{"id":2578,"date":"2025-10-01T04:58:11","date_gmt":"2025-10-01T04:58:11","guid":{"rendered":"https:\/\/mygenehub.com\/?page_id=2578"},"modified":"2025-10-01T12:58:20","modified_gmt":"2025-10-01T12:58:20","slug":"slimming-clinic-questionnaire","status":"publish","type":"page","link":"https:\/\/mygenehub.com\/ar\/slimming-clinic-questionnaire\/","title":{"rendered":"Slimming Clinic questionnaire"},"content":{"rendered":"<style>.kb-row-layout-id2578_32639b-f4 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2578_32639b-f4 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2578_32639b-f4 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);padding-top:40px;padding-bottom:50px;grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2578_32639b-f4{background-image:url('https:\/\/mygenehub.com\/wp-content\/uploads\/2025\/06\/DNA-YOU-Copy.jpg');background-size:cover;background-position:39% 37%;background-attachment:scroll;background-repeat:no-repeat;}.kb-row-layout-id2578_32639b-f4 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id2578_32639b-f4 > .kt-row-column-wrap{row-gap:var(--global-kb-gap-md, 2rem);grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2578_32639b-f4 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}.kb-row-layout-id2578_32639b-f4 {  margin-top: -122px;}@media (max-width: 991.98px) {\t.kb-row-layout-id2578_32639b-f4 {\tmargin-top: -120px;\t}}@media (max-width: 767.98px) {\t.kb-row-layout-id2578_32639b-f4 {\tmargin-top: -70px;\t}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2578_32639b-f4 alignfull kt-row-has-bg wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top\">\n<style>.kadence-column2578_1c0113-06 > .kt-inside-inner-col,.kadence-column2578_1c0113-06 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2578_1c0113-06 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2578_1c0113-06 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2578_1c0113-06 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2578_1c0113-06 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2578_1c0113-06{position:relative;}@media all and (max-width: 1024px){.kadence-column2578_1c0113-06 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2578_1c0113-06 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2578_1c0113-06\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2578_601197-34_0, .wp-block-kadence-advancedheading.kt-adv-heading2578_601197-34_0[data-kb-block=\"kb-adv-heading2578_601197-34_0\"]{text-align:center;font-size:var(--global-kb-font-size-xl, 3rem);font-style:normal;text-transform:uppercase;color:#ffffff;}.wp-block-kadence-advancedheading.kt-adv-heading2578_601197-34_0 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2578_601197-34_0[data-kb-block=\"kb-adv-heading2578_601197-34_0\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}@media all and (max-width: 1024px){.wp-block-kadence-advancedheading.kt-adv-heading2578_601197-34_0, .wp-block-kadence-advancedheading.kt-adv-heading2578_601197-34_0[data-kb-block=\"kb-adv-heading2578_601197-34_0\"]{margin-bottom:var(--global-kb-spacing-xs, 1rem);}}<\/style>\n<p class=\"kt-adv-heading2578_601197-34_0 wp-block-kadence-advancedheading\" data-kb-block=\"kb-adv-heading2578_601197-34_0\"><strong>\u0627\u0633\u062a\u0628\u064a\u0627\u0646 \u0627\u062e\u062a\u0628\u0627\u0631 \u0639\u064a\u0627\u062f\u0629 \u0627\u0644\u062a\u062e\u0633\u064a\u0633<\/strong><\/p>\n<\/div><\/div>\n\n<\/div><\/div>\n\n<style>.kb-row-layout-id2578_f3b07f-8d > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2578_f3b07f-8d > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2578_f3b07f-8d > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);padding-top:var(--global-kb-spacing-sm, 1.5rem);padding-bottom:var(--global-kb-spacing-sm, 1.5rem);grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2578_f3b07f-8d > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id2578_f3b07f-8d > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2578_f3b07f-8d > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2578_f3b07f-8d alignnone wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top\">\n<style>.kadence-column2578_944f5c-c1 > .kt-inside-inner-col,.kadence-column2578_944f5c-c1 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2578_944f5c-c1 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2578_944f5c-c1 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2578_944f5c-c1 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2578_944f5c-c1 