{"id":81841,"date":"2025-04-24T19:19:37","date_gmt":"2025-04-24T19:19:37","guid":{"rendered":"https:\/\/www.merckconnect.ca\/en\/?page_id=81841"},"modified":"2025-05-06T21:44:04","modified_gmt":"2025-05-06T21:44:04","slug":"feedback-form","status":"publish","type":"page","link":"https:\/\/www.merckconnect.ca\/en\/feedback-form\/","title":{"rendered":"Feedback Survey for Evolution of PAH Treatment and Clinical Outcomes"},"content":{"rendered":"\n<p class=\"   mhh-mcn-v1-paragraph mhh-mcn-v1-paragraph--955f07cb2ff9f00f49b36dd49a4272f9\" dir=\"ltr\" lang=\"en-US\">Thank you for attending! Please take 2 minutes to share your feedback. Your responses will help us improve future events.<\/p>\n\n\n\n<p class=\"   mhh-mcn-v1-paragraph mhh-mcn-v1-paragraph--1f0989ce9470ad8506053665fc4134ef\" dir=\"ltr\" lang=\"en-US\"><\/p>\n\n\n<figure class=\"mhh-mcn-v1-image mhh-mcn-v1-image--a54f9c152e22e94c24628ccfb51e0924\">\n                    <img decoding=\"async\"\n        class=\"mhh-mcn-image mhh-mcn-image--full wp-image-19\"\n        src=\"https:\/\/www.merckconnect.ca\/en\/wp-content\/uploads\/sites\/4\/2021\/01\/footer-merck-logo-e1613939136479.png?quality=80&#038;lossy=1\"\n        width=\"200\"\n        height=\"61\"\n        loading=\"lazy\"        alt=\"\"\n            \/>\n            <\/figure>\n\n\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/en\/wp-json\/wp\/v2\/pages\/81841#gf_2' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_27\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_27'>Email<\/label><div class='ginput_container'><input name='input_27' id='input_2_27' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_27'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_2_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >1. Overall, how satisfied are you with this event?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_24'>\n\t\t\t<div class='gchoice gchoice_2_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Very satisfied'  id='choice_2_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_0' id='label_2_24_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Satisfied'  id='choice_2_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_1' id='label_2_24_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Neutral'  id='choice_2_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_2' id='label_2_24_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Dissatisfied'  id='choice_2_24_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_3' id='label_2_24_3' class='gform-field-label gform-field-label--type-inline'>Dissatisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_24_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Very dissatisfied'  id='choice_2_24_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_24_4' id='label_2_24_4' class='gform-field-label gform-field-label--type-inline'>Very dissatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >2. How satisfied are you with the speakers at the event?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_25'>\n\t\t\t<div class='gchoice gchoice_2_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Very satisfied'  id='choice_2_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_0' id='label_2_25_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Satisfied'  id='choice_2_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_1' id='label_2_25_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_25_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Neutral'  id='choice_2_25_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_2' id='label_2_25_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_25_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Dissatisfied'  id='choice_2_25_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_3' id='label_2_25_3' class='gform-field-label gform-field-label--type-inline'>Dissatisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_25_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Very dissatisfied'  id='choice_2_25_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_25_4' id='label_2_25_4' class='gform-field-label gform-field-label--type-inline'>Very dissatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_8\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_8'>Please provide any specific feedback about the speaker(s):<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_2_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >3. How satisfied are you with the logistics of the event (timing, venue, technology, etc.)?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_26'>\n\t\t\t<div class='gchoice gchoice_2_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Very satisfied'  id='choice_2_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_0' id='label_2_26_0' class='gform-field-label gform-field-label--type-inline'>Very satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Satisfied'  id='choice_2_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_1' id='label_2_26_1' class='gform-field-label gform-field-label--type-inline'>Satisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Neutral'  id='choice_2_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_2' id='label_2_26_2' class='gform-field-label gform-field-label--type-inline'>Neutral<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Dissatisfied'  id='choice_2_26_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_3' id='label_2_26_3' class='gform-field-label gform-field-label--type-inline'>Dissatisfied<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_26_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Very dissatisfied'  id='choice_2_26_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_26_4' id='label_2_26_4' class='gform-field-label gform-field-label--type-inline'>Very dissatisfied<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_10\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_10'>Please provide any specific feedback about the logistics of the event:<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_2_10' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_11\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4. What could we improve to make future events more valuable? (Select all that apply)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_11'><div class='gchoice gchoice_2_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='More interactive elements (i.e. case discussions, workshops, Q&amp;A)'  id='choice_2_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_11_1' id='label_2_11_1' class='gform-field-label gform-field-label--type-inline'>More interactive elements (i.e. case discussions, workshops, Q&amp;A)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Shorter or more focussed sessions'  id='choice_2_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_11_2' id='label_2_11_2' class='gform-field-label gform-field-label--type-inline'>Shorter or more focussed sessions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='More in-depth discussion on key topics'  id='choice_2_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_11_3' id='label_2_11_3' class='gform-field-label gform-field-label--type-inline'>More in-depth discussion on key topics<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_11_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.4' type='checkbox'  value='Better event logistics (venue, timing, format)'  id='choice_2_11_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_11_4' id='label_2_11_4' class='gform-field-label gform-field-label--type-inline'>Better event logistics (venue, timing, format)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_11_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.5' type='checkbox'  value='Clearer takeaways and practical implementation guidance'  id='choice_2_11_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_11_5' id='label_2_11_5' class='gform-field-label gform-field-label--type-inline'>Clearer takeaways and practical implementation guidance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_11_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.6' type='checkbox'  value='Other'  id='choice_2_11_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_11_6' id='label_2_11_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_12\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_12'>If