{"id":6346,"date":"2025-10-17T08:47:41","date_gmt":"2025-10-17T13:47:41","guid":{"rendered":"https:\/\/vetaffairs.la.gov\/?page_id=6346"},"modified":"2025-10-17T15:06:29","modified_gmt":"2025-10-17T20:06:29","slug":"retour","status":"publish","type":"page","link":"https:\/\/vetaffairs.la.gov\/fr\/feedback","title":{"rendered":"Enqu\u00eate de satisfaction"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6346\" class=\"elementor elementor-6346\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3f54d76 e-flex e-con-boxed e-con e-parent\" data-id=\"3f54d76\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-54ff9ea elementor-widget elementor-widget-text-editor\" data-id=\"54ff9ea\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>At LDVA, our mission is to advocate for Louisiana veterans and their families and connect them with the benefits they&#8217;ve earned through military service. By providing your feedback on our services, you help us continue our standard of superior customer service and support.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f13d135 elementor-widget elementor-widget-shortcode\" data-id=\"f13d135\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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\/>\n\t\t\t\t\t\t<script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n\n\t\t\t\t\t<\/div><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LfaguwrAAAAAD1Ru0fYnu0M-b2rk9WNME9ICeAJ' data-tabindex='0'><input id=\"input_59df92329d286a5eea14c73eef94a162\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_59df92329d286a5eea14c73eef94a162\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_14' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_14_1\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how likely are you to recommend the Louisiana Department of Veteran Affairs to another veteran in need?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how likely are you to recommend the Louisiana Department of Veteran Affairs to another veteran in need?' class='gsurvey-likert' id='input_14_1'><thead><tr><th id='likert_col_1_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_1' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol1e888b52c'  id='choice_14_1_1'    aria-labelledby='likert_col_1_14_1'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol1b7a732c4'  id='choice_14_1_2'    aria-labelledby='likert_col_2_14_1'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol15dda1d16'  id='choice_14_1_3'    aria-labelledby='likert_col_3_14_1'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol1405b84e7'  id='choice_14_1_4'    aria-labelledby='likert_col_4_14_1'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol1e53f3f7e'  id='choice_14_1_5'    aria-labelledby='likert_col_5_14_1'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol1364612c9'  id='choice_14_1_6'    aria-labelledby='likert_col_6_14_1'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol16d56455e'  id='choice_14_1_7'    aria-labelledby='likert_col_7_14_1'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol1d0c4e771'  id='choice_14_1_8'    aria-labelledby='likert_col_8_14_1'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol1d872bb9f'  id='choice_14_1_9'    aria-labelledby='likert_col_9_14_1'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol15969e93a'  id='choice_14_1_11'    aria-labelledby='likert_col_11_14_1'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_1' type='radio' value='glikertcol164f042ac'  id='choice_14_1_12'    aria-labelledby='likert_col_12_14_1'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_1'>0 = Not at all likely, 10 = Extremely likely<\/div><\/div><div id=\"field_14_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_3'>What was the primary reason for the score you gave?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_14_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_14_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_5'>What is one thing the Louisiana Department of Veteran Affairs could do to improve your experience?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_14_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_14_4\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_4'>If you would like to provide feedback regarding specific services received (nursing home, benefits, cemeteries, or education,), please select an option here:<\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_14_4' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected'>Select an Option<\/option><option value='Veteran Homes' >Veteran Homes<\/option><option value='Veteran Benefits' >Veteran Benefits<\/option><option value='Veteran Cemeteries' >Veteran Cemeteries<\/option><option value='Veteran Education Programs' >Veteran Education Programs<\/option><\/select><\/div><\/div><div id=\"field_14_6\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Veteran Homes<\/h3><\/div><div id=\"field_14_7\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_7'>Facility name where your loved one resides:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_14_7' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'>Select an Option<\/option><option value='Louisiana Veterans Home - Jackson, LA' >Louisiana Veterans Home - Jackson, LA<\/option><option value='Northeast Louisiana Veterans Home - Monroe, LA' >Northeast Louisiana Veterans Home - Monroe, LA<\/option><option value='Northwest Louisiana Veterans Home - Bossier City, LA' >Northwest Louisiana Veterans Home - Bossier City, LA<\/option><option value='Southeast Louisiana Veterans Home - Reserve, LA' >Southeast Louisiana Veterans Home - Reserve, LA<\/option><option value='Southwest Louisiana Veterans Home - Jennings, LA' >Southwest Louisiana Veterans Home - Jennings, LA<\/option><\/select><\/div><\/div><fieldset id=\"field_14_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Upon entering the facility and when approaching staff, were you greeted by staff?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_9'>\n\t\t\t<div class='gchoice gchoice_14_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Yes'  id='choice_14_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_9_0' id='label_14_9_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='No'  id='choice_14_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_9_1' id='label_14_9_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_14_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Did the area you visited appear clean and tidy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_10'>\n\t\t\t<div class='gchoice gchoice_14_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Yes'  id='choice_14_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_10_0' id='label_14_10_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='No'  id='choice_14_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_10_1' id='label_14_10_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_11\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_11'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_14_11' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Were the staff attentive to the needs of your loved one?