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<!DOCTYPE html><html class=''>
<head>
<meta charset='UTF-8'>
<meta name="robots" content="noindex">
<title>The Experiment Factory: Survey</title>
<link rel='stylesheet' type='text/css' href='https://code.getmdl.io/1.1.1/material.blue-red.min.css'>
<link rel='stylesheet' type='text/css' href='static/css/surveys.css'>
<link rel='stylesheet' type='text/css' href='static/js/jquery/ui/smoothness/jquery-ui-1.10.4.custom.min.css'>
<link rel='stylesheet' type='text/css' href='static/surveys/k6_survey/style.css'>
</head>
<body>
<script src='static/js/jquery/jquery-2.1.1.min.js'></script>
<script src='https://code.getmdl.io/1.1.1/material.min.js'></script>
<script src='static/js/jquery/ui/jquery-ui-1.10.4.custom.min.js'></script>
<script src='static/js/jquery/jquery.wizard.js'></script>
<script src='static/js/jquery/form/jquery.form-3.50.js'></script>
<script src='static/js/jquery/validate/jquery.validate-1.12.0.min.js'></script>
<div class="experiment-layout mdl-layout mdl-layout--fixed-header mdl-js-layout mdl-color--grey-100">
<div class="experiment-ribbon"></div>
<main class="experiment-main mdl-layout__content">
<div class="experiment-container mdl-grid">
<div class="mdl-cell mdl-cell--2-col mdl-cell--hide-tablet mdl-cell--hide-phone">
</div>
<div class="experiment-content mdl-color--white mdl-shadow--4dp content mdl-color-text--grey-800 mdl-cell mdl-cell--8-col">
<div id="questions">
<form name="questions" action="#", method="POST">
<div class="step">
<h3>Welcome to this survey. Press <strong>Next</strong> to begin.</h3><br><br><br><br></div>
<div class="step">
<h3>The following questions ask about how you have been feeling during the past 30 days. For each
question, please select the option that best describes how often you had this feeling.</h3><br><br><br><br></div>
<div class="step">
<h3><h4>Q1: During the past 30 days, about how
often did you feel … </h4></h3><br><br><br><br>
<p id="k6_survey_3_options">… nervous?</p>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_3_0">
<input type="radio" id="option-k6_survey_3_0" class="mdl-radio__button required page3" name="k6_survey_3_options" value="1" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… nervous?">
<span class="mdl-radio__label">All of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_3_1">
<input type="radio" id="option-k6_survey_3_1" class="mdl-radio__button required page3" name="k6_survey_3_options" value="2" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… nervous?">
<span class="mdl-radio__label"> Most of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_3_2">
<input type="radio" id="option-k6_survey_3_2" class="mdl-radio__button required page3" name="k6_survey_3_options" value="3" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… nervous?">
<span class="mdl-radio__label"> Some of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_3_3">
<input type="radio" id="option-k6_survey_3_3" class="mdl-radio__button required page3" name="k6_survey_3_options" value="4" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… nervous?">
<span class="mdl-radio__label"> A little of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_3_4">
<input type="radio" id="option-k6_survey_3_4" class="mdl-radio__button required page3" name="k6_survey_3_options" value="5" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… nervous?">
<span class="mdl-radio__label"> None of the time</span>
</label><br><br><br><br>
<p id="k6_survey_4_options">… hopeless?</p>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_4_0">
<input type="radio" id="option-k6_survey_4_0" class="mdl-radio__button required page3" name="k6_survey_4_options" value="1" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… hopeless?">
<span class="mdl-radio__label">All of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_4_1">
<input type="radio" id="option-k6_survey_4_1" class="mdl-radio__button required page3" name="k6_survey_4_options" value="2" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… hopeless?">
<span class="mdl-radio__label"> Most of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_4_2">
<input type="radio" id="option-k6_survey_4_2" class="mdl-radio__button required page3" name="k6_survey_4_options" value="3" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… hopeless?">
<span class="mdl-radio__label"> Some of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_4_3">
<input type="radio" id="option-k6_survey_4_3" class="mdl-radio__button required page3" name="k6_survey_4_options" value="4" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… hopeless?">
