{"id":29,"date":"2025-07-16T05:15:48","date_gmt":"2025-07-16T05:15:48","guid":{"rendered":"https:\/\/healthlinkwellness.com\/?page_id=29"},"modified":"2025-07-25T04:38:29","modified_gmt":"2025-07-25T04:38:29","slug":"book-appointment","status":"publish","type":"page","link":"https:\/\/healthlinkwellness.com\/en\/book-appointment\/","title":{"rendered":"Book Appointment"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"29\" class=\"elementor elementor-29\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5eaea8e2 e-con-full e-flex e-con e-parent\" data-id=\"5eaea8e2\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-560280b7 elementor-widget elementor-widget-image\" data-id=\"560280b7\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1920\" height=\"1080\" src=\"https:\/\/healthlinkwellness.com\/wp-content\/uploads\/2025\/07\/Health_Link_Service_TH.webp\" class=\"attachment-full size-full wp-image-238\" alt=\"\" srcset=\"https:\/\/healthlinkwellness.com\/wp-content\/uploads\/2025\/07\/Health_Link_Service_TH.webp 1920w, https:\/\/healthlinkwellness.com\/wp-content\/uploads\/2025\/07\/Health_Link_Service_TH-300x169.webp 300w, https:\/\/healthlinkwellness.com\/wp-content\/uploads\/2025\/07\/Health_Link_Service_TH-1024x576.webp 1024w, https:\/\/healthlinkwellness.com\/wp-content\/uploads\/2025\/07\/Health_Link_Service_TH-768x432.webp 768w, https:\/\/healthlinkwellness.com\/wp-content\/uploads\/2025\/07\/Health_Link_Service_TH-1536x864.webp 1536w, https:\/\/healthlinkwellness.com\/wp-content\/uploads\/2025\/07\/Health_Link_Service_TH-18x10.webp 18w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-41042d9d e-flex e-con-boxed e-con e-parent\" data-id=\"41042d9d\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-57b3e8ad elementor-widget elementor-widget-heading\" data-id=\"57b3e8ad\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Appointment Form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-39dc1003 elementor-widget elementor-widget-text-editor\" data-id=\"39dc1003\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Please provide complete information so that the doctor can assess your symptoms before consulting.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-48e3368c e-con-full e-flex e-con e-child\" data-id=\"48e3368c\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-67dd9ec7 fluent-form-widget-step-header-yes fluent-form-widget-step-progressbar-yes fluentform-widget-submit-button-custom elementor-widget elementor-widget-fluent-form-widget\" data-id=\"67dd9ec7\" data-element_type=\"widget\" data-widget_type=\"fluent-form-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n            <div class=\"fluentform-widget-wrapper fluentform-widget-custom-radio-checkbox\">\n\n            \n            <div class='fluentform ff-default fluentform_wrapper_4 ffs_default_wrap'><form data-form_id=\"4\" id=\"fluentform_4\" class=\"frm-fluent-form fluent_form_4 ff-el-form-top ff_form_instance_4_1 ff-form-loading ff-form-has-steps ffs_default\" data-form_instance=\"ff_form_instance_4_1\" method=\"POST\" action=\"\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Appointment<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='29' \/><input type=\"hidden\" id=\"_fluentform_4_fluentformnonce\" name=\"_fluentform_4_fluentformnonce\" value=\"9232f17065\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/29\" \/><div class='ff-step-container' data-name=\"step_start-4_9\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"yes\" data-enable_step_page_resume=\"yes\" data-animation_type=\"slide\" ><div class='ff-step-header'><ul class='ff-step-titles'><li class='ff_active'><span>Appointment Method<\/span><\/li><li><span>Personal Information<\/span><\/li><li><span>Pain of Osteoarthritis of the knee<\/span><\/li><li><span>Knees Score <\/span><\/li><li><span>Modified WOMAC Scale for Knee Pain<\/span><\/li><li><span>Daily Routine Assessment<\/span><\/li><\/ul><\/div><span class='ff_step_start'><\/span><div class='ff-step-body'><div class=\"fluentform-step active\" data-name=\"step_start-4_9\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"yes\" data-enable_step_page_resume=\"yes\" data-animation_type=\"slide\" ><div class='ff-el-group ff-el-form-top  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Please select which type of appointment you would prefer. Choose your appointment type:\">Please select which type of appointment you would prefer. Choose your appointment type:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_12_6918e20ba41eba69b4e639c2e3b4effb\"><input  type=\"radio\" name=\"input_radio_12\" data-name=\"input_radio_12\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Clinic Visit (In-Person at the Health Link Clinic)\"  id='input_radio_12_6918e20ba41eba69b4e639c2e3b4effb' aria-label='Clinic Visit (In-Person at the Health Link Clinic)' aria-invalid='false' aria-required=\"false\"> <span>Clinic Visit (In-Person at the Health Link Clinic)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_12_1ce77bf0705c1d9285ee147473ce1b33\"><input  type=\"radio\" name=\"input_radio_12\" data-name=\"input_radio_12\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Telemedicine (Online Consultation)\"  id='input_radio_12_1ce77bf0705c1d9285ee147473ce1b33' aria-label='Telemedicine (Online Consultation)' aria-invalid='false' aria-required=\"false\"> <span>Telemedicine (Online Consultation)<\/span><\/label><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Next<\/button><\/div><\/div><div class=\"fluentform-step\" data-name=\"form_step-4_1\" ><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_1'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div data-type=\"name-element\" data-name=\"names\" class=\"ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_names_first_name_' >First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_4_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your First Name\" aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_names_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_4_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your Last Name\" aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_datetime_1' aria-label=\"Date of Birth\">Date of Birth<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Date of Birth Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_1\" id=\"ff_4_datetime_1\" class=\"ff-el-form-control ff-el-datepicker\" placeholder=\"Select Date\" data-name=\"datetime_1\"  aria-invalid='false' aria-required=\"false\"><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_numeric_field' aria-label=\"Age\">Age<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric_field\" id=\"ff_4_numeric_field\" class=\"ff-el-form-control\" placeholder=\"Enter You Age\" data-name=\"numeric_field\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Sex\">Sex<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_1_16b665bf692c0317af4b2b5e346f0c94\"><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Male\"  id='input_radio_1_16b665bf692c0317af4b2b5e346f0c94' aria-label='Male' aria-invalid='false' aria-required=\"false\"> <span>Male<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_1_5ea6714d34f34fac21ddddf57bb4601b\"><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Female\"  id='input_radio_1_5ea6714d34f34fac21ddddf57bb4601b' aria-label='Female' aria-invalid='false' aria-required=\"false\"> <span>Female<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_email' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_4_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\"  aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text' aria-label=\"Other Contact\">Other Contact<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" placeholder=\"WhatsApp or Etc.\" data-name=\"input_text\" id=\"ff_4_input_text\"  aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Timefram : Pre op\">Timefram : Pre op<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_516306c7f6943a5a4b0f2b4ef68811c6\"><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1-3 week\"  id='input_radio_516306c7f6943a5a4b0f2b4ef68811c6' aria-label='1-3 week' aria-invalid='false' aria-required=\"false\"> <span>1-3 week<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_c654c9dae547bd582f8823b79961c332\"><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1-3 month\"  id='input_radio_c654c9dae547bd582f8823b79961c332' aria-label='1-3 month' aria-invalid='false' aria-required=\"false\"> <span>1-3 month<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_7f14873bb01ee4b4503160040e4e2feb\"><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"4-6 month\"  id='input_radio_7f14873bb01ee4b4503160040e4e2feb' aria-label='4-6 month' aria-invalid='false' aria-required=\"false\"> <span>4-6 month<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_165c34cb03b02f861d01284e0babc0c0\"><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"more than 12 month\"  id='input_radio_165c34cb03b02f861d01284e0babc0c0' aria-label='more than 12 month' aria-invalid='false' aria-required=\"false\"> <span>more than 12 month<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_datetime' aria-label=\"App date\">App date<\/label><\/div><div class='ff-el-input--content'><input  aria-label='App date Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_4_datetime\" class=\"ff-el-form-control ff-el-datepicker\" placeholder=\"Select Date\" data-name=\"datetime\"  aria-invalid='false' aria-required=\"false\"><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"Side\">Side<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_48f5939e4125f071298e6f0d5c9663a5\"><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Left\"  id='checkbox_48f5939e4125f071298e6f0d5c9663a5' aria-label='Left' aria-invalid='false' aria-required=\"false\"> <span>Left<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_4b4e3f138591e92414508c03364a2bf5\"><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Right\"  id='checkbox_4b4e3f138591e92414508c03364a2bf5' aria-label='Right' aria-invalid='false' aria-required=\"false\"> <span>Right<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Next<\/button><\/div><\/div><div class=\"fluentform-step\" data-name=\"form_step-4_2\" ><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_3\" ><p><strong>Patient to complete. Tick (\u2714) one box for every question (during the past 4 weeks)<\/strong><\/p><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"1. How would you describe the pain in your knee?