{"id":374,"date":"2017-01-08T18:23:46","date_gmt":"2017-01-08T17:23:46","guid":{"rendered":"http:\/\/www.hjt-hormonalnijoga.cz\/wp\/?page_id=374"},"modified":"2017-01-23T01:24:34","modified_gmt":"2017-01-23T00:24:34","slug":"caldera_forms_preview-2","status":"publish","type":"page","link":"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/caldera_forms_preview-2\/","title":{"rendered":"P\u0159ihl\u00e1\u0161ka s dotazn\u00edkem"},"content":{"rendered":"<div class=\"caldera-grid\" id=\"caldera_form_1\" data-cf-ver=\"1.9.5\" data-cf-form-id=\"CF586f9bf506b91\"><div id=\"caldera_notices_1\" data-spinner=\"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/wp-admin\/images\/spinner.gif\"><\/div><form data-instance=\"1\" class=\"CF586f9bf506b91 caldera_forms_form cfajax-trigger\" method=\"POST\" enctype=\"multipart\/form-data\" id=\"CF586f9bf506b91_1\" data-form-id=\"CF586f9bf506b91\" aria-label=\"P\u0159ihl&aacute;&scaron;ka s dotazn&iacute;kem\" data-target=\"#caldera_notices_1\" data-template=\"#cfajax_CF586f9bf506b91-tmpl\" data-cfajax=\"CF586f9bf506b91\" data-load-element=\"_parent\" data-load-class=\"cf_processing\" data-post-disable=\"0\" data-action=\"cf_process_ajax_submit\" data-request=\"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/cf-api\/CF586f9bf506b91\" data-hiderows=\"true\">\r\n<input type=\"hidden\" id=\"_cf_verify_CF586f9bf506b91\" name=\"_cf_verify\" value=\"854ebfae77\"  data-nonce-time=\"1781034133\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/domains\/hjt-hormonalnijoga.cz\/wp-json\/wp\/v2\/pages\/374\" \/><div id=\"cf2-CF586f9bf506b91_1\"><\/div><input type=\"hidden\" name=\"_cf_frm_id\" value=\"CF586f9bf506b91\">\r\n<input type=\"hidden\" name=\"_cf_frm_ct\" value=\"1\">\r\n<input type=\"hidden\" name=\"cfajax\" value=\"CF586f9bf506b91\">\r\n<input type=\"hidden\" name=\"_cf_cr_pst\" value=\"374\">\r\n<div class=\"hide\" style=\"display:none; overflow:hidden;height:0;width:0;\">\r\n<label>Phone<\/label><input type=\"text\" name=\"phone\" value=\"\" autocomplete=\"off\">\r\n<\/div><div id=\"CF586f9bf506b91_1-row-1\"  class=\"row  first_row\"><div  class=\"col-sm-12  single\"><div class=\"\"><div style=\"text-align: center; font-size: 20px;\">pro \u00fa\u010dastnice semin\u00e1\u0159e Hormon\u00e1ln\u00ed j\u00f3gov\u00e9 terapie dle Dinah Rodrigu\u00e9z<\/div>\n<p><\/p>\n<\/div><\/div><\/div><div id=\"CF586f9bf506b91_1-row-2\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_5038033\" class=\"form-group\" id=\"fld_5038033_1-wrap\">\r\n\t<label id=\"fld_5038033Label\" for=\"fld_5038033_1\" class=\"control-label\">Jm\u00e9no a p\u0159\u00edjmen\u00ed <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_5038033\" class=\" form-control\" id=\"fld_5038033_1\" name=\"fld_5038033\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_5038033Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_3125338\" class=\"form-group\" id=\"fld_3125338_1-wrap\">\r\n\t<label id=\"fld_3125338Label\" for=\"fld_3125338_1\" class=\"control-label\">Adresa <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_3125338\" class=\" form-control\" id=\"fld_3125338_1\" name=\"fld_3125338\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_3125338Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_4857042\" class=\"form-group\" id=\"fld_4857042_1-wrap\">\r\n\t<label id=\"fld_4857042Label\" for=\"fld_4857042_1\" class=\"control-label\">Obec <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_4857042\" class=\" form-control\" id=\"fld_4857042_1\" name=\"fld_4857042\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_4857042Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_3100922\" class=\"form-group\" id=\"fld_3100922_1-wrap\">\r\n\t<label id=\"fld_3100922Label\" for=\"fld_3100922_1\" class=\"control-label\">PS\u010c <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_3100922\" class=\" form-control\" id=\"fld_3100922_1\" name=\"fld_3100922\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_3100922Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_2237250\" class=\"form-group\" id=\"fld_2237250_1-wrap\">\r\n\t<label id=\"fld_2237250Label\" for=\"fld_2237250_1\" class=\"control-label\">V\u011bk <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_2237250\" class=\" form-control\" id=\"fld_2237250_1\" name=\"fld_2237250\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_2237250Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_208875\" class=\"form-group\" id=\"fld_208875_1-wrap\">\r\n\t<label id=\"fld_208875Label\" for=\"fld_208875_1\" class=\"control-label\">Telefon ( +420 xxx xxx xxx ) <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input  data-inputmask=\"'mask': '+999 999 999 999'\"  required type=\"phone\" data-field=\"fld_208875\" class=\" form-control\" id=\"fld_208875_1\" name=\"fld_208875\" value=\"\" data-type=\"phone\" aria-required=\"true\"   aria-labelledby=\"fld_208875Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_1165572\" class=\"form-group\" id=\"fld_1165572_1-wrap\">\r\n\t<label id=\"fld_1165572Label\" for=\"fld_1165572_1\" class=\"control-label\">Email <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"email\" data-field=\"fld_1165572\" class=\" form-control\" id=\"fld_1165572_1\" name=\"fld_1165572\" value=\"\" data-type=\"email\" aria-required=\"true\"   aria-labelledby=\"fld_1165572Label\" >\t\t\t<\/div>\r\n<\/div>\r\n\n<div data-field-wrapper=\"fld_4854731\" class=\"form-group\" id=\"fld_4854731_1-wrap\">\r\n\t<label id=\"fld_4854731Label\" for=\"fld_4854731_1\" class=\"control-label\">Datum zah\u00e1jen\u00ed semin\u00e1\u0159e <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input  type=\"text\" data-provide=\"cfdatepicker\" name=\"fld_4854731\" value=\"\" id=\"fld_4854731_1\" data-field=\"fld_4854731\" class=\"form-control cfdatepicker is-cfdatepicker\" data-date-format=\"dd.mm.yyyy\" required=\"1\" data-date-start-view=\"month\" data-date-language=\"cs\"   aria-labelledby=\"fld_4854731Label\" required  \/>\n\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF586f9bf506b91_1-row-3\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p><\/p>\n<div style=\"font-size: 18px; text-decoration: underline;\">Zdravotn\u00ed stav - Jestli\u017ee je odpov\u011b\u010f kladn\u00e1, ozna\u010dte [ Ano ]<\/div>\n<p><\/p>\n<\/div><\/div><\/div><div id=\"CF586f9bf506b91_1-row-4\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_6727515\" class=\"form-group red cf-toggle-switch\" id=\"fld_6727515_1-wrap\">\r\n\t<label id=\"fld_6727515Label\" for=\"fld_6727515_1\" class=\"control-label\">Menopauza<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_6727515_1_opt1113579\" data-label=\"Ano\" data-field=\"fld_6727515\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_6727515Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_6727515_1_opt1406619\" data-label=\"Ne\" data-field=\"fld_6727515\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_6727515Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6727515_1_opt1113579\" data-label=\"Ano\" data-field=\"fld_6727515\" data-ref=\"fld_6727515_1_opt1113579\" class=\"cf-toggle-group-radio fld_6727515_1\" name=\"fld_6727515\" value=\"Ano\"  data-radio-field=\"fld_6727515_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6727515_1_opt1406619\" data-label=\"Ne\" data-field=\"fld_6727515\" data-ref=\"fld_6727515_1_opt1406619\" class=\"cf-toggle-group-radio fld_6727515_1\" name=\"fld_6727515\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_6727515_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_6675532\" class=\"form-group cf-toggle-switch\" id=\"fld_6675532_1-wrap\">\r\n\t<label id=\"fld_6675532Label\" for=\"fld_6675532_1\" class=\"control-label\">F\u00e1ze p\u0159ed menopauzou<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_6675532_1_opt1295020\" data-label=\"Ano\" data-field=\"fld_6675532\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_6675532Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_6675532_1_opt1221702\" data-label=\"Ne\" data-field=\"fld_6675532\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_6675532Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6675532_1_opt1295020\" data-label=\"Ano\" data-field=\"fld_6675532\" data-ref=\"fld_6675532_1_opt1295020\" class=\"cf-toggle-group-radio fld_6675532_1\" name=\"fld_6675532\" value=\"Ano\"  data-radio-field=\"fld_6675532_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6675532_1_opt1221702\" data-label=\"Ne\" data-field=\"fld_6675532\" data-ref=\"fld_6675532_1_opt1221702\" class=\"cf-toggle-group-radio fld_6675532_1\" name=\"fld_6675532\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_6675532_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7030524\" class=\"form-group cf-toggle-switch\" id=\"fld_7030524_1-wrap\">\r\n\t<label id=\"fld_7030524Label\" for=\"fld_7030524_1\" class=\"control-label\">P\u0159ed\u010dasn\u00e1 menopauza<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_7030524_1_opt1067062\" data-label=\"Ano\" data-field=\"fld_7030524\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_7030524Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_7030524_1_opt1838035\" data-label=\"Ne\" data-field=\"fld_7030524\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_7030524Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7030524_1_opt1067062\" data-label=\"Ano\" data-field=\"fld_7030524\" data-ref=\"fld_7030524_1_opt1067062\" class=\"cf-toggle-group-radio fld_7030524_1\" name=\"fld_7030524\" value=\"Ano\"  data-radio-field=\"fld_7030524_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7030524_1_opt1838035\" data-label=\"Ne\" data-field=\"fld_7030524\" data-ref=\"fld_7030524_1_opt1838035\" class=\"cf-toggle-group-radio fld_7030524_1\" name=\"fld_7030524\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_7030524_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_2046182\" class=\"form-group cf-toggle-switch\" id=\"fld_2046182_1-wrap\">\r\n\t<label id=\"fld_2046182Label\" for=\"fld_2046182_1\" class=\"control-label\">F\u00e1ze po menopauze<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_2046182_1_opt1548766\" data-label=\"Ano\" data-field=\"fld_2046182\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_2046182Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_2046182_1_opt1636483\" data-label=\"Ne\" data-field=\"fld_2046182\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_2046182Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_2046182_1_opt1548766\" data-label=\"Ano\" data-field=\"fld_2046182\" data-ref=\"fld_2046182_1_opt1548766\" class=\"cf-toggle-group-radio