{"id":43343,"date":"2023-12-28T18:16:04","date_gmt":"2023-12-28T18:16:04","guid":{"rendered":"https:\/\/clinicmono.com\/%d9%86%d9%85%d9%88%d8%b0%d8%ac-%d9%81%d8%ad%d8%b5-%d8%a7%d9%84%d8%b5%d8%ad%d8%a9-%d9%88%d9%85%d8%b3%d8%aa%d8%ad%d8%b6%d8%b1%d8%a7%d8%aa-%d8%a7%d9%84%d8%aa%d8%ac%d9%85%d9%8a%d9%84\/"},"modified":"2024-02-26T02:02:08","modified_gmt":"2024-02-26T02:02:08","slug":"health-check-form-cosmetic","status":"publish","type":"page","link":"https:\/\/clinicmono.com\/ar\/health-check-form-cosmetic\/","title":{"rendered":"\u0646\u0645\u0648\u0630\u062c \u0641\u062d\u0635 \u0627\u0644\u0635\u062d\u0629 \u0645\u0633\u062a\u062d\u0636\u0631\u0627\u062a \u0627\u0644\u062a\u062c\u0645\u064a\u0644"},"content":{"rendered":"<section class=\"l-section wpb_row height_custom with_img\"><div class=\"l-section-img\" role=\"img\" data-img-width=\"1920\" data-img-height=\"400\" style=\"background-image: url(https:\/\/clinicmono.com\/wp-content\/uploads\/2023\/05\/call1.jpg);background-repeat: no-repeat;background-size: auto;\"><\/div><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><h1 style=\"text-align: center;\">\u0646\u0645\u0648\u0630\u062c \u0641\u062d\u0635 \u0627\u0644\u0635\u062d\u0629<\/h1>\n<\/div><\/div><nav class=\"g-breadcrumbs separator_icon align_center\" itemscope itemtype=\"http:\/\/schema.org\/BreadcrumbList\"><div class=\"g-breadcrumbs-item\" itemscope itemprop=\"itemListElement\" itemtype=\"http:\/\/schema.org\/ListItem\"><a itemprop=\"item\" href=\"https:\/\/clinicmono.com\/ar\/\"><span itemprop=\"name\">\u0639\u064a\u0627\u062f\u0629 \u0645\u0648\u0646\u0648<\/span><\/a><meta itemprop=\"position\" content=\"1\"\/><\/div><div class=\"g-breadcrumbs-separator\"><i class=\"far fa-angle-double-right\"><\/i><\/div><div class=\"g-breadcrumbs-item\">\u0635\u0641\u062d\u0627\u062a<\/div><\/nav><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_custom\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"g-cols wpb_row hide_on_tablets hide_on_mobiles via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpforms-container wpforms-render-modern\" id=\"wpforms-42100\"><form id=\"wpforms-form-42100\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"42100\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/ar\/wp-json\/wp\/v2\/pages\/43343\" data-token=\"46cf39930ffc4536216c2e273cb38026\" data-token-time=\"1775536232\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-42100-field_69-container\" class=\"wpforms-field wpforms-field-select wpforms-one-fourth wpforms-field-select-style-classic\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_69\">\u062d\u0627\u0644\u0629 \u0627\u0644\u062c\u062f\u0627\u0631\u0629   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-42100-field_69\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][69]\" required=\"required\"><option value=\"\u0623\u0639\u0632\u0628\"  selected='selected' class=\"choice-1 depth-1\"  >\u0623\u0639\u0632\u0628<\/option><option value=\"\u0645\u062a\u0632\u0648\u062c\"  class=\"choice-2 depth-1\"  >\u0645\u062a\u0632\u0648\u062c<\/option><option value=\"\u0645\u064f\u0637\u0644\u0651\u0642\"  class=\"choice-3 depth-1\"  >\u0645\u064f\u0637\u0644\u0651\u0642<\/option><option value=\"\u0627\u0644\u0623\u0631\u0627\u0645\u0644\"  class=\"choice-4 depth-1\"  >\u0627\u0644\u0623\u0631\u0627\u0645\u0644<\/option><\/select><\/div><div id=\"wpforms-42100-field_1-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_1\">\u0627\u0633\u0645 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-42100-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" placeholder=\"\u0627\u0633\u0645\" aria-errormessage=\"wpforms-42100-field_1-error\" required><\/div><div id=\"wpforms-42100-field_70-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_70\">\u0627\u0633\u0645 \u0627\u0644\u0639\u0627\u0626\u0644\u0629 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-42100-field_70\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][70]\" placeholder=\"\u0627\u0633\u0645 \u0627\u0644\u0639\u0627\u0626\u0644\u0629\" aria-errormessage=\"wpforms-42100-field_70-error\" required><\/div><div id=\"wpforms-42100-field_4-container\" class=\"wpforms-field wpforms-field-email wpforms-one-fourth\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_4\">\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-42100-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" placeholder=\"\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a\" spellcheck=\"false\" aria-errormessage=\"wpforms-42100-field_4-error\" required><\/div><div id=\"wpforms-42100-field_132-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"132\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_132\">\u0639\u064a\u062f \u0645\u064a\u0644\u0627\u062f<\/label><input type=\"text\" id=\"wpforms-42100-field_132\" class=\"wpforms-field-large\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-42100-field_132-error\" ><\/div><div id=\"wpforms-42100-field_75-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fifth\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_75\">\u0625\u0634\u063a\u0627\u0644<\/label><input type=\"text\" id=\"wpforms-42100-field_75\" class=\"wpforms-field-large\" name=\"wpforms[fields][75]\" aria-errormessage=\"wpforms-42100-field_75-error\" ><\/div><div id=\"wpforms-42100-field_76-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fifth\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_76\">\u0627\u0631\u062a\u0641\u0627\u0639<\/label><input type=\"text\" id=\"wpforms-42100-field_76\" class=\"wpforms-field-large\" name=\"wpforms[fields][76]\" aria-errormessage=\"wpforms-42100-field_76-error\" ><\/div><div id=\"wpforms-42100-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fifth\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_77\">\u0648\u0632\u0646<\/label><input type=\"text\" id=\"wpforms-42100-field_77\" class=\"wpforms-field-large\" name=\"wpforms[fields][77]\" aria-errormessage=\"wpforms-42100-field_77-error\" ><\/div><div id=\"wpforms-42100-field_78-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fifth\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_78\">\u0645\u0624\u0634\u0631 \u0643\u062a\u0644\u0629 \u0627\u0644\u062c\u0633\u0645<\/label><input type=\"text\" id=\"wpforms-42100-field_78\" class=\"wpforms-field-large\" name=\"wpforms[fields][78]\" aria-errormessage=\"wpforms-42100-field_78-error\" ><\/div><div id=\"wpforms-42100-field_79-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_79\">\u062f\u0648\u0644\u0629<\/label><input type=\"text\" id=\"wpforms-42100-field_79\" class=\"wpforms-field-large\" name=\"wpforms[fields][79]\" aria-errormessage=\"wpforms-42100-field_79-error\" ><\/div><div id=\"wpforms-42100-field_3-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-third\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_3\">\u0631\u0642\u0645 \u0627\u0644\u062a\u0644\u064a\u0641\u0648\u0646 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-42100-field_3\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" placeholder=\"\u0631\u0642\u0645 \u0627\u0644\u062a\u0644\u064a\u0641\u0648\u0646\" aria-label=\"\u0631\u0642\u0645 \u0627\u0644\u062a\u0644\u064a\u0641\u0648\u0646\" aria-errormessage=\"wpforms-42100-field_3-error\" required><\/div><div id=\"wpforms-42100-field_82-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"82\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_82\">\u0639\u0646\u0648\u0627\u0646<\/label><input type=\"text\" id=\"wpforms-42100-field_82\" class=\"wpforms-field-large\" name=\"wpforms[fields][82]\" placeholder=\"\u0627\u0644\u0639\u0646\u0648\u0627\u0646\/\u0627\u0644\u0645\u062f\u064a\u0646\u0629\/\u0627\u0644\u0648\u0644\u0627\u064a\u0629\" aria-errormessage=\"wpforms-42100-field_82-error\" ><\/div><div id=\"wpforms-42100-field_83-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"83\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_83\">\u0627\u0644\u062a\u062f\u062e\u064a\u0646: (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u0627\u0630\u0643\u0631 \u0627\u0644\u0643\u0645\u064a\u0629):<\/label><input type=\"text\" id=\"wpforms-42100-field_83\" class=\"wpforms-field-large\" name=\"wpforms[fields][83]\" aria-errormessage=\"wpforms-42100-field_83-error\" ><\/div><div id=\"wpforms-42100-field_84-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_84\">  \u0627\u0644\u0643\u062d\u0648\u0644: (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u0627\u0630\u0643\u0631 \u0627\u0644\u0643\u0645\u064a\u0629):<\/label><input type=\"text\" id=\"wpforms-42100-field_84\" class=\"wpforms-field-large\" name=\"wpforms[fields][84]\" aria-errormessage=\"wpforms-42100-field_84-error\" ><\/div><div id=\"wpforms-42100-field_85-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_85\">\u0645\u0648\u0627\u062f \u0623\u062e\u0631\u0649: (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u062d\u062f\u062f):<\/label><input type=\"text\" id=\"wpforms-42100-field_85\" class=\"wpforms-field-large\" name=\"wpforms[fields][85]\" aria-errormessage=\"wpforms-42100-field_85-error\" ><\/div><div id=\"wpforms-42100-field_86-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_86\">  \u062a\u0627\u0631\u064a\u062e \u0622\u062e\u0631 \u062f\u0648\u0631\u0629 \u0634\u0647\u0631\u064a\u0629:<\/label><input type=\"text\" id=\"wpforms-42100-field_86\" class=\"wpforms-field-large\" name=\"wpforms[fields][86]\" aria-errormessage=\"wpforms-42100-field_86-error\" ><\/div><div id=\"wpforms-42100-field_87-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_87\">\u0627\u0644\u0648\u0635\u0641\u0627\u062a \u0627\u0644\u0637\u0628\u064a\u0629\/\u0627\u0644\u0623\u062f\u0648\u064a\u0629:<\/label><input type=\"text\" id=\"wpforms-42100-field_87\" class=\"wpforms-field-large\" name=\"wpforms[fields][87]\" aria-errormessage=\"wpforms-42100-field_87-error\" ><\/div><div id=\"wpforms-42100-field_88-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"88\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_88\">  \u0639\u062f\u062f \u062d\u0627\u0644\u0627\u062a \u0627\u0644\u062d\u0645\u0644:<\/label><input type=\"text\" id=\"wpforms-42100-field_88\" class=\"wpforms-field-large\" name=\"wpforms[fields][88]\" aria-errormessage=\"wpforms-42100-field_88-error\" ><\/div><div id=\"wpforms-42100-field_89-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"89\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_89\">\u0639\u062f\u062f \u0627\u0644\u0648\u0644\u0627\u062f\u0627\u062a \u0627\u0644\u062d\u064a\u0629:<\/label><input type=\"text\" id=\"wpforms-42100-field_89\" class=\"wpforms-field-large\" name=\"wpforms[fields][89]\" aria-errormessage=\"wpforms-42100-field_89-error\" ><\/div><div id=\"wpforms-42100-field_90-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_90\">\u0622\u062e\u0631 \u0648\u0644\u0627\u062f\u0629 (\u0627\u0644\u062a\u0627\u0631\u064a\u062e):<\/label><input type=\"text\" id=\"wpforms-42100-field_90\" class=\"wpforms-field-large\" name=\"wpforms[fields][90]\" aria-errormessage=\"wpforms-42100-field_90-error\" ><\/div><div id=\"wpforms-42100-field_91-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_91\">\u0637\u0631\u064a\u0642\u0629 \u062a\u062d\u062f\u064a\u062f \u0627\u0644\u0646\u0633\u0644: (\u062d\u062f\u062f)<\/label><input type=\"text\" id=\"wpforms-42100-field_91\" class=\"wpforms-field-large\" name=\"wpforms[fields][91]\" aria-errormessage=\"wpforms-42100-field_91-error\" ><\/div><div id=\"wpforms-42100-field_92-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_92\">\u0641\u064a \u062d\u0627\u0644\u0629 \u0627\u0646\u0642\u0637\u0627\u0639 \u0627\u0644\u0637\u0645\u062b\u060c \u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0628\u062f\u0627\u064a\u0629:<\/label><input type=\"text\" id=\"wpforms-42100-field_92\" class=\"wpforms-field-large\" name=\"wpforms[fields][92]\" aria-errormessage=\"wpforms-42100-field_92-error\" ><\/div><div id=\"wpforms-42100-field_94-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"94\"><fieldset><legend class=\"wpforms-field-label\">\u062a\u0639\u0627\u0637\u064a \u0627\u0644\u0645\u062e\u062f\u0631\u0627\u062a:<\/legend><ul id=\"wpforms-42100-field_94\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_94_1\" name=\"wpforms[fields][94]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_94_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_94_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_94_2\" name=\"wpforms[fields][94]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_94_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_94_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_95-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"95\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u062d\u0633\u0627\u0633\u064a\u0629 \u0627\u0644\u062f\u0648\u0627\u0626\u064a\u0629\/\u0627\u0644\u062a\u0641\u0627\u0639\u0644\u0627\u062a \u0627\u0644\u062f\u0648\u0627\u0626\u064a\u0629 \u0627\u0644\u0636\u0627\u0631\u0629:<\/legend><ul id=\"wpforms-42100-field_95\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_95_1\" name=\"wpforms[fields][95]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_95_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_95_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_95_2\" name=\"wpforms[fields][95]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_95_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_95_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_96-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"96\"><fieldset><legend class=\"wpforms-field-label\">\u0631\u062f \u0627\u0644\u0641\u0639\u0644 \u0639\u0644\u0649 \u0627\u0644\u062a\u062e\u062f\u064a\u0631:<\/legend><ul id=\"wpforms-42100-field_96\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_96_1\" name=\"wpforms[fields][96]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_96_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_96_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_96_2\" name=\"wpforms[fields][96]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_96_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_96_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_97-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"97\"><fieldset><legend class=\"wpforms-field-label\">\u0646\u0642\u0644 \u0627\u0644\u062f\u0645:<\/legend><ul id=\"wpforms-42100-field_97\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_97_1\" name=\"wpforms[fields][97]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_97_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_97_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_97_2\" name=\"wpforms[fields][97]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_97_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_97_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_98-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"98\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0645\u0646\u0642\u0648\u0644\u0629 \u062c\u0646\u0633\u064a\u0627:<\/legend><ul id=\"wpforms-42100-field_98\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_98_1\" name=\"wpforms[fields][98]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_98_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_98_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_98_2\" name=\"wpforms[fields][98]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_98_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_98_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_99-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"99\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u062a\u0647\u0627\u0628 \u0627\u0644\u0643\u0628\u062f:<\/legend><ul id=\"wpforms-42100-field_99\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_99_1\" name=\"wpforms[fields][99]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_99_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_99_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_99_2\" name=\"wpforms[fields][99]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_99_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_99_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_100-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"100\"><fieldset><legend class=\"wpforms-field-label\">\u0641\u064a\u0631\u0648\u0633 \u0627\u0644\u0639\u0648\u0632 \u0627\u0644\u0645\u0646\u0627\u0639\u064a \u0627\u0644\u0628\u0634\u0631\u064a:<\/legend><ul id=\"wpforms-42100-field_100\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_100_1\" name=\"wpforms[fields][100]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_100_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_100_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_100_2\" name=\"wpforms[fields][100]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_100_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_100_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_101-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"101\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0631\u0636\u0627\u0639\u0629 \u0627\u0644\u0637\u0628\u064a\u0639\u064a\u0629:<\/legend><ul id=\"wpforms-42100-field_101\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_101_1\" name=\"wpforms[fields][101]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_101_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_101_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_101_2\" name=\"wpforms[fields][101]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_101_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_101_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_102-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"102\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0645\u062e\u0627\u0648\u0641 \u0627\u0644\u0635\u062d\u064a\u0629 \u0627\u0644\u0648\u0631\u0627\u062b\u064a\u0629:<\/legend><ul id=\"wpforms-42100-field_102\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_102_1\" name=\"wpforms[fields][102]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_102_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_102_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_102_2\" name=\"wpforms[fields][102]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_102_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_102_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_103-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"103\"><fieldset><legend class=\"wpforms-field-label\">\u0645\u0631\u0636 \u0627\u0644\u0633\u0643\u0631\u064a<\/legend><ul id=\"wpforms-42100-field_103\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_103_1\" name=\"wpforms[fields][103]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_103_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_103_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_103_2\" name=\"wpforms[fields][103]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_103_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_103_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_104-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"104\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0623\u0646\u0633\u0648\u0644\u064a\u0646:<\/legend><ul id=\"wpforms-42100-field_104\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_104_1\" name=\"wpforms[fields][104]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_104_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_104_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_104_2\" name=\"wpforms[fields][104]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_104_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_104_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_105-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"105\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u062d\u0628\u0648\u0628 \u0627\u0644\u0645\u0636\u0627\u062f\u0629 \u0644\u0645\u0631\u0636 \u0627\u0644\u0633\u0643\u0631 \u0639\u0646 \u0637\u0631\u064a\u0642 \u0627\u0644\u0641\u0645:<\/legend><ul id=\"wpforms-42100-field_105\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_105_1\" name=\"wpforms[fields][105]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_105_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_105_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_105_2\" name=\"wpforms[fields][105]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_105_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_105_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_106-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"106\"><fieldset><legend class=\"wpforms-field-label\">\u0636\u063a\u0637 \u0627\u0644\u062f\u0645:<\/legend><ul id=\"wpforms-42100-field_106\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_106_1\" name=\"wpforms[fields][106]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_106_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_106_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_106_2\" name=\"wpforms[fields][106]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_106_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_106_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_107-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"107\"><fieldset><legend class=\"wpforms-field-label\">\u0633\u0631\u0637\u0627\u0646:<\/legend><ul id=\"wpforms-42100-field_107\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_107_1\" name=\"wpforms[fields][107]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_107_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_107_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_107_2\" name=\"wpforms[fields][107]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_107_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_107_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_108-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"108\"><fieldset><legend class=\"wpforms-field-label\">\u0645\u0631\u0636 \u0643\u0644\u0648\u064a:<\/legend><ul id=\"wpforms-42100-field_108\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_108_1\" name=\"wpforms[fields][108]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_108_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_108_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_108_2\" name=\"wpforms[fields][108]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_108_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_108_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_109-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"109\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0635\u0631\u0639 \u0623\u0648 \u0627\u0644\u0646\u0648\u0628\u0627\u062a:<\/legend><ul id=\"wpforms-42100-field_109\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_109_1\" name=\"wpforms[fields][109]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_109_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_109_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_109_2\" name=\"wpforms[fields][109]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_109_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_109_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_110-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"110\"><fieldset><legend class=\"wpforms-field-label\">\u0641\u0642\u0631 \u062f\u0645:<\/legend><ul id=\"wpforms-42100-field_110\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_110_1\" name=\"wpforms[fields][110]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_110_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_110_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_110_2\" name=\"wpforms[fields][110]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_110_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_110_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_111-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"111\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u062a\u0647\u0627\u0628 \u0627\u0644\u0645\u0641\u0627\u0635\u0644:<\/legend><ul id=\"wpforms-42100-field_111\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_111_1\" name=\"wpforms[fields][111]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_111_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_111_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_111_2\" name=\"wpforms[fields][111]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_111_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_111_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_112-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"112\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0631\u0628\u0648\/\u0627\u0646\u062a\u0641\u0627\u062e \u0627\u0644\u0631\u0626\u0629:<\/legend><ul id=\"wpforms-42100-field_112\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_112_1\" name=\"wpforms[fields][112]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_112_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_112_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_112_2\" name=\"wpforms[fields][112]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_112_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_112_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_113-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"113\"><fieldset><legend class=\"wpforms-field-label\">\u0635\u0639\u0648\u0628\u0629 \u0641\u064a \u0627\u0644\u0628\u0644\u0639\/\u0627\u0644\u0633\u0643\u062a\u0629 \u0627\u0644\u062f\u0645\u0627\u063a\u064a\u0629:<\/legend><ul id=\"wpforms-42100-field_113\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_113_1\" name=\"wpforms[fields][113]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_113_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_113_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_113_2\" name=\"wpforms[fields][113]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_113_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_113_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_114-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"114\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0646\u0632\u064a\u0641 \u0627\u0644\u0645\u0647\u0628\u0644\u064a \u063a\u064a\u0631 \u0627\u0644\u0637\u0628\u064a\u0639\u064a:<\/legend><ul id=\"wpforms-42100-field_114\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_114_1\" name=\"wpforms[fields][114]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_114_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_114_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_114_2\" name=\"wpforms[fields][114]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_114_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_114_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_115-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"115\"><fieldset><legend class=\"wpforms-field-label\">\u062a\u0648\u0631\u0645 \u0627\u0644\u063a\u062f\u062f:<\/legend><ul id=\"wpforms-42100-field_115\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_115_1\" name=\"wpforms[fields][115]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_115_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_115_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_115_2\" name=\"wpforms[fields][115]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_115_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_115_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_116-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"116\"><fieldset><legend class=\"wpforms-field-label\">\u0642\u0644\u0642:<\/legend><ul id=\"wpforms-42100-field_116\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_116_1\" name=\"wpforms[fields][116]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_116_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_116_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_116_2\" name=\"wpforms[fields][116]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_116_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_116_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_117-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"117\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0631\u062a\u062f\u0627\u062f:<\/legend><ul id=\"wpforms-42100-field_117\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_117_1\" name=\"wpforms[fields][117]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_117_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_117_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_117_2\" name=\"wpforms[fields][117]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_117_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_117_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_118-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"118\"><fieldset><legend class=\"wpforms-field-label\">\u0623\u0644\u0645 \u0635\u062f\u0631:<\/legend><ul id=\"wpforms-42100-field_118\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_118_1\" name=\"wpforms[fields][118]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_118_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_118_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_118_2\" name=\"wpforms[fields][118]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_118_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_118_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_119-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"119\"><fieldset><legend class=\"wpforms-field-label\">\u0636\u064a\u0642 \u0641\u064a \u0627\u0644\u062a\u0646\u0641\u0633:<\/legend><ul