\">1. How would you describe the pain in your knee?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_1_f7bd202bd0ba25c70d813706ffdcd3b3\"><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"None\"  id='checkbox_1_f7bd202bd0ba25c70d813706ffdcd3b3' aria-label='None' aria-invalid='false' aria-required=\"false\"> <span>None<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_1_9845b3f8fa7a728fb4b0875e2ccee667\"><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Very Mild\"  id='checkbox_1_9845b3f8fa7a728fb4b0875e2ccee667' aria-label='Very Mild' aria-invalid='false' aria-required=\"false\"> <span>Very Mild<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_1_64264a4157d67aadc0e018f59a27cbdf\"><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Mild\"  id='checkbox_1_64264a4157d67aadc0e018f59a27cbdf' aria-label='Mild' aria-invalid='false' aria-required=\"false\"> <span>Mild<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_1_c5ee91911e83497be933984acc48c9a1\"><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Moderate\"  id='checkbox_1_c5ee91911e83497be933984acc48c9a1' aria-label='Moderate' aria-invalid='false' aria-required=\"false\"> <span>Moderate<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_1_4752aecf6d7beb8d49c8e93e1e53e2bd\"><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Servere\"  id='checkbox_1_4752aecf6d7beb8d49c8e93e1e53e2bd' aria-label='Servere' aria-invalid='false' aria-required=\"false\"> <span>Servere<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"2. How long can you walk (with or without stick) before the pain in your knee becomes severe?\">2. How long can you walk (with or without stick) before the pain in your knee becomes severe?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_2_aa672e21e901a35660bc820cb9c57b11\"><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"No pain \/ more than 30 mins\"  id='checkbox_2_aa672e21e901a35660bc820cb9c57b11' aria-label='No pain \/ more than 30 mins' aria-invalid='false' aria-required=\"false\"> <span>No pain \/ more than 30 mins<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_2_75986b630a85d099dd7b9dfcd4c620c8\"><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"16\u201330 mins\"  id='checkbox_2_75986b630a85d099dd7b9dfcd4c620c8' aria-label='16\u201330 mins' aria-invalid='false' aria-required=\"false\"> <span>16\u201330 mins<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_2_f5e43f570f2e1da63c8e0dd8545e5579\"><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"5\u201315 mins\"  id='checkbox_2_f5e43f570f2e1da63c8e0dd8545e5579' aria-label='5\u201315 mins' aria-invalid='false' aria-required=\"false\"> <span>5\u201315 mins<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_2_892925dc247a2df982a68743750b160c\"><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Around the house only\"  id='checkbox_2_892925dc247a2df982a68743750b160c' aria-label='Around the house only' aria-invalid='false' aria-required=\"false\"> <span>Around the house only<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_2_112a5370125d1a9cd5323e0a0a247846\"><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Not at all \/ pain severe\"  id='checkbox_2_112a5370125d1a9cd5323e0a0a247846' aria-label='Not at all \/ pain severe' aria-invalid='false' aria-required=\"false\"> <span>Not at all \/ pain severe<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"3. After a meal (sat at a table), how painful is the knee to stand up?\">3. After a meal (sat at a table), how painful is the knee to stand up?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_3_377878760b6175ee357257a99c0e8508\"><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Not at all painfull\"  id='checkbox_3_377878760b6175ee357257a99c0e8508' aria-label='Not at all painfull' aria-invalid='false' aria-required=\"false\"> <span>Not at all painfull<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_3_7459f5987288f3f6736536cfa6e0bc20\"><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Slightly painful\"  id='checkbox_3_7459f5987288f3f6736536cfa6e0bc20' aria-label='Slightly painful' aria-invalid='false' aria-required=\"false\"> <span>Slightly painful<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_3_e0394864f09b8574741ce81c9bd97405\"><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Modderately painful\"  id='checkbox_3_e0394864f09b8574741ce81c9bd97405' aria-label='Modderately painful' aria-invalid='false' aria-required=\"false\"> <span>Modderately painful<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_3_80423ac8db4298551d72ec4b015ae282\"><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Very painful\"  id='checkbox_3_80423ac8db4298551d72ec4b015ae282' aria-label='Very painful' aria-invalid='false' aria-required=\"false\"> <span>Very painful<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_3_6dbfce66c65f52e18cc04278c277b782\"><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Unbearabal\"  id='checkbox_3_6dbfce66c65f52e18cc04278c277b782' aria-label='Unbearabal' aria-invalid='false' aria-required=\"false\"> <span>Unbearabal<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"4. Have you been troubled by pain from your knee in bed at night?\">4. Have you been troubled by pain from your knee in bed at night?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_4_32c9d086bee7d24620f5d22594256c5b\"><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Not troubled at all\"  id='checkbox_4_32c9d086bee7d24620f5d22594256c5b' aria-label='Not troubled at all' aria-invalid='false' aria-required=\"false\"> <span>Not troubled at all<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_4_78e89889f3bc44170ce90d53dc614297\"><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Only 1 or 2 nights\"  id='checkbox_4_78e89889f3bc44170ce90d53dc614297' aria-label='Only 1 or 2 nights' aria-invalid='false' aria-required=\"false\"> <span>Only 1 or 2 nights<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_4_d7c71ba0ef28c66d54ae41195b8ce813\"><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Some nights\"  id='checkbox_4_d7c71ba0ef28c66d54ae41195b8ce813' aria-label='Some nights' aria-invalid='false' aria-required=\"false\"> <span>Some nights<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_4_0584ccbaa144bc1a2b22d1de1e04edbe\"><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Most nights\"  id='checkbox_4_0584ccbaa144bc1a2b22d1de1e04edbe' aria-label='Most nights' aria-invalid='false' aria-required=\"false\"> <span>Most nights<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_4_b29167eeb6b3812eabacf6f93152e1e9\"><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Every night\"  id='checkbox_4_b29167eeb6b3812eabacf6f93152e1e9' aria-label='Every night' aria-invalid='false' aria-required=\"false\"> <span>Every night<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"5. How much has pain from your knee interfered with your usual work (including housework)?\">5. How much has pain from your knee interfered with your usual work (including housework)?