Physical activity assessment section template

public/css/style.css

@@ -663,3 +663,13 @@ body .break-spaces {
 .gem-nodes .node span[field] {
     font-weight: bold;
 }
+body .node input[type="number"] {
+    max-width: 70px;
+    min-width: unset !important;
+}
+.section-edit-mask {
+    top: 0;
+    left: 0;
+    width: 100%;
+    height: 100%;
+}

storage/sections/physical-activity-assessment/form.blade.php

@@ -0,0 +1,845 @@
+<?php
+$contentData = false;
+if ($section) {
+    $contentData = json_decode($section->content_data, true);
+}
+if (!$contentData) {
+    $contentData = [];
+}
+$formID = rand(0, 100000);
+?>
+<form method="POST" action="/process_form_submit" onsubmit="return submitForm_NoteSection_{{ $formID }}(this);">
+    <?php if($section): ?>
+    <input type="hidden" name="section_uid" value="<?= $section->uid?>">
+    <?php else: ?>
+    <input type="hidden" name="note_uid" value="<?= $note->uid?>">
+    <input type="hidden" name="section_template_uid" value="<?= $sectionTemplate->uid ?>">
+    <?php endif; ?>
+
+    <div class="my-3 node node-level-0">
+        <p class="text-secondary">Moderate physical activity is any activity that is <u><i>somewhat hard</i></u>
+            and makes you feel like you do when you walk <i><u>fast</u></i> (3– 4 mph).</p>
+        <label class="mb-3">Select the activities you did during the last 7 days at a MODERATE LEVEL <u>nonstop for at
+                least 10
+                minutes</u>:</label>
+        <div class="row">
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__walking_fast_with_a_purpose'] ? 'checked' : '' }}
+                           name="last_7_days__walking_fast_with_a_purpose" onchange="onGemVChange_{{ $formID }}(this)">
+                    Walking fast, with a purpose
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__aerobics_low_impact'] ? 'checked' : '' }}
+                           name="last_7_days__aerobics_low_impact" onchange="onGemVChange_{{ $formID }}(this)">
+                    Aerobics, low impact
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__baseball_softball'] ? 'checked' : '' }}
+                           name="last_7_days__baseball_softball" onchange="onGemVChange_{{ $formID }}(this)">
+                    Baseball, softball
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__bicycling_less_than_12_mph_'] ? 'checked' : '' }}
+                           name="last_7_days__bicycling_less_than_12_mph_" onchange="onGemVChange_{{ $formID }}(this)">
+                    Bicycling (less than 12 mph)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__bowling'] ? 'checked' : '' }}
+                           name="last_7_days__bowling" onchange="onGemVChange_{{ $formID }}(this)">
+                    Bowling
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__calisthenics_light'] ? 'checked' : '' }}
+                           name="last_7_days__calisthenics_light" onchange="onGemVChange_{{ $formID }}(this)">
+                    Calisthenics, light
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__carpentry'] ? 'checked' : '' }}
+                           name="last_7_days__carpentry" onchange="onGemVChange_{{ $formID }}(this)">
+                    Carpentry
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__dancing'] ? 'checked' : '' }}
+                           name="last_7_days__dancing" onchange="onGemVChange_{{ $formID }}(this)">
+                    Dancing
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__fishing_standing'] ? 'checked' : '' }}
+                           name="last_7_days__fishing_standing" onchange="onGemVChange_{{ $formID }}(this)">
+                    Fishing, standing
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__frisbee'] ? 'checked' : '' }}
+                           name="last_7_days__frisbee" onchange="onGemVChange_{{ $formID }}(this)">
+                    Frisbee
+                </label>
+            </div>
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__walking_downstairs'] ? 'checked' : '' }}
+                           name="last_7_days__walking_downstairs" onchange="onGemVChange_{{ $formID }}(this)">
+                    Walking downstairs
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__gardening_planting_raking_weeding'] ? 'checked' : '' }}
+                           name="last_7_days__gardening_planting_raking_weeding"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    Gardening: planting, raking, weeding
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__golf'] ? 'checked' : '' }}
+                           name="last_7_days__golf" onchange="onGemVChange_{{ $formID }}(this)">
+                    Golf
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__gymnastics'] ? 'checked' : '' }}
+                           name="last_7_days__gymnastics" onchange="onGemVChange_{{ $formID }}(this)">
+                    Gymnastics
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__horseback_riding'] ? 'checked' : '' }}
+                           name="last_7_days__horseback_riding" onchange="onGemVChange_{{ $formID }}(this)">
+                    Horseback riding
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__housework_mopping_sweeping_vacuuming'] ? 'checked' : '' }}
+                           name="last_7_days__housework_mopping_sweeping_vacuuming"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    Housework: mopping, sweeping, vacuuming
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__lifting_or_carrying_moderate_loads_5_to_15_lb_'] ? 'checked' : '' }}
+                           name="last_7_days__lifting_or_carrying_moderate_loads_5_to_15_lb_"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    Lifting or carrying moderate loads (5 to 15 lb)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__mowing_lawn_power_mower'] ? 'checked' : '' }}
+                           name="last_7_days__mowing_lawn_power_mower" onchange="onGemVChange_{{ $formID }}(this)">
+                    Mowing lawn, power mower
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__ping_pong'] ? 'checked' : '' }}
+                           name="last_7_days__ping_pong" onchange="onGemVChange_{{ $formID }}(this)">
+                    Ping-pong
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__playing_with_children_kneeling_lifting'] ? 'checked' : '' }}
+                           name="last_7_days__playing_with_children_kneeling_lifting"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    Playing with children: kneeling, lifting
+                </label>
+            </div>
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__rowing_sailing'] ? 'checked' : '' }}
+                           name="last_7_days__rowing_sailing" onchange="onGemVChange_{{ $formID }}(this)">
+                    Rowing, sailing
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__skateboarding'] ? 'checked' : '' }}
+                           name="last_7_days__skateboarding" onchange="onGemVChange_{{ $formID }}(this)">
+                    Skateboarding
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__tai_chi_qigong'] ? 'checked' : '' }}
+                           name="last_7_days__tai_chi_qigong" onchange="onGemVChange_{{ $formID }}(this)">
+                    Tai chi, qigong
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__vigorous_stretching'] ? 'checked' : '' }}
+                           name="last_7_days__vigorous_stretching" onchange="onGemVChange_{{ $formID }}(this)">
+                    Vigorous stretching
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__volleyball'] ? 'checked' : '' }}