id=\"wpforms-42100-field_119\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_119_1\" name=\"wpforms[fields][119]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_119_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_119_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_119_2\" name=\"wpforms[fields][119]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_119_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_119_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_120-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"120\"><fieldset><legend class=\"wpforms-field-label\">\u0635\u0639\u0648\u0628\u0629 \u0641\u064a \u0627\u0644\u0646\u0648\u0645\/\u0627\u0646\u0642\u0637\u0627\u0639 \u0627\u0644\u062a\u0646\u0641\u0633:<\/legend><ul id=\"wpforms-42100-field_120\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_120_1\" name=\"wpforms[fields][120]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_120_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_120_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_120_2\" name=\"wpforms[fields][120]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_120_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_120_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_121-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"121\"><fieldset><legend class=\"wpforms-field-label\">\u063a\u062b\u064a\u0627\u0646:<\/legend><ul id=\"wpforms-42100-field_121\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_121_1\" name=\"wpforms[fields][121]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_121_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_121_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_121_2\" name=\"wpforms[fields][121]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_121_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_121_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_122-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"122\"><fieldset><legend class=\"wpforms-field-label\">\u062f\u0648\u062e\u0629:<\/legend><ul id=\"wpforms-42100-field_122\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_122_1\" name=\"wpforms[fields][122]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_122_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_122_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_122_2\" name=\"wpforms[fields][122]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_122_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_122_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_123-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"123\"><fieldset><legend class=\"wpforms-field-label\">\u0646\u0641\u062e\u0629 (\u0645\u0631\u0636 \u0627\u0644\u0642\u0644\u0628):<\/legend><ul id=\"wpforms-42100-field_123\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_123_1\" name=\"wpforms[fields][123]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_123_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_123_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_123_2\" name=\"wpforms[fields][123]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_123_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_123_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_124-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"124\"><fieldset><legend class=\"wpforms-field-label\">\u0641\u0634\u0644 \u0627\u0644\u0642\u0644\u0628 (\u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0642\u0644\u0628):<\/legend><ul id=\"wpforms-42100-field_124\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_124_1\" name=\"wpforms[fields][124]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_124_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_124_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_124_2\" name=\"wpforms[fields][124]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_124_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_124_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_125-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-fourth\" data-field-id=\"125\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0636\u0637\u0631\u0627\u0628\u0627\u062a \u0627\u0644\u0625\u064a\u0642\u0627\u0639 (\u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0642\u0644\u0628):<\/legend><ul id=\"wpforms-42100-field_125\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42100-field_125_1\" name=\"wpforms[fields][125]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42100-field_125_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_125_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42100-field_125_2\" name=\"wpforms[fields][125]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42100-field_125_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_125_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_126-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"126\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_126\">\u0627\u0644\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062c\u0631\u0627\u062d\u064a (\u0627\u0630\u0643\u0631 \u0623\u064a \u0625\u062c\u0631\u0627\u0621 \u062c\u0631\u0627\u062d\u064a):<\/label><input type=\"text\" id=\"wpforms-42100-field_126\" class=\"wpforms-field-large\" name=\"wpforms[fields][126]\" aria-errormessage=\"wpforms-42100-field_126-error\" ><\/div><div id=\"wpforms-42100-field_127-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"127\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_127\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062c\u0631\u0627\u062d\u064a:<\/label><input type=\"text\" id=\"wpforms-42100-field_127\" class=\"wpforms-field-large\" name=\"wpforms[fields][127]\" aria-errormessage=\"wpforms-42100-field_127-error\" ><\/div><div id=\"wpforms-42100-field_128-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"128\"><label class=\"wpforms-field-label\" for=\"wpforms-42100-field_128\">\u0631\u0633\u0627\u0644\u0629<\/label><textarea id=\"wpforms-42100-field_128\" class=\"wpforms-field-large\" name=\"wpforms[fields][128]\" placeholder=\"\u0631\u0633\u0627\u0644\u0629\" aria-errormessage=\"wpforms-42100-field_128-error\" ><\/textarea><\/div><div id=\"wpforms-42100-field_130-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"130\"><input type=\"hidden\" id=\"wpforms-42100-field_130\" name=\"wpforms[fields][130]\"><\/div><div id=\"wpforms-42100-field_129-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"129\"><input type=\"hidden\" id=\"wpforms-42100-field_129\" name=\"wpforms[fields][129]\" value=\"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/pages\/43343 \"><\/div><div id=\"wpforms-42100-field_131-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"131\"><input type=\"hidden\" id=\"wpforms-42100-field_131\" name=\"wpforms[fields][131]\" value=\"  216.73.216.191 {entry_geolocation}\"><\/div><div id=\"wpforms-42100-field_34-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"34\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">\u0627\u0644\u0642\u0628\u0648\u0644 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-42100-field_34\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-42100-field_34_1\" name=\"wpforms[fields][34][]\" value=\"\u0628\u0627\u0644\u0646\u0642\u0631 \u0639\u0644\u0649 \u0625\u0631\u0633\u0627\u0644\u060c \u0641\u0625\u0646\u0643 \u062a\u0648\u0627\u0641\u0642 \u0639\u0644\u0649 &lt;a href=&quot;https:\/\/clinicmono.com\/ar\/terms-condition\/&quot;&gt;&lt;strong&gt;\u0627\u0644\u0634\u0631\u0648\u0637 \u0648\u0627\u0644\u0623\u062d\u0643\u0627\u0645&lt;\/strong&gt;&lt;\/a&gt; \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0646\u0627\" aria-errormessage=\"wpforms-42100-field_34_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_34_1\">\u0628\u0627\u0644\u0646\u0642\u0631 \u0639\u0644\u0649 \u0625\u0631\u0633\u0627\u0644\u060c \u0641\u0625\u0646\u0643 \u062a\u0648\u0627\u0641\u0642 \u0639\u0644\u0649 <a href=\"https:\/\/clinicmono.com\/ar\/terms-condition\/\"><strong>\u0627\u0644\u0634\u0631\u0648\u0637 \u0648\u0627\u0644\u0623\u062d\u0643\u0627\u0645<\/strong><\/a> \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0646\u0627<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42100-field_133-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"133\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Acceptence (copy) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-42100-field_133\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-42100-field_133_1\" name=\"wpforms[fields][133][]\" value=\"I have read, understood and approved the general terms and conditions, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/clinicmono.com\/clarification-text-for-health-check-form\/&quot;&gt;the clarification text&lt;\/a&gt;, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/clinicmono.com\/explict-consent-form-for-health-check-form\/&quot;&gt;the explicit consent text&lt;\/a&gt;.\" aria-errormessage=\"wpforms-42100-field_133_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42100-field_133_1\">I have read, understood and approved the general terms and conditions, <a target=\"_blank\" href=\"https:\/\/clinicmono.com\/clarification-text-for-health-check-form\/\">the clarification text<\/a>, <a target=\"_blank\" href=\"https:\/\/clinicmono.com\/explict-consent-form-for-health-check-form\/\">the explicit consent text<\/a>.<\/label><\/li><\/ul><\/fieldset><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-42100-field-hp\" class=\"wpforms-field-label\">Name<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-42100-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"42100\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/pages\/43343\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-42100\" class=\"wpforms-submit\" data-alt-text=\"\u0625\u0631\u0633\u0627\u0644...\" data-submit-text=\"\u064a\u064f\u0642\u062f\u0651\u0650\u0645\" aria-live=\"assertive\" value=\"wpforms-submit\">\u064a\u064f\u0642\u062f\u0651\u0650\u0645<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/clinicmono.