{"id":25167,"date":"2021-11-28T16:35:44","date_gmt":"2021-11-28T16:35:44","guid":{"rendered":"https:\/\/bewellwithval.com\/?page_id=25167"},"modified":"2021-11-28T16:36:40","modified_gmt":"2021-11-28T16:36:40","slug":"salud-de-la-mujer","status":"publish","type":"page","link":"https:\/\/bewellwithval.com\/salud-de-la-mujer\/","title":{"rendered":"salud de la mujer"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"25167\" class=\"elementor elementor-25167\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0f6ceb7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0f6ceb7\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-41e95a7\" data-id=\"41e95a7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bead1de elementor-widget elementor-widget-shortcode\" data-id=\"bead1de\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><style type=\"text\/css\">.super-form:not(.super-initialized) *:not(.super-load-icon) { visibility: hidden !important; }<\/style><div id=\"super-form-24649\" style=\"margin:0px 0px 0px 0px;\" class=\"super-form super-form-24649  super-full-rounded super-field-size-medium super-adaptive\" data-hide=\"true\" data-overlay=\"true\" data-field-size=\"medium\"><span class=\"super-load-icon\"><\/span><form tabindex=\"0\" autocomplete=\"on\" enctype=\"multipart\/form-data\"><input type=\"hidden\" name=\"sf_nonce\" value=\"\" \/><input type=\"text\" name=\"super_hp\" size=\"25\" value=\"\" \/><div class=\"super-shortcode super-field super-hidden\"><input class=\"super-shortcode-field\" type=\"hidden\" value=\"24649\" name=\"hidden_form_id\" \/><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>Informaci\u00f3n Personal<\/h1><\/div><div class=\"super-heading-description\" ><div>Toda su informaci\u00f3n ser\u00e1 guardada de manera confidencial entre usted y el Consultor de Salud.<\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column \"><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Nombre<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"first_name\" data-oname=\"first_name\" data-validation=\"empty\" data-email=\"First Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-1 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Apellido<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"last_name\" data-oname=\"last_name\" data-validation=\"empty\" data-email=\"Last Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Edad<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"Edad\" data-oname=\"Edad\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Estatura<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"Estatura\" data-oname=\"Estatura\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-date super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Fecha de Nacimiento<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field super-datepicker\" type=\"text\" autocomplete=\"false\"  value=\"\" \r\n        name=\"Fecha_de_nacimiento\" \r\n        data-format=\"dd-mm-yy\" \r\n        data-jsformat=\"dd-MM-yyyy\" \r\n        data-connected-min=\"\" \r\n        data-connected-min-days=\"1\" \r\n        data-connected-max=\"\" \r\n        data-connected-max-days=\"1\" \r\n        data-range=\"-100:+5\" \r\n        data-first-day=\"1\"\r\n        data-localization=\"\"\r\n        data-change-month=\"true\"\r\n        data-change-year=\"true\"\r\n        data-show-month-after-year=\"\"\r\n        data-show-week=\"\"\r\n        data-number-of-months=\"1\"\r\n        data-show-other-months=\"\"\r\n        data-select-other-months=\"false\" data-work-days=\"true\"data-weekends=\"true\"data-maxPicks=\"1\" data-oname=\"Fecha_de_nacimiento\" data-email=\"Date:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" data-return_age=\"\" readonly=\"true\" \/><span class=\"super-adaptive-placeholder\" data-placeholder=\"Selecione Fecha\" data-placeholderFilled=\"Selecione Fecha\"><span>Selecione Fecha<\/span><\/span><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Lugar de Nacimiento <\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"address_1\" data-oname=\"address_1\" data-validation=\"empty\" data-email=\"Address:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Correo Electr\u00f3nico <\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"email\" name=\"email\" data-oname=\"email\" data-validation=\"email\" data-email=\"E-mail address:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-radio super-has-only-label   super-ungrouped   display-vertical\"><div class=\"super-label super-bottom-margin\">Con que frecuencia revisa su correo electr\u00f3nico?<\/div><div class=\"super-field-wrapper \"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"first_choice\" \/><div>Diario<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"second_choice\" \/><div>Semanal<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"third_choice\" \/><div>Casi nunca<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"option\" value=\"\" data-oname=\"option\" data-email=\"Option:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Telefono:  Casa:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"tel\" name=\"phonenumber\" data-oname=\"phonenumber\" data-validation=\"phone\" data-email=\"Phonenumber:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><span class=\"super-adaptive-placeholder\" data-placeholder=\"Your Phonenumber\" data-placeholderFilled=\"Your Phonenumber\"><span>Your Phonenumber<\/span><\/span><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Trabajo<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"tel\" name=\"phonenumber_1\" data-oname=\"phonenumber_1\" data-validation=\"phone\" data-email=\"Phonenumber:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Celular<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"tel\" name=\"phonenumber_2\" data-oname=\"phonenumber_2\" data-validation=\"phone\" data-email=\"Phonenumber:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Peso Actual:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_1\" data-oname=\"name_1\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Peso Hace 6 meses:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_2\" data-oname=\"name_2\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Peso hace un a\u00f1o:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_3\" data-oname=\"name_3\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfLe gustar\u00eda que su peso fuera diferente?