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_12'>\n\t\t\t<div class='gchoice gchoice_14_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Yes'  id='choice_14_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_12_0' id='label_14_12_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='No'  id='choice_14_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_12_1' id='label_14_12_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_13\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_13'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_13' id='input_14_13' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >During your discussions with staff, were you treated professionally and respectfully?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_14'>\n\t\t\t<div class='gchoice gchoice_14_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Yes'  id='choice_14_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_14_0' id='label_14_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='No'  id='choice_14_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_14_1' id='label_14_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_15\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_15'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_14_15' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Were your interactions with our business office cordial and professional?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_16'>\n\t\t\t<div class='gchoice gchoice_14_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Yes'  id='choice_14_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_16_0' id='label_14_16_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='No'  id='choice_14_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_16_1' id='label_14_16_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Not Applicable'  id='choice_14_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_16_2' id='label_14_16_2' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_17\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_17'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_17' id='input_14_17' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Were you invited to participate in your loved one\u2019s Quarterly Care Plan Conference?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_18'>\n\t\t\t<div class='gchoice gchoice_14_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Yes'  id='choice_14_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_18_0' id='label_14_18_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='No'  id='choice_14_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_18_1' id='label_14_18_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_14_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have a positive working rapport with your loved one\u2019s Social Service Counselor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_19'>\n\t\t\t<div class='gchoice gchoice_14_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_14_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_19_0' id='label_14_19_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_14_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_19_1' id='label_14_19_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_20\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_20'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_20' id='input_14_20' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Were you made aware of facility activities and events?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_21'>\n\t\t\t<div class='gchoice gchoice_14_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Yes'  id='choice_14_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_21_0' id='label_14_21_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='No'  id='choice_14_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_21_1' id='label_14_21_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_22\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_22'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_14_22' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_23\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you feel your loved one is provided the opportunity to participate in activities of their choosing?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_23'>\n\t\t\t<div class='gchoice gchoice_14_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes'  id='choice_14_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_23_0' id='label_14_23_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_14_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_23_1' id='label_14_23_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_24\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_24'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_14_24' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you present at meal times or had the opportunity to dine with your loved one during lunch?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_25'>\n\t\t\t<div class='gchoice gchoice_14_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_14_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_25_0' id='label_14_25_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_14_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_25_1' id='label_14_25_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_14_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Were you satisfied with the meal and interaction of staff during meal time?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_27'>\n\t\t\t<div class='gchoice gchoice_14_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Yes'  id='choice_14_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_27_0' id='label_14_27_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='No'  id='choice_14_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_27_1' id='label_14_27_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_26\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_26'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_14_26' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you satisfied with the overall quality of care provided by our clinical staff?