{"id":1222,"date":"2023-05-30T13:19:21","date_gmt":"2023-05-30T17:19:21","guid":{"rendered":"https:\/\/research.ohioguidestone.org\/study\/?page_id=1222"},"modified":"2025-03-31T13:30:18","modified_gmt":"2025-03-31T17:30:18","slug":"maternal-vitality-study-for-women-mothers","status":"publish","type":"page","link":"https:\/\/research.ohioguidestone.org\/study\/the-maternal-vitality-study\/maternal-vitality-study-for-women-mothers\/","title":{"rendered":"Maternal Vitality Study- Interest Form for Interested Women\/Mothers"},"content":{"rendered":"<p>Interested in signing up for our Maternal Vitality Study? Please complete this interest form below.<\/p>\n<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-1200\"><form id=\"wpforms-form-1200\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1200\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/study\/wp-json\/wp\/v2\/pages\/1222\" data-token=\"3fad235468f96d121a1640381d872929\" data-token-time=\"1776652771\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 6<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:16.666666666667%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-1200-field_10-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"10\"><\/div><div id=\"wpforms-1200-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1200-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-1200-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1200-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-1200-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1200-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1200-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1200-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1200-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1200-field_3\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1200-field_3\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" aria-label=\"Phone\" required><\/div><div id=\"wpforms-1200-field_4-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"4\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1200-field_4\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][4][address1]\" required><label for=\"wpforms-1200-field_4\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1200-field_4-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][4][address2]\" ><label for=\"wpforms-1200-field_4-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1200-field_4-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][4][city]\" required><label for=\"wpforms-1200-field_4-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1200-field_4-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][4][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-1200-field_4-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1200-field_4-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][4][postal]\" required><label for=\"wpforms-1200-field_4-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><div class=\"wpforms-field-description\">If you live in an apartment, or a multi-family home, please put your apartment number or UP\/Down.<\/div><\/div><div id=\"wpforms-1200-field_5-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1200-field_5\">Age<\/label><select id=\"wpforms-1200-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\"><option value=\"Under 15\"  class=\"choice-4 depth-1\"  >Under 15<\/option><option value=\"16-17\"  class=\"choice-5 depth-1\"  >16-17<\/option><option value=\"18 and Up\"  class=\"choice-6 depth-1\"  >18 and Up<\/option><\/select><\/div><div id=\"wpforms-1200-field_35-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-1200-field_35\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1200-field_35\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][35][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><div class=\"wpforms-field-description\">Mom's Date of Birth<\/div><\/div><div id=\"wpforms-1200-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-1200-field_23\">Race<\/label><input type=\"text\" id=\"wpforms-1200-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" ><div class=\"wpforms-field-description\">example: Black<\/div><\/div><div id=\"wpforms-1200-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1200-field_24\">Ethnicity<\/label><input type=\"text\" id=\"wpforms-1200-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" ><div class=\"wpforms-field-description\">examples: African American, African Caribbean, Latino<\/div><\/div><div id=\"wpforms-1200-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"7\"><label class=\"wpforms-field-label\">Are you currently pregnant, or were you recently pregnant within the last 12 months regardless of how your pregnancy ended? (This includes birth, abortion, miscarriage, etc.) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_7_1\" name=\"wpforms[fields][7]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_7_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_7_2\" name=\"wpforms[fields][7]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_7_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1200-field_33-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-1200-field_33\">Would you like to share more about your birth\/delivery story? For example, did you have a vaginal birth or miscarriage? We can also hold this question for later.<\/label><textarea id=\"wpforms-1200-field_33\" class=\"wpforms-field-medium\" name=\"wpforms[fields][33]\" ><\/textarea><\/div><div id=\"wpforms-1200-field_9-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"9\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"1200\" disabled>Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-1200-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"8\"><label class=\"wpforms-field-label\">Have you ever been diagnosed with maternal psychosis by a medical professional? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_8_1\" name=\"wpforms[fields][8]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_8_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_8_2\" name=\"wpforms[fields][8]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_8_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_8_3\" name=\"wpforms[fields][8]\" value=\"Unsure\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_8_3\">Unsure<\/label><\/li><\/ul><div class=\"wpforms-field-description\">People with Postpartum Psychosis (PPP) have a much higher risk of harming themselves, dying by suicide or harming their children. Because of this, PPP is a mental health emergency. If you have the symptoms of PPP or are near someone who shows signs of it, it\u2019s important to seek immediate help. If you believe someone is a danger to themselves or others, you should immediately dial 9-1-1 (or your local emergency services number at 2-1-1). If you are currently receiving therapy services, we encourage you to consult further with your counselor for questions or concerns. If you are not currently receiving therapy services we invite you to join our maternal depression services that serve moms during pregnancy, and any time after pregnancy. We can connect you to this program if you call or email our offices. If you want to reach out on your own for OhioGuidestone services, please contact our OhioGuidestone intake at 440-260-8300 or sign up for services on our website https:\/\/ohioguidestone.org\/request-services\/ . For even more services outside of OGS please visit www.namigreatercleveland.org.  <\/div><\/div><div id=\"wpforms-1200-field_12-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"12\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"1200\" disabled>Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-1200-field_13-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"13\"><label class=\"wpforms-field-label\">Have you ever been diagnosed with a major mental health condition such as schizophrenia or bipolar disorder by a medical professional?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_13_1\" name=\"wpforms[fields][13]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_13_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_13_2\" name=\"wpforms[fields][13]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_13_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_13_3\" name=\"wpforms[fields][13]\" value=\"Unsure\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_13_3\">Unsure<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Schizophrenia refers to a condition and to a spectrum of disorders that all involve a disconnection from reality, including hallucinations and delusions. It affects a person\u2019s ability to recognize the symptoms they have of this condition. Bipolar disorder is a chronic mood disorder that causes intense shifts in mood, energy levels, and behavior. Manic and hypomanic episodes are the main sign of the condition, and most people with bipolar disorder also have depressive episodes.\r\n\r\n\r\n\r\nWe can connect you to this program if you call or email our offices. If you want to reach out on your own for OhioGuidestone services, please contact our OhioGuidestone intake at 440-260-8300 or sign up for services on our website https:\/\/ohioguidestone.org\/request-services\/ . If you are currently receiving therapy services, we encourage you to consult further with your counselor for questions or concerns. For even more services outside of OGS, call 2-1-1 or visit www.namigreatercleveland.org.  <\/div><\/div><div id=\"wpforms-1200-field_14-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"14\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"3\" data-formid=\"1200\" disabled>Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-1200-field_15-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"15\"><label class=\"wpforms-field-label\">Have you ever been diagnosed with a substance use disorder by a medical professional? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_15\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_15_1\" name=\"wpforms[fields][15]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_15_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_15_2\" name=\"wpforms[fields][15]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_15_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_15_3\" name=\"wpforms[fields][15]\" value=\"Unsure\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_15_3\">Unsure<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Substance use disorders occur when the recurrent use of alcohol and\/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.\r\n\r\n\r\nWe can connect you to this program if you call or email our offices. If you want to reach out on your own for OhioGuidestone services, please contact our OhioGuidestone intake at 440-260-8300 or sign up for services on our website https:\/\/ohioguidestone.org\/request-services\/ . If you are currently receiving therapy services, we encourage you to consult further with your counselor for questions or concerns. For even more services outside of OGS, call 2-1-1 or visit www.namigreatercleveland.org.  <\/div><\/div><div id=\"wpforms-1200-field_16-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"16\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"4\" data-formid=\"1200\" disabled>Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-1200-field_17-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"17\"><label class=\"wpforms-field-label\">Are you currently receiving therapy services?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_17_1\" name=\"wpforms[fields][17]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_17_2\" name=\"wpforms[fields][17]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_17_2\">No<\/label><\/li><\/ul><div class=\"wpforms-field-description\">We encourage you to consult with your counselor about whether your interest in our study would disrupt your current therapeutic services. For further questions or concerns regarding maternal depression, we want to invite you to join our maternal depression services that serve moms during pregnancy, and any time after pregnancy. We can connect you to this program if you call or email our offices. If you want to reach out on your own for OhioGuidestone services, please contact our OhioGuidestone intake at 440-260-8300 or sign up for services on our website https:\/\/ohioguidestone.org\/request-services\/ . For even more services outside of OGS, call 2-1-1 or visit www.namigreatercleveland.org.