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_5_dae54d5f63cd26903370d8cb47a3c40e\"><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Not at all\"  id='checkbox_5_dae54d5f63cd26903370d8cb47a3c40e' aria-label='Not at all' aria-invalid='false' aria-required=\"false\"> <span>Not at all<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_5_832a537ea027e29416803fbff6db8c0a\"><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"A little bit\"  id='checkbox_5_832a537ea027e29416803fbff6db8c0a' aria-label='A little bit' aria-invalid='false' aria-required=\"false\"> <span>A little bit<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_5_c3c283f33cf5d274891387e2d5287f89\"><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Moderately\"  id='checkbox_5_c3c283f33cf5d274891387e2d5287f89' aria-label='Moderately' aria-invalid='false' aria-required=\"false\"> <span>Moderately<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_5_a815f40a4847db80565d6c4b178507ea\"><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Greatly\"  id='checkbox_5_a815f40a4847db80565d6c4b178507ea' aria-label='Greatly' aria-invalid='false' aria-required=\"false\"> <span>Greatly<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_5_6528ba613ab4a7f62e1aa4b8ae192552\"><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Totally\"  id='checkbox_5_6528ba613ab4a7f62e1aa4b8ae192552' aria-label='Totally' aria-invalid='false' aria-required=\"false\"> <span>Totally<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"6. Could you walk down one flight of stairs?\">6. Could you walk down one flight of stairs?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_6_99c682257e903b5f1be80a7c9c7fb444\"><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Yes, easily\"  id='checkbox_6_99c682257e903b5f1be80a7c9c7fb444' aria-label='Yes, easily' aria-invalid='false' aria-required=\"false\"> <span>Yes, easily<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_6_af738648ff7ee57ba4cab3a929524fc3\"><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"With little difficulty\"  id='checkbox_6_af738648ff7ee57ba4cab3a929524fc3' aria-label='With little difficulty' aria-invalid='false' aria-required=\"false\"> <span>With little difficulty<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_6_361e6586a1e9c05a1e78841792348a67\"><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"With moderate difficulty\"  id='checkbox_6_361e6586a1e9c05a1e78841792348a67' aria-label='With moderate difficulty' aria-invalid='false' aria-required=\"false\"> <span>With moderate difficulty<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_6_436bf715fd0684c1080c44c825aea2e6\"><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"With extreme difficulty\"  id='checkbox_6_436bf715fd0684c1080c44c825aea2e6' aria-label='With extreme difficulty' aria-invalid='false' aria-required=\"false\"> <span>With extreme difficulty<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_6_ad08f05ecf3263bb03b06964549a1f3c\"><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"No, impossible\"  id='checkbox_6_ad08f05ecf3263bb03b06964549a1f3c' aria-label='No, impossible' aria-invalid='false' aria-required=\"false\"> <span>No, impossible<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"7. Have you been limping when walking because of your knee?\">7. Have you been limping when walking because of your knee?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_7_17b4e55d27524796f0dda2c4904841f3\"><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Rarely \/never\"  id='checkbox_7_17b4e55d27524796f0dda2c4904841f3' aria-label='Rarely \/never' aria-invalid='false' aria-required=\"false\"> <span>Rarely \/never<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_7_efba8fc082b10069c1b07d26d5ee4c64\"><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Sometimes, or just at first\"  id='checkbox_7_efba8fc082b10069c1b07d26d5ee4c64' aria-label='Sometimes, or just at first' aria-invalid='false' aria-required=\"false\"> <span>Sometimes, or just at first<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_7_756af01e7497e8d91dde6e94d9662b0a\"><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Often, not just at fisrt\"  id='checkbox_7_756af01e7497e8d91dde6e94d9662b0a' aria-label='Often, not just at fisrt' aria-invalid='false' aria-required=\"false\"> <span>Often, not just at fisrt<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_7_2fb0843d127dcf35ef16376edf1d5c69\"><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Most of the time\"  id='checkbox_7_2fb0843d127dcf35ef16376edf1d5c69' aria-label='Most of the time' aria-invalid='false' aria-required=\"false\"> <span>Most of the time<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_7_6b667975cb31754468b8277e3ddd5b11\"><input  type=\"checkbox\" name=\"checkbox_7[]\" data-name=\"checkbox_7\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"All of the time\"  id='checkbox_7_6b667975cb31754468b8277e3ddd5b11' aria-label='All of the time' aria-invalid='false' aria-required=\"false\"> <span>All of the time<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"9. Could you kneel down and get up again afterwards?\">9. Could you kneel down and get up again afterwards?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_9_14bef92912a595091344518e1b1defc5\"><input  type=\"checkbox\" name=\"checkbox_9[]\" data-name=\"checkbox_9\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Yes, easily\"  id='checkbox_9_14bef92912a595091344518e1b1defc5' aria-label='Yes, easily' aria-invalid='false' aria-required=\"false\"> <span>Yes, easily<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_9_6d5a4ca5f8178c30f56ff745fb4e70c7\"><input  type=\"checkbox\" name=\"checkbox_9[]\" data-name=\"checkbox_9\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Slightly painful\"  id='checkbox_9_6d5a4ca5f8178c30f56ff745fb4e70c7' aria-label='Slightly painful' aria-invalid='false' aria-required=\"false\"> <span>Slightly painful<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_9_2e14938f3b4a3bc9f58da6c303afc899\"><input  type=\"checkbox\" name=\"checkbox_9[]\" data-name=\"checkbox_9\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Moderately painful\"  id='checkbox_9_2e14938f3b4a3bc9f58da6c303afc899' aria-label='Moderately painful' aria-invalid='false' aria-required=\"false\"> <span>Moderately painful<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_9_e77b5942b3cc9029d5eb66c35c8b91ae\"><input  type=\"checkbox\" name=\"checkbox_9[]\" data-name=\"checkbox_9\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Very painful\"  id='checkbox_9_e77b5942b3cc9029d5eb66c35c8b91ae' aria-label='Very painful' aria-invalid='false' aria-required=\"false\"> <span>Very painful<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_9_21600ad449c4e325e769a3d18d08784e\"><input  type=\"checkbox\" name=\"checkbox_9[]\" data-name=\"checkbox_9\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Unbearable \/ No, impossible\"  id='checkbox_9_21600ad449c4e325e769a3d18d08784e' aria-label='Unbearable \/ No, impossible' aria-invalid='false' aria-required=\"false\"> <span>Unbearable \/ No, impossible<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"10. Have you had any trouble with washing and drying yourself (all over)?\">10. Have you had any trouble with washing and drying yourself (all over)?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_10_79c96678681875479417376a9f398eaa\"><input  type=\"checkbox\" name=\"checkbox_10[]\" data-name=\"checkbox_10\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Not trouble at all\"  id='checkbox_10_79c96678681875479417376a9f398eaa' aria-label='Not trouble at all' aria-invalid='false' aria-required=\"false\"> <span>Not trouble at all<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_10_b5dfa08f9b83bec98e27790991b2f7d6\"><input  type=\"checkbox\" name=\"checkbox_10[]\" data-name=\"checkbox_10\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Very little trouble\"  id='checkbox_10_b5dfa08f9b83bec98e27790991b2f7d6' aria-label='Very little trouble' aria-invalid='false' aria-required=\"false\"> <span>Very little trouble<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_10_40f4cea101b399123d2dd64e45dd3737\"><input  type=\"checkbox\" name=\"checkbox_10[]\" data-name=\"checkbox_10\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Moderate trouble\"  id='checkbox_10_40f4cea101b399123d2dd64e45dd3737' aria-label='Moderate trouble' aria-invalid='false' aria-required=\"false\"> <span>Moderate trouble<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_10_4d83d6e518cc0edb5cccf66d5666a86b\"><input  type=\"checkbox\" name=\"checkbox_10[]\" data-name=\"checkbox_10\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Extreme trouble\"  id='checkbox_10_4d83d6e518cc0edb5cccf66d5666a86b' aria-label='Extreme trouble' aria-invalid='false' aria-required=\"false\"> <span>Extreme trouble<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_10_fa46486852ed956b3c51864a97ca485a\"><input  type=\"checkbox\" name=\"checkbox_10[]\" data-name=\"checkbox_10\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Impossible to do\"  id='checkbox_10_fa46486852ed956b3c51864a97ca485a' aria-label='Impossible to do' aria-invalid='false' aria-required=\"false\"> <span>Impossible to do<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"11. Have you had any trouble getting in and out of a car or using public transport because of your knee?\">11. Have you had any trouble getting in and out of a car or using public transport because of your knee?