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_28'>\n\t\t\t<div class='gchoice gchoice_14_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Yes'  id='choice_14_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_28_0' id='label_14_28_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='No'  id='choice_14_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_28_1' id='label_14_28_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_29\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_29'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_14_29' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_14_30\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how likely are you to recommend our facility to others based your overall impression?<\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how likely are you to recommend our facility to others based your overall impression?' class='gsurvey-likert' id='input_14_30'><thead><tr><th id='likert_col_1_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_30' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_30_1'    aria-labelledby='likert_col_1_14_30'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_30_2'    aria-labelledby='likert_col_2_14_30'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol30058f5ea3'  id='choice_14_30_3'    aria-labelledby='likert_col_3_14_30'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_30_4'    aria-labelledby='likert_col_4_14_30'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol3032f07117'  id='choice_14_30_5'    aria-labelledby='likert_col_5_14_30'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol30b2963b28'  id='choice_14_30_6'    aria-labelledby='likert_col_6_14_30'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol3033a1c221'  id='choice_14_30_7'    aria-labelledby='likert_col_7_14_30'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol3072660184'  id='choice_14_30_8'    aria-labelledby='likert_col_8_14_30'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol3011c6c41a'  id='choice_14_30_9'    aria-labelledby='likert_col_9_14_30'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol30bf83a361'  id='choice_14_30_11'    aria-labelledby='likert_col_11_14_30'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_30' type='radio' value='glikertcol30a270036a'  id='choice_14_30_12'    aria-labelledby='likert_col_12_14_30'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_30'>0 = Not at all likely, 10 = Extremely likely<\/div><\/div><div id=\"field_14_31\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >What is your overall rating of the facility?<\/label><div class='ginput_container ginput_container_likert'><table aria-label='What is your overall rating of the facility?' class='gsurvey-likert' id='input_14_31'><thead><tr><th id='likert_col_1_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_31' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_31_1'    aria-labelledby='likert_col_1_14_31'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_31_2'    aria-labelledby='likert_col_2_14_31'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol30058f5ea3'  id='choice_14_31_3'    aria-labelledby='likert_col_3_14_31'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_31_4'    aria-labelledby='likert_col_4_14_31'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol3032f07117'  id='choice_14_31_5'    aria-labelledby='likert_col_5_14_31'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol30b2963b28'  id='choice_14_31_6'    aria-labelledby='likert_col_6_14_31'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol3033a1c221'  id='choice_14_31_7'    aria-labelledby='likert_col_7_14_31'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol3072660184'  id='choice_14_31_8'    aria-labelledby='likert_col_8_14_31'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol3011c6c41a'  id='choice_14_31_9'    aria-labelledby='likert_col_9_14_31'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol30bf83a361'  id='choice_14_31_11'    aria-labelledby='likert_col_11_14_31'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_31' type='radio' value='glikertcol30a270036a'  id='choice_14_31_12'    aria-labelledby='likert_col_12_14_31'\/><\/td><\/tr><\/tbody><\/table><\/div><\/div><div id=\"field_14_37\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Veteran Benefits<\/h3><\/div><div id=\"field_14_38\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how would you rate the overall professionalism of our Veterans Assistance Counselor?<\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how would you rate the overall professionalism of our Veterans Assistance Counselor?' class='gsurvey-likert' id='input_14_38'><thead><tr><th id='likert_col_1_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_38' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_38_1'    aria-labelledby='likert_col_1_14_38'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_38_2'    aria-labelledby='likert_col_2_14_38'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol30058f5ea3'  id='choice_14_38_3'    aria-labelledby='likert_col_3_14_38'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_38_4'    aria-labelledby='likert_col_4_14_38'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol3032f07117'  id='choice_14_38_5'    aria-labelledby='likert_col_5_14_38'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol30b2963b28'  id='choice_14_38_6'    aria-labelledby='likert_col_6_14_38'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol3033a1c221'  id='choice_14_38_7'    aria-labelledby='likert_col_7_14_38'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol3072660184'  id='choice_14_38_8'    aria-labelledby='likert_col_8_14_38'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol3011c6c41a'  id='choice_14_38_9'    aria-labelledby='likert_col_9_14_38'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol30bf83a361'  id='choice_14_38_11'    aria-labelledby='likert_col_11_14_38'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_38' type='radio' value='glikertcol30a270036a'  id='choice_14_38_12'    aria-labelledby='likert_col_12_14_38'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_38'>0 = Not at all likely, 10 = Extremely likely<\/div><\/div><div id=\"field_14_39\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how would you rate the overall professionalism of our Veterans Service Office environment?