{"id":47,"date":"2025-02-10T16:59:18","date_gmt":"2025-02-10T16:59:18","guid":{"rendered":"https:\/\/ninaterapias.com\/?page_id=47"},"modified":"2025-03-12T19:35:04","modified_gmt":"2025-03-12T19:35:04","slug":"formulario","status":"publish","type":"page","link":"https:\/\/ninaterapias.com\/en\/formulario\/","title":{"rendered":"Formul\u00e1rio"},"content":{"rendered":"<a data-id-d=\"0\" data-remove-href=\"1\" data-img-style=\"\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/ninaterapias.com\/wp-content\/uploads\/2025\/02\/NinaB.png\" height=\"1080\" width=\"1920\" alt=\"\" style=\"\"><\/img><\/a><p><\/p><div data-uniq='6a6f79fc1e299' class='uniq-6a6f79fc1e299 formcraft-css form-live align-center'><style type='text\/css' scoped='scoped'>.fc-form {\n    display: flex;\n    justify-content: center;\n    align-items: center;\n    margin: auto;\n    text-align: center;\n}<\/style><script> window.formcraftLogic = window.formcraftLogic || {}; window.formcraftLogic[2] = [[[[\"field6\",\"contains\",\"Other\"],[]],[[\"show_fields\",\"field8\"]],\"and\"],[[[]],[[]],\"and\"]]; <\/script><div class=\"fc-pagination-cover fc-pagination-1\">\n\t\t\t\t<div class=\"fc-pagination width-100\">\n\t\t\t\t\t<!-- ngRepeat: page in Builder.FormElements track by $index --><div class=\"pagination-trigger \" data-index=\"0\">\n\t\t\t\t\t\t<span class=\"page-number\"><span >1<\/span><\/span>\n\t\t\t\t\t\t<span class=\"page-name \">Step 1<\/span>\n\t\t\t\t\t\t\n\t\t\t\t\t<\/div><!-- end ngRepeat: page in Builder.FormElements track by $index -->\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\n\t\t\t<style scoped=\"scoped\" >\n\t\t\t@media (max-width : 480px) {\n\t\t\t\t.fc_modal-dialog-2 .fc-pagination-cover .fc-pagination\n\t\t\t\t{\n\t\t\t\t\tbackground-color: white !important;\n\t\t\t\t}\n\t\t\t}\n\t\t\t\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .submit-cover .submit-button,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .fileupload-cover .button-file,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover .button,\n\t\t\t.formcraft-datepicker .ui-datepicker-header,\n\t\t\t.formcraft-datepicker .ui-datepicker-title\n\t\t\t{\n\t\t\t\tbackground: #cd5c5c;\n\t\t\t\tcolor: #fff;\n\t\t\t}\n\t\t\t.formcraft-datepicker td .ui-state-active,\n\t\t\t.formcraft-datepicker td .ui-state-hover,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .slider-cover .ui-slider-range\n\t\t\t{\n\t\t\t\tbackground: #cd5c5c;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-header,\n\t\t\t.formcraft-css .fc-form .field-cover>div.full hr\n\t\t\t{\n\t\t\t\tborder-color: #b45050;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-prev:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker .ui-datepicker-next:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker select.ui-datepicker-month:hover,\n\t\t\t#ui-datepicker-div.formcraft-datepicker select.ui-datepicker-year:hover\n\t\t\t{\n\t\t\t\tbackground-color: #b45050;\n\t\t\t}\n\t\t\t.formcraft-css .fc-pagination>div.active .page-number,\n\t\t\t.formcraft-css .form-cover-builder .fc-pagination>div:first-child .page-number\n\t\t\t{\n\t\t\t\tbackground-color: #cd5c5c;\n\t\t\t\tcolor: #fff;\n\t\t\t}\n\t\t\t#ui-datepicker-div.formcraft-datepicker table.ui-datepicker-calendar th,\n\t\t\t#ui-datepicker-div.formcraft-datepicker table.ui-datepicker-calendar td.ui-datepicker-today a,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .star-cover label,\n\t\t\thtml .formcraft-css .fc-form.label-floating .form-element .field-cover.has-focus>span,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .customText-cover a,\n\t\t\t.formcraft-css .prev-next>div span:hover\n\t\t\t{\n\t\t\t\tcolor: #cd5c5c;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .customText-cover a:hover\n\t\t\t{\n\t\t\t\tcolor: #b45050;\n\t\t\t}\n\t\t\thtml .formcraft-css .fc-form.fc-form-2.label-floating .form-element .field-cover > span\n\t\t\t{\n\t\t\t\tcolor: #666666;\n\t\t\t}\n\t\t\thtml .formcraft-css .fc-form .final-success .final-success-check {\n\t\t\t\tborder: 2px solid #666666;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"text\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"email\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"password\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"tel\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover textarea,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover select,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover .time-fields-cover,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover .awesomplete ul\n\t\t\t{\n\t\t\t\tcolor: #777;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"text\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"password\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"email\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"radio\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"checkbox\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"tel\"],\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover select,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover textarea\n\t\t\t{\n\t\t\t\tbackground-color: #fafafa;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"radio\"]:checked,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .field-cover input[type=\"checkbox\"]:checked {\n\t\t\t\tborder-color: #b45050;\n\t\t\t\tbackground: #cd5c5c;\t\t\t\t\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .star-cover label .star\n\t\t\t{\n\t\t\t\ttext-shadow: 0px 1px 0px #b45050;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .slider-cover .ui-slider-range\n\t\t\t{\n\t\t\t\tbox-shadow: 0px 1px 1px #b45050 inset;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .fileupload-cover .button-file\n\t\t\t{\n\t\t\t\tborder-color: #b45050;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"password\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"email\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"tel\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html input[type=\"text\"]:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html textarea:focus,\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html select:focus\n\t\t\t{\n\t\t\t\tborder-color: #cd5c5c;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2 .form-element .form-element-html .field-cover .is-read-only:focus {\n\t\t\t\tborder-color: #ccc;\n\t\t\t}\n\t\t\t.formcraft-css .fc-form.fc-form-2\t\t\t{\n\t\t\t\tfont-family: Cabin;\n\t\t\t}\n\t\t\t@media (max-width : 480px) {\n\t\t\t\thtml .dedicated-page,\n\t\t\t\thtml .dedicated-page .formcraft-css .fc-pagination > div.active\n\t\t\t\t{\n\t\t\t\t\tbackground: white;\n\t\t\t\t}\n\t\t\t}\n\t\t<\/style>\n\t\t<div class=\"form-cover\">\n\t\t\t<form data-auto-scroll=\"\" data-no-message-redirect=\"\" data-thousand=\"\" data-decimal=\".\" data-delay=\"\" data-id=\"2\" class=\"fc-form fc-form-2 align- fc-temp-class save-form- dont-submit-hidden- icons-hide- disable-enter- label-placeholder field-border-visible frame-visible remove-asterisk-true field-alignment-left  \" style=\"width: 480px; color: #666666; font-size: 115%; background: white\">\n\t\t\t\t<!-- ngRepeat: page in Builder.FormElements track by $index --><div class=\"form-page form-page-0\" data-index=\"0\">\n\t\t\t\t\t\n\t\t\t\t\t<div class=\"form-page-content      ng-not-empty\">\n\t\t\t\t\t\t<div data-identifier=\"field7\" data-index=\"0\" style=\"width: 100%\" class=\" form-element form-element-field7 options-false form-element-0 default-false form-element-type-customText is-required-false odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"absolute-false customText-cover field-cover\" style=\"left: ; top: 8px;right: ;bottom: ;color: #666666 !important; background-color:\"><div class=\"full\" style=\"text-align: left\"><p style=\"text-align: center\" ><span style=\"font-size: 26px\"><b>INFORMA\u00c7\u00d5ES CL\u00cdNICAS<\/b><\/span><\/p><\/div><input type=\"hidden\" name=\"field7\" data-field-id=\"field7\" wfd-id=\"id126\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field14\" data-index=\"1\" style=\"width: 100%\" class=\" even form-element form-element-field14 options-false form-element-1 default-false form-element-type-heading is-required-false -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: center; font-size: 1.5em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >Vamos nos conhecer melhor<\/span><\/div><input type=\"hidden\" data-field-id=\"field14\" name=\"field14[]\" value=\"Vamos nos conhecer melhor\" wfd-id=\"id143\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field1\" data-index=\"2\" style=\"width: 50%\" class=\" form-element form-element-field1 options-false form-element-2 default-false form-element-type-oneLineText is-required-true odd -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Nome<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Nome\" make-read-only=\"false\" data-field-id=\"field1\" name=\"field1[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id159\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field2\" data-index=\"3\" style=\"width: 50%\" class=\" even form-element form-element-field2 options-false form-element-3 default-false form-element-type-oneLineText is-required-true -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Sobrenome<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Sobrenome\" make-read-only=\"false\" data-field-id=\"field2\" name=\"field2[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id174\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field52\" data-index=\"4\" style=\"width: 50%\" class=\" form-element form-element-field52 options-false default-false form-element-type-oneLineText is-required-false odd form-element-4 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Data Nascimento<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Data Nascimento\" make-read-only=\"false\" data-field-id=\"field52\" name=\"field52[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id204\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field20\" data-index=\"5\" style=\"width: 50%\" class=\" form-element form-element-field20 options-false default-false form-element-type-oneLineText is-required-true even form-element-5 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Profiss\u00e3o<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Profiss\u00e3o\" make-read-only=\"false\" data-field-id=\"field20\" name=\"field20[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"false\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id219\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field45\" data-index=\"6\" style=\"width: 100%; position: relative; z-index: 999; left: 0px; top: 0px\" class=\" form-element form-element-field45 default-false form-element-type-oneLineText is-required-false options-false odd form-element-6 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover   has-focus\"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Endere\u00e7o<\/span><\/span><span class=\"sub-label\"><span >Seu Endere\u00e7o<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Endere\u00e7o\" make-read-only=\"false\" data-field-id=\"field45\" name=\"field45[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id249\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field47\" data-index=\"7\" style=\"width: 50%\" class=\" form-element form-element-field47 options-false default-false form-element-type-oneLineText is-required-false even form-element-7 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Bairro<\/span><\/span><span class=\"sub-label\"><span >Seu Bairro<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Bairro\" make-read-only=\"false\" data-field-id=\"field47\" name=\"field47[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id264\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field48\" data-index=\"8\" style=\"width: 50%\" class=\" form-element form-element-field48 options-false default-false form-element-type-oneLineText is-required-false odd form-element-8 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Cidade<\/span><\/span><span class=\"sub-label\"><span >Sua Cidade<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Cidade\" make-read-only=\"false\" data-field-id=\"field48\" name=\"field48[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id279\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field50\" data-index=\"9\" style=\"width: 50%\" class=\" form-element form-element-field50 options-false default-false form-element-type-oneLineText is-required-false even form-element-9 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Estado<\/span><\/span><span class=\"sub-label\"><span >UF<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Estado\" make-read-only=\"false\" data-field-id=\"field50\" name=\"field50[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id294\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field46\" data-index=\"10\" style=\"width: 50%\" class=\" form-element form-element-field46 options-false default-false form-element-type-oneLineText is-required-false odd form-element-10 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Cep<\/span><\/span><span class=\"sub-label\"><span >Seu CEP<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Cep\" make-read-only=\"false\" data-field-id=\"field46\" name=\"field46[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"numbers\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id309\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field3\" data-index=\"11\" style=\"width: 100%\" class=\" form-element form-element-field3 options-false default-false form-element-type-email is-required-true even form-element-11 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"email-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >Email<\/span><\/span><span class=\"sub-label\"><span >a valid email<\/span><\/span><\/span><div><span class=\"error\"><\/span><input placeholder=\"Email\" data-field-id=\"field3\" type=\"text\" data-val-type=\"email\" make-read-only=\"\" data-is-required=\"true\" name=\"field3\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\" wfd-id=\"id324\"><i class=\"formcraft-icon\">email<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field4\" data-index=\"12\" style=\"width: 100%\" class=\" form-element form-element-field4 options-false default-false form-element-type-oneLineText is-required-true odd form-element-12 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Celular<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Celular\" make-read-only=\"false\" data-field-id=\"field4\" name=\"field4[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"(00) 00000-0000\" data-mask-placeholder=\"(00) 00000-0000\" data-original-title=\"\" wfd-id=\"id335\"><i class=\"formcraft-icon formcraft-icon-type-stay_primary_portrait\">stay_primary_portrait<\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field19\" data-index=\"13\" style=\"width: 100%\" class=\" form-element form-element-field19 options-false default-false form-element-type-heading is-required-false even form-element-13 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: center; font-size: 1.6em; padding-top: ; padding-bottom: ; color:\" class=\"bold-true\"><span >QUAL O SEU OBJETIVO COM A MASSAGEM?<\/span><\/div><input type=\"hidden\" data-field-id=\"field19\" name=\"field19[]\" value=\"QUAL O SEU OBJETIVO COM A MASSAGEM?\" wfd-id=\"id365\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field78\" data-index=\"14\" style=\"width: 100%\" class=\" form-element form-element-field78 default-false form-element-type-textarea is-required-true odd form-element-14 -handle options-false\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"textarea-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >CONTE PRA GENTE<\/span><\/span><span class=\"sub-label\"><span >DETALHES<\/span><\/span><\/span><div><span class=\"error\"><\/span><textarea data-field-id=\"field78\" placeholder=\"CONTE PRA GENTE\" class=\"validation-lenient\" name=\"field78\" value=\"\" rows=\"5\" data-min-char=\"\" data-max-char=\"\" data-is-required=\"true\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\" style=\"min-height: 126.75px\"><\/textarea><div class=\"count-\"><span class=\"current-count\">0<\/span> \/ <span class=\"max-count \"><\/span><\/div><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field55\" data-index=\"15\" style=\"width: 100%\" class=\" form-element form-element-field55 options-false default-false form-element-type-checkbox is-required-false even form-element-15 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >J\u00c1 RECEBEU MASSAGEM PROFISSIONAL ANTES?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field55\" type=\"radio\" data-is-required=\"false\" name=\"field55[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id392\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field55\" type=\"radio\" data-is-required=\"false\" name=\"field55[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id393\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field56\" data-index=\"16\" style=\"width: 100%\" class=\" form-element form-element-field56 options-false default-false form-element-type-checkbox is-required-false odd form-element-16 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >QUE TIPO DE PRESS\u00c3O PREFERE?