{"id":858,"date":"2025-07-15T15:09:57","date_gmt":"2025-07-15T19:09:57","guid":{"rendered":"https:\/\/www.bridginghopega.org\/encuesta-a-supervivientes\/"},"modified":"2025-07-15T20:42:33","modified_gmt":"2025-07-16T00:42:33","slug":"encuesta-a-supervivientes","status":"publish","type":"page","link":"https:\/\/www.bridginghopega.org\/es\/servicios\/educacion-preventiva\/comentarios-sobre-la-presentacion\/encuesta-a-supervivientes\/","title":{"rendered":"Encuesta a supervivientes"},"content":{"rendered":"<section class=\"single-content-section has-background has-background-color has-text-color default has-transparente-background-color text-left\" data-id=\"block_84b068a669a23bc1a4fe3cb19a30f06e\" data-aos=\"fade-in\">\n    <div class=\"container\">\n        <div class=\"grid\">\n            <div class=\"col-grid col-1-1 lg-col-10-12 offset-lg-col-1-12\">\n                                                <div class=\"has-text-color has-negro-color has-cerceta-300-link-color\" data-aos=\"fade-up\"><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]&gt; *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_21' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Sexual Assault Center Survey for Survivors<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_21'  action='\/es\/wp-json\/wp\/v2\/pages\/858' data-formid='21' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><ul id='gform_fields_21' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_21_30\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_30'>Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_30' id='input_21_30' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/aaaa' aria-describedby=\"input_21_30_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_21_30_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_21_30' class='gform_hidden' value='https:\/\/www.bridginghopega.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_21_32\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_32'>What services have you received from Rape Response?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_21_32' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_21_1\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >As a result of Rape Response services, I now have a better understanding of the effects of the sexual assault.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_1'><li class='gchoice gchoice_21_1_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.1' type='checkbox'  value='Strongly Agree'  id='choice_21_1_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_1_1' id='label_21_1_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_1_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.2' type='checkbox'  value='Agree'  id='choice_21_1_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_1_2' id='label_21_1_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_1_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.3' type='checkbox'  value='Nuetral'  id='choice_21_1_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_1_3' id='label_21_1_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_1_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.4' type='checkbox'  value='Disagree'  id='choice_21_1_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_1_4' id='label_21_1_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_1_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.5' type='checkbox'  value='Strongly Disagree'  id='choice_21_1_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_1_5' id='label_21_1_5' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_3\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I understand that the sexual assault was not my fault.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_3'><li class='gchoice gchoice_21_3_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.1' type='checkbox'  value='Strongly Agree'  id='choice_21_3_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_3_1' id='label_21_3_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_3_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.2' type='checkbox'  value='Agree'  id='choice_21_3_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_3_2' id='label_21_3_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_3_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.3' type='checkbox'  value='Nuetral'  id='choice_21_3_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_3_3' id='label_21_3_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_3_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.4' type='checkbox'  value='Disagree'  id='choice_21_3_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_3_4' id='label_21_3_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_3_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.5' type='checkbox'  value='Strongly Disagree'  id='choice_21_3_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_3_5' id='label_21_3_5' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_4\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I am now more aware of other sources of help available to me.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_4'><li class='gchoice gchoice_21_4_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.1' type='checkbox'  value='Strongly Agree'  id='choice_21_4_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_4_1' id='label_21_4_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_4_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.2' type='checkbox'  value='Agree'  id='choice_21_4_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_4_2' id='label_21_4_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_4_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.3' type='checkbox'  value='Nuetral'  id='choice_21_4_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_4_3' id='label_21_4_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_4_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.4' type='checkbox'  value='Disagree'  id='choice_21_4_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_4_4' id='label_21_4_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_4_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.5' type='checkbox'  value='Strongly Disagree'  id='choice_21_4_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_4_5' id='label_21_4_5' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_5\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >The information I received after the medical exam helped me know what I need to do to take care of my health.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_5'><li class='gchoice gchoice_21_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='Strongly Agree'  id='choice_21_5_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_5_1' id='label_21_5_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='Agree'  id='choice_21_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_5_2' id='label_21_5_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='Nuetral'  id='choice_21_5_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_5_3' id='label_21_5_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='Disagree'  id='choice_21_5_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_5_4' id='label_21_5_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_5_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.5' type='checkbox'  value='Strongly Disagree'  id='choice_21_5_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_5_5' id='label_21_5_5' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_5_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.6' type='checkbox'  value='Not Applicable'  id='choice_21_5_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_5_6' id='label_21_5_6' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_6\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I have the support of others to help me cope with the effects of my sexual assault.