<\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how would you rate the overall professionalism of our Veterans Service Office environment?' class='gsurvey-likert' id='input_14_39'><thead><tr><th id='likert_col_1_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_39' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_39_1'    aria-labelledby='likert_col_1_14_39'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_39_2'    aria-labelledby='likert_col_2_14_39'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol30058f5ea3'  id='choice_14_39_3'    aria-labelledby='likert_col_3_14_39'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_39_4'    aria-labelledby='likert_col_4_14_39'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol3032f07117'  id='choice_14_39_5'    aria-labelledby='likert_col_5_14_39'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol30b2963b28'  id='choice_14_39_6'    aria-labelledby='likert_col_6_14_39'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol3033a1c221'  id='choice_14_39_7'    aria-labelledby='likert_col_7_14_39'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol3072660184'  id='choice_14_39_8'    aria-labelledby='likert_col_8_14_39'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol3011c6c41a'  id='choice_14_39_9'    aria-labelledby='likert_col_9_14_39'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol30bf83a361'  id='choice_14_39_11'    aria-labelledby='likert_col_11_14_39'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_39' type='radio' value='glikertcol30a270036a'  id='choice_14_39_12'    aria-labelledby='likert_col_12_14_39'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_39'>0 = Not at all likely, 10 = Extremely likely<\/div><\/div><fieldset id=\"field_14_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Would you recommend our services to other Veterans and their families?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_40'>\n\t\t\t<div class='gchoice gchoice_14_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Yes'  id='choice_14_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_40_0' id='label_14_40_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='No'  id='choice_14_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_40_1' id='label_14_40_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_41\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_41'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_41' id='input_14_41' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_42\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you feel that all of your questions or concerns were addressed?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_42'>\n\t\t\t<div class='gchoice gchoice_14_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Yes'  id='choice_14_42_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_42_0' id='label_14_42_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='No'  id='choice_14_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_42_1' id='label_14_42_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_43\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_43'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_43' id='input_14_43' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_14_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Did the Veterans Assistance Counselor clearly explain the next steps you need to take, if any?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_44'>\n\t\t\t<div class='gchoice gchoice_14_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='Yes'  id='choice_14_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_44_0' id='label_14_44_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='No'  id='choice_14_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_44_1' id='label_14_44_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_65\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_65'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_65' id='input_14_65' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_14_45\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_45'>Is there anything else you would like to share or suggest to help us improve our customer service?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_45' id='input_14_45' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_14_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_66'>Which veteran service office did you visit for this service?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_14_66' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_14_67\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_67'>If comfortable, please provide the name of the veterans assistance counselor (VAC) you worked with. This helps us recognize great service and improve where needed.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_67' id='input_14_67' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_14_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Veteran Cemeteries<\/h3><\/div><div id=\"field_14_48\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_48'>Facility name where your loved one resides<\/label><div class='ginput_container ginput_container_select'><select name='input_48' id='input_14_48' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected'>Select an Option<\/option><option value='Central Louisiana Veterans Cemetery - Leesville, LA' >Central Louisiana Veterans Cemetery - Leesville, LA<\/option><option value='Northeast Louisiana Veterans Cemetery - Rayville, LA' >Northeast Louisiana Veterans Cemetery - Rayville, LA<\/option><option value='Northwest Louisiana Veterans Cemetery - Keithville, LA' >Northwest Louisiana Veterans Cemetery - Keithville, LA<\/option><option value='Southeast Louisiana Veterans Cemetery - Slidell, LA' >Southeast Louisiana Veterans Cemetery - Slidell, LA<\/option><option value='Southwest Louisiana Veterans Cemetery - Jennings, LA' >Southwest Louisiana Veterans Cemetery - Jennings, LA<\/option><\/select><\/div><\/div><fieldset id=\"field_14_49\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Did you feel the staff treated you and your family with compassion and respect?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_49'>\n\t\t\t<div class='gchoice gchoice_14_49_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='Yes'  id='choice_14_49_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_49_0' id='label_14_49_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_49_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='No'  id='choice_14_49_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_49_1' id='label_14_49_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_52\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_52'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_52' id='input_14_52' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_14_51\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how would you rate the overall appearance and maintenance of the cemetery grounds?