{"id":3062,"date":"2020-04-05T23:13:37","date_gmt":"2020-04-05T20:13:37","guid":{"rendered":"https:\/\/www.spiroulina.gr\/health-questionnaire\/"},"modified":"2020-08-10T18:34:56","modified_gmt":"2020-08-10T15:34:56","slug":"health-questionnaire","status":"publish","type":"page","link":"https:\/\/www.spiroulina.gr\/en\/health-questionnaire\/","title":{"rendered":"Health Questionnaire"},"content":{"rendered":"<input type=\"hidden\" id=\"user_id\" name=\"user_id\" value=\"\">\n\n<input type=\"hidden\" id=\"lang\" name=\"lang\" value=\"en\">\n  \n\t<link rel=\"stylesheet\" href=\"https:\/\/www.spiroulina.gr\/cms\/css\/bootstrap.min.css\">\n \t<link rel=\"stylesheet\" href=\"https:\/\/www.spiroulina.gr\/cms\/css\/font-awesome.min.css\" \/>\n\t<link rel=\"stylesheet\" href=\"https:\/\/www.spiroulina.gr\/cms\/css\/awesome-bootstrap-checkbox.css\"\/>\n\t<link rel=\"stylesheet\" href=\"https:\/\/www.spiroulina.gr\/cms\/css\/jquery.loadingModal.css\">\n \t<link rel=\"stylesheet\" href=\"https:\/\/www.spiroulina.gr\/cms\/css\/main2.css?ver=0.599999618994\">\n\t<script type=\"text\/javascript\" src=\"https:\/\/www.spiroulina.gr\/cms\/js\/jquery-3.4.1.min.js\"><\/script>\n\t<script src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/chosen\/1.4.2\/chosen.jquery.min.js\"><\/script>\n\t<script src=\"https:\/\/www.spiroulina.gr\/cms\/js\/jquery.loadingModal.js\"><\/script>\n    <script type=\"text\/javascript\" src=\"https:\/\/www.spiroulina.gr\/cms\/js\/main2.js?ver=0.59999999999993\"><\/script>\n\n    <main id=\"questionsmain\">\n    \t      \t<div id=\"intro-text\" class=\"container text-center\">\n        \t<h5>\n\t\t\t\tOur philosophy is focused on man        \t\n        \t<\/h5>\n        \t<p class=\"lead\">\n \t\t\t\tAs part of our effort to help you receive the best possible Spiroulina PLATENSIS products and to have the desired results to the maximum extent possible, we suggest you complete the following Health Questionnarie.          \t\t\n        \t<\/p>\n        \t<p class=\"lead2\">\n \t\t\t\tAfter filling it out, you will receive in your email personalized instructions for use of our products (dosage - frequency of reception).         \t\t\n        \t<\/p>\n        \t<p class=\"lead2\">\n \t\t\t\tWe emphasize that spirulina is contraindicated in people suffering from phenylketonuria, autoimmune intestinal (Crohn's, ulcerative colitis) during the period of exacerbation and in all those undergoing dialysis. In case of kidney deficiency spirulina can be taken only with the permission of the treating physician. It is also good to avoid its use in people who have had heart, liver and kidney transplants.    \n        \t<\/p>\n        \t<p class=\"lead2\">\n \t\t\t\tAlso, people with thyroid disease should consume spirulina without iodine, in consultation with their doctor.          \t\t\n        \t<\/p>\n      \t<\/div>\n        \n\t\t<section id=\"components-articles\">\n      \t\t<div class=\"container\">\n          \t\t<div class=\"col-md-2\"><\/div>\n          \t\t<div class=\"col-md-12\">\n              \t\t<div class=\"panel panel-default\">\n                  \t\t<div class=\"panel-body\">\n                  \n                  \t\t\t<form id=\"frm_questions\">\n\n                  \t\t\t\t<div id=\"row_products_label\" class=\"frm_row\">\n\t\t\t                       <label class=\"label_long\">\t\t\t                       \t\n\t\t\t\t\t \t\t\t\tWhich product have you purchased?     \t\t\t                       \t\n\t\t\t                       \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t                    <\/div>  \n\n        \t\t\t            <div id=\"row_products_one\" class=\"container\">\n\n\t\t\t\t\t\t\t\t\t<div class=\"row row_product_selector\">\n\n\t       \t\t\t                    <div class=\"col product-box\">\n\t       \t\t\t                    \t<input id=\"frm_prod_tab_iod\" type=\"radio\" name=\"products\" value=\"prod_tab_iod\" \/>\n\t\t\t\t\t\t\t\t\t       \t<label class=\"product-type label_long\" for=\"frm_prod_tab_iod\">\n\t\t\t\t\t\t\t\t\t        \t<img decoding=\"async\" src=\"https:\/\/www.spiroulina.gr\/cms\/images\/products\/tabletes_me_iodio.png\" class=\"product_img\">\n\t\t\t\t\t\t\t\t\t        \t<div class=\"product_desc\">\n\t\t\t\t\t\t\t\t\t        \t\tSpiroulina PLATENSIS<br>tablets with iodine  \n\t\t\t\t\t\t\t\t\t        \t<\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t\t\t\t    \t<\/div>\n\t\t\t\t\t                    \n\t\t\t\t\t                    <div class=\"col product-box\">\n\t\t\t\t\t                    \t<input id=\"frm_prod_tab_no_iod\" type=\"radio\" name=\"products\" value=\"prod_tab_no_iod\" \/>\n\t\t\t\t\t\t\t\t\t       \t<label class=\"product-type label_long\" for=\"frm_prod_tab_no_iod\">\n\t\t\t\t\t\t\t\t\t        \t<img decoding=\"async\" src=\"https:\/\/www.spiroulina.gr\/cms\/images\/products\/tabletes_xoris_iodio.png\" class=\"product_img\">\n\t\t\t\t\t\t\t\t\t        \t<div class=\"product_desc\">\n\t\t\t\t\t\t\t\t\t        \t\tSpiroulina PLATENSIS<br>tablets without iodine  \n\t\t\t\t\t\t\t\t\t        \t<\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t                    <\/div>\n\n\t\t\t\t\t                    <div class=\"col product-box\">\n\t\t\t\t\t                    \t<input id=\"frm_prod_skoni_iod\" type=\"radio\" name=\"products\" value=\"prod_skoni_iod\" \/>\t\n\t\t\t\t\t\t\t\t\t\t    <label class=\"product-type label_long\" for=\"frm_prod_skoni_iod\">\n\t\t\t\t\t\t\t\t\t        \t<img decoding=\"async\" src=\"https:\/\/www.spiroulina.gr\/cms\/images\/products\/spiroulina_skoni_me_iodio.png\" class=\"product_img\">\n\t\t\t\t\t\t\t\t\t        \t<div class=\"product_desc\">\n\t\t\t\t\t\t\t\t\t        \t\tSpiroulina PLATENSIS<br>powder with iodine  \n\t\t\t\t\t\t\t\t\t        \t<\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t\t\t\t    \t<\/div>\n\n\t\t\t\t                      \t<div class=\"col product-box\">\n\t       \t\t\t                    \t<input id=\"frm_prod_skoni_no_iod\" type=\"radio\" name=\"products\" value=\"prod_skoni_no_iod\" \/>\n\t\t\t\t\t\t\t\t\t\t    <label class=\"product-type label_long\" for=\"frm_prod_skoni_no_iod\">\n\t\t\t\t\t\t\t\t\t        \t<img decoding=\"async\" src=\"https:\/\/www.spiroulina.gr\/cms\/images\/products\/spiroulina_skoni_xoris_iodio.png\" class=\"product_img\">\n\t\t\t\t\t\t\t\t\t        \t<div class=\"product_desc\">\n\t\t\t\t\t\t\t\t\t        \t\tSpiroulina PLATENSIS<br>powder without iodine  \n\t\t\t\t\t\t\t\t\t        \t<\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t\t\t\t        <\/div>\t\n\n\t       \t\t\t                    <div class=\"col product-box\">\n\t       \t\t\t                    \t<input id=\"frm_prod_seven\" type=\"radio\" name=\"products\" value=\"prod_seven\" \/>\n\t\t\t\t\t\t\t\t\t       \t<label class=\"product-type label_long\" for=\"frm_prod_seven\">\n\t\t\t\t\t\t\t\t\t        \t<img decoding=\"async\" src=\"https:\/\/www.spiroulina.gr\/cms\/images\/products\/7days.png\" class=\"product_img\">\n\t\t\t\t\t\t\t        \t\t\t<div class=\"product_desc\">\n\t\t\t\t\t\t\t        \t\t\t\t7 Days Power<br>by Spiroulina PLATENSIS  \n\t\t\t\t\t\t\t        \t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t\t\t\t    \t<\/div>\n\t\t\t\t\t                    \n\t\t\t\t\t                    <div class=\"col product-box\">\n\t\t\t\t\t                    \t<input id=\"frm_prod_flakes_iod\" type=\"radio\" name=\"products\" value=\"prod_flakes_iod\" \/>\n\t\t\t\t\t\t\t\t\t       \t<label class=\"product-type label_long\" for=\"frm_prod_flakes_iod\">\n\t\t\t\t\t\t\t\t\t        \t<img decoding=\"async\" src=\"https:\/\/www.spiroulina.gr\/cms\/images\/products\/flakes_me_iodio.png\" class=\"product_img\">\n\t\t\t\t\t\t\t        \t\t\t<div class=\"product_desc\">\n\t\t\t\t\t\t\t        \t\t\t\tSpiroulina flakes<br>with iodine  \n\t\t\t\t\t\t\t        \t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t                    <\/div>\n\n\t\t\t\t\t                    <div class=\"col product-box\">\n\t\t\t\t\t                    \t<input id=\"frm_prod_flakes_no_iod\" type=\"radio\" name=\"products\" value=\"prod_flakes_no_iod\" \/>\n\t\t\t\t\t\t\t\t\t\t    <label class=\"product-type label_long\" for=\"frm_prod_flakes_no_iod\">\n\t\t\t\t\t\t\t\t\t        \t<img decoding=\"async\" src=\"https:\/\/www.spiroulina.gr\/cms\/images\/products\/flakes_xoris_iodio.png\" class=\"product_img\">\n\t\t\t\t\t\t\t        \t\t\t<div class=\"product_desc\">\n\t\t\t\t\t\t\t\t\t        \t\tSpiroulina flakes<br>without iodine  \n\t\t\t\t\t\t\t        \t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t\t\t\t    \t<\/div>\n<!-- \n\t\t\t\t\t                    <div class=\"col\" id=\"product_fake_placeholder\">\n\t\t\t\t\t\t\t\t\t\t    <label class=\"product-type label_long\" for=\"frm_prod_tab_no_iod\">\n\t\t\t\t\t\t\t\t\t        \t<img decoding=\"async\" src=\"images\/products\/tabletes_xoris_iodio.png\" class=\"product_img\">\n\t\t\t\t\t\t\t        \t\t\t<div class=\"product_desc\"><br><\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t\t\t\t    \t<\/div> -->\n\n\t\t\t\t\t                    <div class=\"col\" id=\"product_noproduct\">\n\t\t\t\t\t                    \t<input id=\"frm_product_noproduct\" type=\"radio\" name=\"products\" value=\"prod_noproduct\" \/>\n\n\t\t\t\t\t\t\t\t\t\t    <label class=\"product-type label_long\" for=\"frm_product_noproduct\">\n<!-- \t\t\t\t\t\t\t\t\t        \t<img decoding=\"async\" src=\"images\/products\/tabletes_xoris_iodio.png\" class=\"product_img\">\n -->\t\t\t\t\t\t\t        \t\t\t<div class=\"product_desc2\">\n\t\t\t\t\t \t\t\t\t\t \t\t\t\tI have not bought any yet  \n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t\t\t\t    \t<\/div>\n\n\n<!-- \t\t\t\t\t                    <div class=\"col\" id=\"product_noproduct-mobile\" style=\"visibility:hidden\">\n\t\t\t\t\t                    \t<input id=\"frm_product_noproduct\" type=\"radio\" name=\"products\" value=\"prod_noproduct\" \/>\n\n\t\t\t\t\t\t\t\t\t\t    <label class=\"product-type label_long\" for=\"frm_product_noproduct\">\n\t\t\t\t\t\t\t        \t\t\t<div class=\"product_desc2\">\u0394\u03b5\u03bd \u03ad\u03c7\u03c9<br>\u03b1\u03b3\u03bf\u03c1\u03ac\u03c3\u03b5\u03b9 \u03b1\u03ba\u03cc\u03bc\u03b1<\/div>\n\t\t\t\t\t\t\t\t\t        <\/label>\n\t\t\t\t\t\t\t\t    \t<\/div> -->\n\t\t\t\t\t\t\t  \t\t<\/div>\n      \t\t\t\t\t       \n\t\t\t\t\t\t\t    <\/div>\n\n\t\t\t\t\t\t\t     \t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"eshop_link\" id=\"eshop_link\" value=\"true\">\n\n \t\t\t\t\t\t\t\t<div id=\"no_product\" class=\"container main_question\" style=\"margin-top: 20px;\">\n\t\t\t\t\t\t\t\t\t\t<!