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div><\/div><\/div><\/div><div class=\"g-cols wpb_row hide_on_default hide_on_laptops via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpforms-container wpforms-render-modern\" id=\"wpforms-42098\"><form id=\"wpforms-form-42098\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"42098\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/ar\/wp-json\/wp\/v2\/pages\/43343\" data-token=\"af0f891e215a6eb5bf1833e8738f828d\" data-token-time=\"1775536232\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-42098-field_69-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_69\">\u062d\u0627\u0644\u0629 \u0627\u0644\u062c\u062f\u0627\u0631\u0629   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-42098-field_69\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][69]\" required=\"required\"><option value=\"\u0623\u0639\u0632\u0628\"  selected='selected' class=\"choice-1 depth-1\"  >\u0623\u0639\u0632\u0628<\/option><option value=\"\u0645\u062a\u0632\u0648\u062c\"  class=\"choice-2 depth-1\"  >\u0645\u062a\u0632\u0648\u062c<\/option><option value=\"\u0645\u064f\u0637\u0644\u0651\u0642\"  class=\"choice-3 depth-1\"  >\u0645\u064f\u0637\u0644\u0651\u0642<\/option><option value=\"\u0627\u0644\u0623\u0631\u0627\u0645\u0644\"  class=\"choice-4 depth-1\"  >\u0627\u0644\u0623\u0631\u0627\u0645\u0644<\/option><\/select><\/div><div id=\"wpforms-42098-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_1\">\u0627\u0633\u0645 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-42098-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" placeholder=\"\u0627\u0633\u0645\" aria-errormessage=\"wpforms-42098-field_1-error\" required><\/div><div id=\"wpforms-42098-field_70-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_70\">\u0627\u0633\u0645 \u0627\u0644\u0639\u0627\u0626\u0644\u0629 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-42098-field_70\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][70]\" placeholder=\"\u0627\u0633\u0645 \u0627\u0644\u0639\u0627\u0626\u0644\u0629\" aria-errormessage=\"wpforms-42098-field_70-error\" required><\/div><div id=\"wpforms-42098-field_4-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_4\">\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-42098-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" placeholder=\"\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a\" spellcheck=\"false\" aria-errormessage=\"wpforms-42098-field_4-error\" required><\/div><div id=\"wpforms-42098-field_132-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"132\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_132\">\u0639\u064a\u062f \u0645\u064a\u0644\u0627\u062f<\/label><input type=\"text\" id=\"wpforms-42098-field_132\" class=\"wpforms-field-large\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-42098-field_132-error\" ><\/div><div id=\"wpforms-42098-field_75-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_75\">\u0625\u0634\u063a\u0627\u0644<\/label><input type=\"text\" id=\"wpforms-42098-field_75\" class=\"wpforms-field-large\" name=\"wpforms[fields][75]\" aria-errormessage=\"wpforms-42098-field_75-error\" ><\/div><div id=\"wpforms-42098-field_76-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"76\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_76\">\u0627\u0631\u062a\u0641\u0627\u0639<\/label><input type=\"text\" id=\"wpforms-42098-field_76\" class=\"wpforms-field-large\" name=\"wpforms[fields][76]\" aria-errormessage=\"wpforms-42098-field_76-error\" ><\/div><div id=\"wpforms-42098-field_77-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"77\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_77\">\u0648\u0632\u0646<\/label><input type=\"text\" id=\"wpforms-42098-field_77\" class=\"wpforms-field-large\" name=\"wpforms[fields][77]\" aria-errormessage=\"wpforms-42098-field_77-error\" ><\/div><div id=\"wpforms-42098-field_78-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_78\">\u0645\u0624\u0634\u0631 \u0643\u062a\u0644\u0629 \u0627\u0644\u062c\u0633\u0645<\/label><input type=\"text\" id=\"wpforms-42098-field_78\" class=\"wpforms-field-large\" name=\"wpforms[fields][78]\" aria-errormessage=\"wpforms-42098-field_78-error\" ><\/div><div id=\"wpforms-42098-field_79-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_79\">\u062f\u0648\u0644\u0629<\/label><input type=\"text\" id=\"wpforms-42098-field_79\" class=\"wpforms-field-large\" name=\"wpforms[fields][79]\" aria-errormessage=\"wpforms-42098-field_79-error\" ><\/div><div id=\"wpforms-42098-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_3\">\u0631\u0642\u0645 \u0627\u0644\u062a\u0644\u064a\u0641\u0648\u0646 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-42098-field_3\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" placeholder=\"\u0631\u0642\u0645 \u0627\u0644\u062a\u0644\u064a\u0641\u0648\u0646\" aria-label=\"\u0631\u0642\u0645 \u0627\u0644\u062a\u0644\u064a\u0641\u0648\u0646\" aria-errormessage=\"wpforms-42098-field_3-error\" required><\/div><div id=\"wpforms-42098-field_82-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"82\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_82\">\u0639\u0646\u0648\u0627\u0646<\/label><input type=\"text\" id=\"wpforms-42098-field_82\" class=\"wpforms-field-large\" name=\"wpforms[fields][82]\" placeholder=\"\u0627\u0644\u0639\u0646\u0648\u0627\u0646\/\u0627\u0644\u0645\u062f\u064a\u0646\u0629\/\u0627\u0644\u0648\u0644\u0627\u064a\u0629\" aria-errormessage=\"wpforms-42098-field_82-error\" ><\/div><div id=\"wpforms-42098-field_83-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"83\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_83\">\u0627\u0644\u062a\u062f\u062e\u064a\u0646: (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u0627\u0630\u0643\u0631 \u0627\u0644\u0643\u0645\u064a\u0629):<\/label><input type=\"text\" id=\"wpforms-42098-field_83\" class=\"wpforms-field-large\" name=\"wpforms[fields][83]\" aria-errormessage=\"wpforms-42098-field_83-error\" ><\/div><div id=\"wpforms-42098-field_84-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"84\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_84\">  \u0627\u0644\u0643\u062d\u0648\u0644: (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u0627\u0630\u0643\u0631 \u0627\u0644\u0643\u0645\u064a\u0629):<\/label><input type=\"text\" id=\"wpforms-42098-field_84\" class=\"wpforms-field-large\" name=\"wpforms[fields][84]\" aria-errormessage=\"wpforms-42098-field_84-error\" ><\/div><div id=\"wpforms-42098-field_85-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_85\">\u0645\u0648\u0627\u062f \u0623\u062e\u0631\u0649: (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u062d\u062f\u062f):<\/label><input type=\"text\" id=\"wpforms-42098-field_85\" class=\"wpforms-field-large\" name=\"wpforms[fields][85]\" aria-errormessage=\"wpforms-42098-field_85-error\" ><\/div><div id=\"wpforms-42098-field_86-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_86\">  \u062a\u0627\u0631\u064a\u062e \u0622\u062e\u0631 \u062f\u0648\u0631\u0629 \u0634\u0647\u0631\u064a\u0629:<\/label><input type=\"text\" id=\"wpforms-42098-field_86\" class=\"wpforms-field-large\" name=\"wpforms[fields][86]\" aria-errormessage=\"wpforms-42098-field_86-error\" ><\/div><div id=\"wpforms-42098-field_87-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_87\">\u0627\u0644\u0648\u0635\u0641\u0627\u062a \u0627\u0644\u0637\u0628\u064a\u0629\/\u0627\u0644\u0623\u062f\u0648\u064a\u0629:<\/label><input type=\"text\" id=\"wpforms-42098-field_87\" class=\"wpforms-field-large\" name=\"wpforms[fields][87]\" aria-errormessage=\"wpforms-42098-field_87-error\" ><\/div><div id=\"wpforms-42098-field_88-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"88\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_88\">  \u0639\u062f\u062f \u062d\u0627\u0644\u0627\u062a \u0627\u0644\u062d\u0645\u0644:<\/label><input type=\"text\" id=\"wpforms-42098-field_88\" class=\"wpforms-field-large\" name=\"wpforms[fields][88]\" aria-errormessage=\"wpforms-42098-field_88-error\" ><\/div><div id=\"wpforms-42098-field_89-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"89\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_89\">\u0639\u062f\u062f \u0627\u0644\u0648\u0644\u0627\u062f\u0627\u062a \u0627\u0644\u062d\u064a\u0629:<\/label><input type=\"text\" id=\"wpforms-42098-field_89\" class=\"wpforms-field-large\" name=\"wpforms[fields][89]\" aria-errormessage=\"wpforms-42098-field_89-error\" ><\/div><div id=\"wpforms-42098-field_90-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_90\">\u0622\u062e\u0631 \u0648\u0644\u0627\u062f\u0629 (\u0627\u0644\u062a\u0627\u0631\u064a\u062e):<\/label><input type=\"text\" id=\"wpforms-42098-field_90\" class=\"wpforms-field-large\" name=\"wpforms[fields][90]\" aria-errormessage=\"wpforms-42098-field_90-error\" ><\/div><div id=\"wpforms-42098-field_91-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_91\">\u0637\u0631\u064a\u0642\u0629 \u062a\u062d\u062f\u064a\u062f \u0627\u0644\u0646\u0633\u0644: (\u062d\u062f\u062f)<\/label><input type=\"text\" id=\"wpforms-42098-field_91\" class=\"wpforms-field-large\" name=\"wpforms[fields][91]\" aria-errormessage=\"wpforms-42098-field_91-error\" ><\/div><div id=\"wpforms-42098-field_92-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_92\">\u0641\u064a \u062d\u0627\u0644\u0629 \u0627\u0646\u0642\u0637\u0627\u0639 \u0627\u0644\u0637\u0645\u062b\u060c \u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0628\u062f\u0627\u064a\u0629:<\/label><input type=\"text\" id=\"wpforms-42098-field_92\" class=\"wpforms-field-large\" name=\"wpforms[fields][92]\" aria-errormessage=\"wpforms-42098-field_92-error\" ><\/div><div id=\"wpforms-42098-field_94-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"94\"><fieldset><legend class=\"wpforms-field-label\">\u062a\u0639\u0627\u0637\u064a \u0627\u0644\u0645\u062e\u062f\u0631\u0627\u062a:<\/legend><ul