<\/div><\/div><div id=\"wpforms-1200-field_18-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"18\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"5\" data-formid=\"1200\" disabled>Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6 last \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-1200-field_20-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"20\"><h3 id=\"wpforms-1200-field_20\">This section asks questions about your mood or feelings. Please think about the past 2 weeks and answer each question. <\/h3><div class=\"wpforms-field-description\">Over the last 2 weeks, how often have you been bothered by the following problems? <\/div><\/div><div id=\"wpforms-1200-field_19-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"19\"><label class=\"wpforms-field-label\">Little interest or pleasure in doing things  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_19\" class=\"wpforms-field-required\"><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_19_4\" name=\"wpforms[fields][19]\" value=\"Not at all (0)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_19_4\">Not at all (0)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_19_5\" name=\"wpforms[fields][19]\" value=\"Several Days (1)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_19_5\">Several Days (1)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_19_6\" name=\"wpforms[fields][19]\" value=\"More than half the days (2)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_19_6\">More than half the days (2)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_19_7\" name=\"wpforms[fields][19]\" value=\"Nearly every day (3)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_19_7\">Nearly every day (3)<\/label><\/li><\/ul><\/div><div id=\"wpforms-1200-field_21-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"21\"><label class=\"wpforms-field-label\">Feeling down, depressed, or hopeless <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_21\" class=\"wpforms-field-required\"><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_21_4\" name=\"wpforms[fields][21]\" value=\"Not at all (0)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_21_4\">Not at all (0)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_21_5\" name=\"wpforms[fields][21]\" value=\"Several Days (1)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_21_5\">Several Days (1)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_21_6\" name=\"wpforms[fields][21]\" value=\"More than half the days (2)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_21_6\">More than half the days (2)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_21_7\" name=\"wpforms[fields][21]\" value=\"Nearly every day (3)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_21_7\">Nearly every day (3)<\/label><\/li><\/ul><\/div><div id=\"wpforms-1200-field_22-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"22\"><h3 id=\"wpforms-1200-field_22\">This section asks questions about your mood or feelings. Please think about the past 2 weeks and answer each question. <\/h3><div class=\"wpforms-field-description\">Over the last 2 weeks, how often have you been bothered by the following problems? <\/div><\/div><div id=\"wpforms-1200-field_25-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"25\"><label class=\"wpforms-field-label\">Feeling nervous, anxious, or on edge  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_25\" class=\"wpforms-field-required\"><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_25_4\" name=\"wpforms[fields][25]\" value=\"Not at all (0)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_25_4\">Not at all (0)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_25_5\" name=\"wpforms[fields][25]\" value=\"Several Days (1)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_25_5\">Several Days (1)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_25_6\" name=\"wpforms[fields][25]\" value=\"More than half the days (2)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_25_6\">More than half the days (2)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_25_7\" name=\"wpforms[fields][25]\" value=\"Nearly every day (3)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_25_7\">Nearly every day (3)<\/label><\/li><\/ul><\/div><div id=\"wpforms-1200-field_26-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"26\"><label class=\"wpforms-field-label\">Not being able to stop or control worrying  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_26\" class=\"wpforms-field-required\"><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_26_4\" name=\"wpforms[fields][26]\" value=\"Not at all (0)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_26_4\">Not at all (0)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_26_5\" name=\"wpforms[fields][26]\" value=\"Several Days (1)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_26_5\">Several Days (1)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_26_6\" name=\"wpforms[fields][26]\" value=\"More than half the days (2)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_26_6\">More than half the days (2)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_26_7\" name=\"wpforms[fields][26]\" value=\"Nearly every day (3)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_26_7\">Nearly every day (3)<\/label><\/li><\/ul><\/div><div id=\"wpforms-1200-field_29-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"29\"><h3 id=\"wpforms-1200-field_29\">Last Section<\/h3><\/div><div id=\"wpforms-1200-field_28-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"28\"><label class=\"wpforms-field-label\">How did you learn about this project? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1200-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_28_1\" name=\"wpforms[fields][28]\" value=\"Help Me Grow\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_28_1\">Help Me Grow<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_28_2\" name=\"wpforms[fields][28]\" value=\"Neighborhood Leadership Institute (NLI)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_28_2\">Neighborhood Leadership Institute (NLI)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_28_3\" name=\"wpforms[fields][28]\" value=\"OhioGuidestone\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_28_3\">OhioGuidestone<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_28_4\" name=\"wpforms[fields][28]\" value=\"A Community Healthcare Site (e.g. Birthing Beautiful Communities, Village of Healing)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_28_4\">A Community Healthcare Site (e.g. Birthing Beautiful Communities, Village of Healing)<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_28_11\" name=\"wpforms[fields][28]\" value=\"Centering Pregnancy Group\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_28_11\">Centering Pregnancy Group<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_28_7\" name=\"wpforms[fields][28]\" value=\"Joyful Together -or- Father&#039;s Feelings\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_28_7\">Joyful Together -or- Father's Feelings<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_28_8\" name=\"wpforms[fields][28]\" value=\"Email\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_28_8\">Email<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_28_9\" name=\"wpforms[fields][28]\" value=\"Facebook or Instagram\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_28_9\">Facebook or Instagram<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"radio\" id=\"wpforms-1200-field_28_10\" name=\"wpforms[fields][28]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1200-field_28_10\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-1200-field_27-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"27\"><h3 id=\"wpforms-1200-field_27\">Thank You!<\/h3><div class=\"wpforms-field-description\">Thank you for completing the eligibility form for our Maternal Vitality Study at OhioGuidestone. \r\n\r\nIf you have any questions, please email or call us. We will follow-up with you for next steps. <\/div><\/div><div id=\"wpforms-1200-field_11-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"11\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-invisible\" style=\"display:none;\"><div class=\"g-recaptcha\" data-sitekey=\"6LcXi9gaAAAAAFrW9BPHjwBD2xZbKb0JPAd89hle\" data-size=\"invisible\"><\/div><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"1200\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1222\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1200\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/research.ohioguidestone.org\/study\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<div class=\"wpforms-save-resume-confirmation\" id=\"wpforms-save-resume-confirmation-1200\" style=\"display: none\">\n\n\t\n\t<div class=\"message\">\n\t\t<p>Your form entry has been saved and a unique link has been created which you can access to resume this form.<\/p>\n<p>Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.<\/p>\n<p>Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.<\/p>\n\t<\/div>\n\n\t<div class=\"wpforms-save-resume-actions\">\n\t\t\t\t\t<div class=\"wpforms-field\">\n\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\tCopy Link\t\t\t\t<\/label>\n\t\t\t\t<div class=\"wpforms-save-resume-shortcode-container\">\n\t\t\t\t\t<input type=\"text\" class=\"wpforms-save-resume-shortcode\" value=\"\" disabled \/>\n\t\t\t\t\t<span class=\"wpforms-save-resume-shortcode-copy\" title=\"Copy resume link to clipboard\">\n\t\t\t\t\t\t\t<span class=\"copy-icon\"><\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\t\t\t\t\t<form class=\"wpforms-validate wpforms-form wpforms-save-resume-email-notification\" method=\"post\" action=\"\/study\/wp-json\/wp\/v2\/pages\/1222\" data-token=\"8290d1047fd97f2a30be096887294cc0\">\n\t\t\t\t<div class=\"wpforms-field wpforms-field-email\">\n\t\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\t\tEmail\t\t\t\t\t\t<span class=\"wpforms-required-label\">*<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<input type=\"email\" name=\"wpforms[save_resume_email]\" required>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpforms-submit-container\">\n\t\t\t\t\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"8dc247c777\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/study\/wp-json\/wp\/v2\/pages\/1222\" \/>\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[form_id]\" value=\"1200\">\n\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[entry_id]\" class=\"wpforms-save-resume-entry-id\" value=\"\">\n\t\t\t\t\t<button type=\"submit\" name=\"wpforms[save-resume]\" class=\"wpforms-submit\" value=\"wpforms-submit\" disabled>\n\t\t\t\t\t\tSend Link\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/form>\n\t\t\t<\/div>\n<\/div>\n\n<p class=\"_04xlpA direction-ltr align-center para-style-body\">\n","protected":false},"excerpt":{"rendered":"<p>Interested in signing up for our Maternal Vitality Study? Please complete this interest form below.<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":1225,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"neve_meta_sidebar":"full-width","neve_meta_container":"","neve_meta_enable_content_width":"on","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"class_list":["post-1222","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1222","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/comments?post=1222"}],"version-history":[{"count":6,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1222\/revisions"}],"predecessor-version":[{"id":1779,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1222\/revisions\/1779"}],"up":[{"embeddable":true,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1225"}],"wp:attachment":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/media?parent=1222"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}