{"id":988,"date":"2024-06-11T08:32:35","date_gmt":"2024-06-11T08:32:35","guid":{"rendered":"https:\/\/harbor.in-testing.co.uk\/?page_id=988"},"modified":"2024-08-05T14:45:10","modified_gmt":"2024-08-05T14:45:10","slug":"drug-addiction-self-assessment-2","status":"publish","type":"page","link":"https:\/\/harborlondon.com\/oldsite\/drug-addiction-self-assessment-2\/","title":{"rendered":"Drug Addiction \u2028Self-Assessment"},"content":{"rendered":"\n<!-- Our front-end template -->\n<section\n    id=\"inner-hero-block_de562bb829df8e70606672ed93535a8e\" \n    class=\"inner-hero  page-hero\"\n>\n            <style>\n            #inner-hero-block_de562bb829df8e70606672ed93535a8e {\n                background-image: url('https:\/\/harborlondon.com\/oldsite\/wp-content\/smush-webp\/2024\/06\/drug-sa.jpg.webp');\n            }\n            @media screen and (min-width: 768px) {\n                #inner-hero-block_de562bb829df8e70606672ed93535a8e {\n                    background-image: url('https:\/\/harborlondon.com\/oldsite\/wp-content\/smush-webp\/2024\/06\/drug-sa.jpg.webp');\n                }\n            }\n        <\/style>\n        <style>\n        .hero-btn-container{\n            display: flex;\n            gap: 10px;\n        }\n        .inner-hero a.btn-hl.btn_boder{\n            background-color: transparent;\n            --tw-text-opacity: 1;\n            color: #fff;\n            border:1px solid #ff7973;\n        }\n    <\/style>\n    <div class=\"site-container\">\n                                    <h1 class=\"hero-fade-in\">Drug addiction self-assessment<\/h1>\n                        <div class=\"hero-btn-container\">\n                        <\/div>\n    <\/div>\n<\/section>\n\n\n\n\n<!-- Our front-end template -->\n<section\n    id=\"self-assessment-block_cf35e5a36a2beecaded9e1fa41648923\" \n    class=\"self-assessment \"\n>\n    <div class=\"site-container\">\n        <div class=\"content\">\n                            <div class=\"text\">\n                    <h2>Drug addiction self-assessment<\/h2>\n                    <div class=\"copy\">\n                        <p><span style=\"font-weight: 400;\">Untreated drug addiction can be detrimental to the individual, as well as all those close to them. If you are witnessing drugs becoming a concerning aspect of your life \u2013 or someone you care for \u2013 our drug addiction self-assessment test offers a starting point to address these issues. Honesty is key to obtaining accurate results.<\/span><\/p>\n                    <\/div>\n                <\/div>\n                                        <div class=\"form\">\n                    <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\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_10' ><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_10' id='gform_10'  action='\/oldsite\/wp-json\/wp\/v2\/pages\/988#gf_10' data-formid='10' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_page_10_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you taken drugs for something other than medicinal purposes?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_1'>\n\t\t\t<div class='gchoice gchoice_10_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Never'  id='choice_10_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_1_0' id='label_10_1_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Rarely'  id='choice_10_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_1_1' id='label_10_1_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_1_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Sometimes'  id='choice_10_1_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_1_2' id='label_10_1_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_10_1_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Often'  id='choice_10_1_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_1_3' id='label_10_1_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_1_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='Very Often'  id='choice_10_1_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_1_4' id='label_10_1_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_3' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_2' class='gform_page' data-js='page-field-id-3' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you ever engaged in polydrug use (using more than one type of drug at a time)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_4'>\n\t\t\t<div class='gchoice gchoice_10_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Never'  id='choice_10_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_4_0' id='label_10_4_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Rarely'  id='choice_10_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_4_1' id='label_10_4_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_4_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Sometimes'  id='choice_10_4_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_4_2' id='label_10_4_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_10_4_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Often'  id='choice_10_4_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_4_3' id='label_10_4_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_4_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Very Often'  id='choice_10_4_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_4_4' id='label_10_4_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_6' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_6' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_3' class='gform_page' data-js='page-field-id-6' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you use drugs more than \u2028once a week?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_5'>\n\t\t\t<div class='gchoice gchoice_10_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Never'  id='choice_10_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_5_0' id='label_10_5_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Rarely'  id='choice_10_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_5_1' id='label_10_5_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Sometimes'  id='choice_10_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_5_2' id='label_10_5_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_10_5_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Often'  id='choice_10_5_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_5_3' id='label_10_5_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_5_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Very Often'  id='choice_10_5_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_5_4' id='label_10_5_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_8' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_8' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_4' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you ever abused prescription medications?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_7'>\n\t\t\t<div class='gchoice gchoice_10_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Never'  id='choice_10_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_7_0' id='label_10_7_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Rarely'  id='choice_10_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_7_1' id='label_10_7_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Sometimes'  id='choice_10_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_7_2' id='label_10_7_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_10_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Often'  id='choice_10_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_7_3' id='label_10_7_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_7_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Very Often'  id='choice_10_7_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_7_4' id='label_10_7_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_9' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_9' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_5' class='gform_page' data-js='page-field-id-9' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you tried to stop using a particular drug and found it difficult?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_10'>\n\t\t\t<div class='gchoice gchoice_10_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Never'  id='choice_10_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_10_0' id='label_10_10_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Rarely'  id='choice_10_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_10_1' id='label_10_10_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Sometimes'  id='choice_10_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_10_2' id='label_10_10_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_10_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Often'  id='choice_10_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_10_3' id='label_10_10_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_10_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Very Often'  id='choice_10_10_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_10_4' id='label_10_10_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_11' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_11' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_6' class='gform_page' data-js='page-field-id-11' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you experience feelings of guilt and shame when using drugs?