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how would you rate the overall appearance and maintenance of the cemetery grounds?' class='gsurvey-likert' id='input_14_51'><thead><tr><th id='likert_col_1_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_51' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_51_1'    aria-labelledby='likert_col_1_14_51'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_51_2'    aria-labelledby='likert_col_2_14_51'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol30058f5ea3'  id='choice_14_51_3'    aria-labelledby='likert_col_3_14_51'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_51_4'    aria-labelledby='likert_col_4_14_51'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol3032f07117'  id='choice_14_51_5'    aria-labelledby='likert_col_5_14_51'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol30b2963b28'  id='choice_14_51_6'    aria-labelledby='likert_col_6_14_51'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol3033a1c221'  id='choice_14_51_7'    aria-labelledby='likert_col_7_14_51'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol3072660184'  id='choice_14_51_8'    aria-labelledby='likert_col_8_14_51'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol3011c6c41a'  id='choice_14_51_9'    aria-labelledby='likert_col_9_14_51'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol30bf83a361'  id='choice_14_51_11'    aria-labelledby='likert_col_11_14_51'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_51' type='radio' value='glikertcol30a270036a'  id='choice_14_51_12'    aria-labelledby='likert_col_12_14_51'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_51'>0 = Extremely Poor, 10 = Exceptional<\/div><\/div><div id=\"field_14_53\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how would you rate the accessibility of the cemetery (roads, signage, parking, etc.)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how would you rate the accessibility of the cemetery (roads, signage, parking, etc.)?' class='gsurvey-likert' id='input_14_53'><thead><tr><th id='likert_col_1_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_53' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_53_1'    aria-labelledby='likert_col_1_14_53'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_53_2'    aria-labelledby='likert_col_2_14_53'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol30058f5ea3'  id='choice_14_53_3'    aria-labelledby='likert_col_3_14_53'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_53_4'    aria-labelledby='likert_col_4_14_53'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol3032f07117'  id='choice_14_53_5'    aria-labelledby='likert_col_5_14_53'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol30b2963b28'  id='choice_14_53_6'    aria-labelledby='likert_col_6_14_53'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol3033a1c221'  id='choice_14_53_7'    aria-labelledby='likert_col_7_14_53'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol3072660184'  id='choice_14_53_8'    aria-labelledby='likert_col_8_14_53'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol3011c6c41a'  id='choice_14_53_9'    aria-labelledby='likert_col_9_14_53'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol30bf83a361'  id='choice_14_53_11'    aria-labelledby='likert_col_11_14_53'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_53' type='radio' value='glikertcol30a270036a'  id='choice_14_53_12'    aria-labelledby='likert_col_12_14_53'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_53'>0 = Extremely Poor, 10 = Exceptional<\/div><\/div><fieldset id=\"field_14_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Did the staff provide clear and timely information about eligibility, burial options, and procedures when requested by you to the cemetery?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_54'>\n\t\t\t<div class='gchoice gchoice_14_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Yes'  id='choice_14_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_54_0' id='label_14_54_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='No'  id='choice_14_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_54_1' id='label_14_54_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_55\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_55'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_55' id='input_14_55' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_14_56\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how satisfied were you with the communication you received from cemetery staff (phone, email, or in-person)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how satisfied were you with the communication you received from cemetery staff (phone, email, or in-person)?' class='gsurvey-likert' id='input_14_56'><thead><tr><th id='likert_col_1_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_56' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_56_1'    aria-labelledby='likert_col_1_14_56'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_56_2'    aria-labelledby='likert_col_2_14_56'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol30058f5ea3'  id='choice_14_56_3'    aria-labelledby='likert_col_3_14_56'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_56_4'    aria-labelledby='likert_col_4_14_56'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol3032f07117'  id='choice_14_56_5'    aria-labelledby='likert_col_5_14_56'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol30b2963b28'  id='choice_14_56_6'    aria-labelledby='likert_col_6_14_56'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol3033a1c221'  id='choice_14_56_7'    aria-labelledby='likert_col_7_14_56'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol3072660184'  id='choice_14_56_8'    aria-labelledby='likert_col_8_14_56'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol3011c6c41a'  id='choice_14_56_9'    aria-labelledby='likert_col_9_14_56'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol30bf83a361'  id='choice_14_56_11'    aria-labelledby='likert_col_11_14_56'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_56' type='radio' value='glikertcol30a270036a'  id='choice_14_56_12'    aria-labelledby='likert_col_12_14_56'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_56'>0 = Very Dissatisfied, 10 = Very Satisfied<\/div><\/div><fieldset id=\"field_14_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Was the public services area and facilities clean, stocked, easily accessible and\/or helpful?