> <label for=\"form-field-field_a1c52cf-2\">low<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_5a5f290 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5a5f290\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t37-Do you want to refer to this hospital again if you or one of your relatives need to be hospitalized?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"yes\" id=\"form-field-field_5a5f290-0\" name=\"form_fields[field_5a5f290]\"> <label for=\"form-field-field_5a5f290-0\">yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"no\" id=\"form-field-field_5a5f290-1\" name=\"form_fields[field_5a5f290]\"> <label for=\"form-field-field_5a5f290-1\">no<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_b92b8b0 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_b92b8b0]\" id=\"form-field-field_b92b8b0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_67d33ee elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_67d33ee]\" id=\"form-field-field_67d33ee\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"PhoneNo\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b37ae4d elementor-col-100\">\n\t\t\t\t\tPlease, make suggestions and criticisms about improving the quality of hospital services\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_e23dc6b elementor-col-100\">\n\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_e23dc6b]\" id=\"form-field-field_e23dc6b\" rows=\"4\" placeholder=\"suggestions\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-eb68c51 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"eb68c51\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\" aria-label=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"21488\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"eb68c51\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Survey Form - \u0646\u06cc\u06a9\u0627\u0646 \u0627\u0642\u062f\u0633\u06cc\u0647\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"21488\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0627\u0633\u062a\u0628\u064a\u0627\u0646 \u0639\u0646 \u0645\u062f\u0649 \u0631\u0636\u0627 \u0627\u0644\u0645\u0631\u0636\u0649 \u0627\u0644\u0623\u062c\u0627\u0646\u0628 \u0627\u0644\u0631\u0627\u0642\u062f\u064a\u0646\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_e7cf6be elementor-col-50\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0627\u0633\u0645 \u0627\u0644\u0645\u0631\u0643\u0632 \u0627\u0644\u0637\u0628\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649 : \u0645\u062c\u0645\u0648\u0639\u0647 \u0645\u0633\u062a\u0634\u0641\u064a\u0627\u062a \u0646\u06cc\u06a9\u0627\u0646\n\u0633\u0628\u06cc\u062f\n\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_245ccf1 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_245ccf1]\" id=\"form-field-field_245ccf1\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"\u062a\u0627\u0631\u064a\u062e \u0645\u0644\u0621 \u0627\u0644\u0627\u0633\u062a\u0645\u0627\u0631\u0629 :\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-email elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"\u0627\u0633\u0645 \u0627\u0644\u0642\u0633\u0645 :\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_c50c2a0 elementor-col-50\">\n\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_c50c2a0]\" id=\"form-field-field_c50c2a0\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"\u0627\u0644\u0639\u0645\u0631:\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-message elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u0627\u0644\u062c\u0646\u0633: \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0631\u062c\u0644\" id=\"form-field-message-0\" name=\"form_fields[message]\" required=\"required\"> <label for=\"form-field-message-0\">\u0631\u062c\u0644<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0627\u0645\u0631\u0623\u0629\" id=\"form-field-message-1\" name=\"form_fields[message]\" required=\"required\"> <label for=\"form-field-message-1\">\u0627\u0645\u0631\u0623\u0629<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bfbe013 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bfbe013\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u0647\u0644 \u0631\u0642\u062f\u062a \u0641\u064a \u0647\u0630\u0627 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649 \u0642\u0628\u0644 \u0627\u0644\u0622\u0646 \u061f \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0646\u0639\u0645\" id=\"form-field-field_bfbe013-0\" name=\"form_fields[field_bfbe013]\" required=\"required\"> <label for=\"form-field-field_bfbe013-0\">\u0646\u0639\u0645<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0644\u0627\" id=\"form-field-field_bfbe013-1\" name=\"form_fields[field_bfbe013]\" required=\"required\"> <label for=\"form-field-field_bfbe013-1\">\u0644\u0627<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_009def2 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_009def2]\" id=\"form-field-field_009def2\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"\u0627\u0633\u0645 \u0627\u0644\u0642\u0633\u0645 \u0627\u0644\u0631\u0627\u0642\u062f \u0641\u064a\u0647 \">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_466ea21 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_466ea21]\" id=\"form-field-field_466ea21\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"\u0645\u062f\u062a \u0627\u0644\u062f\u062e\u0648\u0644:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bda9f5f elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bda9f5f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u0637\u0631\u064a\u0642\u0647 \u0627\u0644\u062f\u062e\u0648\u0644:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0627\u0648\u0627\u0645\u0631 \u0627\u0644\u062f\u0643\u062a\u0648\u0631 \u0627\u0644\u0645\u0639\u0627\u0644\u062c\" id=\"form-field-field_bda9f5f-0\" name=\"form_fields[field_bda9f5f]\" required=\"required\"> <label for=\"form-field-field_bda9f5f-0\">\u0627\u0648\u0627\u0645\u0631 \u0627\u0644\u062f\u0643\u062a\u0648\u0631 \u0627\u0644\u0645\u0639\u0627\u0644\u062c<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0627\u0644\u0637\u0648\u0627\u0631\u0626\" id=\"form-field-field_bda9f5f-1\" name=\"form_fields[field_bda9f5f]\" required=\"required\"> <label for=\"form-field-field_bda9f5f-1\">\u0627\u0644\u0637\u0648\u0627\u0631\u0626<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_2840b8a elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2840b8a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u0627\u0644\u0645\u0633\u062a\u0648\u0649 \u0627\u0644\u062f\u0631\u0627\u0633\u064a : \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0623\u0645\u064a\" id=\"form-field-field_2840b8a-0\" name=\"form_fields[field_2840b8a]\" required=\"required\"> <label for=\"form-field-field_2840b8a-0\">\u0623\u0645\u064a<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062f\u0648\u0646 \u0627\u0644\u062b\u0627\u0646\u0648\u064a\u0629 \" id=\"form-field-field_2840b8a-1\" name=\"form_fields[field_2840b8a]\" required=\"required\"> <label