fld_2046182_1\" name=\"fld_2046182\" value=\"Ano\"  data-radio-field=\"fld_2046182_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_2046182_1_opt1636483\" data-label=\"Ne\" data-field=\"fld_2046182\" data-ref=\"fld_2046182_1_opt1636483\" class=\"cf-toggle-group-radio fld_2046182_1\" name=\"fld_2046182\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_2046182_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_8065865\" class=\"form-group cf-toggle-switch\" id=\"fld_8065865_1-wrap\">\r\n\t<label id=\"fld_8065865Label\" for=\"fld_8065865_1\" class=\"control-label\">Hysterektomie<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_8065865_1_opt1751842\" data-label=\"Ano\" data-field=\"fld_8065865\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_8065865Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_8065865_1_opt1379109\" data-label=\"Ne\" data-field=\"fld_8065865\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_8065865Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_8065865_1_opt1751842\" data-label=\"Ano\" data-field=\"fld_8065865\" data-ref=\"fld_8065865_1_opt1751842\" class=\"cf-toggle-group-radio fld_8065865_1\" name=\"fld_8065865\" value=\"Ano\"  data-radio-field=\"fld_8065865_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_8065865_1_opt1379109\" data-label=\"Ne\" data-field=\"fld_8065865\" data-ref=\"fld_8065865_1_opt1379109\" class=\"cf-toggle-group-radio fld_8065865_1\" name=\"fld_8065865\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_8065865_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9485823\" class=\"form-group cf-toggle-switch\" id=\"fld_9485823_1-wrap\">\r\n\t<label id=\"fld_9485823Label\" for=\"fld_9485823_1\" class=\"control-label\">M\u00e1te vaje\u010dn\u00edky ?<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_9485823_1_opt1570268\" data-label=\"Ano\" data-field=\"fld_9485823\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_9485823Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_9485823_1_opt1714075\" data-label=\"Ne\" data-field=\"fld_9485823\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_9485823Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9485823_1_opt1570268\" data-label=\"Ano\" data-field=\"fld_9485823\" data-ref=\"fld_9485823_1_opt1570268\" class=\"cf-toggle-group-radio fld_9485823_1\" name=\"fld_9485823\" value=\"Ano\"  data-radio-field=\"fld_9485823_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9485823_1_opt1714075\" data-label=\"Ne\" data-field=\"fld_9485823\" data-ref=\"fld_9485823_1_opt1714075\" class=\"cf-toggle-group-radio fld_9485823_1\" name=\"fld_9485823\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_9485823_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7957380\" class=\"form-group cf-toggle-switch\" id=\"fld_7957380_1-wrap\">\r\n\t<label id=\"fld_7957380Label\" for=\"fld_7957380_1\" class=\"control-label\">Zv\u00fd\u0161en\u00e1 krv\u00e1civost<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_7957380_1_opt1424325\" data-label=\"Ano\" data-field=\"fld_7957380\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_7957380Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_7957380_1_opt1056491\" data-label=\"Ne\" data-field=\"fld_7957380\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_7957380Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7957380_1_opt1424325\" data-label=\"Ano\" data-field=\"fld_7957380\" data-ref=\"fld_7957380_1_opt1424325\" class=\"cf-toggle-group-radio fld_7957380_1\" name=\"fld_7957380\" value=\"Ano\"  data-radio-field=\"fld_7957380_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7957380_1_opt1056491\" data-label=\"Ne\" data-field=\"fld_7957380\" data-ref=\"fld_7957380_1_opt1056491\" class=\"cf-toggle-group-radio fld_7957380_1\" name=\"fld_7957380\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_7957380_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_3122694\" class=\"form-group cf-toggle-switch\" id=\"fld_3122694_1-wrap\">\r\n\t<label id=\"fld_3122694Label\" for=\"fld_3122694_1\" class=\"control-label\">Polycystick\u00e9 vaje\u010dn\u00edky<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_3122694_1_opt1316534\" data-label=\"Ano\" data-field=\"fld_3122694\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_3122694Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_3122694_1_opt1117297\" data-label=\"Ne\" data-field=\"fld_3122694\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_3122694Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_3122694_1_opt1316534\" data-label=\"Ano\" data-field=\"fld_3122694\" data-ref=\"fld_3122694_1_opt1316534\" class=\"cf-toggle-group-radio fld_3122694_1\" name=\"fld_3122694\" value=\"Ano\"  data-radio-field=\"fld_3122694_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_3122694_1_opt1117297\" data-label=\"Ne\" data-field=\"fld_3122694\" data-ref=\"fld_3122694_1_opt1117297\" class=\"cf-toggle-group-radio fld_3122694_1\" name=\"fld_3122694\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_3122694_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_3353021\" class=\"form-group cf-toggle-switch\" id=\"fld_3353021_1-wrap\">\r\n\t<label id=\"fld_3353021Label\" for=\"fld_3353021_1\" class=\"control-label\">Cysty na vaje\u010dn\u00edc\u00edch<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_3353021_1_opt1652878\" data-label=\"Ano\" data-field=\"fld_3353021\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_3353021Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_3353021_1_opt1630093\" data-label=\"Ne\" data-field=\"fld_3353021\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_3353021Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_3353021_1_opt1652878\" data-label=\"Ano\" data-field=\"fld_3353021\" data-ref=\"fld_3353021_1_opt1652878\" class=\"cf-toggle-group-radio fld_3353021_1\" name=\"fld_3353021\" value=\"Ano\"  data-radio-field=\"fld_3353021_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_3353021_1_opt1630093\" data-label=\"Ne\" data-field=\"fld_3353021\" data-ref=\"fld_3353021_1_opt1630093\" class=\"cf-toggle-group-radio fld_3353021_1\" name=\"fld_3353021\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_3353021_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_6935497\" class=\"form-group cf-toggle-switch\" id=\"fld_6935497_1-wrap\">\r\n\t<label id=\"fld_6935497Label\" for=\"fld_6935497_1\" class=\"control-label\">Myom<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_6935497_1_opt1351653\" data-label=\"Ano\" data-field=\"fld_6935497\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_6935497Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_6935497_1_opt2063162\" data-label=\"|Ne\" data-field=\"fld_6935497\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_6935497Label\" title=\"Choose Option|Ne\">|Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6935497_1_opt1351653\" data-label=\"Ano\" data-field=\"fld_6935497\" data-ref=\"fld_6935497_1_opt1351653\" class=\"cf-toggle-group-radio fld_6935497_1\" name=\"fld_6935497\" value=\"Ano\"  data-radio-field=\"fld_6935497_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6935497_1_opt2063162\" data-label=\"|Ne\" data-field=\"fld_6935497\" data-ref=\"fld_6935497_1_opt2063162\" class=\"cf-toggle-group-radio fld_6935497_1\" name=\"fld_6935497\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_6935497_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_3566842\" class=\"form-group cf-toggle-switch\" id=\"fld_3566842_1-wrap\">\r\n\t<label id=\"fld_3566842Label\" for=\"fld_3566842_1\" class=\"control-label\">Neplodnost<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_3566842_1_opt1615980\" data-label=\"Ano\" data-field=\"fld_3566842\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_3566842Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_3566842_1_opt1065843\" data-label=\"Ne\" data-field=\"fld_3566842\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_3566842Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_3566842_1_opt1615980\" data-label=\"Ano\" data-field=\"fld_3566842\" data-ref=\"fld_3566842_1_opt1615980\" class=\"cf-toggle-group-radio fld_3566842_1\" name=\"fld_3566842\" value=\"Ano\"  data-radio-field=\"fld_3566842_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_3566842_1_opt1065843\" data-label=\"Ne\" data-field=\"fld_3566842\" data-ref=\"fld_3566842_1_opt1065843\" class=\"cf-toggle-group-radio fld_3566842_1\" name=\"fld_3566842\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_3566842_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7095172\" class=\"form-group cf-toggle-switch\" id=\"fld_7095172_1-wrap\">\r\n\t<label id=\"fld_7095172Label\" for=\"fld_7095172_1\" class=\"control-label\">PMS premenstrua\u010dn\u00ed syndrom<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_7095172_1_opt1437941\" data-label=\"Ano\" data-field=\"fld_7095172\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_7095172Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_7095172_1_opt1520727\" data-label=\"Ne\" data-field=\"fld_7095172\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_7095172Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7095172_1_opt1437941\" data-label=\"Ano\" data-field=\"fld_7095172\" data-ref=\"fld_7095172_1_opt1437941\" class=\"cf-toggle-group-radio fld_7095172_1\" name=\"fld_7095172\" value=\"Ano\"  data-radio-field=\"fld_7095172_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7095172_1_opt1520727\" data-label=\"Ne\" data-field=\"fld_7095172\" data-ref=\"fld_7095172_1_opt1520727\" class=\"cf-toggle-group-radio fld_7095172_1\" name=\"fld_7095172\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_7095172_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7441975\" class=\"form-group cf-toggle-switch\" id=\"fld_7441975_1-wrap\">\r\n\t<label id=\"fld_7441975Label\" for=\"fld_7441975_1\" class=\"control-label\">Rakovina prsu<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_7441975_1_opt1284863\" data-label=\"Ano\" data-field=\"fld_7441975\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_7441975Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_7441975_1_opt1152139\" data-label=\"Ne\" data-field=\"fld_7441975\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_7441975Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7441975_1_opt1284863\" data-label=\"Ano\" data-field=\"fld_7441975\" data-ref=\"fld_7441975_1_opt1284863\" class=\"cf-toggle-group-radio