+                           name="last_7_days__volleyball" onchange="onGemVChange_{{ $formID }}(this)">
+                    Volleyball
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__yoga'] ? 'checked' : '' }}
+                           name="last_7_days__yoga" onchange="onGemVChange_{{ $formID }}(this)">
+                    Yoga
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__washing_car'] ? 'checked' : '' }}
+                           name="last_7_days__washing_car" onchange="onGemVChange_{{ $formID }}(this)">
+                    Washing car
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__water_aerobics'] ? 'checked' : '' }}
+                           name="last_7_days__water_aerobics" onchange="onGemVChange_{{ $formID }}(this)">
+                    Water aerobics
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__ping_weight_lifting'] ? 'checked' : '' }}
+                           name="last_7_days__ping_weight_lifting" onchange="onGemVChange_{{ $formID }}(this)">
+                    Weight lifting
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__working_on_car'] ? 'checked' : '' }}
+                           name="last_7_days__working_on_car" onchange="onGemVChange_{{ $formID }}(this)">
+                    Working on car
+                </label>
+            </div>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0 d-flex align-items-center">
+        <label>During the last 7 days, on how many days did you do a Moderate physical activity Days<u>nonstop for at
+                least 10 minutes at a time</u>?</label>
+        <div class="ml-3 d-inline-flex align-items-center">
+            <input onchange="onGemVChange_{{ $formID }}(this)"
+                   value="{{ @$contentData['last_7_days__moderate_days'] }}"
+                   name="last_7_days__moderate_days" type="number" class="form-control form-control-sm" placeholder="">
+            <span class="ml-2 text-secondary flex-grow-1">Days</span>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0 d-flex align-items-center">
+        <label>On those days, how much time did you spend <u>on average</u> doing Moderate physical
+            activities?</label>
+        <div class="ml-3 d-inline-flex align-items-center">
+            <input onchange="onGemVChange_{{ $formID }}(this)"
+                   value="{{ @$contentData['last_7_days__moderate_mins_per_day'] }}"
+                   name="last_7_days__moderate_mins_per_day" type="number" class="form-control form-control-sm"
+                   placeholder="">
+            <span class="ml-2 text-secondary flex-grow-1">Minutes/Day</span>
+        </div>
+    </div>
+
+    <hr>
+
+    <div class="my-3 node node-level-0">
+        <p class="text-secondary">Vigorous physical activity is any activity that is <i>hard</i>
+            and makes you feel like you do when you run or jog.</p>
+        <label class="mb-3">Select the activities you did during the last 7 days at a VIGOROUS LEVEL <u>at least 10
+                minutes at a time
+                without stopping</u>:</label>
+        <div class="row">
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__jogging_running'] ? 'checked' : '' }}
+                           name="last_7_days__jogging_running" onchange="onGemVChange_{{ $formID }}(this)">
+                    Jogging, running
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__aerobics_high_impact_jazzercise'] ? 'checked' : '' }}
+                           name="last_7_days__aerobics_high_impact_jazzercise"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    Aerobics, high impact (Jazzercise)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__basketball'] ? 'checked' : '' }}
+                           name="last_7_days__basketball" onchange="onGemVChange_{{ $formID }}(this)">
+                    Basketball
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__bicycling_fast_more_than_12_mph'] ? 'checked' : '' }}
+                           name="last_7_days__bicycling_fast_more_than_12_mph"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    Bicycling, fast (more than 12 mph)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__calisthenics_vigorous'] ? 'checked' : '' }}
+                           name="last_7_days__calisthenics_vigorous" onchange="onGemVChange_{{ $formID }}(this)">
+                    Calisthenics, vigorous
+                </label>
+            </div>
+
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__walking_upstairs'] ? 'checked' : '' }}
+                           name="last_7_days__walking_upstairs" onchange="onGemVChange_{{ $formID }}(this)">
+                    Walking upstairs
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__carrying_heavy_loads'] ? 'checked' : '' }}
+                           name="last_7_days__carrying_heavy_loads" onchange="onGemVChange_{{ $formID }}(this)">
+                    Carrying heavy loads
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__jumping_rope'] ? 'checked' : '' }}
+                           name="last_7_days__jumping_rope" onchange="onGemVChange_{{ $formID }}(this)">
+                    Jumping rope
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__judo_karate_kickboxing'] ? 'checked' : '' }}
+                           name="last_7_days__judo_karate_kickboxing" onchange="onGemVChange_{{ $formID }}(this)">
+                    Judo, karate, kickboxing
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__roller_skating_rollerblading'] ? 'checked' : '' }}
+                           name="last_7_days__roller_skating_rollerblading" onchange="onGemVChange_{{ $formID }}(this)">
+                    Roller skating, rollerblading
+                </label>
+            </div>
+
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__soccer'] ? 'checked' : '' }}
+                           name="last_7_days__soccer" onchange="onGemVChange_{{ $formID }}(this)">
+                    Soccer
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__ski_machine_nordic_track'] ? 'checked' : '' }}
+                           name="last_7_days__ski_machine_nordic_track" onchange="onGemVChange_{{ $formID }}(this)">
+                    Ski machine (Nordic Track)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__stair_climbing_stairmaster'] ? 'checked' : '' }}
+                           name="last_7_days__stair_climbing_stairmaster" onchange="onGemVChange_{{ $formID }}(this)">
+                    Stair climbing (StairMaster)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__swimming_laps'] ? 'checked' : '' }}
+                           name="last_7_days__swimming_laps" onchange="onGemVChange_{{ $formID }}(this)">
+                    Swimming laps
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['last_7_days__tennis_racquetball'] ? 'checked' : '' }}
+                           name="last_7_days__tennis_racquetball" onchange="onGemVChange_{{ $formID }}(this)">
+                    Tennis, racquetball
+                </label>
+            </div>
+
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0 d-flex align-items-center">
+        <label>During the last 7 days, on how many days did you do a Vigorous physical activity Days<u>nonstop for at
+                least 10 minutes at a time</u>?</label>
+        <div class="ml-3 d-inline-flex align-items-center">
+            <input onchange="onGemVChange_{{ $formID }}(this)"
+                   value="{{ @$contentData['last_7_days__vigorous_days'] }}"
+                   name="last_7_days__vigorous_days" type="number" class="form-control form-control-sm" placeholder="">
