{"id":2076,"date":"2025-01-22T14:41:58","date_gmt":"2025-01-22T14:41:58","guid":{"rendered":"https:\/\/mpi-iq.com\/?page_id=2076"},"modified":"2025-02-27T07:19:28","modified_gmt":"2025-02-27T07:19:28","slug":"patient-survey","status":"publish","type":"page","link":"https:\/\/mpi-iq.com\/index.php\/patient-survey\/","title":{"rendered":"Patient Survey"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_empty_space height=&#8221;50&#8243;][vc_empty_space height=&#8221;50px&#8221;][vc_column_text]<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-51a91d62-7886-4057-b2bd-f9ec5731bf7e wpforms-render-modern\" id=\"wpforms-2067\"><form id=\"wpforms-form-2067\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2067\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/2076\" data-token=\"2b42ac5b3f8b3360249a2715aded79e1\" data-token-time=\"1741934199\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-2067-field_37-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_37\">\u0627\u0633\u0645 \u0627\u0644\u0645\u0646\u062a\u062c \u0648 \u0642\u0648\u062a\u0647 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2067-field_37\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][37]\" aria-errormessage=\"wpforms-2067-field_37-error\" required><\/div><div id=\"wpforms-2067-field_36-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_36\">\u0627\u0644\u0634\u0643\u0644 \u0627\u0644\u062f\u0648\u0627\u0626\u064a \u0644\u0644\u0645\u0646\u062a\u062c  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2067-field_36\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-2067-field_36-error\" required><\/div><div id=\"wpforms-2067-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_1\">\u0627\u0644\u0645\u062d\u0627\u0641\u0638\u0629<\/label><input type=\"text\" id=\"wpforms-2067-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-2067-field_1-error\" ><\/div><div id=\"wpforms-2067-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_2\">\u0627\u0644\u0623\u062d\u0631\u0641 \u0627\u0644\u0623\u0648\u0644\u0649 \u0645\u0646 \u0627\u0633\u0645 \u0627\u0644\u0645\u0631\u064a\u0636 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2067-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-2067-field_2-error\" required><\/div><div id=\"wpforms-2067-field_4-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">\u062c\u0646\u0633 \u0627\u0644\u0645\u0631\u064a\u0636 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2067-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_4_1\" name=\"wpforms[fields][4]\" value=\"\u0630\u0643\u0631\" aria-errormessage=\"wpforms-2067-field_4_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_4_1\">\u0630\u0643\u0631<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_4_2\" name=\"wpforms[fields][4]\" value=\"\u0623\u0646\u062b\u0649\" aria-errormessage=\"wpforms-2067-field_4_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_4_2\">\u0623\u0646\u062b\u0649<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2067-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_5\">\u0648\u0632\u0646 \u0627\u0644\u0645\u0631\u064a\u0636<\/label><input type=\"text\" id=\"wpforms-2067-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-2067-field_5-error\" ><\/div><div id=\"wpforms-2067-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_6\">\u062a\u0627\u0631\u064a\u062e \u0645\u064a\u0644\u0627\u062f \u0627\u0644\u0645\u0631\u064a\u0636<\/label><input type=\"text\" id=\"wpforms-2067-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-2067-field_6-error\" aria-describedby=\"wpforms-2067-field_6-description\" ><div id=\"wpforms-2067-field_6-description\" class=\"wpforms-field-description\">\u064a\u0648\u0645 \/ \u0634\u0647\u0631 \/ \u0633\u0646\u0629<\/div><\/div><div id=\"wpforms-2067-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_7\">\u0639\u0645\u0631 \u0627\u0644\u0645\u0631\u064a\u0636 \u0648\u0642\u062a \u062d\u062f\u0648\u062b \u0627\u0644\u0623\u062b\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2067-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-2067-field_7-error\" required><\/div><div