for=\"form-field-field_2840b8a-1\">\u062f\u0648\u0646 \u0627\u0644\u062b\u0627\u0646\u0648\u064a\u0629 <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062b\u0627\u0646\u0648\u064a\u0629 \" id=\"form-field-field_2840b8a-2\" name=\"form_fields[field_2840b8a]\" required=\"required\"> <label for=\"form-field-field_2840b8a-2\">\u062b\u0627\u0646\u0648\u064a\u0629 <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062e\u0631\u064a\u062c \u0645\u0639\u0647\u062f \" id=\"form-field-field_2840b8a-3\" name=\"form_fields[field_2840b8a]\" required=\"required\"> <label for=\"form-field-field_2840b8a-3\">\u062e\u0631\u064a\u062c \u0645\u0639\u0647\u062f <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0646 \u0627\u0644\u0628\u0643\u0627\u0644\u0648\u0631\u064a\u0648\u0633 \u0641\u0645\u0627 \u0641\u0648\u0642\" id=\"form-field-field_2840b8a-4\" name=\"form_fields[field_2840b8a]\" required=\"required\"> <label for=\"form-field-field_2840b8a-4\">\u0645\u0646 \u0627\u0644\u0628\u0643\u0627\u0644\u0648\u0631\u064a\u0648\u0633 \u0641\u0645\u0627 \u0641\u0648\u0642<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d78dc08 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d78dc08\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u0637\u0631\u064a\u0642\u0629 \u0627\u0644\u0631\u0642\u0648\u062f \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649 :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0628\u062a\u0639\u0631\u064a\u0641 \u0645\u0646 \u0627\u0644\u0637\u0628\u064a\u0628\u062f\u0648\u0646 \u0627\u0644\u062b\u0627\u0646\u0648\u064a\u0629 \" id=\"form-field-field_d78dc08-0\" name=\"form_fields[field_d78dc08]\" required=\"required\"> <label for=\"form-field-field_d78dc08-0\">\u0628\u062a\u0639\u0631\u064a\u0641 \u0645\u0646 \u0627\u0644\u0637\u0628\u064a\u0628\u062f\u0648\u0646 \u0627\u0644\u062b\u0627\u0646\u0648\u064a\u0629 <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062a\u0639\u0631\u064a\u0641 \u0645\u0646 \u0634\u0631\u0643\u0629\" id=\"form-field-field_d78dc08-1\" name=\"form_fields[field_d78dc08]\" required=\"required\"> <label for=\"form-field-field_d78dc08-1\">\u062a\u0639\u0631\u064a\u0641 \u0645\u0646 \u0634\u0631\u0643\u0629<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0648\u0642\u0639 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649 \u0639\u0644\u0649 \u0627\u0644\u0627\u0646\u062a\u0631\u0646\u062a\" id=\"form-field-field_d78dc08-2\" name=\"form_fields[field_d78dc08]\" required=\"required\"> <label for=\"form-field-field_d78dc08-2\">\u0645\u0648\u0642\u0639 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649 \u0639\u0644\u0649 \u0627\u0644\u0627\u0646\u062a\u0631\u0646\u062a<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0637\u0631\u0642 \u0623\u062e\u0631\u0649\" id=\"form-field-field_d78dc08-3\" name=\"form_fields[field_d78dc08]\" required=\"required\"> <label for=\"form-field-field_d78dc08-3\">\u0637\u0631\u0642 \u0623\u062e\u0631\u0649<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_7a52324 elementor-col-100\">\n\t\t\t\t\t\u0627\u0644\u0633\u0624\u0627\u0644\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_0a60305 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0627\u0644\u062d\u0631\u0627\u0633\u0629\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d20e495 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d20e495\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t1-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u062a\u0639\u0627\u0645\u0644 \u0627\u0644\u062d\u0631\u0633 \u0648\u0627\u0644\u0628\u0648\u0627\u0628\u064a\u0646 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_d20e495-0\" name=\"form_fields[field_d20e495]\"> <label for=\"form-field-field_d20e495-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_d20e495-1\" name=\"form_fields[field_d20e495]\"> <label for=\"form-field-field_d20e495-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_d20e495-2\" name=\"form_fields[field_d20e495]\"> <label for=\"form-field-field_d20e495-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_d20e495-3\" name=\"form_fields[field_d20e495]\"> <label for=\"form-field-field_d20e495-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_e2a179d elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0627\u0644\u0627\u0633\u062a\u0639\u0644\u0627\u0645\u0627\u062a\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f8b8d4a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f8b8d4a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t2-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0625\u0631\u0634\u0627\u062f\u0627\u062a \u0642\u0633\u0645 \u0627\u0644\u0627\u0633\u062a\u0639\u0644\u0627\u0645\u0627\u062a \u0641\u064a \u0628\u062f\u0627\u064a\u0629 \u062f\u062e\u0648\u0644\u0643 \u0625\u0644\u0649 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_f8b8d4a-0\" name=\"form_fields[field_f8b8d4a]\"> <label for=\"form-field-field_f8b8d4a-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_f8b8d4a-1\" name=\"form_fields[field_f8b8d4a]\"> <label for=\"form-field-field_f8b8d4a-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_f8b8d4a-2\" name=\"form_fields[field_f8b8d4a]\"> <label for=\"form-field-field_f8b8d4a-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_f8b8d4a-3\" name=\"form_fields[field_f8b8d4a]\"> <label for=\"form-field-field_f8b8d4a-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_8a6cc14 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8a6cc14\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t3-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0627\u0644\u0639\u0644\u0627\u0626\u0645 \u0627\u0644\u062f\u0644\u064a\u0644\u064a\u0629 \u0627\u0644\u0645\u0646\u0635\u0648\u0628\u0629 \u0641\u064a \u0623\u0631\u062c\u0627\u0621 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_8a6cc14-0\" name=\"form_fields[field_8a6cc14]\"> <label for=\"form-field-field_8a6cc14-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_8a6cc14-1\" name=\"form_fields[field_8a6cc14]\"> <label for=\"form-field-field_8a6cc14-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_8a6cc14-2\" name=\"form_fields[field_8a6cc14]\"> <label for=\"form-field-field_8a6cc14-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_8a6cc14-3\" name=\"form_fields[field_8a6cc14]\"> <label for=\"form-field-field_8a6cc14-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_3a0ccce elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0645\u0643\u062a\u0628 \u0627\u0644\u0627\u0633\u062a\u0642\u0628\u0627\u0644\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_3b5ca94 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3b5ca94\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t4-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0633\u0644\u0648\u0643 \u0627\u0644\u0639\u0627\u0645\u0644\u064a\u0646 \u0641\u064a \u0645\u0643\u062a\u0628 IPD\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_3b5ca94-0\" name=\"form_fields[field_3b5ca94]\"> <label