+            <span class="ml-2 text-secondary flex-grow-1">Days</span>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0 d-flex align-items-center">
+        <label>On those days, how much time did you spend <u>on average</u> doing Vigorous physical activities?</label>
+        <div class="ml-3 d-inline-flex align-items-center">
+            <input onchange="onGemVChange_{{ $formID }}(this)"
+                   value="{{ @$contentData['last_7_days__vigorous_mins_per_day'] }}"
+                   name="last_7_days__vigorous_mins_per_day" type="number" class="form-control form-control-sm"
+                   placeholder="">
+            <span class="ml-2 text-secondary flex-grow-1">Minutes/Day</span>
+        </div>
+    </div>
+
+    <hr>
+
+    <div class="my-3 node node-level-0">
+        <label>Compared with your Usual Physical Activity over the last 3 months, was the last seven days’
+            activity:</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['last_7_days__activity_comparison'] === 'More' ? 'checked' : '' }} name="last_7_days__activity_comparison"
+                       type="radio" value="More" class="mr-1">
+                <span>More</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['last_7_days__activity_comparison'] === 'Less' ? 'checked' : '' }} name="last_7_days__activity_comparison"
+                       type="radio" value="Less" class="mr-1">
+                <span>Less</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['last_7_days__activity_comparison'] === 'About the same' ? 'checked' : '' }} name="last_7_days__activity_comparison"
+                       type="radio" value="About the same" class="mr-1">
+                <span>About the same</span>
+            </label>
+        </div>
+    </div>
+
+    <hr>
+
+    <p class="font-weight-bold">Medical Problems</p>
+
+    <div class="my-3 node node-level-0">
+        <label>1. Has your doctor ever said that you have a heart condition and that you should only do physical
+            activity recommended by a doctor?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_heart_condition'] === 'Yes' ? 'checked' : '' }} name="mp_heart_condition"
+                       type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_heart_condition'] === 'No' ? 'checked' : '' }} name="mp_heart_condition"
+                       type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>2. Do you feel pain in your chest when you do physical activity?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_chest_pain_with_physical_activity'] === 'Yes' ? 'checked' : '' }} name="mp_chest_pain_with_physical_activity"
+                       type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_chest_pain_with_physical_activity'] === 'No' ? 'checked' : '' }} name="mp_chest_pain_with_physical_activity"
+                       type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>3. In the past month, have you had chest pain when you were not doing physical activity?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_chest_pain_without_physical_activity'] === 'Yes' ? 'checked' : '' }} name="mp_chest_pain_without_physical_activity"
+                       type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_chest_pain_without_physical_activity'] === 'No' ? 'checked' : '' }} name="mp_chest_pain_without_physical_activity"
+                       type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>4. Do you lose your balance because of dizziness, or do you ever lose consciousness?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_dizziness'] === 'Yes' ? 'checked' : '' }} name="mp_dizziness" type="radio"
+                       value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_dizziness'] === 'No' ? 'checked' : '' }} name="mp_dizziness" type="radio"
+                       value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>5. Do you have a bone or joint problem that could be made worse by a change in your physical
+            activity?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_bone_joint_problem'] === 'Yes' ? 'checked' : '' }} name="mp_bone_joint_problem"
+                       type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_bone_joint_problem'] === 'No' ? 'checked' : '' }} name="mp_bone_joint_problem"
+                       type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart
+            condition?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_bp_heart_drugs'] === 'Yes' ? 'checked' : '' }} name="mp_bp_heart_drugs"
+                       type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_bp_heart_drugs'] === 'No' ? 'checked' : '' }} name="mp_bp_heart_drugs"
+                       type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>7. Do you know of any other reason why you should not do physical activity?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_other'] === 'Yes' ? 'checked' : '' }} name="mp_other" type="radio"
+                       value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['mp_other'] === 'No' ? 'checked' : '' }} name="mp_other" type="radio" value="No"
+                       class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <hr>
+
+    <p class="font-weight-bold">Physical Activity Plans</p>
+
+    <div class="my-3 node node-level-0">
+        <label>Please check the ONE answer that best describes your physical activity plans for the next 6
+            months:</label>
+        <div class="">
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['pa_plans_next_6_months'] === 'I do not plan to become physically active in the next 6 months' ? 'checked' : '' }}
+                       name="pa_plans_next_6_months"
+                       type="radio"
+                       value="I do not plan to become physically active in the next 6 months" class="mr-1">
+                <span>A. I do not plan to become physically active in the next 6 months.</span>
+            </label>
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['pa_plans_next_6_months'] === 'I am thinking about becoming more physically active' ? 'checked' : '' }}
+                       name="pa_plans_next_6_months"
+                       type="radio"
+                       value="I am thinking about becoming more physically active" class="mr-1">
+                <span>B. I am thinking about becoming more physically active.</span>
+            </label>
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['pa_plans_next_6_months'] === 'I intend to become more physically active in the next 6 months' ? 'checked' : '' }}
+                       name="pa_plans_next_6_months"
+                       type="radio"
+                       value="I intend to become more physically active in the next 6 months" class="mr-1">
+                <span>C. I intend to become more physically active in the next 6 months.</span>
+            </label>
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['pa_plans_next_6_months'] === 'I have been regularly physically active for the last 1–5 months' ? 'checked' : '' }}
+                       name="pa_plans_next_6_months"
+                       type="radio"
+                       value="I have been regularly physically active for the last 1–5 months" class="mr-1">
+                <span>D. I have been regularly physically active for the last 1–5 months.</span>
+            </label>
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['pa_plans_next_6_months'] === 'I have been regularly physically active for the past 6 months or more' ? 'checked' : '' }}
+                       name="pa_plans_next_6_months"
+                       type="radio"
+                       value="I have been regularly physically active for the past 6 months or more" class="mr-1">