<span class="mdl-radio__label"> A little of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_4_4">
<input type="radio" id="option-k6_survey_4_4" class="mdl-radio__button required page3" name="k6_survey_4_options" value="5" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… hopeless?">
<span class="mdl-radio__label"> None of the time</span>
</label><br><br><br><br>
<p id="k6_survey_5_options">… restless or fidgety?</p>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_5_0">
<input type="radio" id="option-k6_survey_5_0" class="mdl-radio__button required page3" name="k6_survey_5_options" value="1" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… restless or fidgety?">
<span class="mdl-radio__label">All of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_5_1">
<input type="radio" id="option-k6_survey_5_1" class="mdl-radio__button required page3" name="k6_survey_5_options" value="2" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… restless or fidgety?">
<span class="mdl-radio__label"> Most of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_5_2">
<input type="radio" id="option-k6_survey_5_2" class="mdl-radio__button required page3" name="k6_survey_5_options" value="3" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… restless or fidgety?">
<span class="mdl-radio__label"> Some of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_5_3">
<input type="radio" id="option-k6_survey_5_3" class="mdl-radio__button required page3" name="k6_survey_5_options" value="4" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… restless or fidgety?">
<span class="mdl-radio__label"> A little of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_5_4">
<input type="radio" id="option-k6_survey_5_4" class="mdl-radio__button required page3" name="k6_survey_5_options" value="5" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… restless or fidgety?">
<span class="mdl-radio__label"> None of the time</span>
</label><br><br><br><br>
<p id="k6_survey_6_options">… so depressed that nothing could cheer you up?</p>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_6_0">
<input type="radio" id="option-k6_survey_6_0" class="mdl-radio__button required page3" name="k6_survey_6_options" value="1" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… so depressed that nothing could cheer you up?">
<span class="mdl-radio__label">All of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_6_1">
<input type="radio" id="option-k6_survey_6_1" class="mdl-radio__button required page3" name="k6_survey_6_options" value="2" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… so depressed that nothing could cheer you up?">
<span class="mdl-radio__label"> Most of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_6_2">
<input type="radio" id="option-k6_survey_6_2" class="mdl-radio__button required page3" name="k6_survey_6_options" value="3" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… so depressed that nothing could cheer you up?">
<span class="mdl-radio__label"> Some of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_6_3">
<input type="radio" id="option-k6_survey_6_3" class="mdl-radio__button required page3" name="k6_survey_6_options" value="4" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… so depressed that nothing could cheer you up?">
<span class="mdl-radio__label"> A little of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_6_4">
<input type="radio" id="option-k6_survey_6_4" class="mdl-radio__button required page3" name="k6_survey_6_options" value="5" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… so depressed that nothing could cheer you up?">
<span class="mdl-radio__label"> None of the time</span>
</label><br><br><br><br>
<p id="k6_survey_7_options">… that everything was an effort?</p>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_7_0">
<input type="radio" id="option-k6_survey_7_0" class="mdl-radio__button required page3" name="k6_survey_7_options" value="1" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… that everything was an effort?">
<span class="mdl-radio__label">All of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_7_1">
<input type="radio" id="option-k6_survey_7_1" class="mdl-radio__button required page3" name="k6_survey_7_options" value="2" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… that everything was an effort?">
<span class="mdl-radio__label"> Most of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_7_2">
<input type="radio" id="option-k6_survey_7_2" class="mdl-radio__button required page3" name="k6_survey_7_options" value="3" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… that everything was an effort?">