-- \t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t<div class=\"alert alert-info\">\n\t\t\t\t\t\t\t\t\t\t<strong><i class=\"fa fa-info-circle\"><\/i><\/strong> \n\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t<\/div> \n\t\t\t\t\t\t\t\t\t\t-->\n\n\t\t\t\t                    <div id=\"row_thyroeidis_problem\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_thyroeidis_treatment\" for=\"frm_thyroeidis_problem\" class=\"label_long\">\n\t\t\t\t                        \tAre you experiencing any problems with your thyroid gland?  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"frm_thyroeidis_treatment_answer\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_thyroeidis_problem_yes\" value=\"yes\" name=\"frm_thyroeidis_problem\" \/>\n\t\t\t\t                        <label for=\"frm_thyroeidis_problem_yes\" class=\"label_for_choice\">\n\t\t\t\t                        \tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_thyroeidis_problem_no\" value=\"no\" name=\"frm_thyroeidis_problem\" \/>\n\t\t\t\t                        <label for=\"frm_thyroeidis_problem_no\" class=\"label_for_choice\">\n\t\t\t\t                        \tNO  \n\t\t\t\t                        <\/label>   \n\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_thyroeidis_problem_unknown\" value=\"no\" name=\"frm_thyroeidis_problem\" \/>\n\t\t\t\t                        <label for=\"frm_thyroeidis_problem_unknown\" class=\"label_for_choice\" id=\"lbl_thyroeidis_problem_unknown\">\n\t\t\t\t                        \tI DON\u2019T KNOW  \n\t\t\t\t                        <\/label> \n\n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\n\t\t\t\t\t\t\t    <\/div>\n\n \t\t\t\t\t\t<!-- \t\t<div id=\"order_data\" class=\"container main_questions\">\n \t\t\t\t\t\t\t\t\t\u0391\u03c1\u03b9\n\t\t\t\t\t\t\t    <\/div>\n -->\n\n        \t\t\t            <div id=\"main_questions_container\">\n\n        \t\t\t            <div id=\"main_section\" class=\"container main_questions\">\n\n\n\n\t\t\t\t\t\t\t\t\t<div id=\"row_mushrooms\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_thyroeidis_treatment\" for=\"frm_mushrooms\" class=\"label_long\">\n\t\t \t\t\t\t\t \t\t\t\tHave you also purchased King Oyster mushrooms?  \t\t\t\t                        \t\n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"frm_mushrooms\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_mushrooms_yes\" value=\"yes\" name=\"frm_mushrooms\"  \/>\n\t\t\t\t                        <label for=\"frm_mushrooms_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_mushrooms_no\" value=\"no\" name=\"frm_mushrooms\" \/>\n\t\t\t\t                        <label for=\"frm_mushrooms_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\t\t\t\t\t\t\t\t    \t\t\t\t                    <div id=\"row_eshop\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_thyroeidis_treatment\" for=\"frm_thyroeidis_treatment\" class=\"label_long\">\n\t\t \t\t\t\t\t \t\t\t\tHave you purchased the product from our online shop?  \t\t\t\t                        \t\n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"frm_eshop\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_from_eshop_yes\" value=\"yes\" name=\"frm_from_eshop\"  \/>\n\t\t\t\t                        <label for=\"frm_from_eshop_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_from_eshop_no\" value=\"no\" name=\"frm_from_eshop\" \/>\n\t\t\t\t                        <label for=\"frm_from_eshop_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                     <div id=\"row_eshop_order\" display:block >\n\t\t\t\t\t                     <div class=\"frm_row\">\n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label for=\"frm_order_no\" class=\"label_long\">\n\t\t\t \t\t\t\t\t \t\t\t\tPlease complete the number of the online order \t\t\t\t\t\t                        \t\n\t\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t\t                      <\/div>  \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <input type=\"text\" id=\"frm_order_no\" name=\"frm_order_no\" class=\"form-control\" maxlength=\"50\" value=\"\" \/> \n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                    <\/div>\n\t\t\t\t                    <\/div>\n\n\n\t\t\t\t                     <div id=\"row_lot_no\">\n\t\t\t\t\t                     <div class=\"frm_row\">\n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        \t<label for=\"frm_lot_no\" id=\"lbl_lot_no\">LOT Number <span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t\t                      <\/div>  \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        \t\t<input type=\"text\" id=\"frm_lot_no\" name=\"frm_lot_no\" class=\"form-control\" maxlength=\"100\" \/> \n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                    <\/div>\n\n\t\t\t\t\t                    <div class=\"info-note\"><i class=\"fa fa-info-circle\" aria-hidden=\"true\"><\/i> \n\t\t\t\t\t                    \tThe lot number is mentioned in the white sticker on each package and its placed above the barcode.  \n\t\t\t\t\t                    <\/div>\n\n\t\t\t\t                    <\/div>\n\n\t\t\t\t                     <div id=\"row_place_of_purchace\">\n\t\t\t\t\t                     <div class=\"frm_row\">\n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        \t<label id=\"lbl_place_of_purchace\" for=\"frm_place_of_purchace\">\n\t\t\t\t\t                        \tMarket place  \n\t\t\t\t                        \t<\/label>\n\t\t\t\t\t                      <\/div>  \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                      <select id=\"frm_place_of_purchace\" name=\"frm_place_of_purchace\" class=\"form-control custom-select\">\n\t \t\t\t                          <option value=\"\" selected><\/option>\n\t \t\t\t                          <option value=\"\u0391\u03c0\u03cc \u03c4\u03b7\u03bd \u03b5\u03c4\u03b1\u03b9\u03c1\u03b5\u03af\u03b1 \u03c3\u03b1\u03c2\">\n\t \t\t\t                          \tFrom you company  \n\t \t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"\u0391\u03c0\u03cc \u03ba\u03b1\u03c4\u03ac\u03c3\u03c4\u03b7\u03bc\u03b1 \u03b2\u03b9\u03bf\u03bb\u03bf\u03b3\u03b9\u03ba\u03ce\u03bd\">\n\t\t\t\t                          \tFrom organic food store  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"\u0391\u03c0\u03cc \u03ac\u03bb\u03bb\u03bf \u03ba\u03b1\u03c4\u03ac\u03c3\u03c4\u03b7\u03bc\u03b1\">\n\t\t\t\t                          \tFrom other store  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"\u0391\u03c0\u03cc \u03c6\u03b1\u03c1\u03bc\u03b1\u03ba\u03b5\u03af\u03bf\">\n\t\t\t\t                          \tFrom pharmacy  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"\u0391\u03c0\u03cc \u03ac\u03bb\u03bb\u03bf \u03b7\u03bb\u03b5\u03ba\u03c4\u03c1\u03bf\u03bd\u03b9\u03ba\u03cc \u03ba\u03b1\u03c4\u03ac\u03c3\u03c4\u03b7\u03bc\u03b1.\">\n\t\t\t\t                          \tFrom other eshop  \n\t\t\t\t                          <\/option>\t\t\t\t                          \n\t\t\t\t                        <\/select>\n<!-- \t\t\t\t                        \t<input type=\"text\" id=\"frm_place_of_purchace\" name=\"frm_place_of_purchace\" class=\"form-control\" maxlength=\"200\" \/> \n -->\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                    <\/div>\n\t\t\t\t                    <\/div>\n\n\t\t\t\t\t\t\t\t    \n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t                    \t<div id=\"row_demographics\" class=\"frm_row\">\n<!-- \t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_age\" id=\"frm_age_label\">H\u03bb\u03b9\u03ba\u03af\u03b1<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                        <input type=\"text\" id=\"frm_age\" name=\"frm_age\" class=\"form-control\" maxlength=\"3\" \/> \n\t\t\t\t                      <\/div> -->\n\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_birthdate\" for=\"frm_birthdate\" class=\"label_long\">   \n\t\t\t\t                        \tBirth Date  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span>\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>  \n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\n\n\n\t\t\t\t                      \t<table>\n\t\t\t\t                      \t\t<tr>\n\t\t\t\t                      \t\t\t<td style=\"text-align: left;\">\n<label id=\"lbl_birthdate\" for=\"frm_birthdate_day\" class=\"label_birthdate_day\">Day:<\/label>\t\t\t\t                      \t\t\t\t\n\t\t\t\t                      \t\t\t<\/td>\n\t\t\t\t                      \t\t\t<td  style=\"text-align: left;\">\n<label id=\"lbl_birthdate\" for=\"frm_birthdate_month\" class=\"label_birthdate_month\">Month:<\/label>\t\t\t\t                      \t\t\t\t\n\t\t\t\t                      \t\t\t<\/td>\n\t\t\t\t                      \t\t\t<td  style=\"text-align: left;\">\n<label id=\"lbl_birthdate\" for=\"frm_birthdate_year\" class=\"label_birthdate_year\">Year:<\/label>\t\t\t\t                      \t\t\t\t\n\t\t\t\t                      \t\t\t<\/td>\n\t\t\t\t                      \t\t<\/tr>\n\n\t\t\t\t                      \t\t<tr>\n\t\t\t\t                      \t\t\t<td style=\"text-align: left;\">\n\t\t\t\t                      \t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"number\" id=\"frm_birthdate_day\" name=\"frm_birthdate_day\" class=\"form-control\" style=\"width:60px;\" maxlength=\"2\"  min=\"1\" max=\"31\" placeholder=\"00\" \/> \n\n\t\t\t\t                      \t\t\t<\/td>\n\t\t\t\t                      \t\t\t<td  style=\"text-align: left;\">\n\t\t\t\t                      \t\t\t\t\t\t\t\t                        <input type=\"number\" id=\"frm_birthdate_month\" name=\"frm_birthdate_month\" class=\"form-control\" style=\"width:60px;\" maxlength=\"2\"  min=\"1\" max=\"12\" placeholder=\"00\" \/> \n\n\t\t\t\t                      \t\t\t<\/td>\n\t\t\t\t                      \t\t\t<td  style=\"text-align: left;\">\n\t\t\t\t                      \t\t\t\t\t\t\t\t                        <input type=\"number\" id=\"frm_birthdate_year\" name=\"frm_birthdate_year\" class=\"form-control\" style=\"width:75px;\" min=\"1900\" max=\"2022\" placeholder=\"0000\" \/> \n\n\t\t\t\t                      \t\t\t<\/td>\n\t\t\t\t                      \t\t<\/tr>\t\t\t\t                      \t\t\n\t\t\t\t                      \t<\/table>\n\n\n\n\n\t\t\t\t                      <!