for=\"form-field-field_3b5ca94-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_3b5ca94-1\" name=\"form_fields[field_3b5ca94]\"> <label for=\"form-field-field_3b5ca94-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_3b5ca94-2\" name=\"form_fields[field_3b5ca94]\"> <label for=\"form-field-field_3b5ca94-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_3b5ca94-3\" name=\"form_fields[field_3b5ca94]\"> <label for=\"form-field-field_3b5ca94-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_ba9c4d2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ba9c4d2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t5-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0627\u0644\u0645\u062f\u0629 \u0627\u0644\u0632\u0645\u0646\u064a\u0629 \u0627\u0644\u0645\u0633\u062a\u063a\u0631\u0642\u0629 \u0645\u0646 \u0625\u062d\u062f\u0627\u062b \u0627\u0644\u0645\u0644\u0641 \u0627\u0644\u0635\u062d\u0649 \u062d\u062a\u0649 \u0627\u0644\u0627\u0646\u062a\u0642\u0627\u0644 \u0625\u0644\u0649 \u0627\u0644\u0642\u0633\u0645 \u0627\u0644\u0639\u0644\u0627\u062c\u064a\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_ba9c4d2-0\" name=\"form_fields[field_ba9c4d2]\"> <label for=\"form-field-field_ba9c4d2-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_ba9c4d2-1\" name=\"form_fields[field_ba9c4d2]\"> <label for=\"form-field-field_ba9c4d2-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_ba9c4d2-2\" name=\"form_fields[field_ba9c4d2]\"> <label for=\"form-field-field_ba9c4d2-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_ba9c4d2-3\" name=\"form_fields[field_ba9c4d2]\"> <label for=\"form-field-field_ba9c4d2-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_2e824a1 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2e824a1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t6-\u062a\u0642\u062f\u064a\u0645 \u0627\u0644\u0625\u0631\u0634\u0627\u062f\u0627\u062a \u0627\u0644\u0644\u0627\u0632\u0645\u0629 \u0641\u064a \u0628\u062f\u0627\u064a\u0629 \u0627\u0644\u062f\u062e\u0648\u0644 \u0625\u0644\u064a \u0627\u0644\u0642\u0633\u0645 \u060c \u0648\u0633\u0648\u0627\u0631 \u0627\u0644\u062a\u0639\u0631\u064a\u0641 \u0648\u062c\u0631\u0633 \u0627\u0633\u062a\u062f\u0639\u0627\u0621 \u0648 ...\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_2e824a1-0\" name=\"form_fields[field_2e824a1]\"> <label for=\"form-field-field_2e824a1-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_2e824a1-1\" name=\"form_fields[field_2e824a1]\"> <label for=\"form-field-field_2e824a1-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_2e824a1-2\" name=\"form_fields[field_2e824a1]\"> <label for=\"form-field-field_2e824a1-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_2e824a1-3\" name=\"form_fields[field_2e824a1]\"> <label for=\"form-field-field_2e824a1-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_0af1586 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0627\u0644\u0623\u0637\u0628\u0627\u0621 \u0627\u0644\u0645\u0639\u0627\u0644\u062c\u0648\u0646\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_df50705 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_df50705\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t7-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0633\u0644\u0648\u0643 \u0627\u0644\u0623\u0637\u0628\u0627\u0621 \u0648\u0637\u0631\u064a\u0642\u0629 \u062a\u0639\u0627\u0645\u0644\u0647\u0645\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_df50705-0\" name=\"form_fields[field_df50705]\"> <label for=\"form-field-field_df50705-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_df50705-1\" name=\"form_fields[field_df50705]\"> <label for=\"form-field-field_df50705-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_df50705-2\" name=\"form_fields[field_df50705]\"> <label for=\"form-field-field_df50705-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_df50705-3\" name=\"form_fields[field_df50705]\"> <label for=\"form-field-field_df50705-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_4e6f697 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4e6f697\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t8-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u062d\u0636\u0648\u0631 \u0627\u0644\u0623\u0637\u0628\u0627\u0621 \u0627\u0644\u0645\u0628\u0643\u0631 \u0639\u0646\u062f \u0627\u0644\u062d\u0627\u062c\u0629 \u0625\u0644\u064a\u0647\u0645\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_4e6f697-0\" name=\"form_fields[field_4e6f697]\"> <label for=\"form-field-field_4e6f697-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_4e6f697-1\" name=\"form_fields[field_4e6f697]\"> <label for=\"form-field-field_4e6f697-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_4e6f697-2\" name=\"form_fields[field_4e6f697]\"> <label for=\"form-field-field_4e6f697-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_4e6f697-3\" name=\"form_fields[field_4e6f697]\"> <label for=\"form-field-field_4e6f697-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b0758e4 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b0758e4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t9-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0627\u0644\u062a\u062b\u0642\u064a\u0641 \u0627\u0644\u0639\u0644\u0627\u062c\u064a \u0627\u0644\u0630\u064a \u0642\u062f\u0645\u0647 \u0644\u0643 \u0627\u0644\u0623\u0637\u0628\u0627\u0621 \u0637\u064a\u0644\u0629 \u0627\u0644\u0639\u0644\u0627\u062c \u0648\u0639\u0646\u062f \u0627\u0644\u062e\u0631\u0648\u062c \u0645\u0646 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649)\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_b0758e4-0\" name=\"form_fields[field_b0758e4]\"> <label for=\"form-field-field_b0758e4-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_b0758e4-1\" name=\"form_fields[field_b0758e4]\"> <label for=\"form-field-field_b0758e4-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_b0758e4-2\" name=\"form_fields[field_b0758e4]\"> <label for=\"form-field-field_b0758e4-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_b0758e4-3\" name=\"form_fields[field_b0758e4]\"> <label for=\"form-field-field_b0758e4-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d765c92 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d765c92\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t10\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0623\u062c\u0648\u0628\u0629 \u0627\u0644\u0623\u0637\u0628\u0627\u0621 \u0644\u0627\u0633\u062a\u0641\u0633\u0627\u0631\u0627\u062a\u0643 \u0627\u0644\u0637\u0628\u064a\u0629 \u0648\u0627\u0644\u0639\u0644\u0627\u062c\u064a\u0629\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_d765c92-0\" name=\"form_fields[field_d765c92]\"> <label for=\"form-field-field_d765c92-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_d765c92-1\" name=\"form_fields[field_d765c92]\"> <label for=\"form-field-field_d765c92-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_d765c92-2\" name=\"form_fields[field_d765c92]\"> <label