<span class="mdl-radio__label"> Some of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_7_3">
<input type="radio" id="option-k6_survey_7_3" class="mdl-radio__button required page3" name="k6_survey_7_options" value="4" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… that everything was an effort?">
<span class="mdl-radio__label"> A little of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_7_4">
<input type="radio" id="option-k6_survey_7_4" class="mdl-radio__button required page3" name="k6_survey_7_options" value="5" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… that everything was an effort?">
<span class="mdl-radio__label"> None of the time</span>
</label><br><br><br><br>
<p id="k6_survey_8_options">… worthless?</p>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_8_0">
<input type="radio" id="option-k6_survey_8_0" class="mdl-radio__button required page3" name="k6_survey_8_options" value="1" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… worthless?">
<span class="mdl-radio__label">All of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_8_1">
<input type="radio" id="option-k6_survey_8_1" class="mdl-radio__button required page3" name="k6_survey_8_options" value="2" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… worthless?">
<span class="mdl-radio__label"> Most of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_8_2">
<input type="radio" id="option-k6_survey_8_2" class="mdl-radio__button required page3" name="k6_survey_8_options" value="3" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… worthless?">
<span class="mdl-radio__label"> Some of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_8_3">
<input type="radio" id="option-k6_survey_8_3" class="mdl-radio__button required page3" name="k6_survey_8_options" value="4" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… worthless?">
<span class="mdl-radio__label"> A little of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_8_4">
<input type="radio" id="option-k6_survey_8_4" class="mdl-radio__button required page3" name="k6_survey_8_options" value="5" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="… worthless?">
<span class="mdl-radio__label"> None of the time</span>
</label><br><br><br><br>
<p id="k6_survey_9_options">Q2: The last six questions asked about feelings that might have occurred during the past 30
days. Taking them altogether, did these feelings occur more often in the past 30 days
than is usual for you, about the same as usual, or less often than usual? (If you never
have any of these feelings, select “about the same as usual”) </p>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_9_0">
<input type="radio" id="option-k6_survey_9_0" class="mdl-radio__button required page3" name="k6_survey_9_options" value="1" meta-options="A lot| Some<br><strong>More often than usual<br>←</strong>| A little| About the same as usual| A little | Some<br><strong>Less often than usual<br>→</strong>| A lot" meta-text="Q2: The last six questions asked about feelings that might have occurred during the past 30
days. Taking them altogether, did these feelings occur more often in the past 30 days
than is usual for you, about the same as usual, or less often than usual? (If you never
have any of these feelings, select “about the same as usual”) ">
<span class="mdl-radio__label">A lot</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_9_1">
<input type="radio" id="option-k6_survey_9_1" class="mdl-radio__button required page3" name="k6_survey_9_options" value="2" meta-options="A lot| Some<br><strong>More often than usual<br>←</strong>| A little| About the same as usual| A little | Some<br><strong>Less often than usual<br>→</strong>| A lot" meta-text="Q2: The last six questions asked about feelings that might have occurred during the past 30
days. Taking them altogether, did these feelings occur more often in the past 30 days
than is usual for you, about the same as usual, or less often than usual? (If you never
have any of these feelings, select “about the same as usual”) ">
<span class="mdl-radio__label"> Some<br><strong>More often than usual<br>←</strong></span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_9_2">
<input type="radio" id="option-k6_survey_9_2" class="mdl-radio__button required page3" name="k6_survey_9_options" value="3" meta-options="A lot| Some<br><strong>More often than usual<br>←</strong>| A little| About the same as usual| A little | Some<br><strong>Less often than usual<br>→</strong>| A lot" meta-text="Q2: The last six questions asked about feelings that might have occurred during the past 30
