{"id":4060,"date":"2026-05-08T10:29:10","date_gmt":"2026-05-08T10:29:10","guid":{"rendered":"https:\/\/fundacjawzc.pl\/?page_id=4060"},"modified":"2026-10-06T08:36:37","modified_gmt":"2026-10-06T08:36:37","slug":"nasi-specjalisci","status":"publish","type":"page","link":"https:\/\/fundacjawzc.pl\/en\/nasi-specjalisci\/","title":{"rendered":"Our Specialists"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4060\" class=\"elementor elementor-4060\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2ab627b e-flex e-con-boxed e-con e-parent\" data-id=\"2ab627b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0f67d4c elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"0f67d4c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Nasi Specjali\u015bci<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8509084 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"8509084\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b26f3c7 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"b26f3c7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\">Fundacja Wyj\u015b\u0107 z Ciemno\u015bci otacza osoby w kryzysie opiek\u0105 do\u015bwiadczonych specjalist\u00f3w \u2013 lekarzy, psycholog\u00f3w, terapeut\u00f3w i ekspert\u00f3w z r\u00f3\u017cnych dziedzin. Ka\u017cdy z nich wnosi unikaln\u0105 wiedz\u0119 i zaanga\u017cowanie w budowanie realnego wsparcia.<br>\nJe\u015bli chcesz do\u0142\u0105czy\u0107 do naszego zespo\u0142u specjalist\u00f3w \u2014 <strong><a style=\"color: #3954a4;\" href=\"\/kontakt\">skontaktuj si\u0119 z nami<\/a><\/strong>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e631a0c e-flex e-con-boxed e-con e-parent\" data-id=\"e631a0c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-19ce6d1 elementor-widget elementor-widget-text-editor\" data-id=\"19ce6d1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div style=\"background-color: #f9f9f9; padding: 30px; border-radius: 10px; border-left: 4px solid #FFD700; margin: 30px 0;\">\n  <h3 style=\"margin-top: 0; text-align: center; color: #3954a4 !important;\">Lek. Oleksandr Duplenko<\/h3>\n  \n  <p><strong>Z dum\u0105 przedstawiamy naszego Partnera<\/strong> \u2013 lek. Oleksandra Duplenko, lekarza, kt\u00f3ry swoj\u0105 wiedz\u0119 i do\u015bwiadczenie pragnie wykorzysta\u0107 w s\u0142u\u017cbie osobom przechodz\u0105cym przez trudne do\u015bwiadczenia \u017cyciowe.<\/p>\n\n  <p>Doktor Oleksandr Duplenko uko\u0144czy\u0142 studia medyczne na Ukrainie, gdzie zdoby\u0142 wykszta\u0142cenie w zakresie medycyny oraz specjalizacj\u0119 w dziedzinie neurologii. Obecnie wykonuje zaw\u00f3d lekarza na terenie Polski, \u0142\u0105cz\u0105c wiedz\u0119 kliniczn\u0105 z g\u0142\u0119bokim zrozumieniem wp\u0142ywu prze\u017cy\u0107 emocjonalnych na stan zdrowia cz\u0142owieka.<\/p>\n\n  <p>Jego obecno\u015b\u0107 w Fundacji to wa\u017cny element naszej misji \u2013 poniewa\u017c wierzymy, \u017ce: <strong>cz\u0142owiek jest ca\u0142o\u015bci\u0105 \u2013 cia\u0142em, emocjami i tym, co dzieje si\u0119 w jego wn\u0119trzu.<\/strong> W sytuacjach, gdy trudne do\u015bwiadczenia, stres i trauma zaczynaj\u0105 manifestowa\u0107 si\u0119 w ciele \u2013 pojawiaj\u0105 si\u0119 objawy neurologiczne, napi\u0119cia, bezsenno\u015b\u0107 czy przewlek\u0142e zm\u0119czenie \u2013 potrzebna jest nie tylko rozmowa, ale r\u00f3wnie\u017c profesjonalna opieka medyczna.<\/p>\n\n  <p>W ramach wsp\u00f3\u0142pracy z Fundacj\u0105 lek. Oleksandr Duplenko prowadzi bezp\u0142atne konsultacje medyczne dla os\u00f3b w kryzysie.<\/p>\n\n  <!-- KARTA Z INFORMACJAMI LOGISTYCZNYMI -->\n  <div style=\"background-color: #fff8e1; border-radius: 8px; padding: 20px; margin: 20px 0;\">\n    <h4 style=\"margin: 0 0 10px 0; color: #3954a4 !important;\">Bezp\u0142atne Konsultacje Neurologiczne<\/h4>\n    <p style=\"margin: 6px 0; line-height: 1.5;\"><strong>Miejsce:<\/strong> Siedziba Fundacji Wyj\u015b\u0107 z Ciemno\u015bci, Gda\u0144sk \u2013 Gradowa G\u00f3ra, ul. Gradowa 11 lok. 302<\/p>\n    <p style=\"margin: 6px 0; line-height: 1.5;\"><strong>Termin:<\/strong> Ka\u017cda sobota, w godzinach 9:00 \u2013 12:00 (cykliczne dy\u017cury)<\/p>\n    <p style=\"margin: 6px 0; line-height: 1.5;\"><strong>Forma:<\/strong> Spotkania stacjonarne<\/p>\n    <p style=\"margin: 6px 0; line-height: 1.5;\"><strong>Kontakt:<\/strong> tel. 571 360 448 | fundacja.wzc.projekty@gmail.com<\/p>\n  <\/div>\n\n  <p>Udzia\u0142 w konsultacji jest w pe\u0142ni bezp\u0142atny i mo\u017cliwy po wcze\u015bniejszym wype\u0142nieniu formularza zg\u0142oszeniowego. Formularz s\u0142u\u017cy wst\u0119pnej weryfikacji i pozwala nam sprawnie um\u00f3wi\u0107 dogodny termin wizyty.<\/p>\n\n  <p>Celem konsultacji jest pierwszy krok \u2013 zatrzymanie si\u0119 przy ciele, zrozumienie jego sygna\u0142\u00f3w i rozpocz\u0119cie drogi do r\u00f3wnowagi. Obecno\u015b\u0107 doktora w Fundacji to nie tylko wsparcie medyczne \u2013 to tak\u017ce znak, \u017ce droga wychodzenia z trudnych do\u015bwiadcze\u0144 wymaga troski o ca\u0142ego cz\u0142owieka.<\/p>\n\n  <!-- ZDJ\u0118CIE LEKARZA -->\n  <a href=\"https:\/\/fundacjawzc.pl\/wp-content\/uploads\/2026\/04\/0.jpg\" target=\"_blank\" rel=\"noopener\">\n    <img decoding=\"async\" style=\"width: 280px; max-width: 60%; display: block; margin: 25px auto 15px auto; border-radius: 10px; cursor: pointer; box-shadow: 0 4px 10px rgba(0,0,0,0.1);\" src=\"https:\/\/fundacjawzc.pl\/wp-content\/uploads\/2026\/04\/0.jpg\" alt=\"Lek. Oleksandr Duplenko \u2013 Partner Fundacji Wyj\u015b\u0107 z Ciemno\u015bci\" \/>\n  <\/a>\n\n  <!-- PRZYCISK DECYZJI MZ -->\n  <p style=\"text-align: center; margin-top: 15px; margin-bottom: 25px;\">\n    <a style=\"display: inline-block; background-color: #ffd700; color: #3954a4 !important; padding: 12px 24px; border-radius: 8px; text-decoration: none; font-weight: bold; box-shadow: 0 2px 6px rgba(0,0,0,0.1);\" href=\"https:\/\/fundacjawzc.pl\/wp-content\/uploads\/2026\/04\/Duplenko-Oleksandr-Decyzja-MZ.pdf\" target=\"_blank\" rel=\"noopener\">\n      Zobacz decyzj\u0119 MZ\n    <\/a>\n  <\/p>\n\n  <!