+                <span>E. I have been regularly physically active for the past 6 months or more.</span>
+            </label>
+        </div>
+    </div>
+
+    <hr>
+
+    <p class="font-weight-bold">Benefits of Physical Activity Important to You</p>
+
+    <div class="my-3 node node-level-0">
+        <label>the 3 <i>benefits</i> of physical activity that are <i>Most Important</i> to You:</label>
+        <div class="row">
+            <div class="col-6">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_for_my_health'] ? 'checked' : '' }}
+                           name="pa_important_for_my_health" onchange="onGemVChange_{{ $formID }}(this)">
+                    1. For my health
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_control_my_weight'] ? 'checked' : '' }}
+                           name="pa_important_control_my_weight" onchange="onGemVChange_{{ $formID }}(this)">
+                    2. Control my weight
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_look_better'] ? 'checked' : '' }}
+                           name="pa_important_look_better" onchange="onGemVChange_{{ $formID }}(this)">
+                    3. Look better
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_feel_better'] ? 'checked' : '' }}
+                           name="pa_important_feel_better" onchange="onGemVChange_{{ $formID }}(this)">
+                    4. Feel better
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_feel_good_about_taking_care_of_myself'] ? 'checked' : '' }}
+                           name="pa_important_feel_good_about_taking_care_of_myself"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    5. Feel good about taking care of myself
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_set_a_good_example_for_my_family_or_friends'] ? 'checked' : '' }}
+                           name="pa_important_set_a_good_example_for_my_family_or_friends"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    6. Set a good example for my family or friends
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_get_my_partner_child_friend_to_be_more_active_with_me'] ? 'checked' : '' }}
+                           name="pa_important_get_my_partner_child_friend_to_be_more_active_with_me"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    7. Get my partner, child, friend to be more active with me
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_teach_my_family_friends_the_importance_of_physical_activity'] ? 'checked' : '' }}
+                           name="pa_important_teach_my_family_friends_the_importance_of_physical_activity"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    8. Teach my family, friends the importance of physical activity
+                </label>
+            </div>
+            <div class="col-6">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_have_time_for_me'] ? 'checked' : '' }}
+                           name="pa_important_have_time_for_me" onchange="onGemVChange_{{ $formID }}(this)">
+                    9. Have time for me
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_lower_my_stress'] ? 'checked' : '' }}
+                           name="pa_important_lower_my_stress" onchange="onGemVChange_{{ $formID }}(this)">
+                    10. Lower my stress
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_improve_my_fitness'] ? 'checked' : '' }}
+                           name="pa_important_improve_my_fitness" onchange="onGemVChange_{{ $formID }}(this)">
+                    11. Improve my fitness
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_lower_my_risk_of_heart_disease'] ? 'checked' : '' }}
+                           name="pa_important_lower_my_risk_of_heart_disease"
+                           onchange="onGemVChange_{{ $formID }}(this)">
+                    12. Lower my risk of heart disease
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_lower_my_blood_pressure'] ? 'checked' : '' }}
+                           name="pa_important_lower_my_blood_pressure" onchange="onGemVChange_{{ $formID }}(this)">
+                    13. Lower my blood pressure
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_lower_my_cholesterol'] ? 'checked' : '' }}
+                           name="pa_important_lower_my_cholesterol" onchange="onGemVChange_{{ $formID }}(this)">
+                    14. Lower my cholesterol
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_control_my_diabetes'] ? 'checked' : '' }}
+                           name="pa_important_control_my_diabetes" onchange="onGemVChange_{{ $formID }}(this)">
+                    15. Control my diabetes
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           {{ @$contentData['pa_important_other'] ? 'checked' : '' }}
+                           name="pa_important_other" onchange="onGemVChange_{{ $formID }}(this)">
+                    <span class="text-nowrap mr-2">16. Other:</span>
+                    <input type="text" class="form-control form-control-sm"
+                           name="pa_important_other_details"
+                           value="{{ @$contentData['pa_important_other_details'] }}">
+                </label>
+            </div>
+        </div>
+    </div>
+
+    <hr>
+
+    <p class="font-weight-bold">Getting Help from Others</p>
+
+    <div class="my-3 node node-level-0">
+        <label>Is there someone who would encourage you or help you with some of your responsibilities so you could get
+            regular
+            physical activity?</label>
+        <div class="d-flex align-items-center mb-3">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['getting_help_from_others'] === 'Yes' ? 'checked' : '' }} name="getting_help_from_others"
+                       type="radio"
+                       value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['getting_help_from_others'] === 'No' ? 'checked' : '' }} name="getting_help_from_others"
+                       type="radio" value="No"
+                       class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+        <div class="d-flex align-items-center mb-3">
+            <input type="text" class="form-control form-control-sm mr-2" placeholder="Who is that?"
+                   name="getting_help_from_others_who" value="{{ @$contentData['getting_help_from_others_who'] }}">
+            <input type="text" class="form-control form-control-sm" placeholder="How could they help?"
+                   name="getting_help_from_others_how" value="{{ @$contentData['getting_help_from_others_how'] }}">
+        </div>
+    </div>
+
+    <p class="font-weight-bold">Helping Others</p>
+
+    <div class="my-3 node node-level-0">
+        <label>Is there a friend or family member you think should get more physical activity?</label>
+        <div class="d-flex align-items-center mb-3">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['helping_others'] === 'Yes' ? 'checked' : '' }} name="helping_others"
+                       type="radio"
+                       value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['helping_others'] === 'No' ? 'checked' : '' }} name="helping_others"
+                       type="radio" value="No"
+                       class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+        <div class="d-flex align-items-center mb-3">
+            <input type="text" class="form-control form-control-sm mr-2" placeholder="Who is that?"
+                   name="helping_others_who" value="{{ @$contentData['helping_others_who'] }}">
+            <input type="text" class="form-control form-control-sm" placeholder="How could you help them?"