days. Taking them altogether, did these feelings occur more often in the past 30 days
than is usual for you, about the same as usual, or less often than usual? (If you never
have any of these feelings, select “about the same as usual”) ">
<span class="mdl-radio__label"> A little</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_9_3">
<input type="radio" id="option-k6_survey_9_3" class="mdl-radio__button required page3" name="k6_survey_9_options" value="4" meta-options="A lot| Some<br><strong>More often than usual<br>←</strong>| A little| About the same as usual| A little | Some<br><strong>Less often than usual<br>→</strong>| A lot" meta-text="Q2: The last six questions asked about feelings that might have occurred during the past 30
days. Taking them altogether, did these feelings occur more often in the past 30 days
than is usual for you, about the same as usual, or less often than usual? (If you never
have any of these feelings, select “about the same as usual”) ">
<span class="mdl-radio__label"> About the same as usual</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_9_4">
<input type="radio" id="option-k6_survey_9_4" class="mdl-radio__button required page3" name="k6_survey_9_options" value="5" meta-options="A lot| Some<br><strong>More often than usual<br>←</strong>| A little| About the same as usual| A little | Some<br><strong>Less often than usual<br>→</strong>| A lot" meta-text="Q2: The last six questions asked about feelings that might have occurred during the past 30
days. Taking them altogether, did these feelings occur more often in the past 30 days
than is usual for you, about the same as usual, or less often than usual? (If you never
have any of these feelings, select “about the same as usual”) ">
<span class="mdl-radio__label"> A little </span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_9_5">
<input type="radio" id="option-k6_survey_9_5" class="mdl-radio__button required page3" name="k6_survey_9_options" value="6" meta-options="A lot| Some<br><strong>More often than usual<br>←</strong>| A little| About the same as usual| A little | Some<br><strong>Less often than usual<br>→</strong>| A lot" meta-text="Q2: The last six questions asked about feelings that might have occurred during the past 30
days. Taking them altogether, did these feelings occur more often in the past 30 days
than is usual for you, about the same as usual, or less often than usual? (If you never
have any of these feelings, select “about the same as usual”) ">
<span class="mdl-radio__label"> Some<br><strong>Less often than usual<br>→</strong></span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_9_6">
<input type="radio" id="option-k6_survey_9_6" class="mdl-radio__button required page3" name="k6_survey_9_options" value="7" meta-options="A lot| Some<br><strong>More often than usual<br>←</strong>| A little| About the same as usual| A little | Some<br><strong>Less often than usual<br>→</strong>| A lot" meta-text="Q2: The last six questions asked about feelings that might have occurred during the past 30
days. Taking them altogether, did these feelings occur more often in the past 30 days
than is usual for you, about the same as usual, or less often than usual? (If you never
have any of these feelings, select “about the same as usual”) ">
<span class="mdl-radio__label"> A lot</span>
</label><br><br><br><br></div>
<div class="step">
<h3><h4>The next few questions are about how these feelings may have affected you in the past 30 days.
You need not answer these questions if you answered “None of the time” to all of the six
questions about your feelings.</h4></h3><br><br><br><br>
<p id="k6_survey_11">Q3: During the past 30 days, how many days out of 30 were you totally unable to work or
carry out your normal activities because of these feelings?<br><br><strong>(Number of Days)</strong></p>
<div class="mdl-textfield mdl-js-textfield">
<input class="mdl-textfield__input page4 " type="number" id="k6_survey_11" name="k6_survey_11" meta-text="Q3: During the past 30 days, how many days out of 30 were you totally unable to work or
carry out your normal activities because of these feelings?<br><br><strong>(Number of Days)</strong>">
<label class="mdl-textfield__label" for="k6_survey_11"></label>
<span class="mdl-textfield__error">Input is not a number!</span>
</div><br><br><br>
<p id="k6_survey_12">Q4: Not counting the days you reported in response to Q3, how many days in the past
30 were you able to do only half or less of what you would normally have been able
to do, because of these feelings?<br><br><strong>(Number of Days)</strong></p>
