{"id":146418,"date":"2022-03-04T18:44:03","date_gmt":"2022-03-04T18:44:03","guid":{"rendered":"https:\/\/www.allencarr.com\/seminar-feedback-form\/"},"modified":"2024-06-20T16:52:25","modified_gmt":"2024-06-20T15:52:25","slug":"seminar-feedback-form","status":"publish","type":"page","link":"https:\/\/www.allencarr.com\/en-us\/contact-us\/seminar-feedback-form\/","title":{"rendered":"In Person Seminar Feedback Form"},"content":{"rendered":"<section class=\"formatted-text  formatted-text--background\">\n\t<div class=\"container container--large\">\n\t\t<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]&gt; *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework consultation_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_25' style='display:none'><div id='gf_25' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_25' class='consultation' action='\/en-us\/wp-json\/wp\/v2\/pages\/146418#gf_25' data-formid='25' novalidate>\n        <div id='gf_progressbar_wrapper_25' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>4<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_25_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_25' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_25_88\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_88'>Comments<\/label><div class='ginput_container'><input name='input_88' id='input_25_88' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_25_88'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_25_18\" class=\"gfield gfield--type-html gfield--input-type-html html_wrapper size_medium gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Seminar Feedback Form<\/h2>\n<p>Thank you for joining us today \u2013 we value your feedback and would greatly appreciate you giving your view of your visit (so far!) by completing this brief questionnaire. There are only 10 questions so will not take long.\n<strong>By way of thanks, your name will be entered into a free draw to win your session fee back.<\/strong><\/p><\/div><div id=\"field_25_15\" class=\"gfield gfield--type-text gfield--input-type-text text_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_15'>1. Please enter your name (no problem if you\u2019d rather remain anonymous)<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_25_15' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_25_75\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full email_wrapper size_large field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_75'>Please enter your email (no problem if you\u2019d rather remain anonymous)<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_75' id='input_25_75' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_25_87\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full select_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_87'>3. Who was your facilitator?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_87' id='input_25_87' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Colleen Dwyer' >Colleen Dwyer<\/option><option value='Cris Hay' >Cris Hay<\/option><option value='Debbie Brewer West' >Debbie Brewer West<\/option><option value='Duncan Bhaskaran Brown' >Duncan Bhaskaran Brown<\/option><option value='Emma Hudson' >Emma Hudson<\/option><option value='Gerry Williams' >Gerry Williams<\/option><option value='Mark Newman' >Mark Newman<\/option><option value='Paul Melvin' >Paul Melvin<\/option><option value='Rob Fielding' >Rob Fielding<\/option><option value='Sam Kelser' >Sam Kelser<\/option><option value='Sun Hui' >Sun Hui<\/option><\/select><\/div><\/div><div id=\"field_25_52\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full select_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_52'>4. Please select from the options below the seminar you\u2019re attending today<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_52' id='input_25_52' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Stop Smoking &amp; Vaping' >Quit Smoking &amp; Vaping<\/option><option value='Stop Drinking' >Quit Drinking<\/option><option value='Weight Loss &amp; Quit Sugar' >Weight Loss &amp; Quit Sugar<\/option><option value='Quit Drugs' >Quit Drugs<\/option><\/select><\/div><\/div><fieldset id=\"field_25_53\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio radio_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5. How easy was it to find details about our Seminars?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_25_53'>\n\t\t\t<div class='gchoice gchoice_25_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Very'  id='choice_25_53_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_53_0' id='label_25_53_0' class='gform-field-label gform-field-label--type-inline'>Very<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='No Problems'  id='choice_25_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_53_1' id='label_25_53_1' class='gform-field-label gform-field-label--type-inline'>No Problems<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_53_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Not Great'  id='choice_25_53_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_53_2' id='label_25_53_2' class='gform-field-label gform-field-label--type-inline'>Not Great<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_25_1' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_25_2' class='gform_page  page_wrapper size_medium' data-js='page-field-id-1' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_25_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_25_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio radio_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >6. How easy was it to book?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_25_9'>\n\t\t\t<div class='gchoice gchoice_25_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Very'  id='choice_25_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_9_0' id='label_25_9_0' class='gform-field-label gform-field-label--type-inline'>Very<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='No Problems'  id='choice_25_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_9_1' id='label_25_9_1' class='gform-field-label gform-field-label--type-inline'>No Problems<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Not Great'  id='choice_25_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_9_2' id='label_25_9_2' class='gform-field-label gform-field-label--type-inline'>Not Great<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_25_70\" class=\"gfield gfield--type-textarea gfield--input-type-textarea textarea_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_70'>Any specific comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_70' id='input_25_70' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_25_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio radio_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >7. How easy was your journey here?