{"id":513,"date":"2023-04-16T15:11:52","date_gmt":"2023-04-16T19:11:52","guid":{"rendered":"https:\/\/carleton.ca\/attendant-services-program\/?page_id=513"},"modified":"2023-04-16T15:13:17","modified_gmt":"2023-04-16T19:13:17","slug":"student-feedback-questionnaire","status":"publish","type":"page","link":"https:\/\/carleton.ca\/attendant-services-program\/student-feedback-questionnaire\/","title":{"rendered":"Student Feedback Questionnaire"},"content":{"rendered":"<div class=\"page\" title=\"Page 2\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>Thank you for your time and feedback. Your perspectives help inform future directions and continuous improvement of student programming, services and support.<\/p>\n<p>IF THIS IS AN EMERGENCY please contact Campus Safety Services at 613-520-4444.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_27' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_27'  action='\/attendant-services-program\/wp-json\/wp\/v2\/pages\/513' data-formid='27' >\n                        <div class='gform-body gform_body'><ul id='gform_fields_27' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_27_15\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_15\"><label class='gfield_label gform-field-label' for='input_27_15' >Name<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_27_15' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_27_16\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_16\"><label class='gfield_label gform-field-label' for='input_27_16' >Carleton E-mail Address<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_27_16' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_27_1\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_1\"><label class='gfield_label gform-field-label' for='input_27_1' >Service or interaction for which you are providing feedback<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_27_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_27_17\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_17\"><label class='gfield_label gform-field-label' for='input_27_17' >Staff member who assisted you<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_27_17' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_27_2\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_2\"><label class='gfield_label gform-field-label' for='input_27_2' >Date of service or interaction (if known)<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_27_2' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_27_3\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_3\"><label class='gfield_label gform-field-label'  >Type of interaction<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_27_3'>\n\t\t\t<li class='gchoice gchoice_27_3_0'>\n\t\t\t\t<input name='input_3' type='radio' value='In person'  id='choice_27_3_0'    \/>\n\t\t\t\t<label for='choice_27_3_0' id='label_27_3_0' class='gform-field-label gform-field-label--type-inline'>In person<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_3_1'>\n\t\t\t\t<input name='input_3' type='radio' value='Virtual'  id='choice_27_3_1'    \/>\n\t\t\t\t<label for='choice_27_3_1' id='label_27_3_1' class='gform-field-label gform-field-label--type-inline'>Virtual<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_3_2'>\n\t\t\t\t<input name='input_3' type='radio' value='Phone'  id='choice_27_3_2'    \/>\n\t\t\t\t<label for='choice_27_3_2' id='label_27_3_2' class='gform-field-label gform-field-label--type-inline'>Phone<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_3_3'>\n\t\t\t\t<input name='input_3' type='radio' value='Email'  id='choice_27_3_3'    \/>\n\t\t\t\t<label for='choice_27_3_3' id='label_27_3_3' class='gform-field-label gform-field-label--type-inline'>Email<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_3_4'>\n\t\t\t\t<input name='input_3' type='radio' value='gf_other_choice'  id='choice_27_3_4'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_27_3_other' name='input_3_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_27_4\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_4\"><h2 class=\"gsection_title\">Commitment to Service Excellence<\/h2><div class='gsection_description' id='gfield_description_27_4'>The Attendant Services Program embraces principles of Service Excellence in all that we do by striving to be caring, professional, reliable, courteous and treating each person as an individual.