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_14_57'>\n\t\t\t<div class='gchoice gchoice_14_57_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='Yes'  id='choice_14_57_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_57_0' id='label_14_57_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_14_57_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_57' type='radio' value='No'  id='choice_14_57_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_14_57_1' id='label_14_57_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_58\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_58'>Please explain:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_58' id='input_14_58' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_14_59\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_59'>How was the condition and cleanliness of the facility utilized (committal shelter)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_59' id='input_14_59' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'>Select an Option<\/option><option value='Excellent' >Excellent<\/option><option value='Good' >Good<\/option><option value='Fair' >Fair<\/option><option value='Poor' >Poor<\/option><option value='Very Poor' >Very Poor<\/option><\/select><\/div><\/div><div id=\"field_14_60\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how likely are you to recommend our cemetery to other veterans based your overall impression?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how likely are you to recommend our cemetery to other veterans based your overall impression?' class='gsurvey-likert' id='input_14_60'><thead><tr><th id='likert_col_1_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_60' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_60_1'    aria-labelledby='likert_col_1_14_60'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_60_2'    aria-labelledby='likert_col_2_14_60'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol30058f5ea3'  id='choice_14_60_3'    aria-labelledby='likert_col_3_14_60'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_60_4'    aria-labelledby='likert_col_4_14_60'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol3032f07117'  id='choice_14_60_5'    aria-labelledby='likert_col_5_14_60'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol30b2963b28'  id='choice_14_60_6'    aria-labelledby='likert_col_6_14_60'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol3033a1c221'  id='choice_14_60_7'    aria-labelledby='likert_col_7_14_60'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol3072660184'  id='choice_14_60_8'    aria-labelledby='likert_col_8_14_60'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol3011c6c41a'  id='choice_14_60_9'    aria-labelledby='likert_col_9_14_60'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol30bf83a361'  id='choice_14_60_11'    aria-labelledby='likert_col_11_14_60'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_60' type='radio' value='glikertcol30a270036a'  id='choice_14_60_12'    aria-labelledby='likert_col_12_14_60'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_60'>0 = Not Likely at All, 10 = Very Likely<\/div><\/div><div id=\"field_14_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Veteran Education Opportunities<\/h3><\/div><div id=\"field_14_63\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how likely are you to recommend the assistance provided by your School Certifying Official (SCO) for processing your VA education benefits to other veterans or dependent students?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how likely are you to recommend the assistance provided by your School Certifying Official (SCO) for processing your VA education benefits to other veterans or dependent students?' class='gsurvey-likert' id='input_14_63'><thead><tr><th id='likert_col_1_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_63' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_63_1'    aria-labelledby='likert_col_1_14_63'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_63_2'    aria-labelledby='likert_col_2_14_63'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol30058f5ea3'  id='choice_14_63_3'    aria-labelledby='likert_col_3_14_63'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_63_4'    aria-labelledby='likert_col_4_14_63'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol3032f07117'  id='choice_14_63_5'    aria-labelledby='likert_col_5_14_63'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol30b2963b28'  id='choice_14_63_6'    aria-labelledby='likert_col_6_14_63'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol3033a1c221'  id='choice_14_63_7'    aria-labelledby='likert_col_7_14_63'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol3072660184'  id='choice_14_63_8'    aria-labelledby='likert_col_8_14_63'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol3011c6c41a'  id='choice_14_63_9'    aria-labelledby='likert_col_9_14_63'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol30bf83a361'  id='choice_14_63_11'    aria-labelledby='likert_col_11_14_63'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_63' type='radio' value='glikertcol30a270036a'  id='choice_14_63_12'    aria-labelledby='likert_col_12_14_63'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_63'>0 = Not Likely at All, 10 = Very Likely<\/div><\/div><div id=\"field_14_62\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how likely are you to recommend the support provided by your LaVetCorps Navigator for connecting you with campus resources, VA services, or community support to other veterans or dependent students?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how likely are you to recommend the support provided by your LaVetCorps Navigator for connecting you with campus resources, VA services, or community support to other veterans or dependent students?' class='gsurvey-likert' id='input_14_62'><thead><tr><th id='likert_col_1_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_62' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_62_1'    aria-labelledby='likert_col_1_14_62'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_62_2'    aria-labelledby='likert_col_2_14_62'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol30058f5ea3'  id='choice_14_62_3'    aria-labelledby='likert_col_3_14_62'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_62_4'    aria-labelledby='likert_col_4_14_62'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol3032f07117'  id='choice_14_62_5'    aria-labelledby='likert_col_5_14_62'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol30b2963b28'  id='choice_14_62_6'    