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_11_ec3657349cdda4b442ad64ea50618f11\"><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Not trouble at all\"  id='checkbox_11_ec3657349cdda4b442ad64ea50618f11' aria-label='Not trouble at all' aria-invalid='false' aria-required=\"false\"> <span>Not trouble at all<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_11_3d10df07d04ea622e56987605e592904\"><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Very little trouble\"  id='checkbox_11_3d10df07d04ea622e56987605e592904' aria-label='Very little trouble' aria-invalid='false' aria-required=\"false\"> <span>Very little trouble<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_11_0f0569dbb1e3eda2e4358ae3349bc523\"><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Moderate trouble\"  id='checkbox_11_0f0569dbb1e3eda2e4358ae3349bc523' aria-label='Moderate trouble' aria-invalid='false' aria-required=\"false\"> <span>Moderate trouble<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_11_b2fbcabe3a7b464442c2d8d59ca69ba7\"><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Extreme trouble\"  id='checkbox_11_b2fbcabe3a7b464442c2d8d59ca69ba7' aria-label='Extreme trouble' aria-invalid='false' aria-required=\"false\"> <span>Extreme trouble<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_11_13aaf389c79514b90db9865c71689216\"><input  type=\"checkbox\" name=\"checkbox_11[]\" data-name=\"checkbox_11\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Impossible to do\"  id='checkbox_11_13aaf389c79514b90db9865c71689216' aria-label='Impossible to do' aria-invalid='false' aria-required=\"false\"> <span>Impossible to do<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"12. Could you do the household shopping on your own?\">12. Could you do the household shopping on your own?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_12_d309a6fe6b45a00eea62a7bed9050495\"><input  type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Yes, easily\"  id='checkbox_12_d309a6fe6b45a00eea62a7bed9050495' aria-label='Yes, easily' aria-invalid='false' aria-required=\"false\"> <span>Yes, easily<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_12_0ba9a0cc9f50cb77dc8316456bbc679a\"><input  type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"With little difficulty\"  id='checkbox_12_0ba9a0cc9f50cb77dc8316456bbc679a' aria-label='With little difficulty' aria-invalid='false' aria-required=\"false\"> <span>With little difficulty<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_12_ad0d215ea02bd9c29bd2e4c10e6c0f06\"><input  type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"With moderate difficulty\"  id='checkbox_12_ad0d215ea02bd9c29bd2e4c10e6c0f06' aria-label='With moderate difficulty' aria-invalid='false' aria-required=\"false\"> <span>With moderate difficulty<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_12_a79a3decf13f22983162e5dbb757cd85\"><input  type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"With extreme difficulty\"  id='checkbox_12_a79a3decf13f22983162e5dbb757cd85' aria-label='With extreme difficulty' aria-invalid='false' aria-required=\"false\"> <span>With extreme difficulty<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"checkbox_12_e5722a531a18562eccd4bbde7ecbd319\"><input  type=\"checkbox\" name=\"checkbox_12[]\" data-name=\"checkbox_12\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"No, impossible\"  id='checkbox_12_e5722a531a18562eccd4bbde7ecbd319' aria-label='No, impossible' aria-invalid='false' aria-required=\"false\"> <span>No, impossible<\/span><\/label><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Next<\/button><\/div><\/div><div class=\"fluentform-step\" data-name=\"form_step-4_4\" ><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_5\" ><p><strong>Instructions : Please rate the activities in catezory according to the following scale of dificulty:<\/strong><\/p>\n<p><strong>0 = None \u00a01 = Slight \u00a02 = Moderate \u00a03 = Very \u00a04 = Extremely \u00a0\u00a0<\/strong><\/p><\/div><div data-type='tabular-element' data-name='pian_tab' class='ff-el-group'><div class='ff-el-input--label asterisk-right'><label aria-label='Pian' for=''>Pian<\/label><\/div><div class='ff-el-input--content'><table class='ff-table ff-checkable-grids ff_flexible_table' role='table'><thead><tr><th><\/th><th>None<\/th><th>Slight<\/th><th>Moderate<\/th><th>Very<\/th><th>Extremely<\/th><\/tr><\/thead><tbody><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>1. Walking                                     <\/td><td data-label='None'><input aria-label=\"Walking                                     -None\" name=\"pian_tab[Walking                                     ]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Walking                                     -Slight\" name=\"pian_tab[Walking                                     ]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Walking                                     -Moderate\" name=\"pian_tab[Walking                                     ]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Walking                                     -Very\" name=\"pian_tab[Walking                                     ]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Walking                                     -Extremely\" name=\"pian_tab[Walking                                     ]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>2. Stair climbing<\/td><td data-label='None'><input aria-label=\"Stair climbing-None\" name=\"pian_tab[Stair climbing]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Stair climbing-Slight\" name=\"pian_tab[Stair climbing]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Stair climbing-Moderate\" name=\"pian_tab[Stair climbing]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Stair climbing-Very\" name=\"pian_tab[Stair climbing]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Stair climbing-Extremely\" name=\"pian_tab[Stair climbing]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>3. Nocturnal<\/td><td data-label='None'><input aria-label=\"Nocturnal-None\" name=\"pian_tab[Nocturnal]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Nocturnal-Slight\" name=\"pian_tab[Nocturnal]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Nocturnal-Moderate\" name=\"pian_tab[Nocturnal]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Nocturnal-Very\" name=\"pian_tab[Nocturnal]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Nocturnal-Extremely\" name=\"pian_tab[Nocturnal]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>4. Rest<\/td><td data-label='None'><input aria-label=\"Rest-None\" name=\"pian_tab[Rest]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Rest-Slight\" name=\"pian_tab[Rest]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Rest-Moderate\" name=\"pian_tab[Rest]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Rest-Very\" name=\"pian_tab[Rest]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Rest-Extremely\" name=\"pian_tab[Rest]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>5. Weight bearing<\/td><td data-label='None'><input aria-label=\"Weight bearing-None\" name=\"pian_tab[Weight bearing]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Weight bearing-Slight\" name=\"pian_tab[Weight bearing]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Weight bearing-Moderate\" name=\"pian_tab[Weight bearing]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Weight bearing-Very\" name=\"pian_tab[Weight bearing]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Weight bearing-Extremely\" name=\"pian_tab[Weight bearing]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><\/tbody><\/table><\/div><\/div><div data-type='tabular-element' data-name='stiffness_grid' class='ff-el-group'><div class='ff-el-input--label asterisk-right'><label aria-label='Stiffness' for=''>Stiffness<\/label><\/div><div class='ff-el-input--content'><table class='ff-table ff-checkable-grids ff_flexible_table' role='table'><thead><tr><th><\/th><th>None<\/th><th>Slight<\/th><th>Moderate<\/th><th>Very<\/th><th>Extremely<\/th><\/tr><\/thead><tbody><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>1. Morning Stiffness<\/td><td data-label='None'><input aria-label=\"Morning Stiffness-None\" name=\"stiffness_grid[Morning Stiffness]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Morning Stiffness-Slight\" name=\"stiffness_grid[Morning Stiffness]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Morning Stiffness-Moderate\" name=\"stiffness_grid[Morning Stiffness]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Morning Stiffness-Very\" name=\"stiffness_grid[Morning Stiffness]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Morning Stiffness-Extremely\" name=\"stiffness_grid[Morning Stiffness]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>2. Stiffness occurring later in the day<\/td><td data-label='None'><input aria-label=\"Stiffness occurring later in the day-None\" name=\"stiffness_grid[Stiffness occurring later in the day]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Stiffness occurring later in the day-Slight\" name=\"stiffness_grid[Stiffness occurring later in the day]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Stiffness occurring later in the day-Moderate\" name=\"stiffness_grid[Stiffness occurring later in the day]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Stiffness occurring later in the day-Very\" name=\"stiffness_grid[Stiffness