+                   name="helping_others_how" value="{{ @$contentData['helping_others_how'] }}">
+        </div>
+    </div>
+
+    <p class="font-weight-bold">Confidence</p>
+
+    <div class="my-3 node node-level-0">
+        <label>How confident are you that you could increase your physical activity if you decided to do so?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['confidence'] === 'Very Confident' ? 'checked' : '' }} name="confidence"
+                       type="radio"
+                       value="Very Confident" class="mr-1">
+                <span>Very Confident</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['confidence'] === 'Fairly Confident' ? 'checked' : '' }} name="confidence"
+                       type="radio"
+                       value="Fairly Confident"
+                       class="mr-1">
+                <span>Fairly Confident</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['confidence'] === 'A Little Confident' ? 'checked' : '' }} name="confidence"
+                       type="radio"
+                       value="A Little Confident" class="mr-1">
+                <span>A Little Confident</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input onchange="onGemVChange_{{ $formID }}(this)"
+                       {{ @$contentData['confidence'] === 'Not at all Confident' ? 'checked' : '' }} name="confidence"
+                       type="radio"
+                       value="Not at all Confident"
+                       class="mr-1">
+                <span>Not at all Confident</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="form-group m-0 d-flex">
+        <button class="btn btn-sm btn-primary mr-2">Done</button>
+        {{--<button class="btn btn-sm btn-default border" onclick="return cancelForm_NoteSection_{{ $formID }}(this)">Cancel</button>--}}
+    </div>
+</form>
+<script>
+    function submitForm_NoteSection_{{ $formID }}(_form) {
+        showMask();
+        $.post(_form.action, $(_form).serialize(), function (_data) {
+            fastReload();
+        });
+        return false;
+    }
+
+    function cancelForm_NoteSection_{{ $formID }}(_trigger) {
+        $(_trigger).closest('.note-section').toggleClass('edit');
+        return false;
+    }
+
+    function onGemVChange_{{ $formID }}(_field) {
+        let name = _field.name, span = $('span[field="' + _field.name + '"]');
+        if (span.length) {
+            span.text(_field.value);
+        } else {
+            name = _field.name.replace('[]', '');
+            span = $('span[field="' + name + '"]');
+            if (span.length) {
+                let value = [];
+                $('[name="' + _field.name + '"]').each(function () {
+                    if (this.checked) value.push(this.value);
+                });
+                span.text(value.join(', '));
+            }
+        }
+
+        // submit here
+        let form = $(_field).closest('form');
+        $.post(form[0].action, form.serialize(), function (_data) {
+            console.log('Submitted!');
+        });
+    }
+</script>

storage/sections/physical-activity-assessment/processor.php

@@ -0,0 +1,2 @@
+<?php
+$newContentData = $request->all();

storage/sections/physical-activity-assessment/summary.php

@@ -0,0 +1,802 @@
+<?php
+$contentData = $newContentData;
+$formID = rand(0, 100000);
+?>
+<div class="position-relative">
+    <?php if($section): ?>
+        <input type="hidden" name="section_uid" value="<?= $section->uid?>">
+    <?php else: ?>
+        <input type="hidden" name="note_uid" value="<?= $note->uid?>">
+        <input type="hidden" name="section_template_uid" value="<?= $sectionTemplate->uid ?>">
+    <?php endif; ?>
+
+    <div class="my-3 node node-level-0">
+        <p class="text-secondary">Moderate physical activity is any activity that is <u><i>somewhat hard</i></u>
+            and makes you feel like you do when you walk <i><u>fast</u></i> (3– 4 mph).</p>
+        <label class="mb-3">Select the activities you did during the last 7 days at a MODERATE LEVEL <u>nonstop for at
+                least 10
+                minutes</u>:</label>
+        <div class="row">
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__walking_fast_with_a_purpose'] ? 'checked' : '' ?>
+                    name="last_7_days__walking_fast_with_a_purpose" >
+                    Walking fast, with a purpose
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__aerobics_low_impact'] ? 'checked' : '' ?>
+                    name="last_7_days__aerobics_low_impact" >
+                    Aerobics, low impact
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__baseball_softball'] ? 'checked' : '' ?>
+                    name="last_7_days__baseball_softball" >
+                    Baseball, softball
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__bicycling_less_than_12_mph_'] ? 'checked' : '' ?>
+                    name="last_7_days__bicycling_less_than_12_mph_" >
+                    Bicycling (less than 12 mph)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__bowling'] ? 'checked' : '' ?>
+                    name="last_7_days__bowling" >
+                    Bowling
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__calisthenics_light'] ? 'checked' : '' ?>
+                    name="last_7_days__calisthenics_light" >
+                    Calisthenics, light
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__carpentry'] ? 'checked' : '' ?>
+                    name="last_7_days__carpentry" >
+                    Carpentry
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__dancing'] ? 'checked' : '' ?>
+                    name="last_7_days__dancing" >
+                    Dancing
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__fishing_standing'] ? 'checked' : '' ?>
+                    name="last_7_days__fishing_standing" >
+                    Fishing, standing
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__frisbee'] ? 'checked' : '' ?>
+                    name="last_7_days__frisbee" >
+                    Frisbee
+                </label>
+            </div>
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__walking_downstairs'] ? 'checked' : '' ?>
+                    name="last_7_days__walking_downstairs" >
+                    Walking downstairs
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__gardening_planting_raking_weeding'] ? 'checked' : '' ?>
+                    name="last_7_days__gardening_planting_raking_weeding"
+                    >
+                    Gardening: planting, raking, weeding
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__golf'] ? 'checked' : '' ?>
+                    name="last_7_days__golf" >
+                    Golf
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__gymnastics'] ? 'checked' : '' ?>
+                    name="last_7_days__gymnastics" >
+                    Gymnastics
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__horseback_riding'] ? 'checked' : '' ?>
+                    name="last_7_days__horseback_riding" >
+                    Horseback riding
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__housework_mopping_sweeping_vacuuming'] ? 'checked' : '' ?>
+                    name="last_7_days__housework_mopping_sweeping_vacuuming"
+                    >
+                    Housework: mopping, sweeping, vacuuming
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__lifting_or_carrying_moderate_loads_5_to_15_lb_'] ? 'checked' : '' ?>
+                    name="last_7_days__lifting_or_carrying_moderate_loads_5_to_15_lb_"
+                    >
+                    Lifting or carrying moderate loads (5 to 15 lb)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__mowing_lawn_power_mower'] ? 'checked' : '' ?>
+                    name="last_7_days__mowing_lawn_power_mower" >
+                    Mowing lawn, power mower
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__ping_pong'] ? 'checked' : '' ?>
+                    name="last_7_days__ping_pong" >
+                    Ping-pong