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2578_944f5c-c1{position:relative;}@media all and (max-width: 1024px){.kadence-column2578_944f5c-c1 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2578_944f5c-c1 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2578_944f5c-c1\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2578_461577-b4_0, .wp-block-kadence-advancedheading.kt-adv-heading2578_461577-b4_0[data-kb-block=\"kb-adv-heading2578_461577-b4_0\"]{text-align:center;font-size:var(--global-kb-font-size-lg, 2rem);font-style:normal;color:#000000;}.wp-block-kadence-advancedheading.kt-adv-heading2578_461577-b4_0 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2578_461577-b4_0[data-kb-block=\"kb-adv-heading2578_461577-b4_0\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<p class=\"kt-adv-heading2578_461577-b4_0 slimming-heading wp-block-kadence-advancedheading\" data-kb-block=\"kb-adv-heading2578_461577-b4_0\"><strong>\u0627\u0633\u062a\u0628\u064a\u0627\u0646 \u0627\u0644\u0639\u0645\u064a\u0644 \u0644\u0640 :<br>\u0639\u0644\u0627\u062c \u0645\u0648\u0646\u062c\u0627\u0631\u0648\/\u0623\u0648\u0632\u064a\u0645\u0628\u064a\u0643\/\u0648\u064a\u063a\u0648\u0641\u064a<\/strong><\/p>\n\n\n<style>.wp-block-kadence-advancedheading.kt-adv-heading2578_8d3cf6-fd_0, .wp-block-kadence-advancedheading.kt-adv-heading2578_8d3cf6-fd_0[data-kb-block=\"kb-adv-heading2578_8d3cf6-fd_0\"]{text-align:center;font-style:normal;color:#000000;}.wp-block-kadence-advancedheading.kt-adv-heading2578_8d3cf6-fd_0 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2578_8d3cf6-fd_0[data-kb-block=\"kb-adv-heading2578_8d3cf6-fd_0\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<p class=\"kt-adv-heading2578_8d3cf6-fd_0 wp-block-kadence-advancedheading\" data-kb-block=\"kb-adv-heading2578_8d3cf6-fd_0\">\u064a\u064f\u0631\u062c\u0649 \u0645\u0644\u0621 \u0627\u0644\u0627\u0633\u062a\u0628\u064a\u0627\u0646 \u0627\u0644\u062a\u0627\u0644\u064a \u062d\u062a\u0649 \u0646\u062a\u0645\u0643\u0646 \u0645\u0646 \u0645\u0637\u0627\u0628\u0642\u062a\u0643 \u0645\u0639 \u0627\u0644\u0637\u0628\u064a\u0628 \u0627\u0644\u0630\u064a \u064a\u0645\u0643\u0646\u0647 \u0627\u0644\u062a\u0635\u0631\u064a\u062d \u0628\u0627\u0644\u0639\u0644\u0627\u062c<\/p>\n<\/div><\/div>\n\n<\/div><\/div>\n\n<div class=\"forminator-ui forminator-custom-form forminator-custom-form-2577 forminator-design--default forminator-custom forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-2577\" data-uid=\"69da3e06c3f97\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-2577\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-2577 forminator-design--default forminator-custom forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"2577\"\n\t\t\t\t\n\t\t\t\tdata-design=\"default\"\n\t\t\t\tdata-color-option=\"default\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"custom\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"69da3e06c3f97\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">\u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0634\u062e\u0635\u064a\u0629<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69da3e06c3f97\" id=\"forminator-field-name-1_69da3e06c3f97-label\" class=\"forminator-label\">\u0627\u0644\u0627\u0633\u0645 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\u0627\u0644\u0627\u0633\u0645\" id=\"forminator-field-name-1_69da3e06c3f97\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_69da3e06c3f97\" id=\"forminator-field-date-1-picker_69da3e06c3f97-label\" class=\"forminator-label\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0644\u0627\u062f\" id=\"forminator-field-date-1-picker_69da3e06c3f97\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-form-2577__field--select-1_69da3e06c3f97\" id=\"forminator-form-2577__field--select-1_69da3e06c3f97-label\" class=\"forminator-label\">\u0627\u0644\u062c\u0646\u0633 <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-2577__field--select-1_69da3e06c3f97\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Gender\" data-search=\"false\" data-search-placeholder=\"Gender\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2577__field--select-1_69da3e06c3f97-label\"><option value=\"\"  >\u0627\u0644\u062c\u0646\u0633<\/option><option value=\"one\"  data-calculation=\"0\">\u0623\u0646\u062b\u0649<\/option><option value=\"two\"  data-calculation=\"0\">\u0627\u0644\u0630\u0643\u0648\u0631<\/option><\/select><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69da3e06c3f97\" id=\"forminator-field-phone-1_69da3e06c3f97-label\" class=\"forminator-label\">\u0627\u062a\u0635\u0644 \u0628\u0646\u0627 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\u0631\u0642\u0645 \u0627\u0644\u0627\u062a\u0635\u0627\u0644\" id=\"forminator-field-phone-1_69da3e06c3f97\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69da3e06c3f97\" id=\"forminator-field-email-1_69da3e06c3f97-label\" class=\"forminator-label\">\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a\" id=\"forminator-field-email-1_69da3e06c3f97\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69da3e06c3f97\" id=\"forminator-field-text-2_69da3e06c3f97-label\" class=\"forminator-label\">\u0627\u0633\u0645 \u062c\u0647\u0629 \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0641\u064a \u062d\u0627\u0644\u0627\u062a \u0627\u0644\u0637\u0648\u0627\u0631\u0626 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\u0627\u0633\u0645 \u062c\u0647\u0629 \u0627\u0644\u0627\u062a\u0635\u0627\u0644 \u0641\u064a \u062d\u0627\u0644\u0627\u062a \u0627\u0644\u0637\u0648\u0627\u0631\u0626\" id=\"forminator-field-text-2_69da3e06c3f97\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12\"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69da3e06c3f97\" id=\"forminator-field-address-1-street_address_69da3e06c3f97-label\" class=\"forminator-label\">\u0627\u0644\u0639\u0646\u0648\u0627\u0646 <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"\u0627\u0644\u0639\u0646\u0648\u0627\u0646\" id=\"forminator-field-address-1-street_address_69da3e06c3f97\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">\u0627\u0644\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0637\u0628\u064a<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-2577__field--select-2_69da3e06c3f97\" id=\"forminator-form-2577__field--select-2_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u0623\u0646\u062a \u0645\u0635\u0627\u0628 \u0628\u0627\u0644\u0633\u0643\u0631\u064a\u061f <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-2577__field--select-2_69da3e06c3f97\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please Select\" data-search=\"false\" data-search-placeholder=\"Please Select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2577__field--select-2_69da3e06c3f97-label\"><option value=\"\"  >\u064a\u0631\u062c\u0649 \u0627\u0644\u0627\u062e\u062a\u064a\u0627\u0631<\/option><option value=\"one\"  data-calculation=\"0\">\u062f\u0627\u0621 \u0627\u0644\u0633\u0643\u0631\u064a \u0645\u0646 \u0627\u0644\u0646\u0648\u0639 1<\/option><option value=\"two\"  data-calculation=\"0\">\u062f\u0627\u0621 \u0627\u0644\u0633\u0643\u0631\u064a \u0645\u0646 \u0627\u0644\u0646\u0648\u0639 2<\/option><option value=\"No\"  data-calculation=\"0\">\u0644\u0627 \u064a\u0648\u062c\u062f \u062f\u0627\u0621 \u0627\u0644\u0633\u0643\u0631\u064a<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-69da3e06c3f97-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u0633\u0628\u0642 \u0623\u0646 \u062a\u0645 \u062a\u0634\u062e\u064a\u0635\u0643 \u0628\u0623\u064a \u0645\u0646 \u0627\u0644\u062d\u0627\u0644\u0627\u062a \u0627\u0644\u062a\u0627\u0644\u064a\u0629\u061f (\u0636\u0639 \u0639\u0644\u0627\u0645\u0629 \u0639\u0644\u0649 \u0643\u0644 \u0645\u0627 \u064a\u0646\u0637\u0628\u0642)<\/span><label id=\"forminator-field-checkbox-1-1-69da3e06c3f97-label\" for=\"forminator-field-checkbox-1-1-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0627\u0636\u0637\u0631\u0627\u0628\u0627\u062a \u0627\u0644\u062c\u0647\u0627\u0632 \u0627\u0644\u0647\u0636\u0645\u064a (\u0645\u062b\u0644 \u062e\u0632\u0644 \u0627\u0644\u0645\u0639\u062f\u0629 \u0648\u0627\u0644\u0623\u0645\u0639\u0627\u0621)\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"None\" id=\"forminator-field-checkbox-1-1-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-1-1-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0627\u0636\u0637\u0631\u0627\u0628\u0627\u062a \u0627\u0644\u062c\u0647\u0627\u0632 \u0627\u0644\u0647\u0636\u0645\u064a (\u0645\u062b\u0644 \u062e\u0632\u0644 \u0627\u0644\u0645\u0639\u062f\u0629 \u0648\u0627\u0644\u0623\u0645\u0639\u0627\u0621)<\/span><\/label><label id=\"forminator-field-checkbox-1-2-69da3e06c3f97-label\" for=\"forminator-field-checkbox-1-2-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0627\u0644\u062a\u0647\u0627\u0628 \u0627\u0644\u0628\u0646\u0643\u0631\u064a\u0627\u0633\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-2-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-1-2-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0627\u0644\u062a\u0647\u0627\u0628 \u0627\u0644\u0628\u0646\u0643\u0631\u064a\u0627\u0633<\/span><\/label><label id=\"forminator-field-checkbox-1-3-69da3e06c3f97-label\" for=\"forminator-field-checkbox-1-3-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0627\u0636\u0637\u0631\u0627\u0628\u0627\u062a \u0627\u0644\u063a\u062f\u0629 \u0627\u0644\u062f\u0631\u0642\u064a\u0629 (\u0645\u062b\u0644 \u0633\u0631\u0637\u0627\u0646 \u0627\u0644\u063a\u062f\u0629 \u0627\u0644\u062f\u0631\u0642\u064a\u0629 \u0627\u0644\u0646\u062e\u0627\u0639\u064a)\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-3-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-1-3-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0627\u0636\u0637\u0631\u0627\u0628\u0627\u062a \u0627\u0644\u063a\u062f\u0629 \u0627\u0644\u062f\u0631\u0642\u064a\u0629 (\u0645\u062b\u0644 \u0633\u0631\u0637\u0627\u0646 \u0627\u0644\u063a\u062f\u0629 \u0627\u0644\u062f\u0631\u0642\u064a\u0629 \u0627\u0644\u0646\u062e\u0627\u0639\u064a)<\/span><\/label><label id=\"forminator-field-checkbox-1-4-69da3e06c3f97-label\" for=\"forminator-field-checkbox-1-4-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0643\u0644\u0649\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Environmental\" id=\"forminator-field-checkbox-1-4-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-1-4-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0643\u0644\u0649<\/span><\/label><label id=\"forminator-field-checkbox-1-5-69da3e06c3f97-label\" for=\"forminator-field-checkbox-1-5-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0645\u0631\u0636 \u0627\u0644\u0643\u0628\u062f\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Liver-disease\" id=\"forminator-field-checkbox-1-5-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-1-5-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0645\u0631\u0636 \u0627\u0644\u0643\u0628\u062f<\/span><\/label><label id=\"forminator-field-checkbox-1-6-69da3e06c3f97-label\" for=\"forminator-field-checkbox-1-6-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0627\u0644\u0633\u0631\u0637\u0627\u0646\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Cancer\" id=\"forminator-field-checkbox-1-6-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-1-6-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0627\u0644\u0633\u0631\u0637\u0627\u0646<\/span><\/label><label id=\"forminator-field-checkbox-1-7-69da3e06c3f97-label\" for=\"forminator-field-checkbox-1-7-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0623\u062e\u0631\u0649\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Other\" id=\"forminator-field-checkbox-1-7-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-1-7-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0623\u062e\u0631\u0649<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69da3e06c3f97\" id=\"forminator-field-text-1_69da3e06c3f97-label\" class=\"forminator-label\">\u0622\u062e\u0631\u0648\u0646\u061f (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f):<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\u0622\u062e\u0631\u0648\u0646\u061f (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f):\" id=\"forminator-field-text-1_69da3e06c3f97\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69da3e06c3f97\" id=\"forminator-field-textarea-2_69da3e06c3f97-label\" class=\"forminator-label\">\u064a\u064f\u0631\u062c\u0649 \u0630\u0643\u0631 \u0623\u064a \u062d\u0627\u0644\u0627\u062a \u0637\u0628\u064a\u0629 \u0623\u062e\u0631\u0649 \u0644\u062f\u064a\u0643:<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_69da3e06c3f97\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_69da3e06c3f97\" id=\"forminator-field-textarea-3_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u062a\u062a\u0646\u0627\u0648\u0644 \u062d\u0627\u0644\u064a\u064b\u0627 \u0623\u064a \u0623\u062f\u0648\u064a\u0629\u061f \u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u064a\u064f\u0631\u062c\u0649 \u0630\u0643\u0631\u0647\u0627:<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_69da3e06c3f97\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_69da3e06c3f97\" id=\"forminator-field-textarea-4_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u0643\u0627\u0646 \u0644\u062f\u064a\u0643 \u0623\u064a \u0631\u062f\u0648\u062f \u0641\u0639\u0644 \u062a\u062d\u0633\u0633\u064a\u0629 \u062a\u062c\u0627\u0647 \u0627\u0644\u0623\u062f\u0648\u064a\u0629\u061f \u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f:<\/label><textarea