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_25_11'>\n\t\t\t<div class='gchoice gchoice_25_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Very'  id='choice_25_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_11_0' id='label_25_11_0' class='gform-field-label gform-field-label--type-inline'>Very<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='No Problems'  id='choice_25_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_11_1' id='label_25_11_1' class='gform-field-label gform-field-label--type-inline'>No Problems<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Not Great'  id='choice_25_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_11_2' id='label_25_11_2' class='gform-field-label gform-field-label--type-inline'>Not Great<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_25_71\" class=\"gfield gfield--type-textarea gfield--input-type-textarea textarea_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_71'>Any specific comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_71' id='input_25_71' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_25_17' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_25_17' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_25_3' class='gform_page  page_wrapper size_medium' data-js='page-field-id-17' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_25_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_25_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio radio_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >8. How warm was your welcome by our Reception Team?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_25_63'>\n\t\t\t<div class='gchoice gchoice_25_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Very'  id='choice_25_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_63_0' id='label_25_63_0' class='gform-field-label gform-field-label--type-inline'>Very<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='No Problems'  id='choice_25_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_63_1' id='label_25_63_1' class='gform-field-label gform-field-label--type-inline'>No Problems<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_63_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Not Very'  id='choice_25_63_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_63_2' id='label_25_63_2' class='gform-field-label gform-field-label--type-inline'>Not Very<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_25_72\" class=\"gfield gfield--type-textarea gfield--input-type-textarea textarea_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_72'>Any specific comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_72' id='input_25_72' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_25_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio radio_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >9. How satisfactory are our facilities (session room, refreshments, toilets, environment)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_25_65'>\n\t\t\t<div class='gchoice gchoice_25_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Very'  id='choice_25_65_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_65_0' id='label_25_65_0' class='gform-field-label gform-field-label--type-inline'>Very<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='No Problems'  id='choice_25_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_65_1' id='label_25_65_1' class='gform-field-label gform-field-label--type-inline'>No Problems<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_65_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Not Very'  id='choice_25_65_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_65_2' id='label_25_65_2' class='gform-field-label gform-field-label--type-inline'>Not Very<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_25_73\" class=\"gfield gfield--type-textarea gfield--input-type-textarea textarea_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_73'>Any specific comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_73' id='input_25_73' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_25_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio center radio_wrapper size_medium gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >10. Have you found your facilitator to be a clear and effective communicator (so far!)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_25_19'>\n<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_25_19'>\n\t\t\t<div class='gchoice gchoice_25_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_25_19_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_25_19\"   \/>\n\t\t\t\t\t<label for='choice_25_19_0' id='label_25_19_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_25_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_19_1' id='label_25_19_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_25_74\" class=\"gfield gfield--type-textarea gfield--input-type-textarea textarea_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_74'>Any specific comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_74' id='input_25_74' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_25_67' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_25_67' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_25_4' class='gform_page  page_wrapper size_medium' data-js='page-field-id-67' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_25_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_25_76\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full select_wrapper size_large gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_76'>11. Overall how satisfied were you with everything?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_76' id='input_25_76' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='Very satisfied' >Very satisfied<\/option><option value='Satisfied' >Satisfied<\/option><option value='Not satisfied' >Not satisfied<\/option><option value='Very unsatisfied' >Very unsatisfied<\/option><\/select><\/div><\/div><div id=\"field_25_77\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full textarea_wrapper size_large gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_77'>12. Please give details as to why you were unsatisfied<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_77' id='input_25_77' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_25_58\" class=\"gfield gfield--type-textarea gfield--input-type-textarea textarea_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_58'>13. Do you have any other suggestions\/comments you would like to make on any aspect of your visit?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_58' id='input_25_58' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_25_82\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full select_wrapper size_large gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_82'>14. Did you attend for free with a Local Authority\/Council?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_82' id='input_25_82' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='No' selected='selected'>No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_25_79\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full select_wrapper size_large gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_79'>14 a. Which local authority\/council did you attend with?