id=\"wpforms-2067-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_15\">\u0627\u0644\u062f\u0648\u0644\u0629 \u0627\u0644\u062a\u064a \u0643\u0627\u0646 \u0627\u0644\u0645\u0631\u064a\u0636 \u064a\u0633\u0643\u0646 \u0641\u064a\u0647\u0627 \u0648\u0642\u062a \u062d\u062f\u0648\u062b \u0627\u0644\u0627\u062b\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a<\/label><input type=\"text\" id=\"wpforms-2067-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-2067-field_15-error\" ><\/div><div id=\"wpforms-2067-field_16-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_16\">\u0627\u0644\u0627\u062b\u0627\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a\u0629 \u0627\u0644\u062d\u0627\u0635\u0644\u0629 \u0644\u0644\u0645\u0631\u064a\u0636 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-2067-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-2067-field_16-error\" required><\/textarea><\/div><div id=\"wpforms-2067-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_17\">\u062a\u0627\u0631\u064a\u062e \u0628\u062f\u0623 \u0627\u0644\u0627\u062b\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2067-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-2067-field_17-error\" aria-describedby=\"wpforms-2067-field_17-description\" required><div id=\"wpforms-2067-field_17-description\" class=\"wpforms-field-description\">\u064a\u0648\u0645 \/ \u0634\u0647\u0631 \/ \u0633\u0646\u0629<\/div><\/div><div id=\"wpforms-2067-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_18\">\u062a\u0627\u0631\u064a\u062e \u0627\u0646\u062a\u0647\u0627\u0621 \u0627\u0644\u0623\u062b\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a<\/label><input type=\"text\" id=\"wpforms-2067-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-2067-field_18-error\" aria-describedby=\"wpforms-2067-field_18-description\" ><div id=\"wpforms-2067-field_18-description\" class=\"wpforms-field-description\">\u064a\u0648\u0645 \/ \u0634\u0647\u0631 \/ \u0633\u0646\u0629<\/div><\/div><div id=\"wpforms-2067-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_19\">\u0645\u062f\u0629 \u0627\u0633\u062a\u0645\u0631\u0627\u0631 \u0627\u0644\u0623\u062b\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a<\/label><input type=\"text\" id=\"wpforms-2067-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-2067-field_19-error\" ><\/div><div id=\"wpforms-2067-field_20-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">\u0646\u062a\u064a\u062c\u0629 \u0627\u0644\u0623\u062b\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a<\/legend><ul id=\"wpforms-2067-field_20\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_20_1\" name=\"wpforms[fields][20]\" value=\"\u062a\u0645 \u0627\u0644\u062a\u0639\u0627\u0641\u064a \u0645\u0646\u0647\" aria-errormessage=\"wpforms-2067-field_20_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_20_1\">\u062a\u0645 \u0627\u0644\u062a\u0639\u0627\u0641\u064a \u0645\u0646\u0647<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_20_2\" name=\"wpforms[fields][20]\" value=\"\u0644\u0645 \u064a\u062a\u0645 \u0627\u0644\u062a\u0639\u0627\u0641\u064a \u0645\u0646\u0647\" aria-errormessage=\"wpforms-2067-field_20_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_20_2\">\u0644\u0645 \u064a\u062a\u0645 \u0627\u0644\u062a\u0639\u0627\u0641\u064a \u0645\u0646\u0647<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_20_3\" name=\"wpforms[fields][20]\" value=\"\u0645\u0631\u0636\" aria-errormessage=\"wpforms-2067-field_20_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_20_3\">\u0645\u0631\u0636<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_20_4\" name=\"wpforms[fields][20]\" value=\"\u0645\u0648\u062a\" aria-errormessage=\"wpforms-2067-field_20_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_20_4\">\u0645\u0648\u062a<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_20_5\" name=\"wpforms[fields][20]\" value=\"\u0644\u0627 \u0623\u0639\u0644\u0645\" aria-errormessage=\"wpforms-2067-field_20_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_20_5\">\u0644\u0627 \u0623\u0639\u0644\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2067-field_21-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">\u0647\u0644 \u0627\u0644\u0623\u062b\u0631 \u0627\u0644\u062c\u0627\u0646\u0628\u064a \u062e\u0637\u064a\u0631 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2067-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_21_1\" name=\"wpforms[fields][21]\" value=\"\u0646\u0639\u0645\" aria-errormessage=\"wpforms-2067-field_21_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_21_1\">\u0646\u0639\u0645<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_21_2\" name=\"wpforms[fields][21]\" value=\"\u0643\u0644\u0627\" aria-errormessage=\"wpforms-2067-field_21_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_21_2\">\u0643\u0644\u0627<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_21_3\" name=\"wpforms[fields][21]\" value=\"\u0644\u0627 \u0623\u0639\u0644\u0645\" aria-errormessage=\"wpforms-2067-field_21_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_21_3\">\u0644\u0627 \u0623\u0639\u0644\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2067-field_38-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"38\"><fieldset><legend class=\"wpforms-field-label\">\u0633\u0628\u0628 \u0627\u0644\u062e\u0637\u0648\u0631\u0629 <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2067-field_38\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_38_1\" name=\"wpforms[fields][38]\" value=\"\u0645\u0647\u062f\u062f \u0644\u0644\u062d\u064a\u0627\u0629\" aria-errormessage=\"wpforms-2067-field_38_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_38_1\">\u0645\u0647\u062f\u062f \u0644\u0644\u062d\u064a\u0627\u0629<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_38_2\" name=\"wpforms[fields][38]\" value=\"\u0627\u0644\u0648\u0641\u0627\u0629\" aria-errormessage=\"wpforms-2067-field_38_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_38_2\">\u0627\u0644\u0648\u0641\u0627\u0629<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_38_3\" name=\"wpforms[fields][38]\" value=\"\u0627\u0644\u0628\u0642\u0627\u0621 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\" aria-errormessage=\"wpforms-2067-field_38_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_38_3\">\u0627\u0644\u0628\u0642\u0627\u0621 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_38_5\" name=\"wpforms[fields][38]\" value=\"\u062a\u0633\u0628\u0628 \u0641\u064a \u0625\u0639\u0627\u0642\u0629\" aria-errormessage=\"wpforms-2067-field_38_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_38_5\">\u062a\u0633\u0628\u0628 \u0641\u064a \u0625\u0639\u0627\u0642\u0629<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_38_4\" name=\"wpforms[fields][38]\" value=\"\u062a\u0634\u0648\u0647 \u062e\u0644\u0642\u064a\" aria-errormessage=\"wpforms-2067-field_38_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_38_4\">\u062a\u0634\u0648\u0647 \u062e\u0644\u0642\u064a<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-2067-field_38_6\" name=\"wpforms[fields][38]\" value=\"\u0644\u0627 \u0627\u0639\u0644\u0645\" aria-errormessage=\"wpforms-2067-field_38_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2067-field_38_6\">\u0644\u0627 \u0627\u0639\u0644\u0645<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2067-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_22\">\u0631\u0642\u0645 \u0627\u0644\u0648\u062c\u0628\u0629 \u0644\u0644\u0645\u0646\u062a\u062c \u0627\u0644\u0645\u0633\u062c\u0644 \u0639\u0644\u0649 \u0627\u0644\u063a\u0644\u0627\u0641 \u0627\u0644\u062e\u0627\u0631\u062c\u064a<\/label><input type=\"text\" id=\"wpforms-2067-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-2067-field_22-error\" aria-describedby=\"wpforms-2067-field_22-description\" ><div id=\"wpforms-2067-field_22-description\" class=\"wpforms-field-description\">\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0635\u0646\u0639      \u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0627\u0646\u062a\u0647\u0627\u0621<\/div><\/div><div id=\"wpforms-2067-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-2067-field_23\">\u0627\u0644\u062c\u0631\u0639\u0629<\/label><input type=\"text\" 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