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_6'><li class='gchoice gchoice_21_6_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.1' type='checkbox'  value='Strongly Agree'  id='choice_21_6_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_6_1' id='label_21_6_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_6_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.2' type='checkbox'  value='Agree'  id='choice_21_6_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_6_2' id='label_21_6_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_6_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.3' type='checkbox'  value='Nuetral'  id='choice_21_6_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_6_3' id='label_21_6_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_6_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.4' type='checkbox'  value='Disagree'  id='choice_21_6_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_6_4' id='label_21_6_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_6_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.5' type='checkbox'  value='Strongly Disagree'  id='choice_21_6_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_6_5' id='label_21_6_5' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_7\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I have a better understanding of how a criminal case is processed from the investigation until the court\u2019s final decision.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_7'><li class='gchoice gchoice_21_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='Strongly Agree'  id='choice_21_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_7_1' id='label_21_7_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='Agree'  id='choice_21_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_7_2' id='label_21_7_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='Nuetral'  id='choice_21_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_7_3' id='label_21_7_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_7_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.4' type='checkbox'  value='Disagree'  id='choice_21_7_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_7_4' id='label_21_7_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_7_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.5' type='checkbox'  value='Strongly Disagree'  id='choice_21_7_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_7_5' id='label_21_7_5' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_7_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.6' type='checkbox'  value='Not Applicable'  id='choice_21_7_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_7_6' id='label_21_7_6' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_16\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I now have a better understanding of my rights as a victim of crime.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_16'><li class='gchoice gchoice_21_16_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.1' type='checkbox'  value='Strongly Agree'  id='choice_21_16_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_16_1' id='label_21_16_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_16_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.2' type='checkbox'  value='Agree'  id='choice_21_16_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_16_2' id='label_21_16_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_16_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.3' type='checkbox'  value='Nuetral'  id='choice_21_16_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_16_3' id='label_21_16_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_16_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.4' type='checkbox'  value='Disagree'  id='choice_21_16_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_16_4' id='label_21_16_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_16_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.5' type='checkbox'  value='Strongly Disagree'  id='choice_21_16_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_16_5' id='label_21_16_5' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_17\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I was provided with useful referrals to help meet my needs.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_17'><li class='gchoice gchoice_21_17_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.1' type='checkbox'  value='Strongly Agree'  id='choice_21_17_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_17_1' id='label_21_17_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_17_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.2' type='checkbox'  value='Agree'  id='choice_21_17_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_17_2' id='label_21_17_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_17_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.3' type='checkbox'  value='Nuetral'  id='choice_21_17_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_17_3' id='label_21_17_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_17_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.4' type='checkbox'  value='Disagree'  id='choice_21_17_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_17_4' id='label_21_17_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_17_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_17.5' type='checkbox'  value='Strongly Disagree'  id='choice_21_17_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_17_5' id='label_21_17_5' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_18\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I felt like my advocate was there to accompany me to appointments related to my case.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_18'><li class='gchoice gchoice_21_18_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.1' type='checkbox'  value='Strongly Agree'  id='choice_21_18_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_18_1' id='label_21_18_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_18_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.2' type='checkbox'  value='Agree'  id='choice_21_18_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_18_2' id='label_21_18_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_18_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.3' type='checkbox'  value='Nuetral'  id='choice_21_18_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_18_3' id='label_21_18_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_18_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.4' type='checkbox'  value='Disagree'  id='choice_21_18_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_18_4' id='label_21_18_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_18_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_18.5' type='checkbox'  value='Strongly Disagree'  id='choice_21_18_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_18_5' id='label_21_18_5' class='gform-field-label gform-field-label--type-inline'>Strongly Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_19\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >The agency took my culture, religion, and orientation into consideration when providing me services.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_19'><li class='gchoice gchoice_21_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='Strongly Agree'  id='choice_21_19_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_19_1' id='label_21_19_1' class='gform-field-label gform-field-label--type-inline'>Strongly Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_19_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.2' type='checkbox'  value='Agree'  id='choice_21_19_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_19_2' id='label_21_19_2' class='gform-field-label gform-field-label--type-inline'>Agree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_19_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.3' type='checkbox'  value='Nuetral'  id='choice_21_19_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_19_3' id='label_21_19_3' class='gform-field-label gform-field-label--type-inline'>Nuetral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_19_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.4' type='checkbox'  value='Disagree'  id='choice_21_19_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_19_4' id='label_21_19_4' class='gform-field-label gform-field-label--type-inline'>Disagree<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice 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