{"id":7606,"date":"2021-04-22T11:36:24","date_gmt":"2021-04-22T16:36:24","guid":{"rendered":"https:\/\/uamscaregiving.org\/springdale\/?page_id=7606"},"modified":"2026-02-06T13:43:22","modified_gmt":"2026-02-06T19:43:22","slug":"spst","status":"publish","type":"page","link":"https:\/\/uamscaregiving.org\/springdale\/spst\/","title":{"rendered":"Starting Point Self Test &#8211; WWE"},"content":{"rendered":"<p>All reporting of your responses will be in the aggregate; no individually identifiable information will be shared.<\/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 gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_155' ><form method='post' enctype='multipart\/form-data'  id='gform_155'  action='\/springdale\/wp-json\/wp\/v2\/pages\/7606' data-formid='155' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_155' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_155_23\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_23\" ><label class='gfield_label gform-field-label' for='input_155_23'>What is today&#039;s date?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='gfield_description' id='gfield_description_155_23'><strong><i>(MM\/DD\/YYYY)<\/i><\/strong><\/div><div class='ginput_container ginput_container_date'>\n                            <input aria-describedby='field_155_23_dmessage' name='input_23' id='input_155_23' type='text' value='04\/25\/2026' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_155_23_date_format gfield_description_155_23\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_155_23_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_155_23' class='gform_hidden' value='https:\/\/uamscaregiving.org\/springdale\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_155_18\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_18\" ><label class='gfield_label gform-field-label' for='input_155_18'>Enter your birthday<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='gfield_description' id='gfield_description_155_18'><strong><i>(MM\/DD\/YYYY)<\/i><\/strong><\/div><div class='ginput_container ginput_container_date'>\n                            <input aria-describedby='field_155_18_dmessage' name='input_18' id='input_155_18' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_155_18_date_format gfield_description_155_18\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_155_18_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_155_18' class='gform_hidden' value='https:\/\/uamscaregiving.org\/springdale\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_155_41\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_41\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<\/label><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_155_41'>\n                            \n                            <span id='input_155_41_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_41.3' id='input_155_41_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_155_41_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_155_41_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_41.6' id='input_155_41_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_155_41_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><\/li><li id=\"field_155_87\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_87\" >______________________________________________________________________________________________________________________<\/li><li id=\"field_155_72\" class=\"gfield gfield--type-number gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_72\" ><label class='gfield_label gform-field-label' for='input_155_72'>PAIN<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='gfield_description' id='gfield_description_155_72'>Please enter the number (no decimals) that best describes how much physical pain your arthritis caused during the week preceding your first participation in the Walk with Ease program.<br><br>\n\n<i><strong>Zero (0) is \"no pain at all\" -- Ten (10) is \"the worst pain possible\"<\/strong><\/i><\/div><div class='ginput_container ginput_container_number'><input name='input_72' id='input_155_72' type='number' step='any' min='0' max='10' value='0' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_155_72 gfield_description_155_72\" \/><div class='gfield_description instruction ' id='gfield_instruction_155_72'>Please enter a number from <strong>0<\/strong> to <strong>10<\/strong>.<\/div><\/div><\/li><li id=\"field_155_74\" class=\"gfield gfield--type-number gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_74\" ><label class='gfield_label gform-field-label' for='input_155_74'>FATIGUE<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='gfield_description' id='gfield_description_155_74'>Please enter the number (no decimals) that best describes how much of a problem fatigue was for you during the week preceding your first participation in the Walk with Ease program.<br><br>\n\n<i><strong>Zero (0) is \"no problem\" -- Ten (10) is \"a major problem\"<\/strong><\/i><\/div><div class='ginput_container ginput_container_number'><input name='input_74' id='input_155_74' type='number' step='any' min='0' max='10' value='0' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_155_74 gfield_description_155_74\" \/><div class='gfield_description instruction ' id='gfield_instruction_155_74'>Please enter a number from <strong>0<\/strong> to <strong>10<\/strong>.<\/div><\/div><\/li><li id=\"field_155_90\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_90\" >______________________________________________________________________________________________________________________<\/li><li id=\"field_155_75\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_75\" ><strong>The following items are about activities you might do during a typical day.  