fld_7441975_1\" name=\"fld_7441975\" value=\"Ano\"  data-radio-field=\"fld_7441975_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_7441975_1_opt1152139\" data-label=\"Ne\" data-field=\"fld_7441975\" data-ref=\"fld_7441975_1_opt1152139\" class=\"cf-toggle-group-radio fld_7441975_1\" name=\"fld_7441975\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_7441975_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9064464\" class=\"form-group cf-toggle-switch\" id=\"fld_9064464_1-wrap\">\r\n\t<label id=\"fld_9064464Label\" for=\"fld_9064464_1\" class=\"control-label\">Endometri\u00f3za<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_9064464_1_opt1771179\" data-label=\"Ano\" data-field=\"fld_9064464\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_9064464Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_9064464_1_opt1603723\" data-label=\"Ne\" data-field=\"fld_9064464\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_9064464Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9064464_1_opt1771179\" data-label=\"Ano\" data-field=\"fld_9064464\" data-ref=\"fld_9064464_1_opt1771179\" class=\"cf-toggle-group-radio fld_9064464_1\" name=\"fld_9064464\" value=\"Ano\"  data-radio-field=\"fld_9064464_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9064464_1_opt1603723\" data-label=\"Ne\" data-field=\"fld_9064464\" data-ref=\"fld_9064464_1_opt1603723\" class=\"cf-toggle-group-radio fld_9064464_1\" name=\"fld_9064464\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_9064464_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_1043973\" class=\"form-group cf-toggle-switch\" id=\"fld_1043973_1-wrap\">\r\n\t<label id=\"fld_1043973Label\" for=\"fld_1043973_1\" class=\"control-label\">Cukrovka<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_1043973_1_opt2074274\" data-label=\"Ano\" data-field=\"fld_1043973\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_1043973Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_1043973_1_opt1914421\" data-label=\"Ne\" data-field=\"fld_1043973\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"|Ne\"  aria-labelledby=\"fld_1043973Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_1043973_1_opt2074274\" data-label=\"Ano\" data-field=\"fld_1043973\" data-ref=\"fld_1043973_1_opt2074274\" class=\"cf-toggle-group-radio fld_1043973_1\" name=\"fld_1043973\" value=\"Ano\"  data-radio-field=\"fld_1043973_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_1043973_1_opt1914421\" data-label=\"Ne\" data-field=\"fld_1043973\" data-ref=\"fld_1043973_1_opt1914421\" class=\"cf-toggle-group-radio fld_1043973_1\" name=\"fld_1043973\" value=\"|Ne\" checked=\"checked\" data-radio-field=\"fld_1043973_1\" data-calc-value=\"|Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_1867058\" class=\"form-group cf-toggle-switch\" id=\"fld_1867058_1-wrap\">\r\n\t<label id=\"fld_1867058Label\" for=\"fld_1867058_1\" class=\"control-label\">Vysok\u00fd tlak<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_1867058_1_opt1400404\" data-label=\"Ano\" data-field=\"fld_1867058\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_1867058Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_1867058_1_opt1539705\" data-label=\"Ne\" data-field=\"fld_1867058\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_1867058Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_1867058_1_opt1400404\" data-label=\"Ano\" data-field=\"fld_1867058\" data-ref=\"fld_1867058_1_opt1400404\" class=\"cf-toggle-group-radio fld_1867058_1\" name=\"fld_1867058\" value=\"Ano\"  data-radio-field=\"fld_1867058_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_1867058_1_opt1539705\" data-label=\"Ne\" data-field=\"fld_1867058\" data-ref=\"fld_1867058_1_opt1539705\" class=\"cf-toggle-group-radio fld_1867058_1\" name=\"fld_1867058\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_1867058_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_8218561\" class=\"form-group cf-toggle-switch\" id=\"fld_8218561_1-wrap\">\r\n\t<label id=\"fld_8218561Label\" for=\"fld_8218561_1\" class=\"control-label\">Osteopenie<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_8218561_1_opt1063109\" data-label=\"Ano\" data-field=\"fld_8218561\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_8218561Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_8218561_1_opt1411389\" data-label=\"Ne\" data-field=\"fld_8218561\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_8218561Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_8218561_1_opt1063109\" data-label=\"Ano\" data-field=\"fld_8218561\" data-ref=\"fld_8218561_1_opt1063109\" class=\"cf-toggle-group-radio fld_8218561_1\" name=\"fld_8218561\" value=\"Ano\"  data-radio-field=\"fld_8218561_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_8218561_1_opt1411389\" data-label=\"Ne\" data-field=\"fld_8218561\" data-ref=\"fld_8218561_1_opt1411389\" class=\"cf-toggle-group-radio fld_8218561_1\" name=\"fld_8218561\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_8218561_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_4409871\" class=\"form-group cf-toggle-switch\" id=\"fld_4409871_1-wrap\">\r\n\t<label id=\"fld_4409871Label\" for=\"fld_4409871_1\" class=\"control-label\">Osteopor\u00f3za<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_4409871_1_opt1969740\" data-label=\"Ano\" data-field=\"fld_4409871\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_4409871Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_4409871_1_opt1869361\" data-label=\"Ne\" data-field=\"fld_4409871\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_4409871Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_4409871_1_opt1969740\" data-label=\"Ano\" data-field=\"fld_4409871\" data-ref=\"fld_4409871_1_opt1969740\" class=\"cf-toggle-group-radio fld_4409871_1\" name=\"fld_4409871\" value=\"Ano\"  data-radio-field=\"fld_4409871_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_4409871_1_opt1869361\" data-label=\"Ne\" data-field=\"fld_4409871\" data-ref=\"fld_4409871_1_opt1869361\" class=\"cf-toggle-group-radio fld_4409871_1\" name=\"fld_4409871\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_4409871_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_6270580\" class=\"form-group cf-toggle-switch\" id=\"fld_6270580_1-wrap\">\r\n\t<label id=\"fld_6270580Label\" for=\"fld_6270580_1\" class=\"control-label\">Zv\u00fd\u0161en\u00fd cholesterol<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_6270580_1_opt1324077\" data-label=\"Ano\" data-field=\"fld_6270580\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_6270580Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_6270580_1_opt1434936\" data-label=\"Ne\" data-field=\"fld_6270580\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_6270580Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6270580_1_opt1324077\" data-label=\"Ano\" data-field=\"fld_6270580\" data-ref=\"fld_6270580_1_opt1324077\" class=\"cf-toggle-group-radio fld_6270580_1\" name=\"fld_6270580\" value=\"Ano\"  data-radio-field=\"fld_6270580_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6270580_1_opt1434936\" data-label=\"Ne\" data-field=\"fld_6270580\" data-ref=\"fld_6270580_1_opt1434936\" class=\"cf-toggle-group-radio fld_6270580_1\" name=\"fld_6270580\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_6270580_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9723074\" class=\"form-group cf-toggle-switch\" id=\"fld_9723074_1-wrap\">\r\n\t<label id=\"fld_9723074Label\" for=\"fld_9723074_1\" class=\"control-label\">Sn\u00ed\u017een\u00e1 funkce \u0161t\u00edtn\u00e9 \u017el\u00e1zy<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_9723074_1_opt1101282\" data-label=\"Ano\" data-field=\"fld_9723074\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_9723074Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_9723074_1_opt1947668\" data-label=\"Ne\" data-field=\"fld_9723074\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_9723074Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9723074_1_opt1101282\" data-label=\"Ano\" data-field=\"fld_9723074\" data-ref=\"fld_9723074_1_opt1101282\" class=\"cf-toggle-group-radio fld_9723074_1\" name=\"fld_9723074\" value=\"Ano\"  data-radio-field=\"fld_9723074_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9723074_1_opt1947668\" data-label=\"Ne\" data-field=\"fld_9723074\" data-ref=\"fld_9723074_1_opt1947668\" class=\"cf-toggle-group-radio fld_9723074_1\" name=\"fld_9723074\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_9723074_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_2092030\" class=\"form-group cf-toggle-switch\" id=\"fld_2092030_1-wrap\">\r\n\t<label id=\"fld_2092030Label\" for=\"fld_2092030_1\" class=\"control-label\">Zv\u00fd\u0161en\u00e1 funkce \u0161t\u00edtn\u00e9 \u017el\u00e1zy<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_2092030_1_opt1466213\" data-label=\"Ano\" data-field=\"fld_2092030\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_2092030Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_2092030_1_opt1756022\" data-label=\"Ne\" data-field=\"fld_2092030\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_2092030Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_2092030_1_opt1466213\" data-label=\"Ano\" data-field=\"fld_2092030\" data-ref=\"fld_2092030_1_opt1466213\" class=\"cf-toggle-group-radio fld_2092030_1\" name=\"fld_2092030\" value=\"Ano\"  data-radio-field=\"fld_2092030_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_2092030_1_opt1756022\" data-label=\"Ne\" data-field=\"fld_2092030\" data-ref=\"fld_2092030_1_opt1756022\" class=\"cf-toggle-group-radio fld_2092030_1\" name=\"fld_2092030\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_2092030_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9729870\" class=\"form-group cf-toggle-switch\" id=\"fld_9729870_1-wrap\">\r\n\t<label id=\"fld_9729870Label\" for=\"fld_9729870_1\" class=\"control-label\">Artritida (z\u00e1n\u011btliv\u00e9 onemocn\u011bn\u00ed