for=\"form-field-field_d765c92-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_d765c92-3\" name=\"form_fields[field_d765c92]\"> <label for=\"form-field-field_d765c92-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f2143dc elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f2143dc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t11\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0625\u0633\u062f\u0627\u0644 \u0627\u0644\u0633\u062a\u0627\u0631 \u0648\u0631\u0639\u0627\u064a\u0629 \u062d\u0631\u064a\u0645\u0643 \u0627\u0644\u0634\u062e\u0635\u064a \u0639\u0646\u062f \u0625\u062c\u0631\u0627\u0621 \u0627\u0644\u062a\u062f\u0627\u0628\u064a\u0631 \u0627\u0644\u0639\u0644\u0627\u062c\u064a\u0629 \u0648\u0627\u0644\u0637\u0628\u064a\u0629\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_f2143dc-0\" name=\"form_fields[field_f2143dc]\"> <label for=\"form-field-field_f2143dc-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_f2143dc-1\" name=\"form_fields[field_f2143dc]\"> <label for=\"form-field-field_f2143dc-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_f2143dc-2\" name=\"form_fields[field_f2143dc]\"> <label for=\"form-field-field_f2143dc-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_f2143dc-3\" name=\"form_fields[field_f2143dc]\"> <label for=\"form-field-field_f2143dc-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8495b9a elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0641\u0631\u064a\u0642 \u0627\u0644\u062a\u0645\u0631\u064a\u0636\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_8218f54 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8218f54\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t12\u0647\u0644 \u0627\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0633\u0644\u0648\u0643 \u0627\u0644\u0645\u0645\u0631\u0636\u064a\u0646 \u0648\u0637\u0631\u064a\u0642\u0629 \u062a\u0639\u0627\u0645\u0644\u0647\u0645\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_8218f54-0\" name=\"form_fields[field_8218f54]\"> <label for=\"form-field-field_8218f54-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_8218f54-1\" name=\"form_fields[field_8218f54]\"> <label for=\"form-field-field_8218f54-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_8218f54-2\" name=\"form_fields[field_8218f54]\"> <label for=\"form-field-field_8218f54-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_8218f54-3\" name=\"form_fields[field_8218f54]\"> <label for=\"form-field-field_8218f54-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_fa9b1b1 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fa9b1b1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t13-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0627\u0633\u062a\u062c\u0627\u0628\u0629 \u0627\u0644\u0645\u0645\u0631\u0636\u064a\u0646 \u0627\u0644\u0645\u0628\u0643\u0631\u0629 \u0639\u0646\u062f \u0627\u0633\u062a\u062f\u0639\u0627\u0626\u0647\u0645 \u0628\u0648\u0627\u0633\u0637\u0629 \u0627\u0644\u062c\u0631\u0633\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_fa9b1b1-0\" name=\"form_fields[field_fa9b1b1]\"> <label for=\"form-field-field_fa9b1b1-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_fa9b1b1-1\" name=\"form_fields[field_fa9b1b1]\"> <label for=\"form-field-field_fa9b1b1-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_fa9b1b1-2\" name=\"form_fields[field_fa9b1b1]\"> <label for=\"form-field-field_fa9b1b1-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_fa9b1b1-3\" name=\"form_fields[field_fa9b1b1]\"> <label for=\"form-field-field_fa9b1b1-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_01ff80f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_01ff80f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t14-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0627\u0644\u062a\u062b\u0642\u064a\u0641 \u0627\u0644\u0639\u0644\u0627\u062c\u064a \u0648\u0627\u0644\u0637\u0628\u064a \u0627\u0644\u0630\u064a \u0642\u062f\u0645\u0647 \u0644\u0643 \u0627\u0644\u0645\u0645\u0631\u0636\u0648\u0646 \u0641\u064a \u0628\u062f\u0627\u064a\u0629 \u0627\u0644\u062f\u062e\u0648\u0644 \u0648\u0637\u064a\u0644\u0629 \u0645\u062f\u0629 \u0627\u0644\u0639\u0644\u0627\u062c \u0648\u0639\u0646\u062f \u0627\u0644\u062e\u0631\u0648\u062c \u0645\u0646 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_01ff80f-0\" name=\"form_fields[field_01ff80f]\"> <label for=\"form-field-field_01ff80f-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_01ff80f-1\" name=\"form_fields[field_01ff80f]\"> <label for=\"form-field-field_01ff80f-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_01ff80f-2\" name=\"form_fields[field_01ff80f]\"> <label for=\"form-field-field_01ff80f-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_01ff80f-3\" name=\"form_fields[field_01ff80f]\"> <label for=\"form-field-field_01ff80f-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d5d1fa5 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d5d1fa5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t15-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0625\u0633\u062f\u0627\u0644 \u0627\u0644\u0633\u062a\u0627\u0631 \u0648\u0631\u0639\u0627\u064a\u0629 \u062d\u0631\u064a\u0645\u0643 \u0627\u0644\u0634\u062e\u0635\u064a \u0639\u0646\u062f \u0625\u062c\u0631\u0627\u0621 \u0627\u0644\u062a\u062f\u0627\u0628\u064a\u0631 \u0627\u0644\u0639\u0644\u0627\u062c\u064a\u0629 \u0648\u062a\u062f\u0627\u0628\u064a\u0631 \u0627\u0644\u062a\u0645\u0631\u064a\u0636\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_d5d1fa5-0\" name=\"form_fields[field_d5d1fa5]\"> <label for=\"form-field-field_d5d1fa5-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_d5d1fa5-1\" name=\"form_fields[field_d5d1fa5]\"> <label for=\"form-field-field_d5d1fa5-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_d5d1fa5-2\" name=\"form_fields[field_d5d1fa5]\"> <label for=\"form-field-field_d5d1fa5-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_d5d1fa5-3\" name=\"form_fields[field_d5d1fa5]\"> <label for=\"form-field-field_d5d1fa5-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_a457370 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u062e\u062f\u0645\u0627\u062a \u0627\u0644\u062a\u0634\u062e\u064a\u0635\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e5a6c26 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e5a6c26\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t16-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0637\u0631\u064a\u0642\u0629 \u0627\u0644\u0641\u062d\u0648\u0635\u0627\u062a \u0627\u0644\u0644\u0627\u0632\u0645\u0629 \u0641\u064a \u0642\u0633\u0645 \u0627\u0644\u0623\u0634\u0639\u0629\u060c \u0648\u0627\u0644\u0633\u0648\u0644\u0627\u0631 \u0648\u0627\u0644\u0633\u064a \u062a\u064a \u0627\u0633\u0643\u0646 \u0648... \u0625\u0630\u0627 \u0643\u0627\u0646 \u0627\u0644\u0639\u0644\u0627\u062c \u064a\u0642\u062a\u0636\u064a \u0630\u0644\u0643\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_e5a6c26-0\" name=\"form_fields[field_e5a6c26]\"> <label