{"id":13492,"date":"2021-11-16T13:03:35","date_gmt":"2021-11-16T19:03:35","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?page_id=13492"},"modified":"2024-02-27T11:29:27","modified_gmt":"2024-02-27T17:29:27","slug":"%d1%81%d0%bf%d0%b8%d1%81%d0%be%d0%ba-%d1%81%d0%b8%d0%bc%d0%bf%d1%82%d0%be%d0%bc%d0%be%d0%b2-%d1%86%d0%b8%d0%ba%d0%bb%d0%b0-%d0%bf%d0%be-%d0%bc%d0%b5%d1%82%d0%be%d0%b4%d1%83-%d0%b5%d1%81%d1%82%d0%b5","status":"publish","type":"page","link":"https:\/\/naturalwomanhood.org\/ru\/cycle-symptom-checklist-by-natural-womanhood\/","title":{"rendered":"\u041a\u043e\u043d\u0442\u0440\u043e\u043b\u044c\u043d\u044b\u0439 \u0441\u043f\u0438\u0441\u043e\u043a \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u043e\u0432 \u0446\u0438\u043a\u043b\u0430"},"content":{"rendered":"\n<p>Is your cycle normal or not? Use this free tool to generate a checklist you can share with your doctor to evaluate your cycle health!<\/p>\n\n\n\n<p>Not sure who to talk to about your cycle symptoms? Request a free guidance appointment with one of our expert advisors <a href=\"https:\/\/naturalwomanhood.org\/free-guidance-consult\/\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a>. Our experienced fertility awareness advisors can help you figure out your options and  the next steps for optimizing your cycle health and fertility. <\/p>\n\n\n\n<p><strong>Please Note<\/strong>: <em>The answers you provide below are yours alone and will never be shared or used in any way or form by Natural Womanhood. When you submit your email address, we will add you to our weekly informational e-news letter, which you can unsubscribe from at any time. <\/em><\/p>\n\n\n\n<p>Use our free checklist tool now to help you keep tabs on your cycle health. <\/p>\n\n\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\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_18' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_18'  action='\/ru\/wp-json\/wp\/v2\/pages\/13492' data-formid='18' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LcuByYpAAAAABOTWLAnC_AQz_S8t3-fx0SS0gRS' data-tabindex='0'><input id=\"input_d2c83a2b70b2758c0e33dce14d878ec9\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_d2c83a2b70b2758c0e33dce14d878ec9\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_18' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_18_15\" 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_18_15'>Comments<\/label><div class='ginput_container'><input name='input_15' id='input_18_15' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_18_15'>\u042d\u0442\u043e \u043f\u043e\u043b\u0435 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u0434\u043b\u044f \u043f\u0440\u043e\u0432\u0435\u0440\u043e\u0447\u043d\u044b\u0445 \u0446\u0435\u043b\u0435\u0439, \u0435\u0433\u043e \u0441\u043b\u0435\u0434\u0443\u0435\u0442 \u043e\u0441\u0442\u0430\u0432\u0438\u0442\u044c \u0431\u0435\u0437 \u0438\u0437\u043c\u0435\u043d\u0435\u043d\u0438\u0439.<\/div><\/div><fieldset id=\"field_18_2\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >How would you describe your last few periods?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_2'>\n\t\t\t<div class='gchoice gchoice_18_2_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Normal'  id='choice_18_2_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_2_0' id='label_18_2_0' class='gform-field-label gform-field-label--type-inline'>Normal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_2_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Light'  id='choice_18_2_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_2_1' id='label_18_2_1' class='gform-field-label gform-field-label--type-inline'>Light<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_2_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Heavy'  id='choice_18_2_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_2_2' id='label_18_2_2' class='gform-field-label gform-field-label--type-inline'>Heavy<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_2_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Absent'  id='choice_18_2_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_2_3' id='label_18_2_3' class='gform-field-label gform-field-label--type-inline'>Absent<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >How long are your periods?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_3'>\n\t\t\t<div class='gchoice gchoice_18_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Normal (3 to 7 days)'  id='choice_18_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_3_0' id='label_18_3_0' class='gform-field-label gform-field-label--type-inline'>Normal (3 to 7 days)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Drawn out (more than 8 days)'  id='choice_18_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_3_1' id='label_18_3_1' class='gform-field-label gform-field-label--type-inline'>Drawn out (more than 8 days)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >Do you ever observe brown bleeding (light spotting of brown blood) either at the beginning or end of your period?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_4'>\n\t\t\t<div class='gchoice gchoice_18_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Yes'  id='choice_18_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_4_0' id='label_18_4_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='No'  id='choice_18_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_4_1' id='label_18_4_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >Do you have chronic discharge (i.e., do you observe cervical mucus or other vaginal secretions most of the month, not just on the days leading up to ovulation)?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_5'>\n\t\t\t<div class='gchoice gchoice_18_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Yes'  id='choice_18_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_5_0' id='label_18_5_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='No'  id='choice_18_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_5_1' id='label_18_5_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >Do you have spotting during your cycle (i.e., intermenstrual bleeding)?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_6'>\n\t\t\t<div class='gchoice gchoice_18_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Yes'  id='choice_18_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_6_0' id='label_18_6_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='No'  id='choice_18_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_6_1' id='label_18_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox 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 gfield_label_before_complex' >Do you experience any pain during your period or other parts of your cycle?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_18_7'><div class='gchoice gchoice_18_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='Pelvic pain'  id='choice_18_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_7_1' id='label_18_7_1' class='gform-field-label gform-field-label--type-inline'>Pelvic pain<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='Bad menstrual cramping'  id='choice_18_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_7_2' id='label_18_7_2' class='gform-field-label gform-field-label--type-inline'>Bad menstrual cramping<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='Painful intercourse'  id='choice_18_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_7_3' id='label_18_7_3' class='gform-field-label gform-field-label--type-inline'>Painful intercourse<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >How long are your cycles?