kloub\u016f)<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_9729870_1_opt1507233\" data-label=\"Ano\" data-field=\"fld_9729870\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_9729870Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_9729870_1_opt1407670\" data-label=\"Ne\" data-field=\"fld_9729870\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_9729870Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9729870_1_opt1507233\" data-label=\"Ano\" data-field=\"fld_9729870\" data-ref=\"fld_9729870_1_opt1507233\" class=\"cf-toggle-group-radio fld_9729870_1\" name=\"fld_9729870\" value=\"Ano\"  data-radio-field=\"fld_9729870_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9729870_1_opt1407670\" data-label=\"Ne\" data-field=\"fld_9729870\" data-ref=\"fld_9729870_1_opt1407670\" class=\"cf-toggle-group-radio fld_9729870_1\" name=\"fld_9729870\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_9729870_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9617634\" class=\"form-group cf-toggle-switch\" id=\"fld_9617634_1-wrap\">\r\n\t<label id=\"fld_9617634Label\" for=\"fld_9617634_1\" class=\"control-label\">Z\u00e1n\u011bt \u0161lach<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_9617634_1_opt1879673\" data-label=\"Ano\" data-field=\"fld_9617634\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_9617634Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_9617634_1_opt1464417\" data-label=\"Ne\" data-field=\"fld_9617634\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_9617634Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9617634_1_opt1879673\" data-label=\"Ano\" data-field=\"fld_9617634\" data-ref=\"fld_9617634_1_opt1879673\" class=\"cf-toggle-group-radio fld_9617634_1\" name=\"fld_9617634\" value=\"Ano\"  data-radio-field=\"fld_9617634_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9617634_1_opt1464417\" data-label=\"Ne\" data-field=\"fld_9617634\" data-ref=\"fld_9617634_1_opt1464417\" class=\"cf-toggle-group-radio fld_9617634_1\" name=\"fld_9617634\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_9617634_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_5970628\" class=\"form-group cf-toggle-switch\" id=\"fld_5970628_1-wrap\">\r\n\t<label id=\"fld_5970628Label\" for=\"fld_5970628_1\" class=\"control-label\">Z\u00e1n\u011bt nosn\u00ed sliznice<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_5970628_1_opt1145561\" data-label=\"Ano\" data-field=\"fld_5970628\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Abno\"  aria-labelledby=\"fld_5970628Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_5970628_1_opt1780285\" data-label=\"Ne\" data-field=\"fld_5970628\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_5970628Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_5970628_1_opt1145561\" data-label=\"Ano\" data-field=\"fld_5970628\" data-ref=\"fld_5970628_1_opt1145561\" class=\"cf-toggle-group-radio fld_5970628_1\" name=\"fld_5970628\" value=\"Abno\"  data-radio-field=\"fld_5970628_1\" data-calc-value=\"Abno\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_5970628_1_opt1780285\" data-label=\"Ne\" data-field=\"fld_5970628\" data-ref=\"fld_5970628_1_opt1780285\" class=\"cf-toggle-group-radio fld_5970628_1\" name=\"fld_5970628\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_5970628_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_468433\" class=\"form-group cf-toggle-switch\" id=\"fld_468433_1-wrap\">\r\n\t<label id=\"fld_468433Label\" for=\"fld_468433_1\" class=\"control-label\">Probl\u00e9my s kr\u010dn\u00ed p\u00e1te\u0159\u00ed<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_468433_1_opt1250172\" data-label=\"Ano\" data-field=\"fld_468433\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_468433Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_468433_1_opt1934205\" data-label=\"Ne\" data-field=\"fld_468433\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_468433Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_468433_1_opt1250172\" data-label=\"Ano\" data-field=\"fld_468433\" data-ref=\"fld_468433_1_opt1250172\" class=\"cf-toggle-group-radio fld_468433_1\" name=\"fld_468433\" value=\"Ano\"  data-radio-field=\"fld_468433_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_468433_1_opt1934205\" data-label=\"Ne\" data-field=\"fld_468433\" data-ref=\"fld_468433_1_opt1934205\" class=\"cf-toggle-group-radio fld_468433_1\" name=\"fld_468433\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_468433_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_6847654\" class=\"form-group cf-toggle-switch\" id=\"fld_6847654_1-wrap\">\r\n\t<label id=\"fld_6847654Label\" for=\"fld_6847654_1\" class=\"control-label\">Zv\u011bt\u0161en\u00e1 kyf\u00f3za<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_6847654_1_opt1538679\" data-label=\"Ano\" data-field=\"fld_6847654\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_6847654Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_6847654_1_opt1446822\" data-label=\"Ne\" data-field=\"fld_6847654\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_6847654Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6847654_1_opt1538679\" data-label=\"Ano\" data-field=\"fld_6847654\" data-ref=\"fld_6847654_1_opt1538679\" class=\"cf-toggle-group-radio fld_6847654_1\" name=\"fld_6847654\" value=\"Ano\"  data-radio-field=\"fld_6847654_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_6847654_1_opt1446822\" data-label=\"Ne\" data-field=\"fld_6847654\" data-ref=\"fld_6847654_1_opt1446822\" class=\"cf-toggle-group-radio fld_6847654_1\" name=\"fld_6847654\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_6847654_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_8336273\" class=\"form-group cf-toggle-switch\" id=\"fld_8336273_1-wrap\">\r\n\t<label id=\"fld_8336273Label\" for=\"fld_8336273_1\" class=\"control-label\">Zv\u011bt\u0161en\u00e1 lord\u00f3za<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_8336273_1_opt1398897\" data-label=\"Ano\" data-field=\"fld_8336273\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_8336273Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_8336273_1_opt1787729\" data-label=\"Ne\" data-field=\"fld_8336273\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_8336273Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_8336273_1_opt1398897\" data-label=\"Ano\" data-field=\"fld_8336273\" data-ref=\"fld_8336273_1_opt1398897\" class=\"cf-toggle-group-radio fld_8336273_1\" name=\"fld_8336273\" value=\"Ano\"  data-radio-field=\"fld_8336273_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_8336273_1_opt1787729\" data-label=\"Ne\" data-field=\"fld_8336273\" data-ref=\"fld_8336273_1_opt1787729\" class=\"cf-toggle-group-radio fld_8336273_1\" name=\"fld_8336273\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_8336273_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_1569866\" class=\"form-group cf-toggle-switch\" id=\"fld_1569866_1-wrap\">\r\n\t<label id=\"fld_1569866Label\" for=\"fld_1569866_1\" class=\"control-label\">Skoli\u00f3za<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_1569866_1_opt1276017\" data-label=\"Ano\" data-field=\"fld_1569866\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_1569866Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_1569866_1_opt1413816\" data-label=\"Ne\" data-field=\"fld_1569866\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_1569866Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_1569866_1_opt1276017\" data-label=\"Ano\" data-field=\"fld_1569866\" data-ref=\"fld_1569866_1_opt1276017\" class=\"cf-toggle-group-radio fld_1569866_1\" name=\"fld_1569866\" value=\"Ano\"  data-radio-field=\"fld_1569866_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_1569866_1_opt1413816\" data-label=\"Ne\" data-field=\"fld_1569866\" data-ref=\"fld_1569866_1_opt1413816\" class=\"cf-toggle-group-radio fld_1569866_1\" name=\"fld_1569866\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_1569866_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_9287520\" class=\"form-group cf-toggle-switch\" id=\"fld_9287520_1-wrap\">\r\n\t<label id=\"fld_9287520Label\" for=\"fld_9287520_1\" class=\"control-label\">Hormon\u00e1ln\u00ed l\u00e9\u010dba<\/label>\r\n\t<div class=\"\">\r\n\t<div class=\"caldera-config-field init_field_type\" data-type=\"toggle_button\">\n\t\t<div class=\"cf-toggle-group-buttons btn-group\">\n\t\t\t<a id=\"fld_9287520_1_opt1402291\" data-label=\"Ano\" data-field=\"fld_9287520\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-default\" data-value=\"Ano\"  aria-labelledby=\"fld_9287520Label\" title=\"Choose OptionAno\">Ano<\/a><a id=\"fld_9287520_1_opt1908403\" data-label=\"Ne\" data-field=\"fld_9287520\" data-active=\"btn-success\" data-default=\"btn-default\" class=\"btn btn-success\" data-value=\"Ne\"  aria-labelledby=\"fld_9287520Label\" title=\"Choose OptionNe\">Ne<\/a>\t\t\n\t\t<\/div>\n\t\t<div style=\"display:none;\" aria-hidden=\"true\">\n\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9287520_1_opt1402291\" data-label=\"Ano\" data-field=\"fld_9287520\" data-ref=\"fld_9287520_1_opt1402291\" class=\"cf-toggle-group-radio fld_9287520_1\" name=\"fld_9287520\" value=\"Ano\"  data-radio-field=\"fld_9287520_1\" data-calc-value=\"Ano\" >\n\t\t\t\t\t\t\t\t<input  type=\"radio\" id=\"fld_9287520_1_opt1908403\" data-label=\"Ne\" data-field=\"fld_9287520\" data-ref=\"fld_9287520_1_opt1908403\" class=\"cf-toggle-group-radio fld_9287520_1\" name=\"fld_9287520\" value=\"Ne\" checked=\"checked\" data-radio-field=\"fld_9287520_1\" data-calc-value=\"Ne\" >\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF586f9bf506b91_1-row-5\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p><\/p>\n<div style=\"font-size: 18px; text-decoration: underline;\">Symptomy - Zhodno\u0165te intenzitu od 0, 1, 2, do 3.