for=\"form-field-field_e5a6c26-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_e5a6c26-1\" name=\"form_fields[field_e5a6c26]\"> <label for=\"form-field-field_e5a6c26-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_e5a6c26-2\" name=\"form_fields[field_e5a6c26]\"> <label for=\"form-field-field_e5a6c26-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_e5a6c26-3\" name=\"form_fields[field_e5a6c26]\"> <label for=\"form-field-field_e5a6c26-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_eb6639b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_eb6639b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t17\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0637\u0631\u064a\u0642\u0629 \u0627\u0644\u0641\u062d\u0648\u0635 \u0627\u0644\u0644\u0627\u0632\u0645\u0629 \u0641\u064a \u0642\u0633\u0645 \u0627\u0644\u062a\u062d\u0644\u064a\u0644 \u0627\u0644\u0645\u062e\u0628\u0631\u064a \u0625\u0630\u0627 \u0643\u0627\u0646 \u0627\u0644\u0639\u0644\u0627\u062c \u064a\u0642\u062a\u0636\u064a \u0630\u0644\u0643\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_eb6639b-0\" name=\"form_fields[field_eb6639b]\"> <label for=\"form-field-field_eb6639b-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_eb6639b-1\" name=\"form_fields[field_eb6639b]\"> <label for=\"form-field-field_eb6639b-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_eb6639b-2\" name=\"form_fields[field_eb6639b]\"> <label for=\"form-field-field_eb6639b-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_eb6639b-3\" name=\"form_fields[field_eb6639b]\"> <label for=\"form-field-field_eb6639b-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_92cc933 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_92cc933\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t18-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0633\u0644\u0648\u0643 \u0627\u0644\u0639\u0627\u0645\u0644\u064a\u0646 \u0641\u064a \u0648\u062d\u062f\u0627\u062a \u0627\u0644\u0641\u062d\u0648\u0635 \u0627\u0644\u0637\u0628\u064a\u0629 \u0648\u0637\u0631\u064a\u0642\u0629 \u062a\u0639\u0627\u0645\u0644\u0647\u0645\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_92cc933-0\" name=\"form_fields[field_92cc933]\"> <label for=\"form-field-field_92cc933-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_92cc933-1\" name=\"form_fields[field_92cc933]\"> <label for=\"form-field-field_92cc933-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_92cc933-2\" name=\"form_fields[field_92cc933]\"> <label for=\"form-field-field_92cc933-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_92cc933-3\" name=\"form_fields[field_92cc933]\"> <label for=\"form-field-field_92cc933-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_9302edd elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9302edd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t19-\u0647\u0644 \u0627\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0631\u0639\u0627\u064a\u0629 \u062d\u0631\u064a\u0645\u0643 \u0627\u0644\u0634\u062e\u0635\u064a \u0639\u0646\u062f \u0625\u062c\u0631\u0627\u0621 \u0627\u0644\u0641\u062d\u0648\u0635 \u0627\u0644\u0637\u0628\u064a\u0629\u061f \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_9302edd-0\" name=\"form_fields[field_9302edd]\"> <label for=\"form-field-field_9302edd-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_9302edd-1\" name=\"form_fields[field_9302edd]\"> <label for=\"form-field-field_9302edd-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_9302edd-2\" name=\"form_fields[field_9302edd]\"> <label for=\"form-field-field_9302edd-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_9302edd-3\" name=\"form_fields[field_9302edd]\"> <label for=\"form-field-field_9302edd-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_7f000cb elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0627\u0644\u0628\u064a\u0626\u0629 \u0648\u062e\u062f\u0645\u0627\u062a \u0627\u0644\u0642\u0633\u0645\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_13bf7c2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_13bf7c2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t20-\u0647\u0644 \u0627\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0633\u0644\u0648\u0643 \u0627\u0644\u0641\u0631\u0627\u0634\u064a\u0646 \u0648\u0639\u0645\u0627\u0644 \u0627\u0644\u0646\u0638\u0627\u0641\u0629 \u0648\u0627\u0644\u062e\u062f\u0645\u0627\u062a\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_13bf7c2-0\" name=\"form_fields[field_13bf7c2]\"> <label for=\"form-field-field_13bf7c2-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_13bf7c2-1\" name=\"form_fields[field_13bf7c2]\"> <label for=\"form-field-field_13bf7c2-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_13bf7c2-2\" name=\"form_fields[field_13bf7c2]\"> <label for=\"form-field-field_13bf7c2-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_13bf7c2-3\" name=\"form_fields[field_13bf7c2]\"> <label for=\"form-field-field_13bf7c2-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_4b9a18d elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4b9a18d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t21-\u0645\u0627 \u0645\u062f\u0649 \u0631\u0636\u0627\u0643 \u0639\u0646 \u0637\u0631\u064a\u0642\u0629 \u0627\u0644\u062a\u0642\u0627\u0644\u0643 \u0625\u0644\u0649 \u0627\u0644\u0642\u0633\u0645 \u0623\u0648 \u062a\u0646\u0642\u0644\u0643 \u0628\u064a\u0646 \u0627\u0644\u0623\u0642\u0633\u0627\u0645 \u0627\u0644\u0645\u062e\u062a\u0644\u0641\u0629 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_4b9a18d-0\" name=\"form_fields[field_4b9a18d]\"> <label for=\"form-field-field_4b9a18d-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_4b9a18d-1\" name=\"form_fields[field_4b9a18d]\"> <label for=\"form-field-field_4b9a18d-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_4b9a18d-2\" name=\"form_fields[field_4b9a18d]\"> <label for=\"form-field-field_4b9a18d-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_4b9a18d-3\" name=\"form_fields[field_4b9a18d]\"> <label for=\"form-field-field_4b9a18d-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_01d94af elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_01d94af\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t22-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0646\u0638\u0627\u0641\u0629 \u0627\u0644\u0642\u0633\u0645\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_01d94af-0\" name=\"form_fields[field_01d94af]\"> <label for=\"form-field-field_01d94af-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_01d94af-1\" name=\"form_fields[field_01d94af]\"> <label for=\"form-field-field_01d94af-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_01d94af-2\" name=\"form_fields[field_01d94af]\"> <label for=\"form-field-field_01d94af-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_01d94af-3\" name=\"form_fields[field_01d94af]\"> <label for=\"form-field-field_01d94af-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_a85185c elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a85185c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t23-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0637\u0631\u064a\u0642\u0629 \u062a\u063a\u064a\u064a\u0631 \u0627\u0644\u0634\u0631\u0627\u0634\u0641 \u0648\u0627\u0644\u0628\u0637\u0627\u0646\u064a\u0627\u062a \u0648\u0627\u0644\u0645\u0644\u0627\u0628\u0633\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_a85185c-0\" name=\"form_fields[field_a85185c]\"> <label for=\"form-field-field_a85185c-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_a85185c-1\" name=\"form_fields[field_a85185c]\"> <label for=\"form-field-field_a85185c-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_a85185c-2\" name=\"form_fields[field_a85185c]\"> <label for=\"form-field-field_a85185c-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_a85185c-3\" name=\"form_fields[field_a85185c]\"> <label for=\"form-field-field_a85185c-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e852ec8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e852ec8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t24-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0625\u0645\u0643\u0627\u0646\u064a\u0627\u062a \u0627\u0644\u062a\u0631\u0641\u064a\u0647 \u0627\u0644\u062a\u0644\u0641\u0632\u064a\u0648\u0646 \u0627\u0644\u0643\u0631\u0627\u0633\u064a \u0627\u0644\u0628\u0631\u0627\u062f \u0627\u0644\u0647\u0627\u062a\u0641 \u0627\u0644\u0636\u064a\u0627\u0621 \u0627\u0644\u0633\u0631\u064a\u0631\u060c \u0627\u0644\u0645\u0635\u0644\u064a \u0627\u0644\u062a\u0643\u064a\u064a\u0641 \u0627\u0644\u062a\u062f\u0641\u0626\u0629 \u0648\u062a\u0647\u0648\u064a\u0629 \u0627\u0644\u063a\u0631\u0641\u0629)\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_e852ec8-0\" name=\"form_fields[field_e852ec8]\"> <label for=\"form-field-field_e852ec8-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_e852ec8-1\" name=\"form_fields[field_e852ec8]\"> <label for=\"form-field-field_e852ec8-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_e852ec8-2\" name=\"form_fields[field_e852ec8]\"> <label for=\"form-field-field_e852ec8-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_e852ec8-3\" name=\"form_fields[field_e852ec8]\"> <label for=\"form-field-field_e852ec8-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_7dc98e7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7dc98e7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t25-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0646\u0648\u0639\u064a\u0629 \u0627\u0644\u0637\u0639\u0627\u0645 \u0648\u062c\u0648\u062f\u062a\u0647\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_7dc98e7-0\" name=\"form_fields[field_7dc98e7]\"> <label for=\"form-field-field_7dc98e7-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_7dc98e7-1\" name=\"form_fields[field_7dc98e7]\"> <label for=\"form-field-field_7dc98e7-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_7dc98e7-2\" name=\"form_fields[field_7dc98e7]\"> <label for=\"form-field-field_7dc98e7-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_7dc98e7-3\" name=\"form_fields[field_7dc98e7]\"> <label for=\"form-field-field_7dc98e7-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_132ba30 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_132ba30\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t26-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0645\u0648\u0627\u0639\u064a\u062f \u0648\u062c\u0628\u0627\u062a \u0627\u0644\u0637\u0639\u0627\u0645\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_132ba30-0\" name=\"form_fields[field_132ba30]\"> <label for=\"form-field-field_132ba30-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_132ba30-1\" name=\"form_fields[field_132ba30]\"> <label for=\"form-field-field_132ba30-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_132ba30-2\" name=\"form_fields[field_132ba30]\"> <label for=\"form-field-field_132ba30-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_132ba30-3\" name=\"form_fields[field_132ba30]\"> <label for=\"form-field-field_132ba30-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_29cae28 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_29cae28\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t27-\u0645\u0644 \u062e\u0636\u0639\u062a \u0644\u0639\u0645\u0644\u064a\u0629 \u062c\u0631\u0627\u062d\u064a\u0629 \u061f \u0646\u0639\u0645 \u0644\u0627 (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0627\u0644\u0625\u064a\u062c\u0627\u0628 \u064a\u0631\u062c\u0649 \u0645\u0644\u0621 \u0627\u0644\u062d\u0641\u0644 \u0627\u0644\u0622\u062a\u064a)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_29cae28-0\" name=\"form_fields[field_29cae28]\"> <label for=\"form-field-field_29cae28-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_29cae28-1\" name=\"form_fields[field_29cae28]\"> <label for=\"form-field-field_29cae28-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_29cae28-2\" name=\"form_fields[field_29cae28]\"> <label for=\"form-field-field_29cae28-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_29cae28-3\" name=\"form_fields[field_29cae28]\"> <label for=\"form-field-field_29cae28-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8a9b557 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0627\u062a\u0627\u0642 \u0639\u0645\u0644 \u062c\u0631\u0627\u062d\u06cc\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e77e42e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e77e42e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t28-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0633\u0644\u0648\u0643 \u0648\u062a\u0639\u0627\u0645\u0644 \u0627\u0644\u0643\u0627\u062f\u0631 \u0627\u0644\u0639\u0627\u0645\u0644 \u0641\u064a \u0635\u0627\u0644\u0629 \u0627\u0644\u0639\u0645\u0644\u064a\u0627\u062a\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_e77e42e-0\" name=\"form_fields[field_e77e42e]\"> <label for=\"form-field-field_e77e42e-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_e77e42e-1\" name=\"form_fields[field_e77e42e]\"> <label for=\"form-field-field_e77e42e-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_e77e42e-2\" name=\"form_fields[field_e77e42e]\"> <label for=\"form-field-field_e77e42e-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_e77e42e-3\" name=\"form_fields[field_e77e42e]\"> <label for=\"form-field-field_e77e42e-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d80d5d6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d80d5d6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t29-\u0647\u0644 \u0623\u0646\u062a \u0639\u0644\u0649 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0625\u062c\u0631\u0627\u0621 \u0627\u0644\u0639\u0645\u0644\u064a\u0629 \u0641\u064a \u0645\u0648\u0639\u062f\u0647\u0627 \u0627\u0644\u0645\u0642\u0631\u0631\u0629\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_d80d5d6-0\" name=\"form_fields[field_d80d5d6]\"> <label