<div class="mdl-textfield mdl-js-textfield">
<input class="mdl-textfield__input page4 " type="number" id="k6_survey_12" name="k6_survey_12" meta-text="Q4: Not counting the days you reported in response to Q3, how many days in the past
30 were you able to do only half or less of what you would normally have been able
to do, because of these feelings?<br><br><strong>(Number of Days)</strong>">
<label class="mdl-textfield__label" for="k6_survey_12"></label>
<span class="mdl-textfield__error">Input is not a number!</span>
</div><br><br><br>
<p id="k6_survey_13">Q5: During the past 30 days, how many times did you see a doctor or other health
professional about these feelings?<br><br><strong>(Number of Times)</strong></p>
<div class="mdl-textfield mdl-js-textfield">
<input class="mdl-textfield__input page4 " type="number" id="k6_survey_13" name="k6_survey_13" meta-text="Q5: During the past 30 days, how many times did you see a doctor or other health
professional about these feelings?<br><br><strong>(Number of Times)</strong>">
<label class="mdl-textfield__label" for="k6_survey_13"></label>
<span class="mdl-textfield__error">Input is not a number!</span>
</div><br><br><br>
<p id="k6_survey_14_options">Q6: During the past 30 days, how often
have physical health problems been
the main cause of these feelings? </p>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_14_0">
<input type="radio" id="option-k6_survey_14_0" class="mdl-radio__button page4" name="k6_survey_14_options" value="1" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="Q6: During the past 30 days, how often
have physical health problems been
the main cause of these feelings? ">
<span class="mdl-radio__label">All of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_14_1">
<input type="radio" id="option-k6_survey_14_1" class="mdl-radio__button page4" name="k6_survey_14_options" value="2" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="Q6: During the past 30 days, how often
have physical health problems been
the main cause of these feelings? ">
<span class="mdl-radio__label"> Most of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_14_2">
<input type="radio" id="option-k6_survey_14_2" class="mdl-radio__button page4" name="k6_survey_14_options" value="3" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="Q6: During the past 30 days, how often
have physical health problems been
the main cause of these feelings? ">
<span class="mdl-radio__label"> Some of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_14_3">
<input type="radio" id="option-k6_survey_14_3" class="mdl-radio__button page4" name="k6_survey_14_options" value="4" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="Q6: During the past 30 days, how often
have physical health problems been
the main cause of these feelings? ">
<span class="mdl-radio__label"> A little of the time</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_14_4">
<input type="radio" id="option-k6_survey_14_4" class="mdl-radio__button page4" name="k6_survey_14_options" value="5" meta-options="All of the time| Most of the time| Some of the time| A little of the time| None of the time" meta-text="Q6: During the past 30 days, how often
have physical health problems been
the main cause of these feelings? ">
<span class="mdl-radio__label"> None of the time</span>
</label><br><br><br><br></div>
<div class="step">
<p id="k6_survey_15_options">Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?</p>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_0">
<input type="checkbox" id="checkbox-k6_survey_15_0" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_0_options" value="ADHD">
<span class="mdl-checkbox__label">ADHD</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_1">
<input type="checkbox" id="checkbox-k6_survey_15_1" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_1_options" value=" Alcohol Dependency">
<span class="mdl-checkbox__label"> Alcohol Dependency</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_2">
<input type="checkbox" id="checkbox-k6_survey_15_2" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_2_options" value=" Anorexi Nervosa">
<span class="mdl-checkbox__label"> Anorexi Nervosa</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_3">
<input type="checkbox" id="checkbox-k6_survey_15_3" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_3_options" value=" Anxiety Disorder">
<span class="mdl-checkbox__label"> Anxiety Disorder</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_4">
<input type="checkbox" id="checkbox-k6_survey_15_4" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_4_options" value=" Autism/Autism Specturm Disorder">