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__playing_with_children_kneeling_lifting'] ? 'checked' : '' ?>
+                    name="last_7_days__playing_with_children_kneeling_lifting"
+                    >
+                    Playing with children: kneeling, lifting
+                </label>
+            </div>
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__rowing_sailing'] ? 'checked' : '' ?>
+                    name="last_7_days__rowing_sailing" >
+                    Rowing, sailing
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__skateboarding'] ? 'checked' : '' ?>
+                    name="last_7_days__skateboarding" >
+                    Skateboarding
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__tai_chi_qigong'] ? 'checked' : '' ?>
+                    name="last_7_days__tai_chi_qigong" >
+                    Tai chi, qigong
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__vigorous_stretching'] ? 'checked' : '' ?>
+                    name="last_7_days__vigorous_stretching" >
+                    Vigorous stretching
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__volleyball'] ? 'checked' : '' ?>
+                    name="last_7_days__volleyball" >
+                    Volleyball
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__yoga'] ? 'checked' : '' ?>
+                    name="last_7_days__yoga" >
+                    Yoga
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__washing_car'] ? 'checked' : '' ?>
+                    name="last_7_days__washing_car" >
+                    Washing car
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__water_aerobics'] ? 'checked' : '' ?>
+                    name="last_7_days__water_aerobics" >
+                    Water aerobics
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__ping_weight_lifting'] ? 'checked' : '' ?>
+                    name="last_7_days__ping_weight_lifting" >
+                    Weight lifting
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__working_on_car'] ? 'checked' : '' ?>
+                    name="last_7_days__working_on_car" >
+                    Working on car
+                </label>
+            </div>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0 d-flex align-items-center">
+        <label>During the last 7 days, on how many days did you do a Moderate physical activity Days<u>nonstop for at
+                least 10 minutes at a time</u>?</label>
+        <div class="ml-3 d-inline-flex align-items-center">
+            <input
+                   value="<?= @$contentData['last_7_days__moderate_days'] ?>"
+                   name="last_7_days__moderate_days" type="number" class="form-control form-control-sm" placeholder="">
+            <span class="ml-2 text-secondary flex-grow-1">Days</span>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0 d-flex align-items-center">
+        <label>On those days, how much time did you spend <u>on average</u> doing Moderate physical
+            activities?</label>
+        <div class="ml-3 d-inline-flex align-items-center">
+            <input
+                   value="<?= @$contentData['last_7_days__moderate_mins_per_day'] ?>"
+                   name="last_7_days__moderate_mins_per_day" type="number" class="form-control form-control-sm"
+                   placeholder="">
+            <span class="ml-2 text-secondary flex-grow-1">Minutes/Day</span>
+        </div>
+    </div>
+
+    <hr>
+
+    <div class="my-3 node node-level-0">
+        <p class="text-secondary">Vigorous physical activity is any activity that is <i>hard</i>
+            and makes you feel like you do when you run or jog.</p>
+        <label class="mb-3">Select the activities you did during the last 7 days at a VIGOROUS LEVEL <u>at least 10
+                minutes at a time
+                without stopping</u>:</label>
+        <div class="row">
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__jogging_running'] ? 'checked' : '' ?>
+                    name="last_7_days__jogging_running" >
+                    Jogging, running
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__aerobics_high_impact_jazzercise'] ? 'checked' : '' ?>
+                    name="last_7_days__aerobics_high_impact_jazzercise"
+                    >
+                    Aerobics, high impact (Jazzercise)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__basketball'] ? 'checked' : '' ?>
+                    name="last_7_days__basketball" >
+                    Basketball
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__bicycling_fast_more_than_12_mph'] ? 'checked' : '' ?>
+                    name="last_7_days__bicycling_fast_more_than_12_mph"
+                    >
+                    Bicycling, fast (more than 12 mph)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__calisthenics_vigorous'] ? 'checked' : '' ?>
+                    name="last_7_days__calisthenics_vigorous" >
+                    Calisthenics, vigorous
+                </label>
+            </div>
+
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__walking_upstairs'] ? 'checked' : '' ?>
+                    name="last_7_days__walking_upstairs" >
+                    Walking upstairs
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__carrying_heavy_loads'] ? 'checked' : '' ?>
+                    name="last_7_days__carrying_heavy_loads" >
+                    Carrying heavy loads
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__jumping_rope'] ? 'checked' : '' ?>
+                    name="last_7_days__jumping_rope" >
+                    Jumping rope
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__judo_karate_kickboxing'] ? 'checked' : '' ?>
+                    name="last_7_days__judo_karate_kickboxing" >
+                    Judo, karate, kickboxing
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__roller_skating_rollerblading'] ? 'checked' : '' ?>
+                    name="last_7_days__roller_skating_rollerblading" >
+                    Roller skating, rollerblading
+                </label>
+            </div>
+
+            <div class="col-4">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__soccer'] ? 'checked' : '' ?>
+                    name="last_7_days__soccer" >
+                    Soccer
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__ski_machine_nordic_track'] ? 'checked' : '' ?>
+                    name="last_7_days__ski_machine_nordic_track" >
+                    Ski machine (Nordic Track)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__stair_climbing_stairmaster'] ? 'checked' : '' ?>
+                    name="last_7_days__stair_climbing_stairmaster" >
+                    Stair climbing (StairMaster)
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__swimming_laps'] ? 'checked' : '' ?>
+                    name="last_7_days__swimming_laps" >
+                    Swimming laps
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['last_7_days__tennis_racquetball'] ? 'checked' : '' ?>
+                    name="last_7_days__tennis_racquetball" >
+                    Tennis, racquetball
+                </label>
+            </div>
+
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0 d-flex align-items-center">
+        <label>During the last 7 days, on how many days did you do a Vigorous physical activity Days<u>nonstop for at
+                least 10 minutes at a time</u>?</label>
+        <div class="ml-3 d-inline-flex align-items-center">
+            <input
+                   value="<?= @$contentData['last_7_days__vigorous_days'] ?>"
+                   name="last_7_days__vigorous_days" type="number" class="form-control form-control-sm" placeholder="">
+            <span class="ml-2 text-secondary flex-grow-1">Days</span>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0 d-flex align-items-center">
+        <label>On those days, how much time did you spend <u>on average</u> doing Vigorous physical activities?</label>
+        <div class="ml-3 d-inline-flex align-items-center">
+            <input