name=\"textarea-4\" placeholder=\"\" id=\"forminator-field-textarea-4_69da3e06c3f97\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-69da3e06c3f97-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u0639\u0627\u0646\u064a\u062a \u0623\u064a\u064b\u0627 \u0645\u0646 \u0627\u0644\u0623\u0639\u0631\u0627\u0636 \u0627\u0644\u062a\u0627\u0644\u064a\u0629\u061f (\u0636\u0639 \u0639\u0644\u0627\u0645\u0629 \u0639\u0644\u0649 \u0643\u0644 \u0645\u0627 \u064a\u0646\u0637\u0628\u0642)<\/span><label id=\"forminator-field-checkbox-2-1-69da3e06c3f97-label\" for=\"forminator-field-checkbox-2-1-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0631\u062f\u0648\u062f \u0627\u0644\u0641\u0639\u0644 \u0627\u0644\u062a\u062d\u0633\u0633\u064a\u0629 \u0627\u0644\u0634\u062f\u064a\u062f\u0629\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"None\" id=\"forminator-field-checkbox-2-1-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-2-1-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0631\u062f\u0648\u062f \u0627\u0644\u0641\u0639\u0644 \u0627\u0644\u062a\u062d\u0633\u0633\u064a\u0629 \u0627\u0644\u0634\u062f\u064a\u062f\u0629<\/span><\/label><label id=\"forminator-field-checkbox-2-2-69da3e06c3f97-label\" for=\"forminator-field-checkbox-2-2-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0646\u0642\u0635 \u0633\u0643\u0631 \u0627\u0644\u062f\u0645 (\u0627\u0646\u062e\u0641\u0627\u0636 \u0633\u0643\u0631 \u0627\u0644\u062f\u0645)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-2-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-2-2-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0646\u0642\u0635 \u0633\u0643\u0631 \u0627\u0644\u062f\u0645 (\u0627\u0646\u062e\u0641\u0627\u0636 \u0633\u0643\u0631 \u0627\u0644\u062f\u0645)<\/span><\/label><label id=\"forminator-field-checkbox-2-3-69da3e06c3f97-label\" for=\"forminator-field-checkbox-2-3-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0627\u0644\u062d\u0645\u0627\u0636 \u0627\u0644\u0643\u064a\u062a\u0648\u0646\u064a \u0627\u0644\u0633\u0643\u0631\u064a\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-3-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-2-3-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0627\u0644\u062d\u0645\u0627\u0636 \u0627\u0644\u0643\u064a\u062a\u0648\u0646\u064a \u0627\u0644\u0633\u0643\u0631\u064a<\/span><\/label><label id=\"forminator-field-checkbox-2-4-69da3e06c3f97-label\" for=\"forminator-field-checkbox-2-4-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0645\u0634\u0627\u0643\u0644 \u0627\u0644\u0639\u064a\u0646 \u0627\u0644\u0645\u062a\u0639\u0644\u0642\u0629 \u0628\u062f\u0627\u0621 \u0627\u0644\u0633\u0643\u0631\u064a\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Environmental\" id=\"forminator-field-checkbox-2-4-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-2-4-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0645\u0634\u0627\u0643\u0644 \u0627\u0644\u0639\u064a\u0646 \u0627\u0644\u0645\u062a\u0639\u0644\u0642\u0629 \u0628\u062f\u0627\u0621 \u0627\u0644\u0633\u0643\u0631\u064a<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69da3e06c3f97\" id=\"forminator-field-text-3_69da3e06c3f97-label\" class=\"forminator-label\">\u0622\u062e\u0631\u0648\u0646\u061f (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f):<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\u0622\u062e\u0631\u0648\u0646\u061f (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f):\" id=\"forminator-field-text-3_69da3e06c3f97\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-4\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">\u0646\u0645\u0637 \u0627\u0644\u062d\u064a\u0627\u0629 \u0648\u0627\u0644\u0648\u0632\u0646 \u0627\u0644\u062a\u0627\u0631\u064a\u062e\u064a<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69da3e06c3f97\" id=\"forminator-field-text-4_69da3e06c3f97-label\" class=\"forminator-label\">\u0645\u0627 \u0647\u0648 \u0648\u0632\u0646\u0643 \u0627\u0644\u062d\u0627\u0644\u064a\u061f<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\u0648\u0632\u0646\u0643 \u0627\u0644\u062d\u0627\u0644\u064a \u0628\u0627\u0644\u0643\u064a\u0644\u0648 \u062c\u0631\u0627\u0645\/\u0628\u0648\u0635\u0629\" id=\"forminator-field-text-4_69da3e06c3f97\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_69da3e06c3f97\" id=\"forminator-field-text-5_69da3e06c3f97-label\" class=\"forminator-label\">\u0645\u0627 \u0647\u0648 \u0637\u0648\u0644\u0643\u061f<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\u0637\u0648\u0644\u0643 \u0627\u0644\u062d\u0627\u0644\u064a \u0628\u0627\u0644\u0633\u0646\u062a\u064a\u0645\u062a\u0631\/\u0627\u0644\u0628\u0648\u0635\u0629\" id=\"forminator-field-text-5_69da3e06c3f97\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_69da3e06c3f97\" id=\"forminator-field-textarea-5_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u062a\u062a\u0628\u0639\u064a\u0646 \u0646\u0638\u0627\u0645\u064b\u0627 \u063a\u0630\u0627\u0626\u064a\u064b\u0627 \u0645\u0639\u064a\u0646\u064b\u0627\u061f \u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u064a\u064f\u0631\u062c\u0649 \u0627\u0644\u0648\u0635\u0641:<\/label><textarea name=\"textarea-5\" placeholder=\"\" id=\"forminator-field-textarea-5_69da3e06c3f97\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-69da3e06c3f97-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u062c\u0631\u0628\u062a \u0637\u0631\u0642\u064b\u0627 \u0623\u062e\u0631\u0649 \u0644\u0625\u0646\u0642\u0627\u0635 \u0627\u0644\u0648\u0632\u0646\u061f (\u0636\u0639 \u0639\u0644\u0627\u0645\u0629 \u0639\u0644\u0649 \u0643\u0644 \u0645\u0627 \u064a\u0646\u0637\u0628\u0642)<\/span><label id=\"forminator-field-checkbox-3-1-69da3e06c3f97-label\" for=\"forminator-field-checkbox-3-1-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0627\u0644\u062d\u0645\u064a\u0629 \u0627\u0644\u063a\u0630\u0627\u0626\u064a\u0629\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"None\" id=\"forminator-field-checkbox-3-1-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-3-1-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0627\u0644\u062d\u0645\u064a\u0629 \u0627\u0644\u063a\u0630\u0627\u0626\u064a\u0629<\/span><\/label><label id=\"forminator-field-checkbox-3-2-69da3e06c3f97-label\" for=\"forminator-field-checkbox-3-2-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0628\u0631\u0627\u0645\u062c \u0627\u0644\u062a\u0645\u0627\u0631\u064a\u0646 \u0627\u0644\u0631\u064a\u0627\u0636\u064a\u0629\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-2-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-3-2-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0628\u0631\u0627\u0645\u062c \u0627\u0644\u062a\u0645\u0627\u0631\u064a\u0646 \u0627\u0644\u0631\u064a\u0627\u0636\u064a\u0629<\/span><\/label><label id=\"forminator-field-checkbox-3-3-69da3e06c3f97-label\" for=\"forminator-field-checkbox-3-3-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u0627\u0644\u0623\u062f\u0648\u064a\u0629 \u0627\u0644\u0645\u0648\u0635\u0648\u0641\u0629 \u0628\u0648\u0635\u0641\u0629 \u0637\u0628\u064a\u0629\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-3-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-3-3-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u0627\u0644\u0623\u062f\u0648\u064a\u0629 \u0627\u0644\u0645\u0648\u0635\u0648\u0641\u0629 \u0628\u0648\u0635\u0641\u0629 \u0637\u0628\u064a\u0629<\/span><\/label><label id=\"forminator-field-checkbox-3-4-69da3e06c3f97-label\" for=\"forminator-field-checkbox-3-4-69da3e06c3f97\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"\u062c\u0631\u0627\u062d\u0629 \u0625\u0646\u0642\u0627\u0635 \u0627\u0644\u0648\u0632\u0646\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Environmental\" id=\"forminator-field-checkbox-3-4-69da3e06c3f97\" aria-labelledby=\"forminator-field-checkbox-3-4-69da3e06c3f97-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u062c\u0631\u0627\u062d\u0629 \u0625\u0646\u0642\u0627\u0635 \u0627\u0644\u0648\u0632\u0646<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_69da3e06c3f97\" id=\"forminator-field-text-6_69da3e06c3f97-label\" class=\"forminator-label\">\u0622\u062e\u0631\u0648\u0646\u061f (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f):<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\u0622\u062e\u0631\u0648\u0646\u061f (\u064a\u0631\u062c\u0649 \u0627\u0644\u062a\u062d\u062f\u064a\u062f):\" id=\"forminator-field-text-6_69da3e06c3f97\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_69da3e06c3f97\" id=\"forminator-field-textarea-6_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u062a\u0645\u0627\u0631\u0633\u064a\u0646 \u0646\u0634\u0627\u0637\u064b\u0627 \u0628\u062f\u0646\u064a\u064b\u0627 \u0645\u0646\u062a\u0638\u0645\u064b\u0627\u061f \u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u064a\u0631\u062c\u0649 \u0627\u0644\u0648\u0635\u0641:<\/label><textarea name=\"textarea-6\" placeholder=\"\" id=\"forminator-field-textarea-6_69da3e06c3f97\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-5\" class=\"forminator-field-section