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_4\" data-oname=\"name_4\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Si es as\u00ed, \u00bfqu\u00e9 tanto?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_5\" data-oname=\"name_5\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>Social<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Estado Civil:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_6\" data-oname=\"name_6\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfD\u00f3nde vive actualmente?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_7\" data-oname=\"name_7\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfHijos?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_8\" data-oname=\"name_8\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfMascotas?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_10\" data-oname=\"name_10\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Profesi\u00f3n:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_9\" data-oname=\"name_9\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Horas laborales por semana:<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_11\" data-oname=\"name_11\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>SALUD<\/h1><\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Por favor, haga una lista de sus principales preocupaciones en materia de salud:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question\" data-oname=\"question\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfOtras preocupaciones y\/o metas?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_1\" data-oname=\"question_1\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_full super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfEn qu\u00e9 etapa de su vida se ha sentido mejor?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_2\" data-oname=\"question_2\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfHa tenido alguna enfermedad grave, hospitalizaci\u00f3n o lesi\u00f3n?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_3\" data-oname=\"question_3\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfC\u00f3mo es\/fue la salud de su madre?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_4\" data-oname=\"question_4\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Como es\/fue la salud de su padre?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_5\" data-oname=\"question_5\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfCu\u00e1les son sus antecedentes \u00e9tnicos?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_7\" data-oname=\"question_7\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfCu\u00e1l es su grupo sangu\u00edneo?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_12\" data-oname=\"name_12\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfC\u00f3mo duerme?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_13\" data-oname=\"name_13\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfCu\u00e1ntas horas?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_14\" data-oname=\"name_14\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfSe despierta durante la noche?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_15\" data-oname=\"name_15\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfPor qu\u00e9?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_16\" data-oname=\"name_16\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfAlg\u00fan dolor, rigidez, hinchaz\u00f3n?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_17\" data-oname=\"name_17\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfEstre\u00f1imiento\/diarrea\/gases?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_18\" data-oname=\"name_18\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfAlergias o sensibilidad? Por favor explique:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_8\" data-oname=\"question_8\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div style=\"padding-top:20px;padding-bottom:20px;\" class=\"super-shortcode super-field super-divider  super-align-left  super-ungrouped   align-left border-single style-dashed back-0\"><div class=\"super-divider-inner\" style=\"width:100%;border-color:#444444;border-top-width:1px;border-bottom-width:1px;height:1px;\"><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>SALUD DE LA MUJER<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfEs regular su menstruaci\u00f3n? <\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_19\" data-oname=\"name_19\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfCu\u00e1ntos d\u00edas le dura?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_44\" data-oname=\"name_44\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-text super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfCon cu\u00e1nta frecuencia?<\/div><div class=\"super-field-wrapper \"><input tabindex=\"-1\" class=\"super-shortcode-field\" type=\"text\" name=\"name_77\" data-oname=\"name_77\" data-email=\"Name:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfTiene dolor o s\u00edntomas? Por favor explique:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_9\" data-oname=\"question_9\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfTiene o est\u00e1 cerca de la menopausia? Por favor explique:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_10\" data-oname=\"question_10\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Historia de control de natalidad:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_11\" data-oname=\"question_11\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfLe dan infecciones de hongos o de v\u00eda urinaria? Por favor explique:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_12\" data-oname=\"question_12\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div style=\"padding-top:20px;padding-bottom:20px;\" class=\"super-shortcode super-field super-divider  super-align-left  super-ungrouped   align-left border-single style-dashed back-0\"><div class=\"super-divider-inner\" style=\"width:100%;border-color:#444444;border-top-width:1px;border-bottom-width:1px;height:1px;\"><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>MEDICA<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfToma alg\u00fan suplemento o medicamento? Por favor haga una lista:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_15\" data-oname=\"question_15\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfQu\u00e9 papel juegan los deportes y el ejercicio en su vida?