occurring later in the day]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Stiffness occurring later in the day-Extremely\" name=\"stiffness_grid[Stiffness occurring later in the day]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><\/tbody><\/table><\/div><\/div><div data-type='tabular-element' data-name='physical_grid' class='ff-el-group'><div class='ff-el-input--label asterisk-right'><label aria-label='Physical Function' for=''>Physical Function<\/label><\/div><div class='ff-el-input--content'><table class='ff-table ff-checkable-grids ff_flexible_table' role='table'><thead><tr><th><\/th><th>None<\/th><th>Slight<\/th><th>Moderate<\/th><th>Very<\/th><th>Extremely<\/th><\/tr><\/thead><tbody><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>1. Descending Stairs<\/td><td data-label='None'><input aria-label=\"Descending Stairs-None\" name=\"physical_grid[Descending Stairs]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Descending Stairs-Slight\" name=\"physical_grid[Descending Stairs]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Descending Stairs-Moderate\" name=\"physical_grid[Descending Stairs]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Descending Stairs-Very\" name=\"physical_grid[Descending Stairs]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Descending Stairs-Extremely\" name=\"physical_grid[Descending Stairs]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>2. Ascending stairs<\/td><td data-label='None'><input aria-label=\"Ascending stairs-None\" name=\"physical_grid[Ascending stairs]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Ascending stairs-Slight\" name=\"physical_grid[Ascending stairs]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Ascending stairs-Moderate\" name=\"physical_grid[Ascending stairs]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Ascending stairs-Very\" name=\"physical_grid[Ascending stairs]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Ascending stairs-Extremely\" name=\"physical_grid[Ascending stairs]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>3. Rising from sitting<\/td><td data-label='None'><input aria-label=\"Rising from sitting-None\" name=\"physical_grid[Rising from sitting]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Rising from sitting-Slight\" name=\"physical_grid[Rising from sitting]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Rising from sitting-Moderate\" name=\"physical_grid[Rising from sitting]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Rising from sitting-Very\" name=\"physical_grid[Rising from sitting]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Rising from sitting-Extremely\" name=\"physical_grid[Rising from sitting]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>4. Standing<\/td><td data-label='None'><input aria-label=\"Standing-None\" name=\"physical_grid[Standing]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Standing-Slight\" name=\"physical_grid[Standing]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Standing-Moderate\" name=\"physical_grid[Standing]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Standing-Very\" name=\"physical_grid[Standing]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Standing-Extremely\" name=\"physical_grid[Standing]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>5. Bending to floor<\/td><td data-label='None'><input aria-label=\"Bending to floor-None\" name=\"physical_grid[Bending to floor]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Bending to floor-Slight\" name=\"physical_grid[Bending to floor]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Bending to floor-Moderate\" name=\"physical_grid[Bending to floor]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Bending to floor-Very\" name=\"physical_grid[Bending to floor]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Bending to floor-Extremely\" name=\"physical_grid[Bending to floor]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>6. Walking on fiat surface<\/td><td data-label='None'><input aria-label=\"Walking on fiat surface-None\" name=\"physical_grid[Walking on fiat surface]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Walking on fiat surface-Slight\" name=\"physical_grid[Walking on fiat surface]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Walking on fiat surface-Moderate\" name=\"physical_grid[Walking on fiat surface]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Walking on fiat surface-Very\" name=\"physical_grid[Walking on fiat surface]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Walking on fiat surface-Extremely\" name=\"physical_grid[Walking on fiat surface]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>7.  Getting in\/out of car<\/td><td data-label='None'><input aria-label=\"Getting in\/out of car-None\" name=\"physical_grid[Getting in\/out of car]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Getting in\/out of car-Slight\" name=\"physical_grid[Getting in\/out of car]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Getting in\/out of car-Moderate\" name=\"physical_grid[Getting in\/out of car]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Getting in\/out of car-Very\" name=\"physical_grid[Getting in\/out of car]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Getting in\/out of car-Extremely\" name=\"physical_grid[Getting in\/out of car]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>8. Going shopping<\/td><td data-label='None'><input aria-label=\"Going shopping-None\" name=\"physical_grid[Going shopping]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Going shopping-Slight\" name=\"physical_grid[Going shopping]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Going shopping-Moderate\" name=\"physical_grid[Going shopping]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Going shopping-Very\" name=\"physical_grid[Going shopping]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Going shopping-Extremely\" name=\"physical_grid[Going shopping]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>9. Putting on socks<\/td><td data-label='None'><input aria-label=\"Putting on socks-None\" name=\"physical_grid[Putting on socks]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Putting on socks-Slight\" name=\"physical_grid[Putting on socks]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Putting on socks-Moderate\" name=\"physical_grid[Putting on socks]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Putting on socks-Very\" name=\"physical_grid[Putting on socks]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Putting on socks-Extremely\" name=\"physical_grid[Putting on socks]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>10. Lying in bed<\/td><td data-label='None'><input aria-label=\"Lying in bed-None\" name=\"physical_grid[Lying in bed]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Lying in bed-Slight\" name=\"physical_grid[Lying in bed]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Lying in bed-Moderate\" name=\"physical_grid[Lying in bed]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Lying in bed-Very\" name=\"physical_grid[Lying in bed]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Lying in bed-Extremely\" name=\"physical_grid[Lying in bed]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>11. Taking off socks<\/td><td data-label='None'><input aria-label=\"Taking off socks-None\" name=\"physical_grid[Taking off socks]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Taking off socks-Slight\" name=\"physical_grid[Taking off socks]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Taking off socks-Moderate\" name=\"physical_grid[Taking off socks]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Taking off socks-Very\" name=\"physical_grid[Taking off socks]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Taking off socks-Extremely\" name=\"physical_grid[Taking off socks]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>12. Rising from bed<\/td><td data-label='None'><input aria-label=\"Rising from bed-None\" name=\"physical_grid[Rising from bed]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Rising from bed-Slight\" name=\"physical_grid[Rising from bed]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Rising from bed-Moderate\" name=\"physical_grid[Rising from bed]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Rising from bed-Very\" name=\"physical_grid[Rising from bed]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Rising from bed-Extremely\" name=\"physical_grid[Rising from bed]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>13. Getting in\/out bath<\/td><td data-label='None'><input aria-label=\"Getting in\/out bath-None\" name=\"physical_grid[Getting in\/out bath]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Getting in\/out bath-Slight\" name=\"physical_grid[Getting in\/out bath]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Getting in\/out bath-Moderate\" name=\"physical_grid[Getting in\/out bath]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Getting in\/out bath-Very\" name=\"physical_grid[Getting in\/out