forminator-col forminator-col-12\"><div class=\"forminator-field\"><h2 class=\"forminator-title\">\u0645\u0648\u0627\u0646\u0639 \u0627\u0644\u0627\u0633\u062a\u0639\u0645\u0627\u0644<\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-2577__field--select-3_69da3e06c3f97\" id=\"forminator-form-2577__field--select-3_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u062a\u0645 \u062a\u0634\u062e\u064a\u0635\u0643 \u0623\u0646\u062a \u0623\u0648 \u0623\u062d\u062f \u0623\u0641\u0631\u0627\u062f \u0639\u0627\u0626\u0644\u062a\u0643 \u0628\u0633\u0631\u0637\u0627\u0646 \u0627\u0644\u063a\u062f\u0629 \u0627\u0644\u062f\u0631\u0642\u064a\u0629 \u0627\u0644\u0646\u062e\u0627\u0639\u064a\u061f<\/label><select  id=\"forminator-form-2577__field--select-3_69da3e06c3f97\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-3\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please Select\" data-search=\"false\" data-search-placeholder=\"Please Select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2577__field--select-3_69da3e06c3f97-label\"><option value=\"\"  >\u064a\u0631\u062c\u0649 \u0627\u0644\u0627\u062e\u062a\u064a\u0627\u0631<\/option><option value=\"one\"  data-calculation=\"0\">\u0646\u0639\u0645<\/option><option value=\"two\"  data-calculation=\"0\">\u0644\u0627 \u064a\u0648\u062c\u062f<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-2577__field--select-4_69da3e06c3f97\" id=\"forminator-form-2577__field--select-4_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u0623\u0646\u062a \u0645\u0635\u0627\u0628 \u0628\u0645\u062a\u0644\u0627\u0632\u0645\u0629 \u0627\u0644\u0648\u0631\u0645 \u0627\u0644\u0635\u0645\u0627\u0648\u064a \u0627\u0644\u0645\u062a\u0639\u062f\u062f \u0645\u0646 \u0627\u0644\u0646\u0648\u0639 2 (MEN 2)\u061f<\/label><select  id=\"forminator-form-2577__field--select-4_69da3e06c3f97\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-4\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please Select\" data-search=\"false\" data-search-placeholder=\"Please Select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2577__field--select-4_69da3e06c3f97-label\"><option value=\"\"  >\u064a\u0631\u062c\u0649 \u0627\u0644\u0627\u062e\u062a\u064a\u0627\u0631<\/option><option value=\"one\"  data-calculation=\"0\">\u0646\u0639\u0645<\/option><option value=\"two\"  data-calculation=\"0\">\u0644\u0627 \u064a\u0648\u062c\u062f<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-2577__field--select-5_69da3e06c3f97\" id=\"forminator-form-2577__field--select-5_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u062a\u0645 \u062a\u0634\u062e\u064a\u0635 \u0625\u0635\u0627\u0628\u062a\u0643 \u0628\u0645\u0631\u0636 \u0645\u0639\u062f\u064a \u0645\u0639\u0648\u064a \u0634\u062f\u064a\u062f \u0623\u0648 \u0627\u0646\u0633\u062f\u0627\u062f \u0645\u0639\u0648\u064a \u062d\u0627\u062f\u061f<\/label><select  id=\"forminator-form-2577__field--select-5_69da3e06c3f97\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-5\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please Select\" data-search=\"false\" data-search-placeholder=\"Please Select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2577__field--select-5_69da3e06c3f97-label\"><option value=\"\"  >\u064a\u0631\u062c\u0649 \u0627\u0644\u0627\u062e\u062a\u064a\u0627\u0631<\/option><option value=\"one\"  data-calculation=\"0\">\u0646\u0639\u0645<\/option><option value=\"two\"  data-calculation=\"0\">\u0644\u0627 \u064a\u0648\u062c\u062f<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-2577__field--select-6_69da3e06c3f97\" id=\"forminator-form-2577__field--select-6_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u0644\u062f\u064a\u0643 \u062a\u0627\u0631\u064a\u062e \u0645\u0631\u0636\u064a \u0645\u0646 \u0627\u0644\u062a\u0647\u0627\u0628 \u0627\u0644\u0628\u0646\u0643\u0631\u064a\u0627\u0633\u061f<\/label><select  id=\"forminator-form-2577__field--select-6_69da3e06c3f97\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-6\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please Select\" data-search=\"false\" data-search-placeholder=\"Please Select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2577__field--select-6_69da3e06c3f97-label\"><option value=\"\"  >\u064a\u0631\u062c\u0649 \u0627\u0644\u0627\u062e\u062a\u064a\u0627\u0631<\/option><option value=\"one\"  data-calculation=\"0\">\u0646\u0639\u0645<\/option><option value=\"two\"  