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_12'>\n\t\t\t<div class='gchoice gchoice_10_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Never'  id='choice_10_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_12_0' id='label_10_12_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Rarely'  id='choice_10_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_12_1' id='label_10_12_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Sometimes'  id='choice_10_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_12_2' id='label_10_12_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_10_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Often'  id='choice_10_12_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_12_3' id='label_10_12_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_12_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Very Often'  id='choice_10_12_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_12_4' id='label_10_12_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_13' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_13' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_7' class='gform_page' data-js='page-field-id-13' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are your relationships suffering because of your drug use?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_14'>\n\t\t\t<div class='gchoice gchoice_10_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Never'  id='choice_10_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_14_0' id='label_10_14_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Rarely'  id='choice_10_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_14_1' id='label_10_14_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Sometimes'  id='choice_10_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_14_2' id='label_10_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_10_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Often'  id='choice_10_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_14_3' id='label_10_14_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_14_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Very Often'  id='choice_10_14_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_14_4' id='label_10_14_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_15' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_15' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_8' class='gform_page' data-js='page-field-id-15' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you find it easier to be in the company of friends who use drugs than people who don\u2019t?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_16'>\n\t\t\t<div class='gchoice gchoice_10_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Never'  id='choice_10_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_16_0' id='label_10_16_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Rarely'  id='choice_10_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_16_1' id='label_10_16_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Sometimes'  id='choice_10_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_16_2' id='label_10_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_10_16_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Often'  id='choice_10_16_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_16_3' id='label_10_16_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_16_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Very Often'  id='choice_10_16_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_16_4' id='label_10_16_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_17' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_17' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_9' class='gform_page' data-js='page-field-id-17' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Has anyone ever pointed out that your drug use may be problematic?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_18'>\n\t\t\t<div class='gchoice gchoice_10_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Never'  id='choice_10_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_18_0' id='label_10_18_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Rarely'  id='choice_10_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_18_1' id='label_10_18_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_18_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Sometimes'  id='choice_10_18_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_18_2' id='label_10_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_10_18_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Often'  id='choice_10_18_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_18_3' id='label_10_18_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_18_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Very Often'  id='choice_10_18_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_18_4' id='label_10_18_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_19' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_10' class='gform_page' data-js='page-field-id-19' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Has your drug use ever caused you \u2028to be violent?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_22'>\n\t\t\t<div class='gchoice gchoice_10_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Never'  id='choice_10_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_22_0' id='label_10_22_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Rarely'  id='choice_10_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_22_1' id='label_10_22_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Sometimes'  id='choice_10_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_22_2' id='label_10_22_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_10_22_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Often'  id='choice_10_22_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_22_3' id='label_10_22_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_22_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Very Often'  id='choice_10_22_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_22_4' id='label_10_22_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_23' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_23' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_11' class='gform_page' data-js='page-field-id-23' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Has drug use negatively impacted your ability to function at work?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_24'>\n\t\t\t<div class='gchoice gchoice_10_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Never'  id='choice_10_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_24_0' id='label_10_24_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Rarely'  id='choice_10_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_24_1' id='label_10_24_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Sometimes'  id='choice_10_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_24_2' id='label_10_24_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_10_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Often'  id='choice_10_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_24_3' id='label_10_24_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_24_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Very Often'  id='choice_10_24_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_24_4' id='label_10_24_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_25' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_25' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_12' class='gform_page' data-js='page-field-id-25' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you ever been arrested for drug use (for possession\/drug driving)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_26'>\n\t\t\t<div class='gchoice gchoice_10_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Never'  id='choice_10_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_26_0' id='label_10_26_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Rarely'  id='choice_10_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_26_1' id='label_10_26_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Sometimes'  id='choice_10_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_26_2' id='label_10_26_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_10_26_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Often'  id='choice_10_26_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_26_3' id='label_10_26_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_26_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Very Often'  id='choice_10_26_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_26_4' id='label_10_26_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_28' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_28' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_13' class='gform_page' data-js='page-field-id-28' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you ever felt physical symptoms of withdrawal when stopping your drug use?