bath]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Getting in\/out bath-Extremely\" name=\"physical_grid[Getting in\/out bath]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>14. Sitting<\/td><td data-label='None'><input aria-label=\"Sitting-None\" name=\"physical_grid[Sitting]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Sitting-Slight\" name=\"physical_grid[Sitting]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Sitting-Moderate\" name=\"physical_grid[Sitting]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Sitting-Very\" name=\"physical_grid[Sitting]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Sitting-Extremely\" name=\"physical_grid[Sitting]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>15. Getting on\/off toilet<\/td><td data-label='None'><input aria-label=\"Getting on\/off toilet-None\" name=\"physical_grid[Getting on\/off toilet]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Getting on\/off toilet-Slight\" name=\"physical_grid[Getting on\/off toilet]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Getting on\/off toilet-Moderate\" name=\"physical_grid[Getting on\/off toilet]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Getting on\/off toilet-Very\" name=\"physical_grid[Getting on\/off toilet]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Getting on\/off toilet-Extremely\" name=\"physical_grid[Getting on\/off toilet]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>16. Heavy domestic duties<\/td><td data-label='None'><input aria-label=\"Heavy domestic duties-None\" name=\"physical_grid[Heavy domestic duties]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Heavy domestic duties-Slight\" name=\"physical_grid[Heavy domestic duties]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Heavy domestic duties-Moderate\" name=\"physical_grid[Heavy domestic duties]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Heavy domestic duties-Very\" name=\"physical_grid[Heavy domestic duties]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Heavy domestic duties-Extremely\" name=\"physical_grid[Heavy domestic duties]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><tr role=\"row\"\"><td class='ff_grid_header' role='cell'>17. Light domestic duties<\/td><td data-label='None'><input aria-label=\"Light domestic duties-None\" name=\"physical_grid[Light domestic duties]\" type=\"radio\" value=\"None\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Slight'><input aria-label=\"Light domestic duties-Slight\" name=\"physical_grid[Light domestic duties]\" type=\"radio\" value=\"Slight\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Moderate'><input aria-label=\"Light domestic duties-Moderate\" name=\"physical_grid[Light domestic duties]\" type=\"radio\" value=\"Moderate\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Very'><input aria-label=\"Light domestic duties-Very\" name=\"physical_grid[Light domestic duties]\" type=\"radio\" value=\"Very\"   aria-invalid='false' aria-required=\"false\"><\/td><td data-label='Extremely'><input aria-label=\"Light domestic duties-Extremely\" name=\"physical_grid[Light domestic duties]\" type=\"radio\" value=\"Extremely\"   aria-invalid='false' aria-required=\"false\"><\/td><\/tr><\/tbody><\/table><\/div><\/div><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Next<\/button><\/div><\/div><div class=\"fluentform-step\" data-name=\"form_step-4_6\" ><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_7\" ><p><strong>Daily Living Ability Barthel ADL index<\/strong><\/p><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"1. Feeding (Eating when the meal is prepared in front of you.)\">1. Feeding (Eating when the meal is prepared in front of you.)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_2_139a863b1029b6fe612342579e07688a\"><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Cannot scoop food into the mouth; someone has to feed.\"  id='input_radio_2_139a863b1029b6fe612342579e07688a' aria-label='0. Cannot scoop food into the mouth; someone has to feed.' aria-invalid='false' aria-required=\"false\"> <span>0. Cannot scoop food into the mouth; someone has to feed.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_2_c1214a773731ba4f62389bba0986a356\"><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. Can scoop food by yourself but needs help, such as having someone prepare the food with a spoon or cut it into small pieces in advance.\"  id='input_radio_2_c1214a773731ba4f62389bba0986a356' aria-label='1. Can scoop food by yourself but needs help, such as having someone prepare the food with a spoon or cut it into small pieces in advance.' aria-invalid='false' aria-required=\"false\"> <span>1. Can scoop food by yourself but needs help, such as having someone prepare the food with a spoon or cut it into small pieces in advance.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_2_8f3767acddfd885513e26f7a7d51bdf3\"><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"2. Can scoop food and help yourself normally.\"  id='input_radio_2_8f3767acddfd885513e26f7a7d51bdf3' aria-label='2. Can scoop food and help yourself normally.' aria-invalid='false' aria-required=\"false\"> <span>2. Can scoop food and help yourself normally.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"2. Grooming (Washing face, combing hairs, brushing tooth, and shaving within the last 24 to 28 hours.)\">2. Grooming (Washing face, combing hairs, brushing tooth, and shaving within the last 24 to 28 hours.)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_3_ebedf0b5b505a5ce39c2793c34281479\"><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Need help\"  id='input_radio_3_ebedf0b5b505a5ce39c2793c34281479' aria-label='0. Need help' aria-invalid='false' aria-required=\"false\"> <span>0. Need help<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_3_ab78e7afa546a2d836e51a0c91a05c28\"><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. You can do it yourself (including those that you can do yourself if the equipment is prepared).\"  id='input_radio_3_ab78e7afa546a2d836e51a0c91a05c28' aria-label='1. You can do it yourself (including those that you can do yourself if the equipment is prepared).' aria-invalid='false' aria-required=\"false\"> <span>1. You can do it yourself (including those that you can do yourself if the equipment is prepared).<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"3. Transfer (Getting up and sitting up from bed, or moving from the bed to a chair)\">3. Transfer (Getting up and sitting up from bed, or moving from the bed to a chair)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_4_2cc2f51344b6bdbcf85039ecffb3f776\"><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Unable to sit (always falls over when sitting) or requires two people to lift you up.\"  id='input_radio_4_2cc2f51344b6bdbcf85039ecffb3f776' aria-label='0. Unable to sit (always falls over when sitting) or requires two people to lift you up.' aria-invalid='false' aria-required=\"false\"> <span>0. Unable to sit (always falls over when sitting) or requires two people to lift you up.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_4_874547f7cf748b60cd84e42fe57c4da0\"><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. Require significant assistance to sit, such as one strong or skilled person, or two ordinary people to support or lift you in order to sit.\"  id='input_radio_4_874547f7cf748b60cd84e42fe57c4da0' aria-label='1. Require significant assistance to sit, such as one strong or skilled person, or two ordinary people to support or lift you in order to sit.' aria-invalid='false' aria-required=\"false\"> <span>1. Require significant assistance to sit, such as one strong or skilled person, or two ordinary people to support or lift you in order to sit.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_4_20852d5ba57aaf89cc60875cb3ccf1f2\"><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"2. Require some assistance, such as being instructed to follow or receiving slight support, or having someone to supervise for safety.\"  id='input_radio_4_20852d5ba57aaf89cc60875cb3ccf1f2' aria-label='2. Require some assistance, such as being instructed to follow or receiving slight support, or having someone to supervise for safety.' aria-invalid='false' aria-required=\"false\"> <span>2. Require some assistance, such as being instructed to follow or receiving slight support, or having someone to supervise for safety.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_4_8fd8351c8d3cbc3ad44c1ebb2ad87c64\"><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"3. Can perform by yourself.\"  id='input_radio_4_8fd8351c8d3cbc3ad44c1ebb2ad87c64' aria-label='3. Can perform by yourself.' aria-invalid='false' aria-required=\"false\"> <span>3. Can perform by yourself.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"4. Toilet use\">4. Toilet use<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_5_7a1f4a2bf01c16e689f3a35cc110f5b3\"><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Cannot help yourself.\"  id='input_radio_5_7a1f4a2bf01c16e689f3a35cc110f5b3' aria-label='0. Cannot help yourself.' aria-invalid='false' aria-required=\"false\"> <span>0. Cannot help yourself.