aria-labelledby='likert_col_6_14_62'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol3033a1c221'  id='choice_14_62_7'    aria-labelledby='likert_col_7_14_62'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol3072660184'  id='choice_14_62_8'    aria-labelledby='likert_col_8_14_62'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol3011c6c41a'  id='choice_14_62_9'    aria-labelledby='likert_col_9_14_62'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol30bf83a361'  id='choice_14_62_11'    aria-labelledby='likert_col_11_14_62'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_62' type='radio' value='glikertcol30a270036a'  id='choice_14_62_12'    aria-labelledby='likert_col_12_14_62'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_62'>0 = Not Likely at All, 10 = Very Likely<\/div><\/div><div id=\"field_14_64\" class=\"gfield gfield--type-survey gfield--input-type-likert gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field \"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >On a scale of 0 to 10, how likely are you to recommend your campus as a supportive environment for veterans or dependent students to others?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_likert'><table aria-label='On a scale of 0 to 10, how likely are you to recommend your campus as a supportive environment for veterans or dependent students to others?' class='gsurvey-likert' id='input_14_64'><thead><tr><th id='likert_col_1_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>0<\/th><th id='likert_col_2_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>1<\/th><th id='likert_col_3_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>2<\/th><th id='likert_col_4_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>3<\/th><th id='likert_col_5_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>4<\/th><th id='likert_col_6_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>5<\/th><th id='likert_col_7_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>6<\/th><th id='likert_col_8_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>7<\/th><th id='likert_col_9_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>8<\/th><th id='likert_col_11_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>9<\/th><th id='likert_col_12_14_64' scope='col' role='presentation' class='gsurvey-likert-choice-label'>10<\/th><\/tr><\/thead><tbody><tr><td data-label='0' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol30b8b5a2e2'  id='choice_14_64_1'    aria-labelledby='likert_col_1_14_64'\/><\/td><td data-label='1' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol30c3a6c6d1'  id='choice_14_64_2'    aria-labelledby='likert_col_2_14_64'\/><\/td><td data-label='2' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol30058f5ea3'  id='choice_14_64_3'    aria-labelledby='likert_col_3_14_64'\/><\/td><td data-label='3' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol30f2f10d7a'  id='choice_14_64_4'    aria-labelledby='likert_col_4_14_64'\/><\/td><td data-label='4' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol3032f07117'  id='choice_14_64_5'    aria-labelledby='likert_col_5_14_64'\/><\/td><td data-label='5' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol30b2963b28'  id='choice_14_64_6'    aria-labelledby='likert_col_6_14_64'\/><\/td><td data-label='6' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol3033a1c221'  id='choice_14_64_7'    aria-labelledby='likert_col_7_14_64'\/><\/td><td data-label='7' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol3072660184'  id='choice_14_64_8'    aria-labelledby='likert_col_8_14_64'\/><\/td><td data-label='8' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol3011c6c41a'  id='choice_14_64_9'    aria-labelledby='likert_col_9_14_64'\/><\/td><td data-label='9' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol30bf83a361'  id='choice_14_64_11'    aria-labelledby='likert_col_11_14_64'\/><\/td><td data-label='10' class='gsurvey-likert-choice'><input name='input_64' type='radio' value='glikertcol30a270036a'  id='choice_14_64_12'    aria-labelledby='likert_col_12_14_64'\/><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_14_64'>0 = Not Likely at All, 10 = Very Likely<\/div><\/div><div id=\"field_14_32\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Contact Information<\/h3><div class='gsection_description' id='gfield_description_14_32'>Please note the below fields are optional and that your feedback is confidential. <\/div><\/div><fieldset id=\"field_14_33\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Veteran&#039;s Name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_14_33'>\n                            \n                            <span id='input_14_33_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.3' id='input_14_33_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_14_33_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_14_33_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.6' id='input_14_33_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_14_33_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_14_34\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Your Name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_14_34'>\n                            \n                            <span id='input_14_34_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_34.3' id='input_14_34_3' value=''   aria-required='false'    autocomplete=\"given-name\" \/>\n                                                    <label for='input_14_34_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_14_34_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_34.6' id='input_14_34_6' value=''   aria-required='false'    autocomplete=\"family-name\" \/>\n                                                    <label for='input_14_34_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_14_35\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_35'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_35' id='input_14_35' type='email' value='' class='large'     aria-invalid=\"false\" aria-describedby=\"gfield_description_14_35\" autocomplete=\"email\"\/>\n                        <\/div><div class='gfield_description' id='gfield_description_14_35'>Format: sample@domain.com<\/div><\/div><div id=\"field_14_36\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_36'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_36' id='input_14_36' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_14_36\" autocomplete=\"tel\" \/><\/div><div class='gfield_description' id='gfield_description_14_36'>Format: (123) 456-7890<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' 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