<\/div>\n<p><\/p>\n<\/div><\/div><\/div><div id=\"CF586f9bf506b91_1-row-6\"  class=\"row \"><div  class=\"col-sm-3  first_col\"><style>\n#s2id_fld_2891132_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_2891132_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_2891132_1.ccselect2-drop-active,\n.s2id_fld_2891132_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_2891132_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_2891132_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_2891132_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_2891132_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_2891132_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_2891132_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_2891132_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_2891132_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_2891132_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_2891132_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_2891132\" class=\"form-group\" id=\"fld_2891132_1-wrap\">\r\n\t<label id=\"fld_2891132Label\" for=\"fld_2891132_1\" class=\"control-label\">N\u00e1valy horka<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_2891132_1\"  data-select-two=\"true\" data-field=\"fld_2891132\" class=\"form-control\" name=\"fld_2891132\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_4763804_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_4763804_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_4763804_1.ccselect2-drop-active,\n.s2id_fld_4763804_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_4763804_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_4763804_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_4763804_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_4763804_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_4763804_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_4763804_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_4763804_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_4763804_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_4763804_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_4763804_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_4763804\" class=\"form-group\" id=\"fld_4763804_1-wrap\">\r\n\t<label id=\"fld_4763804Label\" for=\"fld_4763804_1\" class=\"control-label\">Such\u00e1 vagina<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_4763804_1\"  data-select-two=\"true\" data-field=\"fld_4763804\" class=\"form-control\" name=\"fld_4763804\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_8478517_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_8478517_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_8478517_1.ccselect2-drop-active,\n.s2id_fld_8478517_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_8478517_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_8478517_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_8478517_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_8478517_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_8478517_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_8478517_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_8478517_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_8478517_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_8478517_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_8478517_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_8478517\" class=\"form-group\" id=\"fld_8478517_1-wrap\">\r\n\t<label id=\"fld_8478517Label\" for=\"fld_8478517_1\" class=\"control-label\">Sv\u011bd\u011bn\u00ed vaginy<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_8478517_1\"  data-select-two=\"true\" data-field=\"fld_8478517\" class=\"form-control\" name=\"fld_8478517\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_58409_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_58409_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_58409_1.ccselect2-drop-active,\n.s2id_fld_58409_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_58409_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_58409_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_58409_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_58409_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_58409_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_58409_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_58409_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_58409_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_58409_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_58409_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_58409\" class=\"form-group\" id=\"fld_58409_1-wrap\">\r\n\t<label id=\"fld_58409Label\" for=\"fld_58409_1\" class=\"control-label\">N\u00edzk\u00e9 libido<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_58409_1\"  data-select-two=\"true\" data-field=\"fld_58409\" class=\"form-control\" name=\"fld_58409\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_5674376_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_5674376_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_5674376_1.ccselect2-drop-active,\n.s2id_fld_5674376_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_5674376_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_5674376_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_5674376_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_5674376_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_5674376_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_5674376_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_5674376_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_5674376_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_5674376_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_5674376_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_5674376\" class=\"form-group\" id=\"fld_5674376_1-wrap\">\r\n\t<label id=\"fld_5674376Label\" for=\"fld_5674376_1\" class=\"control-label\">Podr\u00e1\u017ed\u011bnost<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_5674376_1\"  data-select-two=\"true\" data-field=\"fld_5674376\" class=\"form-control\" name=\"fld_5674376\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_7925748_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_7925748_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_7925748_1.ccselect2-drop-active,\n.s2id_fld_7925748_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_7925748_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_7925748_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_7925748_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_7925748_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_7925748_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_7925748_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_7925748_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_7925748_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_7925748_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_7925748_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_7925748\" class=\"form-group\" id=\"fld_7925748_1-wrap\">\r\n\t<label id=\"fld_7925748Label\" for=\"fld_7925748_1\" class=\"control-label\">Nestabiln\u00ed Emoce<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_7925748_1\"  data-select-two=\"true\" data-field=\"fld_7925748\" class=\"form-control\" name=\"fld_7925748\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<\/div><div  class=\"col-sm-3 \"><style>\n#s2id_fld_5670666_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_5670666_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_5670666_1.ccselect2-drop-active,\n.s2id_fld_5670666_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_5670666_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_5670666_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_5670666_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_5670666_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_5670666_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_5670666_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_5670666_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_5670666_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_5670666_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_5670666_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_5670666\" class=\"form-group\" id=\"fld_5670666_1-wrap\">\r\n\t<label id=\"fld_5670666Label\" for=\"fld_5670666_1\" class=\"control-label\">\u00dazkost<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_5670666_1\"  data-select-two=\"true\" data-field=\"fld_5670666\" class=\"form-control\" name=\"fld_5670666\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_6695684_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_6695684_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_6695684_1.ccselect2-drop-active,\n.s2id_fld_6695684_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_6695684_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_6695684_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_6695684_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_6695684_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_6695684_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_6695684_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_6695684_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_6695684_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_6695684_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_6695684_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_6695684\" class=\"form-group\" id=\"fld_6695684_1-wrap\">\r\n\t<label id=\"fld_6695684Label\" for=\"fld_6695684_1\" class=\"control-label\">Tr\u00e1pen\u00ed<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_6695684_1\"  data-select-two=\"true\" data-field=\"fld_6695684\" class=\"form-control\" name=\"fld_6695684\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_4617218_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_4617218_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_4617218_1.ccselect2-drop-active,\n.s2id_fld_4617218_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_4617218_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_4617218_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_4617218_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_4617218_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_4617218_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_4617218_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_4617218_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_4617218_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_4617218_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_4617218_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_4617218\" class=\"form-group\" id=\"fld_4617218_1-wrap\">\r\n\t<label id=\"fld_4617218Label\" for=\"fld_4617218_1\" class=\"control-label\">Bu\u0161en\u00ed srdce<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_4617218_1\"  