<\/div><\/li><li id=\"field_27_18\"  class=\"gfield gfield--type-survey gfield--input-type-likert gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" data-js-reload=\"field_27_18\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >(1) For the interaction you are commenting on, the staff member assisting you was:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table class='gsurvey-likert' id='input_27_18'><thead><tr><th scope='col' class='gsurvey-likert-row-label'><\/th><th scope='col' class='gsurvey-likert-choice-label'>Strongly disagree<\/th><th scope='col' class='gsurvey-likert-choice-label'>Disagree<\/th><th scope='col' class='gsurvey-likert-choice-label'>Agree<\/th><th scope='col' class='gsurvey-likert-choice-label'>Strongly agree<\/th><\/tr><\/thead><tbody><tr><td data-label='' class='gsurvey-likert-row-label'>Helpful<\/td><td data-label='Strongly disagree' class='gsurvey-likert-choice'><input name='input_18.1' type='radio' value='glikertrow5b205022:glikertcol18da3e6007'  id='choice_27_18_1_1'   \/><\/td><td data-label='Disagree' class='gsurvey-likert-choice'><input name='input_18.1' type='radio' value='glikertrow5b205022:glikertcol1814926c3d'  id='choice_27_18_1_2'   \/><\/td><td data-label='Agree' class='gsurvey-likert-choice'><input name='input_18.1' type='radio' value='glikertrow5b205022:glikertcol187fe0f1fc'  id='choice_27_18_1_3'   \/><\/td><td data-label='Strongly agree' class='gsurvey-likert-choice'><input name='input_18.1' type='radio' value='glikertrow5b205022:glikertcol186f151fa4'  id='choice_27_18_1_4'   \/><\/td><\/tr><tr><td data-label='' class='gsurvey-likert-row-label'>Considerate<\/td><td data-label='Strongly disagree' class='gsurvey-likert-choice'><input name='input_18.2' type='radio' value='glikertrow922e1859:glikertcol18da3e6007'  id='choice_27_18_2_1'   \/><\/td><td data-label='Disagree' class='gsurvey-likert-choice'><input name='input_18.2' type='radio' value='glikertrow922e1859:glikertcol1814926c3d'  id='choice_27_18_2_2'   \/><\/td><td data-label='Agree' class='gsurvey-likert-choice'><input name='input_18.2' type='radio' value='glikertrow922e1859:glikertcol187fe0f1fc'  id='choice_27_18_2_3'   \/><\/td><td data-label='Strongly agree' class='gsurvey-likert-choice'><input name='input_18.2' type='radio' value='glikertrow922e1859:glikertcol186f151fa4'  id='choice_27_18_2_4'   \/><\/td><\/tr><tr><td data-label='' class='gsurvey-likert-row-label'>Knowledgeable<\/td><td data-label='Strongly disagree' class='gsurvey-likert-choice'><input name='input_18.3' type='radio' value='glikertrow75652c1b:glikertcol18da3e6007'  id='choice_27_18_3_1'   \/><\/td><td data-label='Disagree' class='gsurvey-likert-choice'><input name='input_18.3' type='radio' value='glikertrow75652c1b:glikertcol1814926c3d'  id='choice_27_18_3_2'   \/><\/td><td data-label='Agree' class='gsurvey-likert-choice'><input name='input_18.3' type='radio' value='glikertrow75652c1b:glikertcol187fe0f1fc'  id='choice_27_18_3_3'   \/><\/td><td data-label='Strongly agree' class='gsurvey-likert-choice'><input name='input_18.3' type='radio' value='glikertrow75652c1b:glikertcol186f151fa4'  id='choice_27_18_3_4'   \/><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_27_7\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_7\"><label class='gfield_label gform-field-label'  >(2) Was the issue you were seeking help with resolved?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_27_7'>\n\t\t\t<li class='gchoice gchoice_27_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='Yes'  id='choice_27_7_0'    \/>\n\t\t\t\t<label for='choice_27_7_0' id='label_27_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='No'  id='choice_27_7_1'    \/>\n\t\t\t\t<label for='choice_27_7_1' id='label_27_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_27_8\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_8\"><label class='gfield_label gform-field-label'  >If not, were you provided feedback or resources for follow up?