-- \t&nbsp;<label id=\"lbl_birthdate\" for=\"frm_birthdate_day\" class=\"label_birthdate_day\">Day:<\/label>\n\t\t\t\t\t\t\t\t\t\t\t<input type=\"number\" id=\"frm_birthdate_day\" name=\"frm_birthdate_day\" class=\"form-control\" style=\"width:40px;\" maxlength=\"2\"  min=\"1\" max=\"31\" placeholder=\"00\" \/> \n\t\t\t\t                        \n\t\t\t\t                        \t<label id=\"lbl_birthdate\" for=\"frm_birthdate_month\" class=\"label_birthdate_month\">Month:<\/label>\n\t\t\t\t                        <input type=\"number\" id=\"frm_birthdate_month\" name=\"frm_birthdate_month\" class=\"form-control\" style=\"width:40px;\" maxlength=\"2\"  min=\"1\" max=\"12\" placeholder=\"00\" \/> \n\n\t\t\t\t                        \n\t\t\t\t                        \t<label id=\"lbl_birthdate\" for=\"frm_birthdate_year\" class=\"label_birthdate_year\">Year:<\/label>\n\t\t\t\t                        <input type=\"number\" id=\"frm_birthdate_year\" name=\"frm_birthdate_year\" class=\"form-control\" style=\"width:62px;\" min=\"1900\" max=\"2022\" placeholder=\"0000\" \/>  -->\n\n\t\t\t\t                        <!-- <input type=\"date\" id=\"frm_birthdate\" placeholder=\"\" name=\"frm_birthdate\" class=\"form-control\" maxlength=\"10\" \/>  -->\n\t\t\t\t                      <\/div>\t       \t\t\t                    \t\n\n\n\t\t\t\t                    <\/div>\n\n\n\n\t\t\t                    \t<div id=\"row_demographics2\" class=\"frm_row\">\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_gender\" for=\"frm_gender\">\n\t\t\t\t                        \tGender  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <select id=\"frm_gender\" name=\"frm_gender\" class=\"form-control custom-select\">\n\t \t\t\t                          <option value=\"\" selected><\/option>\n\t \t\t\t                          <option value=\"1\">\n\t \t\t\t                          \tMale  \n\t \t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"2\">\n\t\t\t\t                          \tFemale  \n\t\t\t\t                          <\/option>\n\t\t\t\t                        <\/select>\n\t\t\t\t                      <\/div>\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_height\" for=\"frm_height\">\n\t\t\t\t                        \tHeight  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                        <input type=\"text\" id=\"frm_height\" name=\"frm_height\" class=\"form-control\" maxlength=\"3\" placeholder=\"cm  \n\t\t\t\t                        \" \/> \n\t\t\t\t                      <\/div>\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\t\t\t                      \n\t\t\t\t                        <label id=\"lbl_weight\" for=\"frm_weight\">\n\t\t\t\t                        \tWeight  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                        <input type=\"text\" id=\"frm_weight\" name=\"frm_weight\" class=\"form-control\" maxlength=\"3\" \/> \n\t\t\t\t                       <\/div>\n\t\t\t\t                    <\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t                    <div id=\"row_profession\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_profession\" id=\"frm_profession_label\" class=\"label_long\">\n\t\t\t\t                        \tOccupation  \n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>  \n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                      \t<select id=\"frm_profession\" name=\"frm_profession\" class=\"form-control  custom-select\">\n\t\t\t\t                          <option selected><\/option>\n\t\t\t\t\t\t\t\t\t\t    <option value=\"\u039c\u03b1\u03b8\u03b7\u03c4\u03ae\u03c2\">\u039c\u03b1\u03b8\u03b7\u03c4\u03ae\u03c2<\/option>\n\t\t\t\t\t\t\t\t\t\t    <option value=\"\u03a6\u03bf\u03b9\u03c4\u03b7\u03c4\u03ae\u03c2\">\u03a6\u03bf\u03b9\u03c4\u03b7\u03c4\u03ae\u03c2<\/option>\n\t\t\t\t\t\t\t\t\t\t    <option value=\"\u039a\u03b1\u03b8\u03b9\u03c3\u03c4\u03b9\u03ba\u03ae \u03b4\u03bf\u03c5\u03bb\u03b5\u03b9\u03ac\">\u039a\u03b1\u03b8\u03b9\u03c3\u03c4\u03b9\u03ba\u03ae \u03b4\u03bf\u03c5\u03bb\u03b5\u03b9\u03ac<\/option>\n\t\t\t\t\t\t\t\t\t\t    <option value=\"\u0388\u03bd\u03c4\u03bf\u03bd\u03b7 \u03c3\u03c9\u03bc\u03b1\u03c4\u03b9\u03ba\u03ae \u03ba\u03b1\u03c4\u03b1\u03c0\u03cc\u03bd\u03b7\u03c3\u03b7\">\u0388\u03bd\u03c4\u03bf\u03bd\u03b7 \u03c3\u03c9\u03bc\u03b1\u03c4\u03b9\u03ba\u03ae \u03ba\u03b1\u03c4\u03b1\u03c0\u03cc\u03bd\u03b7\u03c3\u03b7<\/option>\n\t\t\t\t\t\t\t\t\t\t    <option value=\"\u03a3\u03c5\u03bd\u03c4\u03b1\u03be\u03b9\u03bf\u03cd\u03c7\u03bf\u03c2\">\u03a3\u03c5\u03bd\u03c4\u03b1\u03be\u03b9\u03bf\u03cd\u03c7\u03bf\u03c2<\/option>\n\t\t\t\t\t\t\t\t\t\t  <\/select>\n\n\t\t\t\t                        <!-- <input type=\"text\" id=\"frm_profession\" name=\"frm_profession\" class=\"form-control\" maxlength=\"300\" \/>  -->\n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>\n\n\t\t\t\t                    <div class=\"separator\">\n\t\t\t\t                    \t<img decoding=\"async\" src=\"https:\/\/www.spiroulina.gr\/cms\/images\/separator.png\">\n\t\t\t\t                   \t<\/div> \t\n\n\t\t\t\t                    <div id=\"row_activity_type\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_activity_type\" class=\"label_long\">\n\t\t\t\t                        \tYour everyday life demands  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>  \n\t\t\t\t                      <div id=\"row_activity_type_answers\"  class=\"frm_mobile_row checkbox checkbox-success\">\n\n\t\t\t\t                      \t<input type=\"checkbox\" class=\"\" id=\"frm_activity_type_spiritual\" name=\"frm_activity_type_spiritual\">     \n\t                        \t\t\t<label for=\"frm_activity_type_spiritual\" id=\"lbl_activity_type_spiritual\">\n\t                        \t\t\t\tMental Activity  \n\t                        \t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t<br>\n\t\t\t\t                      \t<input type=\"checkbox\" class=\"\" id=\"frm_activity_type_body\" name=\"frm_activity_type_body\">     \n\t                        \t\t\t<label for=\"frm_activity_type_body\" id=\"lbl_activity_type_body\">\n\t                        \t\t\t\tPhysical Activity   \n\t                        \t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t<br>\n\t\t\t\t                      \t<input type=\"checkbox\" class=\"\" id=\"frm_activity_type_athletic\" name=\"frm_activity_type_athletic\">     \n\t                        \t\t\t<label for=\"frm_activity_type_athletic\"  id=\"lbl_activity_type_athletic\">\n\t                        \t\t\t\tSports Activity   \n\t                        \t\t\t<\/label>\n\n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>\n\n\t\t\t\t                    <div id=\"row_activity_hours\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_activity_hours\" for=\"frm_activity_hours\" class=\"label_long\">\n\t\t\t\t                        \tHow many ours do you have intense activity  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <select id=\"frm_activity_hours\" name=\"frm_activity_hours\" class=\"form-control  custom-select\">\n\t\t\t\t                          <option selected><\/option>\n\t\t\t\t                          <option value=\"1\">\n\t\t\t\t                          \t0 to 4 hours  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"2\">\n\n\t\t\t\t                          \t4 to 8 hours  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"3\">\n\t\t\t\t                          \t8 hours or more  \n\t\t\t\t                          <\/option>\n\t\t\t\t                        <\/select>\n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t                    <div id=\"row_thyroeidis_treatment\" class=\"frm_row\">\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_thyroeidis_treatment\" for=\"frm_thyroeidis_problem\" class=\"label_long\">\n\t\t\t\t                        \tAre you experiencing any problems with your thyroid gland?  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"frm_thyroeidis_treatment_answer\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_thyroeidis_problem_yes1\" value=\"yes\" name=\"frm_thyroeidis_problem\" \/>\n\t\t\t\t                        <label for=\"frm_thyroeidis_problem_yes1\" class=\"label_for_choice\">\n\t\t\t\t                        \tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_thyroeidis_problem_no1\" value=\"no\" name=\"frm_thyroeidis_problem\" \/>\n\t\t\t\t                        <label for=\"frm_thyroeidis_problem_no1\" class=\"label_for_choice\">\n\t\t\t\t                        \tNO  \n\t\t\t\t                        <\/label>   \n\t\t\t\t                      <\/div>\n\t\t\t\t                  \t<\/div>\n\n\t\t\t\t                    \n\t\t\t\t                    <div id=\"frm_thyroeidis_problem_type_init\" class=\"frm_row\">\n\n\t\t\t                      \t  <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_thyroeidis_treatment\" for=\"frm_thyroeidis_problem_type\" class=\"label_long\">\n\t\t\t\t                        \t  \n\t\t\t\t                        \t<\/label>\n\t\t\t\t                      <\/div>\n\n \t\t\t\t\t\t\t\t\t  <div class=\"frm_mobile_row\">\n\t\t\t\t                        <select id=\"frm_thyroeidis_problem_type\" name=\"frm_thyroeidis_problem_type\" class=\"form-control custom-select\">\n\t\t\t\t                          <option selected><\/option>\n\t\t\t\t                          <option value=\"1\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"2\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"3\">\n\t\t\t\t                        \t    \t\n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"4\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"5\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"6\">\n\t\t\t\t                        \t    \t\n\t\t\t\t                          <\/option>\n\t\t\t\t                        <\/select>\n\t\t\t\t                      <\/div>\n\t\t\t\t                  <\/div>\n\n\n\n\n\t\t\t\t                    <div id=\"row_thyroeidis_treatment_init\" class=\"frm_row\">\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_thyroeidis_treatment\" for=\"frm_thyroeidis_treatment\" class=\"label_long\">\n\t\t\t\t                        \tDo you take any medication to control the thyroid gland?  \n\t\t\t\t                        \t<\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"frm_thyroeidis_treatment_answer\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_thyroeidis_treatment_yes\" value=\"yes\" name=\"frm_thyroeidis_treatment\" \/>\n\t\t\t\t                        <label for=\"frm_thyroeidis_treatment_yes\" class=\"label_for_choice\">\n\t\t\t\t                        \tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_thyroeidis_treatment_no\" value=\"no\" name=\"frm_thyroeidis_treatment\" \/>\n\t\t\t\t                        <label for=\"frm_thyroeidis_treatment_no\" class=\"label_for_choice\">\n\t\t\t\t                        \tNO  \n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_thyroeidis_hours\">\n\t\t\t\t\t                    <div class=\"frm_row\">\n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label for=\"frm_medicine_hours\" class=\"label_long\">\n\t\t\t\t\t\t                        If yes, please complete the time of taking it  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                      <div class=\"frm_mobile_row radio_container checkbox checkbox-success\" id=\"row_thyroeidis_hours_answers\">\n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_thyroeidis_hours_morning\" name=\"frm_thyroeidis_hours_morning\" \/>\n\t\t\t\t\t                        <label for=\"frm_thyroeidis_hours_morning\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tMorning  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_thyroeidis_hours_noon\" name=\"frm_thyroeidis_hours_noon\" \/>\n\t\t\t\t\t                        <label for=\"frm_thyroeidis_hours_noon\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tMidday  \n\t\t\t\t\t                        <\/label> \n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_thyroeidis_hours_night\" name=\"frm_thyroeidis_hours_night\" \/>\n\t\t\t\t\t                        <label for=\"frm_thyroeidis_hours_night\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tNight  \n\t\t\t\t\t                        <\/label>  \t\t\t                            \n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                    <\/div>  \n\t\t\t\t                    <\/div>  \t\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t                    <div id=\"row_cholesterol_problem\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_cholesterol\" class=\"label_long\">\n\t\t\t\t                        \t\u0388\u03c7\u03b5\u03c4\u03b5 \u03b1\u03c5\u03be\u03b7\u03bc\u03ad\u03bd\u03b7 \u03c7\u03bf\u03bb\u03b7\u03c3\u03c4\u03b5\u03c1\u03af\u03bd\u03b7?  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_cholesterol_yes\" value=\"yes\" name=\"frm_cholesterol\" \/>\n\t\t\t\t                        <label for=\"frm_cholesterol_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_cholesterol_no\" value=\"no\" name=\"frm_cholesterol\" \/>\n\t\t\t\t                        <label for=\"frm_cholesterol_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\n\t\t\t\t                    <div id=\"row_cholesterol_level\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_cholesterol_level\" class=\"label_long\">\n\t\t\t\t                        \tIf you know what is the level?  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"text\" id=\"frm_cholesterol_level\" name=\"frm_cholesterol_level\" class=\"form-control\" maxlength=\"20\" \/> \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\t\t\t\t                    <div id=\"row_cholesterol_init\" class=\"frm_row\">\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_cholesterol_treatment\" for=\"cholesterol_treatment\" class=\"label_long\">\n\t\t\t\t                        \tDo you take any medication?  \n\t\t\t\t                        \t<\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"frm_cholesterol_treatment_answer\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_cholesterol_treatment_yes\" value=\"yes\" name=\"frm_cholesterol_treatment\" \/>\n\t\t\t\t                        <label for=\"frm_cholesterol_treatment_yes\" class=\"label_for_choice\">\n\t\t\t\t                        \tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_cholesterol_treatment_no\" value=\"no\" name=\"frm_cholesterol_treatment\" \/>\n\t\t\t\t                        <label for=\"frm_cholesterol_treatment_no\" class=\"label_for_choice\">\n\t\t\t\t                        \tNO  \n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_cholesterol_hours\">\n\t\t\t\t\t                    <div class=\"frm_row\">\n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label for=\"frm_cholesterol_hours\" class=\"label_long\">\n\t\t\t\t\t\t                        If yes, please complete the time of taking it  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                      <div class=\"frm_mobile_row radio_container checkbox checkbox-success\" id=\"row_cholesterol_hours_answers\">\n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_cholesterol_hours_morning\" name=\"frm_cholesterol_hours_morning\" \/>\n\t\t\t\t\t                        <label for=\"frm_cholesterol_hours_morning\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tMorning  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_cholesterol_hours_noon\" name=\"frm_cholesterol_hours_noon\" \/>\n\t\t\t\t\t                        <label for=\"frm_cholesterol_hours_noon\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tMidday  \n\t\t\t\t\t                        <\/label> \n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_cholesterol_hours_night\" name=\"frm_cholesterol_hours_night\" \/>\n\t\t\t\t\t                        <label for=\"frm_cholesterol_hours_night\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tNight  \n\t\t\t\t\t                        <\/label>  \t\t\t                            \n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                    <\/div>  \n\t\t\t\t                    <\/div>  \t\n\n\n\n\n\n\n\n\n\t\t\t                    <div id=\"row_sugar_problem\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_sugar\" class=\"label_long\">\n\t\t\t\t                        \t\u0388\u03c7\u03b5\u03c4\u03b5 \u03b1\u03c5\u03be\u03b7\u03bc\u03ad\u03bd\u03bf \u03c3\u03ac\u03ba\u03c7\u03b1\u03c1\u03bf;  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_sugar_yes\" value=\"yes\" name=\"frm_sugar\" \/>\n\t\t\t\t                        <label for=\"frm_sugar_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_sugar_no\" value=\"no\" name=\"frm_sugar\" \/>\n\t\t\t\t                        <label for=\"frm_sugar_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\t\t\t\t                    <div id=\"row_sugar_level\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_sugar_level\" class=\"label_long\">\n\t\t\t\t                        \tIf you know what is the level?  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"text\" id=\"frm_sugar_level\" name=\"frm_sugar_level\" class=\"form-control\" maxlength=\"20\" \/> \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    \n\t\t\t\t                    <div id=\"row_sugar_init\" class=\"frm_row\">\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_sugar_treatment\" for=\"sugar_treatment\" class=\"label_long\">\n\t\t\t\t                        \tDo you take any medication?  \n\t\t\t\t                        \t<\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"frm_sugar_treatment_answer\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_sugar_treatment_yes\" value=\"yes\" name=\"frm_sugar_treatment\" \/>\n\t\t\t\t                        <label for=\"frm_sugar_treatment_yes\" class=\"label_for_choice\">\n\t\t\t\t                        \tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_sugar_treatment_no\" value=\"no\" name=\"frm_sugar_treatment\" \/>\n\t\t\t\t                        <label for=\"frm_sugar_treatment_no\" class=\"label_for_choice\">\n\t\t\t\t                        \tNO  \n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_sugar_hours\">\n\t\t\t\t\t                    <div class=\"frm_row\">\n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label for=\"frm_sugar_hours\" class=\"label_long\">\n\t\t\t\t\t\t                        If yes, please complete the time of taking it  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                      <div class=\"frm_mobile_row radio_container checkbox checkbox-success\" id=\"row_sugar_hours_answers\">\n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_sugar_hours_morning\" name=\"frm_sugar_hours_morning\" \/>\n\t\t\t\t\t                        <label for=\"frm_sugar_hours_morning\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tMorning  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_sugar_hours_noon\" name=\"frm_sugar_hours_noon\" \/>\n\t\t\t\t\t                        <label for=\"frm_sugar_hours_noon\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tMidday  \n\t\t\t\t\t                        <\/label> \n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_sugar_hours_night\" name=\"frm_sugar_hours_night\" \/>\n\t\t\t\t\t                        <label for=\"frm_sugar_hours_night\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tNight  \n\t\t\t\t\t                        <\/label>  \t\t\t                            \n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                    <\/div>  \n\t\t\t\t                    <\/div>  \t\n\n\n\n\n\n\n\t                    \t\t\t<div id=\"row_fat_problem\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_fat\" class=\"label_long\">\n\t\t\t\t                        \t\u0388\u03c7\u03b5\u03c4\u03b5 \u03bb\u03b9\u03c0\u03ce\u03b4\u03b7 \u03b4\u03b9\u03ae\u03b8\u03b7\u03c3\u03b7;  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_fat_yes\" value=\"yes\" name=\"frm_fat\" \/>\n\t\t\t\t                        <label for=\"frm_fat_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_fat_no\" value=\"no\" name=\"frm_fat\" \/>\n\t\t\t\t                        <label for=\"frm_fat_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\n\t\t\t\t                    <div id=\"row_fat_init\" class=\"frm_row\">\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_fat_treatment\" for=\"fat_treatment\" class=\"label_long\">\n\t\t\t\t                        \tDo you take any medication?  \n\t\t\t\t                        \t<\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"frm_fat_treatment_answer\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_fat_treatment_yes\" value=\"yes\" name=\"frm_fat_treatment\" \/>\n\t\t\t\t                        <label for=\"frm_fat_treatment_yes\" class=\"label_for_choice\">\n\t\t\t\t                        \tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_fat_treatment_no\" value=\"no\" name=\"frm_fat_treatment\" \/>\n\t\t\t\t                        <label for=\"frm_fat_treatment_no\" class=\"label_for_choice\">\n\t\t\t\t                        \tNO  \n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_fat_hours\">\n\t\t\t\t\t                    <div class=\"frm_row\">\n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label for=\"frm_fat_hours\" class=\"label_long\">\n\t\t\t\t\t\t                        If yes, please complete the time of taking it  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                      <div class=\"frm_mobile_row radio_container checkbox checkbox-success\" id=\"row_fat_hours_answers\">\n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_fat_hours_morning\" name=\"frm_fat_hours_morning\" \/>\n\t\t\t\t\t                        <label for=\"frm_fat_hours_morning\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tMorning  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_fat_hours_noon\" name=\"frm_fat_hours_noon\" \/>\n\t\t\t\t\t                        <label for=\"frm_fat_hours_noon\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tMidday  \n\t\t\t\t\t                        <\/label> \n\t\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_fat_hours_night\" name=\"frm_fat_hours_night\" \/>\n\t\t\t\t\t                        <label for=\"frm_fat_hours_night\" class=\"label_for_checkbox\">\n\t\t\t\t\t                        \tNight  \n\t\t\t\t\t                        <\/label>  \t\t\t                            \n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                    <\/div>  \n\t\t\t\t                    <\/div>  \t\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t                    <div id=\"row_health_problem\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_health_problem\" class=\"label_long\">\n\t\t\t\t                        \tDo you face any health problem?  