+                   value="<?= @$contentData['last_7_days__vigorous_mins_per_day'] ?>"
+                   name="last_7_days__vigorous_mins_per_day" type="number" class="form-control form-control-sm"
+                   placeholder="">
+            <span class="ml-2 text-secondary flex-grow-1">Minutes/Day</span>
+        </div>
+    </div>
+
+    <hr>
+
+    <div class="my-3 node node-level-0">
+        <label>Compared with your Usual Physical Activity over the last 3 months, was the last seven days’
+            activity:</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['last_7_days__activity_comparison'] === 'More' ? 'checked' : '' ?> name="last_7_days__activity_comparison"
+                type="radio" value="More" class="mr-1">
+                <span>More</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['last_7_days__activity_comparison'] === 'Less' ? 'checked' : '' ?> name="last_7_days__activity_comparison"
+                type="radio" value="Less" class="mr-1">
+                <span>Less</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['last_7_days__activity_comparison'] === 'About the same' ? 'checked' : '' ?> name="last_7_days__activity_comparison"
+                type="radio" value="About the same" class="mr-1">
+                <span>About the same</span>
+            </label>
+        </div>
+    </div>
+
+    <hr>
+
+    <p class="font-weight-bold">Medical Problems</p>
+
+    <div class="my-3 node node-level-0">
+        <label>1. Has your doctor ever said that you have a heart condition and that you should only do physical
+            activity recommended by a doctor?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_heart_condition'] === 'Yes' ? 'checked' : '' ?> name="mp_heart_condition"
+                type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_heart_condition'] === 'No' ? 'checked' : '' ?> name="mp_heart_condition"
+                type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>2. Do you feel pain in your chest when you do physical activity?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_chest_pain_with_physical_activity'] === 'Yes' ? 'checked' : '' ?> name="mp_chest_pain_with_physical_activity"
+                type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_chest_pain_with_physical_activity'] === 'No' ? 'checked' : '' ?> name="mp_chest_pain_with_physical_activity"
+                type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>3. In the past month, have you had chest pain when you were not doing physical activity?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_chest_pain_without_physical_activity'] === 'Yes' ? 'checked' : '' ?> name="mp_chest_pain_without_physical_activity"
+                type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_chest_pain_without_physical_activity'] === 'No' ? 'checked' : '' ?> name="mp_chest_pain_without_physical_activity"
+                type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>4. Do you lose your balance because of dizziness, or do you ever lose consciousness?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_dizziness'] === 'Yes' ? 'checked' : '' ?> name="mp_dizziness" type="radio"
+                value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_dizziness'] === 'No' ? 'checked' : '' ?> name="mp_dizziness" type="radio"
+                value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>5. Do you have a bone or joint problem that could be made worse by a change in your physical
+            activity?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_bone_joint_problem'] === 'Yes' ? 'checked' : '' ?> name="mp_bone_joint_problem"
+                type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_bone_joint_problem'] === 'No' ? 'checked' : '' ?> name="mp_bone_joint_problem"
+                type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart
+            condition?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_bp_heart_drugs'] === 'Yes' ? 'checked' : '' ?> name="mp_bp_heart_drugs"
+                type="radio" value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_bp_heart_drugs'] === 'No' ? 'checked' : '' ?> name="mp_bp_heart_drugs"
+                type="radio" value="No" class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="my-3 node node-level-0">
+        <label>7. Do you know of any other reason why you should not do physical activity?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_other'] === 'Yes' ? 'checked' : '' ?> name="mp_other" type="radio"
+                value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['mp_other'] === 'No' ? 'checked' : '' ?> name="mp_other" type="radio" value="No"
+                class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+    </div>
+
+    <hr>
+
+    <p class="font-weight-bold">Physical Activity Plans</p>
+
+    <div class="my-3 node node-level-0">
+        <label>Please check the ONE answer that best describes your physical activity plans for the next 6
+            months:</label>
+        <div class="">
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input
+                       <?= @$contentData['pa_plans_next_6_months'] === 'I do not plan to become physically active in the next 6 months' ? 'checked' : '' ?>
+                name="pa_plans_next_6_months"
+                type="radio"
+                value="I do not plan to become physically active in the next 6 months" class="mr-1">
+                <span>A. I do not plan to become physically active in the next 6 months.</span>
+            </label>
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input
+                       <?= @$contentData['pa_plans_next_6_months'] === 'I am thinking about becoming more physically active' ? 'checked' : '' ?>
+                name="pa_plans_next_6_months"
+                type="radio"
+                value="I am thinking about becoming more physically active" class="mr-1">
+                <span>B. I am thinking about becoming more physically active.</span>
+            </label>
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input
+                       <?= @$contentData['pa_plans_next_6_months'] === 'I intend to become more physically active in the next 6 months' ? 'checked' : '' ?>
+                name="pa_plans_next_6_months"
+                type="radio"
+                value="I intend to become more physically active in the next 6 months" class="mr-1">
+                <span>C. I intend to become more physically active in the next 6 months.</span>
+            </label>
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input
+                       <?= @$contentData['pa_plans_next_6_months'] === 'I have been regularly physically active for the last 1–5 months' ? 'checked' : '' ?>
+                name="pa_plans_next_6_months"
+                type="radio"
+                value="I have been regularly physically active for the last 1–5 months" class="mr-1">
+                <span>D. I have been regularly physically active for the last 1–5 months.</span>
+            </label>
+            <label class="d-flex align-items-center mt-0 mb-1 mr-3">
+                <input
+                       <?= @$contentData['pa_plans_next_6_months'] === 'I have been regularly physically active for the past 6 months or more' ? 'checked' : '' ?>
+                name="pa_plans_next_6_months"
+                type="radio"
+                value="I have been regularly physically active for the past 6 months or more" class="mr-1">
+                <span>E. I have been regularly physically active for the past 6 months or more.</span>
+            </label>
+        </div>
+    </div>
+
+    <hr>
+
+    <p class="font-weight-bold">Benefits of Physical Activity Important to You</p>
+
+    <div class="my-3 node node-level-0">
+        <label>the 3 <i>benefits</i> of physical activity that are <i>Most Important</i> to You:</label>
+        <div class="row">
+            <div class="col-6">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_for_my_health'] ? 'checked' : '' ?>