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field56\" type=\"radio\" data-is-required=\"false\" name=\"field56[]\" value=\"LEVE\" class=\"validation-lenient\" wfd-id=\"id404\"><span><span >LEVE<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field56\" type=\"radio\" data-is-required=\"false\" name=\"field56[]\" value=\"M\u00c9DIA\" class=\"validation-lenient\" wfd-id=\"id405\"><span><span >M\u00c9DIA<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field56\" type=\"radio\" data-is-required=\"false\" name=\"field56[]\" value=\"FIRME PROFUNDA\" class=\"validation-lenient\" wfd-id=\"id406\"><span><span >FIRME PROFUNDA<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field59\" data-index=\"17\" style=\"width: 100%\" class=\" form-element form-element-field59 options-false default-false form-element-type-heading is-required-false even form-element-17 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: center; font-size: 1.7000000000000002em; padding-top: ; padding-bottom: ; color:\" class=\"bold-true\"><span >HIST\u00d3RICO DE SA\u00dcDE<\/span><\/div><input type=\"hidden\" data-field-id=\"field59\" name=\"field59[]\" value=\"HIST\u00d3RICO DE SA\u00dcDE\" wfd-id=\"id417\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field61\" data-index=\"18\" style=\"width: 100%\" class=\" form-element form-element-field61 options-false default-false form-element-type-checkbox is-required-false odd form-element-18 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >J\u00c1 CONTRAIU O V\u00cdRUS COVID-19?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field61\" type=\"radio\" data-is-required=\"false\" name=\"field61[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id433\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field61\" type=\"radio\" data-is-required=\"false\" name=\"field61[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id434\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field65\" data-index=\"19\" style=\"width: 100%\" class=\" form-element form-element-field65 options-false default-false form-element-type-oneLineText is-required-false even form-element-19 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Se sim, quando e quais sintomas?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"Se sim, quando e quais sintomas?\" make-read-only=\"false\" data-field-id=\"field65\" name=\"field65[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id445\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field64\" data-index=\"20\" style=\"width: 100%\" class=\" form-element form-element-field64 options-false default-false form-element-type-checkbox is-required-false odd form-element-20 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images-false checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >PRECISOU DE INTERNA\u00c7\u00c3O<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field64\" type=\"radio\" data-is-required=\"false\" name=\"field64[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id460\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field64\" type=\"radio\" data-is-required=\"false\" name=\"field64[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id461\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field66\" data-index=\"21\" style=\"width: 100%\" class=\" form-element form-element-field66 options-false default-false form-element-type-checkbox is-required-false even form-element-21 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >J\u00c1 SOFREU ALGUM ACIDENTE, LES\u00c3O OU TRAUMA?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field66\" type=\"radio\" data-is-required=\"false\" name=\"field66[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id472\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field66\" type=\"radio\" data-is-required=\"false\" name=\"field66[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id473\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field24\" data-index=\"22\" style=\"width: 100%\" class=\" form-element form-element-field24 default-false form-element-type-oneLineText is-required-true options-false odd form-element-22 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >NESTE MOMENTO, TEM ALGUMA DOR? ONDE?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"NESTE MOMENTO, TEM ALGUMA DOR? ONDE?\" make-read-only=\"false\" data-field-id=\"field24\" name=\"field24[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id484\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field68\" data-index=\"23\" style=\"width: 100%\" class=\" form-element form-element-field68 options-false default-false form-element-type-checkbox is-required-false even form-element-23 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >FAZ USO DE ALGUM MEDICAMENTO, VITAMINAS OU SUPLEMENTOS?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field68\" type=\"radio\" data-is-required=\"false\" name=\"field68[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id499\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field68\" type=\"radio\" data-is-required=\"false\" name=\"field68[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id500\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field23\" data-index=\"24\" style=\"width: 100%\" class=\" form-element form-element-field23 options-false default-false form-element-type-oneLineText is-required-true odd form-element-24 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, QUAIS?<\/span><\/span><span class=\"sub-label\"><span >Senha<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAIS?\" make-read-only=\"false\" data-field-id=\"field23\" name=\"field23[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id511\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field73\" data-index=\"25\" style=\"width: 100%\" class=\" form-element form-element-field73 options-false default-false form-element-type-checkbox is-required-false even form-element-25 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >J\u00c1 FEZ CIRURGIA?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field73\" type=\"radio\" data-is-required=\"false\" name=\"field73[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id526\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field73\" type=\"radio\" data-is-required=\"false\" name=\"field73[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id527\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field69\" data-index=\"26\" style=\"width: 100%\" class=\" form-element form-element-field69 default-false form-element-type-oneLineText is-required-false options-false odd form-element-26 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, QUAIS?<\/span><\/span><span class=\"sub-label\"><span >CIRURGIA<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAIS?\" make-read-only=\"false\" data-field-id=\"field69\" name=\"field69[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id538\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field38\" data-index=\"27\" style=\"width: 100%\" class=\" form-element form-element-field38 options-false default-false form-element-type-heading is-required-false even form-element-27 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >TEM ALGUMA \u00c1REA DO CORPO QUE PREFERE DAR \u00caNFASE DURANTE A MASSAGEM?<\/span><\/div><input type=\"hidden\" data-field-id=\"field38\" name=\"field38[]\" value=\"TEM ALGUMA \u00c1REA DO CORPO QUE PREFERE DAR \u00caNFASE DURANTE A MASSAGEM?\" wfd-id=\"id553\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field26\" data-index=\"28\" style=\"width: 100%\" class=\" form-element form-element-field26 default-false form-element-type-oneLineText is-required-false options-false odd form-element-28 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >ONDE?<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"ONDE?\" make-read-only=\"false\" data-field-id=\"field26\" name=\"field26[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id569\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field40\" data-index=\"29\" style=\"width: 100%\" class=\" form-element form-element-field40 options-false default-false form-element-type-heading is-required-false even form-element-29 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >TEM ALERGIA OU AVERS\u00c3O A ALGUM CREME, \u00d3LEO OU AROMA?<\/span><\/div><input type=\"hidden\" data-field-id=\"field40\" name=\"field40[]\" value=\"TEM ALERGIA OU AVERS\u00c3O A ALGUM CREME, \u00d3LEO OU AROMA?