-- SEKCJA FORMULARZA ZG\u0141OSZENIOWEGO -->\n  <hr style=\"border: none; border-top: 1px solid #e0e0e0; margin: 30px 0;\" \/>\n\n  <h3 style=\"margin-top: 20px; color: #3954a4 !important;\">Formularz zg\u0142oszeniowy na konsultacj\u0119<\/h3>\n  <p style=\"margin-bottom: 20px;\">Wype\u0142nij poni\u017cszy formularz, aby zapisa\u0107 si\u0119 na bezp\u0142atn\u0105 konsultacj\u0119 medyczn\u0105 z lek. Oleksandrem Duplenko. Skontaktujemy si\u0119 z Tob\u0105 w celu potwierdzenia dok\u0142adnej godziny spotkania.<\/p>\n\n  <!-- SHORTCODE WPFORMS ZOSTANIE WSTAWIONY PONI\u017bEJ -->\n  <!-- [wpforms id=\"TW\u00d3J_ID_FORMULARZA\"] -->\n\n\n\n<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f317e0c e-flex e-con-boxed e-con e-parent\" data-id=\"f317e0c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5837f60 elementor-widget elementor-widget-wpforms\" data-id=\"5837f60\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container \" id=\"wpforms-3721\"><form id=\"wpforms-form-3721\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3721\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/4060\" data-token=\"c93403b03f2be533e22515da11438396\" data-token-time=\"1794596028\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-3721-field_108-container\" class=\"wpforms-field wpforms-field-text wpforms-field-readonly\" data-field-id=\"108\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3721-field_108\">Jeden wiersz tekstu (kopia) (kopia) (kopia) (kopia) (kopia) (kopia)<\/label><input type=\"text\" id=\"wpforms-3721-field_108\" class=\"wpforms-field-small\" name=\"wpforms[fields][108]\" placeholder=\"1. Dane podstawowe\" ><\/div><div id=\"wpforms-3721-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-3721-field_1\">Imi\u0119 i nazwisko <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3721-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" required><\/div><div id=\"wpforms-3721-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-3721-field_5\">Numer telefonu <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3721-field_5\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-3721-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-3721-field_12\">Adres zamieszkania <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3721-field_12\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][12]\" required><\/div><div id=\"wpforms-3721-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-3721-field_11\">PESEL <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3721-field_11\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><div id=\"wpforms-3721-field_109-container\" class=\"wpforms-field wpforms-field-text wpforms-field-readonly\" data-field-id=\"109\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3721-field_109\">Jeden wiersz tekstu (kopia) (kopia) (kopia) (kopia) (kopia) (kopia) (kopia)<\/label><input type=\"text\" id=\"wpforms-3721-field_109\" class=\"wpforms-field-small\" name=\"wpforms[fields][109]\" placeholder=\"2. Sytuacja \u017cyciowa i rodzinna\" ><\/div><div id=\"wpforms-3721-field_151-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"151\"><label class=\"wpforms-field-label\">Czy obecnie znajduje si\u0119 Pani \/ Pan w kryzysie \u017cyciowym? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_151\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_151_1\" name=\"wpforms[fields][151]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_151_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_151_2\" name=\"wpforms[fields][151]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_151_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_13-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"13\"><label class=\"wpforms-field-label\">Jakiego rodzaju trudno\u015bci obecnie Pani \/ Pan do\u015bwiadcza? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_13_1\" name=\"wpforms[fields][13]\" value=\"rozpad zwi\u0105zku \/ rozw\u00f3d \/ separacja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_1\">rozpad zwi\u0105zku \/ rozw\u00f3d \/ separacja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_13_2\" name=\"wpforms[fields][13]\" value=\"przemoc psychiczna\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_2\">przemoc psychiczna<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_13_3\" name=\"wpforms[fields][13]\" value=\"przemoc fizyczna\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_3\">przemoc fizyczna<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_13_4\" name=\"wpforms[fields][13]\" value=\"d\u0142ugotrwa\u0142y stres rodzinny\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_4\">d\u0142ugotrwa\u0142y stres rodzinny<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_13_5\" name=\"wpforms[fields][13]\" value=\"trudna sytuacja opieku\u0144cza\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_5\">trudna sytuacja opieku\u0144cza<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_13_6\" name=\"wpforms[fields][13]\" value=\"strata bliskiej osoby\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_6\">strata bliskiej osoby<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_13_7\" name=\"wpforms[fields][13]\" value=\"problemy mieszkaniowe\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_7\">problemy mieszkaniowe<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_13_8\" name=\"wpforms[fields][13]\" value=\"problemy finansowe\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_8\">problemy finansowe<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_13_9\" name=\"wpforms[fields][13]\" value=\"samotno\u015b\u0107 \/ brak wsparcia\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_9\">samotno\u015b\u0107 \/ brak wsparcia<\/label><\/li><li class=\"choice-10 depth-1 wpforms-other-choice\"><input type=\"radio\" id=\"wpforms-3721-field_13_10\" data-other-choice=\"true\" name=\"wpforms[fields][13]\" value=\"Inna sytuacja kryzysowa\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_13_10\">Inna sytuacja kryzysowa<\/label><\/li><\/ul><input type=\"text\" id=\"wpforms-3721-field_13_other\" class=\"wpforms-other-input wpforms-field-required wpforms-field-large wpforms-hidden\" name=\"wpforms[fields][13][other]\" disabled=\"disabled\" required><\/div><div id=\"wpforms-3721-field_14-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"14\"><label class=\"wpforms-field-label\">Czy sytuacja trwa: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_14_1\" name=\"wpforms[fields][14]\" value=\"kr\u00f3cej