+                    name="pa_important_for_my_health" >
+                    1. For my health
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_control_my_weight'] ? 'checked' : '' ?>
+                    name="pa_important_control_my_weight" >
+                    2. Control my weight
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_look_better'] ? 'checked' : '' ?>
+                    name="pa_important_look_better" >
+                    3. Look better
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_feel_better'] ? 'checked' : '' ?>
+                    name="pa_important_feel_better" >
+                    4. Feel better
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_feel_good_about_taking_care_of_myself'] ? 'checked' : '' ?>
+                    name="pa_important_feel_good_about_taking_care_of_myself"
+                    >
+                    5. Feel good about taking care of myself
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_set_a_good_example_for_my_family_or_friends'] ? 'checked' : '' ?>
+                    name="pa_important_set_a_good_example_for_my_family_or_friends"
+                    >
+                    6. Set a good example for my family or friends
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_get_my_partner_child_friend_to_be_more_active_with_me'] ? 'checked' : '' ?>
+                    name="pa_important_get_my_partner_child_friend_to_be_more_active_with_me"
+                    >
+                    7. Get my partner, child, friend to be more active with me
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_teach_my_family_friends_the_importance_of_physical_activity'] ? 'checked' : '' ?>
+                    name="pa_important_teach_my_family_friends_the_importance_of_physical_activity"
+                    >
+                    8. Teach my family, friends the importance of physical activity
+                </label>
+            </div>
+            <div class="col-6">
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_have_time_for_me'] ? 'checked' : '' ?>
+                    name="pa_important_have_time_for_me" >
+                    9. Have time for me
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_lower_my_stress'] ? 'checked' : '' ?>
+                    name="pa_important_lower_my_stress" >
+                    10. Lower my stress
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_improve_my_fitness'] ? 'checked' : '' ?>
+                    name="pa_important_improve_my_fitness" >
+                    11. Improve my fitness
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_lower_my_risk_of_heart_disease'] ? 'checked' : '' ?>
+                    name="pa_important_lower_my_risk_of_heart_disease"
+                    >
+                    12. Lower my risk of heart disease
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_lower_my_blood_pressure'] ? 'checked' : '' ?>
+                    name="pa_important_lower_my_blood_pressure" >
+                    13. Lower my blood pressure
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_lower_my_cholesterol'] ? 'checked' : '' ?>
+                    name="pa_important_lower_my_cholesterol" >
+                    14. Lower my cholesterol
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_control_my_diabetes'] ? 'checked' : '' ?>
+                    name="pa_important_control_my_diabetes" >
+                    15. Control my diabetes
+                </label>
+                <label class="mb-1 d-flex align-items-center">
+                    <input type="checkbox" class="mr-2"
+                           <?= @$contentData['pa_important_other'] ? 'checked' : '' ?>
+                    name="pa_important_other" >
+                    <span class="text-nowrap mr-2">16. Other:</span>
+                    <input type="text" class="form-control form-control-sm"
+                           name="pa_important_other_details"
+                           value="<?= @$contentData['pa_important_other_details'] ?>">
+                </label>
+            </div>
+        </div>
+    </div>
+
+    <hr>
+
+    <p class="font-weight-bold">Getting Help from Others</p>
+
+    <div class="my-3 node node-level-0">
+        <label>Is there someone who would encourage you or help you with some of your responsibilities so you could get
+            regular
+            physical activity?</label>
+        <div class="d-flex align-items-center mb-3">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['getting_help_from_others'] === 'Yes' ? 'checked' : '' ?> name="getting_help_from_others"
+                type="radio"
+                value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['getting_help_from_others'] === 'No' ? 'checked' : '' ?> name="getting_help_from_others"
+                type="radio" value="No"
+                class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+        <div class="d-flex align-items-center mb-3">
+            <input type="text" class="form-control form-control-sm mr-2" placeholder="Who is that?"
+                   name="getting_help_from_others_who" value="<?= @$contentData['getting_help_from_others_who'] ?>">
+            <input type="text" class="form-control form-control-sm" placeholder="How could they help?"
+                   name="getting_help_from_others_how" value="<?= @$contentData['getting_help_from_others_how'] ?>">
+        </div>
+    </div>
+
+    <p class="font-weight-bold">Helping Others</p>
+
+    <div class="my-3 node node-level-0">
+        <label>Is there a friend or family member you think should get more physical activity?</label>
+        <div class="d-flex align-items-center mb-3">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['helping_others'] === 'Yes' ? 'checked' : '' ?> name="helping_others"
+                type="radio"
+                value="Yes" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['helping_others'] === 'No' ? 'checked' : '' ?> name="helping_others"
+                type="radio" value="No"
+                class="mr-1">
+                <span>No</span>
+            </label>
+        </div>
+        <div class="d-flex align-items-center mb-3">
+            <input type="text" class="form-control form-control-sm mr-2" placeholder="Who is that?"
+                   name="helping_others_who" value="<?= @$contentData['helping_others_who'] ?>">
+            <input type="text" class="form-control form-control-sm" placeholder="How could you help them?"
+                   name="helping_others_how" value="<?= @$contentData['helping_others_how'] ?>">
+        </div>
+    </div>
+
+    <p class="font-weight-bold">Confidence</p>
+
+    <div class="my-3 node node-level-0">
+        <label>How confident are you that you could increase your physical activity if you decided to do so?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['confidence'] === 'Very Confident' ? 'checked' : '' ?> name="confidence"
+                type="radio"
+                value="Very Confident" class="mr-1">
+                <span>Very Confident</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['confidence'] === 'Fairly Confident' ? 'checked' : '' ?> name="confidence"
+                type="radio"
+                value="Fairly Confident"
+                class="mr-1">
+                <span>Fairly Confident</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['confidence'] === 'A Little Confident' ? 'checked' : '' ?> name="confidence"
+                type="radio"
+                value="A Little Confident" class="mr-1">
+                <span>A Little Confident</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input
+                       <?= @$contentData['confidence'] === 'Not at all Confident' ? 'checked' : '' ?> name="confidence"
+                type="radio"
+                value="Not at all Confident"
+                class="mr-1">
+                <span>Not at all Confident</span>
+            </label>
+        </div>
+    </div>
+
+    <div class="section-edit-mask position-absolute"></div>
+
+</div>
+
+