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_27_8'>\n\t\t\t<li class='gchoice gchoice_27_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='Yes'  id='choice_27_8_0'    \/>\n\t\t\t\t<label for='choice_27_8_0' id='label_27_8_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='No'  id='choice_27_8_1'    \/>\n\t\t\t\t<label for='choice_27_8_1' id='label_27_8_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_27_9\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_9\"><h2 class=\"gsection_title\">Commitment to Inclusive Culture<\/h2><div class='gsection_description' id='gfield_description_27_9'>The Attendant Services Program values respectful, diverse, accessible and equitable environments and continuously strives towards inclusion.<\/div><\/li><li id=\"field_27_19\"  class=\"gfield gfield--type-survey gfield--input-type-likert gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" data-js-reload=\"field_27_19\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >(3) With respect to the interaction you are commenting on:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table class='gsurvey-likert' id='input_27_19'><thead><tr><th scope='col' class='gsurvey-likert-row-label'><\/th><th scope='col' class='gsurvey-likert-choice-label'>Strongly disagree<\/th><th scope='col' class='gsurvey-likert-choice-label'>Disagree<\/th><th scope='col' class='gsurvey-likert-choice-label'>Agree<\/th><th scope='col' class='gsurvey-likert-choice-label'>Strongly agree<\/th><\/tr><\/thead><tbody><tr><td data-label='' class='gsurvey-likert-row-label'>I felt respected<\/td><td data-label='Strongly disagree' class='gsurvey-likert-choice'><input name='input_19.1' type='radio' value='glikertrowa68a9dbe:glikertcol190b294591'  id='choice_27_19_1_1'   \/><\/td><td data-label='Disagree' class='gsurvey-likert-choice'><input name='input_19.1' type='radio' value='glikertrowa68a9dbe:glikertcol190451f5a4'  id='choice_27_19_1_2'   \/><\/td><td data-label='Agree' class='gsurvey-likert-choice'><input name='input_19.1' type='radio' value='glikertrowa68a9dbe:glikertcol190d5baf8d'  id='choice_27_19_1_3'   \/><\/td><td data-label='Strongly agree' class='gsurvey-likert-choice'><input name='input_19.1' type='radio' value='glikertrowa68a9dbe:glikertcol197ea347fb'  id='choice_27_19_1_4'   \/><\/td><\/tr><tr><td data-label='' class='gsurvey-likert-row-label'>I felt my perspective mattered<\/td><td data-label='Strongly disagree' class='gsurvey-likert-choice'><input name='input_19.2' type='radio' value='glikertrowdd4b3f2a:glikertcol190b294591'  id='choice_27_19_2_1'   \/><\/td><td data-label='Disagree' class='gsurvey-likert-choice'><input name='input_19.2' type='radio' value='glikertrowdd4b3f2a:glikertcol190451f5a4'  id='choice_27_19_2_2'   \/><\/td><td data-label='Agree' class='gsurvey-likert-choice'><input name='input_19.2' type='radio' value='glikertrowdd4b3f2a:glikertcol190d5baf8d'  id='choice_27_19_2_3'   \/><\/td><td data-label='Strongly agree' class='gsurvey-likert-choice'><input name='input_19.2' type='radio' value='glikertrowdd4b3f2a:glikertcol197ea347fb'  id='choice_27_19_2_4'   \/><\/td><\/tr><tr><td data-label='' class='gsurvey-likert-row-label'>I felt I was treated fairly<\/td><td data-label='Strongly disagree' class='gsurvey-likert-choice'><input name='input_19.3' type='radio' value='glikertrow84fcc262:glikertcol190b294591'  id='choice_27_19_3_1'   \/><\/td><td data-label='Disagree' class='gsurvey-likert-choice'><input name='input_19.3' type='radio' value='glikertrow84fcc262:glikertcol190451f5a4'  id='choice_27_19_3_2'   \/><\/td><td data-label='Agree' class='gsurvey-likert-choice'><input name='input_19.3' type='radio' value='glikertrow84fcc262:glikertcol190d5baf8d'  id='choice_27_19_3_3'   \/><\/td><td data-label='Strongly agree' class='gsurvey-likert-choice'><input name='input_19.3' type='radio' value='glikertrow84fcc262:glikertcol197ea347fb'  id='choice_27_19_3_4'   \/><\/td><\/tr><tr><td data-label='' class='gsurvey-likert-row-label'>I