{"id":5306,"date":"2025-09-26T09:05:28","date_gmt":"2025-09-26T02:05:28","guid":{"rendered":"https:\/\/bangkokmentalhealthhospital.com\/?post_type=quizzes&#038;p=5306"},"modified":"2025-10-16T15:49:24","modified_gmt":"2025-10-16T08:49:24","slug":"happy-mom-check","status":"publish","type":"quizzes","link":"https:\/\/bangkokmentalhealthhospital.com\/th\/quizzes\/happy-mom-check\/","title":{"rendered":"1 \u0e40\u0e14\u0e37\u0e2d\u0e19 \u0e40\u0e0a\u0e47\u0e01\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e43\u0e08\u0e41\u0e21\u0e48\u0e17\u0e31\u0e48\u0e27\u0e44\u0e17\u0e22 Happy Mom Check: 1 Month Challenge"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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action='\/th\/wp-json\/wp\/v2\/quizzes\/5306#gf_18' data-formid='18' novalidate><div id='gf_page_steps_18' class='gf_page_steps'><div id='gf_step_18_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>\u0e04\u0e27\u0e32\u0e21\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21<\/span><\/div><div id='gf_step_18_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e17\u0e31\u0e48\u0e27\u0e44\u0e1b<\/span><\/div><div id='gf_step_18_3' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>\u0e41\u0e1a\u0e1a\u0e17\u0e14\u0e2a\u0e2d\u0e1a\u0e04\u0e31\u0e14\u0e01\u0e23\u0e2d\u0e07\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e08\u0e34\u0e15<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_18_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_18' class='gform_fields left_label form_sublabel_below description_below validation_below'><div id=\"field_18_47\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_47\" >\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e2a\u0e19\u0e31\u0e1a\u0e2a\u0e19\u0e38\u0e19\u0e40\u0e1b\u0e49\u0e32\u0e2b\u0e21\u0e32\u0e22\u0e02\u0e2d\u0e07\u0e42\u0e04\u0e23\u0e07\u0e01\u0e32\u0e23 \u201c1 \u0e40\u0e14\u0e37\u0e2d\u0e19 \u0e40\u0e0a\u0e47\u0e01\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e43\u0e08\u0e41\u0e21\u0e48\u0e17\u0e31\u0e48\u0e27\u0e44\u0e17\u0e22 Happy Mom Check: 30-Day Challenge\u201d \u0e0b\u0e36\u0e48\u0e07\u0e21\u0e35\u0e27\u0e31\u0e15\u0e16\u0e38\u0e1b\u0e23\u0e30\u0e2a\u0e07\u0e04\u0e4c\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e23\u0e27\u0e1a\u0e23\u0e27\u0e21\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e40\u0e0a\u0e34\u0e07\u0e25\u0e36\u0e01\u0e41\u0e25\u0e30\u0e08\u0e31\u0e14\u0e17\u0e33\u0e23\u0e32\u0e22\u0e07\u0e32\u0e19\u0e2a\u0e16\u0e32\u0e19\u0e01\u0e32\u0e23\u0e13\u0e4c\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e08\u0e34\u0e15\u0e02\u0e2d\u0e07\u0e41\u0e21\u0e48\u0e43\u0e19\u0e1b\u0e23\u0e30\u0e40\u0e17\u0e28\u0e44\u0e17\u0e22 \u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e02\u0e2d\u0e07\u0e04\u0e38\u0e13\u0e43\u0e19\u0e41\u0e1a\u0e1a\u0e2a\u0e33\u0e23\u0e27\u0e08\u0e19\u0e35\u0e49\u0e08\u0e30\u0e21\u0e35\u0e04\u0e27\u0e32\u0e21\u0e2a\u0e33\u0e04\u0e31\u0e0d\u0e2d\u0e22\u0e48\u0e32\u0e07\u0e22\u0e34\u0e48\u0e07\n<br>\n\u0e42\u0e1b\u0e23\u0e14\u0e1e\u0e34\u0e08\u0e32\u0e23\u0e13\u0e32\u0e41\u0e25\u0e30\u0e40\u0e25\u0e37\u0e2d\u0e01\u0e43\u0e2b\u0e49\u0e04\u0e27\u0e32\u0e21\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21\u0e15\u0e32\u0e21\u0e27\u0e31\u0e15\u0e16\u0e38\u0e1b\u0e23\u0e30\u0e2a\u0e07\u0e04\u0e4c\u0e14\u0e31\u0e07\u0e15\u0e48\u0e2d\u0e44\u0e1b\u0e19\u0e35\u0e49:\n<br><br>\n<h4><b>1. \u0e01\u0e32\u0e23\u0e43\u0e2b\u0e49\u0e04\u0e27\u0e32\u0e21\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e19\u0e33\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e44\u0e1b\u0e43\u0e0a\u0e49\u0e27\u0e34\u0e40\u0e04\u0e23\u0e32\u0e30\u0e2b\u0e4c\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e08\u0e31\u0e14\u0e17\u0e33\u0e23\u0e32\u0e22\u0e07\u0e32\u0e19\u0e1c\u0e25\u0e2a\u0e33\u0e23\u0e27\u0e08<\/b><\/h4>\n\n<ul><li><b>\u0e27\u0e31\u0e15\u0e16\u0e38\u0e1b\u0e23\u0e30\u0e2a\u0e07\u0e04\u0e4c:<\/b> \u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e08\u0e32\u0e01\u0e41\u0e1a\u0e1a\u0e2a\u0e33\u0e23\u0e27\u0e08\u0e02\u0e2d\u0e07\u0e04\u0e38\u0e13 (\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e17\u0e31\u0e48\u0e27\u0e44\u0e1b\u0e41\u0e25\u0e30\u0e1c\u0e25\u0e01\u0e32\u0e23\u0e1b\u0e23\u0e30\u0e40\u0e21\u0e34\u0e19 EPDS) \u0e08\u0e30\u0e16\u0e39\u0e01\u0e19\u0e33\u0e44\u0e1b\u0e23\u0e27\u0e21\u0e01\u0e31\u0e1a\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e02\u0e2d\u0e07\u0e1c\u0e39\u0e49\u0e40\u0e02\u0e49\u0e32\u0e23\u0e48\u0e27\u0e21\u0e17\u0e48\u0e32\u0e19\u0e2d\u0e37\u0e48\u0e19\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e27\u0e34\u0e40\u0e04\u0e23\u0e32\u0e30\u0e2b\u0e4c\u0e17\u0e32\u0e07\u0e2a\u0e16\u0e34\u0e15\u0e34\n\u0e42\u0e14\u0e22\u0e17\u0e35\u0e21\u0e08\u0e34\u0e15\u0e41\u0e1e\u0e17\u0e22\u0e4c\u0e41\u0e25\u0e30\u0e19\u0e31\u0e01\u0e08\u0e34\u0e15\u0e27\u0e34\u0e17\u0e22\u0e32\u0e02\u0e2d\u0e07\u0e42\u0e23\u0e07\u0e1e\u0e22\u0e32\u0e1a\u0e32\u0e25\u0e41\u0e1a\u0e07\u0e04\u0e47\u0e2d\u0e01 \u0e40\u0e21\u0e19\u0e17\u0e31\u0e25 \u0e40\u0e2e\u0e25\u0e17\u0e4c \u0e41\u0e25\u0e30\u0e19\u0e33\u0e40\u0e2a\u0e19\u0e2d\u0e1c\u0e25\u0e25\u0e31\u0e1e\u0e18\u0e4c\u0e43\u0e19\u0e23\u0e39\u0e1b\u0e41\u0e1a\u0e1a\u0e23\u0e32\u0e22\u0e07\u0e32\u0e19\u0e40\u0e0a\u0e34\u0e07\u0e25\u0e36\u0e01\u0e15\u0e48\u0e2d\u0e2a\u0e32\u0e18\u0e32\u0e23\u0e13\u0e30<\/li>\n<li><b>\u0e04\u0e27\u0e32\u0e21\u0e40\u0e1b\u0e47\u0e19\u0e2a\u0e48\u0e27\u0e19\u0e15\u0e31\u0e27:<\/b> \u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e17\u0e35\u0e48\u0e19\u0e33\u0e44\u0e1b\u0e43\u0e0a\u0e49\u0e43\u0e19\u0e01\u0e32\u0e23\u0e27\u0e34\u0e40\u0e04\u0e23\u0e32\u0e30\u0e2b\u0e4c\u0e08\u0e30\u0e40\u0e1b\u0e47\u0e19\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e41\u0e1a\u0e1a\u0e44\u0e21\u0e48\u0e23\u0e30\u0e1a\u0e38\u0e15\u0e31\u0e27\u0e15\u0e19 (Anonymized Data) \u0e41\u0e25\u0e30\u0e08\u0e30\u0e44\u0e21\u0e48\u0e21\u0e35\u0e01\u0e32\u0e23\u0e40\u0e1b\u0e34\u0e14\u0e40\u0e1c\u0e22\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e2a\u0e48\u0e27\u0e19\u0e1a\u0e38\u0e04\u0e04\u0e25\u0e17\u0e35\u0e48\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e23\u0e30\u0e1a\u0e38\u0e15\u0e31\u0e27\u0e15\u0e19\n\u0e02\u0e2d\u0e07\u0e04\u0e38\u0e13\u0e44\u0e14\u0e49\u0e42\u0e14\u0e22\u0e40\u0e14\u0e47\u0e14\u0e02\u0e32\u0e14<\/li><\/ul><\/div><fieldset id=\"field_18_48\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_48\" ><legend class='gfield_label gform-field-label' >\u0e15\u0e31\u0e27\u0e40\u0e25\u0e37\u0e2d\u0e01<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_48'>\n\t\t\t<div class='gchoice gchoice_18_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='\u0e02\u0e49\u0e32\u0e1e\u0e40\u0e08\u0e49\u0e32 \u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21 \u0e43\u0e2b\u0e49\u0e21\u0e35\u0e01\u0e32\u0e23\u0e19\u0e33\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e44\u0e1b\u0e43\u0e0a\u0e49\u0e27\u0e34\u0e40\u0e04\u0e23\u0e32\u0e30\u0e2b\u0e4c\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e27\u0e31\u0e15\u0e16\u0e38\u0e1b\u0e23\u0e30\u0e2a\u0e07\u0e04\u0e4c\u0e14\u0e31\u0e07\u0e01\u0e25\u0e48\u0e32\u0e27'  id='choice_18_48_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_48_0' id='label_18_48_0' class='gform-field-label gform-field-label--type-inline'>\u0e02\u0e49\u0e32\u0e1e\u0e40\u0e08\u0e49\u0e32 <b>&#8220;\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21&#8221;<\/b> \u0e43\u0e2b\u0e49\u0e21\u0e35\u0e01\u0e32\u0e23\u0e19\u0e33\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e44\u0e1b\u0e43\u0e0a\u0e49\u0e27\u0e34\u0e40\u0e04\u0e23\u0e32\u0e30\u0e2b\u0e4c\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e27\u0e31\u0e15\u0e16\u0e38\u0e1b\u0e23\u0e30\u0e2a\u0e07\u0e04\u0e4c\u0e14\u0e31\u0e07\u0e01\u0e25\u0e48\u0e32\u0e27<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='\u0e02\u0e49\u0e32\u0e1e\u0e40\u0e08\u0e49\u0e32 \u0e44\u0e21\u0e48\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21 \u0e43\u0e2b\u0e49\u0e21\u0e35\u0e01\u0e32\u0e23\u0e19\u0e33\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e44\u0e1b\u0e43\u0e0a\u0e49\u0e27\u0e34\u0e40\u0e04\u0e23\u0e32\u0e30\u0e2b\u0e4c\u0e43\u0e19\u0e04\u0e23\u0e31\u0e49\u0e07\u0e19\u0e35\u0e49'  id='choice_18_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_48_1' id='label_18_48_1' class='gform-field-label gform-field-label--type-inline'>\u0e02\u0e49\u0e32\u0e1e\u0e40\u0e08\u0e49\u0e32 <b>&#8220;\u0e44\u0e21\u0e48\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21&#8221;<\/b> \u0e43\u0e2b\u0e49\u0e21\u0e35\u0e01\u0e32\u0e23\u0e19\u0e33\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e44\u0e1b\u0e43\u0e0a\u0e49\u0e27\u0e34\u0e40\u0e04\u0e23\u0e32\u0e30\u0e2b\u0e4c\u0e43\u0e19\u0e04\u0e23\u0e31\u0e49\u0e07\u0e19\u0e35\u0e49<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_50\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_50\" ><h4><b>2. \u0e01\u0e32\u0e23\u0e43\u0e2b\u0e49\u0e04\u0e27\u0e32\u0e21\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e01\u0e32\u0e23\u0e15\u0e34\u0e14\u0e15\u0e48\u0e2d\u0e01\u0e25\u0e31\u0e1a\u0e43\u0e19\u0e2d\u0e19\u0e32\u0e04\u0e15<\/b><\/h4>\n\n<ul><li><b>\u0e27\u0e31\u0e15\u0e16\u0e38\u0e1b\u0e23\u0e30\u0e2a\u0e07\u0e04\u0e4c:<\/b> \u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e43\u0e2b\u0e49\u0e42\u0e23\u0e07\u0e1e\u0e22\u0e32\u0e1a\u0e32\u0e25\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e15\u0e34\u0e14\u0e15\u0e48\u0e2d\u0e04\u0e38\u0e13\u0e43\u0e19\u0e01\u0e23\u0e13\u0e35\u0e17\u0e35\u0e48\u0e15\u0e49\u0e2d\u0e07\u0e01\u0e32\u0e23\u0e43\u0e2b\u0e49\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e40\u0e1e\u0e34\u0e48\u0e21\u0e40\u0e15\u0e34\u0e21, \u0e01\u0e32\u0e23\u0e43\u0e2b\u0e49\u0e04\u0e33\u0e1b\u0e23\u0e36\u0e01\u0e29\u0e32\u0e40\u0e1a\u0e37\u0e49\u0e2d\u0e07\u0e15\u0e49\u0e19, \u0e2b\u0e23\u0e37\u0e2d\u0e40\u0e0a\u0e34\u0e0d\u0e40\u0e02\u0e49\u0e32\u0e23\u0e48\u0e27\u0e21\u0e01\u0e34\u0e08\u0e01\u0e23\u0e23\u0e21\u0e02\u0e2d\u0e07\u0e42\u0e04\u0e23\u0e07\u0e01\u0e32\u0e23\u0e43\u0e19\u0e2d\u0e19\u0e32\u0e04\u0e15 \u0e17\u0e35\u0e48\u0e40\u0e01\u0e35\u0e48\u0e22\u0e27\u0e02\u0e49\u0e2d\u0e07\u0e01\u0e31\u0e1a\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e08\u0e34\u0e15<\/li>\n<li><b>\u0e04\u0e27\u0e32\u0e21\u0e40\u0e1b\u0e47\u0e19\u0e2a\u0e48\u0e27\u0e19\u0e15\u0e31\u0e27:<\/b> \u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e2a\u0e33\u0e2b\u0e23\u0e31\u0e1a\u0e15\u0e34\u0e14\u0e15\u0e48\u0e2d\u0e02\u0e2d\u0e07\u0e04\u0e38\u0e13\u0e08\u0e30\u0e16\u0e39\u0e01\u0e40\u0e01\u0e47\u0e1a\u0e40\u0e1b\u0e47\u0e19\u0e04\u0e27\u0e32\u0e21\u0e25\u0e31\u0e1a\u0e41\u0e25\u0e30\u0e08\u0e30\u0e44\u0e21\u0e48\u0e21\u0e35\u0e01\u0e32\u0e23\u0e2a\u0e48\u0e07\u0e15\u0e48\u0e2d\u0e43\u0e2b\u0e49\u0e01\u0e31\u0e1a\u0e1a\u0e38\u0e04\u0e04\u0e25\u0e17\u0e35\u0e48\u0e2a\u0e32\u0e21\u0e2b\u0e23\u0e37\u0e2d\u0e2b\u0e19\u0e48\u0e27\u0e22\u0e07\u0e32\u0e19\u0e2d\u0e37\u0e48\u0e19\u0e43\u0e14<\/li><\/ul><\/div><fieldset id=\"field_18_49\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_49\" ><legend class='gfield_label gform-field-label' >\u0e15\u0e31\u0e27\u0e40\u0e25\u0e37\u0e2d\u0e01<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_49'>\n\t\t\t<div class='gchoice gchoice_18_49_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='\u0e02\u0e49\u0e32\u0e1e\u0e40\u0e08\u0e49\u0e32 \u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21 \u0e43\u0e2b\u0e49\u0e40\u0e08\u0e49\u0e32\u0e2b\u0e19\u0e49\u0e32\u0e17\u0e35\u0e48\u0e02\u0e2d\u0e07\u0e42\u0e23\u0e07\u0e1e\u0e22\u0e32\u0e1a\u0e32\u0e25\u0e2b\u0e23\u0e37\u0e2d\u0e40\u0e08\u0e49\u0e32\u0e2b\u0e19\u0e49\u0e32\u0e17\u0e35\u0e48\u0e1c\u0e39\u0e49\u0e40\u0e01\u0e35\u0e48\u0e22\u0e27\u0e02\u0e49\u0e2d\u0e07\u0e15\u0e34\u0e14\u0e15\u0e48\u0e2d\u0e01\u0e25\u0e31\u0e1a'  id='choice_18_49_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_49_0' id='label_18_49_0' class='gform-field-label gform-field-label--type-inline'>\u0e02\u0e49\u0e32\u0e1e\u0e40\u0e08\u0e49\u0e32 <b>&#8220;\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21&#8221;<\/b> \u0e43\u0e2b\u0e49\u0e40\u0e08\u0e49\u0e32\u0e2b\u0e19\u0e49\u0e32\u0e17\u0e35\u0e48\u0e02\u0e2d\u0e07\u0e42\u0e23\u0e07\u0e1e\u0e22\u0e32\u0e1a\u0e32\u0e25\u0e2b\u0e23\u0e37\u0e2d\u0e40\u0e08\u0e49\u0e32\u0e2b\u0e19\u0e49\u0e32\u0e17\u0e35\u0e48\u0e1c\u0e39\u0e49\u0e40\u0e01\u0e35\u0e48\u0e22\u0e27\u0e02\u0e49\u0e2d\u0e07\u0e15\u0e34\u0e14\u0e15\u0e48\u0e2d\u0e01\u0e25\u0e31\u0e1a<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_49_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='\u0e02\u0e49\u0e32\u0e1e\u0e40\u0e08\u0e49\u0e32 \u0e44\u0e21\u0e48\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21 \u0e43\u0e2b\u0e49\u0e21\u0e35\u0e01\u0e32\u0e23\u0e15\u0e34\u0e14\u0e15\u0e48\u0e2d\u0e01\u0e25\u0e31\u0e1a\u0e43\u0e19\u0e2d\u0e19\u0e32\u0e04\u0e15'  id='choice_18_49_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_49_1' id='label_18_49_1' class='gform-field-label gform-field-label--type-inline'>\u0e02\u0e49\u0e32\u0e1e\u0e40\u0e08\u0e49\u0e32 <b>&#8220;\u0e44\u0e21\u0e48\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21&#8221;<\/b> \u0e43\u0e2b\u0e49\u0e21\u0e35\u0e01\u0e32\u0e23\u0e15\u0e34\u0e14\u0e15\u0e48\u0e2d\u0e01\u0e25\u0e31\u0e1a\u0e43\u0e19\u0e2d\u0e19\u0e32\u0e04\u0e15<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_52\" ><label class='gfield_label gform-field-label' for='input_18_52'>\u0e0a\u0e37\u0e48\u0e2d-\u0e19\u0e32\u0e21\u0e2a\u0e01\u0e38\u0e25<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_18_52' type='text' value='' class='large'    placeholder='\u0e0a\u0e37\u0e48\u0e2d-\u0e19\u0e32\u0e21\u0e2a\u0e01\u0e38\u0e25' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_18_53\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_53\" ><label class='gfield_label gform-field-label' for='input_18_53'>\u0e40\u0e1a\u0e2d\u0e23\u0e4c\u0e42\u0e17\u0e23\u0e28\u0e31\u0e1e\u0e17\u0e4c<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_53' id='input_18_53' type='tel' value='' class='large'  placeholder='\u0e40\u0e1a\u0e2d\u0e23\u0e4c\u0e42\u0e17\u0e23\u0e28\u0e31\u0e1e\u0e17\u0e4c' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_18_51\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_51\" ><h4><b>\u0e02\u0e49\u0e2d\u0e15\u0e01\u0e25\u0e07\u0e41\u0e25\u0e30\u0e40\u0e07\u0e37\u0e48\u0e2d\u0e19\u0e44\u0e02: <\/b><\/h4>\n\n<ul><li>\u0e01\u0e32\u0e23\u0e15\u0e31\u0e14\u0e2a\u0e34\u0e19\u0e43\u0e08\u0e43\u0e2b\u0e49\u0e2b\u0e23\u0e37\u0e2d\u0e44\u0e21\u0e48\u0e43\u0e2b\u0e49\u0e04\u0e27\u0e32\u0e21\u0e22\u0e34\u0e19\u0e22\u0e2d\u0e21\u0e43\u0e19\u0e02\u0e49\u0e2d\u0e43\u0e14\u0e02\u0e49\u0e2d\u0e2b\u0e19\u0e36\u0e48\u0e07\u0e08\u0e30\u0e44\u0e21\u0e48\u0e2a\u0e48\u0e07\u0e1c\u0e25\u0e01\u0e23\u0e30\u0e17\u0e1a\u0e15\u0e48\u0e2d\u0e2a\u0e34\u0e17\u0e18\u0e34\u0e43\u0e19\u0e01\u0e32\u0e23\u0e17\u0e33\u0e41\u0e1a\u0e1a\u0e2a\u0e33\u0e23\u0e27\u0e08\u0e02\u0e2d\u0e07\u0e04\u0e38\u0e13<\/li>\n<li>\u0e04\u0e38\u0e13\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e22\u0e38\u0e15\u0e34\u0e01\u0e32\u0e23\u0e17\u0e33\u0e41\u0e1a\u0e1a\u0e2a\u0e33\u0e23\u0e27\u0e08\u0e44\u0e14\u0e49\u0e15\u0e25\u0e2d\u0e14\u0e40\u0e27\u0e25\u0e32<\/li><\/ul><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                         <input type='button' id='gform_next_button_18_42' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_18_2' class='gform_page' data-js='page-field-id-42' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_18_2' class='gform_fields left_label form_sublabel_below description_below validation_below'><div id=\"field_18_56\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_56\" >\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e43\u0e19\u0e2a\u0e48\u0e27\u0e19\u0e19\u0e35\u0e49\u0e40\u0e1b\u0e47\u0e19\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e40\u0e0a\u0e34\u0e07\u0e1b\u0e23\u0e30\u0e0a\u0e32\u0e01\u0e23\u0e28\u0e32\u0e2a\u0e15\u0e23\u0e4c (Demographic) \u0e17\u0e35\u0e48\u0e21\u0e35\u0e08\u0e38\u0e14\u0e1b\u0e23\u0e30\u0e2a\u0e07\u0e04\u0e4c\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e41\u0e1a\u0e48\u0e07\u0e01\u0e25\u0e38\u0e48\u0e21\u0e1c\u0e39\u0e49\u0e15\u0e2d\u0e1a\u0e41\u0e1a\u0e1a\u0e2a\u0e33\u0e23\u0e27\u0e08\u0e2a\u0e33\u0e2b\u0e23\u0e31\u0e1a\u0e01\u0e32\u0e23\u0e27\u0e34\u0e40\u0e04\u0e23\u0e32\u0e30\u0e2b\u0e4c\u0e1c\u0e25\u0e25\u0e31\u0e1e\u0e18\u0e4c\u0e40\u0e0a\u0e34\u0e07\u0e2a\u0e16\u0e34\u0e15\u0e34 <b>\u0e42\u0e14\u0e22\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e40\u0e2b\u0e25\u0e48\u0e32\u0e19\u0e35\u0e49\u0e08\u0e30\u0e44\u0e21\u0e48\u0e23\u0e30\u0e1a\u0e38\u0e15\u0e31\u0e27\u0e15\u0e19\u0e02\u0e2d\u0e07\u0e04\u0e38\u0e13<\/b> \u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e43\u0e2b\u0e49\u0e40\u0e23\u0e32\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e40\u0e02\u0e49\u0e32\u0e43\u0e08\u0e04\u0e27\u0e32\u0e21\u0e2a\u0e31\u0e21\u0e1e\u0e31\u0e19\u0e18\u0e4c\u0e23\u0e30\u0e2b\u0e27\u0e48\u0e32\u0e07\u0e02\u0e49\u0e2d\u0e21\u0e39\u0e25\u0e1e\u0e37\u0e49\u0e19\u0e10\u0e32\u0e19 (\u0e40\u0e0a\u0e48\u0e19 \u0e2d\u0e32\u0e22\u0e38, \u0e2d\u0e32\u0e0a\u0e35\u0e1e, \u0e08\u0e31\u0e07\u0e2b\u0e27\u0e31\u0e14\u0e17\u0e35\u0e48\u0e2d\u0e22\u0e39\u0e48) \u0e01\u0e31\u0e1a\u0e20\u0e32\u0e27\u0e30\u0e2a\u0e38\u0e02\u0e20\u0e32\u0e1e\u0e08\u0e34\u0e15\u0e44\u0e14\u0e49\u0e0a\u0e31\u0e14\u0e40\u0e08\u0e19\u0e22\u0e34\u0e48\u0e07\u0e02\u0e36\u0e49\u0e19 \u0e0b\u0e36\u0e48\u0e07\u0e08\u0e30\u0e0a\u0e48\u0e27\u0e22\u0e43\u0e2b\u0e49\u0e01\u0e32\u0e23\u0e2a\u0e23\u0e38\u0e1b\u0e1c\u0e25\u0e01\u0e32\u0e23\u0e2a\u0e33\u0e23\u0e27\u0e08\u0e21\u0e35\u0e04\u0e27\u0e32\u0e21\u0e41\u0e21\u0e48\u0e19\u0e22\u0e33\u0e41\u0e25\u0e30\u0e40\u0e1b\u0e47\u0e19\u0e1b\u0e23\u0e30\u0e42\u0e22\u0e0a\u0e19\u0e4c\u0e2a\u0e39\u0e07\u0e2a\u0e38\u0e14<\/div><fieldset id=\"field_18_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_55\" ><legend class='gfield_label gform-field-label' >\u0e2d\u0e32\u0e22\u0e38<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_55'>\n\t\t\t<div class='gchoice gchoice_18_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='\u0e15\u0e48\u0e33\u0e01\u0e27\u0e48\u0e32 20 \u0e1b\u0e35'  id='choice_18_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_55_0' id='label_18_55_0' class='gform-field-label gform-field-label--type-inline'>\u0e15\u0e48\u0e33\u0e01\u0e27\u0e48\u0e32 20 \u0e1b\u0e35<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='20 - 29 \u0e1b\u0e35'  id='choice_18_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_55_1' id='label_18_55_1' class='gform-field-label gform-field-label--type-inline'>20 &#8211; 29 \u0e1b\u0e35<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_55_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='30 - 39 \u0e1b\u0e35'  id='choice_18_55_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_55_2' id='label_18_55_2' class='gform-field-label gform-field-label--type-inline'>30 &#8211; 39 \u0e1b\u0e35<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_55_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='40 - 49 \u0e1b\u0e35'  id='choice_18_55_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_55_3' id='label_18_55_3' class='gform-field-label gform-field-label--type-inline'>40 &#8211; 49 \u0e1b\u0e35<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_55_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='50 \u0e1b\u0e35\u0e02\u0e36\u0e49\u0e19\u0e44\u0e1b'  id='choice_18_55_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_55_4' id='label_18_55_4' class='gform-field-label gform-field-label--type-inline'>50 \u0e1b\u0e35\u0e02\u0e36\u0e49\u0e19\u0e44\u0e1b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_57\" ><legend class='gfield_label gform-field-label' >\u0e2d\u0e32\u0e0a\u0e35\u0e1e\u0e1b\u0e31\u0e08\u0e08\u0e38\u0e1a\u0e31\u0e19<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_57'>\n\t\t\t<div class='gchoice gchoice_18_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u0e1e\u0e19\u0e31\u0e01\u0e07\u0e32\u0e19\u0e1a\u0e23\u0e34\u0e29\u0e31\u0e17\u0e40\u0e2d\u0e01\u0e0a\u0e19'  id='choice_18_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_57_0' id='label_18_57_0' class='gform-field-label gform-field-label--type-inline'>\u0e1e\u0e19\u0e31\u0e01\u0e07\u0e32\u0e19\u0e1a\u0e23\u0e34\u0e29\u0e31\u0e17\u0e40\u0e2d\u0e01\u0e0a\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u0e02\u0e49\u0e32\u0e23\u0e32\u0e0a\u0e01\u0e32\u0e23\/\u0e1e\u0e19\u0e31\u0e01\u0e07\u0e32\u0e19\u0e23\u0e31\u0e10\u0e27\u0e34\u0e2a\u0e32\u0e2b\u0e01\u0e34\u0e08'  id='choice_18_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_57_1' id='label_18_57_1' class='gform-field-label gform-field-label--type-inline'>\u0e02\u0e49\u0e32\u0e23\u0e32\u0e0a\u0e01\u0e32\u0e23\/\u0e1e\u0e19\u0e31\u0e01\u0e07\u0e32\u0e19\u0e23\u0e31\u0e10\u0e27\u0e34\u0e2a\u0e32\u0e2b\u0e01\u0e34\u0e08<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_57_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u0e40\u0e08\u0e49\u0e32\u0e02\u0e2d\u0e07\u0e01\u0e34\u0e08\u0e01\u0e32\u0e23\/\u0e18\u0e38\u0e23\u0e01\u0e34\u0e08\u0e2a\u0e48\u0e27\u0e19\u0e15\u0e31\u0e27'  id='choice_18_57_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_57_2' id='label_18_57_2' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e08\u0e49\u0e32\u0e02\u0e2d\u0e07\u0e01\u0e34\u0e08\u0e01\u0e32\u0e23\/\u0e18\u0e38\u0e23\u0e01\u0e34\u0e08\u0e2a\u0e48\u0e27\u0e19\u0e15\u0e31\u0e27<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_57_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u0e1f\u0e23\u0e35\u0e41\u0e25\u0e19\u0e0b\u0e4c\/\u0e2d\u0e32\u0e0a\u0e35\u0e1e\u0e2d\u0e34\u0e2a\u0e23\u0e30'  id='choice_18_57_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_57_3' id='label_18_57_3' class='gform-field-label gform-field-label--type-inline'>\u0e1f\u0e23\u0e35\u0e41\u0e25\u0e19\u0e0b\u0e4c\/\u0e2d\u0e32\u0e0a\u0e35\u0e1e\u0e2d\u0e34\u0e2a\u0e23\u0e30<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_57_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u0e41\u0e21\u0e48\u0e1a\u0e49\u0e32\u0e19\/\u0e44\u0e21\u0e48\u0e44\u0e14\u0e49\u0e17\u0e33\u0e07\u0e32\u0e19'  id='choice_18_57_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_57_4' id='label_18_57_4' class='gform-field-label gform-field-label--type-inline'>\u0e41\u0e21\u0e48\u0e1a\u0e49\u0e32\u0e19\/\u0e44\u0e21\u0e48\u0e44\u0e14\u0e49\u0e17\u0e33\u0e07\u0e32\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_57_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u0e19\u0e31\u0e01\u0e40\u0e23\u0e35\u0e22\u0e19\/\u0e19\u0e31\u0e01\u0e28\u0e36\u0e01\u0e29\u0e32'  id='choice_18_57_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_57_5' id='label_18_57_5' class='gform-field-label gform-field-label--type-inline'>\u0e19\u0e31\u0e01\u0e40\u0e23\u0e35\u0e22\u0e19\/\u0e19\u0e31\u0e01\u0e28\u0e36\u0e01\u0e29\u0e32<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_57_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u0e40\u0e01\u0e29\u0e15\u0e23\u0e01\u0e23\/\u0e23\u0e31\u0e1a\u0e08\u0e49\u0e32\u0e07\u0e17\u0e31\u0e48\u0e27\u0e44\u0e1b'  id='choice_18_57_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_57_6' id='label_18_57_6' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e01\u0e29\u0e15\u0e23\u0e01\u0e23\/\u0e23\u0e31\u0e1a\u0e08\u0e49\u0e32\u0e07\u0e17\u0e31\u0e48\u0e27\u0e44\u0e1b<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_57_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='\u0e2d\u0e37\u0e48\u0e19\u0e46'  id='choice_18_57_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_57_7' id='label_18_57_7' class='gform-field-label gform-field-label--type-inline'>\u0e2d\u0e37\u0e48\u0e19\u0e46<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_58\" ><label class='gfield_label gform-field-label' for='input_18_58'>\u0e42\u0e1b\u0e23\u0e14\u0e23\u0e30\u0e1a\u0e38<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_18_58' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_18_60\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_60\" ><label class='gfield_label gform-field-label' for='input_18_60'>\u0e08\u0e31\u0e07\u0e2b\u0e27\u0e31\u0e14\u0e17\u0e35\u0e48\u0e1e\u0e31\u0e01\u0e2d\u0e32\u0e28\u0e31\u0e22\u0e43\u0e19\u0e1b\u0e31\u0e08\u0e08\u0e38\u0e1a\u0e31\u0e19<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_18_60' type='text' value='' class='large'  aria-describedby=\"gfield_description_18_60\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_18_60'>\u0e23\u0e30\u0e1a\u0e38\u0e23\u0e32\u0e22\u0e0a\u0e37\u0e48\u0e2d\u0e08\u0e31\u0e07\u0e2b\u0e27\u0e31\u0e14 \u0e40\u0e0a\u0e48\u0e19 \u0e01\u0e23\u0e38\u0e07\u0e40\u0e17\u0e1e\u0e21\u0e2b\u0e32\u0e19\u0e04\u0e23, \u0e19\u0e19\u0e17\u0e1a\u0e38\u0e23\u0e35, \u0e40\u0e0a\u0e35\u0e22\u0e07\u0e43\u0e2b\u0e21\u0e48, \u0e20\u0e39\u0e40\u0e01\u0e47\u0e15, \u0e2f\u0e25\u0e2f<\/div><\/div><fieldset id=\"field_18_61\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_61\" ><legend class='gfield_label gform-field-label' >\u0e2a\u0e16\u0e32\u0e19\u0e30\u0e2a\u0e21\u0e23\u0e2a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_61'>\n\t\t\t<div class='gchoice gchoice_18_61_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='\u0e42\u0e2a\u0e14'  