\" wfd-id=\"id584\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field27\" data-index=\"30\" style=\"width: 100%\" class=\" form-element form-element-field27 options-false default-false form-element-type-oneLineText is-required-true odd form-element-30 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, RELATE<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, RELATE\" make-read-only=\"false\" data-field-id=\"field27\" name=\"field27[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id600\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field34\" data-index=\"31\" style=\"width: 100%\" class=\" form-element form-element-field34 options-false default-false form-element-type-heading is-required-false even form-element-31 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: left; font-size: 0.9999999999999997em; padding-top: ; padding-bottom: ; color:\" class=\"bold-false\"><span >SENTE SUAS PERNAS QUENTES, FORMIGANDO, VERMELHA E COM DOR?<\/span><\/div><input type=\"hidden\" data-field-id=\"field34\" name=\"field34[]\" value=\"SENTE SUAS PERNAS QUENTES, FORMIGANDO, VERMELHA E COM DOR?\" wfd-id=\"id615\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field41\" data-index=\"32\" style=\"width: 100%\" class=\" form-element form-element-field41 options-false default-false form-element-type-oneLineText is-required-true odd form-element-32 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, RELATE OS SINTOMAS<\/span><\/span><span class=\"sub-label\"><span >SINTOMAS<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, RELATE OS SINTOMAS\" make-read-only=\"false\" data-field-id=\"field41\" name=\"field41[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id631\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field77\" data-index=\"33\" style=\"width: 100%\" class=\" form-element form-element-field77 options-false default-false form-element-type-heading is-required-false even form-element-33 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: center; font-size: 1.7000000000000002em; padding-top: ; padding-bottom: ; color:\" class=\"bold-true\"><span >H\u00c1BITOS DI\u00c1RIOS<\/span><\/div><input type=\"hidden\" data-field-id=\"field77\" name=\"field77[]\" value=\"H\u00c1BITOS DI\u00c1RIOS\" wfd-id=\"id646\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field74\" data-index=\"34\" style=\"width: 100%\" class=\" form-element form-element-field74 options-false default-false form-element-type-checkbox is-required-false odd form-element-34 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >J\u00c1 TEVE TROMBOSE VENOSA PROFUNDA?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field74\" type=\"radio\" data-is-required=\"false\" name=\"field74[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id662\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field74\" type=\"radio\" data-is-required=\"false\" name=\"field74[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id663\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field75\" data-index=\"35\" style=\"width: 100%\" class=\" form-element form-element-field75 options-false default-false form-element-type-checkbox is-required-false even form-element-35 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >TRATAMENTO EST\u00c9TICO ANTERIOR?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field75\" type=\"radio\" data-is-required=\"false\" name=\"field75[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id674\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field75\" type=\"radio\" data-is-required=\"false\" name=\"field75[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id675\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field70\" data-index=\"36\" style=\"width: 100%\" class=\" form-element form-element-field70 options-false default-false form-element-type-oneLineText is-required-false odd form-element-36 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><span >TRATAMENTO<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field70\" name=\"field70[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id686\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field79\" data-index=\"37\" style=\"width: 100%\" class=\" form-element form-element-field79 options-false default-false form-element-type-checkbox is-required-false even form-element-37 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >UTILIZA\u00c7\u00c3O DE COSM\u00c9TICOS?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field79\" type=\"radio\" data-is-required=\"false\" name=\"field79[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id701\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field79\" type=\"radio\" data-is-required=\"false\" name=\"field79[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id702\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field71\" data-index=\"38\" style=\"width: 100%\" class=\" form-element form-element-field71 options-false default-false form-element-type-oneLineText is-required-false odd form-element-38 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, QUAIS?<\/span><\/span><span class=\"sub-label\"><span >COSMT\u00c9TICOS<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAIS?\" make-read-only=\"false\" data-field-id=\"field71\" name=\"field71[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id713\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field80\" data-index=\"39\" style=\"width: 100%\" class=\" form-element form-element-field80 options-false default-false form-element-type-checkbox is-required-false even form-element-39 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >EXPOSI\u00c7\u00c3O AO SOL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field80\" type=\"radio\" data-is-required=\"false\" name=\"field80[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id728\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field80\" type=\"radio\" data-is-required=\"false\" name=\"field80[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id729\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field81\" data-index=\"40\" style=\"width: 100%\" class=\" form-element form-element-field81 options-false default-false form-element-type-checkbox is-required-false odd form-element-40 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >USA FILTRO SOLAR?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field81\" type=\"radio\" data-is-required=\"false\" name=\"field81[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id740\"><span><span >N\u00c3O<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field81\" type=\"radio\" data-is-required=\"false\" name=\"field81[]\" value=\"MODERADAMENTE\" class=\"validation-lenient\" wfd-id=\"id741\"><span><span >MODERADAMENTE<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field81\" type=\"radio\" data-is-required=\"false\" name=\"field81[]\" value=\"FRENQUENTEMENTE\" class=\"validation-lenient\" wfd-id=\"id742\"><span><span >FRENQUENTEMENTE<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field82\" data-index=\"41\" style=\"width: 100%\" class=\" form-element form-element-field82 options-false default-false form-element-type-checkbox is-required-false even form-element-41 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >TABAGISMO?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field82\" type=\"radio\" data-is-required=\"false\" name=\"field82[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id753\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field82\" type=\"radio\" data-is-required=\"false\" name=\"field82[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id754\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field72\" data-index=\"42\" style=\"width: 100%\" class=\" form-element form-element-field72 options-false default-false form-element-type-oneLineText is-required-false odd form-element-42 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, QUANTOS CIGARROS POR DIA?<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUANTOS CIGARROS POR DIA?\" make-read-only=\"false\" data-field-id=\"field72\" name=\"field72[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"numbers\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id765\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field83\" data-index=\"43\" style=\"width: 100%\" class=\" form-element form-element-field83 options-false default-false form-element-type-checkbox is-required-false even form-element-43 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >INGERE BEBIDA ALCO\u00d3LICA?