id=\"wpforms-42098-field_94\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_94_1\" name=\"wpforms[fields][94]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_94_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_94_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_94_2\" name=\"wpforms[fields][94]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_94_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_94_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_95-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"95\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u062d\u0633\u0627\u0633\u064a\u0629 \u0627\u0644\u062f\u0648\u0627\u0626\u064a\u0629\/\u0627\u0644\u062a\u0641\u0627\u0639\u0644\u0627\u062a \u0627\u0644\u062f\u0648\u0627\u0626\u064a\u0629 \u0627\u0644\u0636\u0627\u0631\u0629:<\/legend><ul id=\"wpforms-42098-field_95\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_95_1\" name=\"wpforms[fields][95]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_95_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_95_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_95_2\" name=\"wpforms[fields][95]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_95_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_95_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_96-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"96\"><fieldset><legend class=\"wpforms-field-label\">\u0631\u062f \u0627\u0644\u0641\u0639\u0644 \u0639\u0644\u0649 \u0627\u0644\u062a\u062e\u062f\u064a\u0631:<\/legend><ul id=\"wpforms-42098-field_96\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_96_1\" name=\"wpforms[fields][96]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_96_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_96_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_96_2\" name=\"wpforms[fields][96]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_96_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_96_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_97-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"97\"><fieldset><legend class=\"wpforms-field-label\">\u0646\u0642\u0644 \u0627\u0644\u062f\u0645:<\/legend><ul id=\"wpforms-42098-field_97\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_97_1\" name=\"wpforms[fields][97]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_97_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_97_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_97_2\" name=\"wpforms[fields][97]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_97_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_97_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_98-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"98\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0645\u0646\u0642\u0648\u0644\u0629 \u062c\u0646\u0633\u064a\u0627:<\/legend><ul id=\"wpforms-42098-field_98\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_98_1\" name=\"wpforms[fields][98]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_98_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_98_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_98_2\" name=\"wpforms[fields][98]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_98_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_98_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_99-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"99\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u062a\u0647\u0627\u0628 \u0627\u0644\u0643\u0628\u062f:<\/legend><ul id=\"wpforms-42098-field_99\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_99_1\" name=\"wpforms[fields][99]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_99_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_99_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_99_2\" name=\"wpforms[fields][99]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_99_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_99_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_100-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"100\"><fieldset><legend class=\"wpforms-field-label\">\u0641\u064a\u0631\u0648\u0633 \u0627\u0644\u0639\u0648\u0632 \u0627\u0644\u0645\u0646\u0627\u0639\u064a \u0627\u0644\u0628\u0634\u0631\u064a:<\/legend><ul id=\"wpforms-42098-field_100\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_100_1\" name=\"wpforms[fields][100]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_100_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_100_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_100_2\" name=\"wpforms[fields][100]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_100_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_100_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_101-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"101\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0631\u0636\u0627\u0639\u0629 \u0627\u0644\u0637\u0628\u064a\u0639\u064a\u0629:<\/legend><ul id=\"wpforms-42098-field_101\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_101_1\" name=\"wpforms[fields][101]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_101_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_101_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_101_2\" name=\"wpforms[fields][101]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_101_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_101_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_102-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"102\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0645\u062e\u0627\u0648\u0641 \u0627\u0644\u0635\u062d\u064a\u0629 \u0627\u0644\u0648\u0631\u0627\u062b\u064a\u0629:<\/legend><ul id=\"wpforms-42098-field_102\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_102_1\" name=\"wpforms[fields][102]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_102_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_102_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_102_2\" name=\"wpforms[fields][102]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_102_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_102_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_103-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"103\"><fieldset><legend class=\"wpforms-field-label\">\u0645\u0631\u0636 \u0627\u0644\u0633\u0643\u0631\u064a<\/legend><ul id=\"wpforms-42098-field_103\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_103_1\" name=\"wpforms[fields][103]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_103_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_103_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_103_2\" name=\"wpforms[fields][103]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_103_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_103_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_104-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"104\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0623\u0646\u0633\u0648\u0644\u064a\u0646:<\/legend><ul id=\"wpforms-42098-field_104\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_104_1\" name=\"wpforms[fields][104]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_104_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_104_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_104_2\" name=\"wpforms[fields][104]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_104_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_104_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_105-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"105\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u062d\u0628\u0648\u0628 \u0627\u0644\u0645\u0636\u0627\u062f\u0629 \u0644\u0645\u0631\u0636 \u0627\u0644\u0633\u0643\u0631 \u0639\u0646 \u0637\u0631\u064a\u0642 \u0627\u0644\u0641\u0645:<\/legend><ul id=\"wpforms-42098-field_105\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_105_1\" name=\"wpforms[fields][105]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_105_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_105_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_105_2\" name=\"wpforms[fields][105]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_105_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_105_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_106-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"106\"><fieldset><legend class=\"wpforms-field-label\">\u0636\u063a\u0637 \u0627\u0644\u062f\u0645:<\/legend><ul id=\"wpforms-42098-field_106\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_106_1\" name=\"wpforms[fields][106]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_106_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_106_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_106_2\" name=\"wpforms[fields][106]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_106_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_106_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_107-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"107\"><fieldset><legend class=\"wpforms-field-label\">\u0633\u0631\u0637\u0627\u0646:<\/legend><ul id=\"wpforms-42098-field_107\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_107_1\" name=\"wpforms[fields][107]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_107_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_107_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_107_2\" name=\"wpforms[fields][107]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_107_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_107_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_108-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"108\"><fieldset><legend class=\"wpforms-field-label\">\u0645\u0631\u0636 \u0643\u0644\u0648\u064a:<\/legend><ul