ni\u017c 1 miesi\u0105c\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_14_1\">kr\u00f3cej ni\u017c 1 miesi\u0105c<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_14_2\" name=\"wpforms[fields][14]\" value=\"1\u20133 miesi\u0105ce\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_14_2\">1\u20133 miesi\u0105ce<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_14_3\" name=\"wpforms[fields][14]\" value=\"3\u20136 miesi\u0119cy\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_14_3\">3\u20136 miesi\u0119cy<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_14_4\" name=\"wpforms[fields][14]\" value=\"ponad 6 miesi\u0119cy\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_14_4\">ponad 6 miesi\u0119cy<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_14_5\" name=\"wpforms[fields][14]\" value=\"ponad 1 rok\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_14_5\">ponad 1 rok<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_15-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"15\"><label class=\"wpforms-field-label\">Jak opisa\u0142(a)by Pani \/ Pan swoj\u0105 obecn\u0105 sytuacj\u0119 rodzinn\u0105? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_15\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_15_1\" name=\"wpforms[fields][15]\" value=\"mieszkam sam \/ sama\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_15_1\">mieszkam sam \/ sama<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_15_2\" name=\"wpforms[fields][15]\" value=\"mieszkam z partnerem \/ partnerk\u0105\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_15_2\">mieszkam z partnerem \/ partnerk\u0105<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_15_3\" name=\"wpforms[fields][15]\" value=\"mieszkam z dzie\u0107mi\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_15_3\">mieszkam z dzie\u0107mi<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_15_4\" name=\"wpforms[fields][15]\" value=\"mieszkam z rodzin\u0105\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_15_4\">mieszkam z rodzin\u0105<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_15_5\" name=\"wpforms[fields][15]\" value=\"mam ograniczone wsparcie bliskich\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_15_5\">mam ograniczone wsparcie bliskich<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_15_12\" name=\"wpforms[fields][15]\" value=\"nie mam \u017cadnego realnego wsparcia\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_15_12\">nie mam \u017cadnego realnego wsparcia<\/label><\/li><li class=\"choice-11 depth-1 wpforms-other-choice\"><input type=\"radio\" id=\"wpforms-3721-field_15_11\" data-other-choice=\"true\" name=\"wpforms[fields][15]\" value=\"Inne\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_15_11\">Inne<\/label><\/li><\/ul><input type=\"text\" id=\"wpforms-3721-field_15_other\" class=\"wpforms-other-input wpforms-field-required wpforms-field-large wpforms-hidden\" name=\"wpforms[fields][15][other]\" disabled=\"disabled\" required><\/div><div id=\"wpforms-3721-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-3721-field_16\">Prosz\u0119 kr\u00f3tko opisa\u0107 swoj\u0105 sytuacj\u0119 rodzinn\u0105 i \u017cyciow\u0105: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3721-field_16\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][16]\" required><\/div><div id=\"wpforms-3721-field_107-container\" class=\"wpforms-field wpforms-field-text wpforms-field-readonly\" data-field-id=\"107\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3721-field_107\">Jeden wiersz tekstu (kopia) (kopia) (kopia) (kopia) (kopia)<\/label><input type=\"text\" id=\"wpforms-3721-field_107\" class=\"wpforms-field-medium\" name=\"wpforms[fields][107]\" placeholder=\"3. Objawy somatyczne i neurologiczne\" ><\/div><div id=\"wpforms-3721-field_112-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"112\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119powa\u0142a u Pani\/Pana bezsenno\u015b\u0107 lub trudno\u015bci z zasypianiem? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_112\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_112_1\" name=\"wpforms[fields][112]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_112_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_112_2\" name=\"wpforms[fields][112]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_112_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_113-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"113\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie cz\u0119sto wybudza si\u0119 Pani\/Pan w nocy? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_113\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_113_1\" name=\"wpforms[fields][113]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_113_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_113_2\" name=\"wpforms[fields][113]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_113_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_114-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"114\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie odczuwa Pani\/Pan niewyspanie mimo snu? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_114\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_114_1\" name=\"wpforms[fields][114]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_114_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_114_2\" name=\"wpforms[fields][114]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_114_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_115-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"115\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puj\u0105 u Pani\/Pana b\u00f3le g\u0142owy? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_115\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_115_1\" name=\"wpforms[fields][115]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_115_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_115_2\" name=\"wpforms[fields][115]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_115_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_116-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"116\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puj\u0105 u Pani\/Pana zawroty g\u0142owy? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_116\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_116_1\" name=\"wpforms[fields][116]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_116_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_116_2\" name=\"wpforms[fields][116]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_116_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_126-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"126\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie odczuwa Pani\/Pan ucisk w g\u0142owie? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_126\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_126_1\" name=\"wpforms[fields][126]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_126_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_126_2\" name=\"wpforms[fields][126]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_126_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_125-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"125\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puj\u0105 u Pani\/Pana szumy uszne? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_125\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_125_1\" name=\"wpforms[fields][125]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_125_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_125_2\" name=\"wpforms[fields][125]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_125_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_124-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"124\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puje u Pani\/Pana dr\u017cenie r\u0105k? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_124\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_124_1\" name=\"wpforms[fields][124]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_124_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_124_2\" name=\"wpforms[fields][124]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_124_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_123-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"123\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puje u Pani\/Pana dr\u017cenie ca\u0142ego cia\u0142a lub wewn\u0119trzne dr\u017cenie? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_123\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_123_1\" name=\"wpforms[fields][123]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_123_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_123_2\" name=\"wpforms[fields][123]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_123_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_122-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"122\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puje u Pani\/Pana mrowienie lub dr\u0119twienie ko\u0144czyn? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_122\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_122_1\" name=\"wpforms[fields][122]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_122_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_122_2\" name=\"wpforms[fields][122]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_122_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_121-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"121\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie odczuwa Pani\/Pan napi\u0119cie mi\u0119\u015bni karku, bark\u00f3w lub plec\u00f3w? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_121\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_121_1\" name=\"wpforms[fields][121]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_121_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_121_2\" name=\"wpforms[fields][121]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_121_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_120-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"120\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puj\u0105 u Pani\/Pana skurcze mi\u0119\u015bni, tiki lub mimowolne napi\u0119cia? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_120\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_120_1\" name=\"wpforms[fields][120]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_120_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_120_2\" name=\"wpforms[fields][120]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_120_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_119-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"119\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puje u Pani\/Pana ko\u0142atanie serca lub wysoki puls? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_119\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_119_1\" name=\"wpforms[fields][119]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_119_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_119_2\" name=\"wpforms[fields][119]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_119_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_117-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"117\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puje u Pani\/Pana podwy\u017cszone ci\u015bnienie t\u0119tnicze w stresie? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_117\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_117_1\" name=\"wpforms[fields][117]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_117_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_117_2\" name=\"wpforms[fields][117]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_117_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_118-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"118\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie odczuwa Pani\/Pan duszno\u015b\u0107 lub \u201ebrak powietrza\u201d? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_118\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_118_1\" name=\"wpforms[fields][118]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_118_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_118_2\" name=\"wpforms[fields][118]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_118_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_127-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"127\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puje u Pani\/Pana b\u00f3l w klatce piersiowej pojawiaj\u0105cy si\u0119 przy napi\u0119ciu? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_127\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_127_1\" name=\"wpforms[fields][127]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_127_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_127_2\" name=\"wpforms[fields][127]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_127_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_130-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"130\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puj\u0105 u Pani\/Pana problemy \u017co\u0142\u0105dkowe lub jelitowe nasilaj\u0105ce si\u0119 w stresie? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_130\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_130_1\" name=\"wpforms[fields][130]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_130_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_130_2\" name=\"wpforms[fields][130]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_130_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_133-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"133\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie zdarza si\u0119 Pani\/Panu przejadanie pod wp\u0142ywem stresu? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_133\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_133_1\" name=\"wpforms[fields][133]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_133_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_133_2\" name=\"wpforms[fields][133]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_133_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_132-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"132\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puje u Pani\/Pana brak apetytu pod wp\u0142ywem stresu? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_132\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_132_1\" name=\"wpforms[fields][132]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_132_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_132_2\" name=\"wpforms[fields][132]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_132_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_131-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"131\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puj\u0105 u Pani\/Pana nudno\u015bci, \u015bcisk \u017co\u0142\u0105dka lub md\u0142o\u015bci? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_131\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_131_1\" name=\"wpforms[fields][131]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_131_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_131_2\" name=\"wpforms[fields][131]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_131_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_128-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"128\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie odczuwa Pani\/Pan przewlek\u0142e zm\u0119czenie? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_128\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_128_1\" name=\"wpforms[fields][128]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_128_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_128_2\" name=\"wpforms[fields][128]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_128_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_129-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"129\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie odczuwa Pani\/Pan og\u00f3lne os\u0142abienie organizmu? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_129\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_129_1\" name=\"wpforms[fields][129]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_129_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_129_2\" name=\"wpforms[fields][129]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_129_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_134-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"134\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie ma Pani\/Pan problemy z koncentracj\u0105? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_134\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_134_1\" name=\"wpforms[fields][134]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_134_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_134_2\" name=\"wpforms[fields][134]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_134_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_135-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"135\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puje u Pani\/Pana pogorszenie pami\u0119ci lub tzw. \u201emg\u0142a poznawcza\u201d? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_135\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_135_1\" name=\"wpforms[fields][135]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_135_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_135_2\" name=\"wpforms[fields][135]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_135_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_136-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"136\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puje u Pani\/Pana nadwra\u017cliwo\u015b\u0107 na bod\u017ace, ha\u0142as lub \u015bwiat\u0142o? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_136\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_136_1\" name=\"wpforms[fields][136]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_136_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_136_2\" name=\"wpforms[fields][136]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_136_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_137-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"137\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie wyst\u0119puj\u0105 u Pani\/Pana nag\u0142e napady silnego napi\u0119cia lub paniki? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_137\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_137_1\" name=\"wpforms[fields][137]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_137_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_137_2\" name=\"wpforms[fields][137]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_137_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_138-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"138\"><label class=\"wpforms-field-label\">Czy w ostatnim czasie odczuwa Pani\/Pan przeci\u0105\u017cenie organizmu? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_138\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_138_1\" name=\"wpforms[fields][138]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_138_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_138_2\" name=\"wpforms[fields][138]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_138_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_139-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"139\"><label class=\"wpforms-field-label\">Czy objawy nasilaj\u0105 si\u0119 po trudnych wydarzeniach, konfliktach lub przewlek\u0142ym stresie? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_139\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_139_1\" name=\"wpforms[fields][139]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_139_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_139_2\" name=\"wpforms[fields][139]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_139_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_140-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"140\"><label class=\"wpforms-field-label\">Czy objawy utrudniaj\u0105 Pani\/Panu codzienne funkcjonowanie? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_140\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_140_1\" name=\"wpforms[fields][140]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_140_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_140_2\" name=\"wpforms[fields][140]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_140_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_141-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"141\"><label class=\"wpforms-field-label\">Czy objawy wp\u0142ywaj\u0105 na Pani\/Pana sen, prac\u0119 lub relacje rodzinne? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_141\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_141_1\" name=\"wpforms[fields][141]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_141_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_141_2\" name=\"wpforms[fields][141]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_141_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_106-container\" class=\"wpforms-field wpforms-field-text wpforms-field-readonly\" data-field-id=\"106\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3721-field_106\">Jeden wiersz tekstu (kopia) (kopia) (kopia) (kopia)<\/label><input type=\"text\" id=\"wpforms-3721-field_106\" class=\"wpforms-field-small\" name=\"wpforms[fields][106]\" placeholder=\"4. Kr\u00f3tszy opis objaw\u00f3w\" ><\/div><div id=\"wpforms-3721-field_80-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-3721-field_80\">Prosz\u0119 opisa\u0107 w\u0142asnymi s\u0142owami, jakie objawy obecnie najbardziej Pani \/ Panu dokuczaj\u0105: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3721-field_80\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][80]\" required><\/div><div id=\"wpforms-3721-field_81-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"81\"><label class=\"wpforms-field-label\" for=\"wpforms-3721-field_81\">Od kiedy wyst\u0119puj\u0105 objawy? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3721-field_81\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][81]\" required><\/div><div id=\"wpforms-3721-field_143-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"143\"><label class=\"wpforms-field-label\">Czy objawy pojawi\u0142y si\u0119 po konkretnym wydarzeniu \u017cyciowym? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_143\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_143_1\" name=\"wpforms[fields][143]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_143_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_143_2\" name=\"wpforms[fields][143]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_143_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_85-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"85\"><label class=\"wpforms-field-label\" for=\"wpforms-3721-field_85\">Je\u015bli tak, jakim?<\/label><input type=\"text\" id=\"wpforms-3721-field_85\" class=\"wpforms-field-large\" name=\"wpforms[fields][85]\" ><\/div><div id=\"wpforms-3721-field_105-container\" class=\"wpforms-field wpforms-field-text wpforms-field-readonly\" data-field-id=\"105\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3721-field_105\">Jeden wiersz tekstu (kopia) (kopia) (kopia)<\/label><input type=\"text\" id=\"wpforms-3721-field_105\" class=\"wpforms-field-medium\" name=\"wpforms[fields][105]\" placeholder=\"5. Dotychczasowe leczenie i konsultacje\" ><\/div><div id=\"wpforms-3721-field_144-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"144\"><label class=\"wpforms-field-label\">Czy by\u0142a ju\u017c Pani \/ by\u0142a ju\u017c Pan konsultowana\/y przez lekarza z powodu tych objaw\u00f3w? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_144\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_144_1\" name=\"wpforms[fields][144]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_144_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_144_2\" name=\"wpforms[fields][144]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_144_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_87-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"87\"><label class=\"wpforms-field-label\">Je\u015bli tak, przez jakiego specjalist\u0119?