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_79' id='input_25_79' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select<\/option><option value='Not applicable' >Not applicable<\/option><option value='Bedfordshire Council' >Bedfordshire Council<\/option><option value='Bexley Council' >Bexley Council<\/option><option value='Bolton Council' >Bolton Council<\/option><option value='Buckinghamshire Council' >Buckinghamshire Council<\/option><option value='Bury Council' >Bury Council<\/option><option value='Cambridgeshire Council' >Cambridgeshire Council<\/option><option value='Cardiff &amp; Vale of Glamorgan' >Cardiff &amp; Vale of Glamorgan<\/option><option value='Cumberland Council' >Cumberland Council<\/option><option value='Doncaster Council' >Doncaster Council<\/option><option value='Dorset Council' >Dorset Council<\/option><option value='East Sussex Council' >East Sussex Council<\/option><option value='Essex Council' >Essex Council<\/option><option value='Hampshire Council' >Hampshire Council<\/option><option value='Hertfordshire County Council' >Hertfordshire County Council<\/option><option value='Kent County Council' >Kent County Council<\/option><option value='Kingston Council' >Kingston Council<\/option><option value='Lambeth Council' >Lambeth Council<\/option><option value='Luton Council' >Luton Council<\/option><option value='Medway Council' >Medway Council<\/option><option value='Merton Council' >Merton Council<\/option><option value='Norfolk Council' >Norfolk Council<\/option><option value='North Yorkshire Council' >North Yorkshire Council<\/option><option value='Oxfordshire Council' >Oxfordshire Council<\/option><option value='Reading Council' >Reading Council<\/option><option value='Redbridge Council' >Redbridge Council<\/option><option value='Salford Council' >Salford Council<\/option><option value='Southend Council' >Southend Council<\/option><option value='Southampton Council' >Southampton Council<\/option><option value='Southwark Council' >Southwark Council<\/option><option value='Stoke Council' >Stoke Council<\/option><option value='Suffolk Council' >Suffolk Council<\/option><option value='Sutton Council' >Sutton Council<\/option><option value='Thurrock Council' >Thurrock Council<\/option><option value='Westmorland &amp; Furness Council' >Westmorland &amp; Furness Council<\/option><option value='Lancashire Council' >Lancashire Council<\/option><\/select><\/div><\/div><fieldset id=\"field_25_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full radio_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >15. How satisfied were you with the referral process from the local authority quit smoking service?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_25_81'>\n\t\t\t<div class='gchoice gchoice_25_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Very satisfied'  id='choice_25_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_81_0' id='label_25_81_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Satisfied'  id='choice_25_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_81_1' id='label_25_81_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_81_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Not satisfied'  id='choice_25_81_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_81_2' id='label_25_81_2' class='gform-field-label gform-field-label--type-inline'>Not satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_81_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Very unsatisfied'  id='choice_25_81_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_81_3' id='label_25_81_3' class='gform-field-label gform-field-label--type-inline'>Very unsatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_25_83\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full radio_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >16. Would you recommend the service to a friend, colleague or family member?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_25_83'>\n\t\t\t<div class='gchoice gchoice_25_83_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='Yes'  id='choice_25_83_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_83_0' id='label_25_83_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_83_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='No'  id='choice_25_83_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_83_1' id='label_25_83_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_25_84\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full textarea_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_84'>16 a. Any comment<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_84' id='input_25_84' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_25_85\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full radio_wrapper size_medium gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >17. If you were to relapse back to smoking, would you feel comfortable in using the quit smoking service again?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_25_85'>\n\t\t\t<div class='gchoice gchoice_25_85_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='Yes'  id='choice_25_85_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_85_0' id='label_25_85_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_25_85_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_85' type='radio' value='No'  id='choice_25_85_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_25_85_1' id='label_25_85_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_25_86\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full textarea_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_86'>18. Any comment<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_86' id='input_25_86' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_25_68\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full textarea_wrapper size_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_68'>Any specific comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_68' id='input_25_68' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_25_20\" class=\"gfield gfield--type-html gfield--input-type-html html_wrapper size_medium gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Thank you for completing this form. Your name (if you provided it) has been added to a free draw! \ud83d\ude0a <\/div><div id=\"field_25_49\" class=\"gfield gfield--type-captcha gfield--input-type-captcha captcha_wrapper size_medium field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_25_49'>CAPTCHA<\/label><div id='input_25_49' class='ginput_container ginput_recaptcha' data-sitekey='6Lf8cgokAAAAAM5c4tLjj_MRuYRA4ynDCjHmxgLA'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><div class='gfield_description' id='gfield_description_25_49'>Please enter the characters above before submitting<\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_25' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' 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