[wpforms id="23856" title="false" description="false"]
<div class="wpforms-container wpforms-container-full survey_form" id="wpforms-23856"><form id="wpforms-form-23856" class="wpforms-validate wpforms-form" data-formid="23856" method="post" enctype="multipart/form-data" action="/category/education/"><noscript class="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</noscript><div class="wpforms-field-container"><div id="wpforms-23856-field_8-container" class="wpforms-field wpforms-field-radio work_mainly wpforms-conditional-trigger" data-field-id="8"><label class="wpforms-field-label" for="wpforms-23856-field_8">1. In the last 6 months, is your work mainly:</label><ul id="wpforms-23856-field_8"><li class="choice-1 depth-1"><input type="radio" id="wpforms-23856-field_8_1" name="wpforms[fields][8]" value="Emergency" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_8_1">Emergency</label></li><li class="choice-2 depth-1"><input type="radio" id="wpforms-23856-field_8_2" name="wpforms[fields][8]" value="Paediatric Emergency" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_8_2">Paediatric Emergency</label></li><li class="choice-3 depth-1"><input type="radio" id="wpforms-23856-field_8_3" name="wpforms[fields][8]" value="Paediatrics" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_8_3">Paediatrics</label></li><li class="choice-4 depth-1"><input type="radio" id="wpforms-23856-field_8_4" name="wpforms[fields][8]" value="Other" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_8_4">Other</label></li></ul></div><div id="wpforms-23856-field_14-container" class="wpforms-field wpforms-field-text more_info wpforms-conditional-field wpforms-conditional-show" data-field-id="14" style="display:none;"><label class="wpforms-field-label" for="wpforms-23856-field_14">Please provide more info</label><input type="text" id="wpforms-23856-field_14" class="wpforms-field-medium" name="wpforms[fields][14]" ></div><div id="wpforms-23856-field_10-container" class="wpforms-field wpforms-field-radio mostly_access wpforms-conditional-trigger" data-field-id="10"><label class="wpforms-field-label" for="wpforms-23856-field_10">2. Where do you most frequently you access DFTB?</label><ul id="wpforms-23856-field_10"><li class="choice-1 depth-1"><input type="radio" id="wpforms-23856-field_10_1" name="wpforms[fields][10]" value="At home" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_10_1">At home</label></li><li class="choice-2 depth-1"><input type="radio" id="wpforms-23856-field_10_2" name="wpforms[fields][10]" value="At work" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_10_2">At work</label></li><li class="choice-3 depth-1"><input type="radio" id="wpforms-23856-field_10_3" name="wpforms[fields][10]" value="Commuting" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_10_3">Commuting</label></li><li class="choice-4 depth-1"><input type="radio" id="wpforms-23856-field_10_4" name="wpforms[fields][10]" value="Other" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_10_4">Other</label></li></ul></div><div id="wpforms-23856-field_16-container" class="wpforms-field wpforms-field-text more_info2 wpforms-conditional-field wpforms-conditional-show" data-field-id="16" style="display:none;"><label class="wpforms-field-label" for="wpforms-23856-field_16">Please provide more info (copy)</label><input type="text" id="wpforms-23856-field_16" class="wpforms-field-medium" name="wpforms[fields][16]" ></div><div id="wpforms-23856-field_12-container" class="wpforms-field wpforms-field-checkbox main_reason wpforms-conditional-trigger" data-field-id="12"><label class="wpforms-field-label" for="wpforms-23856-field_12">3. What's the main reason you access DFTB?</label><ul id="wpforms-23856-field_12"><li class="choice-1 depth-1"><input type="checkbox" id="wpforms-23856-field_12_1" name="wpforms[fields][12][]" value="I cannot find the answer to this stuff anywhere else" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_12_1">I cannot find the answer to this stuff anywhere else</label></li><li class="choice-2 depth-1"><input type="checkbox" id="wpforms-23856-field_12_2" name="wpforms[fields][12][]" value="To answer a specific clinical question" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_12_2">To answer a specific clinical question</label></li><li class="choice-3 depth-1"><input type="checkbox" id="wpforms-23856-field_12_3" name="wpforms[fields][12][]" value="Analysis of the latest research" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_12_3">Analysis of the latest research</label></li><li class="choice-4 depth-1"><input type="checkbox" id="wpforms-23856-field_12_4" name="wpforms[fields][12][]" value="To study for my college exam" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_12_4">To study for my college exam</label></li><li class="choice-5 depth-1"><input type="checkbox" id="wpforms-23856-field_12_5" name="wpforms[fields][12][]" value="Variety of content" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_12_5">Variety of content</label></li><li class="choice-6 depth-1"><input type="checkbox" id="wpforms-23856-field_12_6" name="wpforms[fields][12][]" value="DFTB is a valued and trusted resource" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_12_6">DFTB is a valued and trusted resource</label></li><li class="choice-7 depth-1"><input type="checkbox" id="wpforms-23856-field_12_7" name="wpforms[fields][12][]" value="The link seemed interesting, so I clicked it!" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_12_7">The link seemed interesting, so I clicked it!</label></li><li class="choice-8 depth-1"><input type="checkbox" id="wpforms-23856-field_12_8" name="wpforms[fields][12][]" value="Other" ><label class="wpforms-field-label-inline" for="wpforms-23856-field_12_8">Other</label></li></ul></div><div id="wpforms-23856-field_15-container" class="wpforms-field wpforms-field-text single_line wpforms-conditional-field wpforms-conditional-show" data-field-id="15" style="display:none;"><label class="wpforms-field-label" for="wpforms-23856-field_15">Single Line Text</label><input type="text" id="wpforms-23856-field_15" class="wpforms-field-medium" name="wpforms[fields][15]" ></div><div id="wpforms-23856-field_13-container" class="wpforms-field wpforms-field-net_promoter_score how_likely" data-field-id="13"><label class="wpforms-field-label" for="wpforms-23856-field_13">4. How likely are you to recommend DFTB to a peer/colleague?</label>
<table cellspacing="0" cellpadding="0" class="wpforms-field-large modern">
<thead>
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<th colspan="11">
<span class="not-likely">Not at all Likely</span>
<span class="extremely-likely">Extremely Likely</span>
</th>
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<tr>
<td><input type="radio" id="wpforms-23856-field_13_0" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="0" ><label for="wpforms-23856-field_13_0">0</label></td><td><input type="radio" id="wpforms-23856-field_13_1" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="1" ><label for="wpforms-23856-field_13_1">1</label></td><td><input type="radio" id="wpforms-23856-field_13_2" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="2" ><label for="wpforms-23856-field_13_2">2</label></td><td><input type="radio" id="wpforms-23856-field_13_3" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="3" ><label for="wpforms-23856-field_13_3">3</label></td><td><input type="radio" id="wpforms-23856-field_13_4" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="4" ><label for="wpforms-23856-field_13_4">4</label></td><td><input type="radio" id="wpforms-23856-field_13_5" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="5" ><label for="wpforms-23856-field_13_5">5</label></td><td><input type="radio" id="wpforms-23856-field_13_6" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="6" ><label for="wpforms-23856-field_13_6">6</label></td><td><input type="radio" id="wpforms-23856-field_13_7" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="7" ><label for="wpforms-23856-field_13_7">7</label></td><td><input type="radio" id="wpforms-23856-field_13_8" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="8" ><label for="wpforms-23856-field_13_8">8</label></td><td><input type="radio" id="wpforms-23856-field_13_9" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="9" ><label for="wpforms-23856-field_13_9">9</label></td><td><input type="radio" id="wpforms-23856-field_13_10" class="wpforms-screen-reader-element wpforms-net-promoter-score-option" name="wpforms[fields][13]" value="10" ><label for="wpforms-23856-field_13_10">10</label></td> </tr>
</tbody>
</table>
</div><div id="wpforms-23856-field_4-container" class="wpforms-field wpforms-field-textarea more_about" data-field-id="4"><label class="wpforms-field-label" for="wpforms-23856-field_4">5. I'd really love to see more about...</label><textarea id="wpforms-23856-field_4" class="wpforms-field-small" name="wpforms[fields][4]" ></textarea></div></div><div class="wpforms-field wpforms-field-hp"><label for="wpforms-23856-field-hp" class="wpforms-field-label">Phone</label><input type="text" name="wpforms[hp]" id="wpforms-23856-field-hp" class="wpforms-field-medium"></div><div class="wpforms-submit-container" ><input type="hidden" name="wpforms[id]" value="23856"><input type="hidden" name="wpforms[author]" value="164"><button type="submit" name="wpforms[submit]" class="wpforms-submit om-trigger-conversion" id="wpforms-submit-23856" value="wpforms-submit" aria-live="assertive" data-alt-text="Sending..." data-submit-text="Submit">Submit</button></div></form></div> <!-- .wpforms-container -->
Connecting Advanced Care Practitioners
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