id=\"wpforms-42098-field_108\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_108_1\" name=\"wpforms[fields][108]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_108_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_108_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_108_2\" name=\"wpforms[fields][108]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_108_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_108_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_109-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"109\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0635\u0631\u0639 \u0623\u0648 \u0627\u0644\u0646\u0648\u0628\u0627\u062a:<\/legend><ul id=\"wpforms-42098-field_109\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_109_1\" name=\"wpforms[fields][109]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_109_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_109_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_109_2\" name=\"wpforms[fields][109]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_109_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_109_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_110-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"110\"><fieldset><legend class=\"wpforms-field-label\">\u0641\u0642\u0631 \u062f\u0645:<\/legend><ul id=\"wpforms-42098-field_110\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_110_1\" name=\"wpforms[fields][110]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_110_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_110_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_110_2\" name=\"wpforms[fields][110]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_110_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_110_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_111-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"111\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u062a\u0647\u0627\u0628 \u0627\u0644\u0645\u0641\u0627\u0635\u0644:<\/legend><ul id=\"wpforms-42098-field_111\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_111_1\" name=\"wpforms[fields][111]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_111_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_111_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_111_2\" name=\"wpforms[fields][111]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_111_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_111_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_112-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"112\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0631\u0628\u0648\/\u0627\u0646\u062a\u0641\u0627\u062e \u0627\u0644\u0631\u0626\u0629:<\/legend><ul id=\"wpforms-42098-field_112\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_112_1\" name=\"wpforms[fields][112]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_112_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_112_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_112_2\" name=\"wpforms[fields][112]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_112_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_112_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_113-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"113\"><fieldset><legend class=\"wpforms-field-label\">\u0635\u0639\u0648\u0628\u0629 \u0641\u064a \u0627\u0644\u0628\u0644\u0639\/\u0627\u0644\u0633\u0643\u062a\u0629 \u0627\u0644\u062f\u0645\u0627\u063a\u064a\u0629:<\/legend><ul id=\"wpforms-42098-field_113\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_113_1\" name=\"wpforms[fields][113]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_113_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_113_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_113_2\" name=\"wpforms[fields][113]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_113_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_113_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_114-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"114\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0644\u0646\u0632\u064a\u0641 \u0627\u0644\u0645\u0647\u0628\u0644\u064a \u063a\u064a\u0631 \u0627\u0644\u0637\u0628\u064a\u0639\u064a:<\/legend><ul id=\"wpforms-42098-field_114\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_114_1\" name=\"wpforms[fields][114]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_114_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_114_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_114_2\" name=\"wpforms[fields][114]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_114_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_114_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_115-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"115\"><fieldset><legend class=\"wpforms-field-label\">\u062a\u0648\u0631\u0645 \u0627\u0644\u063a\u062f\u062f:<\/legend><ul id=\"wpforms-42098-field_115\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_115_1\" name=\"wpforms[fields][115]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_115_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_115_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_115_2\" name=\"wpforms[fields][115]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_115_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_115_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_116-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"116\"><fieldset><legend class=\"wpforms-field-label\">\u0642\u0644\u0642:<\/legend><ul id=\"wpforms-42098-field_116\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_116_1\" name=\"wpforms[fields][116]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_116_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_116_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_116_2\" name=\"wpforms[fields][116]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_116_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_116_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_117-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"117\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0631\u062a\u062f\u0627\u062f:<\/legend><ul id=\"wpforms-42098-field_117\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_117_1\" name=\"wpforms[fields][117]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_117_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_117_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_117_2\" name=\"wpforms[fields][117]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_117_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_117_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_118-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"118\"><fieldset><legend class=\"wpforms-field-label\">\u0623\u0644\u0645 \u0635\u062f\u0631:<\/legend><ul id=\"wpforms-42098-field_118\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_118_1\" name=\"wpforms[fields][118]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_118_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_118_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_118_2\" name=\"wpforms[fields][118]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_118_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_118_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_119-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"119\"><fieldset><legend class=\"wpforms-field-label\">\u0636\u064a\u0642 \u0641\u064a \u0627\u0644\u062a\u0646\u0641\u0633:<\/legend><ul id=\"wpforms-42098-field_119\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_119_1\" name=\"wpforms[fields][119]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_119_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_119_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_119_2\" name=\"wpforms[fields][119]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_119_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_119_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_120-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"120\"><fieldset><legend class=\"wpforms-field-label\">\u0635\u0639\u0648\u0628\u0629 \u0641\u064a \u0627\u0644\u0646\u0648\u0645\/\u0627\u0646\u0642\u0637\u0627\u0639 \u0627\u0644\u062a\u0646\u0641\u0633:<\/legend><ul id=\"wpforms-42098-field_120\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_120_1\" name=\"wpforms[fields][120]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_120_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_120_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_120_2\" name=\"wpforms[fields][120]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_120_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_120_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_121-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"121\"><fieldset><legend class=\"wpforms-field-label\">\u063a\u062b\u064a\u0627\u0646:<\/legend><ul id=\"wpforms-42098-field_121\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_121_1\" name=\"wpforms[fields][121]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_121_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_121_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_121_2\" name=\"wpforms[fields][121]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_121_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_121_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_122-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"122\"><fieldset><legend class=\"wpforms-field-label\">\u062f\u0648\u062e\u0629:<\/legend><ul id=\"wpforms-42098-field_122\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_122_1\" name=\"wpforms[fields][122]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_122_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_122_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_122_2\" name=\"wpforms[fields][122]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_122_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_122_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_123-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"123\"><fieldset><legend