{"id":6192,"date":"2020-08-13T16:51:46","date_gmt":"2020-08-13T21:51:46","guid":{"rendered":"https:\/\/uamscaregiving.org\/springdale\/?page_id=6192"},"modified":"2026-03-03T09:17:40","modified_gmt":"2026-03-03T15:17:40","slug":"zoom-essentrics","status":"publish","type":"page","link":"https:\/\/uamscaregiving.org\/springdale\/zoom-essentrics\/","title":{"rendered":"Zoom Essentrics"},"content":{"rendered":"<p><strong>NEW SCHEDULE! Essentrics<\/strong> is offered weekly on Wednesdays and Thursdays at 9:00 AM.<\/p>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_67' style='display:none'><div id='gf_67' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_67'  action='\/springdale\/wp-json\/wp\/v2\/pages\/6192#gf_67' data-formid='67' novalidate>\n        <div id='gf_progressbar_wrapper_67' 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'>3<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_67_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_67' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_67_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_11\" ><legend class='gfield_label gform-field-label' >AGREEMENT IS REQUIRED FOR PARTICIPATION<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_67_11'>I have carefully read the <strong><a href=\"https:\/\/uamscaregiving.org\/springdale\/release-of-waiver-and-liability\/\" target=\"_blank\"> Schmieding Center's Release and Waiver of Liability Statement<\/a><\/strong> and understand it to be a release and waiver of all potential claims and causes of action for my injury or death or damage to my property that occurs while participating in programs offered by the UAMS Schmieding Center, either in-person or via technology, and it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act(s) or omission(s).<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_11'>\n\t\t\t<div class='gchoice gchoice_67_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='I agree'  id='choice_67_11_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_67_11\"   \/>\n\t\t\t\t\t<label for='choice_67_11_0' id='label_67_11_0' class='gform-field-label gform-field-label--type-inline'>I agree<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_67_9' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_67\").val(\"2\");  jQuery(\"#gform_67\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_67\").val(\"2\");  jQuery(\"#gform_67\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_67_2' class='gform_page' data-js='page-field-id-9' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_67_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_67_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_3\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Enter requested information below.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_67_3'>\n                            \n                            <span id='input_67_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_67_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_67_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_67_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_67_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_67_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><\/fieldset><div id=\"field_67_1\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_1\" ><label class='gfield_label gform-field-label' for='input_67_1'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_1' id='input_67_1' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_67_2\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_2\" ><label class='gfield_label gform-field-label' for='input_67_2'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_2' id='input_67_2' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_67_6\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_6\" ><label class='gfield_label gform-field-label' for='input_67_6'>Residence County<\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_67_6' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Benton' >Benton<\/option><option value='Washington' >Washington<\/option><option value='Madison' >Madison<\/option><option value='Baxter' >Baxter<\/option><option value='Boone' >Boone<\/option><option value='Carroll' >Carroll<\/option><option value='Izard' >Izard<\/option><option value='Marion' >Marion<\/option><option value='Newton' >Newton<\/option><option value='Searcy' >Searcy<\/option><option value='Stone' >Stone<\/option><option value='other' >other<\/option><\/select><\/div><\/div><div id=\"field_67_8\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_8\" ><label class='gfield_label gform-field-label' for='input_67_8'>Gender<\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_67_8' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_67_7\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_7\" ><label class='gfield_label gform-field-label' for='input_67_7'>Race<\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_67_7' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='African-American' >African-American<\/option><option value='American Indian' >American Indian<\/option><option value='Asian\/Pacific Islander' >Asian\/Pacific Islander<\/option><option value='Caucasian' >Caucasian<\/option><option value='Hispanic' >Hispanic<\/option><option value='Middle Eastern' >Middle Eastern<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_67_21\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_21\" ><label class='gfield_label gform-field-label' for='input_67_21'>How did you learn about this program?<\/label><div class='ginput_container ginput_container_select'><select name='input_21' id='input_67_21' class='large gfield_select'     aria-invalid=\"false\" ><option value='My Center on Aging' >My Center on Aging<\/option><option value='Facebook' >Facebook<\/option><option value='Website' >Website<\/option><option value='Word of Mouth' >Word of Mouth<\/option><option value='My Healthcare Provider (e.g., doctor, nurse, etc.)' >My Healthcare Provider (e.g., doctor, nurse, etc.)<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_67_13' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_67\").val(\"1\");  jQuery(\"#gform_67\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_67\").val(\"1\");  jQuery(\"#gform_67\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_67_13' class='gform_next_button gform-theme-button button' value='Next complete our survey'  onclick='jQuery(\"#gform_target_page_number_67\").val(\"3\");  jQuery(\"#gform_67\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_67\").val(\"3\");  jQuery(\"#gform_67\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_67_3' class='gform_page' data-js='page-field-id-13' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_67_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_67_20\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_20\" ><strong><h4><mark>Survey data is required by our funder to offer this program at no cost to participants.  