{"id":139,"date":"2023-04-12T02:29:25","date_gmt":"2023-04-12T06:29:25","guid":{"rendered":"https:\/\/riverheightsoptometry.com\/?page_id=139"},"modified":"2023-05-31T12:42:34","modified_gmt":"2023-05-31T16:42:34","slug":"osdi-form","status":"publish","type":"page","link":"https:\/\/riverheightsoptometry.com\/osdi-form\/","title":{"rendered":"OSDI Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"139\" class=\"elementor elementor-139\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-49099ab elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"49099ab\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;shape_divider_bottom&quot;:&quot;waves&quot;,&quot;shape_divider_bottom_negative&quot;:&quot;yes&quot;,&quot;_ob_glider_is_slider&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t<div class=\"elementor-shape elementor-shape-bottom\" data-negative=\"true\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 1000 100\" preserveAspectRatio=\"none\">\n\t<path class=\"elementor-shape-fill\" d=\"M790.5,93.1c-59.3-5.3-116.8-18-192.6-50c-29.6-12.7-76.9-31-100.5-35.9c-23.6-4.9-52.6-7.8-75.5-5.3\n\tc-10.2,1.1-22.6,1.4-50.1,7.4c-27.2,6.3-58.2,16.6-79.4,24.7c-41.3,15.9-94.9,21.9-134,22.6C72,58.2,0,25.8,0,25.8V100h1000V65.3\n\tc0,0-51.5,19.4-106.2,25.7C839.5,97,814.1,95.2,790.5,93.1z\"\/>\n<\/svg>\t\t<\/div>\n\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7754530\" data-id=\"7754530\" data-element_type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"ob-is-breaking-bad ob-bb-inner elementor-section elementor-inner-section elementor-element elementor-element-ab2e8f2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ab2e8f2\" data-element_type=\"section\" data-settings=\"{&quot;_ob_bbad_use_it&quot;:&quot;yes&quot;,&quot;_ob_bbad_sssic_use&quot;:&quot;no&quot;,&quot;_ob_glider_is_slider&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-2913afe\" data-id=\"2913afe\" data-element_type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3102a56 ob-harakiri-inherit elementor-invisible ob-has-background-overlay elementor-widget elementor-widget-heading\" data-id=\"3102a56\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeIn&quot;,&quot;_animation_delay&quot;:100,&quot;_ob_use_harakiri&quot;:&quot;yes&quot;,&quot;_ob_harakiri_writing_mode&quot;:&quot;inherit&quot;,&quot;_ob_harakiri_text_clip&quot;:&quot;none&quot;,&quot;_ob_perspektive_use&quot;:&quot;no&quot;,&quot;_ob_poopart_use&quot;:&quot;yes&quot;,&quot;_ob_shadough_use&quot;:&quot;no&quot;,&quot;_ob_allow_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_widget_stalker_use&quot;:&quot;no&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 15-04-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h1 class=\"elementor-heading-title elementor-size-default\">OSDI Form<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-b2d8695 elementor-hidden-mobile\" data-id=\"b2d8695\" data-element_type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-688bed8\" data-id=\"688bed8\" data-element_type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"ob-is-breaking-bad elementor-section elementor-top-section elementor-element elementor-element-4d4e695 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4d4e695\" data-element_type=\"section\" data-settings=\"{&quot;_ob_bbad_use_it&quot;:&quot;yes&quot;,&quot;_ob_bbad_sssic_use&quot;:&quot;no&quot;,&quot;_ob_glider_is_slider&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c291f56\" data-id=\"c291f56\" data-element_type=\"column\" data-settings=\"{&quot;_ob_bbad_is_stalker&quot;:&quot;no&quot;,&quot;_ob_teleporter_use&quot;:false,&quot;_ob_column_hoveranimator&quot;:&quot;no&quot;,&quot;_ob_column_has_pseudo&quot;:&quot;no&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9267b4a elementor-button-align-start ob-has-background-overlay elementor-widget elementor-widget-form\" data-id=\"9267b4a\" data-element_type=\"widget\" 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.e-font-icon-svg{height:1em}.elementor-select-wrapper .select-caret-down-wrapper{position:absolute;top:50%;transform:translateY(-50%);inset-inline-end:10px;pointer-events:none;font-size:11px}.elementor-select-wrapper .select-caret-down-wrapper svg{display:unset;width:1em;aspect-ratio:unset;fill:currentColor}.elementor-select-wrapper .select-caret-down-wrapper i{font-size:19px;line-height:2}.elementor-select-wrapper.remove-before:before{content:\"\"!important}<\/style>\t\t<form class=\"elementor-form\" method=\"post\" id=\"ODSI_FORM\" name=\"OSDI Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"139\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"9267b4a\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-first_name elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-first_name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[first_name]\" id=\"form-field-first_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-last_name elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-last_name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[last_name]\" id=\"form-field-last_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Last Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_3b77395 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3b77395\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhone Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_3b77395]\" id=\"form-field-field_3b77395\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone Number\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_9aec628 elementor-col-100\">\n\t\t\t\t\t<b>Have you experienced any of the following during the last week:<\/b>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_1 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEyes that are sensitive to light?