for=\"form-field-field_d80d5d6-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_d80d5d6-1\" name=\"form_fields[field_d80d5d6]\"> <label for=\"form-field-field_d80d5d6-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_d80d5d6-2\" name=\"form_fields[field_d80d5d6]\"> <label for=\"form-field-field_d80d5d6-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_d80d5d6-3\" name=\"form_fields[field_d80d5d6]\"> <label for=\"form-field-field_d80d5d6-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_59aa54c elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_59aa54c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t30-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u062a\u0645\u0647\u064a\u062f\u064a\u0629 \u0627\u0644\u062a\u064a \u0642\u062f\u0645\u062a \u0644\u0643 \u0642\u0628\u0644 \u0625\u062c\u0631\u0627\u0621 \u0627\u0644\u0639\u0645\u0644\u064a\u0629\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_59aa54c-0\" name=\"form_fields[field_59aa54c]\"> <label for=\"form-field-field_59aa54c-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_59aa54c-1\" name=\"form_fields[field_59aa54c]\"> <label for=\"form-field-field_59aa54c-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_59aa54c-2\" name=\"form_fields[field_59aa54c]\"> <label for=\"form-field-field_59aa54c-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_59aa54c-3\" name=\"form_fields[field_59aa54c]\"> <label for=\"form-field-field_59aa54c-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_75c8b3e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_75c8b3e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t31-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u062a\u0645\u0647\u064a\u062f\u064a\u0629 \u0627\u0644\u062a\u064a \u0642\u062f\u0645\u062a \u0644\u0643 \u0642\u0628\u0644 \u0625\u062c\u0631\u0627\u0621 \u0627\u0644\u0639\u0645\u0644\u064a\u0629\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_75c8b3e-0\" name=\"form_fields[field_75c8b3e]\"> <label for=\"form-field-field_75c8b3e-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_75c8b3e-1\" name=\"form_fields[field_75c8b3e]\"> <label for=\"form-field-field_75c8b3e-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_75c8b3e-2\" name=\"form_fields[field_75c8b3e]\"> <label for=\"form-field-field_75c8b3e-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_75c8b3e-3\" name=\"form_fields[field_75c8b3e]\"> <label for=\"form-field-field_75c8b3e-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_9e9dcb6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9e9dcb6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t32-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0635\u062d\u064a\u0629 \u0627\u0644\u062a\u064a \u062a\u0644\u0642\u064a\u062a\u0647\u0627 \u0628\u0639\u062f \u0627\u0644\u0639\u0645\u0644\u064a\u0629 \u0627\u0644\u062c\u0631\u0627\u062d\u064a\u0629\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_9e9dcb6-0\" name=\"form_fields[field_9e9dcb6]\"> <label for=\"form-field-field_9e9dcb6-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_9e9dcb6-1\" name=\"form_fields[field_9e9dcb6]\"> <label for=\"form-field-field_9e9dcb6-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_9e9dcb6-2\" name=\"form_fields[field_9e9dcb6]\"> <label for=\"form-field-field_9e9dcb6-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_9e9dcb6-3\" name=\"form_fields[field_9e9dcb6]\"> <label for=\"form-field-field_9e9dcb6-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_aef1b48 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\n<br>\u0625\u062f\u0627\u0631\u0629 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_15beae4 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_15beae4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t33-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0648\u062d\u062f\u0629 \u0627\u0644\u0640 170 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_15beae4-0\" name=\"form_fields[field_15beae4]\"> <label for=\"form-field-field_15beae4-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_15beae4-1\" name=\"form_fields[field_15beae4]\"> <label for=\"form-field-field_15beae4-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_15beae4-2\" name=\"form_fields[field_15beae4]\"> <label for=\"form-field-field_15beae4-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_15beae4-3\" name=\"form_fields[field_15beae4]\"> <label for=\"form-field-field_15beae4-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bb09cbd elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bb09cbd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t34-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u062a\u0648\u0641\u0631 \u0627\u0644\u0623\u062f\u0648\u064a\u0629 \u0627\u0644\u0645\u0648\u062c\u0648\u062f\u0629 \u0641\u064a \u0627\u0644\u0648\u0635\u0641\u0629\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_bb09cbd-0\" name=\"form_fields[field_bb09cbd]\"> <label for=\"form-field-field_bb09cbd-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_bb09cbd-1\" name=\"form_fields[field_bb09cbd]\"> <label for=\"form-field-field_bb09cbd-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_bb09cbd-2\" name=\"form_fields[field_bb09cbd]\"> <label for=\"form-field-field_bb09cbd-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_bb09cbd-3\" name=\"form_fields[field_bb09cbd]\"> <label for=\"form-field-field_bb09cbd-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d905afa elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d905afa\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t35-\u0647\u0644 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0645\u062a\u0627\u0628\u0639\u0629 \u0634\u0643\u0627\u0648\u0649 \u0627\u0644\u0645\u0631\u0636\u0649 \u0648\u0627\u0646\u062a\u0642\u0627\u062f\u0627\u062a\u0647\u0645 \u0645\u0646 \u0642\u0628\u0644 \u0627\u0644\u0645\u0639\u0644\u0645\u064a\u0646 \u0628\u0627\u0644\u0623\u0645\u0631\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_d905afa-0\" name=\"form_fields[field_d905afa]\"> <label for=\"form-field-field_d905afa-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_d905afa-1\" name=\"form_fields[field_d905afa]\"> <label for=\"form-field-field_d905afa-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_d905afa-2\" name=\"form_fields[field_d905afa]\"> <label for=\"form-field-field_d905afa-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_d905afa-3\" name=\"form_fields[field_d905afa]\"> <label for=\"form-field-field_d905afa-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_20a34e8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_20a34e8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t36-\u0645\u0646 \u0623\u0646\u062a \u0631\u0627\u0636 \u0639\u0646 \u0627\u0644\u0625\u0645\u0643\u0627\u0646\u064a\u0627\u062a \u0627\u0644\u0631\u0641\u0627\u0647\u064a\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649 \u0643\u0627\u0644\u062d\u0627\u0644\u0648\u0646\u060c \u0648\u0627\u0644\u0627\u064a\u0646\u062a\u0631\u0646\u062a \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0645\u062a\u0627\u0632\ud83d\ude00\" id=\"form-field-field_20a34e8-0\" name=\"form_fields[field_20a34e8]\"> <label for=\"form-field-field_20a34e8-0\">\u0645\u0645\u062a\u0627\u0632\ud83d\ude00<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u062c\u064a\u062f \ud83d\ude42\" id=\"form-field-field_20a34e8-1\" name=\"form_fields[field_20a34e8]\"> <label for=\"form-field-field_20a34e8-1\">\u062c\u064a\u062f \ud83d\ude42<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u0644\u0627\u0626\u0645\ud83d\ude15\" id=\"form-field-field_20a34e8-2\" name=\"form_fields[field_20a34e8]\"> <label for=\"form-field-field_20a34e8-2\">\u0645\u0644\u0627\u0626\u0645\ud83d\ude15<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0633\u064a\u0626\u0629 \ud83d\ude20\" id=\"form-field-field_20a34e8-3\" name=\"form_fields[field_20a34e8]\"> <label for=\"form-field-field_20a34e8-3\">\u0633\u064a\u0626\u0629 \ud83d\ude20<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_4104797 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4104797\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t37-\u0645\u0646 \u062d\u064a\u062b \u0627\u0644\u0645\u062c\u0645\u0648\u0639 \u0645\u0627 \u0647\u0648 \u0645\u062f\u0649 \u0631\u0636\u0627\u0643 \u0639\u0646 \u062e\u062f\u0645\u0627\u062a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0643\u062b\u064a\u0631\u0629\" id=\"form-field-field_4104797-0\" name=\"form_fields[field_4104797]\"> <label for=\"form-field-field_4104797-0\">\u0643\u062b\u064a\u0631\u0629<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0645\u062a\u0648\u0633\u0637\" id=\"form-field-field_4104797-1\" name=\"form_fields[field_4104797]\"> <label for=\"form-field-field_4104797-1\">\u0645\u062a\u0648\u0633\u0637<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0642\u0644\u064a\u0644\" id=\"form-field-field_4104797-2\" name=\"form_fields[field_4104797]\"> <label for=\"form-field-field_4104797-2\">\u0642\u0644\u064a\u0644<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_3744faa elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3744faa\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t38-\u0645\u0625\u0630\u0627 \u0627\u0642\u062a\u0636\u062a \u0627\u0644\u0636\u0631\u0648\u0631\u0629 \u0623\u0646 \u062a\u0631\u0642\u062f \u062b\u0627\u0646\u064a\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649 \u0623\u0646\u062a \u0623\u0648 \u0623\u062d\u062f \u0623\u0642\u0631\u0628\u0627\u0646\u0643 \u0648\u0627\u0635\u062f\u0642\u0627\u0626\u0643 \u0641\u0647\u0644 \u062a\u0631\u063a\u0628 \u0641\u064a \u0645\u0631\u0627\u062c\u0639\u0629 \u0647\u0630\u0627 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649 \u0644\u0644\u0645\u0631\u0629 \u0627\u0644\u062b\u0627\u0646\u064a\u0629\u061f\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0646\u0639\u0645\" id=\"form-field-field_3744faa-0\" name=\"form_fields[field_3744faa]\"> <label for=\"form-field-field_3744faa-0\">\u0646\u0639\u0645<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"\u0644\u0627\" id=\"form-field-field_3744faa-1\" name=\"form_fields[field_3744faa]\"> <label for=\"form-field-field_3744faa-1\">\u0644\u0627<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8dcefb8 elementor-col-100\">\n\t\t\t\t\t\u0627\u0630 \u0631\u063a\u0628\u062a\u0645 \u0628\u0627 \u0627\u064a\u062c\u0627\u062f \u0627\u062a\u0635\u0627\u0644 \u0628\u064a\u0646 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u064a \u0648 \u0645\u0639\u0643\u0645 \u064a\u0631\u062c\u064a \u0643\u062a\u0627\u0628\u0647 \u0631\u0642\u0645 \u0627\u0644\u0647\u0627\u062a\u0641 \u0627\u0644\u062b\u0627\u0628\u062a \u0627\u0648 \u0646\u0642\u0627\u0644 (\u0627\u0644\u0645\u0648\u0628\u0627\u064a\u0644 )\u0627\u0648 \u062d\u062a\u064a \u0627\u0644\u0639\u0646\u0648\u0627\u0646 \u0627\u0644\u0643\u062a\u0631\u0648\u0646\u064a \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_b92b8b0 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_b92b8b0]\" id=\"form-field-field_b92b8b0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_67d33ee elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_67d33ee]\" id=\"form-field-field_67d33ee\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"\u0647\u0627\u062a\u0641\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b37ae4d elementor-col-100\">\n\t\t\t\t\t\u064a\u0631\u062c\u064a \u0645\u0646\u0643\u0645 \u0627\u0646 \u062a\u0643\u062a\u0628\u0648\u0627 \u0627\u064a \u0627\u0646\u062a\u0642\u0627\u062f \u0627\u0648 \u0627\u0642\u062a\u0631\u0627\u062d \u0644\u0643\u064a \u0646\u0642\u062f\u0645 \u0627\u0641\u0636\u0644 \u062e\u062f\u0645\u0627\u062a \u0644\u0643\u0645 \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_e23dc6b elementor-col-100\">\n\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_e23dc6b]\" id=\"form-field-field_e23dc6b\" rows=\"4\" placeholder=\"\u064a\u0631\u062c\u064a \u0645\u0646\u0643\u0645 \u0627\u0646 \u062a\u0643\u062a\u0628\u0648\u0627 \u0627\u064a \u0627\u0646\u062a\u0642\u0627\u062f\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_014f011 elementor-col-100\">\n\t\t\t\t\t<div style=\"text-align: center\">\n    <p>\u062a\u0634\u0643\u0631 \u0644\u0643\u0645 \u0627\u062f\u0627\u0631\u0647 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u064a \u0639\u0644\u064a \u0643\u062a\u0627\u0628\u0647 \u0647\u0630\u0627 \u0627\u0633\u062a\u0645\u0627\u0631\u0647\n<br>\u0645\u062f\u064a\u0631\u064a\u0647 \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u064at\n<\/p>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">\u062a\u0633\u062c\u06cc\u0644<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Questionnaire of hospitalized patients and their companions in Nikan Hospital Dear patient, In the hope of good health, please plan your comments for more appropriate medical treatment and improve the conditions of the hospital after completing the following section. Specify your comments in the column beside the questions with the\u00a0\u00fcmark. (This form of information is &hellip;<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-21488","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.4 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Survey Form - \u0646\u06cc\u06a9\u0627\u0646 \u0627\u0642\u062f\u0633\u06cc\u0647<\/title>\n<meta name=\"robots\" content=\"noindex, nofollow\" \/>\n<meta property=\"og:locale\" content=\"fa_IR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Survey Form\" \/>\n<meta property=\"og:description\" content=\"Questionnaire of hospitalized patients and their companions in Nikan Hospital Dear patient, In the hope of good health, please plan your comments for more appropriate medical treatment and improve the conditions of the hospital after completing the following section. Specify your comments in the column beside the questions with the\u00a0\u00fcmark. 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