class=\"wpforms-field-label\">\u0646\u0641\u062e\u0629 (\u0645\u0631\u0636 \u0627\u0644\u0642\u0644\u0628):<\/legend><ul id=\"wpforms-42098-field_123\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_123_1\" name=\"wpforms[fields][123]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_123_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_123_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_123_2\" name=\"wpforms[fields][123]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_123_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_123_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_124-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"124\"><fieldset><legend class=\"wpforms-field-label\">\u0641\u0634\u0644 \u0627\u0644\u0642\u0644\u0628 (\u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0642\u0644\u0628):<\/legend><ul id=\"wpforms-42098-field_124\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_124_1\" name=\"wpforms[fields][124]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_124_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_124_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_124_2\" name=\"wpforms[fields][124]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_124_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_124_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_125-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"125\"><fieldset><legend class=\"wpforms-field-label\">\u0627\u0636\u0637\u0631\u0627\u0628\u0627\u062a \u0627\u0644\u0625\u064a\u0642\u0627\u0639 (\u0623\u0645\u0631\u0627\u0636 \u0627\u0644\u0642\u0644\u0628):<\/legend><ul id=\"wpforms-42098-field_125\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-42098-field_125_1\" name=\"wpforms[fields][125]\" value=\"\u0644\u0627\" aria-errormessage=\"wpforms-42098-field_125_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_125_1\">\u0644\u0627<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-42098-field_125_2\" name=\"wpforms[fields][125]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-42098-field_125_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_125_2\">\u0646\u0639\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_126-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"126\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_126\">\u0627\u0644\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062c\u0631\u0627\u062d\u064a (\u0627\u0630\u0643\u0631 \u0623\u064a \u0625\u062c\u0631\u0627\u0621 \u062c\u0631\u0627\u062d\u064a):<\/label><input type=\"text\" id=\"wpforms-42098-field_126\" class=\"wpforms-field-large\" name=\"wpforms[fields][126]\" aria-errormessage=\"wpforms-42098-field_126-error\" ><\/div><div id=\"wpforms-42098-field_127-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"127\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_127\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u062c\u0631\u0627\u062d\u064a:<\/label><input type=\"text\" id=\"wpforms-42098-field_127\" class=\"wpforms-field-large\" name=\"wpforms[fields][127]\" aria-errormessage=\"wpforms-42098-field_127-error\" ><\/div><div id=\"wpforms-42098-field_128-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"128\"><label class=\"wpforms-field-label\" for=\"wpforms-42098-field_128\">\u0631\u0633\u0627\u0644\u0629<\/label><textarea id=\"wpforms-42098-field_128\" class=\"wpforms-field-large\" name=\"wpforms[fields][128]\" placeholder=\"\u0631\u0633\u0627\u0644\u0629\" aria-errormessage=\"wpforms-42098-field_128-error\" ><\/textarea><\/div><div id=\"wpforms-42098-field_129-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"129\"><input type=\"hidden\" id=\"wpforms-42098-field_129\" name=\"wpforms[fields][129]\"><\/div><div id=\"wpforms-42098-field_130-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"130\"><input type=\"hidden\" id=\"wpforms-42098-field_130\" name=\"wpforms[fields][130]\" value=\"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/pages\/43343 \"><\/div><div id=\"wpforms-42098-field_131-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"131\"><input type=\"hidden\" id=\"wpforms-42098-field_131\" name=\"wpforms[fields][131]\" value=\"  216.73.216.191 {entry_geolocation}\"><\/div><div id=\"wpforms-42098-field_34-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"34\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">\u0627\u0644\u0642\u0628\u0648\u0644 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-42098-field_34\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-42098-field_34_1\" name=\"wpforms[fields][34][]\" value=\"\u0628\u0627\u0644\u0646\u0642\u0631 \u0639\u0644\u0649 \u0625\u0631\u0633\u0627\u0644\u060c \u0641\u0625\u0646\u0643 \u062a\u0648\u0627\u0641\u0642 \u0639\u0644\u0649 &lt;a href=&quot;https:\/\/clinicmono.com\/ar\/terms-condition\/&quot;&gt;&lt;strong&gt;\u0627\u0644\u0634\u0631\u0648\u0637 \u0648\u0627\u0644\u0623\u062d\u0643\u0627\u0645&lt;\/strong&gt;&lt;\/a&gt; \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0646\u0627\" aria-errormessage=\"wpforms-42098-field_34_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_34_1\">\u0628\u0627\u0644\u0646\u0642\u0631 \u0639\u0644\u0649 \u0625\u0631\u0633\u0627\u0644\u060c \u0641\u0625\u0646\u0643 \u062a\u0648\u0627\u0641\u0642 \u0639\u0644\u0649 <a href=\"https:\/\/clinicmono.com\/ar\/terms-condition\/\"><strong>\u0627\u0644\u0634\u0631\u0648\u0637 \u0648\u0627\u0644\u0623\u062d\u0643\u0627\u0645<\/strong><\/a> \u0627\u0644\u062e\u0627\u0635\u0629 \u0628\u0646\u0627<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-42098-field_133-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"133\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Acceptence (copy) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-42098-field_133\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-42098-field_133_1\" name=\"wpforms[fields][133][]\" value=\"I have read, understood and approved the general terms and conditions, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/clinicmono.com\/clarification-text-for-health-check-form\/&quot;&gt;the clarification text&lt;\/a&gt;, &lt;a target=&quot;_blank&quot; href=&quot;https:\/\/clinicmono.com\/explict-consent-form-for-health-check-form\/&quot;&gt;the explicit consent text&lt;\/a&gt;.\" aria-errormessage=\"wpforms-42098-field_133_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-42098-field_133_1\">I have read, understood and approved the general terms and conditions, <a target=\"_blank\" href=\"https:\/\/clinicmono.com\/clarification-text-for-health-check-form\/\">the clarification text<\/a>, <a target=\"_blank\" href=\"https:\/\/clinicmono.com\/explict-consent-form-for-health-check-form\/\">the explicit consent text<\/a>.<\/label><\/li><\/ul><\/fieldset><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v3\" ><input type=\"hidden\" name=\"wpforms[recaptcha]\" value=\"\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"42098\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/pages\/43343\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-42098\" class=\"wpforms-submit\" data-alt-text=\"\u0625\u0631\u0633\u0627\u0644...\" data-submit-text=\"\u064a\u064f\u0642\u062f\u0651\u0650\u0645\" aria-live=\"assertive\" value=\"wpforms-submit\">\u064a\u064f\u0642\u062f\u0651\u0650\u0645<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/clinicmono.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"\u0646\u0645\u0648\u0630\u062c \u0641\u062d\u0635 \u0627\u0644\u0635\u062d\u0629 \u0639\u064a\u0627\u062f\u0629 \u0645\u0648\u0646\u0648\u0635\u0641\u062d\u0627\u062aPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.\u062d\u0627\u0644\u0629 \u0627\u0644\u062c\u062f\u0627\u0631\u0629 *\u0623\u0639\u0632\u0628\u0645\u062a\u0632\u0648\u062c\u0645\u064f\u0637\u0644\u0651\u0642\u0627\u0644\u0623\u0631\u0627\u0645\u0644\u0627\u0633\u0645 *\u0627\u0633\u0645 \u0627\u0644\u0639\u0627\u0626\u0644\u0629 *\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a *\u0639\u064a\u062f \u0645\u064a\u0644\u0627\u062f\u0625\u0634\u063a\u0627\u0644\u0627\u0631\u062a\u0641\u0627\u0639\u0648\u0632\u0646\u0645\u0624\u0634\u0631 \u0643\u062a\u0644\u0629 \u0627\u0644\u062c\u0633\u0645\u062f\u0648\u0644\u0629\u0631\u0642\u0645 \u0627\u0644\u062a\u0644\u064a\u0641\u0648\u0646 *\u0639\u0646\u0648\u0627\u0646\u0627\u0644\u062a\u062f\u062e\u064a\u0646: (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u0627\u0630\u0643\u0631 \u0627\u0644\u0643\u0645\u064a\u0629): \u0627\u0644\u0643\u062d\u0648\u0644: (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u0627\u0630\u0643\u0631 \u0627\u0644\u0643\u0645\u064a\u0629):\u0645\u0648\u0627\u062f \u0623\u062e\u0631\u0649: (\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0644\u0625\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645\u060c \u062d\u062f\u062f): \u062a\u0627\u0631\u064a\u062e...","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"rank_math_lock_modified_date":false,"_mi_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"procedure":[],"class_list":["post-43343","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/pages\/43343"}],"collection":[{"href":"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/comments?post=43343"}],"version-history":[{"count":12,"href":"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/pages\/43343\/revisions"}],"predecessor-version":[{"id":119628,"href":"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/pages\/43343\/revisions\/119628"}],"wp:attachment":[{"href":"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/media?parent=43343"}],"wp:term":[{"taxonomy":"procedure","embeddable":true,"href":"https:\/\/clinicmono.com\/ar\/wp-json\/wp\/v2\/procedure?post=43343"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}