id='choice_18_61_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_61_0' id='label_18_61_0' class='gform-field-label gform-field-label--type-inline'>\u0e42\u0e2a\u0e14<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_61_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='\u0e2a\u0e21\u0e23\u0e2a (\u0e08\u0e14\u0e17\u0e30\u0e40\u0e1a\u0e35\u0e22\u0e19)'  id='choice_18_61_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_61_1' id='label_18_61_1' class='gform-field-label gform-field-label--type-inline'>\u0e2a\u0e21\u0e23\u0e2a (\u0e08\u0e14\u0e17\u0e30\u0e40\u0e1a\u0e35\u0e22\u0e19)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_61_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='\u0e2a\u0e21\u0e23\u0e2a (\u0e44\u0e21\u0e48\u0e08\u0e14\u0e17\u0e30\u0e40\u0e1a\u0e35\u0e22\u0e19)'  id='choice_18_61_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_61_2' id='label_18_61_2' class='gform-field-label gform-field-label--type-inline'>\u0e2a\u0e21\u0e23\u0e2a (\u0e44\u0e21\u0e48\u0e08\u0e14\u0e17\u0e30\u0e40\u0e1a\u0e35\u0e22\u0e19)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_61_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='\u0e2b\u0e22\u0e48\u0e32\/\u0e41\u0e22\u0e01\u0e01\u0e31\u0e19\u0e2d\u0e22\u0e39\u0e48'  id='choice_18_61_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_61_3' id='label_18_61_3' class='gform-field-label gform-field-label--type-inline'>\u0e2b\u0e22\u0e48\u0e32\/\u0e41\u0e22\u0e01\u0e01\u0e31\u0e19\u0e2d\u0e22\u0e39\u0e48<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_61_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='\u0e2b\u0e21\u0e49\u0e32\u0e22'  id='choice_18_61_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_61_4' id='label_18_61_4' class='gform-field-label gform-field-label--type-inline'>\u0e2b\u0e21\u0e49\u0e32\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_62\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_62\" ><legend class='gfield_label gform-field-label' >\u0e23\u0e32\u0e22\u0e44\u0e14\u0e49\u0e23\u0e27\u0e21\u0e02\u0e2d\u0e07\u0e04\u0e23\u0e2d\u0e1a\u0e04\u0e23\u0e31\u0e27\u0e15\u0e48\u0e2d\u0e40\u0e14\u0e37\u0e2d\u0e19<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_62'>\n\t\t\t<div class='gchoice gchoice_18_62_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='\u0e15\u0e48\u0e33\u0e01\u0e27\u0e48\u0e32 15,000 \u0e1a\u0e32\u0e17'  id='choice_18_62_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_62_0' id='label_18_62_0' class='gform-field-label gform-field-label--type-inline'>\u0e15\u0e48\u0e33\u0e01\u0e27\u0e48\u0e32 15,000 \u0e1a\u0e32\u0e17<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_62_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='15,001 - 30,000 \u0e1a\u0e32\u0e17'  id='choice_18_62_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_62_1' id='label_18_62_1' class='gform-field-label gform-field-label--type-inline'>15,001 &#8211; 30,000 \u0e1a\u0e32\u0e17<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_62_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='30,001 - 50,000 \u0e1a\u0e32\u0e17'  id='choice_18_62_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_62_2' id='label_18_62_2' class='gform-field-label gform-field-label--type-inline'>30,001 &#8211; 50,000 \u0e1a\u0e32\u0e17<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_62_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='50,001 - 100,000 \u0e1a\u0e32\u0e17'  id='choice_18_62_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_62_3' id='label_18_62_3' class='gform-field-label gform-field-label--type-inline'>50,001 &#8211; 100,000 \u0e1a\u0e32\u0e17<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_62_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='\u0e21\u0e32\u0e01\u0e01\u0e27\u0e48\u0e32 100,000 \u0e1a\u0e32\u0e17'  id='choice_18_62_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_62_4' id='label_18_62_4' class='gform-field-label gform-field-label--type-inline'>\u0e21\u0e32\u0e01\u0e01\u0e27\u0e48\u0e32 100,000 \u0e1a\u0e32\u0e17<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_63\" ><legend class='gfield_label gform-field-label' >\u0e23\u0e32\u0e22\u0e44\u0e14\u0e49\u0e02\u0e2d\u0e07\u0e04\u0e23\u0e2d\u0e1a\u0e04\u0e23\u0e31\u0e27\u0e40\u0e21\u0e37\u0e48\u0e2d\u0e40\u0e17\u0e35\u0e22\u0e1a\u0e01\u0e31\u0e1a\u0e23\u0e32\u0e22\u0e08\u0e48\u0e32\u0e22<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_63'>\n\t\t\t<div class='gchoice gchoice_18_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='\u0e23\u0e32\u0e22\u0e44\u0e14\u0e49\u0e21\u0e32\u0e01\u0e01\u0e27\u0e48\u0e32\u0e23\u0e32\u0e22\u0e08\u0e48\u0e32\u0e22'  id='choice_18_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_63_0' id='label_18_63_0' class='gform-field-label gform-field-label--type-inline'>\u0e23\u0e32\u0e22\u0e44\u0e14\u0e49\u0e21\u0e32\u0e01\u0e01\u0e27\u0e48\u0e32\u0e23\u0e32\u0e22\u0e08\u0e48\u0e32\u0e22<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='\u0e23\u0e32\u0e22\u0e44\u0e14\u0e49\u0e1e\u0e2d\u0e46 \u0e01\u0e31\u0e1a\u0e23\u0e32\u0e22\u0e08\u0e48\u0e32\u0e22'  id='choice_18_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_63_1' id='label_18_63_1' class='gform-field-label gform-field-label--type-inline'>\u0e23\u0e32\u0e22\u0e44\u0e14\u0e49\u0e1e\u0e2d\u0e46 \u0e01\u0e31\u0e1a\u0e23\u0e32\u0e22\u0e08\u0e48\u0e32\u0e22<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_63_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='\u0e23\u0e32\u0e22\u0e44\u0e14\u0e49\u0e19\u0e49\u0e2d\u0e22\u0e01\u0e27\u0e48\u0e32\u0e23\u0e32\u0e22\u0e08\u0e48\u0e32\u0e22'  id='choice_18_63_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_63_2' id='label_18_63_2' class='gform-field-label gform-field-label--type-inline'>\u0e23\u0e32\u0e22\u0e44\u0e14\u0e49\u0e19\u0e49\u0e2d\u0e22\u0e01\u0e27\u0e48\u0e32\u0e23\u0e32\u0e22\u0e08\u0e48\u0e32\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_64\" ><legend class='gfield_label gform-field-label' >\u0e08\u0e33\u0e19\u0e27\u0e19\u0e2a\u0e21\u0e32\u0e0a\u0e34\u0e01\u0e43\u0e19\u0e04\u0e23\u0e2d\u0e1a\u0e04\u0e23\u0e31\u0e27\u0e17\u0e35\u0e48\u0e2d\u0e32\u0e28\u0e31\u0e22\u0e2d\u0e22\u0e39\u0e48\u0e43\u0e19\u0e1a\u0e49\u0e32\u0e19\u0e40\u0e14\u0e35\u0e22\u0e27\u0e01\u0e31\u0e19 (\u0e23\u0e27\u0e21\u0e15\u0e31\u0e27\u0e04\u0e38\u0e13\u0e41\u0e21\u0e48\u0e41\u0e25\u0e30\u0e1a\u0e38\u0e15\u0e23)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_64'>\n\t\t\t<div class='gchoice gchoice_18_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='1 - 2 \u0e04\u0e19'  id='choice_18_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_64_0' id='label_18_64_0' class='gform-field-label gform-field-label--type-inline'>1 &#8211; 2 \u0e04\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='3 - 4 \u0e04\u0e19'  id='choice_18_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_64_1' id='label_18_64_1' class='gform-field-label gform-field-label--type-inline'>3 &#8211; 4 \u0e04\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_64_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='5 - 6 \u0e04\u0e19'  id='choice_18_64_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_64_2' id='label_18_64_2' class='gform-field-label gform-field-label--type-inline'>5 &#8211; 6 \u0e04\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_64_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='7 \u0e04\u0e19\u0e02\u0e36\u0e49\u0e19\u0e44\u0e1b'  id='choice_18_64_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_64_3' id='label_18_64_3' class='gform-field-label gform-field-label--type-inline'>7 \u0e04\u0e19\u0e02\u0e36\u0e49\u0e19\u0e44\u0e1b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_65\" ><legend class='gfield_label gform-field-label' >\u0e08\u0e33\u0e19\u0e27\u0e19\u0e1a\u0e38\u0e15\u0e23\u0e17\u0e31\u0e49\u0e07\u0e2b\u0e21\u0e14 (\u0e23\u0e27\u0e21\u0e16\u0e36\u0e07\u0e1a\u0e38\u0e15\u0e23\u0e17\u0e35\u0e48\u0e2d\u0e22\u0e39\u0e48\u0e43\u0e19\u0e04\u0e23\u0e23\u0e20\u0e4c)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_65'>\n\t\t\t<div class='gchoice gchoice_18_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='1 \u0e04\u0e19'  id='choice_18_65_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_65_0' id='label_18_65_0' class='gform-field-label gform-field-label--type-inline'>1 \u0e04\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='2 \u0e04\u0e19'  id='choice_18_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_65_1' id='label_18_65_1' class='gform-field-label gform-field-label--type-inline'>2 \u0e04\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_65_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='3 \u0e04\u0e19'  id='choice_18_65_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_65_2' id='label_18_65_2' class='gform-field-label gform-field-label--type-inline'>3 \u0e04\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_65_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='4 \u0e04\u0e19\u0e02\u0e36\u0e49\u0e19\u0e44\u0e1b'  id='choice_18_65_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_65_3' id='label_18_65_3' class='gform-field-label gform-field-label--type-inline'>4 \u0e04\u0e19\u0e02\u0e36\u0e49\u0e19\u0e44\u0e1b<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_66\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_66\" ><legend class='gfield_label gform-field-label' >\u0e2d\u0e32\u0e22\u0e38\u0e02\u0e2d\u0e07\u0e1a\u0e38\u0e15\u0e23\u0e04\u0e19\u0e2a\u0e38\u0e14\u0e17\u0e49\u0e2d\u0e07<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_66'>\n\t\t\t<div class='gchoice gchoice_18_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='\u0e01\u0e33\u0e25\u0e31\u0e07\u0e15\u0e31\u0e49\u0e07\u0e04\u0e23\u0e23\u0e20\u0e4c\u0e04\u0e19\u0e41\u0e23\u0e01'  id='choice_18_66_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_66_0' id='label_18_66_0' class='gform-field-label gform-field-label--type-inline'>\u0e01\u0e33\u0e25\u0e31\u0e07\u0e15\u0e31\u0e49\u0e07\u0e04\u0e23\u0e23\u0e20\u0e4c\u0e04\u0e19\u0e41\u0e23\u0e01<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='\u0e19\u0e49\u0e2d\u0e22\u0e01\u0e27\u0e48\u0e32 6 \u0e40\u0e14\u0e37\u0e2d\u0e19'  id='choice_18_66_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_66_1' id='label_18_66_1' class='gform-field-label gform-field-label--type-inline'>\u0e19\u0e49\u0e2d\u0e22\u0e01\u0e27\u0e48\u0e32 6 \u0e40\u0e14\u0e37\u0e2d\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_66_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='6 \u0e40\u0e14\u0e37\u0e2d\u0e19 - 1 \u0e1b\u0e35'  id='choice_18_66_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_66_2' id='label_18_66_2' class='gform-field-label gform-field-label--type-inline'>6 \u0e40\u0e14\u0e37\u0e2d\u0e19 &#8211; 1 \u0e1b\u0e35<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_66_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='1 \u0e1b\u0e35 - 3 \u0e1b\u0e35'  id='choice_18_66_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_66_3' id='label_18_66_3' class='gform-field-label gform-field-label--type-inline'>1 \u0e1b\u0e35 &#8211; 3 \u0e1b\u0e35<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_66_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='3 \u0e1b\u0e35 - 6 \u0e1b\u0e35'  id='choice_18_66_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_66_4' id='label_18_66_4' class='gform-field-label gform-field-label--type-inline'>3 \u0e1b\u0e35 &#8211; 6 \u0e1b\u0e35<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_66_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='\u0e21\u0e32\u0e01\u0e01\u0e27\u0e48\u0e32 6 \u0e1b\u0e35'  id='choice_18_66_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_66_5' id='label_18_66_5' class='gform-field-label gform-field-label--type-inline'>\u0e21\u0e32\u0e01\u0e01\u0e27\u0e48\u0e32 6 \u0e1b\u0e35<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_69\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_69\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u0e1c\u0e39\u0e49\u0e17\u0e35\u0e48\u0e21\u0e35\u0e2a\u0e48\u0e27\u0e19\u0e0a\u0e48\u0e27\u0e22\u0e40\u0e25\u0e35\u0e49\u0e22\u0e07\u0e14\u0e39\u0e1a\u0e38\u0e15\u0e23\u0e21\u0e32\u0e01\u0e17\u0e35\u0e48\u0e2a\u0e38\u0e14\u0e04\u0e37\u0e2d\u0e43\u0e04\u0e23? (\u0e40\u0e25\u0e37\u0e2d\u0e01\u0e44\u0e14\u0e49\u0e21\u0e32\u0e01\u0e01\u0e27\u0e48\u0e32 1 \u0e02\u0e49\u0e2d)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_18_69'><div class='gchoice gchoice_18_69_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.1' type='checkbox'  value='\u0e04\u0e39\u0e48\u0e2a\u0e21\u0e23\u0e2a\/\u0e41\u0e1f\u0e19'  id='choice_18_69_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_69_1' id='label_18_69_1' class='gform-field-label gform-field-label--type-inline'>\u0e04\u0e39\u0e48\u0e2a\u0e21\u0e23\u0e2a\/\u0e41\u0e1f\u0e19<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_69_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.2' type='checkbox'  value='\u0e04\u0e38\u0e13\u0e15\u0e32 \u0e04\u0e38\u0e13\u0e22\u0e32\u0e22'  id='choice_18_69_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_69_2' id='label_18_69_2' class='gform-field-label gform-field-label--type-inline'>\u0e04\u0e38\u0e13\u0e15\u0e32 \u0e04\u0e38\u0e13\u0e22\u0e32\u0e22<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_69_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.3' type='checkbox'  value='\u0e04\u0e38\u0e13\u0e1b\u0e39\u0e48 \u0e04\u0e38\u0e13\u0e22\u0e48\u0e32'  id='choice_18_69_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_69_3' id='label_18_69_3' class='gform-field-label gform-field-label--type-inline'>\u0e04\u0e38\u0e13\u0e1b\u0e39\u0e48 \u0e04\u0e38\u0e13\u0e22\u0e48\u0e32<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_69_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.4' type='checkbox'  value='\u0e1e\u0e35\u0e48\u0e40\u0e25\u0e35\u0e49\u0e22\u0e07\u0e40\u0e14\u0e47\u0e01\/\u0e1c\u0e39\u0e49\u0e0a\u0e48\u0e27\u0e22'  id='choice_18_69_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_69_4' id='label_18_69_4' class='gform-field-label gform-field-label--type-inline'>\u0e1e\u0e35\u0e48\u0e40\u0e25\u0e35\u0e49\u0e22\u0e07\u0e40\u0e14\u0e47\u0e01\/\u0e1c\u0e39\u0e49\u0e0a\u0e48\u0e27\u0e22<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_69_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.5' type='checkbox'  value='\u0e1a\u0e38\u0e15\u0e23\u0e04\u0e19\u0e42\u0e15\/\u0e1e\u0e35\u0e48\u0e19\u0e49\u0e2d\u0e07'  id='choice_18_69_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_69_5' id='label_18_69_5' class='gform-field-label gform-field-label--type-inline'>\u0e1a\u0e38\u0e15\u0e23\u0e04\u0e19\u0e42\u0e15\/\u0e1e\u0e35\u0e48\u0e19\u0e49\u0e2d\u0e07<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_69_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.6' type='checkbox'  value='\u0e40\u0e25\u0e35\u0e49\u0e22\u0e07\u0e14\u0e39\u0e14\u0e49\u0e27\u0e22\u0e15\u0e31\u0e27\u0e40\u0e2d\u0e07\u0e04\u0e19\u0e40\u0e14\u0e35\u0e22\u0e27'  id='choice_18_69_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_69_6' id='label_18_69_6' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e25\u0e35\u0e49\u0e22\u0e07\u0e14\u0e39\u0e14\u0e49\u0e27\u0e22\u0e15\u0e31\u0e27\u0e40\u0e2d\u0e07\u0e04\u0e19\u0e40\u0e14\u0e35\u0e22\u0e27<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_69_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.7' type='checkbox'  value='\u0e2d\u0e37\u0e48\u0e19\u0e46'  id='choice_18_69_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_69_7' id='label_18_69_7' class='gform-field-label gform-field-label--type-inline'>\u0e2d\u0e37\u0e48\u0e19\u0e46<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_68\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_68\" ><label class='gfield_label gform-field-label' for='input_18_68'>\u0e42\u0e1b\u0e23\u0e14\u0e23\u0e30\u0e1a\u0e38<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_18_68' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_18_70\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_70\" ><legend class='gfield_label gform-field-label' >\u0e04\u0e38\u0e13\u0e21\u0e35\u0e42\u0e23\u0e04\u0e1b\u0e23\u0e30\u0e08\u0e33\u0e15\u0e31\u0e27\u0e17\u0e32\u0e07\u0e01\u0e32\u0e22\u0e2b\u0e23\u0e37\u0e2d\u0e44\u0e21\u0e48?