data-select-two=\"true\" data-field=\"fld_4617218\" class=\"form-control\" name=\"fld_4617218\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_697115_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_697115_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_697115_1.ccselect2-drop-active,\n.s2id_fld_697115_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_697115_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_697115_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_697115_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_697115_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_697115_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_697115_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_697115_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_697115_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_697115_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_697115_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_697115\" class=\"form-group\" id=\"fld_697115_1-wrap\">\r\n\t<label id=\"fld_697115Label\" for=\"fld_697115_1\" class=\"control-label\">\u00danava<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_697115_1\"  data-select-two=\"true\" data-field=\"fld_697115\" class=\"form-control\" name=\"fld_697115\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_1461104_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_1461104_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_1461104_1.ccselect2-drop-active,\n.s2id_fld_1461104_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_1461104_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_1461104_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_1461104_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_1461104_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_1461104_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_1461104_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_1461104_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_1461104_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_1461104_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_1461104_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_1461104\" class=\"form-group\" id=\"fld_1461104_1-wrap\">\r\n\t<label id=\"fld_1461104Label\" for=\"fld_1461104_1\" class=\"control-label\">Skl\u00ed\u010denost<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_1461104_1\"  data-select-two=\"true\" data-field=\"fld_1461104\" class=\"form-control\" name=\"fld_1461104\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_3538160_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_3538160_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_3538160_1.ccselect2-drop-active,\n.s2id_fld_3538160_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_3538160_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_3538160_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_3538160_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_3538160_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_3538160_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_3538160_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_3538160_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_3538160_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_3538160_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_3538160_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_3538160\" class=\"form-group\" id=\"fld_3538160_1-wrap\">\r\n\t<label id=\"fld_3538160Label\" for=\"fld_3538160_1\" class=\"control-label\">Deprese<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_3538160_1\"  data-select-two=\"true\" data-field=\"fld_3538160\" class=\"form-control\" name=\"fld_3538160\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<\/div><div  class=\"col-sm-3 \"><style>\n#s2id_fld_7882162_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_7882162_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_7882162_1.ccselect2-drop-active,\n.s2id_fld_7882162_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_7882162_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_7882162_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_7882162_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_7882162_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_7882162_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_7882162_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_7882162_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_7882162_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_7882162_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_7882162_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_7882162\" class=\"form-group\" id=\"fld_7882162_1-wrap\">\r\n\t<label id=\"fld_7882162Label\" for=\"fld_7882162_1\" class=\"control-label\">Migr\u00e9na<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_7882162_1\"  data-select-two=\"true\" data-field=\"fld_7882162\" class=\"form-control\" name=\"fld_7882162\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_1480948_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_1480948_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_1480948_1.ccselect2-drop-active,\n.s2id_fld_1480948_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_1480948_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_1480948_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_1480948_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_1480948_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_1480948_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_1480948_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_1480948_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_1480948_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_1480948_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_1480948_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_1480948\" class=\"form-group\" id=\"fld_1480948_1-wrap\">\r\n\t<label id=\"fld_1480948Label\" for=\"fld_1480948_1\" class=\"control-label\">Panika<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_1480948_1\"  data-select-two=\"true\" data-field=\"fld_1480948\" class=\"form-control\" name=\"fld_1480948\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_9746160_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_9746160_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_9746160_1.ccselect2-drop-active,\n.s2id_fld_9746160_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_9746160_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_9746160_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_9746160_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_9746160_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_9746160_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_9746160_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_9746160_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_9746160_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_9746160_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_9746160_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_9746160\" class=\"form-group\" id=\"fld_9746160_1-wrap\">\r\n\t<label id=\"fld_9746160Label\" for=\"fld_9746160_1\" class=\"control-label\">Bolest hlavy<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_9746160_1\"  data-select-two=\"true\" data-field=\"fld_9746160\" class=\"form-control\" name=\"fld_9746160\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_1362147_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_1362147_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_1362147_1.ccselect2-drop-active,\n.s2id_fld_1362147_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_1362147_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_1362147_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_1362147_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_1362147_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_1362147_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_1362147_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_1362147_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_1362147_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_1362147_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_1362147_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_1362147\" class=\"form-group\" id=\"fld_1362147_1-wrap\">\r\n\t<label id=\"fld_1362147Label\" for=\"fld_1362147_1\" class=\"control-label\">Bolesti kloub\u016f<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_1362147_1\"  data-select-two=\"true\" data-field=\"fld_1362147\" class=\"form-control\" name=\"fld_1362147\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_23027_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_23027_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_23027_1.ccselect2-drop-active,\n.s2id_fld_23027_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_23027_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_23027_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_23027_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_23027_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_23027_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_23027_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_23027_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_23027_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_23027_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_23027_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_23027\" class=\"form-group\" id=\"fld_23027_1-wrap\">\r\n\t<label id=\"fld_23027Label\" for=\"fld_23027_1\" class=\"control-label\">Sv\u011bd\u011bn\u00ed k\u016f\u017ee<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_23027_1\"  data-select-two=\"true\" data-field=\"fld_23027\" class=\"form-control\" name=\"fld_23027\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_2558526_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_2558526_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_2558526_1.ccselect2-drop-active,\n.s2id_fld_2558526_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_2558526_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_2558526_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_2558526_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_2558526_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_2558526_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_2558526_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_2558526_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_2558526_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_2558526_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_2558526_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_2558526\" class=\"form-group\" id=\"fld_2558526_1-wrap\">\r\n\t<label