{"id":155,"date":"2020-11-12T02:32:55","date_gmt":"2020-11-12T02:32:55","guid":{"rendered":"https:\/\/thenewdaystudy.com\/?page_id=155"},"modified":"2021-08-26T14:59:26","modified_gmt":"2021-08-26T14:59:26","slug":"survey","status":"publish","type":"page","link":"https:\/\/thenewdaystudy.com\/survey","title":{"rendered":"NEW DAY Study Survey"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-404\"><form id=\"wpforms-form-404\" class=\"wpforms-validate wpforms-form\" data-formid=\"404\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F155\" data-token=\"6a06cf073cc3796c86170a78ab11813e\"><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 2<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:50%;background-color:#72b239;\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \"><div id=\"wpforms-404-field_9-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"9\"><\/div><div id=\"wpforms-404-field_3-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-404-field_3\">If diagnosed with diabetes, are you experiencing any visual problems or have you been diagnosed with Diabetic Macular Edema (DME)? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-404-field_3\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_3_1\" name=\"wpforms[fields][3]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_3_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_3_2\" name=\"wpforms[fields][3]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_3_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-404-field_6-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-404-field_6\">Have you ever been treated for DME? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-404-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_6_1\" name=\"wpforms[fields][6]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_6_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_6_2\" name=\"wpforms[fields][6]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_6_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-404-field_7-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"7\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-404-field_7\">If yes, has it been within the last 12 months? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-404-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_7_1\" name=\"wpforms[fields][7]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_7_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_7_2\" name=\"wpforms[fields][7]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_7_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-404-field_4-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-404-field_4\">Do you have, or have you ever been told you have glaucoma? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-404-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_4_1\" name=\"wpforms[fields][4]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_4_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_4_2\" name=\"wpforms[fields][4]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_4_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-404-field_16-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-404-field_16\">Will you be able to commit to visiting your doctor at least once a month for the 18-month duration of the study? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-404-field_16\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_16_1\" name=\"wpforms[fields][16]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_16_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-404-field_16_2\" name=\"wpforms[fields][16]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-404-field_16_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-404-field_8-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"8\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"404\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2 last \" style=\"display:none;\"><div id=\"wpforms-404-field_11-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-404-field_11\">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-404-field_11\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][11][first]\" required><label for=\"wpforms-404-field_11\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-404-field_11-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][11][last]\" required><label for=\"wpforms-404-field_11-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-404-field_12-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-404-field_12\">Phone<\/label><input type=\"tel\" id=\"wpforms-404-field_12\" class=\"wpforms-field-small wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][12]\" placeholder=\"(201) 555-1234\" ><\/div><div id=\"wpforms-404-field_13-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-404-field_13\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-404-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" required><\/div><div id=\"wpforms-404-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-404-field_15\">Zip Code<\/label><input type=\"text\" id=\"wpforms-404-field_15\" class=\"wpforms-field-small\" name=\"wpforms[fields][15]\" ><\/div><div id=\"wpforms-404-field_10-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"10\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"404\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-404\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"class_list":{"0":"post-155","1":"page","2":"type-page","3":"status-publish","5":"entry"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.7 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NEW DAY Study Survey - New Day Study<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" 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