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_13\" data-oname=\"question_13\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfAlg\u00fan curador, ayudante o terapia con el cual est\u00e9 involucrado? Por favor, ind\u00edquelos:<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_14\" data-oname=\"question_14\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div style=\"padding-top:20px;padding-bottom:20px;\" class=\"super-shortcode super-field super-divider  super-align-left  super-ungrouped   align-left border-single style-dashed back-0\"><div class=\"super-divider-inner\" style=\"width:100%;border-color:#444444;border-top-width:1px;border-bottom-width:1px;height:1px;\"><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>ALIMENTOS<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfSu familia y\/o sus amistades la apoyar\u00edan en su deseo de hacer cambios en su manera de comer y\/o estilo de vida?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_16\" data-oname=\"question_16\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-radio super-has-only-label   super-ungrouped   display-vertical\"><div class=\"super-label super-bottom-margin\">\u00bfUsted cocina? <\/div><div class=\"super-field-wrapper \"><div class=\"super-items-list\"><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"first_choice\" \/><div>SI<\/div><\/label><label class=\"super-item\" ><span class=\"super-before\"><span class=\"super-after\"><\/span><\/span><input type=\"radio\" value=\"second_choice\" \/><div>NO<\/div><\/label><\/div><input class=\"super-shortcode-field\" type=\"hidden\" name=\"option_1\" value=\"\" data-oname=\"option_1\" data-email=\"Option:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" \/><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfQu\u00e9 porcentaje de su comida est\u00e1 hecha en casa?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_17\" data-oname=\"question_17\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_two_fifth super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfD\u00f3nde consigue el resto?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_18\" data-oname=\"question_18\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_two_fifth super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">\u00bfLe dan antojos de az\u00facar, caf\u00e9, cigarros o tiene alguna adicci\u00f3n fuerte?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_19\" data-oname=\"question_19\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>\u00bfQu\u00e9 alimentos com\u00eda con frecuencia de ni\u00f1a?<\/h1><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Desayuno<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_21\" data-oname=\"question_21\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Almuerzo<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_22\" data-oname=\"question_22\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Cena<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_23\" data-oname=\"question_23\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Meriendas<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_24\" data-oname=\"question_24\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_half super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">L\u00edquidos<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_25\" data-oname=\"question_25\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-shortcode super-field super-heading   super-ungrouped  \"><div class=\"super-heading-title\"><h1>\u00bfQu\u00e9 tipo de alimentos come hoy en d\u00eda?<\/h1><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Desayuno<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question998\" data-oname=\"question998\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Almuerzo<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question76\" data-oname=\"question76\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Cena<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question878\" data-oname=\"question878\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div class=\"super-grid super-shortcode\"><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-1 first-column \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">Meriendas<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_26\" data-oname=\"question_26\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-2  \"><div class=\"super-shortcode super-field super-textarea super-has-only-label   super-ungrouped  \"><div class=\"super-label super-bottom-margin\">L\u00edquidos<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_27\" data-oname=\"question_27\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><div class=\"super-shortcode super_one_third super-column grid-level-0 column-number-3  \"><div class=\"super-shortcode super-field super-textarea super-has-label-desc   super-ungrouped  \"><div class=\"super-label\">COMENTARIOS ADICIONALES<\/div><div class=\"super-description\">\u00bfHay algo m\u00e1s que quisiera compartir?<\/div><div class=\"super-field-wrapper \"><textarea tabindex=\"-1\" class=\"super-shortcode-field\" name=\"question_28\" data-oname=\"question_28\" data-email=\"Question:\" data-exclude=\"0\" data-absolute-default=\"\" data-default-value=\"\" ><\/textarea><\/div><div class=\"super-error-msg\">Field is required!<\/div><div class=\"super-empty-error-msg\">Field is required!<\/div><\/div><\/div><\/div><div data-color=\"#f26c68\" data-light=\"#ff807c\" data-dark=\"#d44e4a\" data-hover-color=\"#444444\" data-hover-light=\"#585858\" data-hover-dark=\"#262626\" 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