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field83\" type=\"radio\" data-is-required=\"false\" name=\"field83[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id780\"><span><span >N\u00c3O<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field83\" type=\"radio\" data-is-required=\"false\" name=\"field83[]\" value=\"SOCIALMENTE\" class=\"validation-lenient\" wfd-id=\"id781\"><span><span >SOCIALMENTE<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field83\" type=\"radio\" data-is-required=\"false\" name=\"field83[]\" value=\"DIARIAMENTE\" class=\"validation-lenient\" wfd-id=\"id782\"><span><span >DIARIAMENTE<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field84\" data-index=\"44\" style=\"width: 100%\" class=\" form-element form-element-field84 options-false default-false form-element-type-checkbox is-required-false odd form-element-44 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >FUNCIONAMENTO INTESTINAL<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field84\" type=\"radio\" data-is-required=\"false\" name=\"field84[]\" value=\"REGULAR\" class=\"validation-lenient\" wfd-id=\"id793\"><span><span >REGULAR<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field84\" type=\"radio\" data-is-required=\"false\" name=\"field84[]\" value=\"IRREGULAR\" class=\"validation-lenient\" wfd-id=\"id794\"><span><span >IRREGULAR<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field91\" data-index=\"45\" style=\"width: 100%\" class=\" form-element form-element-field91 options-false default-false form-element-type-oneLineText is-required-true even form-element-45 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >INGEST\u00c3O DE \u00c1GUA (COPOS\/DIA):<\/span><\/span><span class=\"sub-label\"><span >quantos como de \u00e1gua?<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"INGEST\u00c3O DE \u00c1GUA (COPOS\/DIA):\" make-read-only=\"false\" data-field-id=\"field91\" name=\"field91[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"true\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id805\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field85\" data-index=\"46\" style=\"width: 100%\" class=\" form-element form-element-field85 options-false default-false form-element-type-checkbox is-required-true odd form-element-46 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >COMO \u00c9 SUA ALIMENTA\u00c7\u00c3O?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field85\" type=\"radio\" data-is-required=\"true\" name=\"field85[]\" value=\"BOA\" class=\"validation-lenient\" wfd-id=\"id820\"><span><span >BOA<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field85\" type=\"radio\" data-is-required=\"true\" name=\"field85[]\" value=\"REGULAR\" class=\"validation-lenient\" wfd-id=\"id821\"><span><span >REGULAR<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field85\" type=\"radio\" data-is-required=\"true\" name=\"field85[]\" value=\"P\u00c9SSIMA\" class=\"validation-lenient\" wfd-id=\"id822\"><span><span >P\u00c9SSIMA<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field86\" data-index=\"47\" style=\"width: 100%\" class=\" form-element form-element-field86 options-false default-false form-element-type-checkbox is-required-true even form-element-47 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >PRATICA ATIVIDADE F\u00cdSICA?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field86\" type=\"radio\" data-is-required=\"true\" name=\"field86[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id833\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field86\" type=\"radio\" data-is-required=\"true\" name=\"field86[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id834\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field92\" data-index=\"48\" style=\"width: 100%\" class=\" form-element form-element-field92 options-false default-false form-element-type-oneLineText is-required-false odd form-element-48 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUE TIPO?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUE TIPO?\" make-read-only=\"false\" data-field-id=\"field92\" name=\"field92[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"false\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id845\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field93\" data-index=\"49\" style=\"width: 100%\" class=\" form-element form-element-field93 options-false default-false form-element-type-oneLineText is-required-false even form-element-49 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >QUANTAS VEZES NA SEMANA?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"QUANTAS VEZES NA SEMANA?\" make-read-only=\"false\" data-field-id=\"field93\" name=\"field93[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"numbers\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id860\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field87\" data-index=\"50\" style=\"width: 100%\" class=\" form-element form-element-field87 options-false default-false form-element-type-checkbox is-required-false odd form-element-50 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >USA ANTINCONPECIONAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field87\" type=\"radio\" data-is-required=\"false\" name=\"field87[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id875\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field87\" type=\"radio\" data-is-required=\"false\" name=\"field87[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id876\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field94\" data-index=\"51\" style=\"width: 100%\" class=\" form-element form-element-field94 options-false default-false form-element-type-oneLineText is-required-false even form-element-51 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field94\" name=\"field94[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id887\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field88\" data-index=\"52\" style=\"width: 100%\" class=\" form-element form-element-field88 options-false default-false form-element-type-checkbox is-required-false odd form-element-52 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >\u00c9 GESTANTE?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field88\" type=\"radio\" data-is-required=\"false\" name=\"field88[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id902\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field88\" type=\"radio\" data-is-required=\"false\" name=\"field88[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id903\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field89\" data-index=\"53\" style=\"width: 100%\" class=\" form-element form-element-field89 options-false default-false form-element-type-checkbox is-required-false even form-element-53 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >GESTA\u00c7\u00d5ES ANTERIORES?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field89\" type=\"radio\" data-is-required=\"false\" name=\"field89[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id914\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field89\" type=\"radio\" data-is-required=\"false\" name=\"field89[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id915\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field95\" data-index=\"54\" style=\"width: 100%\" class=\" form-element form-element-field95 options-false default-false form-element-type- is-required-false odd form-element-54 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, QUANTAS E A QUANTO TEMPO?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUANTAS E A QUANTO TEMPO?\" make-read-only=\"\" data-field-id=\"field95\" name=\"field95[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id926\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field97\" data-index=\"55\" style=\"width: 100%\" class=\" form-element form-element-field97 options-false default-false form-element-type-heading is-required-false even form-element-55 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: center; font-size: 1.7000000000000002em; padding-top: ; padding-bottom: ; color:\" class=\"bold-true\"><span >HIST\u00d3RICO CL\u00cdNICO<\/span><\/div><input type=\"hidden\" data-field-id=\"field97\" name=\"field97[]\" value=\"HIST\u00d3RICO CL\u00cdNICO\" wfd-id=\"id941\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field90\" data-index=\"56\" style=\"width: 100%\" class=\" form-element form-element-field90 options-false default-false form-element-type-checkbox is-required-false odd form-element-56 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >TRATAMENTO M\u00c9DICO ATUAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field90\" type=\"radio\" data-is-required=\"false\" name=\"field90[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id957\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field90\" type=\"radio\" data-is-required=\"false\" name=\"field90[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id958\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field98\" data-index=\"57\" style=\"width: 100%\" class=\" form-element form-element-field98 options-false default-false form-element-type-oneLineText is-required-false even form-element-57 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field98\" name=\"field98[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id969\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field99\" data-index=\"58\" style=\"width: 100%\" class=\" form-element form-element-field99 options-false default-false form-element-type-checkbox is-required-false odd form-element-58 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ANTECEDENTES AL\u00c9RGICOS?