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_5_efc3f0a0cdbe4cbe0d66b4a74582893e\"><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. Can do some things by yourself (at least clean up after finishing) but needs help with certain tasks.\"  id='input_radio_5_efc3f0a0cdbe4cbe0d66b4a74582893e' aria-label='1. Can do some things by yourself (at least clean up after finishing) but needs help with certain tasks.' aria-invalid='false' aria-required=\"false\"> <span>1. Can do some things by yourself (at least clean up after finishing) but needs help with certain tasks.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_5_58a38edd5fec3589d3da2345a5e4254a\"><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"2. Can help yourself well (can get on and off the toilet independently, can clean up properly after finishing, and can put on clothes neatly).\"  id='input_radio_5_58a38edd5fec3589d3da2345a5e4254a' aria-label='2. Can help yourself well (can get on and off the toilet independently, can clean up properly after finishing, and can put on clothes neatly).' aria-invalid='false' aria-required=\"false\"> <span>2. Can help yourself well (can get on and off the toilet independently, can clean up properly after finishing, and can put on clothes neatly).<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"5. Mobility (Movement within a room or house)\">5. Mobility (Movement within a room or house)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_6_97695d269f5378b5a7f628c9215ea277\"><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Can&#039;t move anywhere\"  id='input_radio_6_97695d269f5378b5a7f628c9215ea277' aria-label='0. Can&#039;t move anywhere' aria-invalid='false' aria-required=\"false\"> <span>0. Can't move anywhere<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_6_57ad71aceefef8964aae5084dcad4b58\"><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. Require a wheelchair to move around independently (without needing someone to push) and can navigate corners or doorways.\"  id='input_radio_6_57ad71aceefef8964aae5084dcad4b58' aria-label='1. Require a wheelchair to move around independently (without needing someone to push) and can navigate corners or doorways.' aria-invalid='false' aria-required=\"false\"> <span>1. Require a wheelchair to move around independently (without needing someone to push) and can navigate corners or doorways.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_6_ced4ddc770a139313d2c651d40230a96\"><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"2. Walking or moving with assistance, such as being supported or told to do something, or requiring attention for safety.\"  id='input_radio_6_ced4ddc770a139313d2c651d40230a96' aria-label='2. Walking or moving with assistance, such as being supported or told to do something, or requiring attention for safety.' aria-invalid='false' aria-required=\"false\"> <span>2. Walking or moving with assistance, such as being supported or told to do something, or requiring attention for safety.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_6_af818a3713dc00105e9c86848df19b53\"><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"3. Can walk or move on your own.\"  id='input_radio_6_af818a3713dc00105e9c86848df19b53' aria-label='3. Can walk or move on your own.' aria-invalid='false' aria-required=\"false\"> <span>3. Can walk or move on your own.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"6. Dressing (Wearing clothes)\">6. Dressing (Wearing clothes)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_7_b3976f76a64266a7178e5407e990afa0\"><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Need someone to help put on clothing; can hardly help yourself or can do so very little.\"  id='input_radio_7_b3976f76a64266a7178e5407e990afa0' aria-label='0. Need someone to help put on clothing; can hardly help yourself or can do so very little.' aria-invalid='false' aria-required=\"false\"> <span>0. Need someone to help put on clothing; can hardly help yourself or can do so very little.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_7_4144be34bc2c5921bfa07a26a9730405\"><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. Can help yourself about 50%; the rest requires assistance from others.\"  id='input_radio_7_4144be34bc2c5921bfa07a26a9730405' aria-label='1. Can help yourself about 50%; the rest requires assistance from others.' aria-invalid='false' aria-required=\"false\"> <span>1. Can help yourself about 50%; the rest requires assistance from others.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_7_cdc43cff78f68e13ebbd274f64dc52fd\"><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"2. Can help yourself well (including buttoning, zipping, or using adapted clothing that is suitable).\"  id='input_radio_7_cdc43cff78f68e13ebbd274f64dc52fd' aria-label='2. Can help yourself well (including buttoning, zipping, or using adapted clothing that is suitable).' aria-invalid='false' aria-required=\"false\"> <span>2. Can help yourself well (including buttoning, zipping, or using adapted clothing that is suitable).<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"7. Stairs (Going up and down one floor)\">7. Stairs (Going up and down one floor)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_8_5ddb7726b771bb97fc7a1de930b5cadc\"><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Not possible\"  id='input_radio_8_5ddb7726b771bb97fc7a1de930b5cadc' aria-label='0. Not possible' aria-invalid='false' aria-required=\"false\"> <span>0. Not possible<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_8_ac5a0f5788ce72df8cc6a53c98f45a0c\"><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. Need assistance\"  id='input_radio_8_ac5a0f5788ce72df8cc6a53c98f45a0c' aria-label='1. Need assistance' aria-invalid='false' aria-required=\"false\"> <span>1. Need assistance<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_8_85a7ad817abbb515fcdcaa806b3734a4\"><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"2. Can go up and down on your own (if a walking aid, such as a walker, is required, it must also be able to assist you in going up and down).\"  id='input_radio_8_85a7ad817abbb515fcdcaa806b3734a4' aria-label='2. Can go up and down on your own (if a walking aid, such as a walker, is required, it must also be able to assist you in going up and down).' aria-invalid='false' aria-required=\"false\"> <span>2. Can go up and down on your own (if a walking aid, such as a walker, is required, it must also be able to assist you in going up and down).<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"8. Bathing\">8. Bathing<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_9_0c6be706b617ccc208242fe60557298f\"><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Need assistance or need someone to help do it.\"  id='input_radio_9_0c6be706b617ccc208242fe60557298f' aria-label='0. Need assistance or need someone to help do it.' aria-invalid='false' aria-required=\"false\"> <span>0. Need assistance or need someone to help do it.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_9_7336a8e847dcc2e917d91700f788f489\"><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. Can take a bath yourself.\"  id='input_radio_9_7336a8e847dcc2e917d91700f788f489' aria-label='1. Can take a bath yourself.' aria-invalid='false' aria-required=\"false\"> <span>1. Can take a bath yourself.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"9. Bowels (Retention of feces in the past week)\">9. Bowels (Retention of feces in the past week)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_10_df3578d25f96b80aea989ed9e964ad60\"><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Cannot hold it or always requires an enema.\"  id='input_radio_10_df3578d25f96b80aea989ed9e964ad60' aria-label='0. Cannot hold it or always requires an enema.' aria-invalid='false' aria-required=\"false\"> <span>0. Cannot hold it or always requires an enema.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_10_88b24f0957726c4e02f378a2bf33ee74\"><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. Sometimes cannot hold it (less than once a week).\"  id='input_radio_10_88b24f0957726c4e02f378a2bf33ee74' aria-label='1. Sometimes cannot hold it (less than once a week).' aria-invalid='false' aria-required=\"false\"> <span>1. Sometimes cannot hold it (less than once a week).<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_10_270b7647cb5a1fab19548144bc6f035d\"><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"2. Can hold it as usual.\"  id='input_radio_10_270b7647cb5a1fab19548144bc6f035d' aria-label='2. Can hold it as usual.' aria-invalid='false' aria-required=\"false\"> <span>2. Can hold it as usual.<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  aria-label=\"10. Bladder (Urinary retention in the past week)\">10. Bladder (Urinary retention in the past week)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_11_6b49489d8b6cc797bc637e402f94e836\"><input  type=\"radio\" name=\"input_radio_11\" data-name=\"input_radio_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"0. Cannot hold it, or requires a urinary catheter but cannot take care of it by yourself.