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_health_problem_yes\" value=\"yes\" name=\"frm_health_problem\" \/>\n\t\t\t\t                        <label for=\"frm_health_problem_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_health_problem_no\" value=\"no\" name=\"frm_health_problem\" \/>\n\t\t\t\t                        <label for=\"frm_health_problem_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"other_medical\">\n\n\t\t\t\t                    <div id=\"row_medical_issues\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_medical_issues\" class=\"label_long\">\n\t\t\t\t                        \tIf yes, please write exactly which your health problems are:  \n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>\n\n\t\t\t                    \t<div id=\"row_medical_issues2\" class=\"frm_row\">\n  \n\t\t\t\t                      <div class=\"frm_mobile_row checkbox checkbox-success\">\n\t\t\t\t                        <input type=\"checkbox\" class=\"form-control\" id=\"frm_medical_issue_diavitis\" name=\"frm_medical_issue_diavitis\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_diavitis\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tDiabetes  \n\t\t\t\t                        <\/label>\n\t\t\t\t                       \n\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_asthma\" name=\"frm_medical_issue_asthma\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_asthma\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tAsthma  \n\t\t\t\t                        <\/label> \n\t\t\t\t                        \n\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_nefrosiko\" name=\"frm_medical_issue_nefrosiko\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_nefrosiko\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tNephrotic Syndrome  \n\t\t\t\t                        <\/label> \n\n\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_cancer\" name=\"frm_medical_issue_cancer\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_cancer\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tCancer  \n\t\t\t\t                        <\/label>  \t\t\t  \n\n\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_iogeneis\" name=\"frm_medical_issue_iogeneis\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_iogeneis\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tViral Diseases  \n\t\t\t\t                        <\/label>  \t\t\t  \n\n\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_giransi\" name=\"frm_medical_issue_giransi\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_giransi\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tPremature Aging  \n\t\t\t\t                        <\/label>  \t\t\t  \n\n\t \t\t\t                      <\/div>\n\t\t\t                    \t<\/div>\n\n\t\t\t\t                    <div id=\"row_medical_issues3\" class=\"frm_row\">\n\t  \n\t\t\t\t                      <div class=\"frm_mobile_row checkbox checkbox-success\"> \n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control \" id=\"frm_medical_issue_kourasi\" name=\"frm_medical_issue_kourasi\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_kourasi\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tIncreased Fatigue - Decreased Performance  \n\t\t\t\t                        <\/label>  \t\t\t  \t\t                        \n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option for_women\" id=\"frm_medical_issue_proem\" name=\"frm_medical_issue_proem\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_proem\" class=\"label_for_checkbox for_women\">\n\t\t\t\t                        \tPremenstrual Syndrome - Menopause  \n\t\t\t\t                        <\/label>  \t\t\t  \t\t                        \n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_heart\" name=\"frm_medical_issue_heart\" \/>\n\t\t\t\t                        <label id=\"frm_medical_issue_heart_label\" for=\"frm_medical_issue_heart\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tCardiovascular Diseases  \n\t\t\t\t                        <\/label>  \t\t\n\n\t \t\t\t                      <\/div>\n\t\t\t\t                    <\/div>\n\t\t\t                    \n\t\t\t\t                    <div id=\"row_medical_issues4\" class=\"frm_row\">\n\t  \n\t\t\t\t                      <div class=\"frm_mobile_row checkbox checkbox-success\">  \t\t  \t\t                        \n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_metabolism\" name=\"frm_medical_issue_metabolism\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_metabolism\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tMetabolic Problems  \n\t\t\t\t                        <\/label> \t\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_ypovitaminosi\" name=\"frm_medical_issue_ypovitaminosi\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_ypovitaminosi\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t\u03a5\u03c0\u03bf\u03b2\u03b9\u03c4\u03b1\u03bc\u03af\u03bd\u03c9\u03c3\u03b7  \n\t\t\t\t                        <\/label> \t\t \n\t\t\t\t\t                    \n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_ypatikes\" name=\"frm_medical_issue_ypatikes\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_ypatikes\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tLiver Diseases  \n\t\t\t\t                        <\/label> \t\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_piesi\" name=\"frm_medical_issue_piesi\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_piesi\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label> \t\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_osteoporosi\" name=\"frm_medical_issue_osteoporosi\" \/>\n\t\t\t\t                        <label id=\"frm_medical_issue_osteoporosi_label\" for=\"frm_medical_issue_osteoporosi\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label> \t\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_arthritis\" name=\"frm_medical_issue_arthritis\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_arthritis\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label> \t\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_ponoi_osta\" name=\"frm_medical_issue_ponoi_osta\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_ponoi_osta\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label> \t\t\t\t\t                        \t\t\t\t                        \t\t\t\t                        \n\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_myalgies\" name=\"frm_medical_issue_myalgies\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_myalgies\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label> \t\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_thromvofilia\" name=\"frm_medical_issue_thromvofilia\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_thromvofilia\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label> \t\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_gastro\" name=\"frm_medical_issue_gastro\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_gastro\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label> \t\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_xap\" name=\"frm_medical_issue_xap\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_xap\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label> \t\t\n\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_rinitida\" name=\"frm_medical_issue_rinitida\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_rinitida\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tLiver Diseases  \n\t\t\t\t                        <\/label> \t\t\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_aytoanoso\" name=\"frm_medical_issue_aytoanoso\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_aytoanoso\" class=\"label_for_checkbox\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label> \t\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t\t                    <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medical_issue_other\" name=\"frm_medical_issue_other\" \/>\n\t\t\t\t                        <label for=\"frm_medical_issue_other\" class=\"label_for_checkbox\">\n\t\t \t\t\t\t\t \t\t\t\tOther  \n\t\t\t\t                        <\/label> \t\n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>\n\n\t\t\t\t                    <div id=\"row_health_other\">\n\t\t\t\t\t                    <div class=\"frm_row\">\n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label for=\"frm_health_other\" class=\"label_long\">\n\t\t\t\t\t\t                        If you have any other health problem please describe  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                      <\/div>  \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <input type=\"text\" id=\"frm_health_other\" name=\"frm_health_other\" class=\"form-control\" maxlength=\"300\" \/> \n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                    <\/div>\n\t\t\t\t                    <\/div>   \n\n\t\t\t\t                    <div id=\"row_medical_treatment\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_medical_treatment\" class=\"label_long\">\n\t\t\t\t                        \tDo you take any medication about the health problem?  \n\t\t\t\t                        <\/label><span class=\"required-field\">*<\/span>\n\t\t\t\t                     <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_medical_treatment_yes\" name=\"frm_medical_treatment\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_medical_treatment_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_medical_treatment_no\" name=\"frm_medical_treatment\" value=\"no\" \/>\n\t\t\t\t                        <label  for=\"frm_medical_treatment_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_medicine_hours\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_medicine_hours\" class=\"label_long\">\n\t\t\t\t                        \tIf yes, Please note the time of taking it  \n\t\t\t\t                        <\/label><span class=\"required-field\">*<\/span>\n\t\t\t\t                      <\/div>\n\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container checkbox checkbox-success\" id=\"row_medicine_hours_answers\">\n\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medicine_hours_morning\" name=\"frm_medicine_hours_morning\" \/>\n\t\t\t\t                        <label for=\"frm_medicine_hours_morning\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tMorning  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medicine_hours_noon\" name=\"frm_medicine_hours_noon\" \/>\n\t\t\t\t                        <label for=\"frm_medicine_hours_noon\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tMidday  \n\t\t\t\t                        <\/label> \n\t\t\t\t                        <input type=\"checkbox\" class=\"form-control checkbox-next-option\" id=\"frm_medicine_hours_night\" name=\"frm_medicine_hours_night\" \/>\n\t\t\t\t                        <label for=\"frm_medicine_hours_night\" class=\"label_for_checkbox\">\n\t\t\t\t                        \tNight  \n\t\t\t\t                        <\/label>  \t\n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                \t<\/div>\n\n\n\n\t\t                    \n\n\t\t\t\t                    <div id=\"row_weight_goal\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_weight_goal\" class=\"label_long\">\n\t\t\t\t                        \tAre you interested in  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>  \n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <select id=\"frm_weight_goal\" name=\"frm_weight_goal\" class=\"form-control custom-select\">\n\t\t\t\t                          <option selected><\/option>\n\t\t\t\t                          <option value=\"1\">\n\n\t\t\t\t                          \tLosing weight  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"2\">\n\t\t\t\t                          \tGaining weight  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"3\">\n\t\t\t\t                        \tKeeping your weight constant    \t\n\t\t\t\t                          <\/option>\n\t\t\t\t                        <\/select>\n\t\t\t\t                      <\/div>\n\n\t\t\t\t                      <div id=\"row_weight_change\" class=\"frm_mobile_row\">\n\t\t\t\t              \t\t\t<label id=\"lbl_weight_change\" for=\"frm_weight_change\">\n\t\t\t\t              \t\t\t\tHow many kilos?  \n\t\t\t\t              \t\t\t\t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                        <input type=\"text\" id=\"frm_weight_change\" name=\"frm_weight_change\" class=\"form-control\" maxlength=\"3\" \/> \n\t\t\t\t                      <\/div>\n\n\t\t\t\t                    <\/div>\n\n\t\t\t\t                    <div id=\"row_sport_activity\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_sport_activity\" class=\"label_long\">\n\t\t\t\t                        \tDo you exercise?  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"row_sport_activity_answers\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_sport_activity_yes\" value=\"yes\" name=\"frm_sport_activity\" \/>\n\t\t\t\t                        <label for=\"frm_sport_activity_yes\" class=\"label_for_choice\">\n\t\t\t\t                        \tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_sport_activity_no\" value=\"no\" name=\"frm_sport_activity\" \/>\n\t\t\t\t                        <label  for=\"frm_sport_activity_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                     <div id=\"row_sport\">\n\t\t\t\t\t                     <div class=\"frm_row\">\n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label for=\"frm_sport\" class=\"label_long\">\n\t\t\t\t\t\t                        If yes, what type of exercise?  \n\t\t\t\t\t                        <\/label>\n\t\t\t\t\t                      <\/div>  \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <input type=\"text\" id=\"frm_sport\" name=\"frm_sport\" class=\"form-control\" maxlength=\"300\" \/> \n\t\t\t\t\t                      <\/div>\n\t\t\t\t\t                    <\/div>\n\t\t\t\t                    <\/div>\n\n\t\t\t                  \n\t\t\t\t                    <div id=\"row_sport_hours\">\n\t\t\t\t\t                    <div class=\"frm_row\">\t\t\t\t                    \t\n\t\t\t\t\t                      \t<div class=\"frm_mobile_row\">\n\t\t\t\t\t                        \t<label id=\"lbl_sport_hours\" for=\"frm_sport_hours\" class=\"label\">\n\t\t\t\t\t                        \t\tHow many hours?  \n\t\t\t\t\t                        \t\t<span class=\"required-field\">*<\/span><\/label>\n<!-- \t\t\t\t\t                        \t<input type=\"text\" id=\"frm_sport_hours\" name=\"frm_sport_hours\" class=\"form-control\" maxlength=\"2\" \/> \n -->\t\t\t\t\t\t                    <select id=\"frm_sport_hours\" name=\"frm_sport_hours\" class=\"form-control custom-select\">\n\t\t\t\t\t\t                          <option selected><\/option>\n\t\t\t\t\t\t                          <option value=\"1\">1<\/option>\n\t\t\t\t\t\t                          <option value=\"2\">2<\/option>\n\t\t\t\t\t\t                          <option value=\"3\">3<\/option>\n\t\t\t\t\t\t                          <option value=\"4\">4<\/option>\n\t\t\t\t\t\t                          <option value=\"5\">5<\/option>\n\t\t\t\t\t\t                          <option value=\"6\">6<\/option>\n\t\t\t\t\t\t                          <option value=\"7\">7<\/option>\n\t\t\t\t\t\t                          <option value=\"8\">8<\/option>\n\t\t\t\t\t\t                          <option value=\"9\">9<\/option>\n\t\t\t\t\t\t                          <option value=\"10\">10<\/option>\n\t\t\t\t\t\t                        <\/select>\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\t                <\/div>\n\t\t\t                    \n\n\n\t\t\t\t                    <div id=\"row_sport_level\">\n\t\t\t\t\t                    <div class=\"frm_row\">\t\t\t\t                    \t\n\t\t\t\t\t                      \t<div class=\"frm_mobile_row\">\n\t\t\t\t\t                        \t<label id=\"lbl_sport_level\" for=\"frm_sport_level\" class=\"label\">\n\t\t\t\t\t                        \t\tIn what level?  \n\t\t\t\t\t                        \t\t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t\t\t                        <select id=\"frm_sport_level\" name=\"frm_sport_level\" class=\"form-control custom-select\">\n\t\t\t\t\t\t                          <option selected><\/option>\n\t\t\t\t\t\t                          <option value=\"1\">\n\t\t\t\t\t\t                          \tAmateur  \t\n\t\t\t\t\t\t                          <\/option>\n\t\t\t\t\t\t                          <option value=\"2\">\n\t\t\t\t\t\t                          \tProfessional  \n\t\t\t\t\t\t                          <\/option>\n\t\t\t\t\t\t                          <option value=\"3\">\n\t\t\t\t\t\t\t\t                    Championship  \n\t\t\t\t\t\t                          <\/option>\t\t\t\t\t\t                          \n\t\t\t\t\t\t                        <\/select>\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\t                <\/div>\n\n\n\n\n\t\t\t\t                    <div id=\"row_entero_problem\"  class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_entero\" class=\"label_long\">\n\t\t\t\t                       \t\t Do you face any of the below intestine problems?   \t\n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\" id=\"row_sport_activity_answers\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_frm_entero_yes\" value=\"yes\" name=\"frm_entero\" \/>\n\t\t\t\t                        <label for=\"frm_frm_entero_yes\" class=\"label_for_choice\">\n\t\t\t\t                        \tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_entero_no\" value=\"no\" name=\"frm_entero\" \/>\n\t\t\t\t                        <label  for=\"frm_entero_no\" class=\"label_for_choice\">\n\t\t\t\t                        \tNO  \n\t\t\t\t                        <\/label>   \n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_entero_rare\" value=\"rare\" name=\"frm_entero\" \/>\n\t\t\t\t                        <label  for=\"frm_entero_rare\" class=\"label_for_choice\" style=\"width:70px;\">\n\t\t\t\t                        \tRARELY  \n\t\t\t\t                        <\/label>       \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_entero_init\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_entero_problem\" class=\"label_long\">\n\t\t\t\t                        \tIf yes please indentify   \n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <select id=\"frm_entero_problem\" name=\"frm_entero_problem\" class=\"form-control custom-select\" multiple>\n\t\t\t\t                          <option value=\"\" selected><\/option>\n\t\t\t\t                          <option value=\"1\">\n\t\t\t\t                          \tIrritable bowel to constipation  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"2\">\n\t\t\t\t                          \tIrritable bowel to diarrhea  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"3\">\n\t\t\t\t                          \tFlatulence (bloating)  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"4\">\n\t\t\t\t                          \t\u0391\u03b9\u03bc\u03bf\u03c1\u03c1\u03bf\u0390\u03b4\u03b5\u03c2  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"5\">\n\t\t\t\t                          \tPain  \n\t\t\t\t                          <\/option>\n\n\n\n\t\t\t\t                          <option value=\"7\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"8\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"9\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\t\t\t\t                          \t\t\t\t                          \n\n\n\n\n\t\t\t\t                          <option value=\"6\">\n\t\t\t\t                          \tOther  \n\t\t\t\t                          <\/option>\n\t\t\t\t                        <\/select>\n\n\n\t\t\t\t                        <script>\n\t\t\t\t                      \t\t$(\"#frm_entero_problem\").mousedown(function(e){\n\t\t\t\t\t\t\t\t\t\t\t\t\t    e.preventDefault();\n\t\t\t\t\t\t\t\t\t\t\t\t\t\tvar select = this;\n\t\t\t\t\t\t\t\t\t\t\t\t\t    var scroll = select.scrollTop;\n\t\t\t\t\t\t\t\t\t\t\t\t\t    e.target.selected = !e.target.selected;\n\t\t\t\t\t\t\t\t\t\t\t\t\t    