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_70'>\n\t\t\t<div class='gchoice gchoice_18_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='\u0e21\u0e35'  id='choice_18_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_70_0' id='label_18_70_0' class='gform-field-label gform-field-label--type-inline'>\u0e21\u0e35<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='\u0e44\u0e21\u0e48\u0e21\u0e35'  id='choice_18_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_70_1' id='label_18_70_1' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48\u0e21\u0e35<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_71\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_71\" ><legend class='gfield_label gform-field-label' >\u0e04\u0e38\u0e13\u0e40\u0e04\u0e22\u0e40\u0e02\u0e49\u0e32\u0e23\u0e31\u0e1a\u0e01\u0e32\u0e23\u0e23\u0e31\u0e01\u0e29\u0e32\u0e17\u0e32\u0e07\u0e08\u0e34\u0e15\u0e40\u0e27\u0e0a\u0e21\u0e32\u0e01\u0e48\u0e2d\u0e19\u0e2b\u0e23\u0e37\u0e2d\u0e44\u0e21\u0e48?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_71'>\n\t\t\t<div class='gchoice gchoice_18_71_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='\u0e40\u0e04\u0e22'  id='choice_18_71_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_71_0' id='label_18_71_0' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e04\u0e22<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_71_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='\u0e44\u0e21\u0e48\u0e40\u0e04\u0e22'  id='choice_18_71_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_71_1' id='label_18_71_1' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48\u0e40\u0e04\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_72\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_72\" ><label class='gfield_label gform-field-label' for='input_18_72'>\u0e42\u0e1b\u0e23\u0e14\u0e23\u0e30\u0e1a\u0e38\u0e42\u0e23\u0e04\u0e2b\u0e23\u0e37\u0e2d\u0e2d\u0e32\u0e01\u0e32\u0e23\u0e17\u0e35\u0e48\u0e40\u0e04\u0e22\u0e44\u0e14\u0e49\u0e23\u0e31\u0e1a\u0e01\u0e32\u0e23\u0e23\u0e31\u0e01\u0e29\u0e32\u0e2b\u0e23\u0e37\u0e2d\u0e27\u0e34\u0e19\u0e34\u0e08\u0e09\u0e31\u0e22<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_72' id='input_18_72' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer left_label'>\n                        <input type='button' id='gform_previous_button_18_54' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_18_54' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_18_3' class='gform_page' data-js='page-field-id-54' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_18_3' class='gform_fields left_label form_sublabel_below description_below validation_below'><div id=\"field_18_23\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_23\" ><h3 class=\"gsection_title\">Question 1<\/h3><\/div><fieldset id=\"field_18_22\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_22\" ><legend class='gfield_label gform-field-label' >\u0e09\u0e31\u0e19\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e2b\u0e31\u0e27\u0e40\u0e23\u0e32\u0e30\u0e41\u0e25\u0e30\u0e21\u0e2d\u0e07\u0e14\u0e39\u0e2a\u0e34\u0e48\u0e07\u0e15\u0e48\u0e32\u0e07 \u0e46 \u0e43\u0e19\u0e41\u0e07\u0e48\u0e17\u0e35\u0e48\u0e02\u0e1a\u0e02\u0e31\u0e19<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_22'>\n\t\t\t<div class='gchoice gchoice_18_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='gquiz2226eec9de'  id='choice_18_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_22_0' id='label_18_22_0' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e17\u0e48\u0e32\u0e17\u0e35\u0e48\u0e09\u0e31\u0e19\u0e17\u0e33\u0e21\u0e32\u0e40\u0e2a\u0e21\u0e2d \u0e46<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='gquiz2219db163a'  id='choice_18_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_22_1' id='label_18_22_1' class='gform-field-label gform-field-label--type-inline'>\u0e15\u0e2d\u0e19\u0e19\u0e35\u0e49\u0e44\u0e21\u0e48\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e17\u0e33\u0e44\u0e14\u0e49\u0e21\u0e32\u0e01\u0e40\u0e2b\u0e21\u0e37\u0e2d\u0e19\u0e2d\u0e22\u0e48\u0e32\u0e07\u0e17\u0e35\u0e48\u0e40\u0e04\u0e22\u0e17\u0e33<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='gquiz229adaae26'  id='choice_18_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_22_2' id='label_18_22_2' class='gform-field-label gform-field-label--type-inline'>\u0e17\u0e35\u0e48\u0e41\u0e19\u0e48 \u0e46 \u0e04\u0e37\u0e2d\u0e19\u0e49\u0e2d\u0e22\u0e25\u0e07\u0e01\u0e27\u0e48\u0e32\u0e17\u0e35\u0e48\u0e40\u0e04\u0e22\u0e17\u0e33<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_22_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='gquiz22194e488f'  id='choice_18_22_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_22_3' id='label_18_22_3' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e17\u0e33\u0e44\u0e14\u0e49\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_33\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_33\" ><h3 class=\"gsection_title\">Question 2<\/h3><\/div><fieldset id=\"field_18_24\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_24\" ><legend class='gfield_label gform-field-label' >\u0e09\u0e31\u0e19\u0e21\u0e2d\u0e07\u0e44\u0e1b\u0e02\u0e49\u0e32\u0e07\u0e2b\u0e19\u0e49\u0e32\u0e40\u0e1e\u0e37\u0e48\u0e2d\u0e2b\u0e32\u0e04\u0e27\u0e32\u0e21\u0e40\u0e1e\u0e25\u0e34\u0e14\u0e40\u0e1e\u0e25\u0e34\u0e19\u0e43\u0e08\u0e01\u0e31\u0e1a\u0e2a\u0e34\u0e48\u0e07\u0e15\u0e48\u0e32\u0e07 \u0e46<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_24'>\n\t\t\t<div class='gchoice gchoice_18_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='gquiz2226eec9de'  id='choice_18_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_24_0' id='label_18_24_0' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e17\u0e48\u0e32 \u0e46 \u0e01\u0e31\u0e1a\u0e17\u0e35\u0e48\u0e09\u0e31\u0e19\u0e40\u0e04\u0e22\u0e17\u0e33<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='gquiz2219db163a'  id='choice_18_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_24_1' id='label_18_24_1' class='gform-field-label gform-field-label--type-inline'>\u0e19\u0e49\u0e2d\u0e22\u0e25\u0e07\u0e01\u0e27\u0e48\u0e32\u0e17\u0e35\u0e48\u0e40\u0e04\u0e22\u0e17\u0e33<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='gquiz229adaae26'  id='choice_18_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_24_2' id='label_18_24_2' class='gform-field-label gform-field-label--type-inline'>\u0e17\u0e35\u0e48\u0e41\u0e19\u0e48 \u0e46 \u0e04\u0e37\u0e2d\u0e19\u0e49\u0e2d\u0e22\u0e25\u0e07\u0e01\u0e27\u0e48\u0e32\u0e17\u0e35\u0e48\u0e40\u0e04\u0e22\u0e17\u0e33<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='gquiz22194e488f'  id='choice_18_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_24_3' id='label_18_24_3' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e23\u0e35\u0e22\u0e01\u0e44\u0e14\u0e49\u0e27\u0e48\u0e32\u0e40\u0e01\u0e37\u0e2d\u0e1a\u0e44\u0e21\u0e48\u0e21\u0e35\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_34\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_34\" ><h3 class=\"gsection_title\">Question 3<\/h3><\/div><fieldset id=\"field_18_25\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_25\" ><legend class='gfield_label gform-field-label' >\u0e09\u0e31\u0e19\u0e42\u0e17\u0e29\u0e15\u0e31\u0e27\u0e40\u0e2d\u0e07\u0e40\u0e21\u0e37\u0e48\u0e2d\u0e21\u0e35\u0e40\u0e2b\u0e15\u0e38\u0e01\u0e32\u0e23\u0e13\u0e4c\u0e40\u0e25\u0e27\u0e23\u0e49\u0e32\u0e22\u0e40\u0e01\u0e34\u0e14\u0e02\u0e36\u0e49\u0e19<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_25'>\n\t\t\t<div class='gchoice gchoice_18_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='gquiz2226eec9de'  id='choice_18_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_25_0' id='label_18_25_0' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e40\u0e01\u0e37\u0e2d\u0e1a\u0e15\u0e25\u0e2d\u0e14\u0e40\u0e27\u0e25\u0e32<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='gquiz2219db163a'  id='choice_18_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_25_1' id='label_18_25_1' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e40\u0e1b\u0e47\u0e19\u0e1a\u0e32\u0e07\u0e04\u0e23\u0e31\u0e49\u0e07<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_25_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='gquiz229adaae26'  id='choice_18_25_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_25_2' id='label_18_25_2' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48\u0e1a\u0e48\u0e2d\u0e22\u0e19\u0e31\u0e01<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_25_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='gquiz22194e488f'  id='choice_18_25_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_25_3' id='label_18_25_3' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e44\u0e21\u0e48\u0e40\u0e04\u0e22\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_35\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_35\" ><h3 