data-calculation=\"0\">\u0644\u0627 \u064a\u0648\u062c\u062f<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-7\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-2577__field--select-7_69da3e06c3f97\" id=\"forminator-form-2577__field--select-7_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u0623\u0646\u062a\u0650 \u062d\u0627\u0645\u0644 \u062d\u0627\u0644\u064a\u064b\u0627 \u0623\u0648 \u062a\u062e\u0637\u0637\u064a\u0646 \u0644\u0644\u062d\u0645\u0644\u061f<\/label><select  id=\"forminator-form-2577__field--select-7_69da3e06c3f97\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-7\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please Select\" data-search=\"false\" data-search-placeholder=\"Please Select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2577__field--select-7_69da3e06c3f97-label\"><option value=\"\"  >\u064a\u0631\u062c\u0649 \u0627\u0644\u0627\u062e\u062a\u064a\u0627\u0631<\/option><option value=\"one\"  data-calculation=\"0\">\u0646\u0639\u0645<\/option><option value=\"two\"  data-calculation=\"0\">\u0644\u0627 \u064a\u0648\u062c\u062f<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-8\" class=\"forminator-field-select forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-form-2577__field--select-8_69da3e06c3f97\" id=\"forminator-form-2577__field--select-8_69da3e06c3f97-label\" class=\"forminator-label\">\u0647\u0644 \u062a\u0631\u0636\u0639\u064a\u0646 \u0637\u0641\u0644\u0643\u0650 \u0631\u0636\u0627\u0639\u0629 \u0637\u0628\u064a\u0639\u064a\u0629\u061f<\/label><select  id=\"forminator-form-2577__field--select-8_69da3e06c3f97\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-8\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Please Select\" data-search=\"false\" data-search-placeholder=\"Please Select\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-2577__field--select-8_69da3e06c3f97-label\"><option value=\"\"  >\u064a\u0631\u062c\u0649 \u0627\u0644\u0627\u062e\u062a\u064a\u0627\u0631<\/option><option value=\"one\"  data-calculation=\"0\">\u0646\u0639\u0645<\/option><option value=\"two\"  data-calculation=\"0\">\u0644\u0627 \u064a\u0648\u062c\u062f<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_69da3e06c3f97\" id=\"forminator-field-consent-1_69da3e06c3f97-label\" class=\"forminator-label\">\u0627\u0644\u0645\u0648\u0627\u0641\u0642\u0629 <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_69da3e06c3f97__label\" class=\"forminator-checkbox forminator-consent\" aria-labelledby=\"forminator-field-consent-1_69da3e06c3f97-label\" aria-hidden=\"true\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_69da3e06c3f97\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_69da3e06c3f97-label\" aria-describedby=\"forminator-field-consent-1_69da3e06c3f97__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_69da3e06c3f97__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>\u0623\u0624\u0643\u062f \u0623\u0646 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u0645\u0642\u062f\u0645\u0629 \u062f\u0642\u064a\u0642\u0629 \u0648\u0643\u0627\u0645\u0644\u0629 \u0639\u0644\u0649 \u062d\u062f \u0639\u0644\u0645\u064a. \u0623\u0641\u0647\u0645 \u0623\u0646 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u063a\u064a\u0631 \u0627\u0644\u0635\u062d\u064a\u062d\u0629 \u0623\u0648 \u0627\u0644\u0645\u062d\u062c\u0648\u0628\u0629 \u0642\u062f \u062a\u0624\u062b\u0631 \u0639\u0644\u0649 \u0639\u0644\u0627\u062c\u064a.<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12\"><div class=\"forminator-captcha-left forminator-hcaptcha\" data-theme=\"light\"  data-sitekey=\"794a1074-dc26-4618-92d6-dafc30262188\" data-size=\"normal\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">\u0625\u0631\u0633\u0627\u0644 \u0631\u0633\u0627\u0644\u0629<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"37206befe7\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/ar\/wp-json\/wp\/v2\/pages\/2578\" \/><input type=\"hidden\" name=\"form_id\" value=\"2577\"><input type=\"hidden\" name=\"page_id\" value=\"2578\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/mygenehub.com\/ar\/slimming-clinic-questionnaire\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"trp-form-language\" value=\"ar\"\/><\/form>","protected":false},"excerpt":{"rendered":"<p>Slimming Clinic Test questionnaire Client Questionnaire for :Mounjaro\/Ozempic\/Wegovy Treatment Please fill in the following questionnaire so we can match you to a clinician who can authorise 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