Only aggregate (group) data from this survey is reported.<\/mark><\/h4><\/strong><\/div><fieldset id=\"field_67_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_14\" ><legend class='gfield_label gform-field-label' >How often do you exercise at home?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_14'>\n\t\t\t<div class='gchoice gchoice_67_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='4'  id='choice_67_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_14_0' id='label_67_14_0' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='3'  id='choice_67_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_14_1' id='label_67_14_1' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='2'  id='choice_67_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_14_2' id='label_67_14_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='1'  id='choice_67_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_14_3' id='label_67_14_3' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_14_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='0'  id='choice_67_14_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_14_4' id='label_67_14_4' class='gform-field-label gform-field-label--type-inline'>SCSHE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_67_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_15\" ><legend class='gfield_label gform-field-label' >How often are you active?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_15'>\n\t\t\t<div class='gchoice gchoice_67_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='4'  id='choice_67_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_15_0' id='label_67_15_0' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='3'  id='choice_67_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_15_1' id='label_67_15_1' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_15_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='2'  id='choice_67_15_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_15_2' id='label_67_15_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_15_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='1'  id='choice_67_15_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_15_3' id='label_67_15_3' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_15_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='0'  id='choice_67_15_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_15_4' id='label_67_15_4' class='gform-field-label gform-field-label--type-inline'>SCSHE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_67_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_17\" ><legend class='gfield_label gform-field-label' >How often are you sad or blue?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_17'>\n\t\t\t<div class='gchoice gchoice_67_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='4'  id='choice_67_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_17_0' id='label_67_17_0' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='3'  id='choice_67_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_17_1' id='label_67_17_1' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_17_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='2'  id='choice_67_17_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_17_2' id='label_67_17_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_17_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='1'  id='choice_67_17_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_17_3' id='label_67_17_3' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_17_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='0'  id='choice_67_17_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_17_4' id='label_67_17_4' class='gform-field-label gform-field-label--type-inline'>SCSHE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_67_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_18\" ><legend class='gfield_label gform-field-label' >How often do you gather with family\/friends?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_18'>\n\t\t\t<div class='gchoice gchoice_67_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='4'  id='choice_67_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_18_0' id='label_67_18_0' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='3'  id='choice_67_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_18_1' id='label_67_18_1' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_18_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='2'  id='choice_67_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_18_2' id='label_67_18_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_18_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='1'  id='choice_67_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_18_3' id='label_67_18_3' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_18_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='0'  id='choice_67_18_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_18_4' id='label_67_18_4' class='gform-field-label gform-field-label--type-inline'>SCSHE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_67_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_16\" ><legend class='gfield_label gform-field-label' >How often do you fall?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_67_16'>\n\t\t\t<div class='gchoice gchoice_67_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='4'  id='choice_67_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_16_0' id='label_67_16_0' class='gform-field-label gform-field-label--type-inline'>All the time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='3'  id='choice_67_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_16_1' id='label_67_16_1' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='2'  id='choice_67_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_16_2' id='label_67_16_2' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_16_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='1'  id='choice_67_16_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_16_3' id='label_67_16_3' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_67_16_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='0'  id='choice_67_16_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_67_16_4' id='label_67_16_4' class='gform-field-label gform-field-label--type-inline'>SCSHE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><div id=\"field_67_19\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_67_19\" ><label class='gfield_label gform-field-label' for='input_67_19'>Testimonial<\/label><div class='gfield_description' id='gfield_description_67_19'>Your comments about this program.  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