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field99\" type=\"radio\" data-is-required=\"false\" name=\"field99[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id984\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field99\" type=\"radio\" data-is-required=\"false\" name=\"field99[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id985\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field101\" data-index=\"59\" style=\"width: 100%\" class=\" form-element form-element-field101 options-false default-false form-element-type-oneLineText is-required-false even form-element-59 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAIS?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAIS?\" make-read-only=\"false\" data-field-id=\"field101\" name=\"field101[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id996\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field100\" data-index=\"60\" style=\"width: 100%\" class=\" form-element form-element-field100 options-false default-false form-element-type-checkbox is-required-false odd form-element-60 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ESTRESSE?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field100\" type=\"radio\" data-is-required=\"false\" name=\"field100[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1011\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field100\" type=\"radio\" data-is-required=\"false\" name=\"field100[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1012\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field103\" data-index=\"61\" style=\"width: 100%\" class=\" form-element form-element-field103 options-false default-false form-element-type-checkbox is-required-false even form-element-61 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ENXAQUECA?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field103\" type=\"radio\" data-is-required=\"false\" name=\"field103[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1023\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field103\" type=\"radio\" data-is-required=\"false\" name=\"field103[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1024\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field102\" data-index=\"62\" style=\"width: 100%\" class=\" form-element form-element-field102 options-false default-false form-element-type-checkbox is-required-false odd form-element-62 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >DEPRESS\u00c3O?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field102\" type=\"radio\" data-is-required=\"false\" name=\"field102[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1035\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field102\" type=\"radio\" data-is-required=\"false\" name=\"field102[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1036\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field104\" data-index=\"63\" style=\"width: 100%\" class=\" form-element form-element-field104 options-false default-false form-element-type-checkbox is-required-false even form-element-63 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >INS\u00d4NIA?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field104\" type=\"radio\" data-is-required=\"false\" name=\"field104[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1047\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field104\" type=\"radio\" data-is-required=\"false\" name=\"field104[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1048\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field105\" data-index=\"64\" style=\"width: 100%\" class=\" form-element form-element-field105 options-false default-false form-element-type-checkbox is-required-false odd form-element-64 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >DOR NA ATM?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field105\" type=\"radio\" data-is-required=\"false\" name=\"field105[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1059\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field105\" type=\"radio\" data-is-required=\"false\" name=\"field105[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1060\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field106\" data-index=\"65\" style=\"width: 100%\" class=\" form-element form-element-field106 options-false default-false form-element-type-checkbox is-required-false even form-element-65 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >BRUXISMO?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field106\" type=\"radio\" data-is-required=\"false\" name=\"field106[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1071\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field106\" type=\"radio\" data-is-required=\"false\" name=\"field106[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1072\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field107\" data-index=\"66\" style=\"width: 100%\" class=\" form-element form-element-field107 options-false default-false form-element-type-checkbox is-required-false odd form-element-66 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >USA LENTES DE CONTATO?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field107\" type=\"radio\" data-is-required=\"false\" name=\"field107[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1083\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field107\" type=\"radio\" data-is-required=\"false\" name=\"field107[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1084\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field108\" data-index=\"67\" style=\"width: 100%\" class=\" form-element form-element-field108 options-false default-false form-element-type-checkbox is-required-false even form-element-67 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ALGUMA DOEN\u00c7A DE PELE?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field108\" type=\"radio\" data-is-required=\"false\" name=\"field108[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1095\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field108\" type=\"radio\" data-is-required=\"false\" name=\"field108[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1096\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field112\" data-index=\"68\" style=\"width: 100%\" class=\" form-element form-element-field112 options-false default-false form-element-type-oneLineText is-required-false odd form-element-68 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field112\" name=\"field112[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1107\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field110\" data-index=\"69\" style=\"width: 100%\" class=\" form-element form-element-field110 options-false default-false form-element-type-checkbox is-required-false even form-element-69 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >\u00c9 PORTADOR DE MARCAPASSO?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field110\" type=\"radio\" data-is-required=\"false\" name=\"field110[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1122\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field110\" type=\"radio\" data-is-required=\"false\" name=\"field110[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1123\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field111\" data-index=\"70\" style=\"width: 100%\" class=\" form-element form-element-field111 options-false default-false form-element-type-checkbox is-required-false odd form-element-70 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >TEM ALTERA\u00c7\u00d5ES CARD\u00cdACAS?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field111\" type=\"radio\" data-is-required=\"false\" name=\"field111[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1134\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field111\" type=\"radio\" data-is-required=\"false\" name=\"field111[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1135\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field113\" data-index=\"71\" style=\"width: 100%\" class=\" form-element form-element-field113 options-false default-false form-element-type-oneLineText is-required-false even form-element-71 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAIS?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAIS?\" make-read-only=\"false\" data-field-id=\"field113\" name=\"field113[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1146\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field114\" data-index=\"72\" style=\"width: 100%\" class=\" form-element form-element-field114 options-false default-false form-element-type-checkbox is-required-false odd form-element-72 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >COMO \u00c9 SUA PRESS\u00c3O ARTERIAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field114\" type=\"radio\" data-is-required=\"false\" name=\"field114[]\" value=\"NORMAL\" class=\"validation-lenient\" wfd-id=\"id1161\"><span><span >NORMAL<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field114\" type=\"radio\" data-is-required=\"false\" name=\"field114[]\" value=\"BAIXA\" class=\"validation-lenient\" wfd-id=\"id1162\"><span><span >BAIXA<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field114\" type=\"radio\" data-is-required=\"false\" name=\"field114[]\" value=\"ALTA\" class=\"validation-lenient\" wfd-id=\"id1163\"><span><span >ALTA<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field115\" data-index=\"73\" style=\"width: 100%\" class=\" form-element form-element-field115 options-false default-false form-element-type-checkbox is-required-false even form-element-73 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ALGUM DIST\u00daRBIO CIRCULAT\u00d3RIO?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field115\" type=\"radio\" data-is-required=\"false\" name=\"field115[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1174\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field115\" type=\"radio\" data-is-required=\"false\" name=\"field115[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1175\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field123\" data-index=\"74\" style=\"width: 100%\" class=\" form-element form-element-field123 options-false default-false form-element-type-oneLineText is-required-false odd form-element-74 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field123\" name=\"field123[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1186\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field116\" data-index=\"75\" style=\"width: 100%\" class=\" form-element form-element-field116 options-false default-false form-element-type-checkbox is-required-false even form-element-75 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ALGUM DIST\u00daRBIO RENAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field116\" type=\"radio\" data-is-required=\"false\" name=\"field116[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1201\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field116\" type=\"radio\" data-is-required=\"false\" name=\"field116[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1202\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field124\" data-index=\"76\" style=\"width: 100%\" class=\" form-element form-element-field124 options-false default-false form-element-type-oneLineText is-required-false odd form-element-76 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field124\" name=\"field124[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1213\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field117\" data-index=\"77\" style=\"width: 100%\" class=\" form-element form-element-field117 options-false default-false form-element-type-checkbox is-required-false even form-element-77 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ALGUM DIST\u00daRBIO HORMONAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field117\" type=\"radio\" data-is-required=\"false\" name=\"field117[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1228\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field117\" type=\"radio\" data-is-required=\"false\" name=\"field117[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1229\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field125\" data-index=\"78\" style=\"width: 100%\" class=\" form-element form-element-field125 options-false default-false form-element-type-oneLineText is-required-false odd form-element-78 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field125\" name=\"field125[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1240\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field118\" data-index=\"79\" style=\"width: 100%\" class=\" form-element form-element-field118 options-false default-false form-element-type-checkbox is-required-false even form-element-79 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ALGUM DIST\u00daRBIO GASTROINSTESTINAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field118\" type=\"radio\" data-is-required=\"false\" name=\"field118[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1255\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field118\" type=\"radio\" data-is-required=\"false\" name=\"field118[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1256\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field126\" data-index=\"80\" style=\"width: 100%\" class=\" form-element form-element-field126 options-false default-false form-element-type-oneLineText is-required-false odd form-element-80 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field126\" name=\"field126[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1267\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field119\" data-index=\"81\" style=\"width: 100%\" class=\" form-element form-element-field119 options-false default-false form-element-type-checkbox is-required-false even form-element-81 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >TEM ALTERA\u00c7\u00d5ES PSICOL\u00d3GICAS OU PSIQUI\u00c1TRICAS?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field119\" type=\"radio\" data-is-required=\"false\" name=\"field119[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1282\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field119\" type=\"radio\" data-is-required=\"false\" name=\"field119[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1283\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field127\" data-index=\"82\" style=\"width: 100%\" class=\" form-element form-element-field127 options-false default-false form-element-type-oneLineText is-required-false odd form-element-82 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, QUAIS?<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAIS?\" make-read-only=\"false\" data-field-id=\"field127\" name=\"field127[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1294\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field120\" data-index=\"83\" style=\"width: 100%\" class=\" form-element form-element-field120 options-false default-false form-element-type-checkbox is-required-false even form-element-83 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ANTECEDENTES ONCOL\u00d3GICOS?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field120\" type=\"radio\" data-is-required=\"false\" name=\"field120[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1309\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field120\" type=\"radio\" data-is-required=\"false\" name=\"field120[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1310\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field128\" data-index=\"84\" style=\"width: 100%\" class=\" form-element form-element-field128 options-false default-false form-element-type-oneLineText is-required-false odd form-element-84 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field128\" name=\"field128[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1321\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field121\" data-index=\"85\" style=\"width: 100%\" class=\" form-element form-element-field121 options-false default-false form-element-type-checkbox is-required-false even form-element-85 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >TEM DIABETES?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field121\" type=\"radio\" data-is-required=\"false\" name=\"field121[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1336\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field121\" type=\"radio\" data-is-required=\"false\" name=\"field121[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1337\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field129\" data-index=\"86\" style=\"width: 100%\" class=\" form-element form-element-field129 options-false default-false form-element-type-oneLineText is-required-false odd form-element-86 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAL TIPO?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL TIPO?\" make-read-only=\"false\" data-field-id=\"field129\" name=\"field129[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1348\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field132\" data-index=\"87\" style=\"width: 100%\" class=\" form-element form-element-field132 options-false default-false form-element-type-checkbox is-required-false even form-element-87 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ALGUMA PR\u00d3TESE MET\u00c1LICA?