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_8'>\n\t\t\t<div class='gchoice gchoice_18_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Short (less than 24 days)'  id='choice_18_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_8_0' id='label_18_8_0' class='gform-field-label gform-field-label--type-inline'>Short (less than 24 days)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Regular (24-36 days)'  id='choice_18_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_8_1' id='label_18_8_1' class='gform-field-label gform-field-label--type-inline'>Regular (24-36 days)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Long (Over 36 days)'  id='choice_18_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_8_2' id='label_18_8_2' class='gform-field-label gform-field-label--type-inline'>Long (Over 36 days)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Variable (varies by 5 or more days from cycle to cycle)'  id='choice_18_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_8_3' id='label_18_8_3' class='gform-field-label gform-field-label--type-inline'>Variable (varies by 5 or more days from cycle to cycle)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >Do you chart your cycle in a way that identifies your peak day \/ ovulation?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_9'>\n\t\t\t<div class='gchoice gchoice_18_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Yes'  id='choice_18_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_9_0' id='label_18_9_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='No'  id='choice_18_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_9_1' id='label_18_9_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >If so, do you notice that the time between peak day and the first day of your next period (i.e., your luteal phase) is less than 8 days? Longer than 16 days or more? Or is it variable (more than 3 days of change, from cycle to cycle)?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_10'>\n\t\t\t<div class='gchoice gchoice_18_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Yes'  id='choice_18_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_10_0' id='label_18_10_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='No'  id='choice_18_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_10_1' id='label_18_10_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox 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 gfield_label_before_complex' >Do you experience the following symptoms at least 5 days before your period starts?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_18_11'><div class='gchoice gchoice_18_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Irritability or mood swings'  id='choice_18_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_11_1' id='label_18_11_1' class='gform-field-label gform-field-label--type-inline'>Irritability or mood swings<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Depression or anxiety'  id='choice_18_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_11_2' id='label_18_11_2' class='gform-field-label gform-field-label--type-inline'>Depression or anxiety<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='Fatigue'  id='choice_18_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_11_3' id='label_18_11_3' class='gform-field-label gform-field-label--type-inline'>Fatigue<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_11_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.4' type='checkbox'  value='Bloating'  id='choice_18_11_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_11_4' id='label_18_11_4' class='gform-field-label gform-field-label--type-inline'>Bloating<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_11_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.5' type='checkbox'  value='Breast tenderness'  id='choice_18_11_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_11_5' id='label_18_11_5' class='gform-field-label gform-field-label--type-inline'>Breast tenderness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_11_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.6' type='checkbox'  value='Food cravings'  id='choice_18_11_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_11_6' id='label_18_11_6' class='gform-field-label gform-field-label--type-inline'>Food cravings<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_11_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.7' type='checkbox'  value='Headaches'  id='choice_18_11_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_11_7' id='label_18_11_7' class='gform-field-label gform-field-label--type-inline'>Headaches<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_11_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.8' type='checkbox'  value='Insomnia'  id='choice_18_11_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_11_8' id='label_18_11_8' class='gform-field-label gform-field-label--type-inline'>Insomnia<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_18_11_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.9' type='checkbox'  value='Trouble concentrating'  id='choice_18_11_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_11_9' id='label_18_11_9' class='gform-field-label gform-field-label--type-inline'>Trouble concentrating<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >Are you trying to conceive?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_12'>\n\t\t\t<div class='gchoice gchoice_18_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Yes'  id='choice_18_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_12_0' id='label_18_12_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='No'  id='choice_18_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_12_1' id='label_18_12_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_18_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >If yes, how long have you been trying?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_18_13'>\n\t\t\t<div class='gchoice gchoice_18_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='3 months or less'  id='choice_18_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_13_0' id='label_18_13_0' class='gform-field-label gform-field-label--type-inline'>3 months or less<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='4 to 8 months'  id='choice_18_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_13_1' id='label_18_13_1' class='gform-field-label gform-field-label--type-inline'>4 to 8 months<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_18_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='More than 8 months'  id='choice_18_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_18_13_2' id='label_18_13_2' class='gform-field-label gform-field-label--type-inline'>More than 8 months<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_18_14\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full exclude gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_14'>Enter your email address to receive a PDF of your answers in a helpful checklist format. 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