id=\"fld_2558526Label\" for=\"fld_2558526_1\" class=\"control-label\">Nespavost<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_2558526_1\"  data-select-two=\"true\" data-field=\"fld_2558526\" class=\"form-control\" name=\"fld_2558526\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<\/div><div  class=\"col-sm-3  last_col\"><style>\n#s2id_fld_3716356_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_3716356_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_3716356_1.ccselect2-drop-active,\n.s2id_fld_3716356_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_3716356_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_3716356_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_3716356_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_3716356_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_3716356_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_3716356_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_3716356_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_3716356_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_3716356_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_3716356_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_3716356\" class=\"form-group\" id=\"fld_3716356_1-wrap\">\r\n\t<label id=\"fld_3716356Label\" for=\"fld_3716356_1\" class=\"control-label\">Ztr\u00e1ta \u010dichu<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_3716356_1\"  data-select-two=\"true\" data-field=\"fld_3716356\" class=\"form-control\" name=\"fld_3716356\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_9025996_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_9025996_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_9025996_1.ccselect2-drop-active,\n.s2id_fld_9025996_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_9025996_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_9025996_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_9025996_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_9025996_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_9025996_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_9025996_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_9025996_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_9025996_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_9025996_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_9025996_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_9025996\" class=\"form-group\" id=\"fld_9025996_1-wrap\">\r\n\t<label id=\"fld_9025996Label\" for=\"fld_9025996_1\" class=\"control-label\">Ztr\u00e1ta pam\u011bti<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_9025996_1\"  data-select-two=\"true\" data-field=\"fld_9025996\" class=\"form-control\" name=\"fld_9025996\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_373477_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_373477_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_373477_1.ccselect2-drop-active,\n.s2id_fld_373477_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_373477_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_373477_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_373477_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_373477_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_373477_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_373477_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_373477_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_373477_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_373477_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_373477_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_373477\" class=\"form-group\" id=\"fld_373477_1-wrap\">\r\n\t<label id=\"fld_373477Label\" for=\"fld_373477_1\" class=\"control-label\">Pad\u00e1n\u00ed vlas\u016f<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_373477_1\"  data-select-two=\"true\" data-field=\"fld_373477\" class=\"form-control\" name=\"fld_373477\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_4725462_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_4725462_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_4725462_1.ccselect2-drop-active,\n.s2id_fld_4725462_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_4725462_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_4725462_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_4725462_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_4725462_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_4725462_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_4725462_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_4725462_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_4725462_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_4725462_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_4725462_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_4725462\" class=\"form-group\" id=\"fld_4725462_1-wrap\">\r\n\t<label id=\"fld_4725462Label\" for=\"fld_4725462_1\" class=\"control-label\">Such\u00e1 k\u016f\u017ee<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_4725462_1\"  data-select-two=\"true\" data-field=\"fld_4725462\" class=\"form-control\" name=\"fld_4725462\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_3125027_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_3125027_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_3125027_1.ccselect2-drop-active,\n.s2id_fld_3125027_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_3125027_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_3125027_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_3125027_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_3125027_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_3125027_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_3125027_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_3125027_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_3125027_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_3125027_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_3125027_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_3125027\" class=\"form-group\" id=\"fld_3125027_1-wrap\">\r\n\t<label id=\"fld_3125027Label\" for=\"fld_3125027_1\" class=\"control-label\">L\u00e1mav\u00e9 nehty<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_3125027_1\"  data-select-two=\"true\" data-field=\"fld_3125027\" class=\"form-control\" name=\"fld_3125027\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<style>\n#s2id_fld_3656574_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_3656574_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_3656574_1.ccselect2-drop-active,\n.s2id_fld_3656574_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_3656574_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_3656574_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_3656574_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_3656574_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_3656574_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_3656574_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_3656574_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_3656574_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_3656574_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_3656574_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_3656574\" class=\"form-group\" id=\"fld_3656574_1-wrap\">\r\n\t<label id=\"fld_3656574Label\" for=\"fld_3656574_1\" class=\"control-label\">Pomal\u00e9 my\u0161len\u00ed<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_3656574_1\"  data-select-two=\"true\" data-field=\"fld_3656574\" class=\"form-control\" name=\"fld_3656574\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<\/div><\/div><div id=\"CF586f9bf506b91_1-row-7\"  class=\"row \"><div  class=\"col-sm-12  single\"><style>\n#s2id_fld_7828294_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_7828294_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_7828294_1.ccselect2-drop-active,\n.s2id_fld_7828294_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_7828294_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_7828294_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_7828294_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_7828294_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_7828294_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_7828294_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_7828294_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_7828294_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_7828294_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_7828294_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_7828294\" class=\"form-group\" id=\"fld_7828294_1-wrap\">\r\n\t<label id=\"fld_7828294Label\" for=\"fld_7828294_1\" class=\"control-label\">PMT p\u0159edmenstrua\u010dn\u00ed tenze Emo\u010dn\u00ed nestabilita<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_7828294_1\"  data-select-two=\"true\" data-field=\"fld_7828294\" class=\"form-control\" name=\"fld_7828294\"  >\n\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"0\"\n\t\t\t\t\tvalue=\"0\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\t0\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"1\"\n\t\t\t\t\tvalue=\"1\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t1\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"2\"\n\t\t\t\t\tvalue=\"2\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t2\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"3\"\n\t\t\t\t\tvalue=\"3\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\t3\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<\/div><\/div><div id=\"CF586f9bf506b91_1-row-8\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_1011393\" class=\"form-group\" id=\"fld_1011393_1-wrap\">\r\n\t<label id=\"fld_1011393Label\" for=\"fld_1011393_1\" class=\"control-label\">Jin\u00e9 zdravotn\u00ed komplikace<\/label>\r\n\t<div class=\"\">\r\n\t\t<textarea name=\"fld_1011393\" value=\"\" data-field=\"fld_1011393\" class=\"form-control\" id=\"fld_1011393_1\" rows=\"4\"    aria-labelledby=\"fld_1011393Label\" ><\/textarea>\n\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF586f9bf506b91_1-row-9\"  class=\"row \"><div  class=\"col-sm-12  single\"><style>\n#s2id_fld_893914_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choice,\n#s2id_fld_893914_1.ccselect2-container.ccselect2-dropdown-open .ccselect2-choices,\n.s2id_fld_893914_1.ccselect2-drop-active,\n.s2id_fld_893914_1.ccselect2-drop.ccselect2-drop-above.ccselect2-drop-active,\n.s2id_fld_893914_1.ccselect2-container-active .ccselect2-choice,\n.s2id_fld_893914_1.