{"id":40239,"date":"2021-09-02T08:48:33","date_gmt":"2021-09-02T13:48:33","guid":{"rendered":"https:\/\/preventblindness.org\/?page_id=40239"},"modified":"2024-06-11T11:01:32","modified_gmt":"2024-06-11T16:01:32","slug":"tell-us-about-your-experience","status":"publish","type":"page","link":"https:\/\/preventblindness.org\/tell-us-about-your-experience\/","title":{"rendered":"Tell Us About Your Experience"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_4' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/wp-json\/wp\/v2\/pages\/40239' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_2\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Let us know more about your visit at preventblindness.org. Your feedback will help us provide a better experience for all our users.<\/div><div id=\"field_4_1\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_1'>Why did you visit preventblindness.org today?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_1' id='input_4_1' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_3\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_3'>Did you find what you were looking for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_4_3' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_4_4\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>What were you looking for specifically?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_4' id='input_4_4' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_4_5\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Do you agree with the following statements?\n\nThe pages I have read:<\/div><fieldset id=\"field_4_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >are easy to understand.<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_6'>\n\t\t\t<div class='gchoice gchoice_4_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='yes'  id='choice_4_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_6_0' id='label_4_6_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='no'  id='choice_4_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_6_1' id='label_4_6_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_6_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='not sure'  id='choice_4_6_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_6_2' id='label_4_6_2' class='gform-field-label gform-field-label--type-inline'>not sure<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >are up to date.<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_7'>\n\t\t\t<div class='gchoice gchoice_4_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='yes'  id='choice_4_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_0' id='label_4_7_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='no'  id='choice_4_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_1' id='label_4_7_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='not sure'  id='choice_4_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_2' id='label_4_7_2' class='gform-field-label gform-field-label--type-inline'>not sure<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >allow me to take action.<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_8'>\n\t\t\t<div class='gchoice gchoice_4_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='yes'  id='choice_4_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_0' id='label_4_8_0' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='no'  id='choice_4_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_1' id='label_4_8_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='not sure'  id='choice_4_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_2' id='label_4_8_2' class='gform-field-label gform-field-label--type-inline'>not sure<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_9\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_9'>How can we improve your experience on preventblindness.org<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_9' id='input_4_9' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_4_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >With which of the groups do you most strongly identify?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_10'><div class='gchoice gchoice_4_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='patient'  id='choice_4_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_10_1' id='label_4_10_1' class='gform-field-label gform-field-label--type-inline'>patient<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='parent\/caregiver'  id='choice_4_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_10_2' id='label_4_10_2' class='gform-field-label gform-field-label--type-inline'>parent\/caregiver<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='student'  id='choice_4_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_10_3' id='label_4_10_3' class='gform-field-label gform-field-label--type-inline'>student<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='educator'  id='choice_4_10_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_10_4' id='label_4_10_4' class='gform-field-label gform-field-label--type-inline'>educator<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_10_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.5' type='checkbox'  value='health care professional'  id='choice_4_10_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_10_5' id='label_4_10_5' class='gform-field-label gform-field-label--type-inline'>health care professional<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_10_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.6' type='checkbox'  value='media\/journalist'  id='choice_4_10_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_10_6' id='label_4_10_6' class='gform-field-label gform-field-label--type-inline'>media\/journalist<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_10_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.7' type='checkbox'  value='public policy professional'  id='choice_4_10_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_10_7' id='label_4_10_7' class='gform-field-label gform-field-label--type-inline'>public policy professional<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_10_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.8' type='checkbox'  value='academic\/researcher'  id='choice_4_10_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_10_8' id='label_4_10_8' class='gform-field-label gform-field-label--type-inline'>academic\/researcher<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_10_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.9' type='checkbox'  value='other'  id='choice_4_10_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_10_9' id='label_4_10_9' class='gform-field-label gform-field-label--type-inline'>other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_11\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_11'>Would you like us to contact you about your feedback?<\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_4_11' class='large gfield_select'     aria-invalid=\"false\" ><option value='yes' >yes<\/option><option value='no' >no<\/option><\/select><\/div><\/div><div id=\"field_4_12\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >If you answered yes to the previous question, please provide your contact information.<\/div><fieldset id=\"field_4_13\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_13'>\n                            \n                            <span id='input_4_13_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_13.3' id='input_4_13_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_13_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_13_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_13.6' id='input_4_13_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_13_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_4_14\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_14'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_14' id='input_4_14' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_15\" class=\"gfield gfield--type-phone gfield--input-type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_15'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_15' id='input_4_15' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_16\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Subscribe to our enews<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_16'><div class='gchoice gchoice_4_16_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.1' type='checkbox'  value='I would like to receive eye health and safety news from Prevent Blindness'  id='choice_4_16_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_16_1' id='label_4_16_1' class='gform-field-label gform-field-label--type-inline'>I would like to receive eye health and safety news from Prevent Blindness<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_17\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_17'>CAPTCHA<\/label><div id='input_4_17' class='ginput_container ginput_recaptcha' 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