class=\"gsection_title\">Question 4<\/h3><\/div><fieldset id=\"field_18_26\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_26\" ><legend class='gfield_label gform-field-label' >\u0e09\u0e31\u0e19\u0e23\u0e39\u0e49\u0e2a\u0e36\u0e01\u0e01\u0e23\u0e30\u0e27\u0e19\u0e01\u0e23\u0e30\u0e27\u0e32\u0e22\u0e2b\u0e23\u0e37\u0e2d\u0e01\u0e31\u0e07\u0e27\u0e25\u0e42\u0e14\u0e22\u0e44\u0e21\u0e48\u0e21\u0e35\u0e40\u0e2b\u0e15\u0e38\u0e1c\u0e25\u0e2a\u0e21\u0e04\u0e27\u0e23<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_26'>\n\t\t\t<div class='gchoice gchoice_18_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='gquiz2226eec9de'  id='choice_18_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_26_0' id='label_18_26_0' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e44\u0e21\u0e48\u0e23\u0e39\u0e49\u0e2a\u0e36\u0e01\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e31\u0e49\u0e19\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='gquiz2219db163a'  id='choice_18_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_26_1' id='label_18_26_1' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48\u0e04\u0e48\u0e2d\u0e22\u0e08\u0e30\u0e23\u0e39\u0e49\u0e2a\u0e36\u0e01\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e31\u0e49\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='gquiz229adaae26'  id='choice_18_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_26_2' id='label_18_26_2' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e1a\u0e48\u0e2d\u0e22\u0e21\u0e32\u0e01<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_26_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='gquiz22194e488f'  id='choice_18_26_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_26_3' id='label_18_26_3' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e40\u0e1b\u0e47\u0e19\u0e1a\u0e32\u0e07\u0e04\u0e23\u0e31\u0e49\u0e07<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_36\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_36\" ><h3 class=\"gsection_title\">Question 5<\/h3><\/div><fieldset id=\"field_18_27\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_27\" ><legend class='gfield_label gform-field-label' >\u0e09\u0e31\u0e19\u0e23\u0e39\u0e49\u0e2a\u0e36\u0e01\u0e2b\u0e27\u0e32\u0e14\u0e1c\u0e27\u0e32\u0e2b\u0e23\u0e37\u0e2d\u0e15\u0e01\u0e2d\u0e01\u0e15\u0e01\u0e43\u0e08\u0e42\u0e14\u0e22\u0e44\u0e21\u0e48\u0e21\u0e35\u0e40\u0e2b\u0e15\u0e38\u0e1c\u0e25\u0e2a\u0e21\u0e04\u0e27\u0e23<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_27'>\n\t\t\t<div class='gchoice gchoice_18_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='gquiz2226eec9de'  id='choice_18_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_27_0' id='label_18_27_0' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e1a\u0e48\u0e2d\u0e22\u0e21\u0e32\u0e01\u0e17\u0e35\u0e40\u0e14\u0e35\u0e22\u0e27<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='gquiz2219db163a'  id='choice_18_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_27_1' id='label_18_27_1' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e40\u0e1b\u0e47\u0e19\u0e1a\u0e32\u0e07\u0e04\u0e23\u0e31\u0e49\u0e07<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='gquiz229adaae26'  id='choice_18_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_27_2' id='label_18_27_2' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e44\u0e21\u0e48\u0e1a\u0e48\u0e2d\u0e22\u0e21\u0e32\u0e01<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='gquiz22194e488f'  id='choice_18_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_27_3' id='label_18_27_3' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e44\u0e21\u0e48\u0e40\u0e04\u0e22\u0e40\u0e1b\u0e47\u0e19\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e31\u0e49\u0e19\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_37\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_37\" ><h3 class=\"gsection_title\">Question 6<\/h3><\/div><fieldset id=\"field_18_28\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_28\" ><legend class='gfield_label gform-field-label' >\u0e21\u0e35\u0e40\u0e23\u0e37\u0e48\u0e2d\u0e07\u0e15\u0e48\u0e32\u0e07 \u0e46 \u0e40\u0e01\u0e34\u0e14\u0e02\u0e36\u0e49\u0e19\u0e17\u0e31\u0e1a\u0e16\u0e21\u0e09\u0e31\u0e19\u0e44\u0e1b\u0e2b\u0e21\u0e14<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_28'>\n\t\t\t<div class='gchoice gchoice_18_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='gquiz2226eec9de'  id='choice_18_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_28_0' id='label_18_28_0' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e2a\u0e48\u0e27\u0e19\u0e21\u0e32\u0e01\u0e09\u0e31\u0e19\u0e44\u0e21\u0e48\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e23\u0e31\u0e1a\u0e21\u0e37\u0e2d\u0e01\u0e31\u0e1a\u0e40\u0e23\u0e37\u0e48\u0e2d\u0e07\u0e40\u0e2b\u0e25\u0e48\u0e32\u0e19\u0e35\u0e49\u0e44\u0e14\u0e49\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='gquiz2219db163a'  id='choice_18_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_28_1' id='label_18_28_1' class='gform-field-label gform-field-label--type-inline'>\u0e1a\u0e32\u0e07\u0e04\u0e23\u0e31\u0e49\u0e07\u0e09\u0e31\u0e19\u0e01\u0e47\u0e44\u0e21\u0e48\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e23\u0e31\u0e1a\u0e21\u0e37\u0e2d\u0e01\u0e31\u0e1a\u0e40\u0e23\u0e37\u0e48\u0e2d\u0e07\u0e40\u0e2b\u0e25\u0e48\u0e32\u0e19\u0e35\u0e49\u0e44\u0e14\u0e49\u0e40\u0e2b\u0e21\u0e37\u0e2d\u0e19\u0e2d\u0e22\u0e48\u0e32\u0e07\u0e1b\u0e01\u0e15\u0e34<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='gquiz229adaae26'  id='choice_18_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_28_2' id='label_18_28_2' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e2a\u0e48\u0e27\u0e19\u0e21\u0e32\u0e01\u0e09\u0e31\u0e19\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e23\u0e31\u0e1a\u0e21\u0e37\u0e2d\u0e01\u0e31\u0e1a\u0e40\u0e23\u0e37\u0e48\u0e2d\u0e07\u0e15\u0e48\u0e32\u0e07 \u0e46 \u0e44\u0e14\u0e49\u0e14\u0e35<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_28_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='gquiz22194e488f'  id='choice_18_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_28_3' id='label_18_28_3' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e09\u0e31\u0e19\u0e2a\u0e32\u0e21\u0e32\u0e23\u0e16\u0e23\u0e31\u0e1a\u0e21\u0e37\u0e2d\u0e01\u0e31\u0e1a\u0e40\u0e23\u0e37\u0e48\u0e2d\u0e07\u0e15\u0e48\u0e32\u0e07 \u0e46 \u0e44\u0e14\u0e49\u0e40\u0e2b\u0e21\u0e37\u0e2d\u0e19\u0e17\u0e35\u0e48\u0e09\u0e31\u0e19\u0e17\u0e33\u0e21\u0e32\u0e15\u0e25\u0e2d\u0e14<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_38\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_38\" ><h3 class=\"gsection_title\">Question 7<\/h3><\/div><fieldset id=\"field_18_29\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_29\" ><legend class='gfield_label gform-field-label' >\u0e09\u0e31\u0e19\u0e44\u0e21\u0e48\u0e21\u0e35\u0e04\u0e27\u0e32\u0e21\u0e2a\u0e38\u0e02\u0e40\u0e2d\u0e32\u0e21\u0e32\u0e01 \u0e46 \u0e08\u0e19\u0e19\u0e2d\u0e19\u0e44\u0e21\u0e48\u0e2b\u0e25\u0e31\u0e1a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_29'>\n\t\t\t<div class='gchoice gchoice_18_29_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='gquiz2226eec9de'  id='choice_18_29_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_29_0' id='label_18_29_0' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e2a\u0e48\u0e27\u0e19\u0e21\u0e32\u0e01\u0e40\u0e1b\u0e47\u0e19\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e35\u0e49<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_29_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='gquiz2219db163a'  id='choice_18_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_29_1' id='label_18_29_1' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e1a\u0e32\u0e07\u0e04\u0e23\u0e31\u0e49\u0e07\u0e40\u0e1b\u0e47\u0e19\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e35\u0e49<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_29_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='gquiz229adaae26'  id='choice_18_29_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_29_2' id='label_18_29_2' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e1b\u0e47\u0e19\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e35\u0e49\u0e44\u0e21\u0e48\u0e04\u0e48\u0e2d\u0e22\u0e1a\u0e48\u0e2d\u0e22\u0e19\u0e31\u0e01<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_29_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='gquiz22194e488f'  