Did your health status preceding your participation in the Walk with Ease program limit you in these activities? <\/strong><br><br>\n<i>For each item listed below choose the appropriate response for you<\/i><\/li><li id=\"field_155_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_55\" ><label class='gfield_label gform-field-label' >Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports<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_radio'><ul class='gfield_radio' id='input_155_55'>\n\t\t\t<li class='gchoice gchoice_155_55_0'>\n\t\t\t\t<input name='input_55' type='radio' value='1'  id='choice_155_55_0'    \/>\n\t\t\t\t<label for='choice_155_55_0' id='label_155_55_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_55_1'>\n\t\t\t\t<input name='input_55' type='radio' value='2'  id='choice_155_55_1'    \/>\n\t\t\t\t<label for='choice_155_55_1' id='label_155_55_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_55_2'>\n\t\t\t\t<input name='input_55' type='radio' value='3'  id='choice_155_55_2'    \/>\n\t\t\t\t<label for='choice_155_55_2' id='label_155_55_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_76\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_76\" ><label class='gfield_label gform-field-label' >Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf<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_radio'><ul class='gfield_radio' id='input_155_76'>\n\t\t\t<li class='gchoice gchoice_155_76_0'>\n\t\t\t\t<input name='input_76' type='radio' value='1'  id='choice_155_76_0'    \/>\n\t\t\t\t<label for='choice_155_76_0' id='label_155_76_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_76_1'>\n\t\t\t\t<input name='input_76' type='radio' value='2'  id='choice_155_76_1'    \/>\n\t\t\t\t<label for='choice_155_76_1' id='label_155_76_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_76_2'>\n\t\t\t\t<input name='input_76' type='radio' value='3'  id='choice_155_76_2'    \/>\n\t\t\t\t<label for='choice_155_76_2' id='label_155_76_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_82\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_82\" ><label class='gfield_label gform-field-label' >Lifting or carrying groceries<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_radio'><ul class='gfield_radio' id='input_155_82'>\n\t\t\t<li class='gchoice gchoice_155_82_0'>\n\t\t\t\t<input name='input_82' type='radio' value='1'  id='choice_155_82_0'    \/>\n\t\t\t\t<label for='choice_155_82_0' id='label_155_82_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_82_1'>\n\t\t\t\t<input name='input_82' type='radio' value='2'  id='choice_155_82_1'    \/>\n\t\t\t\t<label for='choice_155_82_1' id='label_155_82_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_82_2'>\n\t\t\t\t<input name='input_82' type='radio' value='3'  id='choice_155_82_2'    \/>\n\t\t\t\t<label for='choice_155_82_2' id='label_155_82_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_84\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_84\" ><label class='gfield_label gform-field-label' >Climbing several flights of stairs<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_radio'><ul class='gfield_radio' id='input_155_84'>\n\t\t\t<li class='gchoice gchoice_155_84_0'>\n\t\t\t\t<input name='input_84' type='radio' value='1'  id='choice_155_84_0'    \/>\n\t\t\t\t<label for='choice_155_84_0' id='label_155_84_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_84_1'>\n\t\t\t\t<input name='input_84' type='radio' value='2'  id='choice_155_84_1'    \/>\n\t\t\t\t<label for='choice_155_84_1' id='label_155_84_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_84_2'>\n\t\t\t\t<input name='input_84' type='radio' value='3'  id='choice_155_84_2'    \/>\n\t\t\t\t<label for='choice_155_84_2' id='label_155_84_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_86\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_86\" ><label class='gfield_label gform-field-label' >Climbing one flight of stairs<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_radio'><ul class='gfield_radio' id='input_155_86'>\n\t\t\t<li class='gchoice gchoice_155_86_0'>\n\t\t\t\t<input name='input_86' type='radio' value='1'  id='choice_155_86_0'    \/>\n\t\t\t\t<label for='choice_155_86_0' id='label_155_86_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_86_1'>\n\t\t\t\t<input name='input_86' type='radio' value='2'  id='choice_155_86_1'    \/>\n\t\t\t\t<label for='choice_155_86_1' id='label_155_86_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_86_2'>\n\t\t\t\t<input name='input_86' type='radio' value='3'  id='choice_155_86_2'    \/>\n\t\t\t\t<label for='choice_155_86_2' id='label_155_86_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_83\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_83\" ><label class='gfield_label gform-field-label' >Bending, kneeling, or stooping<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_radio'><ul class='gfield_radio' id='input_155_83'>\n\t\t\t<li class='gchoice gchoice_155_83_0'>\n\t\t\t\t<input name='input_83' type='radio' value='1'  id='choice_155_83_0'    \/>\n\t\t\t\t<label for='choice_155_83_0' id='label_155_83_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_83_1'>\n\t\t\t\t<input name='input_83' type='radio' value='2'  id='choice_155_83_1'    \/>\n\t\t\t\t<label for='choice_155_83_1' id='label_155_83_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_83_2'>\n\t\t\t\t<input name='input_83' type='radio' value='3'  id='choice_155_83_2'    \/>\n\t\t\t\t<label for='choice_155_83_2' id='label_155_83_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_80\" ><label class='gfield_label gform-field-label' >Walking more than a mile<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_radio'><ul class='gfield_radio' id='input_155_80'>\n\t\t\t<li class='gchoice gchoice_155_80_0'>\n\t\t\t\t<input name='input_80' type='radio' value='1'  id='choice_155_80_0'    \/>\n\t\t\t\t<label for='choice_155_80_0' id='label_155_80_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_80_1'>\n\t\t\t\t<input name='input_80' type='radio' value='2'  id='choice_155_80_1'    \/>\n\t\t\t\t<label for='choice_155_80_1' id='label_155_80_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_80_2'>\n\t\t\t\t<input name='input_80' type='radio' value='3'  id='choice_155_80_2'    \/>\n\t\t\t\t<label for='choice_155_80_2' id='label_155_80_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_81\" ><label class='gfield_label gform-field-label' >Walking several hundred yards<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_radio'><ul class='gfield_radio' id='input_155_81'>\n\t\t\t<li class='gchoice gchoice_155_81_0'>\n\t\t\t\t<input name='input_81' type='radio' value='1'  id='choice_155_81_0'    \/>\n\t\t\t\t<label for='choice_155_81_0' id='label_155_81_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_81_1'>\n\t\t\t\t<input name='input_81' type='radio' value='2'  id='choice_155_81_1'    \/>\n\t\t\t\t<label for='choice_155_81_1' id='label_155_81_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_81_2'>\n\t\t\t\t<input name='input_81' type='radio' value='3'  id='choice_155_81_2'    \/>\n\t\t\t\t<label for='choice_155_81_2' id='label_155_81_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_79\" ><label class='gfield_label gform-field-label' >Walking one hundred yards<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_radio'><ul class='gfield_radio' id='input_155_79'>\n\t\t\t<li class='gchoice gchoice_155_79_0'>\n\t\t\t\t<input name='input_79' type='radio' value='1'  id='choice_155_79_0'    \/>\n\t\t\t\t<label for='choice_155_79_0' id='label_155_79_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_79_1'>\n\t\t\t\t<input name='input_79' type='radio' value='2'  id='choice_155_79_1'    \/>\n\t\t\t\t<label for='choice_155_79_1' id='label_155_79_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_79_2'>\n\t\t\t\t<input name='input_79' type='radio' value='3'  id='choice_155_79_2'    \/>\n\t\t\t\t<label for='choice_155_79_2' id='label_155_79_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_78\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_78\" ><label class='gfield_label gform-field-label' >Bathing or dressing yourself<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_radio'><ul class='gfield_radio' id='input_155_78'>\n\t\t\t<li class='gchoice gchoice_155_78_0'>\n\t\t\t\t<input name='input_78' type='radio' value='1'  id='choice_155_78_0'    \/>\n\t\t\t\t<label for='choice_155_78_0' id='label_155_78_0' class='gform-field-label gform-field-label--type-inline'>Not at all<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_78_1'>\n\t\t\t\t<input name='input_78' type='radio' value='2'  id='choice_155_78_1'    \/>\n\t\t\t\t<label for='choice_155_78_1' id='label_155_78_1' class='gform-field-label gform-field-label--type-inline'>Yes, a little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_155_78_2'>\n\t\t\t\t<input name='input_78' type='radio' value='3'  id='choice_155_78_2'    \/>\n\t\t\t\t<label for='choice_155_78_2' id='label_155_78_2' class='gform-field-label gform-field-label--type-inline'>Yes, a lot<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_155_85\" class=\"gfield gfield--type-number gfield_contains_required gfield_calculation field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_155_85\" ><label class='gfield_label gform-field-label' for='input_155_85'>Your Physical Limitations score<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_number'><input name='input_85' id='input_155_85' type='text' step='any'   value='{Bathing or dressing yourself:78}+{Walking one hundred yards:79}+{Walking several hundred yards:81}+{Walking more than a mile:80}+{Bending, kneeling, or stooping:83}+{Climbing several flights of stairs:84}+{Lifting or carrying groceries:82}+{Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf:76}+{Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports:55}+{Climbing one flight of stairs:86}' class='medium'  readonly=\"readonly\"   aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_155' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_155\"]){return false;}  if( !jQuery(\"#gform_155\")[0].checkValidity || jQuery(\"#gform_155\")[0].checkValidity()){window[\"gf_submitting_155\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_155\"]){return false;} if( !jQuery(\"#gform_155\")[0].checkValidity || jQuery(\"#gform_155\")[0].checkValidity()){window[\"gf_submitting_155\"]=true;}  jQuery(\"#gform_155\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_155' value='1' \/>\n            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value=\"121\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n                        <\/div><script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 155, 'https:\/\/uamscaregiving.org\/springdale\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_155').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_155');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_155').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 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