{"id":1169,"date":"2025-08-12T06:54:02","date_gmt":"2025-08-12T06:54:02","guid":{"rendered":"https:\/\/rehabdynamics.com.au\/?page_id=1169"},"modified":"2025-11-18T04:18:19","modified_gmt":"2025-11-18T04:18:19","slug":"survey-form-chinese","status":"publish","type":"page","link":"https:\/\/rehabdynamics.com.au\/zh\/survey-form-chinese\/","title":{"rendered":"Survey Form &#8211; Chinese"},"content":{"rendered":"\n<div\n\tclass=\"root-eb-wpforms-23d5y wp-block-essential-blocks-wpforms\">\n\t<div class=\"eb-parent-eb-wpforms-23d5y  eb-parent-wrapper\">\n\t\t<div class=\"eb-wpforms-23d5y eb-wpforms-wrapper\">\n\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-1139\"><form id=\"wpforms-form-1139\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1139\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/zh\/wp-json\/wp\/v2\/pages\/1169\" data-token=\"f5bc739e379805a8156f2bf0f83394bd\" 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for=\"wpforms-1139-field_1\">\u60a8\u5f9e\u6211\u5011\u9019\u88e1\u7372\u5f97\u7684\u662f\u54ea\u7a2e\u985e\u578b\u7684\u670d\u52d9 <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1139-field_1\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1139-field_1_1\" name=\"wpforms[fields][1]\" value=\"\u5de5\u50b7\u5eb7\u5fa9\u670d\u52d9\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1139-field_1_1\">\u5de5\u50b7\u5eb7\u5fa9\u670d\u52d9<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1139-field_1_2\" name=\"wpforms[fields][1]\" value=\"\u7b2c\u4e09\u65b9\u4fdd\u96aa\uff08CTP\uff09\u5eb7\u5fa9\u670d\u52d9\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1139-field_1_2\">\u7b2c\u4e09\u65b9\u4fdd\u96aa\uff08CTP\uff09\u5eb7\u5fa9\u670d\u52d9<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1139-field_1_3\" name=\"wpforms[fields][1]\" value=\"\u570b\u5bb6\u6b98\u969c\u4fdd\u96aa\u8a08\u5283\uff08NDIS\uff09\u670d\u52d9\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1139-field_1_3\">\u570b\u5bb6\u6b98\u969c\u4fdd\u96aa\u8a08\u5283\uff08NDIS\uff09\u670d\u52d9<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1139-field_1_4\" name=\"wpforms[fields][1]\" value=\"\u5c45\u5bb6\u990a\u8001\u670d\u52d9\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1139-field_1_4\">\u5c45\u5bb6\u990a\u8001\u670d\u52d9<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1139-field_1_5\" name=\"wpforms[fields][1]\" value=\"\u5176\u4ed6\u670d\u52d9\uff0d\u8acb\u5728\u4e0b\u65b9\u63d0\u4f9b\u8a73\u7d30\u8cc7\u8a0a\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1139-field_1_5\">\u5176\u4ed6\u670d\u52d9\uff0d\u8acb\u5728\u4e0b\u65b9\u63d0\u4f9b\u8a73\u7d30\u8cc7\u8a0a<\/label><\/li><\/ul><\/div><div id=\"wpforms-1139-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1139-field_2\">\u5176\u4ed6\u670d\u52d9\uff0d\u8acb\u5728\u4e0b\u65b9\u63d0\u4f9b\u8a73\u7d30\u8cc7\u8a0a<\/label><input type=\"text\" id=\"wpforms-1139-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" ><\/div><div id=\"wpforms-1139-field_3-container\" class=\"wpforms-field wpforms-field-rating\" data-field-id=\"3\"><label class=\"wpforms-field-label\">\u60a8\u5c0d\u6211\u5011\u7684\u670d\u52d9\u6eff\u610f\u5ea6\u8a55\u50f9\u70ba\u4f55? <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-1139-field_3_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_3_1\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][3]\" value=\"1\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-1139-field_3_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_3_2\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][3]\" value=\"2\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-1139-field_3_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_3_3\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][3]\" value=\"3\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-1139-field_3_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_3_4\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][3]\" value=\"4\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-1139-field_3_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_3_5\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][3]\" value=\"5\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><\/div><\/div><div id=\"wpforms-1139-field_4-container\" class=\"wpforms-field wpforms-field-rating\" data-field-id=\"4\"><label class=\"wpforms-field-label\">\u60a8\u6709\u591a\u5927\u53ef\u80fd\u6703\u5411\u4ed6\u4eba\u63a8\u85a6RehabDynamics? <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-rating-items\"><label class=\"wpforms-field-rating-item choice-1\" for=\"wpforms-1139-field_4_1\"><span class=\"wpforms-screen-reader-element\">Rate 1 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_4_1\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][4]\" value=\"1\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-2\" for=\"wpforms-1139-field_4_2\"><span class=\"wpforms-screen-reader-element\">Rate 2 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_4_2\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][4]\" value=\"2\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-3\" for=\"wpforms-1139-field_4_3\"><span class=\"wpforms-screen-reader-element\">Rate 3 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_4_3\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][4]\" value=\"3\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-4\" for=\"wpforms-1139-field_4_4\"><span class=\"wpforms-screen-reader-element\">Rate 4 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_4_4\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][4]\" value=\"4\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><label class=\"wpforms-field-rating-item choice-5\" for=\"wpforms-1139-field_4_5\"><span class=\"wpforms-screen-reader-element\">Rate 5 out of 5<\/span><input type=\"radio\" id=\"wpforms-1139-field_4_5\" class=\"wpforms-field-required wpforms-screen-reader-element\" name=\"wpforms[fields][4]\" value=\"5\" required><svg width=\"38\" height=\"38\" style=\"height:38px;width:38px;\" fill=\"currentColor\" color=\"#e27730\" viewBox=\"0 0 1792 1792\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M1728 647q0 22-26 48l-363 354 86 500q1 7 1 20 0 21-10.5 35.5t-30.5 14.5q-19 0-40-12l-449-236-449 236q-22 12-40 12-21 0-31.5-14.5t-10.5-35.5q0-6 2-20l86-500-364-354q-25-27-25-48 0-37 56-46l502-73 225-455q19-41 49-41t49 41l225 455 502 73q56 9 56 46z\"\/><\/svg><\/label><\/div><\/div><div 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