other, please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_2_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_13\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5. What types of topics would you like to see covered in future events? (Select all that apply)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_13'><div class='gchoice gchoice_2_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Practical case studies and patient management strategies'  id='choice_2_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_1' id='label_2_13_1' class='gform-field-label gform-field-label--type-inline'>Practical case studies and patient management strategies<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='More case-based discussions'  id='choice_2_13_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_2' id='label_2_13_2' class='gform-field-label gform-field-label--type-inline'>More case-based discussions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='More practical applications and real-world examples'  id='choice_2_13_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_3' id='label_2_13_3' class='gform-field-label gform-field-label--type-inline'>More practical applications and real-world examples<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.4' type='checkbox'  value='More focus on emerging treatments and guidelines'  id='choice_2_13_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_4' id='label_2_13_4' class='gform-field-label gform-field-label--type-inline'>More focus on emerging treatments and guidelines<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_13_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.5' type='checkbox'  value='Content tailored to my specific specialty or patient population'  id='choice_2_13_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_5' id='label_2_13_5' class='gform-field-label gform-field-label--type-inline'>Content tailored to my specific specialty or patient population<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_13_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.6' type='checkbox'  value='Other'  id='choice_2_13_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_6' id='label_2_13_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_14\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_14'>If other, please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_2_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_15\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_15'>6. Are there other specialties\/colleagues that would benefit from being invited to similar learning events in the future?<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_2_15' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_16\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_16'>7. Any final comments or suggestions?<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_2_16' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_20\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >8. Please select your specialty<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_20'>\n\t\t\t<div class='gchoice gchoice_2_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Respirologist with PH specialty'  id='choice_2_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_0' id='label_2_20_0' class='gform-field-label gform-field-label--type-inline'>Respirologist with PH specialty<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Respirologist'  id='choice_2_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_1' id='label_2_20_1' class='gform-field-label gform-field-label--type-inline'>Respirologist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Cardiologist with PH specialty'  id='choice_2_20_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_2' id='label_2_20_2' class='gform-field-label gform-field-label--type-inline'>Cardiologist with PH specialty<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Cardiologist'  id='choice_2_20_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_3' id='label_2_20_3' class='gform-field-label gform-field-label--type-inline'>Cardiologist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Rheumatologist'  id='choice_2_20_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_4' id='label_2_20_4' class='gform-field-label gform-field-label--type-inline'>Rheumatologist<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Nurse'  id='choice_2_20_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_5' id='label_2_20_5' class='gform-field-label gform-field-label--type-inline'>Nurse<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_20_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Other'  id='choice_2_20_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_6' id='label_2_20_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_21\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_21'>If other, please specify<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_2_21' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_22\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >9. Please select the your Province or Territory<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_22'>\n\t\t\t<div class='gchoice gchoice_2_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='British Columbia'  id='choice_2_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_0' id='label_2_22_0' class='gform-field-label gform-field-label--type-inline'>British Columbia<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Saskatchewan'  id='choice_2_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_1' id='label_2_22_1' class='gform-field-label gform-field-label--type-inline'>Saskatchewan<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Alberta'  id='choice_2_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_2' id='label_2_22_2' class='gform-field-label gform-field-label--type-inline'>Alberta<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Manitoba'  id='choice_2_22_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_3' id='label_2_22_3' class='gform-field-label gform-field-label--type-inline'>Manitoba<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Ontario'  id='choice_2_22_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_4' id='label_2_22_4' class='gform-field-label gform-field-label--type-inline'>Ontario<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Quebec'  id='choice_2_22_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_5' id='label_2_22_5' class='gform-field-label gform-field-label--type-inline'>Quebec<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='New Brunswick'  id='choice_2_22_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_6' id='label_2_22_6' class='gform-field-label gform-field-label--type-inline'>New Brunswick<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Prince Edward Island'  id='choice_2_22_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_7' id='label_2_22_7' class='gform-field-label gform-field-label--type-inline'>Prince Edward Island<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Nova Scotia'  id='choice_2_22_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_8' id='label_2_22_8' class='gform-field-label gform-field-label--type-inline'>Nova Scotia<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Newfoundland and Labrador'  id='choice_2_22_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_9' id='label_2_22_9' class='gform-field-label gform-field-label--type-inline'>Newfoundland and Labrador<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Nunavut'  id='choice_2_22_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_10' id='label_2_22_10' class='gform-field-label gform-field-label--type-inline'>Nunavut<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Northwest Territories'  id='choice_2_22_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_11' id='label_2_22_11' class='gform-field-label gform-field-label--type-inline'>Northwest Territories<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_22_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Yukon'  id='choice_2_22_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_22_12' id='label_2_22_12' class='gform-field-label gform-field-label--type-inline'>Yukon<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_23\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description 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