<span class="mdl-checkbox__label"> Autism/Autism Specturm Disorder</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_5">
<input type="checkbox" id="checkbox-k6_survey_15_5" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_5_options" value=" Borderline Personality Disorder">
<span class="mdl-checkbox__label"> Borderline Personality Disorder</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_6">
<input type="checkbox" id="checkbox-k6_survey_15_6" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_6_options" value=" Bulimia">
<span class="mdl-checkbox__label"> Bulimia</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_7">
<input type="checkbox" id="checkbox-k6_survey_15_7" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_7_options" value=" Drug Dependency">
<span class="mdl-checkbox__label"> Drug Dependency</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_8">
<input type="checkbox" id="checkbox-k6_survey_15_8" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_8_options" value=" Depression">
<span class="mdl-checkbox__label"> Depression</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_9">
<input type="checkbox" id="checkbox-k6_survey_15_9" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_9_options" value=" Manic-Depressive (Bilpolar) illness">
<span class="mdl-checkbox__label"> Manic-Depressive (Bilpolar) illness</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_10">
<input type="checkbox" id="checkbox-k6_survey_15_10" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_10_options" value=" Obessive Compulsive Disorder">
<span class="mdl-checkbox__label"> Obessive Compulsive Disorder</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_11">
<input type="checkbox" id="checkbox-k6_survey_15_11" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_11_options" value=" Schizophrenia">
<span class="mdl-checkbox__label"> Schizophrenia</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_12">
<input type="checkbox" id="checkbox-k6_survey_15_12" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_12_options" value=" Other">
<span class="mdl-checkbox__label"> Other</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_15_13">
<input type="checkbox" id="checkbox-k6_survey_15_13" meta-options="ADHD| Alcohol Dependency| Anorexi Nervosa| Anxiety Disorder| Autism/Autism Specturm Disorder| Borderline Personality Disorder| Bulimia| Drug Dependency| Depression| Manic-Depressive (Bilpolar) illness| Obessive Compulsive Disorder| Schizophrenia| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following psychological disorders (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_15_13_options" value=" None">
<span class="mdl-checkbox__label"> None</span>
</label><br><br><br>
<p id="k6_survey_16">If you responded “other” to the above question, please describe:</p>
<div class="mdl-textfield mdl-js-textfield">
<input class="mdl-textfield__input page5 " name="k6_survey_16" type="text" id="k6_survey_16" meta-text="If you responded “other” to the above question, please describe:">
<label class="mdl-textfield__label" for="k6_survey_16"></label>
</div><br><br><br>
<p id="k6_survey_17_options">Have you been diagnosed with any neurological disorder (e.g. Alzheimer's, Parkinson's)?</p>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_17_0">
<input type="radio" id="option-k6_survey_17_0" class="mdl-radio__button required page5" name="k6_survey_17_options" value="1" meta-options="Yes| No" meta-text="Have you been diagnosed with any neurological disorder (e.g. Alzheimer's, Parkinson's)?">
<span class="mdl-radio__label">Yes</span>
</label>
<label class="mdl-radio mdl-js-radio mdl-js-ripple-effect" for="option-k6_survey_17_1">
<input type="radio" id="option-k6_survey_17_1" class="mdl-radio__button required page5" name="k6_survey_17_options" value=" 0" meta-options="Yes| No" meta-text="Have you been diagnosed with any neurological disorder (e.g. Alzheimer's, Parkinson's)?">
<span class="mdl-radio__label"> No</span>
</label><br><br><br><br>
<p id="k6_survey_18">If you responded “yes” to the above question, please describe:</p>
<div class="mdl-textfield mdl-js-textfield">
<input class="mdl-textfield__input page5 " name="k6_survey_18" type="text" id="k6_survey_18" meta-text="If you responded “yes” to the above question, please describe:">
<label class="mdl-textfield__label" for="k6_survey_18"></label>
</div><br><br><br>
<p id="k6_survey_19_options">Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?</p>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_19_0">