<\/label><ul id=\"wpforms-3721-field_87\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_87_1\" name=\"wpforms[fields][87]\" value=\"lekarz rodzinny\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_87_1\">lekarz rodzinny<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_87_2\" name=\"wpforms[fields][87]\" value=\"neurolog\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_87_2\">neurolog<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_87_3\" name=\"wpforms[fields][87]\" value=\"psychiatra\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_87_3\">psychiatra<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_87_5\" name=\"wpforms[fields][87]\" value=\"psycholog \/ psychoterapeuta\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_87_5\">psycholog \/ psychoterapeuta<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_87_6\" name=\"wpforms[fields][87]\" value=\"internista\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_87_6\">internista<\/label><\/li><li class=\"choice-4 depth-1 wpforms-other-choice\"><input type=\"radio\" id=\"wpforms-3721-field_87_4\" data-other-choice=\"true\" name=\"wpforms[fields][87]\" value=\"Inny\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_87_4\">Inny<\/label><\/li><\/ul><input type=\"text\" id=\"wpforms-3721-field_87_other\" class=\"wpforms-other-input wpforms-field-required wpforms-field-medium wpforms-hidden\" name=\"wpforms[fields][87][other]\" disabled=\"disabled\" required><\/div><div id=\"wpforms-3721-field_145-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"145\"><label class=\"wpforms-field-label\">Czy przyjmuje Pani \/ Pan obecnie leki zwi\u0105zane z tymi objawami? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_145\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_145_1\" name=\"wpforms[fields][145]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_145_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_145_2\" name=\"wpforms[fields][145]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_145_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_104-container\" class=\"wpforms-field wpforms-field-text wpforms-field-readonly\" data-field-id=\"104\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3721-field_104\">Jeden wiersz tekstu (kopia) (kopia)<\/label><input type=\"text\" id=\"wpforms-3721-field_104\" class=\"wpforms-field-medium\" name=\"wpforms[fields][104]\" placeholder=\"6. Dopasowanie do profilu Fundacji\" ><\/div><div id=\"wpforms-3721-field_152-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"152\"><label class=\"wpforms-field-label\">Czy uwa\u017ca Pani \/ Pan, \u017ce objawy s\u0105 zwi\u0105zane z d\u0142ugotrwa\u0142ym stresem, traum\u0105 lub trudn\u0105 sytuacj\u0105 \u017cyciow\u0105? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_152\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_152_1\" name=\"wpforms[fields][152]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_152_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_152_2\" name=\"wpforms[fields][152]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_152_2\">Nie<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_152_3\" name=\"wpforms[fields][152]\" value=\"Nie wiem\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_152_3\">Nie wiem<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_146-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"146\"><label class=\"wpforms-field-label\">Czy zg\u0142oszenie dotyczy wsparcia w zwi\u0105zku z kryzysem \u017cyciowym i jego wp\u0142ywem na organizm? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_146\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_146_1\" name=\"wpforms[fields][146]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_146_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_146_2\" name=\"wpforms[fields][146]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_146_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_147-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"147\"><label class=\"wpforms-field-label\">Czy jest Pani \/ Pan gotowa\/y na wizyt\u0119 stacjonarn\u0105 w siedzibie Fundacji w Gda\u0144sku na Gradowej G\u00f3rze? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_147\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_147_1\" name=\"wpforms[fields][147]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_147_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_147_2\" name=\"wpforms[fields][147]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_147_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_148-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"148\"><label class=\"wpforms-field-label\">Czy rozumie Pani \/ Pan, \u017ce formularz stanowi wst\u0119pn\u0105 kwalifikacj\u0119 i nie gwarantuje automatycznego przyznania terminu? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_148\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_148_1\" name=\"wpforms[fields][148]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_148_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_148_2\" name=\"wpforms[fields][148]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_148_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_103-container\" class=\"wpforms-field wpforms-field-text wpforms-field-readonly\" data-field-id=\"103\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3721-field_103\">Jeden wiersz tekstu (kopia)<\/label><input type=\"text\" id=\"wpforms-3721-field_103\" class=\"wpforms-field-small\" name=\"wpforms[fields][103]\" placeholder=\"7. Pilno\u015b\u0107 sytuacji\" ><\/div><div id=\"wpforms-3721-field_149-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"149\"><label class=\"wpforms-field-label\">Czy objawy s\u0105 obecnie: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_149\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_149_1\" name=\"wpforms[fields][149]\" value=\"\u0142agodne\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_149_1\">\u0142agodne<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_149_2\" name=\"wpforms[fields][149]\" value=\"umiarkowane\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_149_2\">umiarkowane<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_149_3\" name=\"wpforms[fields][149]\" value=\"silne\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_149_3\">silne<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_149_4\" name=\"wpforms[fields][149]\" value=\"bardzo nasilone\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_149_4\">bardzo nasilone<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_150-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"150\"><label class=\"wpforms-field-label\">Czy potrzebuje Pani \/ Pan mo\u017cliwie szybkiego kontaktu? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_150\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_150_1\" name=\"wpforms[fields][150]\" value=\"Tak\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_150_1\">Tak<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3721-field_150_2\" name=\"wpforms[fields][150]\" value=\"Nie\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_150_2\">Nie<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_102-container\" class=\"wpforms-field wpforms-field-text wpforms-field-readonly\" data-field-id=\"102\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-3721-field_102\">Jeden wiersz tekstu<\/label><input type=\"text\" id=\"wpforms-3721-field_102\" class=\"wpforms-field-small\" name=\"wpforms[fields][102]\" placeholder=\"8. O\u015bwiadczenia\" ><\/div><div id=\"wpforms-3721-field_97-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"97\"><label class=\"wpforms-field-label wpforms-label-hide\">O\u015bwiadczenie <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_97\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3721-field_97_1\" name=\"wpforms[fields][97][]\" value=\"O\u015bwiadczam, \u017ce podane przeze mnie informacje s\u0105 zgodne z prawd\u0105\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_97_1\">O\u015bwiadczam, \u017ce podane przeze mnie informacje s\u0105 zgodne z prawd\u0105<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_98-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"98\"><label class=\"wpforms-field-label wpforms-label-hide\">O\u015bwiadczenie <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_98\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3721-field_98_1\" name=\"wpforms[fields][98][]\" value=\"Wyra\u017cam zgod\u0119 na przetwarzanie moich danych osobowych oraz danych dotycz\u0105cych zdrowia w celu wst\u0119pnej kwalifikacji do bezp\u0142atnej konsultacji realizowanej przez Fundacj\u0119 Wyj\u015b\u0107 z Ciemno\u015bci\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_98_1\">Wyra\u017cam zgod\u0119 na przetwarzanie moich danych osobowych oraz danych dotycz\u0105cych zdrowia w celu wst\u0119pnej kwalifikacji do bezp\u0142atnej konsultacji realizowanej przez Fundacj\u0119 Wyj\u015b\u0107 z Ciemno\u015bci<\/label><\/li><\/ul><\/div><div id=\"wpforms-3721-field_99-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"99\"><label class=\"wpforms-field-label wpforms-label-hide\">O\u015bwiadczenie <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3721-field_99\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3721-field_99_1\" name=\"wpforms[fields][99][]\" value=\"Potwierdzam, \u017ce zapozna\u0142am\/zapozna\u0142em si\u0119 z klauzul\u0105 informacyjn\u0105 dotycz\u0105c\u0105 przetwarzania danych osobowych\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3721-field_99_1\">Potwierdzam, \u017ce zapozna\u0142am\/zapozna\u0142em si\u0119 z klauzul\u0105 informacyjn\u0105 dotycz\u0105c\u0105 przetwarzania danych osobowych<\/label><\/li><\/ul><\/div>\t\t<div id=\"wpforms-3721-field_2-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"2\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-3721-field_2\" >Czy Jeden \u017cyciowym<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-3721-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-3721-field_96-container\" class=\"wpforms-field wpforms-field-textarea wpforms-field-readonly\" data-field-id=\"96\"><label class=\"wpforms-field-label\" for=\"wpforms-3721-field_96\">Klauzula informacyjna<\/label><textarea id=\"wpforms-3721-field_96\" class=\"wpforms-field-medium\" name=\"wpforms[fields][96]\" placeholder=\"Podane dane b\u0119d\u0105 przetwarzane przez Fundacj\u0119 Wyj\u015b\u0107 z Ciemno\u015bci w celu przyj\u0119cia zg\u0142oszenia, przeprowadzenia wst\u0119pnej kwalifikacji i kontaktu w sprawie ewentualnego terminu konsultacji. Dane dotycz\u0105ce zdrowia nale\u017c\u0105 do szczeg\u00f3lnych kategorii danych osobowych i wymagaj\u0105 odpowiedniej podstawy oraz szczeg\u00f3lnej ochrony.\" ><\/textarea><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-3721-field_2-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-3721-field_2-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-3721-field_2-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3721\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/fundacjawzc.pl\/en\/wp-json\/wp\/v2\/pages\/4060\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3721\" class=\"wpforms-submit\" data-alt-text=\"Wysy\u0142anie...\" data-submit-text=\"WY\u015aLIJ ZG\u0141OSZENIE\" aria-live=\"assertive\" value=\"wpforms-submit\">WY\u015aLIJ ZG\u0141OSZENIE<\/button><img decoding=\"async\" src=\"https:\/\/fundacjawzc.pl\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Nasi Specjali\u015bci Fundacja Wyj\u015b\u0107 z Ciemno\u015bci otacza osoby w kryzysie opiek\u0105 do\u015bwiadczonych specjalist\u00f3w \u2013 lekarzy, psycholog\u00f3w, terapeut\u00f3w i ekspert\u00f3w z r\u00f3\u017cnych dziedzin. Ka\u017cdy z nich wnosi unikaln\u0105 wiedz\u0119 i zaanga\u017cowanie w budowanie realnego wsparcia. Je\u015bli chcesz do\u0142\u0105czy\u0107 do naszego zespo\u0142u specjalist\u00f3w \u2014 skontaktuj si\u0119 z nami. Lek. Oleksandr Duplenko Z dum\u0105 przedstawiamy naszego Partnera \u2013 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-4060","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/fundacjawzc.pl\/en\/wp-json\/wp\/v2\/pages\/4060","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/fundacjawzc.pl\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/fundacjawzc.pl\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/fundacjawzc.pl\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/fundacjawzc.pl\/en\/wp-json\/wp\/v2\/comments?post=4060"}],"version-history":[{"count":34,"href":"https:\/\/fundacjawzc.pl\/en\/wp-json\/wp\/v2\/pages\/4060\/revisions"}],"predecessor-version":[{"id":5809,"href":"https:\/\/fundacjawzc.pl\/en\/wp-json\/wp\/v2\/pages\/4060\/revisions\/5809"}],"wp:attachment":[{"href":"https:\/\/fundacjawzc.pl\/en\/wp-json\/wp\/v2\/media?parent=4060"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}