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_27'>\n\t\t\t<div class='gchoice gchoice_10_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Never'  id='choice_10_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_27_0' id='label_10_27_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Rarely'  id='choice_10_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_27_1' id='label_10_27_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Sometimes'  id='choice_10_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_27_2' id='label_10_27_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_10_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Often'  id='choice_10_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_27_3' id='label_10_27_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_27_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Very Often'  id='choice_10_27_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_27_4' id='label_10_27_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_30' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_30' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_14' class='gform_page' data-js='page-field-id-30' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_14' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_29\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you ever blacked-out through drug use?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_29'>\n\t\t\t<div class='gchoice gchoice_10_29_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Never'  id='choice_10_29_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_29_0' id='label_10_29_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_29_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Rarely'  id='choice_10_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_29_1' id='label_10_29_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_29_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Sometimes'  id='choice_10_29_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_29_2' id='label_10_29_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_10_29_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Often'  id='choice_10_29_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_29_3' id='label_10_29_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_29_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Very Often'  id='choice_10_29_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_29_4' id='label_10_29_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_40' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_40' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_15' class='gform_page' data-js='page-field-id-40' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_15' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_10_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you ever sought help \u2028for your drug use?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_31'>\n\t\t\t<div class='gchoice gchoice_10_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Never'  id='choice_10_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_31_0' id='label_10_31_0' class='gform-field-label gform-field-label--type-inline'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Rarely'  id='choice_10_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_31_1' id='label_10_31_1' class='gform-field-label gform-field-label--type-inline'>Rarely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Sometimes'  id='choice_10_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_31_2' id='label_10_31_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_10_31_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Often'  id='choice_10_31_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_31_3' id='label_10_31_3' class='gform-field-label gform-field-label--type-inline'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_31_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Very Often'  id='choice_10_31_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_31_4' id='label_10_31_4' class='gform-field-label gform-field-label--type-inline'>Very Often<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        \n<div class=\"button-container previous-button-container\"> <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2829)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M2.10068 7.53612L7.85746 13.2929L7.15035 14L0.540981 7.39063L0.187428 7.03708L0.540981 6.68352L7.15035 0.0741523L7.85746 0.781259L2.1026 6.53612L16 6.53612L16 7.53612L2.10068 7.53612Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2829\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(0 14) rotate(-90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg><input type='button' id='gform_previous_button_10_33' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/><\/div>\n \n<div class=\"button-container next-button-container\"><input type='button' id='gform_next_button_10_33' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"17\" height=\"14\" viewBox=\"0 0 17 14\" fill=\"none\">\n<g clip-path=\"url(#clip0_3070_2838)\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M14.8993 6.46388L9.14254 0.707107L9.84965 0L16.459 6.60937L16.8126 6.96292L16.459 7.31648L9.84965 13.9258L9.14254 13.2187L14.8974 7.46388L1 7.46388V6.46388L14.8993 6.46388Z\" fill=\"black\"\/>\n<\/g>\n<defs>\n<clipPath id=\"clip0_3070_2838\">\n<rect width=\"14\" height=\"17\" fill=\"white\" transform=\"translate(17) rotate(90)\"\/>\n<\/clipPath>\n<\/defs>\n<\/svg> <\/div>\n \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_16' class='gform_page' data-js='page-field-id-33' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_16' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_10_32\" 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\"  ><h3>You have completed the \u2028Harbor Drug Addiction Test.<\/h3>\n<p><b>To learn the results of your test, \u2028please enter your details below.<\/b><\/p>\n<p>Details will be kept strictly confidential \u2028and will not be shared.<\/p><\/div><div id=\"field_10_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_34'>Name<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_10_34' type='text' value='' class='large'    placeholder='Name here'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_35\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_35'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_35' id='input_10_35' type='email' value='' class='large'   placeholder='example@email.com'  aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_36\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_36'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_36' id='input_10_36' type='tel' value='' class='large'  placeholder='00000 000 000'  aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_37\" class=\"gfield 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class=\"cta-container__text\">\n                <div class=\"header item-fade-up\">\n                    <h6>Learn more<\/h6>\n                    <h2>Explore further<\/h2>\n                    \n                <\/div>\n                                    <p>Visit our dedicated drug page to learn more about how we can assist you or your loved ones on the journey to recovery.<\/p>\n                                <\/div>\n                                        <div class=\"links-container\">\n                                            <a href=\"https:\/\/harborlondon.com\/oldsite\/condition\/addictions\/drug\/\" class=\"single-link-box\">\n                            <img decoding=\"async\" src=\"https:\/\/harborlondon.com\/oldsite\/wp-content\/smush-webp\/2024\/06\/pexels-readymade-3850701-scaled-e1719933380701.jpg.webp\" alt=\"\">\n                            <div class=\"label\">\n                                <h3>Drug addiction<\/h3>\n                                <svg 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