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_1-0\" name=\"form_fields[question_1]\"> <label for=\"form-field-question_1-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_1-1\" name=\"form_fields[question_1]\"> <label for=\"form-field-question_1-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_1-2\" name=\"form_fields[question_1]\"> <label for=\"form-field-question_1-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_1-3\" name=\"form_fields[question_1]\"> <label for=\"form-field-question_1-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_1-4\" name=\"form_fields[question_1]\"> <label for=\"form-field-question_1-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEyes that feel gritty?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_2-0\" name=\"form_fields[question_2]\"> <label for=\"form-field-question_2-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_2-1\" name=\"form_fields[question_2]\"> <label for=\"form-field-question_2-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_2-2\" name=\"form_fields[question_2]\"> <label for=\"form-field-question_2-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_2-3\" name=\"form_fields[question_2]\"> <label for=\"form-field-question_2-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_2-4\" name=\"form_fields[question_2]\"> <label for=\"form-field-question_2-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPainful or sore eyes?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_3-0\" name=\"form_fields[question_3]\"> <label for=\"form-field-question_3-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_3-1\" name=\"form_fields[question_3]\"> <label for=\"form-field-question_3-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_3-2\" name=\"form_fields[question_3]\"> <label for=\"form-field-question_3-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_3-3\" name=\"form_fields[question_3]\"> <label for=\"form-field-question_3-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_3-4\" name=\"form_fields[question_3]\"> <label for=\"form-field-question_3-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_4 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBlurred Vision?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_4-0\" name=\"form_fields[question_4]\"> <label for=\"form-field-question_4-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_4-1\" name=\"form_fields[question_4]\"> <label for=\"form-field-question_4-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_4-2\" name=\"form_fields[question_4]\"> <label for=\"form-field-question_4-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_4-3\" name=\"form_fields[question_4]\"> <label for=\"form-field-question_4-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_4-4\" name=\"form_fields[question_4]\"> <label for=\"form-field-question_4-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_5 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPoor vision?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_5-0\" name=\"form_fields[question_5]\"> <label for=\"form-field-question_5-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_5-1\" name=\"form_fields[question_5]\"> <label for=\"form-field-question_5-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_5-2\" name=\"form_fields[question_5]\"> <label for=\"form-field-question_5-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_5-3\" name=\"form_fields[question_5]\"> <label for=\"form-field-question_5-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_5-4\" name=\"form_fields[question_5]\"> <label for=\"form-field-question_5-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_712e1d4 elementor-col-100\">\n\t\t\t\t\t<b>Have problems with your eyes limited you in performing any of the following during the last week:<\/b>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReading?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_6-0\" name=\"form_fields[question_6]\"> <label for=\"form-field-question_6-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_6-1\" name=\"form_fields[question_6]\"> <label for=\"form-field-question_6-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_6-2\" name=\"form_fields[question_6]\"> <label for=\"form-field-question_6-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_6-3\" name=\"form_fields[question_6]\"> <label for=\"form-field-question_6-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_6-4\" name=\"form_fields[question_6]\"> <label for=\"form-field-question_6-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDriving at night?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_7-0\" name=\"form_fields[question_7]\"> <label for=\"form-field-question_7-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_7-1\" name=\"form_fields[question_7]\"> <label for=\"form-field-question_7-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_7-2\" name=\"form_fields[question_7]\"> <label for=\"form-field-question_7-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_7-3\" name=\"form_fields[question_7]\"> <label for=\"form-field-question_7-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_7-4\" name=\"form_fields[question_7]\"> <label for=\"form-field-question_7-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWorking with a computer or bank machine? (ATM)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_8-0\" name=\"form_fields[question_8]\"> <label for=\"form-field-question_8-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_8-1\" name=\"form_fields[question_8]\"> <label for=\"form-field-question_8-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_8-2\" name=\"form_fields[question_8]\"> <label for=\"form-field-question_8-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_8-3\" name=\"form_fields[question_8]\"> <label for=\"form-field-question_8-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_8-4\" name=\"form_fields[question_8]\"> <label for=\"form-field-question_8-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_9 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWatching TV?