felt supported<\/td><td data-label='Strongly disagree' class='gsurvey-likert-choice'><input name='input_19.4' type='radio' value='glikertrowb8d1adb6:glikertcol190b294591'  id='choice_27_19_4_1'   \/><\/td><td data-label='Disagree' class='gsurvey-likert-choice'><input name='input_19.4' type='radio' value='glikertrowb8d1adb6:glikertcol190451f5a4'  id='choice_27_19_4_2'   \/><\/td><td data-label='Agree' class='gsurvey-likert-choice'><input name='input_19.4' type='radio' value='glikertrowb8d1adb6:glikertcol190d5baf8d'  id='choice_27_19_4_3'   \/><\/td><td data-label='Strongly agree' class='gsurvey-likert-choice'><input name='input_19.4' type='radio' value='glikertrowb8d1adb6:glikertcol197ea347fb'  id='choice_27_19_4_4'   \/><\/td><\/tr><tr><td data-label='' class='gsurvey-likert-row-label'>Services were accessible for my needs<\/td><td data-label='Strongly disagree' class='gsurvey-likert-choice'><input name='input_19.5' type='radio' value='glikertrowef07660f:glikertcol190b294591'  id='choice_27_19_5_1'   \/><\/td><td data-label='Disagree' class='gsurvey-likert-choice'><input name='input_19.5' type='radio' value='glikertrowef07660f:glikertcol190451f5a4'  id='choice_27_19_5_2'   \/><\/td><td data-label='Agree' class='gsurvey-likert-choice'><input name='input_19.5' type='radio' value='glikertrowef07660f:glikertcol190d5baf8d'  id='choice_27_19_5_3'   \/><\/td><td data-label='Strongly agree' class='gsurvey-likert-choice'><input name='input_19.5' type='radio' value='glikertrowef07660f:glikertcol197ea347fb'  id='choice_27_19_5_4'   \/><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_27_11\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_11\"><h2 class=\"gsection_title\">Additional Feedback<\/h2><\/li><li id=\"field_27_12\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_12\"><label class='gfield_label gform-field-label'  >(4) I would rate my overall experience with this interaction as:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_27_12'>\n\t\t\t<li class='gchoice gchoice_27_12_0'>\n\t\t\t\t<input name='input_12' type='radio' value='Very Poor'  id='choice_27_12_0'    \/>\n\t\t\t\t<label for='choice_27_12_0' id='label_27_12_0' class='gform-field-label gform-field-label--type-inline'>Very Poor<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_12_1'>\n\t\t\t\t<input name='input_12' type='radio' value='Poor'  id='choice_27_12_1'    \/>\n\t\t\t\t<label for='choice_27_12_1' id='label_27_12_1' class='gform-field-label gform-field-label--type-inline'>Poor<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_12_2'>\n\t\t\t\t<input name='input_12' type='radio' value='Slightly Poor'  id='choice_27_12_2'    \/>\n\t\t\t\t<label for='choice_27_12_2' id='label_27_12_2' class='gform-field-label gform-field-label--type-inline'>Slightly Poor<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_12_3'>\n\t\t\t\t<input name='input_12' type='radio' value='Fair'  id='choice_27_12_3'    \/>\n\t\t\t\t<label for='choice_27_12_3' id='label_27_12_3' class='gform-field-label gform-field-label--type-inline'>Fair<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_12_4'>\n\t\t\t\t<input name='input_12' type='radio' value='Good'  id='choice_27_12_4'    \/>\n\t\t\t\t<label for='choice_27_12_4' id='label_27_12_4' class='gform-field-label gform-field-label--type-inline'>Good<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_12_5'>\n\t\t\t\t<input name='input_12' type='radio' value='Very Good'  id='choice_27_12_5'    \/>\n\t\t\t\t<label for='choice_27_12_5' id='label_27_12_5' class='gform-field-label gform-field-label--type-inline'>Very Good<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_27_12_6'>\n\t\t\t\t<input name='input_12' type='radio' value='Excellent'  id='choice_27_12_6'    \/>\n\t\t\t\t<label for='choice_27_12_6' id='label_27_12_6' class='gform-field-label gform-field-label--type-inline'>Excellent<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_27_13\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_13\"><label class='gfield_label gform-field-label' for='input_27_13' 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