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_893914_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choice,\n.s2id_fld_893914_1.ccselect2-dropdown-open.ccselect2-drop-above .ccselect2-choices,\n.s2id_fld_893914_1.ccselect2-container-multi.ccselect2-container-active .ccselect2-choices,\n.s2id_fld_893914_1.ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n    border-color: #4b8dc9 !important;\n}\n.s2id_fld_893914_1 .ccselect2-results .ccselect2-highlighted,\n.s2id_fld_893914_1 .ccselect2-container-multi .ccselect2-choices .ccselect2-search-choice-focus{\n\tbackground: #5b9dd9 !important;\n}\n.has-error .s2id_fld_893914_1 .ccselect2-container .ccselect2-choice {\n\tborder-color: #dd4b39 !important;\n\tbackground-color: #f2dede !important;\n\tbackground-image: none;\n}\n<\/style>\n<script>\nwindow.addEventListener('DOMContentLoaded', function(){\n\tjQuery( function($){\n\t\t\t\n\t\tvar opts = {};\n\t\t\n\t\t$(document).on('cf.bind', '#fld_893914_1', function() {\n\t\t\t$(this).select2( opts );\n\t\t});\n\t});\n});\n<\/script>\n<div data-field-wrapper=\"fld_893914\" class=\"form-group\" id=\"fld_893914_1-wrap\">\r\n\t<label id=\"fld_893914Label\" for=\"fld_893914_1\" class=\"control-label\">Kde jste se o HJT dozv\u011bd\u011bla ? <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t<select  id=\"fld_893914_1\"  data-select-two=\"true\" data-field=\"fld_893914\" class=\"form-control\" name=\"fld_893914\" required=\"required\" >\n\t\t<option value=\"\"><\/option>\r\n\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"internet\"\n\t\t\t\t\tvalue=\"internet\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\tz internetu\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"\u010dasopis\"\n\t\t\t\t\tvalue=\"\u010dasopis\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\tz \u010dasopisu\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"kamar\u00e1dka\"\n\t\t\t\t\tvalue=\"kamar\u00e1dka\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\tod kamar\u00e1dky\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"m\u00e9dia\"\n\t\t\t\t\tvalue=\"m\u00e9dia\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\tz m\u00e9di\u00ed\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"jin\u00e9\"\n\t\t\t\t\tvalue=\"jin\u00e9\"\n\t\t\t\t\t\t\t\t\t\t>\n\t\t\t\t\tjin\u00e9\t\t\t\t<\/option>\n\t\t\t\t\t\t\t\t<option\n\t\t\t\t\tdata-calc-value=\"nevybral(a) nic\"\n\t\t\t\t\tvalue=\"nevybral(a) nic\"\n\t\t\t\t\t\t\t\t\t\tselected=\"selected\">\n\t\t\t\t\tvyberte jednu z nab\u00edzen\u00fdch mo\u017enost\u00ed\t\t\t\t<\/option>\n\t\t\t\t\t\t<\/select>\n\t\t\t\t\t<\/div>\r\n<\/div>\r\n\n<\/div><\/div><div id=\"CF586f9bf506b91_1-row-10\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p><\/p>\n<div style=\"text-align: left; font-size: 15px;\">T\u00edmto d\u00e1v\u00e1m souhlas s pou\u017e\u00edv\u00e1n\u00edm m\u00fdch osobn\u00edch dat z tohoto dotazn\u00edku pouze pro pot\u0159ebu Hormon\u00e1ln\u00ed<br \/>\nj\u00f3gov\u00e9 terapie.<br \/>\n<br \/>Data jsou d\u016fv\u011brn\u00e1 a nebudou poskytnuta t\u0159et\u00ed osob\u011b.<br \/>\n<br \/>Tento dotazn\u00edk byl vytvo\u0159en autorkou<br \/>\nHormon\u00e1ln\u00ed j\u00f3gov\u00e9 terapie Dinah Rodrigu\u00e9z.<br \/>\n<br \/>D\u00e1le potvrzuji, \u017ee jsem obdr\u017eela v\u0161echny relevantn\u00ed informace k pr\u016fb\u011bhu semin\u00e1\u0159e a mnou uveden\u00e9 \u00fadaje jsou pravdiv\u00e9 a \u00fapln\u00e9.<br \/>\n<br \/>Potvrzuji, \u017ee se v\u00edkendov\u00e9ho semin\u00e1\u0159e Hormon\u00e1ln\u00ed j\u00f3gov\u00e9 terapie \u00fa\u010dastn\u00edm na vlastn\u00ed riziko.<\/div>\n<\/div><div class=\"\"><p><\/p>\n<div style=\"text-align: left; font-size: 15px; text-decoration: underline;\"><strong>\u00dadaje pro platbu a platebn\u00ed podm\u00ednky :<\/strong><\/div>\n<p><\/p>\n<div style=\"text-align: left; font-size: 15px; text-decoration: none;\">FIO Banka<br \/>\n<br \/>\u010c\u00edslo \u00fa\u010dtu :<strong>  2600687511 \/ 2010<\/strong> <\/p>\n<p>Jako variabiln\u00ed symbol uv\u00e1d\u011bjte :<strong>    datum kon\u00e1n\u00ed semin\u00e1\u0159e<\/strong> ve tvaru DDMMRRRR ( nap\u0159. 7.11.2014 = 07112014 ) , abychom v\u011bd\u011bli na jak\u00fd semin\u00e1\u0159 pod\u00e1v\u00e1te p\u0159ihl\u00e1\u0161ku.<\/p>\n<p>Do zpr\u00e1vy pro p\u0159\u00edjemce <strong>uv\u00e1d\u011bjte va\u0161e p\u0159\u00edjmen\u00ed<\/strong> , jinak nebude Va\u0161e platba identifikov\u00e1na.<\/p>\n<p>Cena kurzu je stanovena ve v\u00fd\u0161i <strong>2 500,00 K\u010d.<\/strong><\/p>\n<p><strong>Z\u00e1loha<\/strong> je stanovena ve v\u00fd\u0161i <strong>1 000,00 K\u010d a je splatn\u00e1 do 5 dn\u016f od odesl\u00e1n\u00ed p\u0159ihl\u00e1\u0161ky.<\/strong> Z\u00e1loha se<br \/>\nzapo\u010d\u00edt\u00e1v\u00e1 do ceny kurzu. <\/p>\n<p><strong>Doplatek<\/strong> kurzu ve v\u00fd\u0161i <strong>1 500,00 K\u010d  je splatn\u00fd nejpozd\u011bji do 14 dn\u016f p\u0159ed zah\u00e1jen\u00edm 1. dne kurzu.<\/strong> <br \/>Nap\u0159. Term\u00edn kon\u00e1n\u00ed kurzu 7.-8.11.2014, doplatek splatn\u00fd ( m\u00e1 b\u00fdt p\u0159ips\u00e1n na \u00fa\u010det p\u0159\u00edjemce )<br \/>\nke dni 23.10.2014.<\/p>\n<p>V p\u0159\u00edpad\u011b p\u0159ihl\u00e1\u0161en\u00ed na kurz m\u00e9n\u011b ne\u017e 14 kalend\u00e1\u0159n\u00edch dn\u016f p\u0159ed zah\u00e1jen\u00edm 1. dne kurzu se hrad\u00ed p\u0159\u00edmo cena kurzu tj. 2 500,00 K\u010d.\n<\/p><\/div>\n<div style=\"text-align: left; font-size: 15px; text-decoration: underline;\"><strong>Storno podm\u00ednky :<\/strong><\/div>\n<div style=\"text-align: left; font-size: 15px; text-decoration: none;\">Potvrzen\u00e1 p\u0159ihl\u00e1\u0161ka na p\u0159\u00edslu\u0161n\u00fd kurz je oboustrann\u011b z\u00e1vazn\u00e1 a jej\u00ed zru\u0161en\u00ed podl\u00e9h\u00e1 obecn\u00fdm pravidl\u016fm stornovac\u00edch poplatk\u016f. <\/p>\n<p>Pakli\u017ee se kurzu nem\u016f\u017eete z\u00fa\u010dastnit, jste povinni se z kurzu p\u00edsemn\u011b odhl\u00e1sit a uvolnit m\u00edsto<br \/>\ndal\u0161\u00edm z\u00e1jemc\u016fm. V p\u0159\u00edpad\u011b, \u017ee se p\u00edsemn\u011b z kurzu neodhl\u00e1s\u00edte a kurzu se nez\u00fa\u010dastn\u00edte, budou V\u00e1m takt\u00e9\u017e \u00fa\u010dtov\u00e1ny stornovac\u00ed poplatky. V p\u0159\u00edpad\u011b, \u017ee nebude uhrazen doplatek ceny kurzu a sou\u010dasn\u011b se kurzu nez\u00fa\u010dastn\u00edte, z\u00e1loha cel\u00e1 propad\u00e1. <\/p>\n<p><strong>Stornovac\u00ed poplatky :<\/strong> <\/p>\n<p>Storno \u00fa\u010dasti minim\u00e1ln\u011b 1 m\u011bs\u00edc p\u0159ed term\u00ednem kon\u00e1n\u00ed kurzu \u2013 stornopoplatek 10% ceny.<\/p>\n<p>Storno \u00fa\u010dasti minim\u00e1ln\u011b 14 dn\u00ed p\u0159ed term\u00ednem kon\u00e1n\u00ed kurzu \u2013 stornopoplatek 50% ceny.<\/p>\n<p>Storno \u00fa\u010dasti m\u00e9n\u011b ne\u017e 1 t\u00fdden p\u0159ed term\u00ednem kon\u00e1n\u00ed kurzu \u2013 stornopoplatek 100% ceny.<\/p>\n<p><strong>Stornopoplatk\u016fm se m\u016f\u017eete vyhnout v p\u0159\u00edpad\u011b, \u017ee za sebe najdete n\u00e1hradn\u00edka, kter\u00fd se kurzu z\u00fa\u010dastn\u00ed.<\/strong><\/p>\n<p>\u00da\u010dastn\u00edk sv\u00fdm souhlasem stvrzuje, \u017ee se sezn\u00e1mil s v\u00fd\u0161e uveden\u00fdmi podm\u00ednkami \u00fa\u010dasti na<br \/>\nkurzu. <\/p><\/div>\n<p><\/p>\n<\/div><\/div><\/div><div id=\"CF586f9bf506b91_1-row-11\"  class=\"row  last_row\"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_9604257\" class=\"form-group\" id=\"fld_9604257_1-wrap\">\r\n\t<label id=\"fld_9604257Label\" for=\"fld_9604257_1\" class=\"control-label\">Souhlas\u00edm s podm\u00ednkami kurzu <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_9604257_1_opt1584726\"\n                >\n                            <input\n                                data-parsley-required=\"true\" data-parsley-group=\"fld_9604257_1\" data-parsley-multiple=\"fld_9604257_1\"                                type=\"checkbox\"\n                                data-label=\"Ano\"\n                                data-field=\"fld_9604257\"\n                                id=\"fld_9604257_1_opt1584726\"\n                                class=\"fld_9604257_1 option-required\"\n                                name=\"fld_9604257[opt1584726]\"\n                                value=\"Ano\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_9604257_1\"\n                                                                data-calc-value=\"Ano\"\n                            >\n                    Ano                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-3 \"><input    type=\"hidden\" data-field=\"fld_6176505\" class=\" form-control\" id=\"fld_6176505_1\" name=\"fld_6176505\" value=\"..........................................................................\" data-type=\"hidden\"   ><\/div><div  class=\"col-sm-3  last_col\"><div data-field-wrapper=\"fld_5233563\" class=\"form-group\" id=\"fld_5233563_1-wrap\">\r\n<div class=\"\">\r\n\t<input  class=\"btn btn-default\" type=\"submit\" name=\"fld_5233563\" id=\"fld_5233563_1\" value=\"Odeslat p\u0159ihl\u00e1\u0161ku s dotazn\u00edkem\" data-field=\"fld_5233563\"  >\n<\/div>\r\n<\/div>\r\n\t<input class=\"button_trigger_1\" type=\"hidden\" name=\"fld_5233563\" id=\"fld_5233563_1_btn\" value=\"\" data-field=\"fld_5233563\"  \/>\n<\/div><\/div><\/form>\r\n<\/div>\r\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"","meta":{"ngg_post_thumbnail":0},"_links":{"self":[{"href":"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/wp-json\/wp\/v2\/pages\/374"}],"collection":[{"href":"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/wp-json\/wp\/v2\/comments?post=374"}],"version-history":[{"count":1,"href":"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/wp-json\/wp\/v2\/pages\/374\/revisions"}],"predecessor-version":[{"id":834,"href":"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/wp-json\/wp\/v2\/pages\/374\/revisions\/834"}],"wp:attachment":[{"href":"https:\/\/www.hjt-hormonalnijoga.cz\/domains\/hjt-hormonalnijoga.cz\/wp-json\/wp\/v2\/media?parent=374"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}