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_9-0\" name=\"form_fields[question_9]\"> <label for=\"form-field-question_9-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_9-1\" name=\"form_fields[question_9]\"> <label for=\"form-field-question_9-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_9-2\" name=\"form_fields[question_9]\"> <label for=\"form-field-question_9-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_9-3\" name=\"form_fields[question_9]\"> <label for=\"form-field-question_9-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_9-4\" name=\"form_fields[question_9]\"> <label for=\"form-field-question_9-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_a856131 elementor-col-100\">\n\t\t\t\t\t<b>Have your eyes felt uncomfortable in any of the following situations during the last week:<\/b>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_10 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_10\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWindy conditions?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_10-0\" name=\"form_fields[question_10]\"> <label for=\"form-field-question_10-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_10-1\" name=\"form_fields[question_10]\"> <label for=\"form-field-question_10-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_10-2\" name=\"form_fields[question_10]\"> <label for=\"form-field-question_10-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_10-3\" name=\"form_fields[question_10]\"> <label for=\"form-field-question_10-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_10-4\" name=\"form_fields[question_10]\"> <label for=\"form-field-question_10-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_11 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_11\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlaces or areas with low humidity (very dry)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_11-0\" name=\"form_fields[question_11]\"> <label for=\"form-field-question_11-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_11-1\" name=\"form_fields[question_11]\"> <label for=\"form-field-question_11-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_11-2\" name=\"form_fields[question_11]\"> <label for=\"form-field-question_11-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_11-3\" name=\"form_fields[question_11]\"> <label for=\"form-field-question_11-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_11-4\" name=\"form_fields[question_11]\"> <label for=\"form-field-question_11-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-question_12 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-question_12\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAreas that are air conditioned?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"All of the time\" id=\"form-field-question_12-0\" name=\"form_fields[question_12]\"> <label for=\"form-field-question_12-0\">All of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Most of the time\" id=\"form-field-question_12-1\" name=\"form_fields[question_12]\"> <label for=\"form-field-question_12-1\">Most of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Half of the time\" id=\"form-field-question_12-2\" name=\"form_fields[question_12]\"> <label for=\"form-field-question_12-2\">Half of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Some of the time\" id=\"form-field-question_12-3\" name=\"form_fields[question_12]\"> <label for=\"form-field-question_12-3\">Some of the time<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"None of the time\" id=\"form-field-question_12-4\" name=\"form_fields[question_12]\"> <label for=\"form-field-question_12-4\">None of the time<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-acceptance elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[acceptance]\" id=\"form-field-acceptance\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\">\n\t\t\t\t<label for=\"form-field-acceptance\">I agree to give consent for River Heights Optometry to use my quiz.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-sm\" id=\"odsi-form-button\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit Quiz<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>OSDI Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/riverheightsoptometry.com\/wp-json\/wp\/v2\/pages\/139"}],"collection":[{"href":"https:\/\/riverheightsoptometry.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/riverheightsoptometry.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/riverheightsoptometry.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/riverheightsoptometry.com\/wp-json\/wp\/v2\/comments?post=139"}],"version-history":[{"count":0,"href":"https:\/\/riverheightsoptometry.com\/wp-json\/wp\/v2\/pages\/139\/revisions"}],"wp:attachment":[{"href":"https:\/\/riverheightsoptometry.com\/wp-json\/wp\/v2\/media?parent=139"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}