id='choice_18_29_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_29_3' id='label_18_29_3' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e44\u0e21\u0e48\u0e40\u0e04\u0e22\u0e40\u0e1b\u0e47\u0e19\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e35\u0e49\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_39\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_39\" ><h3 class=\"gsection_title\">Question 8<\/h3><\/div><fieldset id=\"field_18_30\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_30\" ><legend class='gfield_label gform-field-label' >\u0e09\u0e31\u0e19\u0e23\u0e39\u0e49\u0e2a\u0e36\u0e01\u0e40\u0e28\u0e23\u0e49\u0e32\u0e43\u0e08\u0e41\u0e25\u0e30\u0e44\u0e21\u0e48\u0e21\u0e35\u0e04\u0e27\u0e32\u0e21\u0e2a\u0e38\u0e02<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_30'>\n\t\t\t<div class='gchoice gchoice_18_30_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='gquiz2226eec9de'  id='choice_18_30_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_30_0' id='label_18_30_0' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e40\u0e1b\u0e47\u0e19\u0e2a\u0e48\u0e27\u0e19\u0e21\u0e32\u0e01<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_30_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='gquiz2219db163a'  id='choice_18_30_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_30_1' id='label_18_30_1' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e40\u0e1b\u0e47\u0e19\u0e1a\u0e32\u0e07\u0e04\u0e23\u0e31\u0e49\u0e07<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_30_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='gquiz229adaae26'  id='choice_18_30_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_30_2' id='label_18_30_2' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e44\u0e21\u0e48\u0e04\u0e48\u0e2d\u0e22\u0e40\u0e1b\u0e47\u0e19\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e35\u0e49\u0e1a\u0e48\u0e2d\u0e22\u0e19\u0e31\u0e01<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_30_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='gquiz22194e488f'  id='choice_18_30_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_30_3' id='label_18_30_3' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e44\u0e21\u0e48\u0e40\u0e04\u0e22\u0e40\u0e1b\u0e47\u0e19\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e35\u0e49\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_40\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_40\" ><h3 class=\"gsection_title\">Question 9<\/h3><\/div><fieldset id=\"field_18_31\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_31\" ><legend class='gfield_label gform-field-label' >\u0e09\u0e31\u0e19\u0e44\u0e21\u0e48\u0e21\u0e35\u0e04\u0e27\u0e32\u0e21\u0e2a\u0e38\u0e02\u0e08\u0e19\u0e16\u0e36\u0e07\u0e01\u0e31\u0e1a\u0e15\u0e49\u0e2d\u0e07\u0e23\u0e49\u0e2d\u0e07\u0e44\u0e2b\u0e49<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_31'>\n\t\t\t<div class='gchoice gchoice_18_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='gquiz2226eec9de'  id='choice_18_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_31_0' id='label_18_31_0' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e2a\u0e48\u0e27\u0e19\u0e21\u0e32\u0e01\u0e40\u0e1b\u0e47\u0e19\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e35\u0e49<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='gquiz2219db163a'  id='choice_18_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_31_1' id='label_18_31_1' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e40\u0e1b\u0e47\u0e19\u0e1a\u0e32\u0e07\u0e04\u0e23\u0e31\u0e49\u0e07<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='gquiz229adaae26'  id='choice_18_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_31_2' id='label_18_31_2' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e1b\u0e47\u0e19\u0e1a\u0e32\u0e07\u0e04\u0e23\u0e31\u0e49\u0e07\u0e40\u0e17\u0e48\u0e32\u0e19\u0e31\u0e49\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_31_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='gquiz22194e488f'  id='choice_18_31_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_31_3' id='label_18_31_3' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48 \u0e44\u0e21\u0e48\u0e40\u0e04\u0e22\u0e40\u0e1b\u0e47\u0e19\u0e40\u0e0a\u0e48\u0e19\u0e19\u0e35\u0e49\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_44\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_44\" ><h3 class=\"gsection_title\">Question 10<\/h3><\/div><fieldset id=\"field_18_45\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" data-js-reload=\"field_18_45\" ><legend class='gfield_label gform-field-label' >\u0e04\u0e27\u0e32\u0e21\u0e04\u0e34\u0e14\u0e17\u0e35\u0e48\u0e08\u0e30\u0e17\u0e33\u0e23\u0e49\u0e32\u0e22\u0e15\u0e31\u0e27\u0e40\u0e2d\u0e07\u0e40\u0e04\u0e22\u0e40\u0e01\u0e34\u0e14\u0e02\u0e36\u0e49\u0e19\u0e01\u0e31\u0e1a\u0e09\u0e31\u0e19<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_45'>\n\t\t\t<div class='gchoice gchoice_18_45_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='gquiz2226eec9de'  id='choice_18_45_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_45_0' id='label_18_45_0' class='gform-field-label gform-field-label--type-inline'>\u0e43\u0e0a\u0e48 \u0e40\u0e01\u0e34\u0e14\u0e02\u0e36\u0e49\u0e19\u0e1a\u0e48\u0e2d\u0e22\u0e17\u0e35\u0e40\u0e14\u0e35\u0e22\u0e27<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_45_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='gquiz2219db163a'  id='choice_18_45_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_45_1' id='label_18_45_1' class='gform-field-label gform-field-label--type-inline'>\u0e40\u0e1b\u0e47\u0e19\u0e1a\u0e32\u0e07\u0e04\u0e23\u0e31\u0e49\u0e07<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_45_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='gquiz229adaae26'  id='choice_18_45_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_45_2' id='label_18_45_2' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48\u0e04\u0e48\u0e2d\u0e22\u0e08\u0e30\u0e40\u0e01\u0e34\u0e14\u0e02\u0e36\u0e49\u0e19<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_45_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='gquiz22194e488f'  id='choice_18_45_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_45_3' id='label_18_45_3' class='gform-field-label gform-field-label--type-inline'>\u0e44\u0e21\u0e48\u0e40\u0e04\u0e22\u0e40\u0e01\u0e34\u0e14\u0e02\u0e36\u0e49\u0e19\u0e40\u0e25\u0e22<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_32\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_32\" ><b>\u0e2d\u0e49\u0e32\u0e07\u0e2d\u0e34\u0e07:<\/b> Cox, J.L., Holden, J.M., &#038; Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786.<\/div><div id=\"field_18_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_18_41\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_18_41'>ref URL<\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_18_41' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_18_73\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_18_73\" ><label class='gfield_label gform-field-label' for='input_18_73'>Phone<\/label><div class='ginput_container'><input name='input_73' id='input_18_73' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_18_73'>This field is for validation purposes and should be left unchanged.<\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer left_label'><input type='submit' id='gform_previous_button_18' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_18' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Send'  \/> <input type='hidden' name='gform_ajax' value='form_id=18&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;styles={&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}&amp;hash=482d129aff297939e150029205d8d87f' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_18' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_18' id='gform_theme_18' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_18' id='gform_style_settings_18' value='{&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_18' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='18' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_18' value='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