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field132\" type=\"radio\" data-is-required=\"false\" name=\"field132[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1363\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field132\" type=\"radio\" data-is-required=\"false\" name=\"field132[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1364\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field130\" data-index=\"88\" style=\"width: 100%\" class=\" form-element form-element-field130 options-false default-false form-element-type-oneLineText is-required-false odd form-element-88 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >SE SIM, ONDE?<\/span><\/span><span class=\"sub-label\"><span >your full name<\/span><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, ONDE?\" make-read-only=\"false\" data-field-id=\"field130\" name=\"field130[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1375\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field133\" data-index=\"89\" style=\"width: 100%\" class=\" form-element form-element-field133 options-false default-false form-element-type-checkbox is-required-false even form-element-89 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"images- checkbox-cover field-cover\"><span class=\"sub-label-false\"><span class=\"main-label\"><span >ALGUM OUTRO TIPO DE DOEN\u00c7A?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field133\" type=\"radio\" data-is-required=\"false\" name=\"field133[]\" value=\"SIM\" class=\"validation-lenient\" wfd-id=\"id1390\"><span><span >SIM<\/span><\/span><\/label><label style=\"width:\" ><img alt=\"\"><input data-field-id=\"field133\" type=\"radio\" data-is-required=\"false\" name=\"field133[]\" value=\"N\u00c3O\" class=\"validation-lenient\" wfd-id=\"id1391\"><span><span >N\u00c3O<\/span><\/span><\/label><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field131\" data-index=\"90\" style=\"width: 100%\" class=\" form-element form-element-field131 options-false default-false form-element-type-oneLineText is-required-false odd form-element-90 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"oneLineText-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >SE SIM, QUAL?<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><input type=\"text\" placeholder=\"SE SIM, QUAL?\" make-read-only=\"false\" data-field-id=\"field131\" name=\"field131[]\" data-min-char=\"\" data-max-char=\"\" data-val-type=\"\" data-regexp=\"\" data-is-required=\"false\" data-allow-spaces=\"\" class=\"validation-lenient\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-input-mask=\"\" data-mask-placeholder=\"\" data-original-title=\"\" wfd-id=\"id1402\"><i class=\"formcraft-icon formcraft-icon-type-\"><\/i><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field76\" data-index=\"91\" style=\"width: 100%\" class=\" form-element form-element-field76 options-false default-false form-element-type-heading is-required-false even form-element-91 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div style=\"background-color:\" class=\"heading-cover field-cover \"><div style=\"text-align: center; font-size: 1.5em; padding-top: ; padding-bottom: ; color:\" class=\"bold-\"><span >OBSERVA\u00c7\u00d5ES<\/span><\/div><input type=\"hidden\" data-field-id=\"field76\" name=\"field76[]\" value=\"OBSERVA\u00c7\u00d5ES\" wfd-id=\"id1417\"><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field33\" data-index=\"92\" style=\"width: 100%\" class=\" form-element form-element-field33 options-false default-false form-element-type-textarea is-required-false odd form-element-92 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><label class=\"textarea-cover field-cover  \"><span class=\"sub-label-false\"><span class=\"main-label\"><span >Fa\u00e7a alguma observa\u00e7\u00e3o sobre o tratamento em si<\/span><\/span><span class=\"sub-label\"><\/span><\/span><div><span class=\"error\"><\/span><textarea data-field-id=\"field33\" placeholder=\"Fa\u00e7a alguma observa\u00e7\u00e3o sobre o tratamento em si\" class=\"validation-lenient\" name=\"field33\" value=\"\" rows=\"5\" data-min-char=\"\" data-max-char=\"\" data-is-required=\"false\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"focus\" data-html=\"true\" data-original-title=\"\" style=\"min-height: 126.75px\"><\/textarea><div class=\"count-\"><span class=\"current-count\">0<\/span> \/ <span class=\"max-count \"><\/span><\/div><\/div><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field136\" data-index=\"93\" style=\"width: 100%\" class=\" form-element form-element-field136 options-false default-false form-element-type-thumb is-required-true even form-element-93 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"thumb-cover field-cover \"><span class=\"sub-label-true\"><span class=\"main-label\"><span >TERMO DE RESPONSABILIDADE<\/span><\/span><span class=\"sub-label\"><span >Declaro estar ciente sobre todos os benef\u00edcios e contraindica\u00e7\u00f5es, relacionados ao tratamento de  Massoterapia. As declara\u00e7\u00f5es acima s\u00e3o verdadeiras, n\u00e3o cabendo ao profissional a responsabilidade por informa\u00e7\u00f5es omitidas.<\/span><\/span><\/span><div class=\"thumb-label-cover hide-checkbox update-label\" data-placement=\"right\" data-toggle=\"tooltip\" tooltip=\"\" data-trigger=\"hover\" data-html=\"true\" data-original-title=\"\"><span class=\"error\"><\/span><div><label tooltip=\"\" data-toggle=\"tooltip\" style=\"width:\" class=\" odd\" data-original-title=\"Aceito\"><i class=\"formcraft-icon thumbs-up\">thumb_up<\/i><i class=\"formcraft-icon thumbs-down\">thumb_down<\/i><input data-field-id=\"field136\" type=\"radio\" data-is-required=\"true\" name=\"field136\" value=\"1\" class=\"validation-lenient\" wfd-id=\"id1444\"><\/label><label tooltip=\"\" data-toggle=\"tooltip\" style=\"width:\"  data-original-title=\"N\u00e3o Aceito\"><i class=\"formcraft-icon thumbs-up\">thumb_up<\/i><i class=\"formcraft-icon thumbs-down\">thumb_down<\/i><input data-field-id=\"field136\" type=\"radio\" data-is-required=\"true\" name=\"field136\" value=\"0\" class=\"validation-lenient\" wfd-id=\"id1445\"><\/label><\/div><\/div><\/div><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div><div data-identifier=\"field10\" data-index=\"94\" style=\"width: 100%\" class=\" form-element form-element-field10 options-false default-false form-element-type-submit is-required-false odd form-element-94 -handle\">\n\t\t\t\t\t\t\t<div class=\"form-element-html\"><div ><div class=\"align-center wide-false submit-cover field-cover\"><button type=\"submit\" class=\"button submit-button\"><span class=\"text \">Enviar<\/span><span class=\"spin-cover\"><i style=\"color:\" class=\"loading-icon icon-cog animate-spin\"><\/i><\/span><\/button><\/div><div class=\"submit-response \"><\/div><label ><input type=\"text\" class=\"required_field\" name=\"website\" autocomplete=\"maple-syrup-pot\" wfd-id=\"id1454\"><\/label><\/div><\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div><!-- end ngRepeat: page in Builder.FormElements track by $index -->\n\t\t\t<\/form>\n\t\t\t<div class=\"prev-next prev-next-1\" style=\"width: 480px; color: #666666; font-size: 115%; background: white\">\n\t\t\t\t<div>\n\t\t\t\t\t\n\t\t\t\t\t<span class=\"inactive page-prev \"><i class=\"formcraft-icon\">keyboard_arrow_left<\/i>Previous<\/span><\/div>\n\t\t\t\t<div>\n\t\t\t\t\t\n\t\t\t\t\t<span class=\"page-next \">Next<i class=\"formcraft-icon\">keyboard_arrow_right<\/i><\/span><\/div>\n\t\t\t<\/div>\n\t\t<\/div><\/div><p><\/p><p><\/p><p class=\"wp-block-paragraph\"><\/p>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"rs_blank_template":"","rs_page_bg_color":"","slide_template_v7":"","footnotes":""},"class_list":["post-47","page","type-page","status-publish","hentry","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/ninaterapias.com\/en\/wp-json\/wp\/v2\/pages\/47","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ninaterapias.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ninaterapias.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ninaterapias.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ninaterapias.com\/en\/wp-json\/wp\/v2\/comments?post=47"}],"version-history":[{"count":6,"href":"https:\/\/ninaterapias.com\/en\/wp-json\/wp\/v2\/pages\/47\/revisions"}],"predecessor-version":[{"id":86,"href":"https:\/\/ninaterapias.com\/en\/wp-json\/wp\/v2\/pages\/47\/revisions\/86"}],"wp:attachment":[{"href":"https:\/\/ninaterapias.com\/en\/wp-json\/wp\/v2\/media?parent=47"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}