setTimeout(function(){select.scrollTop = scroll;}, 0);\n\t\t\t\t\t\t\t\t\t\t\t\t\t    \n\t\t\t\t\t\t\t\t\t\t\t$(\"#frm_entero_problem\").focus();\n\t\t\t\t\t\t\t\t\t\t\t\t\t}).mousemove(function(e){e.preventDefault()});\n\t\t\t\t                      \t<\/script>\n\t\t\t\t                      <\/div>\n\t\t\t\t                     <\/div> \n\n\t\t\t\t                     \n\t\t\t\t                    <div id=\"row_entero_text\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_entero_text\" for=\"frm_entero_text\" class=\"label_long\">\n\t\t\t\t                        \tIf you have any other problem with your intestine describe shortly  \n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>  \n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <input type=\"text\" id=\"frm_entero_text\" name=\"frm_entero_text\" class=\"form-control\" maxlength=\"300\" \/> \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div> \n\t\t\t\t                                       \n                        \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n         \n\t\t\t\t                    <div id=\"row_emor\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_emor\" class=\"label_long\">\n\t\t\t\t                        \t\u0388\u03c7\u03b5\u03c4\u03b5 \u03b1\u03b9\u03bc\u03bf\u03c1\u03c1\u03bf\u0390\u03b4\u03b5\u03c2;  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        \t<\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                       <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_emor_yes-en\" id=\"frm_emor_yes\" name=\"frm_emor\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_emor_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_emor_no\" name=\"frm_emor\" value=\"no\" \/>\n\t\t\t\t                        <label for=\"frm_emor_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_emor_rare\" name=\"frm_emor\" value=\"rare\" \/>\n\t\t\t\t                        <label for=\"frm_emor_rare\" class=\"label_for_choice\" style=\"width:70px;\">\n\t\t \t\t\t\t\t \t\t\t\tRARELY \t\t\t\t                        \t\n\t\t\t\t                        <\/label>    \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t                    <div id=\"row_cramps\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_medical_treatment\" class=\"label_long\">\n\t\t\t\t                        \tDo you have cramps problems?  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                       <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_cramps_yes-en\" id=\"frm_cramps_yes\" name=\"frm_cramps\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_cramps_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_cramps_no\" name=\"frm_cramps\" value=\"no\" \/>\n\t\t\t\t                        <label for=\"frm_cramps_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_cramps_rare\" name=\"frm_cramps\" value=\"rare\" \/>\n\t\t\t\t                        <label for=\"frm_cramps_rare\" class=\"label_for_choice\" style=\"width:70px;\">\n\t\t \t\t\t\t\t \t\t\t\tRARELY \t\t\t\t                        \t\n\t\t\t\t                        <\/label>    \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_iron\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_iron\" class=\"label_long\">\n\t\t\t\t                        \tIs your body iron in normal levels?  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                    \n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_iron_yes\" name=\"frm_iron\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_iron_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_iron_no\" name=\"frm_iron\" value=\"no\" \/>\n\t\t\t\t                        <label for=\"frm_iron_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\t\t\t                    \t<div id=\"row_iron_type\" class=\"frm_row\">\n\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label id=\"lbl_entero_text\" for=\"frm_iron_type\" class=\"label_long\">\n\t\t\t\t                        \t  \n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>  \n\n \t\t\t\t\t\t\t\t\t  <div class=\"frm_mobile_row\">\n\t\t\t\t                        <select id=\"frm_iron_type\" name=\"frm_iron_type\" class=\"form-control custom-select\">\n\t\t\t\t                          <option selected><\/option>\n\t\t\t\t                          <option value=\"1\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"2\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"3\">\n\t\t\t\t                        \t    \t\n\t\t\t\t                          <\/option>\n\t\t\t\t                          <option value=\"4\">\n\t\t\t\t                          \t  \n\t\t\t\t                          <\/option>\n\t\t\t\n\t\t\t\t                        <\/select>\n\t\t\t\t                      <\/div>\n\t\t\t\t                   <\/div>     \n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t                    <div id=\"row_hair\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_hair\" class=\"label_long\">\n\t\t\t\t                        \tDo you have hair loss?  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_hair_yes-en\" id=\"frm_hair_yes\" name=\"frm_hair\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_hair_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_hair_no\" value=\"no\" name=\"frm_hair\" \/>\n\t\t\t\t                        <label for=\"frm_hair_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>  \n\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_hair_normal\" value=\"normal\" name=\"frm_hair\" \/>\n\t\t\t\t                        <label for=\"frm_hair_normal\" class=\"label_for_choice\" style=\"width:120px;\">\n\t\t \t\t\t\t\t \t\t\t\tNORMAL \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_nails\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_nails\" class=\"label_long\">\n\t\t\t\t                        \tDo your nails brake?  \n\t\t\t\t                        \t<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_nails_yes-en\" id=\"frm_nails_yes\" name=\"frm_nails\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_nails_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_nails_no\" value=\"no\" name=\"frm_nails\" \/>\n\t\t\t\t                        <label for=\"frm_nails_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t                    <div id=\"row_vitamin_d_know\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_vitamin_d_know\" class=\"label_long\">\n\t\t\t\t                        \tDo you know your vitamin D levels?  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_vitamin_d_know_yes-en\" id=\"frm_vitamin_d_know_yes\" name=\"frm_vitamin_d_know\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_vitamin_d_know_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_vitamin_d_know_no\" value=\"no\" name=\"frm_vitamin_d_know\" \/>\n\t\t\t\t                        <label for=\"frm_vitamin_d_know_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\t\t\t\t                    <div id=\"row_vitamin_d_level\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_vitamin_d_level\" class=\"label_long\">\n\t\t\t\t                        \tIf you know what is the level?  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"text\" id=\"frm_vitamin_d_level\" name=\"frm_vitamin_d_level\" class=\"form-control\" maxlength=\"20\" \/> \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\t\t\t\t                    <div id=\"row_vitamin_d_supplement\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_vitamin_d_supplement\" class=\"label_long\">\n\t\t\t\t                        \tDo you take vitamin D supplement?  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_vitamin_d_supplement_yes-en\" id=\"frm_vitamin_d_supplement_yes\" name=\"frm_vitamin_d_supplement\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_vitamin_d_supplement_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_vitamin_d_supplement_no\" value=\"no\" name=\"frm_vitamin_d_supplement\" \/>\n\t\t\t\t                        <label for=\"frm_vitamin_d_supplement_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t                    <div id=\"row_vitamin_d_supplement\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_probiotics_supplement\" class=\"label_long\">\n\t\t\t\t                        \t\u039b\u03b1\u03bc\u03b2\u03ac\u03bd\u03b5\u03c4\u03b5 \u03c0\u03c1\u03bf\u03b2\u03b9\u03bf\u03c4\u03b9\u03ba\u03ac  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_probiotics_supplement_yes-en\" id=\"frm_probiotics_supplement_yes\" name=\"frm_probiotics_supplement\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_probiotics_supplement_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_probiotics_supplement_no\" value=\"no\" name=\"frm_probiotics_supplement\" \/>\n\t\t\t\t                        <label for=\"frm_probiotics_supplement_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t\t\t\t\t\t\t<div id=\"row_vitamin_d_supplement\" class=\"frm_row\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_animal\" class=\"label_long\">\n\t\t\t\t                        \t\u039a\u03b1\u03c4\u03b1\u03bd\u03b1\u03bb\u03ce\u03bd\u03b5\u03c4\u03b5 \u03b6\u03c9\u03b9\u03ba\u03ac \u03c4\u03c1\u03cc\u03c6\u03b9\u03bc\u03b1 \u03ae \u03b3\u03b1\u03bb\u03b1\u03ba\u03c4\u03bf\u03ba\u03bf\u03bc\u03b9\u03ba\u03ac;  \n\t\t\t\t                        \t<!-- <span class=\"required-field\">*<\/span> -->\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_animal_yes-en\" id=\"frm_animal_yes\" name=\"frm_animal\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_animal_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_animal_no\" value=\"no\" name=\"frm_animal\" \/>\n\t\t\t\t                        <label for=\"frm_animal_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\t\t\t                    \t<div id=\"women_only\" class=\"for_women\">\n\t \t\t\t\t\t \t\t\t\tONLY FOR FEMALES  \t\n\t\t\t                    \t<\/div>\n\n\t\t\t\t                    <div id=\"row_period\" class=\"frm_row for_women\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_period\" class=\"label_long\">\n\t\t \t\t\t\t\t \t\t\t\tIs your period stable?  \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control\" id=\"frm_period_yes\" name=\"frm_period\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_period_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_period_no\" name=\"frm_period\" value=\"no\" \/>\n\t\t\t\t                        <label  for=\"frm_period_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_emin\" class=\"frm_row for_women\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_emin\" class=\"label_long\">\n\t\t \t\t\t\t\t \t\t\t\tAre you in menopause?  \n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_emin_yes-en\" id=\"frm_emin_yes\" name=\"frm_emin\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_emin_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_emin_no\" name=\"frm_emin\" value=\"no\" \/>\n\t\t\t\t                        <label  for=\"frm_emin_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div id=\"row_hormon\" class=\"frm_row for_women\">\n\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t                        <label for=\"frm_hormon\" class=\"label_long\">\n\t\t \t\t\t\t\t \t\t\t\tDo you have hormone problems?  \n\t\t\t\t                        <\/label>\n\t\t\t\t                      <\/div>\n\t\t\t\t                      <div class=\"frm_mobile_row radio_container radio radio-danger2\">\n\t\t\t\t                        <input type=\"radio\" class=\"form-control frm_hormon_yes-en\" id=\"frm_hormon_yes\" name=\"frm_hormon\" value=\"yes\" \/>\n\t\t\t\t                        <label for=\"frm_hormon_yes\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tYES  \t\t\t\t                        \t\n\t\t\t\t                        <\/label>\n\t\t\t\t                        <input type=\"radio\" class=\"form-control radio-next-option\" id=\"frm_hormon_no\" name=\"frm_hormon\" value=\"no\" \/>\n\t\t\t\t                        <label  for=\"frm_hormon_no\" class=\"label_for_choice\">\n\t\t \t\t\t\t\t \t\t\t\tNO \t\t\t\t                        \t\n\t\t\t\t                        <\/label>     \n\t\t\t\t                      <\/div>\n\t\t\t\t                    <\/div>  \n\n\t\t\t\t                    <div class=\"separator\">\n\t\t\t\t                    \t<img decoding=\"async\" src=\"https:\/\/www.spiroulina.gr\/cms\/images\/separator.png\">\n\t\t\t\t                   \t<\/div> \t\n\n\t\t\t\t                <\/div>\n\n\n\n\t       \t\t\t             \n\n\t\t                        <\/div>\n\n\n\n\n\n\n\n\n\n\t\t\t\t                <div id=\"contact_info\" class=\"container main_questions\">\n\n\n\n\n\n\n\t\t\t\t                \t<div class=\"row\">\n\n\t       \t\t\t                    <div class=\"col\">   \n\t       \t\t\t\t                    <div class=\"frm_mobile_row\">\n\t\t\t\t    \t\t                    <label for=\"frm_first_name\" class=\"label_long\">\n\n\t\t\t\t \t\t\t\t\t \t\t\t\tFirst name  \n\t\t\t\t    \t\t                    \t<span class=\"required-field comm-data\">*<\/span><\/label>\n\t\t\t\t\t                      \t<\/div>  \n\t\t\t\t\t                      \t<div class=\"frm_mobile_row\">\n\t\t\t\t\t                        \t<input type=\"text\" id=\"frm_first_name\" name=\"frm_first_name\" class=\"form-control\" maxlength=\"300\" \/> \n\t\t\t\t\t                      \t<\/div>\n\t       \t\t\t                    <\/div>\t\n\n<!-- \n\t       \t\t\t                    <div class=\"col\">   \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label id=\"lbl_birthdate\" for=\"frm_birthdate\" class=\"label_long\">\u0397\u03bc\u03b5\u03c1\u03bf\u03bc\u03b7\u03bd\u03af\u03b1 \u03b3\u03ad\u03bd\u03bd\u03b7\u03c3\u03b7\u03c2<\/label>\n\t\t\t\t\t                      <\/div>  \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <input type=\"date\" id=\"frm_birthdate\" placeholder=\"\u03c8\" name=\"frm_birthdate\"   class=\"form-control\" maxlength=\"10\" \/> \n\t\t\t\t\t                      <\/div>\t       \t\t\t                    \t\n\n\t       \t\t\t                    <\/div>\t -->\n\t       \t\t\t                <\/div>    \t\t\n\n\n\n\n\t\t\t                \t<div class=\"row\" id=\"contact_info_row2\">\n\n\t       \t\t\t \t\n\n\t       \t\t\t                    <div class=\"col\">   \n\t       \t\t\t\t                    <div class=\"frm_mobile_row\">\n\t\t\t\t    \t\t                    <label for=\"frm_last_name\" class=\"label_long\">\n\n\t\t\t\t \t\t\t\t\t \t\t\t\tLast name  \n\t\t\t\t    \t\t                    \t<span class=\"required-field comm-data\">*<\/span><\/label>\n\t\t\t\t\t                      \t<\/div>  \n\t\t\t\t\t                      \t<div class=\"frm_mobile_row\">\n\t\t\t\t\t                        \t<input type=\"text\" id=\"frm_last_name\" name=\"frm_last_name\" class=\"form-control\" maxlength=\"300\" \/> \n\t\t\t\t\t                      \t<\/div>\n\t       \t\t\t                    <\/div>\n\n\t       \t\t\t                <\/div>    \t\t\n\n\n\n\n\n\n\t\t\t                \t<div class=\"row\" id=\"contact_info_row2\">\n\n\t       \t\t\t                    <div class=\"col\">   \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label for=\"frm_tel\" class=\"label_long\">\n\t\t\t \t\t\t\t\t \t\t\t\tPhone number  \n\t\t\t\t\t                        \t<span class=\"required-field comm-data\">*<\/span><\/label>\n\t\t\t\t\t                      <\/div>  \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <input type=\"text\" id=\"frm_tel\" name=\"frm_tel\" class=\"form-control frm_tel-en\" maxlength=\"16\" \/> \n\t\t\t\t\t                      <\/div>\n\t       \t\t\t                    <\/div>\t\n\n\t       \t\t\t                   \n\t       \t\t\t                <\/div> \n\n\n\n\t\t\t\t                <div class=\"row\" id=\"contact_info_row2\">\n\n\t       \t\t\t            \n\t       \t\t\t                    <div class=\"col\">   \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <label id=\"lbl_email\" for=\"frm_email\" class=\"label_long\">Email<span class=\"required-field\">*<\/span><\/label>\n\t\t\t\t\t                      <\/div>  \n\t\t\t\t\t                      <div class=\"frm_mobile_row\">\n\t\t\t\t\t                        <input type=\"text\" id=\"frm_email\" name=\"frm_email\" class=\"form-control\" maxlength=\"300\" \/> \n\t\t\t\t\t                      <\/div>\n\t       \t\t\t                    <\/div>\t\n\t       \t\t\t                <\/div> \n\n\t       \t\t\t               \n\n\n\t       \t\t\t             <\/div>  \n\n\n\n\n\t\t\n\n\n\t       \t\t\t             <\/div> \n\n\n\n\n\n\n\n\t       \t\t\t             <div class=\"container\">\n\n\t\t\t\t                     <div id=\"row_notes\" class=\"frm_row-data\">\n\t\t\t\t                        <label for=\"frm_notes\" class=\"label_long\">\n\t \t\t\t\t\t \t\t\t\tPlease describe shortly what you want to accomplish by taking our products, in order for us to focus on your wishes.  \n\t\t\t\t                    \t<\/label>\n\t\t\t\t                    <\/div>\n \t\t\t                      \n\t\t\t                     \t<div id=\"row_notes2\" class=\"frm_row\">\n\t\t\t                      \t\t<textarea id=\"from_notes\" name=\"from_notes\" class=\"form-control rounded-1\" maxlength=\"2000\"><\/textarea>\n\t\t\t                    \t<\/div>   \n\n\t\t\t\t                     <div id=\"row_accept_terms\" class=\"frm_row main_questions\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox checkbox-success\" id=\"frm_accept_terms_container\"><div  \n\t\t\t\t\t\t\t\t\t\t >\n\t                        \t\t\t\t<input type=\"checkbox\" class=\"styled\" id=\"frm_accept_terms\" name=\"frm_accept_terms\"\n\n\t                        \t\t\t\t >     \n\t                        \t\t\t\t<label for=\"frm_accept_terms\">\n\t\t                        \t\t\t\tI accept the   \t\n\t                        \t\t\t\t\t<a href=\"\n\t\t\t \t\t\t\t\t \t\t\t\thttps:\/\/www.spiroulina.gr\/en\/privacy-policy\/  \t                        \t\t\t\t\t\n\t                        \t\t\t\t\t\" target=\"_blank\" id=\"accept_terms_link\">\n\t\t\t \t\t\t\t\t \t\t\t\tPrivate Policy  \t                        \t\t\t\t\t\n\t                        \t\t\t\t<\/a><span class=\"required-field\">*<\/span><\/label>                   \t\t\t\t  \n\t                        \t\t\t\t<\/div>                        \t\t\n\t                    \t\t\t\t<\/div>\n\t\t\t                      \t<\/div>\n\n\n\n\t         \n\n\n\t\t                      \t<\/div>\n\n\n\n\n\t                      \t        <div id=\"error-correct\" class=\"alert alert-danger alert-before\">\n\t\t \t\t\t\t\t \t\t\t\tPlease correct the answers to the fields that are mentioned with red colour.  \t \t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/div>\n\n\t                      \t        <div id=\"error-server\" class=\"alert alert-danger alert-before\">\n\t\t \t\t\t\t\t \t\t\t\tAn error occurred. Please try again later.  \t \t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t                     <div id=\"row_submit_btn\" class=\"frm_row main_questions main_questions\" >\n\t\t\t                      \t\t<button class=\"btn btn-info btn-block waves-effect waves-light\" id=\"submit-btn\" type=\"submit\">\n\t\t \t\t\t\t\t \t\t\t\tSend  \t\t\t                      \t\t\t\n\t\t\t                      \t\t<\/button>\n\t\t\t                      \t<\/div>\n\n\n\n\n\n\t\t\t\n\n\n          \t\t\t\t\t<\/form>\n\n          \t\t\t\t\t<div id=\"responseMsg\" class=\"response\"><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<div class=\"\" id=\"\" style=\"font-size:12px;color: #818181;\">\n\t\t                        \t\t\t\tIn case your Spiroulina PLATENSIS will be used by other members of your family, it is suggested that they also fill up this questionnaire.  \t\t\n\t                    \t\t\t\t<\/div>\n\n                  \t\t<\/div>\n              \t\t<\/div>\n\n         \t\t <\/div>\n\n      \t\t<\/div>\n\n\t\t<\/section>\n\n    <\/main>\n\n\n\n\t\t<footer class=\"page_footer ls ms s-pt-80 s-pb-70 s-py-lg-120 s-pt-xl-135 s-pb-xl-105 c-gutter-60  text-center text-md-left\" id=\"footer-section\">\n\t\t\t\t\n\t\t<\/footer>\n\n\t\t\t\n<!-- \t\t<\/div>\n -->\n\t\t<!-- eof #box_wrapper -->\n<!-- \t<\/div>\n -->\n\t<!-- eof #canvas 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center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-3062","page","type-page","status-publish","has-post-thumbnail","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.spiroulina.gr\/en\/wp-json\/wp\/v2\/pages\/3062","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.spiroulina.gr\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.spiroulina.gr\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.spiroulina.gr\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.spiroulina.gr\/en\/wp-json\/wp\/v2\/comments?post=3062"}],"version-history":[{"count":4,"href":"https:\/\/www.spiroulina.gr\/en\/wp-json\/wp\/v2\/pages\/3062\/revisions"}],"predecessor-version":[{"id":6512,"href":"https:\/\/www.spiroulina.gr\/en\/wp-json\/wp\/v2\/pages\/3062\/revisions\/6512"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.spiroulina.gr\/en\/wp-json\/wp\/v2\/media\/6861"}],"wp:attachment":[{"href":"https:\/\/www.spiroulina.gr\/en\/wp-json\/wp\/v2\/media?parent=3062"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}