\"  id='input_radio_11_6b49489d8b6cc797bc637e402f94e836' aria-label='0. Cannot hold it, or requires a urinary catheter but cannot take care of it by yourself.' aria-invalid='false' aria-required=\"false\"> <span>0. Cannot hold it, or requires a urinary catheter but cannot take care of it by yourself.<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_11_94ddf240aeed1b8168a541feff7618a0\"><input  type=\"radio\" name=\"input_radio_11\" data-name=\"input_radio_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"1. Sometimes cannot hold it (less than once a week).\"  id='input_radio_11_94ddf240aeed1b8168a541feff7618a0' aria-label='1. Sometimes cannot hold it (less than once a week).' aria-invalid='false' aria-required=\"false\"> <span>1. Sometimes cannot hold it (less than once a week).<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for=\"input_radio_11_85011aa31ac4383e522938c3b6dd3118\"><input  type=\"radio\" name=\"input_radio_11\" data-name=\"input_radio_11\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"2. Can hold it as usual.\"  id='input_radio_11_85011aa31ac4383e522938c3b6dd3118' aria-label='2. Can hold it as usual.' aria-invalid='false' aria-required=\"false\"> <span>2. Can hold it as usual.<\/span><\/label><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><button  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary'>Next<\/button><\/div><\/div><div class=\"fluentform-step\" data-name=\"form_step-4_8\" ><div class='ff-el-group  ff-dropzone'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_file-upload_1' aria-label=\"Attract file\">Attract file<\/label><\/div><div class='ff-el-input--content'><label for='ff_4_file-upload_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn' tabindex='0'>Choose File<\/span> <input type=\"file\" name=\"file-upload\" id=\"ff_4_file-upload_1\" class=\"ff-el-form-control  ff-screen-reader-element\" data-name=\"file-upload\" multiple=\"1\"  aria-invalid='false' aria-required=\"false\"><\/label><\/div><\/div>        <div class=\"ff-step-t-container ff-inner_submit_container ff-column-container ff_columns_total_2\">\n            <div class=\"ff-t-cell ff-t-column-1\"><div class='step-nav ff_step_nav_last'><button  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary'>Previous<\/button><\/div><\/div>\n            <div class=\"ff-t-cell ff-t-column-2\">\n                <div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\" >Submit Form<\/button><\/div>            <\/div>\n        <\/div>\n        <\/div><\/div><\/div>\n        <\/fieldset><input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form><div id='fluentform_4_errors' class='ff-errors-in-stack ff_form_instance_4_1 ff-form-loading_errors ff_form_instance_4_1_errors'><\/div><\/div>        <script type=\"text\/javascript\">\n            window.fluent_form_ff_form_instance_4_1 = {\"id\":\"4\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"asteriskPlacement\":\"asterisk-right\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"cssClassName\":\"\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_4_1\",\"form_id_selector\":\"fluentform_4\",\"rules\":{\"input_radio_12\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"names[first_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"names[middle_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"names[last_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"datetime_1\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"numeric_field\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global_message\":\"This field must contain numeric value\",\"global\":true},\"min\":{\"value\":\"\",\"message\":\"Validation fails for minimum value\",\"global_message\":\"Validation fails for minimum value\",\"global\":true},\"max\":{\"value\":\"\",\"message\":\"Validation fails for maximum value\",\"global_message\":\"Validation fails for maximum value\",\"global\":true},\"digits\":{\"value\":\"\",\"message\":\"Validation fails for limited digits\",\"global_message\":\"Validation fails for limited 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required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_1\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_2\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_3\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_4\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_5\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_6\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_7\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_9\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_10\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_11\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"checkbox_12\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"pian_tab[Walking                                     ]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"pian_tab[Stair climbing]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"pian_tab[Nocturnal]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"pian_tab[Rest]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"pian_tab[Weight bearing]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"stiffness_grid[Morning Stiffness]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"stiffness_grid[Stiffness occurring later in the day]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Descending Stairs]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Ascending stairs]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Rising from sitting]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Standing]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Bending to floor]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Walking on fiat surface]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Getting in\\\/out of car]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Going shopping]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Putting on socks]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Lying in bed]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Taking off socks]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Rising from bed]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Getting in\\\/out bath]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Sitting]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true,\"per_row\":false}},\"physical_grid[Getting on\\\/off toilet]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is 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data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">Subscribe to our Newletter<\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f839d00 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"f839d00\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm elementor-animation-grow\" href=\"#\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">SIGN UP NOW<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7381b0a e-con-full e-flex e-con e-child\" data-id=\"7381b0a\" data-element_type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2b09ac9 elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"2b09ac9\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" id=\"Layer_2\" viewbox=\"0 0 81.7 109.5\"><polygon class=\"st0\" points=\"40.8 0 40.8 0 40.8 0 40.8 0\"><\/polygon><path class=\"st0\" d=\"M40.8,0C18.3,0,0,18.3,0,40.9s24,51,35.2,65.9c2.8,3.8,8.5,3.8,11.3,0,11.2-14.8,35.2-48.6,35.2-65.9S63.4,0,40.8,0ZM40.8,61c-11.1,0-20.1-9-20.1-20.1s9-20.1,20.1-20.1,20.1,9,20.1,20.1-9,20.1-20.1,20.1Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ba4e336 elementor-widget elementor-widget-heading\" data-id=\"ba4e336\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">Map and Directions<\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-35f2df4 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"35f2df4\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm elementor-animation-grow\" href=\"#\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">GET DIRECTIONS<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Appointment Form Please provide complete information so that the doctor can assess your symptoms before consulting. Appointment Appointment Method Personal Information Pain of Osteoarthritis of the knee Knees Score Modified WOMAC Scale for Knee Pain Daily Routine Assessment Please select which type of appointment you would prefer. Choose your appointment type: Clinic Visit (In-Person at [&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-29","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u0e19\u0e31\u0e14\u0e2b\u0e21\u0e32\u0e22\u0e1e\u0e1a\u0e41\u0e1e\u0e17\u0e22\u0e4c | Health Link Clinic \u2013 \u0e08\u0e2d\u0e07\u0e04\u0e34\u0e27\u0e07\u0e48\u0e32\u0e22 \u0e23\u0e27\u0e14\u0e40\u0e23\u0e47\u0e27 \u0e17\u0e31\u0e19\u0e43\u0e08<\/title>\n<meta name=\"description\" content=\"\u0e08\u0e2d\u0e07\u0e04\u0e34\u0e27\u0e1e\u0e1a\u0e41\u0e1e\u0e17\u0e22\u0e4c\u0e17\u0e35\u0e48 Health Link Clinic \u0e44\u0e14\u0e49\u0e07\u0e48\u0e32\u0e22 \u0e46 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