<input type="checkbox" id="checkbox-k6_survey_19_0" meta-options="Type II diabetes| Metabolic Syndrome| High Blood Pressure| Heart Disease| Stroke| Cancer| Sleep Apnea| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_19_0_options" value="Type II diabetes">
<span class="mdl-checkbox__label">Type II diabetes</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_19_1">
<input type="checkbox" id="checkbox-k6_survey_19_1" meta-options="Type II diabetes| Metabolic Syndrome| High Blood Pressure| Heart Disease| Stroke| Cancer| Sleep Apnea| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_19_1_options" value=" Metabolic Syndrome">
<span class="mdl-checkbox__label"> Metabolic Syndrome</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_19_2">
<input type="checkbox" id="checkbox-k6_survey_19_2" meta-options="Type II diabetes| Metabolic Syndrome| High Blood Pressure| Heart Disease| Stroke| Cancer| Sleep Apnea| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_19_2_options" value=" High Blood Pressure">
<span class="mdl-checkbox__label"> High Blood Pressure</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_19_3">
<input type="checkbox" id="checkbox-k6_survey_19_3" meta-options="Type II diabetes| Metabolic Syndrome| High Blood Pressure| Heart Disease| Stroke| Cancer| Sleep Apnea| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_19_3_options" value=" Heart Disease">
<span class="mdl-checkbox__label"> Heart Disease</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_19_4">
<input type="checkbox" id="checkbox-k6_survey_19_4" meta-options="Type II diabetes| Metabolic Syndrome| High Blood Pressure| Heart Disease| Stroke| Cancer| Sleep Apnea| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_19_4_options" value=" Stroke">
<span class="mdl-checkbox__label"> Stroke</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_19_5">
<input type="checkbox" id="checkbox-k6_survey_19_5" meta-options="Type II diabetes| Metabolic Syndrome| High Blood Pressure| Heart Disease| Stroke| Cancer| Sleep Apnea| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_19_5_options" value=" Cancer">
<span class="mdl-checkbox__label"> Cancer</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_19_6">
<input type="checkbox" id="checkbox-k6_survey_19_6" meta-options="Type II diabetes| Metabolic Syndrome| High Blood Pressure| Heart Disease| Stroke| Cancer| Sleep Apnea| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_19_6_options" value=" Sleep Apnea">
<span class="mdl-checkbox__label"> Sleep Apnea</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_19_7">
<input type="checkbox" id="checkbox-k6_survey_19_7" meta-options="Type II diabetes| Metabolic Syndrome| High Blood Pressure| Heart Disease| Stroke| Cancer| Sleep Apnea| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_19_7_options" value=" Other">
<span class="mdl-checkbox__label"> Other</span>
</label>
<label class="mdl-checkbox mdl-js-checkbox mdl-js-ripple-effect" for="checkbox-k6_survey_19_8">
<input type="checkbox" id="checkbox-k6_survey_19_8" meta-options="Type II diabetes| Metabolic Syndrome| High Blood Pressure| Heart Disease| Stroke| Cancer| Sleep Apnea| Other| None" meta-text="Do you have or have you ever been diagnosed with any of the following medical conditions (check all that apply)?" class="mdl-checkbox__input page5 required" name="k6_survey_19_8_options" value=" None">
<span class="mdl-checkbox__label"> None</span>
</label><br><br><br>
<p id="k6_survey_20">If you responded “other” to the above question, please describe:</p>
<div class="mdl-textfield mdl-js-textfield">
<input class="mdl-textfield__input page5 " name="k6_survey_20" type="text" id="k6_survey_20" meta-text="If you responded “other” to the above question, please describe:">
<label class="mdl-textfield__label" for="k6_survey_20"></label>
</div><br><br><br></div>
<div class="step">
<h3>Congratulations for completing this survey! Press <strong>finish</strong> to continue.</h3><br><br><br><br></div>
<div class="navigation">
<ul class="clearfix">
<li><button type="button" name="backward" class="mdl-button mdl-js-button mdl-button--raised mdl-js-ripple-effect mdl-button--accent backward">Previous</button></li>
<li><button type="button" name="forward" class="forward mdl-button mdl-js-button mdl-button--raised mdl-js-ripple-effect mdl-button--accent">Next</button></li>
<li><button type="submit" name="process" class="submit mdl-button mdl-js-button mdl-button--raised mdl-js-ripple-effect mdl-button--accent">Finish</button></li>
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<div class="pad">
<div id="progressbar"></div>
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